Unique Characteristics of the High Arch

When it comes to abnormal foot mechanics, a pronated or flat foot is the most common condition, but there is a smaller minority or people that have a high arch or supinated foot which can equally cause problems in the lower extremity.  An elevated arch tends to transmit rather than absorb shock as it is very rigid and inflexible, this results in increased forces up the kinetic chain to the knee and hip, making it susceptible to stress fractures of the foot and leg.  A study reported in Clinical Biomechanics found that high arched subjects had increased leg stiffness and vertical loading rates compared to low arched runners. 

While athletes with excessive pronation or supination of the feet are susceptible to more knee injuries, they differ in the type of injury patterns.  High arched runners report more lateral knee injuries, as they tend to be more bow legged, as opposed to low arched runners who show more medial knee injuries as they are knocked kneed.  Stress fractures in the calcaneus and seasmoids bones of the feet are more common in high arches, whereas soft tissue injuries are more common in low arches.  High arched runners experience more lateral ankle sprains and iliotibial band problems, while low arched runners have more medial meniscus and patellar tendonitis problems. 

A high arched foot generally requires improved flexibility (mobilization/stretching) of the foot and stabilizing orthotics to help decrease the shock at the heel strike, absorbing some of the forces and minimizing transmission up the leg.  These components would help to reduce the injury potential of the rigid foot with associated knee injuries, particularly in the case of runners, as running multiplies the forces three times more on heel strike.   

The unique nature of a rigid, high arch was recently reinforced to me when I had a patient who had one high rigid foot, and requested fitting for orthotics.  Her history included being a runner in the past and suffering a calcaneal stress fracture and a long history of iliotibial band issues on the rigid foot side, both conditions associated with a high arch.  

Plantar fasciitis and heel spurs can occur with both a pronated or supinated foot, due to the abnormal structure and pulling on the fascia.  Treatment is similar with both of these conditions, which can include ice, cold laser, mobilization, stretching, and orthotics.  Just as with a low arch, a person with a high arch will have to take extra care of the feet and have good foot wear for life. 

Restricted Carbohydrate Diet

In order to obtain and maintain your ideal body weight there is no magic bullet.  Obviously getting rid of processed food in your diet and increasing your veggie and fruit intake are  essential, as well as weight training to preserve lean muscle mass and cardio to burn fat stores.  The controversy seems to be in the low or no carbohydrate diets that are the current fad.

Weight loss without carbohydrate restriction is very difficult for most people.  When you eat a carbohydrate compared to a protein or fat, it is broken down rather quickly into glucose.  Once your bloodstream is flooded with glucose from your meal, insulin has to be released to make the energy accessible to the cells, but if there is excess glucose floating around, it gets stored as fat.  There is a strong correlation with type two diabetes and high carbohydrate diets, as when there is a constant stimulation of the pancreas to release insulin to process the excessive glucose, it eventual “wears out”.

So what does carbohydrate restriction mean?  One gram of carbohydrates equals four calories.  Many low carbohydrate diets reduce carbohydrate consumption to 20% or less of your diet, but a restricted carbohydrate is a more realistic 30% of your total calories from carbohydrates.  So if an average woman eats 1200 calories a day, than no more than 360 calories should be from carbohydrates, or roughly 90 grams of carbohydrates.  The change to a diet with reduced carbohydrates would put the body into ketosis, and shift the focus of energy from the immediate glucose available in the bloodstream to ketones, thus accessing fat stores to lose weight. 

There has been much research in the field of restricted carbohydrate diets. The New England Journal of Medicine published a clinical trial in 2008 comparing a low carbohydrate diet versus a low fat diet in obese patients and found that the low carbohydrate diet produced increased weight loss, decreased triglycerides and increased insulin sensitivity as opposed to the low fat diet. 

So the bottom line is start cutting back on your processed grains, such as bread, pasta, rice, cookies, pastries; and critically look at the nutritional information on all processed foods for the carbohydrate count.  Make sure any of the carbohydrates that you do consume are of high quality, preferably whole foods such as fruit and veggies and whole grains. 

Balance Exercises to Reduce Falls in the Elderly

As our society grays, it will become more important to avoid a health care crisis if a focus can be kept on keeping the elderly living in their own homes as independently as possible for as long as possible.  One of the largest sources of injury and hospitalization is from falls in seniors.  If the result is a hip fracture, there is a 50 % chance of permanent mobility issues that may result in the senior being unable to return to their home. 

Exercise is touted as one of the best preventative measures to not only reduce cardiovascular disease, type two diabetes and certain cancers, but to also stave off the progression of unhealthy aging, such as loss of muscle and bone mass; less flexible joints and reduced elasticity of tendons and ligaments.  One of the biggest barriers to exercise in the senior population is the fear of a fall, hence often the best strategy to get seniors moving is to start with restoring their balance to reduce this fear.  Balance is a function of input to the brain from information gathered in the vestibular (inner ear) system, visual system and somatosensory system (muscle, joint and skin receptors). 

There are a lot of exercises that can be used to enhance the balance of seniors, but they should all be done supervised and graduated within limits of the senior’s abilities.  There should always be a support available to the senior, such as a chair, wall, or counter to give the senior stability and confidence to perform the exercises.  Most balance exercises can be performed at home with little to no equipment needed, making it very cost effective.

One of the simpliest balance exercises to start with is by standing on one foot, while hanging on to a support.  Progression can be made to letting go of the support, but keeping it in reach if needed.  Once this has been mastered, the next step is closing the eyes, thereby removing the visual input, and having the mechanoreceptors in the muscles and joints to work harder.  

Another simple balance exercise is to go to the corner of the room, and with the two walls as support, place one foot in front of the other, keeping the weight is on the back foot.  This is challenging as it narrows the base of support for the body, as many seniors start to develop a wide stance to compensate for their lack of balance.   Again, the further challenge would be to not touch the walls, but keep the hands out for support if needed, and then to progress to closing the eyes. 

The internet is filled with websites on balance exercises, and another source would be the health district and senior centres, which may offer supervised classes.  So to keep the seniors in your life independent longer, think about doing some simple balance exercises and encourage them get more active. 

Cold Laser Post Knee Replacement

With an aging baby boomer population that have been more active than past generations, advanced osteoarthritis of the knee is a common condition in modern society.  Seniors who typically have a knee replaced are in poor physical shape due to inactivity; have poor muscle tone or bone mass; and are often overweight, which leads to long recovery and rehabilitation.  Boomers generally are in better physical shape and are having knee replacements at a younger age in order to return to their activities.

Cold laser therapy is a modality that is used to help reduce pain and inflammation; speed tissue healing by increasing vasodilation to bring in oxygen and nutrients and most importantly increasing ATP production, the cell’s energy source, to promote collagen formation.  Cold laser is safe to use on orthopedic appliances such as pins, plates and replaced joints as it does not heat. Ultrasound is contraindicated as it produces heat and electrotherapy is contraindicated as it conducts. 

Cold laser can be applied almost immediately after surgery as long as the wound is not open and there is no infection.  With surgery, the soft issues have been traumatized and your body is rapidly repairing the damage.  This is a time when there is a high need for cellular energy and nutrients.  The Theralase cold laser can penetrate 2 inches directly and 4 inches indirectly into the soft tissue;  speeding  the healing process by up to 50%, with much stronger collagen and less scar tissue.  This can allow the patient to participate in rehabilitation to strengthen up the muscles and allow an earlier return to activities.

Predicting Childhood Obesity

A simple formula, more accurately than complex genetic tests, can predict whether a baby is likely to become obese in childhood.  The formula is available as an online calculator http://files-good.ibl.fr/childhood-obesity which esitmates the child's obesity risk based on a few factors:
            
              - birth weight
              - body mass index of parents
              - number of people in household
              - the mother's professional status
              - the mother's smoking status during pregnancy

The researchers behind the study, published in the online journal PLOS ONE, hope that their calculator can be used to spot infants at high risk and help their families to prevent their children from putting on too much weight, as once a child becomes obese, it is difficult to lose.

The study, lead by Professor Philipe Froguel, from the School of Public Health at Imperial College in London, looked at 4,000 children born in Finland.  They were looking for genetic profiles as markers for childhood obesity, but failed to make accurate predictions.  Instead they looked at information readily available at the time of birth, and found those factors were more accurate.  The formula has worked not only in Finnish kids, but has been replicated in Italy and the US. 

Professor Froguel states that the beauty of the formula is its simplicity, it takes very little time to gather the information and costs nothing.  While not all children who have the risk factors are destined to become obese, as one in ten cases are caused by a rare genetic mutation that affects appetite, the majority of children can be targeted early to prevent a life time of struggles with their weight. 

Relaxation with Deep Breathing

Effective relaxation techniques provide a powerful antidote to stress; it can revitalize the body, steady the emotions, and create greater mental clarity.  It is a matter of letting go, instead of holding on to, of not doing, rather than doing.  As you relax, muscle tension is reduced and there is a decrease in the activity of the sympathetic nervous system. 

Deep breathing can be learned in minutes and have immediate benefits, but long lasting effects will be appreciated after several weeks of practice.  It can quickly reduce anxiety and pain on the spot, allowing emotional control.  Longer term it can alleviate irritability, muscle tension, fatigue, panic attacks and depression.  Steps for effective deep breathing include:

• Allow for 10 minutes of undisturbed time
• Find a quiet place to sit or lie down
• Close your eyes, scan your body for tension and begin to relax those muscles
• Place your hand on your stomach and breathe through your nose
• Focus breathing through your stomach by visualizing a balloon expanding and contracting
• Count down 10 seconds for each inhale/exhale

Meditation can be added on to deep breathing, by consciously focusing the mind on an object, word, phrase or activity and allowing background noise, thoughts or concerns to fade away.  Follow the steps for deep breathing, but allow your relaxation to deepen by meditating to the natural rhythm of your breathing.  As your mind wanders, choose to bring it back to your focus point.  With practice, you will begin to lose awareness of thoughts and experience a profound stillness of the mind. 

Dental Applications with Cold Laser

The dental profession has been on the leading edge of research using cold laser, with over 100 clinical trials in the last year alone.  The cold laser is effective in reducing pain and inflammation, as well as accelerate soft tissue repair by increasing collagen formation.  The five following dental conditions are common and have shown excellent results by applying cold laser:

TMJ Dysfunction is dentally addressed with TMJ splints to realign a bite issue, but it is often treated in conjunction with manual therapy, as there is increased soft tissue pain and headaches when the splint is adjusted.  Studies have shown that there is a clinically significant reduction in jaw pain and increased mandibular movement with cold laser, as effective as splinting.  Even greater results are shown when using both splints and cold laser together. 

Gingivitis improved dramatically with the inclusion of cold laser with traditional periodontal treatment than with traditional treatment alone.  There was a reduction in bleeding, gum inflammation, and plaque, all important to prevent advancement of dental cavities.

Dental extraction pain can be substantially reduced with using cold laser following the extraction. Studies showed substantial reduction of pain and inflammation and improved healing compared to the control groups.

Orthodontic forces involving braces were split mouth studies, where laser was applied on one side of the mouth only, so the patient is their own control.  There was significant reduction of pain on the laser side after brace readjustments and interestingly increased tooth movement, which could decrease treatment time.  Cold laser was also used in a clinical trial involving maxilla expansion, and there was not only a reduction of pain, but increased opening of the midpalate suture and accelerated bone regeneration compared to the control group. 

Oral ulcers and cold sores are seen secondarily in the dental profession, and using cold laser has shown to not only reduce pain, but speed healing of these conditions and in the instance of cold sores, even help prevent reoccurrence. 

 The amount of time involved for dental applications of laser is minimal, as the area is often small, so only minutes would be required, allowing an easy integration into the dental practice.  But best of all would be improved patient outcomes, and less pain, making it less fearful to go to the dentist!