DR. STEVEN D. STARK BSc, DPM
Q & A
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Orthotics
How long do Orthotics last?
The Orthotics shell (the arch) should last approximately 3-5 years with normal wear & tear. The top covers can be upgraded at anytime. The forefoot post, which is a two polymer forefoot stabilizer, will last 18 months to two years. This is the most important part of the orthotic. Athletes or professions such as chefs, landscapers, postal employees or others who spend a majority of their day outdoors or on their feet should have their Orthotics evaluated yearly to ensure they are performing optimally. Children will outgrow their orthotics approximately every two shoe sizes.
Are there different Orthotics for different shoes or activities?
Yes. Orthotics are customized for certain sports such as soccer, figure skating, hockey, and skiing. The Sports Specific Forefoot Post Orthotic must match the profile of the shoe/boot in order to stabilize the forefoot without displacing the foot inside the shoe/boot.
Most running shoes, walking shoes, golf shoes and the like are more standardized and therefore the regular orthotic should fit them all.
What’s the difference between an Arch Support and an Orthotic?
You can buy an arch support at the drugstore but not a “custom” orthotic. Orthotics are a medical device, prescribed by a qualified doctor and manufactured with the specific requirements necessary to help correct biomechanical & structural changes.
What is an Orthotic?
An orthotic is a precision made podiatric appliance designed to externally support the bones of the foot in the position needed for proper function and motion. It is always prescribed and manufactured by a licensed doctor and an accredited Lab.
Are you wearing an Arch Support or an Orthotic?
Arch Supports can be bought in most drugstores, shopping center retail stores, or from non-medical persons and technicians. They are a mass produced product with added modifications. They are not a medical device and they are not custom made by a licensed doctor.
Note: In most cases, only proper functional orthotics, prescribed and produced by a Doctor, are covered by your Extended Health Insurance coverage.
Can I get Orthotics for my high heels?
No. Due to the angle of the arch & last of the high heel shoe, no orthotic can provide stabilization. Orthotics are meant to be worn in any flat shoes and up to approximately a 1½” heel.
The time you spend in high heels should be limited to activities such going to the theater or a restaurant and never for a day of shopping or extensive walking!
Note: Your lower extremities muscles shorten rapidly to positional function, such as wearing high heels. Your calf muscles and hamstrings shorten as a result of wearing high heels routinely. This changes your joint position and stride length when walking. A proper stretching routine is essential to offset the results of wearing high heels.
Bunions
What is a Bunion?
Bunions are a growing bone deformity with ligament tearing and secondary joint dislocation. Increasing hypermobility and compensation of the forefoot blocks the motion of the big toe joint. When the big toe joint won’t bend enough for you to go up on your toes, you start to abduct (spin) off the side of the big toe joint. This abnormal function and pressure on the joint every step you take is what causes the bone growth (exostosis) and the ligament tearing and gradual dislocation (subluxation) of the big toe joint.
Do Bunions Recur?
Statistically a bunion (joint deformity) will recur after it is surgically removed if the cause of the bunion is not addressed. Removing the excess bone (exostosis) and straightening the joint corrects the result of the problem. The cause of the problem is the structural changes in the foot that results in the blockage of the big toe joint motion when walking, forcing people to spin off the side of the big toe joint.
How do I stop my Bunion from recurring?
A biomechanical assessment from a qualified doctor is necessary to evaluate the biomechanical & structural changes that cause the bunion. Custom Functional Orthotics are required to correct and maintain good alignment and proper joint motion of the forefoot in order to prevent the bunion from recurring.
Did I inherit my bunions from my Mother or Father?
Functional Health
I have one foot that is bigger than the other
It is a misconception that one foot is bigger than the other. Everyone has one foot that compensates more than the other. This compensation involves increasing pronation (the arch lowering), elongation, and widening of the forefoot.
Why do people shrink?
People don’t shrink as they age, they compensate. Everyone’s posture changes as they age because of the loss of ligament integrity in their joints, especially in the feet. Ligaments stabilize joints, and are made of collagen. Ligaments weaken and lengthen over time and use. This is called plastic deformity of ligament structures. The resulting hypermobility (abnormal motion) and displacement of the joints results in compensation of the foot. These changes are magnified up the leg from the foot, and the resulting changes in the pelvis and spine are greater than the changes in the foot.
Why did my arches fall?
Arches don’t fall. Increasing hypermobility of the forefoot results in compensation (pronation) of the midfoot (the arch) in order to keep the ball of the foot on the ground. The changes in the arch are the secondary changes, the increasing hypermobility and displacement of the forefoot are the primary changes.
I’m overweight, should I jog for weight loss?
Walking, not jogging, is the ideal exercise for weight loss. The force of your feet hitting the ground walking equals your body weight plus 20%. Jogging or running doubles or triples the weight bearing impact on the feet. This causes excess stress for the muscles & joints of the lower back, hips, knees and feet.
Puberty & Pregnancy. What do they have in common?
Both cause hormonal changes & hypermobility in the ligaments of the body. This affects all joints, especially the 107 small ligaments of the feet. Good supportive shoes are necessary to minimize the changes and compensation which will cause long term problems.
Planter Fasciitis
My heel hurts. Do I have Plantar Fasciitis?
If the pain in at the bottom of the heel, then probably. If the pain is at the back of the heel, then that is most probably an achilles problem.
What is Plantar Fasciitis?
The Plantar Fascia attaches to the bottom of the heel and extends beneath the arch to the ball of the foot and toes. It is an inelastic structure and cannot be stretched! Any change in structure or function that blocks the motion of the forefoot causes increase traction on the plantar fascia. Overloading the plantar fascia tears the periosteum (the tough connective tissue that covers bones) away from the heel. This causes inflammation underneath the periosteum of the bone. That hurts!!!
Why does my heel hurt in the morning?
Microscopic tearing occurs during the day, but inflammation builds up during rest. That is why the heel hurts most in the morning!
What causes Plantar Fasciitis
Plantar Fasciitis is caused by increased traction on the plantar fascia because of changes in the forefoot and arch…and also…Poorly made Orthotics.
If an Orthotic shell (the rigid part) blocks joint motion at the ball of the foot, it can cause increased traction on the plantar fascia causing tearing of the periosteum of the heel.