Foot Notes Blog


January 2015

New exercise for #plantarfasciitis

Jan 20, 2015 2:55 PM
Peter Guy

A recent study published in the Scandanvian Journal of Medicine and Science in Sports found that the following simple strength-training exercise provides more relief than traditional stretching of the plantar fascia:

Stand barefoot with your sore foot on a step, a box or even a thick book, with a rolled-up towel placed under your toes and your heel hanging over the step’s back edge. Lift your other leg off the floor, bent slightly at the knee. Slowly raise your sore heel, count 3 seconds, pause for 2, then lower for 3 seconds. Do three sets of 8 to 12 repetitions every other day.


Myths about diabetes

Jan 7, 2015 11:06 AM
Peter Guy

These are some myths about #diabetes you should know.


How does your nail salon measure up

Jan 6, 2015 10:35 AM
Peter Guy

How does your nail salon measure up with preventing the spread of nail fungus?


Are expensive running shoes worth the expense

Jan 5, 2015 10:03 AM
Peter Guy

I tend to agree with the main points of this article on #runningshoes. But if you have #footpain get it treated.


If you wore high heels on new years eve

Jan 4, 2015 9:01 PM
Peter Guy

If you wore high heels on new years eve, you probably should have read this article.


March 2014

Don't let plantar fasciitis cause you pain after a long winter of inactivity

Mar 27, 2014 6:18 PM
Peter Guy

It has been a long winter in southern Ontario. Most people have limited their walking outside due to snow and ice on sidewalks and roads. The good news is most of the snow and ice has melted from the sidewalks making it safer to walk without slipping. The bad news is that first spring walk or run might lead to heel pain.

Plantar fasciitis is the most common cause of heel pain. The pain is caused by inflammation of the tissue along the bottom of your foot that connects your heel bone to your toes. Plantar fasciitis causes stabbing or burning pain that is usually worse in the morning because the fascia tightens overnight. The pain usually decreases as your foot limbers up, but it may return after standing for a long time or after getting up from a seated position. If plantar fasciitis is not dealt with quickly it can become chronic. The pain of plantar fasciitis can be dealt with by using conservative therapies however in a small number of cases surgical intervention may be indicated.

Plantar fasciitis usually comes on gradually, but can occur suddenly and be severe. It can affect both feet, but often occurs in only one foot at a time.

Symptoms include:

  • Sharp pain in the inside part of the bottom of your heels.
  • Heel pain that tends to be worse with the first few steps after awakening, climbing stairs or standing on your tiptoes.
  • Heel pain after standing long periods or after getting up from sitting.
  • Heel pain after, not during, exercise.
  • Mild swelling in your heel.

Normally, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot especially when you heel is lifting off the ground. The plantar fascia helps the foot from bending. If the foot structure is unstable, the plantar fascia can stretch or pull away from the heel bone. Small tears can be created in the fascia if tension on that bowstring becomes too great. Repeated stretching and tearing can cause the fascia to become irritated or inflamed and thickened.

Causes of the condition include:

  • Physical activity overload. It’s common in long-distance runners. Jogging, walking or stair climbing can also place too much stress on the heel bone and the soft tissue attached to it, especially when starting an aggressive exercise program. Even household exertion, such as moving furniture or large appliances, can trigger the pain.
  • Faulty foot mechanics. Being flat-footed, having a high arch or even having an abnormal walking pattern, can adversely affect the way the weight is distributed when you’re on your feet, putting added stress on the plantar fascia.
  • Improper shoes. Thin-soled, loose shoes or ones which lack arch support or the ability to absorb shock don’t protect your feet. If you’re a wearer of high-heeled shoes, your Achilles tendon – which is attached to your heel – can contract and shorten, causing strain on the tissue around your heel.
  • Arthritis. Some types cause inflammation in the tendons in the bottom of your foot, leading to fasciitis.
  • Diabetes. We don’t know why, but plantar fasciitis occurs more often in diabetics.

Developing plantar fasciitis is more likely if you are:

  • Active in sports. This may put a lot of stress on your heel bone and attached tissue. Included are running, dancing and jumping.
  • High or low arched feet. Flat feet may have poor shock absorption, increasing the stretch and strain on the plantar fascia. High arched feet have tighter plantar fascia, which also leads to poor shock absorption.
  • Middle-aged or older. Heel pain tends to be more common with aging, because the arch of your foot tends to sag more, putting stress on the plantar fascia.
  • Overweight. Carrying around extra pounds can break down the fatty tissue under the heel bone and cause heel pain.
  • Pregnant. With this comes weight gain and swelling that can cause you body’s ligaments, including your foot ligaments, to relax. Mechanical problems and inflammatory conditions can result.
  • Occupation. Certain occupations demand this, such as teaching, working in a factory, or being a waitress. Damaging your plantar fascia is more common in these cases.
  • Wearing shoes with poor support or stiff soles. Using a lot of poorly designed pumps, loafers, and boots can lead to plantar problems.

Over time the plantar fascia can become thickened. This leads to a chronic pain situation which is more difficult to treat. Chronic pain in you heel will unfortunately change the way you walk and will put more stress on other joints in your body such as your ankles, knees and lower back. Chronic pain will limit your regular activities or your ability to work.

For most people, the condition improves within a year of starting conservative treatment. The longer you delay treatment the longer it will take to heal your plantar fasciitis.

Non-surgical treatments that may assist healing include:

  • Footwear.  Footwear should have firm heel counters and a stiff midsole. The shoe should not be able to be twisted easily.  The area across the ball of the foot should be flexible to allow for the toes to bend.  If athletic footwear is required the type of athletic footwear should be sport specific. If a running shoe is required, the right class of running shoe should be determined. For example, do you require a cushioning running shoe, mild or moderate stability running shoe or a motion control running shoe?
  • Night splints. This is a splint fitted to your calf and foot while you sleep, holding the plantar fascia and Achilles tendon in a lengthened position overnight so they can be stretched more effectively.
  • Taping. Application of athletic taping to support the bottom of your foot. Foot orthotics are indicated if this arch taping is successful
  • Foot orthotics. These are over the counter or custom orthopedic devices that fit inside your shoes to help stabilize the foot bones. Foot orthotics can help distribute pressure more evenly underneath the plantar surfaces of both feet
  • Walking cast. A removable walking cast in chronic conditions
  • Physical therapy.
  1. Exercise to stretch the calf muscles and to strengthen lower leg and foot muscles and increase range of motion of certain foot joints .
  2. Ice massage to the area of the origin of the plantar fascia
  3. Low level laser therapy to reduce pain and initiate healing
  4. Mobilisations and manipulations of the foot joints.

When conservative treatments aren’t effective these treatments can be considered:

  • Corticosteroids injections. One or two injections of this kind of medication, such as Prednisone, into the region of the plantar fascia attachment at the heel, provides temporary relief. Multiple injections should be avoided because they can weaken your plantar fascia and even cause it to rupture, as well as shrink the fat pad covering the heel bone.
  • Extracorporeal shock wave therapy. Sound waves are directed at the area of heel pain to stimulate healing. It’s usually used for chronic cases unresponsive to conservative treatments. This is not used for children, pregnant women or people with a history of bleeding problems.
  • Plantar fasciotomy surgery. A small number of suffers need surgery to detach a plantar fascia from the heel bone (plantar fasciotomy). This is an option only when the pain is severe and all else fails. A side effect is weakening of the arch in your foot.

One of the analogies, I like using to explain plantar fasciitis is the flooded basement analogy.  The water on the basement floor is like the symptoms of plantar fasciitis. You can get rid of the water but, the crack in the basement wall allowing water into the basement is the cause. If you don’t address the crack in the wall the water will come back into your basement during the next rainfall.

If you don’t address the cause of your plantar fasciitis your symptoms will come back.  

In summary, your heel pain will reoccur if you don’t address your: faulty foot mechanics, weak or tight foot and lower leg muscles, physical activity levels, footwear, arthritis or diabetes.


February 2014

6 more weeks of cracked dry skin

Feb 2, 2014 4:52 PM
Peter Guy

Today is Groundhog Day in both Canada and the USA. The groundhog Wiarton Willie came out of his burrow and saw his shadow. Unfortunately, for us it means 6 more weeks of winter weather. 

Winter weather can be difficult on our skin. The humidity inside our homes can be very dry especially if a humidifier is not installed on a furnace. You can see the effects low humidity on wood furniture.  Skin needs to be hydrated or moisturized to maintain its ability to withstand stretching or tension.

Cracked dry skin especially on our feet can mean trouble.  Some people suffer every winter with dry cracked heels or cracks on the bottom of their feet. As the skin gets drier it cannot withstand any type tension or pulling apart of the skin. This happens very easily on our heels. With every foot step we take, the skin at the edges of our heel will stretch.  If our skin is adequately hydrated this skin stretching is not a problem.  Dry skin is easier to stretch and tear causing deep cracks in the heels.  As the body tries to repair the crack, thick callus will accumulate on either side of the crack.  The deep crack in the skin can be painful because the nerve endings deep in the skin are aggravated.

 Keeping your skin moisturized if you are diabetic is a must.  If the skin becomes too dry on the foot it can change the balance of bacteria on the surface of the skin. There are many types of good bacteria that live on the skin.  The good bacteria prevent the bad bacteria form causing skin infections.  If the skin becomes too dry it will upset the balance of good bacteria and bad bacteria on the skin. Therefore dry skin can increase the risk for skin infections in the feet of diabetics.

You can prevent dry skin by regularly using an emollient or skin moisturizer.  I recommend a urea-based skin moisturizers. Urea as a humectant.  Humectants attract and retain moisture nearby by drawing the water vapor into and/or beneath the skin surface.   I recommend using a urea based emollient at least once per day applied after a bath or shower.  Urea based emollients can cause stinging when applied to the skin which is why applying after a shower or bath is recommended.  Some examples of a urea based emollients are Dermal Therapy (25% urea), Uremol 20 (20% urea) and Urisec 22 (22% urea). If the cracked skin on your feet is not healed by using the recommended emollients you should seek treatment from your local chiropodist/podiatrist.

Be good to your feet moisturize your skin daily during the winter.


September 2013

Student athletes - Avoiding heel pain

Sep 3, 2013 11:33 PM
Peter Guy

Over the past few weeks heel pain has sidelined or hobbled  Albert Pujol’s of the Los Angeles Angels, Mike Napoli of the Boston Red Sox’s and Jarius Byrd of the Buffalo Bills.  If you are student athlete going back to high school or university, heel pain is something you want to avoid.  Heel pain will change the way you perform your sport.  

If you are developing heel pain, you will start to notice pain when you take your first step in the morning.  As time goes on, you will dread your first step out of bed because it is going to be painful. With practice you will perfect a method to keep as much weight off of your painful heel.  You will realize the pain will get a little better as the day goes on but you also know that when you get home and sit down but have to get up again it’s going to be painful! 

One of the main reasons heel pain occurs is because the plantar fascia pulls away from its attachment under the heel bone.  This pulling away occurs with every step you take while walking or running.  The plantar fascia has role to keep your foot stable as you lift your heel off the ground while walking or running. The plantar fascia helps to resist your foot from bending.

To give you an idea of what I am describing, I want you to take your hand and place it with your palm down on top of a table.  Slowly lift the palm of your hand off the table.  The more you lift your palm, the more you will pivot on the tips of your fingers.  Now bend you hand, you will feel a tightening in the palm of your hand.  You have just stretched your palmar fascia.  When you bend your hand this is simulating what your foot is doing when you lift your heel off the ground and the weight is on your forefoot. 

When we walk or run, there is a small period of time when all the weight of our body is only supported on one foot.  During this time the heel lifts off the ground and the foot will want to bend. If the foot is stable not much bending will occur to stress the plantar fascia.  If your foot is unstable, the foot will bend in the middle and the plantar fascia will try to prevent the foot from bending.  This is when the damage to the plantar fascia occurs causing heel pain.

Your foot can be unstable for a number of reasons, the most common reason is flat feet. If your foot is unstable because you have flat feet  you may not be able to withstand the bending forces applied to the middle of the foot especially if you play a sport that involves running, jumping, or twisting  of the foot.

Whatever sport you play make sure you have the right type of footwear for the demands of your sport.  You may require a custom made foot orthoses to help to stabilize your foot and prevent the bending forces on the foot.  Most sports shoes will be orthotic friendly however some sports shoes such as soccer shoes may not be orthotic friendly.

The orthotic used for heel pain is pathology specific.  It will have wide orthotic shell to support the mid-foot joints, a deep heel cup to stabilize the heel with and cushioning in the bottom of the heel cup.

If your heel pain has lasted for more than 2 weeks and the intensity of the pain is getting worse you should immediately seek professional help from a chiropodist/podiatrist or your family doctor.  The longer your heel pain is left untreated, the greater the chance it can become chronic.  The longer you have heel pain the more likely you will start to change the way you walk or run leading other problems.  In the worst case scenario, you can develop heel pain in the other heel because you have compensated by putting more weigh on the non-painful heel.

I routinely see patients with heel pain who have waited longer than 4 to 6 months before they seek treatment or they have followed bad advice.  If you have chronic heel pain it may require a longer duration of time and a more comprehensive approach to resolve your heel pain.   If your heel pain is not chronic there is usually an easy solution for your heel pain.  If you have heel pain do not let it become chronic and get treatment at the earliest possible date.

Act quickly so you can stay in the game.


April 2013

Are you embarrassed by your thick, yellow nails?

Apr 12, 2013 9:19 PM
Peter Guy

Thick, yellow nails are usually caused by the presence of a fungal nail infection. A fungal infection of the toe nails is a common foot problem. Nail fungus (onychomycosis) is an infection of the nail plate and nail bed. It is caused by various types of fungi, which are commonly found throughout the environment. Fungi are simple parasitic plant organisms that do not require sunlight for growth. A group of fungi called dermatophytes have evolved to attack human nails and skin.
The infection of the nail begins with some type of trauma to the nail. The dermatophyte gains entry into the nail and begins to feed on the nail protein called keratin. The big toe nail is the most commonly infected toe nail.
Our big toe nails can get damaged or traumatized from:

  1.  The way we walk or run. ( because of a unstable low arched foot or bunion)

  2. The shoes we wear ( tight fitting shoes or high heels)

  3. The type of job (the requirement to use steel-toed safety boots).

Furthermore, the environment inside of a shoe is dark and damp which provides a perfect growing climate for nails and skin fungus. Other contributory factors are a history of athlete's foot (fungal skin infection of the foot) and sweaty feet.
Several research studies have estimated onychomycosis affects 3% to 13% of the population. The vast majority of people who have fungal nails don't even recognize the existence of a problem and therefore don't seek treatment for many years because their thick nails are not yet causing them pain.
The rate of fungal infections rises sharply among older adults above 65 years as they start to experience more medical problems. For instance, those who suffer chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails. This can result in fungal nails being considered a minor problem in comparison to other concurrent medical problems.
Fungal infections of the nail can be graded as mild, moderate or severe. The severe fungal nail infection occurs when the infection extends into the nail matrix (the area of the nail at the base which has white half-moon). A severe fungal nail infection is very difficult to treat and has a poor prognosis.
Fungal nails can be treated by:

  1. Thinning the nail plate

  2. Removing diseased nail and fungal debris back to healthy appearing nail.

  3. Applying topical nail softeners and topical anti-fungal medication exposed nail bed and remaining nail plate

  4. Application of laser to nail plate

  5. Oral anti-fungal medication

If you suspect you have a fungal nail infection you should visit a chiropodist/podiatrist to confirm if you have a fungal nail infection and discuss your treatment options.


January 2013

Mark Wahlberg talks about his ingrown nail on the Ellen Show

Jan 20, 2013 1:51 PM
Peter Guy

Recently on the Ellen Show Mark Wahlberg discussed the removal of a portion of nail that was causing him pain in his nail groove. His co star Micky O'Keefe from the movie "The Fighter" advised Mark to see his daughter-in-law who is a podiatrist. A portion of Mark's big toenail that was digging into his skin was removed permanently so it would not grow back.
I use an internet service called Google Alerts. I subscribed to an alert for "Ingrown nails". Any query on "ingrown nails" is sent to my smart phone. One of the most common questions concerning ingrown nails is from the website "" . Most questions are usually "what I can do to cure or get rid of my ingrown toenail". This type of question occurs daily. Many people suffer from the pain of ingrown nails.
Mark Wahlberg stated his nail was growing the wrong way. I am only guessing but Mark may have tried to cut his nail hoping to relieve the pressure in his nail groove. Unfortunately this action may have made the problem worse. He may have also aggravated the problem by wearing tight shoes. I'm glad he took the advice of visiting a podiatrist.
Ingrown nails usually pierce the skin causing inflammation and infection. If an ingrown nail is treated early all that may be required is the removal of a small piece of nail to alleviate the problem, most times without the need for freezing.
Unfortunately, some people delay treatment of their infected ingrown nail. Usually in these cases, the nail is highly curved which puts a great amount of pressure in the nail groove. The consequence of delayed treatment is procedure requiring a permanent partial or total removal of the nail performed using local anesthesia. This procedure uses a chemical called phenol to destroy the nail matrix. Destruction of the nail matrix prevents the removed nail from growing back.. The post operative care requires soaking of the nail bed using salt water followed by the use of an antibiotic cream. In some cases, if the infection is moderate to severe an oral antibiotic may be required. Generally the nail procedure will take about two to three weeks to heal.
Do not delay seeking treatment for an ingrown nail. It will probably only get worse.


November 2012

Digital video gait analysis reveals what is causing your foot and lower extremity pain

Nov 24, 2012 6:35 PM
Peter Guy

My colleague and good friend Brian Cragg from Markham Footcare has produced a very informative YouTube video (shown below) outlining the benefits of using the PediGait synchronous 4 camera gait analysis system. We both introduced this technology into our offices in April 2012.
Gait analysis is used on a daily basis by chiropodists/podiatrists as a component of the physical evaluation of the presenting patient. Typically, gait analysis consists of watching a patient walk back and forth in a hallway. The information observed in the gait analysis helps to reveal the the cause the patient's presenting symptoms.

Hallway gait analysis provides valuable information to the practitioner but provides no visual feedback for you "the patient" relating to the way you walk or run.
Since the introduction of PediGait into our Whitby office, we have elevated clinical gait analysis to the next level by providing more informed patient education as well as direct visual feedback to help you to understand why you have foot, ankle, shin, knee, hip and back pain.

The benefits of the Pedigait system include:

  1. Films and records you walking or running on a treadmill simultaneously from the front view, back view, left side view and right side view.

  2. Archives a permanent visual record of your gait that can be played back immediately or at a future date.

  3. Immediate playback to allow observation of your gait from four views at the same time or from one single view on a large high definition TV

  4. The video can be slowed down, viewed frame by frame or paused to allow you to see your gait in complete detail from four different views or one single view.

  5. Provides comparisons between multiple video captures such as walking or running barefoot, with shoes and with shoes plus orthotics.

  6. Can provide a video file either for insurance purposes, or for another health professional such as your family doctor or simply to view on your home computer

Finally, one of the benefits for the chiropodist/podiatrist is the ability to view your gait analysis video in more detail after you are no longer in the office.  If your treatment plan requires a prescription foot orthotic, the archived visual record of the captured 4 views is extremely useful when writing a prescription for custom foot orthotics.


Low level laser therapy (LLLT) for the foot

Nov 8, 2012 9:45 PM
Peter Guy

Today in Whitby, ON, James Carroll the CEO and founder of Thor Photomedicine spoke about low level laser therapy (LLLT) to a number of my podiatric collegues. He discussed how light emitting diodes (LED's) and near infra red laser light promotes tissue healing, improves lymphatic drainage, provides analgesia and relaxes muscles via trigger points.
To understand how LLLT works you will have to learn about mitochondria. Mitochondria are the energy factories of our human cells. The mitochondria produce an energy-rich molecule called adenosine triphosphate (ATP). ATP is produce by a complex chemical pathway which includes a protein called cytochrome C oxidase. Cytochrome C oxidase will bind oxygen to help complete the formation of ATP.
In the event of any type of tissue injury to the cells of skin, ligaments, muscle, tendon, nerve and bone, the mitochondria in the cells will start to produce nitric oxide. The nitric oxide will bind to cytochrome C oxidase preventing oxygen from binding. When oxygen doesn't bind to ctyochrome C oxidase the production ATP is reduced. If there is a decrease in ATP there is no energy for cells to function efficiently. This lack of ATP can delay tissue healing.
When the proper spectrum of light wave energy is applied to an injured area, the cytochrome C oxidase will absorb the light energy and force the nitric oxide off of the cytochrome C oxidase. This will allow oxygen to bind to cytochrome C oxidase and an increase the production of ATP. The increase in ATP in any injured cell will allow for local tissue healing, promotion increased immune function via lymphatic drainage, provide analgesia via nerve inhibition and relax muscle via stimulation of trigger points.
If you have acute pain and swelling in the foot it can significantly reduced after one or two treatments with LLLT. Chronic pain and swelling in the foot will also respond favourably with several treatments. LLLT can reduce the amount of time it takes to heal chronic skin wounds, diabetic foot ulcers and venous ulcers.
We have been using a Thor Laser at Whitby Family Footcare Clinic for several months with some favourable patient outcomes on achilles tendinitis, plantar fasciitis and wound healing.
I want to thank James Carroll for presenting an very informative seminar on LLLT


Dr. Warren Joseph speaks at Ontario Society of Chiropodists meeting in Toronto

Nov 4, 2012 10:33 PM
Peter Guy

I had the opportunity to listen to an excellent lecture given by Dr. Warren Joseph DPM. He spoke about antiboitics and there use in podiatric practice. He outlined the commonly used antibiotics prescribed by chiropodists and podiatrists for skin, soft tissue and bone infections in the foot.  He outlined the most effective antibiotics for diabetic foot infections as well as his concern about the resistant strains of bacteria that are difficult to treat with existing antibiotics.  Dr Joseph explained the antibiotic dosage prescribed to  patients should be 1 pill once per day or twice per day, if possible.  Otherwise, patients may not take the prescibed dosage if they have to take a pill 3 or 4 times per day.

If you are taking antibiotics you should finish your prescribed number of pills. In other words, don't stop taking them until they are all finished even if you feel much better before they are finished.

After the lecture,  I was presented with an Ontario Society of Chiropodists 25 year membership pin by Craig Hunt.  Many of my collegues I went to school with or I have taught over past 25 years also received their 5, 10, 15 or 25 year membership pins.  It was a great ending to an OSC meeting.


October 2012

Reggie Love former aide to President Obama addresses delegates at CFPM conference in London, ON

Oct 28, 2012 4:23 PM
Peter Guy

During this past weekend I had the pleasure to meet Reggie Love at the Canadian Federation of Podiatric Medicine (CFPM) conference. He recently resigned as a personal aide to US President Barack Obama to devote more time to finishing his MBA at the Wharton Business School. 

As part of a motivational speech to the delegates at the conference he spoke of his experiences at Duke University in North Carolina as a basketball and football player from 2001- 2005.  He described his failure to make the Green Bay Packers and Dallas Cowboys of the NFL in 2006/2007. All of these experiences helped hime to meet the demands of intially  working in Barack Obama's, United States senate office in Washington DC,  the subsequent U.S. presidential campaign and finally in the White House as a personal aide to the U.S. President.

He discussed being prepared for every task may not elimanate all errors but can significantly minimize the serious ones.  All errors should be treated as a learning experience to prevent them in the future.  Sometimes the easy solutions are overlooked when they might be staring you right in the face. 

In the picture above from left to right are Stephen Hartman CFPM CEO,  Reggie Love,  Peter Guy and Ian McLean, CFPM President.


August 2012

The Olympic marathon run

Aug 12, 2012 1:17 AM
Peter Guy

This is the final day of the Olympics and one of the last events is the marathon run of 26 miles. This event brings together the 100 best marathon runners from all over the world. The trio of runners from Kenya: Wilson Kipsang Kiprotich, Abel Kirui and Emmanuel Mutai could sweep the marathon medals. The eventual marathon winner will be the runner most able to keep a constant speed throughout the race over the varied terrain. The best marathon runners have a body type best suited for marathon running but more importantly, they can minimize their injury rate by proper training and recovery. Many recreational marathon runners develop many foot and lower leg injuries because of poor training methods, improper footwear and poor lower extremity biomechanics. Structural problems occurring in the foot and lower leg can cause plantar fasciitis, shin splints, Achilles tendinitis, and ilio-tibial band syndrome. If these problems occur should be addressed as soon as possible before the injury becomes chronic. Good luck to all the Olympic marathon runners.


The Mexican upset win over Brazil and congratulations to the Canadian women's soccer team.

Aug 11, 2012 12:09 PM
Peter Guy

This morning I have been watching the 2012 Olympic men’s soccer/football finals. It has been an excellent game between Mexico and Brazil. You can hear the Samba beat in the stands at Wembly Stadium. I have been impressed with the speed of the players. I know from treating soccer player in my practice that some of these players are participating with some type of foot injury. Plantar fasciitis, hallux limitus, bunions and ankle sprains are some of the most common foot injuries that occur while playing. Women soccer players’ tend to develop patellofemoral syndrome if their feet are flat or if the Q angle is large. I am sure the therapists and trainers involved in the Olympic soccer tournament have minimized these foot injuries. If you have any of these foot injuries as a result of playing recreational sports or due the repetitive nature of your job you should not delay getting treatment for these injuries. Congratulations to the Canadian Olympic Women’s soccer team for their bronze medal and to the Mexican Olympic Men’s soccer team for their gold medal.


The dream 100 metre final

Aug 5, 2012 4:51 PM
Peter Guy

Tonight in the main stadium at the London games in front of 80,000 spectators the men’s 100 metre final will held, The final 8 runners are Richard THOMPSON, Asafa POWELL, Tyson GAY, Yohan BLAKE, Justin GATLIN, Usain BOLT, Ryan BAILEY and Churandy MARTINA. This is considered to be a dream final and a much anticipated event at the games. In watching the semi-finals and preliminary rounds it was amazing to see the fluid mechanics of running demonstrated by the top runners. Usain Bolt is the favorite to repeat as champion. As a chiropodist/podiatrist I am amazed at the power that he unleashes using his long legs and arms. His feet act like well-oiled springs that transmit the power from his upper and lower leg muscles for push off from the track. Unfortunately, recreational runners can damage their muscles, tendons, ligaments and bones if their feet cannot properly act like springs to transmit power. Plantar fasciitis is one such problem that prevents the foot to act like a spring. The plantar fascia is one of many supportive structures on the bottom of the foot. If the plantar fascia is damaged the foot cannot properly act like spring. Plantar fasciitis is something that should be treated right away by a chiropodist/podiatrist before it becomes chronic. And the winner is Usain Bolt. Congratulations!


July 2012

Good luck to the Canadian Olympic Team

Jul 28, 2012 12:23 AM
Peter Guy

Over the next 3 weeks the London Summer Olympics will be showcasing thousands of athletes from all over the world. These athletes have been training for years to hone their performance to meet summer game standards and strive for a podium finish.  There is no doubt these athletes have injured themselves during their training while running, walking, jumping, lifting, aiming, throwing, diving, vaulting, rowing and swimming. Some athletes may even be competing at the London games with some type of injury.  The good news is that Olympic athletes have access to many different health professionals to treat their ailments to help them get ready for competition. 

Some of the lower leg extremity problems that can hamper an athlete included:

Hip pain

·         Bursitis

·         Leg length difference

Knee pain

·         Jumper’s knee (patellar tendinopathy)

·         Patellofemoral syndrome,

·         Ilio tibial band syndrome,

·         Runner’s knee (Chondromalacia patella)

Leg pain

·         Shin splints (tibial stress syndrome)

Ankle pain

·         Achilles tendonitis (Achilles tendinopathy)

·         Recurrent ankle sprain (lateral ankle instability)

Foot pain

·         Plantar fasciitis

·         Heel spur syndrome

·         Collapsed arch (adult acquired flat foot)

·         High Arch (pes cavus)

·         Callus and Corns

·         Bunions and metatarsalagia

·         Morton’s neuroma

Many of athletic injuries listed above can occur due to an work related injury caused by repetitive stress, unstable foot posture and improper footwear.  Many occupational injuries get worse because people will try to work through the injury and not seek help in a timely fashion. Chiropodists and podiatrists are part of your health team to get you back to work pain free.  Chiropodists and podiatrists can identify the mechanical instability in your foot or lower leg that may be causing your injury.  We will examine your feet, lower legs, walking pattern, footwear and any systemic medical problems that may contributing your injury such as diabetes. Custom foot orthotics may be part of the solution to get you pain free and back to work

I wish the Canadian Olympic team members the best of luck in London


Flip flop fungus

Jul 20, 2012 11:58 AM
Peter Guy

Yesterday on the on the drive home from the office I was listening to “Here and Now” hosted by Laura Di Battista on CBC radio. She was talking with Michael Bhardwaj (@radiobhardwaj) the national science columnist for CBC Radio. He was discussing  a flip flop fungus experiment that was reported by Jason Feifer in the New York Magazine. Michael outlined the variety of fungus and bacteria found on the upper surface of flip flops to Laura’s horror. Michael stated even though there are many bacteria and fungus on the surface of your feet and flip flops, our healthy immune systems can deal with the bacteria and fungus. He suggested washing the upper surface of your flip flops touching your feet with soap and water. This gets rid of 99.9% of the bacteria and fungus.
Foot fungus is a common complaint that I treat on a daily basis in my office.  A fungi is a microscopic plant like organism that thrives in moist, humid and dark environments. A mushroom that grows on a lawn or in a forest is a fungus that feeds on wood. In contrast, the fungus that infects the foot feeds off a protein called keratin found in the skin and nails.

Foot fungus appears in a number of presentations on the skin and nails of the foot. A fungal skin infection is called tinea pedis. One of the most common areas for a fungal skin infection is in between the toes. A fungal infection in between the toes results in red, hot, split, itchy and wet skin. A fungal nail infection is called onychomycosis. A fungal infection of the nail results in a thick, yellow and sometimes painful nail.

How can you get a fungal infection of the skin and nails? First, the fungal organism requires entry via some type of damage to the skin or nails. Second, the body’s immune system needs to be compromised. If the body’s immune system is compromised by stress, poor nutrition or disease such as diabetes a fungal foot infection can easily occur. I have many patients who have diabetes and fungal nails. Foot fungus is naturally found on human skin and is prevented from becoming a problem by virtue a complex interaction between “good” and “bad” bacteria on your skin. The good bacteria on the skin are like a “neighborhood watch program” repelling the bad bacteria. As long as there is good bacteria on your skin the likely hood of any type on skin or nail infection is low.
Unfortunately, the fungus that causes skin and nail infections has the ability to survive and infect another day. The fungus can produce a seed or spore that can survive for years. Once the conditions for growth are present the spore will germinate and cause another fungal skin or nail infection. This fact makes preventing a reinfection of skin and nails difficult because the spores can be found in an old pair of shoes or on top of your flip flops from the previous summer. Make sure you disinfect your shoe and socks of spores. Our office dispenses a couple of products that help to disinfect your shoes.

Enjoy the rest of the summer.


June 2012

Euro Cup 2012

Jun 10, 2012 11:52 AM
Peter Guy

The Euro Cup is an exciting time for soccer/football fans. Soccer is a very good sport for keeping young people active.  Unfortunately, with all the running that occurs during a game, injuries can occur to the foot and lower leg. The list of injuries include: knee cap pain; ankle sprains; shin splints; heel pain; arch pain and forefoot pain.  Some of these injuries are caused due to an underlying structural problem that puts stress on the supporting soft tissue structures such as muscle, tendons, ligaments and joint capsules.

If your child is suffering from any foot or lower leg problem we can evaluate your child's running style.  We can record your child running on a treadmill which allows us to observe if there are any structural problems causing the foot or lower leg compalint via Pedigait slow motion analysis.   Enjoy the Euro Cup during the month of June and we hope your favourite Euro Cup team is victorious.


March 2012

Is an old ankle sprain causing your current foot pain?

Mar 6, 2012 3:02 PM
Peter Guy

I have many patients who seek treatment for a vague pain or discomfort along the outside (lateral aspect) of their foot. During the discussion of their history of the pain or discomfort, the patient will report an ankle sprain injury that occurred the previous 3-5 years. The patients will also report the acute ankle sprain healed without incident. Ankle sprains occur when you roll over on the outside (lateral) of the ankle and tear the ligaments on the outside of the ankle. Sometimes this injury can cause bones to fracture.
Acute ankle sprains are one the most common lower extremity injuries that people seek treatment for in US and Canadian emergency departments.
The treatment for your acute ankle sprain in the ER may include x-rays, use of an Aircast™, crutches, activity modification, icing, application of a tensor bandage, referral to a physical therapist, or surgery to realign ankle bone fractures. Balance exercises are usually prescribed to reestablish sensory receptors around the ankle that send balance information to balance centres in the ear. People who have chronic ankle instability cannot easily balance themselves standing on one foot with their eyes open. If they close their eyes it is even worse. Surprisingly, many people will not seek any health professional treatment with their ankle sprain.
What is the link between pain on the outside (lateral aspect) of the foot and the old ankle sprain?
One of the least recognized outcomes of ankle sprain is an injury to the ligaments around the cuboid bone on the lateral aspect of the midfoot. A lateral ankle sprain can cause a rotation of the cuboid bone due a protective muscle reflex of the peroneus longus tendon. During an ankle sprain the peroneus longus muscle may try to prevent your ankle from rolling over. The peroneus longus tendon is a muscle that helps to stabilize the lateral aspect of the foot. The peroneus longus tendon courses from the lateral side of the foot to underneath the cuboid and crosses to the other side of the foot.
Long after your ankle has healed the cuboid can still be slightly out of alignment in relation to the adjacent bones. The nerves around the cuboid joints can be irritated because it is misaligned. A cuboid subluxation may cause lateral foot pain and weakness as the heel lifts off the ground while walking. The pain often radiates from outside to inside underneath the foot following the course of the peroneous longus tendon, the front of the ankle joint or distally along the fourth ray.
An examination will elicit pain when the cuboid is pushed upwards from underneath. The range of motion of the cuboid is minimal when compared to the cuboid on the other foot.
The treatment to realign a subluxed cuboid consists of a series of osteopathic manual foot manipulations. These manipulations will restore the cuboid joint range of motion as well as the joints behind and in front of the cuboid. There are a number of medical conditions where manipulations are not indicated. The medical conditions include: inflammatory arthritis, gout, nerve or blood vessel abnormalities, bone tumors, osteoporosis and bone fractures.
After the manipulation has been performed the area should be iced. Felt padding is usually applied underneath the cuboid along with arch taping to stabilize the foot. A couple of follow manipulations may be required. Balance exercises and muscle strengthening may be recommended.
An old ankle injury could be the cause of your current vague foot pain.


February 2012

What is the benefit of custom foot orthotics?

Feb 28, 2012 12:20 AM
Peter Guy

Many of the foot problems that I treat in my offices in Whitby and Peterborough are due to faulty foot and lower leg posture.
In other words, when the bones in your foot are not aligned properly it causes you to over compensate when walking or running that can lead to various foot conditions including:
- Achilles tendon problems
- Bunions
- Flat feet
- Heel spurs
- Plantar fasciitis

These foot faults can also cause functional malalignment in the knee, hip and back leading to soft tissue stress and pain.
The simplest and most effective way to correct faulty biomechanics is with a custom foot orthotic. Just as prescription eyeglasses correct your vision, a custom foot orthotic is an insert that fits into your shoes.
The prescription features for your foot orthotic are formulated from your specific complaint, your physical examination findings and your pattern of walking. Your foot orthotic is molded from a 3 dimensional plaster cast or scan of your foot. The molded shell is modified to include the specific prescription features that will address your complaint. The goal of orthotic therapy is to stabilize your foot posture by reducing the stresses on the bones, ligaments, joints, tendons and muscles and allowing the foot to propel the body forward without collapsing.
Many of our patients not only receive relief from their foot pain, but also gain relief from their knee, hip and back pain. If you are suffering from foot and lower extremity pain you owe it to yourself to get an evaluation to see if you would benefit from prescription custom foot orthotics.


Annnoucing the acquistion of a Thor laser system

Feb 13, 2012 7:42 PM
Peter Guy

In January 2012,  I was excited to acquired a Thor laser sytem for use in the Whitby and Peterborough offices . 

The Thor laser system is a cold or low level laser which has many indications for the treatment of foot and lower leg pain and dysfunction. The Thor laser provides low level laser therapy (LLLT). Thor LLLT improves tissue repair, reduces pain and in!ammation wherever the beam is applied. Treatments take only a few minutes and can be applied two or more times a week. Thor LLLT is an excellent alternative to NSAIDs.  LLLT produces a signifcant reduction of in!ammation equal to or better than NSAIDs within 2 hours and analgesic effects that last for 48 hours. The  healing time of chronic tendonitis is reduced by  up to 70%.

LLLT works because when human cells are stressed by injury, nitric oxide (NO) inhibits oxygen consumption by mitochondrial cytochrome C oxidase. This reduces production of ATP (cell energy) and causes oxidative stress leading to increased in!ammation and reduced production of ATP.  LLLT displaces NO from cytochrome C oxidase thereby reducing in!ammation and restoring ATP production, helping tissues heal more quickly.


• Acute or chronic tendinopathies/fasciitis

• Sprains and strains

• Osteoarthritis

• Post-operative pain

•Tissue healing using

810 nm infra-red laser cluster probe 1000 mW & 69 diode LED cluster probe 1390 mW (34-660 nm diodes & 35-850 nm diodes)

• Off label use for the treatment of fungal nails using.

810 nm single infra-red laser probe 450 mW





November 2011

Diabetes Awareness Month and the 90th anniversary of the discovery of insulin by Banting and Best

Nov 22, 2011 8:45 PM
Peter Guy

I want to thank Elaine Petreman who invited me to speak on "Foot Care and Diabetes" yesterday afternoon at St Mark's Church in Peterborough, ON. Over a 90 minute period I answered many questions posed by the attendees during an interactive presentation. There were many sponsors present at the event. Elaine along with Greg Mather organized a great event. They both volunteer for the Peterborough chapter of the Canadian Diabetes Association and should be commended for helping to educate people about their diabetes. The discovery of insulin was a very important discovery by the medical researchers at the University of Toronto in 1921. Their discovery has saved countless lives around the world.  Unfortunately, diabetic complications such retinopathy(eye), nephropathy(kidney), neuropathy(nerve) and macrovascular(blood vessel blockage) are common problems that occur in diabetics with uncontrolled blood glucose. The prevention of diabetic foot ulcers can save the heath care system the cost of foot and leg amputations. The work of the Canadian Diabetes Association is important to help educate Canadians of the dangers of uncontrolled diabetes and its complications.


The joys of being a clinical instructor

Nov 9, 2011 1:44 PM
Peter Guy

On November 2, 2011, I was honored to receive a student nominated award for "Excellence in Clinical Instruction and Supervision" affectionately called the “Crystal Apple”.  It was presented to me during a clinical instructor professional development day at the Michener Institute for Applied Health Sciences in Toronto.  During my award presentation,  the letter from the nominating student was read out to the audience.  It was a humbling experience to hear how you can affect the student learning experience.  Over my lifetime I have been blessed by the knowledge and skills taught to me by teachers from primary school right through to my professional degree.  I have also been exposed to many ideas and techniques by my colleagues during my professional career.  I hope, I have pass on some of these learning experiences from past teachers or colleagues to my past and present students.  The following quote sums up what I hope to impart to a student. "Wisdom is knowing what to do next, skill is knowing how to do it and virtue is doing it" (David Starr Jordan). Thank you for the award.



September 2011

Andy Murray was wearing a protective ankle brace during the US Open .

Sep 10, 2011 11:08 PM
Peter Guy

The US Open tennis men’s semi final matches have been entertaining. The afternoon match between Roger Federer and the eventual winner Novak Djokovic was a long hard battle. I am currently watching Andy Murray and Rafael Nadal playing an exciting match. Many of the rallies have been long in duration with some incredible ball placements.
During the match I noticed that Andy Murray was wearing an ankle brace which appeared to be an AirCast A60™ ankle brace. The brace he was wearing was a protective ankle brace. This ankle brace allows him to sense if he is about roll over on his ankles. Andy Murray suffered an ankle roll over injury during the French Open in May 2011. This past ankle injury does not appear to be hindering his play in the US Open.
If you suffer have from an ankle sprains while playing recreational or competitive sports you can understand how your ability to run, start, stop, turn, jump or land is compromised. Assuming no breaking of bones has occurred during the ankle roll over an ankle sprain is caused by a tearing of the ankle ligaments crossing the outside of the ankle joint. The rehabilitation of an ankle sprain requires a number of steps:

  1. The rehabilitation process begins by reducing the swelling and pain around the ankle joint using compression, ice and elevation.
  2. Once the pain and swelling have been reduced strengthening exercises for muscles around the ankle joint
  3. Modified activity can begin.
  4. Eventually proprioception exercises are prescribed to reestablish sensors on the ankle ligaments. These sensors give continuing feedback to the brain about the position of the ankle joint while running, turning, jumping or landing.
  5. Using a protective ankle brace such as a AirCast A60 can enhance proprioception and possibly prevent an ankle rollover

A protective ankle brace can be prescribed to individuals with a high probability of an ankle roll over due to a laterally unstable foot and lower leg structure. Over the counter protective ankle braces are considered ankle foot orthotics.
In some cases, a custom made ankle foot orthotic can be prescribed if the ankle joint becomes too unstable for an over the counter ankle brace. A custom ankle foot orthotic requires a cast of the foot and lower leg. Custom ankle foot orthotics addresses the foot instability as well as providing protection for the ankle ligaments.
Lateral ankle instability is just one of the indications for the use of a custom ankle foot orthotic. Ankle arthritis, extremely flat feet and drop foot are other indications for an ankle foot orthotic.
Unfortunately, Andy Murray lost his match. The pairing for US Open final is Novak Djokovic and Rafael Nadal. It should be a good match.


July 2011

The barefoot running craze has created a new category of running shoe termed “Minimalist”

Jul 12, 2011 10:01 PM
Peter Guy

Running shoes are used by the vast majority of runners. During the past 2 years you may have watched someone barefoot running on the sidewalk, running track or grass field. Barefoot running differs in a number of ways from runners wearing running shoes.

  1. Barefoot runners adopt a different style of running. A barefoot runner will initially strike the ground with the ball of the foot which is followed by gradual lowering of the heel to the ground. This results in the initial impact force being greater underneath the ball of the foot but is reduced by the gradual lowering of the heel to the ground.
  2. A runner wearing running shoes will initially strike the ground with their heel or mid-foot which is followed by a gradual lowering of the forefoot to the ground. This results in the initial impact being greater underneath the heel followed by an increase in force underneath the forefoot as the heel lifts off the ground.
  3. Barefoot runners have shorter stride length between left and right foot strikes.
  4. Runners wearing shoes who are heel strikers will generally have a longer stride length between left and right heel strikes.
  5. Muscle activity also differs in a barefoot runner vs. a runner wearing shoes. The calf muscles via the Achilles tendon which inserts into the back of the heel controls the lowering of the heel to the ground.
  6. In contrast, a runner wearing running shoes who heel strikes will gradually lower the forefoot to the ground. The anterior shin muscles via the tendons that insert into the top of the foot control the lowering of the foot to the ground.

Running injuries are always a concern whether the runner wears shoes or goes barefoot.
Most of the running injuries that have been documented in the medical literature have occurred in runners wearing running shoes. To date there have no studies documenting the types of injuries resulting from barefoot running. Nevertheless, it is possible to predict the injuries that might occur due to barefoot running.

  1. Increased impact underneath the ball of the foot might cause stress fractures in the metatarsals or blistering/callus formation on the plantar skin.
  2. Achilles tendonitis may occur due to calf muscle overuse or tight calf muscles.

In the past 25 years, the running shoe industry has developed different categories of running shoes in response to the types of running injuries that have occurred due to faulty lower extremity mechanics.

The four general categories of running shoes are:

  1. Cushioning,
  2. Mild stabilization,
  3. Moderate stabilization and
  4. Maximum control.

The cushioning shoe is recommended for a runner requiring maximum shock absorption. The cushioning shoe will be appropriate for a runner with high arches. The maximum control shoe is recommended for a runner with very flat feet requiring support in the arch.
The minimalist running shoe is a new category recently introduced by the running shoe companies in response to the interest in barefoot running. The minimalist shoe has been developed to help protect the foot and cushion forefoot impact. The running shoe companies are promoting the style of barefoot running (short stride and forefoot strike) coupled with forefoot protection using the minimalist running shoe. There are four examples of minimalist running shoes pictured.
The minimalist shoe can be recommended to a runner wanting to adopt a barefoot running style with the proviso the runner has no faulty lower extremity mechanics.


June 2011

Is my child's in-toeing serious?

Jun 12, 2011 2:27 PM
Peter Guy

I have treated many children with foot problems over the past 26 years. One of the childhood foot problems that I have treated is in-toeing. In-toeing occurs in about 2 out of every 1000 children.
Many parents become concerned when they see their child’s feet pointing inwards while walking, especially if it is associated with tripping. Other concerns include the abnormal shoe wear on the outside of the toe box due to scuffing of the toes while walking, the child complaining of being tired after walking or the child asking to be carried instead of walking.

My goal as a chiropodist/podiatrist is to inform the concerned parent that in-toeing almost always self corrects as the child grows towards adulthood.

If you watch the majority adults walk you will notice their feet will point straight ahead or outward. In-toeing ("pigeon toes") describes a position where the feet turn inward instead of pointing straight ahead during walking or running. In-toeing happens from birth to adolescence due to a delay in rotational or torsional unwinding during a normal bone development. There may be a prior family history of in-toeing. Prevention is not usually possible because the causes are due developmental or genetic reasons.
There are three causes of in-toeing:
  1. Internal femoral torsion (also called femoral anteversion) occurs when the femur or thigh bone has an inward twist in the shaft of the bone.
  2. Internal tibial torsion occurs when the tibia or shinbone in the lower leg has an inward twist in the shaft of the bone.
  3. Metatarsus adductus occurs when metatarsal bones in the foot are bent inward like the shape of a kidney bean.
These three causes of in-toeing can be identified by performing a series of measurements which involves taking six different measurements of the angles of the feet, legs, and hips when the child is in various positions. A gait analysis is also performed to observe to position of the knee cap and while walking or running. This combination of examinations allows for detection of the three causes of in-toeing.
Is in-toeing serious?
The tripping associated with in-toeing is the parental concern that usually initiates an office visit. Apart from this concern, children with in-toeing are generally healthy and have no limitations in their activities or sports. Parents can expect their child to live a normal, active, and healthy life. Some young children with in-toeing may have problems getting shoes that fit, because of the curve in their feet. A shoe fitting problem might make parents consider treatment for their child. In very rare cases, some children have a severe twist in the leg bone (tibia) or thigh bone (femur), which can be a concern because it looks bad or causes tripping, but as mentioned before in-toeing can self correct by adulthood. In a very tiny proportion of children with in-toeing, surgery may be required to correct in-toeing due to severe internal femoral or tibial torsion.
In summary, the vast majority of children who have in-toeing will gradually self correct until their feet point straight ahead as they develop into adults. The tripping associated with in-toeing also reduces over time.

Please follow the link to find further information on the causes and treatments for in-toeing at


I have shin splints, what does this mean?

Jun 1, 2011 9:15 PM
Peter Guy

I decided to write about shin splints after discovering it was the most read topic on my website this past month. On reflection, I should not really be surprised, because spring weather leads to increased physical activity and overuse injuries.

Shin splints are common among runners, race walkers and individuals who participate in soccer, football, lacrosse and dance. Shin splints are a non specific diagnosis for lower leg pain. One common cause of shin splints is periostitis. Periostitis is an inflammation of the periosteum. The periosteum is a dense connective tissue covering the shin bone or tibia. Periostitis results from an overuse injury that usually develops gradually over a period of weeks to months. Periostitis can also occur after one excessive bout of exercise. The periosteum serves as an attachment site for the muscles originating on the tibia. Muscle overuse causes the periosteum to pull away from the tibia causing inflammation.

Periostitis of the tibia has also been classified as medial tibial stress syndrome. Medial tibial stress syndrome is associated with an overuse of the anterior and posterior tibial muscles. Both of these lower leg muscles have attachments via tendons to the foot bones. The origin of these two muscles is where you will complain of pain. The locations of pain are the lower inside half of the tibia and, less commonly, the upper outside portion of the tibia.  You will usually notice the pain when you start exercising and it decreases or goes away as you continue to exercise. Your pain maybe worse after you stop exercising or it will bother you the next morning.

The pain from periostitis of the tibialis posterior muscle is located on the lower inside half of the tibia. Abnormal foot and lower leg alignment can cause excessive flattening of the foot that requires excessive work from the posterior tibial muscle to help stabilize the arch. This stress causes microtears and inflammation in the periosteum attached to the lower inside half of the tibia. Custom foot orthotics paired with the appropriate running shoes is quite successful in treating posterior tibial muscle periostitis due faulty foot mechanics.

Pain from periostitis of the anterior tibial muscle is located on the upper outside portion of the tibia. Anterior shin splints often occur in both legs. Anterior shin splints is caused from over-training or improper training, especially, if your running program includes a lot of excessive downhill running or a sport requiring rapid starts and stops.
You may also have an imbalance between the weaker anterior muscle group and the larger and stronger posterior group. Tightness of the calf muscles may further aggravate this condition. These stresses result in microtears and inflammation in the periosteum attached to the upper outside portion of the tibia. Successful treatment includes modified rest with changes in your training program. Physical therapy to address muscle weakness, tightness and imbalance is paramount. Foot orthotics will be indicated if abnormal foot mechanics are the cause of the muscle tightness or imbalance.
In some cases of periostitis there can be a progression to micro-fractures or stress fractures along the tibia. Generally there is not a sudden break of the bone but usually you will complain of a gradual increase in pain until it becomes quite severe.

There are a number other causes of lower leg pain that can mimic periostitis. They include: tendonitis, a partial muscle tear, growth plate inflammation, referred lower back pain, lower leg muscle imbalance, a leg length difference and compartment syndrome.
Compartment syndrome can occur in muscles originating from the tibia. Muscles are surrounded by fascia which allows for a separation between adjacent muscles. This fascia does not stretch. Pressure within the muscles can increase due to activity. The fascia does not allow the pressure to diminish. This can lead to muscle damage and pain. If you have shin splints a proper diagnosis via a thorough history and physical examination is essential to rule out causes other than periostitis.

Conservative treatment for tibial periostial injuries usually consists of modified activity, ice, immobilization, compression and elevation, physical therapy, foot orthotics, appropriate footwear, and proper training techniques. However, the most important part of the treatment is educating you on the tissue(muscle, tendon, fascia, ligaments, periosteum and bone) injury process. I discuss the concept that everyone has a unique biomechanical yield point where tissue injury occurs, even if you have the best training technique, footwear and equipment.  In other words, you have to listen to your body and give yourself enough time to recover from any tissue injury (minor or major) before you resume exercising. If you continue to exercise without adequate tissue recovery, the tissue injury yield point becomes lower when compared to the previous exercise session. This means even less activity can more tissue damage. This is why less activity can make your shin splints worse if tissue recovery is not allowed to occur during a rest period.  For more information on the treatment protocol for shin splints please visit


April 2011

What are the benefits and risks of wearing MBT™ footwear?

Apr 25, 2011 8:46 PM
Peter Guy

In this blog, I will discuss the benefits and risks of wearing MBT™ footwear if you have a specific foot and lower leg problem. To help answer this question, I have summarized feedback from various chiropodists and podiatrists from Canada and the USA gathered by Dr. Chris MacLean, Director of Biomechanics at Paris Orthotics Ltd in Vancouver, BC.
Some of the benefits of wearing MBT shoes are definitely due to the rocker shaped outer sole. A pilot study in 2005 by Department of Orthopaedic Surgery at the Edinburgh Royal Infirmary used pressure sensing insoles inside of MBT footwear while the study participants were either standing or walking. They compared the pressure readings in the MBT™ shoes to pressure readings inside of a flat soled running shoe. The study specifically compared the peak pressures of the heel, midfoot, ball of the foot (forefoot) and toes between the two shoe groups.
Results of this study showed:
  1. MBT’s decreased peak pressures in the forefoot and midfoot when walking,
  2. MBT’s decreased peak pressures and in the midfoot and heel when standing,
  3. Peak pressure was raised in the toes in MBT’s in both standing and walking conditions,
  4. The most dramatic difference was during standing, where the MBT shoes increased peak pressure in the toes by 76%, and lowered peak pressure in the midfoot and heels by 21% and 11% respectively and
  5. The most consistent finding, when both standing and walking, was decreased pressures in the midfoot in MBT’s.

These results of the Department of Orthopaedic Surgery at the Edinburgh Royal Infirmary study are consistent with the feedback that Chris MacLean gathered on the benefits of wearing MBT footwear.
What foot problems can benefit from MBT footwear?
  1. 1. Stiffness in the big to joint(hallux limitus),
  2. Bunions,
  3. Heel pain or plantar fasciitis,
  4. Pain in the forefoot( metatarsalagia),
  5. Decreasing weight away from the ball of the foot,
  6. Painful callus on the ball of the foot,
  7. Inflammation of the joint capsule in the forefoot,
  8. Neuroma ( irritation of nerves between the metatarsal bones of the foot),
  9. Foot osteoarthritis and
  10. Someone who mostly stands while they work.

In my last blog, I discussed the effects of wearing MBT footwear. I have summarized these effects.
  1. Wearing MBT shoes increased the activity of many of the lower leg and thigh muscles while subjects stood or walked wearing MBT shoes,
  2. Wearing MBT shoes is similar to balancing on a wobble board. Wobble boards are used for rehab after an ankle sprain which helps to strengthen muscles around an injured ankle joint and promote balance. Postural sway increased while wearing MBT shoes and
  3. Wearing MBT a shoes while walking caused an increase in ankle joint dorsiflexion (dorsiflexion of the ankle happens when you move your foot towards your leg) from initial heel contact through to midstance (midstance is the time when your swinging leg is even to your weight bearing foot and leg). Increased ankle dorsiflexion at contact to midstance makes your calf muscle stretch more while walking as compared to subjects wearing the New Balance shoe. If you have tight calf muscles the use of MBT footwear may cause strain on the tendo Achilles resulting in tendinitis.

If you are considering MBT footwear you probably should have good balance, good muscle flexibility and an intact nervous system.
These are problems that are considered too risky to use MBT footwear

  1. Achilles tendinitis or peroneal tendinitis(these tendons are found on the outside of the foot and are damaged during ankle sprain)
  2. Poor balance
  3.  History of ankle sprains
  4. Loss of nerve transmission to the lower extremities such as diabetic neuropathy
  5. Neurological deficits such as multiple sclerosis
  6. Stress fractures especially while standing
  7. Knee problems

Before you consider buying a pair of “Toning or Physiological shoes you should be aware of the risks and benefits of wearing these types of shoes. Most if not all of the research has been conducted using MBT footwear, therefore, the MBT footwear benefit and risk profile may not apply to the other “Toning and Physiological” brands of footwear.
In my next blog entry I will discuss the topic of minimalist running shoes used for barefoot running.


MBT™ footwear: A chiropodist’s view of the “Physiological” footwear

Apr 21, 2011 11:05 PM
Peter Guy

Over the past year, I have been asked on several occasions to express my opinion on the benefits and risks of wearing unconventional footwear such as MBT™ (Masai Barefoot Technology) shoes , Sketchers “Shape Up”™ shoes and other similar shoes.
I have reviewed research presented at scientific seminars, talked to a MBT footwear medical representative and I have also received feedback from a few patients over the past year who have used MBT shoes or other similar shoes. In this blog I will discuss the design of MBT footwear and its effects on the thigh and lower leg muscles while standing and walking in MBT footwear. I will also discuss the effects on ankle joint motion while walking in MBT footwear.
MBT footwear was developed in Switzerland in 1996 and came to North America in 2003. The unstable MBT shoe has been promoted as the original “barefoot” function shoe. This shoe has a rounded sole starting from the heel and continues to the toe and a cushioned sensor under the heel area that creates a natural degree of instability. This instability is felt from both the back to front directions and from inside to outside directions. The basic concept behind the unstable shoe is to transform flat and hard surfaces such as concrete sidewalks into uneven surfaces such as grass or sand. The design of the MBT footwear has been promoted to provide some of the benefits of barefoot walking.
The features of MBT footwear are thought to specifically activate, strengthen and condition the smaller neglected extrinsic foot muscles that originate in the lower leg and attach via tendons into the foot. This muscle activation is thought to occur while standing or walking in MBT footwear. By activating these neglected muscles, posture and gait could be improved and the loads or stresses on the lower limb joints may be reduced to help prevent injuries and reduce pain.
MBT footwear has been studied by a few university based biomechanics research laboratories. It is important to note the findings of these research papers can only be applied to MBT shoes and cannot be compared to similar type shoes such as Sketcher™ “Shape Up” shoes because of the shoe design differences.
In 2005, the University of Calgary Biomechanics laboratory conducted one study observing the effect on muscle activity while subjects just stood while wearing MBT shoes. When we stand, the muscles in our legs and thighs are active to prevent us from buckling at our hips, knees and ankles. The results of this study demonstrated an increase in the activity of many of the lower leg and thigh muscles while subjects stood wearing MBT shoes. These results seem to be consistent with the muscle activation benefits as promoted by the makers of MBT shoes. The researchers also measured postural sway of the upper body while standing and wearing a MBT shoe. Postural sway is the phenomenon of constant displacement and correction of the position of the center of gravity within the base of support. In layman’s terms this describes is our ability to keep balanced without falling over. Using a MBT shoe is similar to balancing on a wobble board. Wobble boards are used for rehab after an ankle sprain which helps to strengthen muscles around an injured ankle joint and promote balance. Postural sway increased while wearing MBT shoes compared to a New Balance shoe.
In 2005, the University of Calgary Biomechanics Laboratory conducted a second study where they compared subjects wearing a New Balance 756 running shoe and subjects wearing MBT shoes while walking. The investigators measured the differences in muscle activity and ankle joint motion. They found increased muscle activity in the subjects in the MBT shoe group versus the subjects in the New Balance shoe group. Again these results were consistent with the muscle activation benefits as promoted by the makers of MBT shoes.
Wearing MBT shoes while walking caused an increase in ankle joint dorsiflexion (dorsiflexion of the ankle happens when you move your foot towards your leg) from initial heel contact through to midstance (midstance is the time when your swinging leg is even to your weight bearing foot and leg). Increased ankle dorsiflexion at contact to midstance makes your calf muscle stretch more while walking as compared to subjects wearing the New Balance shoe.
In 2009 researchers at Stanford University conducted a study examining what happened when individuals ran in MBT shoes versus New Balance 658 running shoes. They found running in MBT footwear led to a greater amount of ankle dorsiflexion from initial heel contact through to midstance. If you have tight calf muscles the use of MBT footwear while walking or running may cause strain on the tendo Achilles leading to tendinitis.
These increases in muscular activity that have been reported in these studies have led to the “Toning or Physiological” footwear category. A number of shoe companies have developed their own Toning or Physiological footwear to capitalize on the popularity of MBT footwear. Until research has been conducted on these other “Toning and Physiological” shoe brands you can not apply the MBT footwear research findings to other shoe brands.
In my next blog, I will outline the lower leg and foot problems that can be relieved by wearing MBT shoes and the lower leg and foot problems that will be aggravated if you wear MBT footwear.


Is your heel pain making you miserable?

Apr 10, 2011 9:25 PM
Peter Guy

The alarm clock radio has just rang and your day is about to begin. You dread your first step out of bed because it is going to be painful but you have perfected a method to keep as much weight off of your painful heel.  You realize the pain will get a little better as the day goes on but you also know that when you get home and sit down but have to get up again its going to be painful!  Does this sound familiar?
If you are reading my blog,  you may already know that you may have plantar fasciitis or heel spur syndrome.  Heel pain occurs because the plantar fascia pulls away from its attachment under the heel bone.  This pulling away occurs with every step you take while walking.  The plantar fascia has role in keeping your foot stable as you lift you heel off the ground while walking. The plantar fascia helps to resist your foot from bending.
To give you an idea of what I am describing, I want you to take your hand and place it with your palm down on top of a table.  Slowly lift the palm of your hand off the table.  The more you lift your palm, the more you will pivot on the tips of your fingers.  Now bend you hand, you will feel a tightening in the palm of your hand.  You have just stretched your palmar fascia.  When you bend your hand this is simulating what your foot is doing when you lift your heel off the ground and the weight is on your forefoot.  This is the time you cause damage to your heel causing pain.
This is a common problem for anyone in their 40" and 50's. There can be many factors which can lead to the "perfect storm" of heel pain.  Over the years, we all gain a little weight,  we don't exercise enough, we work on concrete floors covered with tile or carpet and we continue to use old and worn out footwear.  Sometimes heel pain can occur because we start a new activity that places a lot of bending stresses on the foot that can lead to a painful heel.
In Canada during the springtime we all want to be outside after a long winter.   Warmer weather brings more activity which unfortunately can lead to heel pain.  During this time of the year, we recieve many calls concerning heel pain. There can be many causes of heel pain, but the bottom line is you want  your heel pain to go away.
Your family and friends will most likely have advice on out to get rid of your heel pain, sometimes their advice is good and sometimes it is bad.  If your heel pain has lasted for more than 2 weeks and the intensity of the pain is getting worse you should immediately  seek professional help from a chiropodist/podiatrist or your family doctor.  The longer your heel pain is left untreated, the greater the chance it can become chronic.  The longer you have heel pain the more likely  you will start to change the way you walk leading other problems.  In the worse case scenario, you can develop heel pain in the other heel because you have compensated by putting more weigh on the non painful heel.  Another compensation is developing  a tight calf muscle because you don't want to put any weight on your painful heel.
I routinely see patients with heel pain who have waited longer than 4 to 6 months before they seek treatment or they have followed bad advice.  If you have chronic heel pain it may require a longer duration of  time and a more comprehensive approach to resolve your heel pain.   If your heel pain is not chronic there is usually an easy solution for your heel pain. 
If you have heel pain do not let it become chronic and get treatment at the earliest possible date.


March 2011

Is my foot orthotic a custom made device?

Mar 21, 2011 11:29 PM
Peter Guy

Custom foot orthotics (CFO) are prescription medical devices designed to stabilized and control the function of the foot and its alignment with the lower leg. CFO's are used to treat or prevent injury caused by excessive motion or a lack of motion in the foot and lower leg. Your prescription CFO device is tailored to your needs and activities. The goal of a CFO is to allow you to stand, walk or run more efficiently.  Your CFO is not just a piece of plastic. Chiropodists/podiatrists are trained to prescribe custom foot orthotics. The prescription CFO is based on the findings from the description your complaint, your medical history, a detailed biomechanical examination of your foot and lower extremity, a gait analysis of your walking pattern. All of this gathered information is used to formulate a prescription. Your prescription could include an addition such as an accommodation to relieve pressure that is causing callus on the bottom of your foot. Some additions can encourage joint motion or prevent joint motion. Ultimately, the prescription foot orthotic device must be tailored to your needs and activities. Unfortunately, you may not have a foot orthotic that is a custom made foot orthotic device.
There are many kinds of in-shoe devices that are referred to as “Orthotics". You will see advertisements on TV infomercials, exhibits at consumer shows and retail stores for "Orthotics". Shoe inserts and arch supports are being increasingly referred to as “Orthotics". Foot orthotics are prescribed and/or dispensed by many varied health professionals including chiropodists/podiatrists, orthopedic surgeons, sports physicians, pedorthists, orthotists, chiropractors and physical therapists. The general public will have a difficult time telling the difference between a true CFO and an over the counter (OTC) type foot orthotic without asking the right questions. You must ask you foot orthotic provider if they are going to make your foot orthotic from a 3 dimensional cast of your foot.
The Prescription Foot Orthotic Laboratory Association (PFOLA) has developed technical standards to differentiate between various types of foot inserts (orthotics). The definitions are based on how the foot is evaluated and how the foot was casted.
The following are excerpts from PFOLA technical standards document on foot modeling and device definitions. These definitions are sent to extended health insurance providers to demonstrate they are reimbursing you for a true anatomical custom made foot orthotic which is made from a anatomical volumetric 3 dimensional model.

Foot Modelling Definitions

Anatomical Volumetric Foot Model (AVFM)
A digital or physical model that captures a person’s three dimensional(3D) plantar foot anatomy when the foot is non-weightbearing, semi-weightbearing, or fully-weightbearing.

A physical AVFM captures foot anatomy through direct contact to duplicate plantar foot anatomy. The most common examples are plaster of paris casts or foam impressions taken directly from the foot. Any material or method that uses direct capture of the entire plantar foot anatomy creates an AVFM.
A digital AVFM must use actual 3 dimensional (3D) data points taken directly from the foot to duplicate plantar foot anatomy. The most common examples include laser 3D scanners, stero-digital 3D imaging systems, and pin array systems.

Extrapolated Volumetric Foot Model (EVFM).
A digital model that approximates a person’s 3D plantar foot anatomy through application of mathematical models that extrapolate pressure data, or extrapolate temperature data, or extrapolate light data to form the digital model when the foot is non-weightbearing, semi-weightbearing, or fully-weightbearing. The most common examples are pressure mapping systems, photographs and ink or carbon paper imprinting system. A physical 3D cast of your foot will not have been used to make the EVFM orthotic.

Device Definitions

Anatomical Custom Foot Orthotic (ACFO)
An in shoe device that is made directly from an Anatomical Volumetric Foot Model (AVFM). The AVFM is modified with the appropriate medial and/or lateral arch fill, lateral column expansion, heel expansion, and intrinsic forefoot and/or rearfoot corrections as defined by the prescribing physician. The entire upper surface of the foot orthotic device matches the surface of the modified, or corrected, AVFM.

Extrapolation System Foot Orthotic (ESFO)
An in shoe device that is made directly from an Extrapolated Volumetric Foot Model (EVFM). The EVFM is modified with the appropriate medial and/or lateral arch fill, lateral column expansion, heel expansion, and intrinsic forefoot and/or rearfoot corrections as defined by the prescribing physician. The entire dorsal surface of said custom device matches the surface of the modified, or corrected, EVFM. The ESFO will not approximated the contours of your arch as well as a ACFO. If a close fit to your foot contours is required an EFSO may be contra-indicated.

Library System Foot Orthotic (LSFO)
An in shoe device that is made from a library of pre-manufactured shells, pre-manufactured corrected positive molds or pre-determined digital shape files (from which shells or molds are milled.) The foot orthotic shape is chosen by matching a library shape with either an AVFM or EVFM. Over the counter(OTC) foot orthotics are LSFO. Some of these LSFO will be used by chiropodists/ podiatrists when an ACFO is not indicated. OTC Powersteps ® orthotic supports are a good example of LSFO that might be dispensed in chiropopy/podiatry office.

These industry definitions have helped to differentiate if a foot orthotic is truly a custom foot orthotic. The prospective foot orthotic patient has to be educated to ask the right question.  Are you making my foot orthotic from a true representation of the surface contours of the bottom of my foot? Hopefully the answer is yes.


January 2011

Is your New Year’s resolution going to cause foot pain?

Jan 10, 2011 7:46 PM
Peter Guy

The beginning of a new year is a chance for all of us to start fresh. Some of us will begin to exercise as a new year’s resolution. At the best of times, sticking to an exercise program can be difficult for most people. Injuries to your feet can hinder your ability to exercise and may cause you to give up your new year’s resolution.
I routinely see a number of new patients seeking help for various types of foot and lower extremity ailments after starting a new exercise program. An unstable foot structure coupled with the introduction of new stresses on the foot due to exercise can cause knee, ankle, heel, arch and forefoot pain.
It is important to realize your body tissues have adapted to your sedentary lifestyle. Any new exercise program will cause stretching, pulling, twisting and bending to your ligaments that connect your bones together and the muscles and tendons that move your bone joints. This new activity will change the length of these body tissues causing damage. If you rest these body tissues they will heal and become stronger for the next session of exercise.
If you approach your exercise program without the proper amount of rest and recovery between exercise sessions you can cause overuse damage to your ligaments, tendons, muscles and their attachments to bone. For instance, heel pain can be caused by pulling away of the plantar fascia away from the heel bone. The plantar fascia gets stretched because the unstable foot will bend as the heel lifts off the ground while walking or running. You will complain of pain as your heel hits the ground first thing in the morning. This pain can get worse if you try to walk through the pain.

I am concerned about the proposed new exercise guidelines that were discussed in the Globe and Mail newspaper on Jan 4, 2011.
The Canadian Society of Exercise Physiology has recommended new fitness guidelines for Canadians. Their major recommendation was to spend less time exercising over one week and instead perform several intense bouts of exercise over a very short period of time. This new recommendation may cause injuries in people with an unstable foot.  If you adopt these new exercise guidelines you may be putting too much stress on the ligaments, tendons, muscles and bones of the foot and lower extremity in too short a period of time.  You need to adapt your body tissues gradually to these new exercise guidelines to prevent injury.
Injuries during exercise are usually caused because:
1. you perform too many exercise repetitions in a short period of time;
2. you exercise for too long a period of time in one session;
3. you exercise using too much weight;
4. you don’t take into consideration your bodyweight;
5. you use walking and running shoes that are to old and worn out, sometimes changing your workout shoes will prevent problems from occurring;
6. you do not allow for enough rest and recovery to help heal damaged tissues before you exercise again.

I advise my patients that everyone has a different biomechanical tissue stress limit based on their body type. In other words, your ligaments, muscles, tendons and bones can be only stretched, twisted, pulled or bent to certain point before a tissue injury occurs. If you have been sedentary it won’t take much activity to cause a tissue injury. The key is to gradually stress your body tissues over time to make them stronger to prevent injury. Professional athletes have built up their body tissues over a long time to withstand the large amounts of stress occurring during their sport. Even a professional athlete has a biomechanical tissue stress limit in their ability to withstand stress. Unfortunately, when a professional athlete has stresses applied to their body tissues exceeding their biomechanical limit the injury consequences can be disastrous.
Remember a new exercise program should be designed to have a gradual increase in repetitions with enough recovery in between exercise sessions. Good luck with your new year’s resolution of exercise.


November 2010

The Mantracker was trailed to Ottawa

Nov 15, 2010 10:45 AM
Peter Guy

Terry Grant the star of the Outdoor Life Network series Mantracker was a key note speaker at the Canadian Federation of Podiatric Medicine conference this past weekend in Ottawa, Ontario. His appearance was kindly sponsored by Vittoria Phoenix. He was warmly received by the delegates at the conference. He discussed the success of his Canadian reality TV show and his experiences over the past five seasons of filming Mantracker. He outlined a number of his strategies for tracking his prey. Terry answered many questions posed by the delegates. After his speech was finished, Terry graciously posed for pictures with many of his fans. The CFPM conference will no doubt be very memorable because of the presence of the Mantracker.


October 2010

Thank a Veteran on Remembrance Day

Oct 24, 2010 8:28 PM
Peter Guy

On Remembrance Day 2011 I will be in Ottawa, Ontario attending the Canadian Federation of Podiatric Medicine Conference. I will be taking a break from the conference to attend the ceremony at the cenotaph near parliament hill.
I started practicing as a chiropodist in 1985 in London, Ontario. I was privileged to meet many war veterans at the Western Counties Wing at Parkwood Hospital. I did not recall many of these veterans ever talk about their experiences during WW2 or the Korean War. I could only imagine what they had experienced.
During the past 10 years the number of WW2 veterans has been dwindling. I have noticed they have started to share some of their stories. I think movies such as “Saving Private Ryan” allowed them to open up. I had some veterans state they could not watch those opening scenes of the movie.
I wish I had documented some of their stories. Some of the stories were very funny and some were very sad. I do recall some the stories involved situations where a veteran would confront some type of inequality or exhibited a stubborn independence.
Recently, a long time patient of mine from Peterborough, ON was able to attend the 65th anniversary of Canada’s liberation of the Netherlands during May 2010. He was very touched by the response of the Dutch people during the anniversary ceremonies he attended. Unfortunately, he died 2 months ago.
Over the years, I have tried to thank as many of my war veteran patients for their sacrifices. Our war veterans have left a legacy that has allowed Canada to become a great country that welcomes everyone. Thank a war veteran on Remembrance Day.


Are your sandals causing the pain in the balls of your feet?

Oct 5, 2010 9:15 PM
Peter Guy

In southern Ontario many people can’t wait to start wearing their sandals after a long winter.  Unfortunately wearing sandals over many years can result in pain in the balls of your feet.  Metatarsalagia is a general term for pain in the ball of the foot but does not specify the exact cause of the pain.  The many causes of metatarsalagia are outlined below.

  • Sports that place tremendous pounding on the ball of the foot, like jogging.

  • Flat feet and bunions

  • An enlarged metatarsal head.

  • Calluses or corns that cause the weight on the foot to be unevenly distributed.

  • Ill-fitting shoes that put pressure on the bones of the feet.

  • Shoes with small toe boxes that cramp your toes.

  • The thinning or shifting of the fatty tissue of the foot pad due to aging. 

  • Arthritis or any degenerative disease of the joints.

  • Systemic conditions such as diabetes, which can cause nerve-type pain in the foot.

Most of the causes listed above are the result of mechanical stresses applied the foot over a long period of time.

Many people love to wear their sandals during the summer.  Sandals that cause the most problems are flip flop sandals or sandals with one to three straps over the front of the sandal.  If you wear these types of sandals you may have to compensate by clawing your toes to prevent the sandals from not falling off your feet. Unfortunately, this places a lot of stress underneath the ball of the foot as shown in the diagram. 

People will often complain of pain in the balls of the feet when it is time to switch back to regular shoes at the end of summer. The toes may continue to claw since they may be confined in a shoe with a shallow toe box.

I usually recommend that my patients switch to sandals with a back strap that firmly holds the foot in the sandal. Regular shoes should have deep to box to prevent back pressure from claw toes on the metatarsal heads.  If the fat pad under the ball of the foot has thinned out, there are many over the counter cushion insoles or gel cushion pads that can be used to cushion the foot. Osteopathic foot manipulations can be performed to increase the range of motions in the foot.  Exercises can be prescribed to strengthen the small muscles of the forefoot that help to prevent the toes from clawing.  If the pain in the ball of the foot is due to a bunion deformity a custom foot orthotics can be prescribed to help stabilize the foot and take pressure off the bunion and the ball of the foot.  Custom foot orthotics can be used inside of sandals. Many sandal styles come with a removable foot bed. The foot bed can be removed and the custom foot orthotic can be replaced inside the sandal. 

I hope you can avoid pain in the balls of your feet while wearing your sandals. Enjoy next summer.


August 2010

The pain of high heels

Aug 16, 2010 10:34 PM
Peter Guy

The stiletto high heel shoe has been a very popular shoe style for generations of women. The popularity of high heeled shoes above 2 to 3 inches has not diminished with each new female generation. Furthermore, some women state once you get use to high heels they are comfortable.  It is quite amusing to hear mothers warning their young daughters not to wear high heels.
My older female patients with foot problems complain they were foolish to wear high heels but at the time they couldn’t resist wearing high heels because they looked better wearing their high heels.
I recommend that regular high heel wearers to start using lower heeled shoes or flats. Unfortunately this can lead to new complaints such as “it hurts the back of my heel” or “my calf muscles get sore”. The mechanical explanation for this pain is that the calf muscle shortens to adapt to the regular use of high heels.
In the July 17, 2010 issue of the Economist magazine there was an article on “Stiletto Stiffness”. The article reviewed the research conducted by Dr Marco Narici. He was able to recruit 80 females that regularly used 2 inch high heels 5 times a week for 2 years. From this group he picked 11 females who complained of pain while walking without heels. This group of 11 high heel wears was compared to a control group of 9 females who never used high heels.

Dr Narici expected the regular high wearing group to have a smaller calf muscle volumes as well a shorter calf muscles. He thought the high heel wearer’s calf muscles would not produce as much muscle force compared to the control group. Dr Narici found that the calf muscles fibres were 13% shorter in the high heel group compared to the control group. However, what surprised Dr Narici were the calf muscle volumes and calf muscle forces were similar between both groups. The difference was the high heel group had thicker Achilles tendons as compared to control group. A thicker and stiffer Achilles tendon makes up for a shorter calf muscle therefore producing similar muscle force as compared the control group. These results explain the discomfort in the back of the heel and calf muscle that regular high heel wears will experience when they are not wearing their high heels.

Sadly, I don't think this new information on the heel and calf pain caused by the regular use of heels will stop young women from wearing high heels. I suppose, I will hear the next generation of women tell their daughters not to wear high heels.


July 2010

Soccer players need the right fitting soccer shoe

Jul 27, 2010 12:23 AM
Peter Guy

Soccer players want their soccer shoes to feel like a tight glove. This allows for a better “feel for the ball” during play. Unfortunately, this can cause some shoe fitting problems.
While trying on a new soccer shoe you need to check the following while standing or walking:

  1. Do you feel the end of your longest toe protruding into the toe box? There should be a small amount of room from the tip of the longest toe to the end of the shoe.

  2. Does the width of the “ball of your foot” match the width of the shoe? The shoe upper will bulge beyond the sole plate if your foot is too wide. This can cause your foot to rub against the upper of the soccer shoe.

  3. If your soccer shoe has a removable insole you place it on the floor and stand on the insole. You can quickly see if your longest toe extends beyond the end of the insole and if the width of your forefoot extends beyond the borders the insole.

  4. A removable insole has another advantage. If you have a custom foot orthotic you can remove the insole and easily insert your orthotic inside your shoe. If there is no removable insole you can remove the existing attached insole by ripping it out. If there is remaining unwanted foam material attached inside the shoe it can be carefully removed using a blunt straight edge screwdriver.

  5. If you have pain in the “ball of your foot” or metatarsal pain, the cleat of the shoe may be directly underneath that area of pain. If the shoe has removable cleats you can remove it to see if reduces the pain. Otherwise, you will have to find another shoe with a different cleat pattern.

If you are happy with the fit of your soccer shoe, you should check to see if there are any manufacturing flaws in your new shoe by placing it on countertop.

  1. Does the heel counter lean to one side or the other?

  2. Does the upper lean to one side or the other?

  3. Is the upper of the shoe is firmly mounted on the outer sole?

How do decide when its time to replace your old soccer shoes?

  1. Check if the heel counter is still firm. The heel counter will weaken over time due to wear and tear. A weak heel counter allows the foot to go through excessive motions causing foot instability. This can lead to ankle sprains or aggravate conditions such as calcaneal apophysitis, plantar fasciitis, Achilles tendinitis, shin splints and patellofemoral syndrome.

  2. If you observe the heel counter or the shoe upper leaning to one side or the other it is time to replace your shoe.

  3. Check the cleats for excessive wear since it will cause the shoe to lean to one side.

  4. Finally, check the tongue of the shoe. The tongue may no longer be providing cushioning on the top of your foot when you strike the ball with the instep of your foot. This may cause irritation to the top of your foot over a period of time.


Pain underneath the knee cap is a common injury in teenage female soccer players

Jul 24, 2010 2:50 PM
Peter Guy

Pain underneath the knee cap or patellofemoral syndrome is a common injury in female soccer players after the age of 14 years. There are a number of factors that can combine together to place stress on the knee cap or patella. These factors include: stability of the soccer shoe, outdoor or indoor field surface, anatomy around the knee joint of female soccer player, intensity of training, and foot instability.
To make sense of this injury, you need a basic understanding of the anatomy in the front of the knee. The quadriceps muscle originates in the pelvis above the hip joint and continues toward the knee joint where it attaches to the patella. The patellar ligament continues from below the patella and attaches into the tibia below the knee joint. The quadriceps keeps your knee joint straight when you stand, but more importantly, the quadriceps keeps the knee stable as the knee bends. The quadriceps are a grouping of 4 muscles. The patella acts like a pulley as the knee bends causing the patella to be pressed in to a groove in the femur. If all of the 4 quadriceps muscles are balanced, the patella will move within the femoral groove without causing any pain.

Causes of patellofemoral syndrome

  1.  Weakness of one of the quadriceps muscles called the vastus medialis. If the muscle is weak it will cause the patella to displace out of the femoral groove.

  2. The patella can be displaced from the femoral groove due to a large Q angle. Females have a wider pelvis resulting in a larger Q angle when compared to males. The Q angle is formed from the intersection of two lines through the patella. The first line is drawn from a point in the front of the hip bone called the iliac crest to the middle of the patella. The second line is from the middle of the patella to a bony tubercle on the tibia. Displacement of the patella results in less surface between the patella and the femur. This causes an increase in pressure underneath the knee cap resulting in pain.

  3. The Q angle can increase if the foot is excessively pronated. The Q angle can be measured while lying down and standing. A custom foot orthotic is indicated if there is an increase in the Q angle from lying to standing.

Unfortunately, fitting an custom foot orthotic inside a soccer shoe can be difficult. I will discuss soccer shoes and orthotic fit in one of my upcoming blogs.

Chiropodists and podiatrists will evaluate if a pronated foot is having an impact on the Q angle, however, a referral to a physiotherapist, sports medicine physician or orthopedic surgeon maybe required if other causes of patellofemoral syndrome are identified. If your daughter is complaining of pain underneath the knee cap get it evaluated a soon as possible.


Common childhood soccer injuries in the foot

Jul 12, 2010 10:45 PM
Peter Guy

Over the past month, soccer or football fans have witnessed “the beautiful game” being played at the highest international level at the World Cup in South Africa. Yesterday I watched the final game, along with billions of other people throughout the world, as the Spanish beat the Dutch. Congratulations to the long suffering football fans of Spain.
The World Cup has focused attention on youth soccer in Canada. Parents with kids registered in soccer in their communities already known soccer is a popular participation sport for children. According to Stats Canada, soccer has the highest participation rate for children aged 5-14.  According to the Whitby Iroquois Soccer Club there are over 6000 registered soccer players from age 5 to 20 in Whitby, ON.

One of the attractions of soccer is there are fewer traumatic injuries in soccer as compared to other sports, however, soccer injuries in the foot and ankle are a common occurrence.  The American Academy of Pediatrics conducted an analysis of all soccer injuries and found there was a variation in the body location where the injury occurred depending on age and gender of the soccer player. Foot injuries accounted for 1% to 28%, of all soccer injuries. Ankle injuries account for 13% - 23% of all soccer injuries. Knee injuries account for 10% - 26% of all soccer injuries.

In my practice in Whitby, ON I have treated many children and teenagers with soccer related foot injuries and problems such as ankle sprains, plantar fasciitis, shin splints and ingrown nails. The most common injury in boys aged 10 to 13 years is calcaneal apophysitis or Sever's disease. This is caused by traction injury to the back of the heel by the Achilles tendon. This traction pulls apart the growth plate at the back of the heel bone away from the main heel bone. The stress on the back of the heel can be caused by a tight calf muscle, an increase level of running in cleated shoes and running on very soft ground after a rainfall. The combination of all of these factors can leave the foot unstable putting excessive stress on the growth plate in the heel. This injury can be treated by using heel lifts and gentle calf muscle stretching. These two interventions reduce the stress applied to the heel growth plate from the calf muscle and Achilles tendon. Once the initial pain and discomfort has been relieved, custom foot orthoses can be prescribed to stabilize the foot and heel from excessive motion.

In my next blog, I will discuss shin splints in female soccer players and the elements of a good soccer shoe. Enjoy watching your kids play soccer this summer.


Queen Elizabeth’s visit to Toronto brings back childhood memories

Jul 5, 2010 10:53 AM
Peter Guy

Canadians love the pageantry of a royal visit to Canada. I remember the royal visit to Canada in 1973 marking the 25 anniversary of Queen’s coronation. I was 13 years old and I was only 5 to 10 feet away from her as she walked on the red carpet towards the stage at Nathan Phillips Square in Toronto that summer day in July.  I don t remember what she said to the crowd but I felt like I had witnessed history in the making. I could not imagine that 37 years later the Queen would still be doing her job with such grace and style. Queen Elizabeth is an amazing role model for people over the age of eighty. Everyday in my practice I  encounter patients the same age as the Queen who are just as accomplished and active. I am hopeful for my future when I see my patients who are over the age 80 who are quite healthy and fully engaged in their communities. I know growing older has some obstacles but I am amazed at what you can still accomplish in your eighties.   I hope to help many future eighty year olds with their foot problems and to keep them active and healthy. I am glad that I provide an important service which keeps the older population moving and active with pain free feet.  I hope the Queen keeps active and engaged as long as she can, just like all of my patients over the age of eighty.


June 2010

Helping to relieve foot pain in a changing Canadian demographic

Jun 28, 2010 3:00 PM
Peter Guy

I have been healing foot problems for 25 years. I never get tired of patients who walk out of my office in less pain than before their visit to my office. The percentage of Canadians over 55 years of age is getting larger day by day. Older Canadians are remaining in the work force due to financial reasons. More now than ever footcare provided by a chiropodist/ podiatrist is a valuable health service to keep the Canadians of all age groups walking without foot pain. The goal of my blog is to educate Canadians about their foot health. I hope you will enjoy.  My website is


May 2010

Olympic women's hockey gold medalist Becky Kellar on dedication and sacrifice

May 1, 2010 3:32 PM
Peter Guy

I was quite honoured and pleasantly surprised to be presented with an award in recognition for leadership and dedication to the profession at the 25th Ontario Society of Chiropodists Conference on Friday May 1, 2010. It was presented by Craig Hunt.

I was also quite excited to listen to Becky Kellar a defenseman on the 2010 Canadian Olympic womens gold medal hockey team. She recounted her sacrifices in the year leading up to the Vancouver Olympics. I couldn't resist posing for a picture with her medal.



Become a Fan on Facebook
Follow us on Twitter