As runners, we’re hard on our feet. We asked a foot doc to answer four key questions about feet

The Fix: Running Injuries

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If you thought the catch-all term for “foot doctor” was podiatrist, you’re only kind of right.

“Podiatry is an American designation,” explains pedorthist Peter Charbonneau. “There are five major schools of podiatry in the States. They are trained in the management of all foot issues, dermatological as well as biomechanical and even minor surgical procedures.”

There are podiatrists still practicing in Canada, but if you visit one, chances are that they will be on the older side. “About 20 years ago, in Ontario, for example, the government decided to follow the British foot care model, which separates chiropody and pedorthics.”

RELATED: Your feet will thank you.

The dermatology of the foot, warts and fungal infections fall into the territory of chiropodists. Biomechanical issues of the foot are where a pedorthist should be consulted. Runners, generally speaking, face overuse injuries of the foot and are better off seeing a pedorthist.

Charbonneau himself is very oriented towards athletic patients, with an undergrad in kinesiology as well as a degree in athletic therapy. He knows runners, being runner himself (he describes himself as an “8–10k, three-times-a-week kind of guy”). We asked Charbonneau about some of the common foot topics of interest for runners: plantar fasciitis, bunions, orthotics and barefoot running.

Plantar fasciitis

What causes it?
I see plenty of runners with plantar fasciitis. It is easy to diagnose, but tricky to treat. Plantar fasciitis is an overuse condition, which means that you have to look at overall biomechanics to treat it. If you don’t address underlying biomechanical imbalances, the condition is likely to continue recurring despite the patient taking time off from running.

High arches and low arches are both susceptible to the condition and it is generally more common the higher the mileage the patient is engaging in.

It’s rare to find a person that’s completely biomechanically symmetrical. Almost all of us have a dominant hand and a dominant foot – one side of our body likes to be more in charge. I find the most efficient way to form a treatment plan is to analyze a runner from the hips down. This means looking at them when they’re static, mobile and doing a gait-cadence analysis.

I’m not a fan of saying that there’s a perfect formula for running, or that everyone should be running the exact same way, but improving mobility and stabilizing the core are aspects that most runners, injured on not, should work on.

Bunions

What the heck are they?

Bunions are quite common, especially with female runners. Bunions occur when the foot is seeking additional stability. This may sound like a strange comparison, but think of what your hands would look like when you’re doing a handstand. Would you want your fingers together or spread out?

The wider the stance, the more you’re stabilized. So that’s what the bunion is trying to do for you. I’ve heard some people say that high heels are the cause of bunions, but that’s a complete fallacy. The reason that bunions are more common in females is because of the angle at which the hips are aligned. The wider hips of the female anatomy increased the angle at which the thigh bones are coming down to meet the knees.

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Bunions aren’t dangerous, but if they’re giving a runner a lot of pain I would recommend that they visit a practitioner.

Orthotics

Who is a good candidate for orthotics?

Some people can function very well with poor biomechanics and some people can’t. It’s not fair, but that’s the way it is. If someone comes to me and they have tried all the usual conservative therapy options, such as modified training, strengthening weak areas of the body and undergoing phys- iotherapy, but is still really struggling with a recurring injury, that’s when we start to think about orthotics.

Barefoot running

As a foot expert, what’s your take on barefoot running?

Barefoot running comes from track athletes running on the infield. What that does is get you to run in a more efficient way and be more aware of what you’re really feeling in terms of your gait. However, there’s only a small portion of the population that are able to tolerate this unsupported environment for higher mileage training.

Minimalist shoes have been around for a long time and they’ve always had a place in training. I’m definitely not saying that runners should get rid of their racing flats, but I would caution people who start doing long runs in them.

Regardless of whether you’re a runner or not, I’m a big fan of letting your feet experience different things. Having a few pairs of shoes to train in, doing barefoot strides on a soft surface and walking around barefoot at home are good ways to mix it up. As a whole, we spend way too much time in shoes and some of the smaller muscles in our feet essentially go to sleep when we do.

Editor’s note: This feature appeared in the November/December issue of Canadian Running.


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6 Comments

  • Paul says:

    I would agree with this advice if your going to go barefoot running, to take it slow in ramping up your mileage. I’m not entirely sure what constitute higher mileage training, but from the evolutionary evidence I strongly suspect that runners can achieve distances up to marathons distances by gradually increasing workouts running barefoot. The number of people that cannot effectively run barefoot would be a lot smaller than what the author thinks, and would likely be limited to very specific malformations of the foot, or possibly very specific health issues.

  • Paul says:

    I would agree with this advice if your going to go barefoot running, to take it slow in ramping up your mileage. I’m not entirely sure what constitute higher mileage training, but from the evolutionary evidence I strongly suspect that runners can achieve distances up to marathons distances by gradually increasing workouts running barefoot. The number of people that cannot effectively run barefoot would be a lot smaller than what the author thinks, and would likely be limited to very specific malformations of the foot, or possibly very specific health issues.

  • John Doe says:

    Unfortunately, Mr Carbonneau is factually incorrect. Currently there are 11 schools of podiatry in the USA and most are affiliated with Medical school programs. As well there is a podiatry school in Canada at Trois Rivieres University. Each year for the last five years 25 podiatric medical students have been graduating. from UQTR. All of these students have been practicing 5 years or less. Globally there are over 85,000 podiatrists. Podiatric medical education focuses on a variety of subject matters: Biomechanics, Surgery, Dermatology, Paediatrics, Diabetes & Wound Care, Sports Medicine, Rheumatology and General Podiatry. No one profession is more knowledgeable and has the training in biomechanics than a podiatrist, period. In Ontario pedorthists are non regulated and as a result are not recognized as a accredited health profession.

  • John Doe says:

    Unfortunately, Mr Carbonneau is factually incorrect. Currently there are 11 schools of podiatry in the USA and most are affiliated with Medical school programs. As well there is a podiatry school in Canada at Trois Rivieres University. Each year for the last five years 25 podiatric medical students have been graduating. from UQTR. All of these students have been practicing 5 years or less. Globally there are over 85,000 podiatrists. Podiatric medical education focuses on a variety of subject matters: Biomechanics, Surgery, Dermatology, Paediatrics, Diabetes & Wound Care, Sports Medicine, Rheumatology and General Podiatry. No one profession is more knowledgeable and has the training in biomechanics than a podiatrist, period. In Ontario pedorthists are non regulated and as a result are not recognized as a accredited health profession.

  • College Podiatric Surgeons BC says:

    The College of Podiatric Surgeons of B.C. is a statutory body, similar to other true health profession regulators or licensing bodies, with a legal obligation to regulate the profession of podiatric medicine in BC in the public interest. We are expected to intervene where the public may be misled with respect to who is a regulated professional and who is qualified and permitted to diagnose and prescribe treatment for lower leg and foot ailments. We have concerns with the above-captioned article which conveys inaccurate messages.

    The article quotes a person who is represented as a ‘foot doctor’. Use of ‘doctor’ in Canada is restricted by statute to specified, regulated health care professionals who are granted restricted scopes of practice. The individual at issue is a ‘pedorthist’, an occupation that is not regulated by statute or granted permission to use the title ‘doctor’. We also note that the ‘College of Pedorthics of Canada’ purports to be ‘the licensing body for the pedorthic profession in Canada’; but it is not a statutory licensing entity or regulator – rather it is a private body. One does not have to be ‘certified’ as a CPC member to work as or call themselves a pedorthist. Furthermore the regulation of professions is usually a provincial, not federal, matter.

    Compounding the above, according to the article the pedorthist variously states or infers that:
    – The pedorthist assesses, diagnoses and treats ‘plantar fasciitis’ and biomechanical issues.
    – Podiatrists perform only ‘minor surgical procedures’.
    – ‘Podiatry’ is really a U.S. and not a Canadian designation; here pedorthics and chiropody are the foot health care providers and patients should consult chiropodists for foot dermatological care, warts and fungal infections, and pedorthists for biomechanical issues of the foot rather than podiatrists.

    In fact, a pedorthist may ‘assess’ a client’s biomechanics for the purpose of providing treatment prescribed by a regulated professional. But, a pedorthist is not legally entitled to diagnose or prescribe treatment for foot and lower leg ailments. Conveying the message in BC offends the Health Professions Act prohibition against non registrants purporting to be qualified and allowed to provide such services. This is an important public protection issue. Pedorthists do not have the training – let alone legal right – to diagnose and prescribe treatment for many conditions including plantar fasciitis. They also do not have the podiatric level of biomechanical training.

    In addition, chiropody too is not recognized or regulated in many provinces including B.C. and Alberta; in those jurisdictions neither chiropodists nor pedorthists are permitted to independently offer such services to the public.

    Lastly, ‘podiatry’ is indeed a Canadian designation entrenched by statute in many provinces, and the podiatric scope of practice runs from primary wellness and dermatology of the foot, warts and fungal infections, to major surgery including bone procedures, biomechanical expertise, and prescribing and fitting of orthotics.

    We will close by underscoring that pedorthists do have a valuable place in foot and lower leg health care. Some treatment tasks as mentioned above are delegated by podiatrists to pedorthists, under appropriate supervision. We hope to build on and refine that relationship.

  • Vancouver Podiatry says:

    I am disappointed at the lack of research this publication put into the article. It mis represents Podiatry as a profession in Canada. I myself am a young, athletic, Kinesiology trained podiatrist practicing in BC. I have worked with the Canadian National team for basketball and the Vancouver Whitecaps. So stating that we are on the older side…take a look in the mirror. The information about bunions, where did it state above that the joint in mal aligned and fixing it by surgical re alignment can help?… Oh year the pedorthist can’t even order X-rays to evaluate much less fix it. Very disappointing Canadian Running Magazine.

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