• Management of persons with underlying medical disorders such as Rheumatoid arthritis, diabetes, kidney disease, peripheral vascular diseases etc. Many of these persons maybe classified as “high risk” due to complications which may manifest themselves in the lower limbs, such as poor circulation
• Treatment of dermatological conditions such as plantar warts or athletes foot and fungal nails.
• Treatment and management of painful conditions such as calluses, corns and nail disorders, including permanent nail surgery.
• Provision of care for persons who are disabled or cannot reach their feet due to medical conditions.
• Assessment and management of biomechanical dysfunction (structural imbalances) and deformities.
• The prescription and manufacture of custom orthotics (devices worn in shoes to improve or correct foot function and comfort), custom footwear; orthopedic footwear, braces etc.
• Foot health education for all age groups.
• As part of the health care team a Chiropodist will liaison with other medical practitioners and refer when appropriate.

Chiropodists work both in private clinics as well as in health care facilities such as hospital. In private clinics the patient must pay for the services they receive. In hospitals the services are usually free of charge, under the auspices of the Ministry of Health.

Many of the services/treatments provided by Chiropodists are covered by: extended medical insurances; W.S.I.B., First Nations/Health Canada and Veterans Affairs.

Bluewater Health closed the only publicly funded chiropody service in Sarnia/ Lambton in March 2007.

Sometimes biomechanical problems develop interrupting smooth, pain free gait (walking). Careful examination of your feet and gait, by a Chiropodist, is an essential step in correctly addressing your foot problems. Biomechanical problems can be simply due to body structure or related to a medical condition. In order to address a biomechanical problem, your chiropodist may prescribe custom orthotics.

Custom orthotics alter the way your feet interact with the ground. Everyone’s feet, legs, hips and biomechanics are unique. Improper foot alignment or skeletal imbalances can cause pain throughout your body by overstressing muscles, tendons, bones and joints. As you walk, custom orthotics help to control your foot motion and weight distribution. They work to eliminate the specific causes of your pain, not just the symptoms.

Chiropodists, Podiatrists and Orthotists are the only professions in Ontario who are licensed to prescribe, manufacture and dispense custom orthotics. Many other paramedical professions provide orthotics or arch supports but their educational background and biomechanical knowledge does not allow them to be licensed in this province.

When you walk, the first part of your foot to hit the ground is the outer edge of your heel, and then your foot pronates (rolls inwards). This is good, up to a point. Pronation ”unlocks” the foot, allowing it to absorb the shock of your body hitting the ground. Too little pronation sends the shock of landing up your leg and can result in shin splints, knee, hip and/or back pain. Too much supination (the foot rolls on its outside edge too far when landing on the ground during heel strike) and you will not push off your body weight properly, leading to callus buildup or corns, often under your little toe.

Problems can present at any stage of the walking process, and custom prescribed orthotics address your specific problem. Therefore, careful examination of your feet and gait by a chiropodist is essential. No orthotic can be truly considered custom without a thorough biomechanical examination, gait analysis and a three dimensional volumetric casting of the feet.

Orthotics come in a variety of materials, ranging from rigid plastics to soft foams. Soft orthotics tend to provide cushioning and protection while rigid orthotics provide biomechanical control. Most adults require some control and cushioning combined.

While prescribing your orthotics the chiropodist will endeavor to choose the proper choices of materials to fit your specific needs to provide maximum support and comfort.

Rigid orthotics are made from strong thermal plastics or graphite materials. They provide maximum control to improve the foots function (performance). They are sometimes used for growing children to control/ resolve biomechanical issues.

Semi-rigid orthotics control foot movement and provide some shock absorption. They use flexible plastics and help to reduce pain due to over used strained soft tissues in the feet and legs.

Soft orthotics cushion the feet when standing/ walking, but do little to control the foot biomechanics.

Accommodative orthotics protect the feet form the stresses of standing / walking. They often incorporate foams or cork material and may have indentations or raised area to take pressure off of painful areas of the feet.

Procedure

1. A medical history must be completed
2. A biomechanical examination to your feet and legs is essential when prescribing custom molded orthotics. This would include examination while standing, walking, and non weight bearing.
3. A cast of the foot is developed using the neutral-subtalar joint position technique. They may be measured using the new 3 dimensional laser scan or by plaster of casts.
4. The casts and documentation are sent to an orthotic laboratory to be assessed and the orthotics are produced by a team of experts using the latest techniques, computerized programs and equipment.
5. The orthotics are fit to the patient in my office and the patient is thoroughly educated regarding their use etc. Follow up is provided for one year at no charge.
6. I only prescribe or develop custom molded orthotics for patients who I feel will benefit from their use.

Please consider incorporating the following four procedures into your daily routine.

A) Daily Inspection Each day using your hands as well as your eyes inspect the whole foot, including between and underneath the toes for cuts, cracks, swelling, bruises, redness, etc. Proper lighting is essential. If you are unable to bend down to examine your feet, the use of a mirror is advised. If you locate an abrasion, cleanse the area thoroughly, dry it and apply a mild antiseptic with a sterile dressing. Check and change the dressing at least twice daily. If it does not appear to be healing or if any part of your foot or leg changes colour (that is, dark blue or black) contact your doctor or chiropodist immediately.

B) Daily washing Regular daily washing of the feet with a mild soap in lukewarm water is very important to remove all debris and bacteria which accumulate on the skin. Thus, keeping the feet clean will substantially decrease the risk of infection should an injury occur. Do not soak feet for more than ten minutes as this will cause the skin to become dry and scaly.

C) Proper Drying It is very important to remove all moisture from the feet after washing, especially between the toes where fungus can develop if the skin becomes soggy. The “patting technique” with a towel should be used as this will decrease the chance of abrasions caused by more aggressive drying techniques. If your feet tend to perspire, application of rubbing alcohol between the toes and talcum powder on the rest of the foot is advised.

D) Emollient Use After drying the feet, application of a moisturizing cream to help keep the skin soft and supple should be undertaken. It is important however, not to place the cream between the toes as this area must be kept as dry as possible.

Diabetics or persons with poor circulation should have a Biomechanical Foot examination and chiropodial foot treatments (if required) performed. You will be educated about any existing foot issues and taught to detect and prevent issues that may arise in the future.

As a chiropodist, I can advise you about your own specific foot issues and plan a strategy to keep your feet healthy.

FOOTWEAR
Improper, ill fitting footwear is estimated to cause approximately 80% of the problems that women develop with their feet. Think of yourself as an automobile and your shoes are the tires. If they are worn down or improper for the vehicle and its activities then, “you” the vehicle, will not handle properly! Injuries or pressure lesions such as calluses and corns and nail issues will likely develop sooner or later. Many of these issues are preventable with proper fitting footwear.

POINTS TO REMEMBER
A shoe should be chosen and worn for specific types of activities. Will you be dressing up, playing sports, working or walking?

Over time your feet will change. Be aware that your shoe size may change also. Consider the following ideas:

1. Length – There should be at least ½ inch between the end of your longest toe and the shoe when standing.
2. Width – Pointed shoes can help to create bunions. The widest part of your shoe should fit the widest part of the foot.
3. Depth – You must provide room for your toes, especially if you have corns or calluses. The toe box should allow the toes to wiggle easily.

The height of the heel for a walking shoe is approximately 1 to 1 ½ inches, and the heel should fit snuggly.

Always, buy your shoes later in the day when your feet are the largest (they may swell a little) and never wear them home from the store. Try them at home first while they are still clean. If you have problems with the shoes fit, you may be able to return them for exchange or refund. Wear your new shoes for short intervals to break them in, and choose natural materials such as leather. Always have your feet measured while standing, and if you have one foot larger than the other, always fit for the larger foot. You can use extra padding to fill in the extra space on the smaller foot.