I am a cashier at a busy gourmet market and deli. Being alert and on my feet for several hours a day is what I do.
Mr. Gracey helped me so much. He built shoes specifically for me and my weary feet. I now have again, a "spring in my stride". Thank you so much, Mr. Gracey!!
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My Brother-in-Law runs one of the premier talent agencies in the country, Peyton Entertainment Productions (Orlando, Florida). His old nemesis, Mr. Heel Spur, has plagued his left heel for years. He has other LE pathologies, but this tale is not so much about him but his house. You see, the floor plan of the house when drawn out, resembles an 'L'. Master bedroom and guest bedroom are in the top of the L, while most of the rest of the house makes up the foot. A concrete patio and a pool are adjacent to the living room and hardwood floors over a concrete foundation exist most everywhere. The distance from the top of the L to the rest of the house is roughly 30 feet and to enter the kitchen area is a 90deg turn. An island counter is in the kitchen and makes it possible to circumnavigate the entire house making only left turns.
On my last visit, we stayed a week and much of the time we were barefoot within the house. I spent a very small amount of time considering the lay-out of the house; counting my steps left and right, exploring distances between heavily walked points within the house, and taking into account the elevation changes from one room to the next. It turns out, that my gait strategy for turning corners and passing through transoms, relied heavily on my left foot. I would elect to 'carve' a corner by landing hard on my left heel to round it more often than not. When I would use my right forefoot to pivot-turn left, my first step forward with my left heel was always noticeably with more force than usual. Hmmm...I was using my left foot to strike first when stepping down over a threshold to get out to the patio AND stepping up, over the same footplate to enter the house. I consider myself both right handed and right footed. I wasn't so surprised to find that after only a few days, my left heel had a pointy, sharp pain on the posteriolateral side! Ouch! That either means I had developed a small bruise or I had exposed an existing heel spur that I never knew about. There is no way to build a heel spur in such a short amount of time. But given the change in my usual environment, the pattern of steps and my walking conditions, it comes as no surprise that a small, temporary pathology occurred. Turns out at least one more person in his family experiences the exact same pain as He and I did. House traffic patterns can have a profound effect on the ground reaction forces that go through the foot. To drop the pressures and protect his foot while it heals, I gave him a pair of my Graceyfeet Shoes. The fit and feel was good enough for him to wear them to Universal Studios theme park for the day! He still had pain, but the shoes were just the tool he needed to last the 4-5 hour outing. The most important place to wear his new Graceyfeet shoes is in his home. The turns, delays, accelerations, distances, and angles his feet have to navigate plus the hard surfaces all contribute to his pain. He has flip-flops that he states are his most comfortable shoes, but the new Graceyfeet shoes should give him the drop in pressure and the dynamics he needs to stay off his heel. I wish him well in his recovery and hope the shoes he wears provide the appropriate environment for healing. House traffic patterns are being monitored in the living situations of the elderly in hopes of finding better ways of understanding movement and perfecting the living environments for persons with injuries or advanced age. Hopefully, the information will reveal way we can build homes that address the health and well-being for persons of all ages. THANKS KATE! Below are a couple abstracts from articles written on physical performance and gender in walking. There is clearly a difference between male and female gait strategies and much of it appears to culminate in how the forefoot (FF) is loaded. Females walk with reduced sagittal plane motion and employ more of a hip strategy for balance during directional changes. Males employ an ankle strategy that limits their frontal plane motion and improves acceleration and deceleration. Males typically load the Lateral FF, while females load the Medial FF and use their Glutes and Lateral Vastus muscles to a greater extent. Excessively loading the MFF can result in overuse syndromes including plantar fasciitis, heel spurs, and bunions. Men don't often develop large bunions but they are susceptible to lateral forefoot fractures and heel spurs. Of course, shoewear plays a major role in how the foot is loaded when standing and walking. http://ukpmc.ac.uk/abstract/MED/10200375/reload=0;jsessionid=3DE8497F5653DC7B44B1DDD5D634DAB8.jvm1 http://www.sciencedirect.com/science/article/pii/S0966636209005839 http://www.drbarrykatzman.com/articles/heelspurstudy.shtml Check out the Remedy page to learn how to get used to your orthotics appropriately.
Quite possibly the greatest compliment that can be bestowed from a restaurant/market owner, Thank You!
Yesterday, I fitted my good friend (and co-owner of The Broad Branch Market here in DC) with a new pair of Graceyfeet orthotics. He had been icing and massaging his feet every night after standing, cooking, and lifting heavy boxes at his job and was quite frustrated by his lack of healing. An appalling revelation was discovered in that his shoes were absolutely shot! Simply over worn to the point that his ankles rolled severely and the forces that resulted were causing him great distress. A broken heel counter, bare and worn outsole, grease-slicked to a blackish-grey: It was clear he was in need of new shoes for his orthotics to work properly and he knew it. We agreed that I would accompany him to the DSW in Silver Spring, MD and offer some personal fitting advice. Once in the store, we made our way to the athletic shoe section and started our search. I began to select shoes that would be most appropriate while he narrowed that selection based on price and personal taste. One Saucony running shoe, one Nike cross-trainer, and one New Balance running shoe. The New Balance won in the end for it's sturdy, yet cushioned structure, while the Nike fit but was not a style that would suit him best. The Saucony, even at a sz. 13, was too small. Ultimately, He found the right shoe and spoke the words, "These feel delicious!". He changed into his new shoes with the Graceyfeet orthotics and dumped the old shoes in the garbage. I am so very happy for him and invite anyone reading this to experience the most cutting edge orthotic care in the world. And for my local customers, I'll even provide a fitting service if you need it. Now THAT's customer care! Thank you Greg A.!! Thank you Sarah W.!! Thank you Frederick B.!!...It is a pleasure to serve you. : Sometimes the simplest phrases are the ones that affect me the most as a caregiver. In my experience, the response of a patient who is ready to accept the healing process generally ranges from skeptical criticism to elated, joyful squeaks. Interpreting patient response can only be done with much conversation. I cannot document smiles, or raised eyebrows, or squeals for that matter, so I remember the specifics of what a person says and write the most descriptive reactions in their chart. But all in all, each person will reveal a part of themselves in their initial reaction to my unique orthotics, and I listen to their words (or guttural utterances) very carefully.
It is never easy to change old habits like the style of shoes one wears, because there has been so much emotion wrapped up in their choices throughout the years. Some folks have historically selected the wrong style of shoe out of a want to follow the latest fashion trends, while others have worn poor footwear because they felt a connection to a past fashion. Perhaps a school-mate wore that style, or a long ago connection to a respected family member who wore a particular brand of shoe. Sometimes the patient has selected a shoe that was right initially, but through an acquired injury or disease process, is no longer appropriate. So changing footwear habits out of a medical need not only is an admittance and acceptance of one's pathology, but a huge step toward healing. When a patient dons a shoe with my custom Graceyfeet orthotic inside for the first time, the shorter the phrases and louder their voice is, the more emotion is being shown, the more barriers are being overcome, and a greater attitude towards personal growth through physical healing is achieved. In essence, the interpretive song and dance of better health can be seen and heard in a patient's first steps with a new Graceyfeet orthotic. I am thankful to be a humble witness. Everyone, the website will be undergoing a few important changes soon. Over the next few weeks and months, we will be posting educational videos to help healthcare providers better serve their patients. Some videos will be filled with tons of useful information and available for anyone to learn from. Others will be technical in nature and password protected.
A flare is used to widen the base of support under the foot usually under the heel. A flange provides rigidity to the heel portion of the uppers allowing for a greater force to be placed on it without the heel counter buckling.
Typically, the intervention will center around whether the person has a fixed or mobile hindfoot deformity. In the presence of excessive inversion at initial contact, a lateral flare will improve heel strike by increasing the lever arm and applying a valgus tourque moment at the lateral heel as the foot loads. A mobile hindfoot will correct and overall limb alignment will improve during weight bearing. With a fixed deformity, a flare will shift the valgus stress to the next more proximal joint, usually the knee. Unless there is a correctable degree of valgum present at the knee, a flare alone is not recommended for the correction of excessive inversion in a fixed hind foot deformity. A flange works differently. Again, if we use the excessive inversion example, Stiffening the heel counter places greater force coupling around the superior aspect of the lateral calcaneous. This modification is not used to correct, but to accommodate the deformity, decelerate ballistic frontal plane motion, and minimize the effects of an inverted hind-foot. Ultimately this results in a better fit, less stress on the knees and hips, and improved shoe wear. Combining the two provides maximum control over hind foot frontal plane mechanics. Everyone, I'm in Breckenridge. I ski the trees in my cavort orthotics and LOOOOVE them! I'll be honing my skills and furthering my knowledge of anatomy and biomechanics for...animals! Yes, I make custom braces for pets too! It's a difficult task, but a rewarding feeling knowing your device is helping a loved, furry member of your family recover from a surgery, or rehab from an injury.
An AFO supports the forefoot and prevents plantar flexion or "foot drop" during swing. But don't forget, an AFO additionally substitutes for the lack of a plantarflexion moment during stance phase of gait. You see, the plantar flexors must be active during midstance and terminal stance to counter the dorsiflexor moment that is produced by the ground reaction force about the ankle jt. In the presence of weak plantarflexors, the ankle dorsiflexes too rapidly and, because the lower extremity is positioned in a closed chain, the knee flexes.
Midstance knee flexion affects the person's stability. Someone with weak plantar flexors must compensate proximally at the hip, (High-stepping, abducting, circumducting, excessive quad firing, compensatory genurecurvatum, etc.) or must wear an external device (an AFO) that substitutes the force that the plantar flexors ordinarily provide. An AFO with a dorsiflexion stop can be used to stabilize the knee in extension using GRF control in stance and would also allow knee flexion in swing phase. The degree of correct plantarflexion moment can be dialed in by building the brace in 5-10deg of plantarflexion and adjusting heel height accordingly. I suppose you could also restrict knee flexion through the use of a KAFO with a locked knee. But the 3PP system which prevents knee flexion in stance phase would also prevent knee flexion in swing phase producing an inefficient walking pattern. The KAFO is a very safe orthosis for sure but, dang, that is one bulky beast of a brace! And Dude still has his Quads, right? Just a 3/5 mmt on the hammy's. The GRF control device (AFO) is more energy efficient but not as safe when compared to the 3PP control orthosis (KAFO) which creates a less energy efficient but safer gait pattern. A patient might do well with solid ankle AFOs (or a heel-less, anterior cuff style. Then you could include a pressure reducing FO!!) and bilateral rocker sole modifications. If you go this route, the rocker sole mods are the key to controlling the tibia's advancement over the toes through the correct placement of the rocker axis. It will also reduce the plantar pressures that can get pretty high in the FF found with a co-poly full-length footplate. The world of professional cycling is divided not into racers and non-racers but rather by varying degrees of users. Among the cyclists I make orthotics and wedges for are persons who consider themselves racers but may only accumulate 60 miles in a week or less during certain parts of the year. Hardly a professional training schedule you might say, but consider that they often come to me in an off season or on a down-training schedule and their mileage reflects their current load. My recommendation and fabrication technique is based on their current needs which may include less aggressive FF wedging, more flexible materials, and greater pedal float to actually allow for less influence over the STJ, greater medial midfoot excursion at full peak knee extension moment, and knee valgus during peak power stroke angles. (I also move the pedal axis proximal by 5mm)
WHY? Because at reduced loads and distances, (and in the absence of pathology) it's just plain comfortable! As their distances and workloads increase, I switch them to firmer orthotic materials (carbon fiber), fully corrected wedge angles, stiffer soled shoes (again, CF), tighter degree of float, etc...until they are locked-in to their full training/raceday LE posture. |
Chris Gracey MPT, Cped
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