post ankle injury

Weak Ankles Got You Down?

Do you have “weak” ankles? Suffered multiple ankle sprains in your life? Even the ones you ignored?

unstable ankle

Chronic ankle instability is a common condition that can develop after suffering multiple ankle injuries and are often a result of “minor sprains” left untreated or not properly rehabilitated. Many of us “walk off” one or two of these while playing sports in our youth. No big deal, we thought. Unfortunately, these minor tweaks can sneak back up on us years later. 

The ankle is a complex joint with a very unique structure. When standing and walking the ankle assists the leg with movement over the foot, and assists the foot with shock absorption for the entire body. To work properly, the ankle depends very heavily on the surrounding muscles and joints.

ankle anatomy

An injury to your foot or ankle often “alters” your walking for a bit. It may disrupt your balance, or can have profound effects on other parts of your body due to compensations (sore hip anyone?).

When you sprain your ankle, the ligaments (whose job is to hold bone to bone) are stretched or torn. Ligaments do not regenerate or repair themselves, so each additional sprain leads to further stretching and weakening. This is why it is so easy to sprain your ankle over and over again.

After an injury, rehabilitation is so important. The ankle requires stability; and since the ligaments are stretched or torn, the only way to regain joint stability is for muscles to double their duty – function/strength and stability.

Typically, the “giving way” that occurs during a sprain, happens while you’re walking or doing other activities. It is typical for it to happen more frequently on uneven terrain, but can just as easily happen while walking on a smooth surface. In severe cases, it can also happen when you’re just standing.

post ankle injury

Common Complaints:
1) A repeated turning of the ankle, especially on uneven surfaces or when participating in sports
2) Ongoing discomfort within the joint with pain and swelling.
3) The ankle feels wobbly or unstable.

How can we help?

Custom foot orthotics incorporate your anatomical structure, and promote the function of the joint effectively. Proprioception and balance are essential, and when ankle instability is high, assistance from an external source can help the foot and ankle remember the desired motor pattern of the muscles.
Custom orthotics can also reduce the lateral spill and turning over of the ankle by ensuring the lateral forefoot balance is even to promote forward motion through the 1st and 2nd toe, and not off the outside of the foot.

Higher cut footwear (shoes that allow you to sit deeper) can improve your proprioception and increase the sensory stability of the ankle. Confidence with each step maintains activity and reduces symptoms related to immobility.

foot ankle compression

Compression socks that end just below the knee can promote healthy fluid movement and reduce stagnant swelling present from repeated trauma. Fluid build-up can restrict joint movement and cause stiffness, impact muscle function and performance. (How can those muscles do their job if they are over run by swelling?)
Compression socks will help move the fluid from the foot/ankle and up the leg to the pump in the calf. From there, each step or muscle contraction pumps the fluid back up the body to be recycled.

Bracing is another option that allows for the ankle to be functional and protected during activity. There are different types of braces, sleeves, wraps and boots that can be effective in reducing injury. One of our favourites is the ASO Ankle Brace. The option to have more or less support is available. The boot design with lacing accommodates different foot shapes and sizes. The ankle cuff caps off the support by stabilizing the tibia and fibula and the long flexors and extensors contributing to ankle function.

Let us help your ankles! Give us a call today to book an appointment.

The Dos and Don’ts for Sandal Season

Over one quarter of the bones of your entire skeleton are in your feet. Deciding what to wear on them should be a top priority. Between your two feet there are 52 bones, 66 joints and over 200 muscles and tendons. When treated poorly, your risk of injury increases exponentially.

Do – Ditch the plastic, single board “flip flop”. (the ones you get at a grocery store, clothing outlet and retail stores)

Don’t – Leave home without taking care of your feet.

Think about it this way, would you opt to purchase poor quality tires for your brand new vehicle?

Unsupported flip flops create a multitude of injuries. I have to say I am tempted to attach my business card to each flip flop I see in department, grocery and retail stores. Let’s face it, if you invest $10 or less on a pair of plastic single board flip flops, and then walk any distance, it is highly probable an injury will follow.hammer toes

In the body there are small muscle groups and larger muscle groups. As your body starts to fatigue, usually the smaller muscle groups tire first. These small muscles often impact important joint positioning and associated function. When this happens the larger muscle groups pick up the slack as they are generally more powerful. Over time the larger muscles are forced to do more work. However, as the tired smaller muscles fail to support proper joint positioning, the function of the larger muscles becomes compromised and injuries to supporting muscles, tendons, ligaments and joints are probable. The principles described above are the same principles seen in the foot.

Within the foot the larger (long) flexors and extensors that operate the toes originate in the calf and run under and over the arch. The smaller muscles in the foot originate under the heel and through the midfoot. These muscles follow the arch of the foot in multiple layers ending at the toes.

When you wear a plastic flip flop your toes work extremely hard to hold that sandal on. They grip, pull and bend to keep that little poor footwear choiceplastic board on your foot. Overuse (walking all day in a flip flop, walking on the beach, hiking (Gasp and cringe!! I have seen this from the Bruce trail, Escarpment lookouts, to mountain hikes in Banff Alberta), you are bound to develop an injury (check out this article for interesting facts on plantar fasciitis). I came across the picture to the left and it perfectly depicted this experience.  Injuries such as calf strain, Achilles tendinitis, plantar fascia conditions are all probable under these conditions.
Toe deformities such as clawing toes, hammer toes and mallet toes are all related to muscle/tendon dysfunction along with ligament and joint damage.

Do – Avoid injuries by adding a moulded sandal or a sandal that can accommodate your orthotics to your shopping list

Mephisto sandals such as the Helen and Zach models are built for optimal comfort. This brand of sandal has secured the top spot on the list of our most recommended sandals. The heel, arch and forefoot are tailored for comfort, function and the straps are designed strategically to reduce strain to the long flexors and extensors within the feet.

Many companies offer sandals that have the option of removing the foot bed to discreetly insert your custom orthotic. These sandals often include features that assist with comfort for all day wear. They are lightweight with a firm sole, include strategic strapping for security over the foot and ankle, and are available in a multitude of styles for various activities.

Don’t – Opt for cheap and poor quality sandals.

Good arch contour and gentle support reduce plantar foot strain and allow the joints, muscles and tendons in your foot to be positioned for better function. Adequate straps are placed and positioned on the sandal to allow the foot to work properly and reduce potential injuries.

For more information on custom orthotics in sandals or for footwear education email us at We can make your summer more comfortable.Supportive Sandal

The Right Fit – A Guide To Proper Fitting Footwear

Image 1

When searching for a new pair of shoes, finding the right pair that fits you the best can be a difficult and daunting task. Understanding shoe anatomy can assist you when we dive deeper into fit. Take a look at image 1 to help guide you through the different parts that make up a shoe.

Important Things To Consider When Making Your Footwear Choice

Consider the shape of your foot

Are your feet wide or narrow?
Do you have high arches or low arches?
Do you have any abnormalities or bony prominence’s that affect fit of footwear?

Not all shoe widths, sizes and shapes are the same. Individuals can vary in size from brand to brand, so don’t get hung up on the size number when choosing a shoe. Consider the last shape, fit of the toe box, and features such as seamless uppers, or the type of closure (laces, velcro, slip on) as it relates to your foot.

Every shoe is made on a last which can vary between each individual shoe manufacturing company. Additionally, different last shapes can vary between shoe models within the same brand. In general there are three different categories of lasts. These are the straight last, semi-curved last and curved last.

Typically the wider and flatter your foot, you should gravitate towards a shoe that is made on a straight last. Low arched (Pes Planus) feet generally need a sole unit that mimics the shape of your foot, broad and more rectangle in shape. If you are not sure what the last of the shoe looks like, a trick is to look at the bottom of the shoe and check the shape of the sole unit. If the sole is narrow and cuts into the arch this shoe is not for you. Your foot will overhang the base of the shoe and be squished into a position that is not natural to your shape, this can create balance and stability problems.  With a low arch or flat foot, check to see if the shoe you desire comes in different widths and try them on. You may be surprised how simply increasing your width can improve your comfort!

3 Lasts

Individuals with high arched (Pes Cavus) feet will typically fit better in a shoe that is made on a semi-curved or curved last. The semi-curved and curved last tends to contour to the foot structure, offering a glove like feel and hug into the arch. High arched feet generally require more depth and adjustability through the instep. This foot structure takes up more space height wise through the instep as the bony structure and arch is raised significantly.  Shoes with less volume such as slip on shoes can be a struggle for the high arched foot structure. Less space and a lack of adjustability can lead to uncomfortable pressure, toe clawing, and numbness. In conjunction with the curve of the last, you need to consider the toe shape of each last. This can range from narrow tapered toe boxes, a circular toe box, square toe box, and an anatomical toe box. High arched feet can be deceiving, and can often be wider at the ball of the foot, have elongated toes and dropped metatarsal arches. Similar to the low arched foot, if the shoe you desire comes in different widths, try them on!

** Tip – when trying on the shoe, remove the factory liner and stand on it. Does your foot fit within the shape and space of this liner? This is a good indicator of fit.

Upper construction and design can assist with fit and comfort as well. Many shoe companies now design their uppers with less stitching and printed designs. Less stitching improves flexibility of the upper material, thereby reducing irritation to the top of the foot and providing a better overall fit. Feet that have characteristics such as clawing of toes, bunions and any other bony prominence’s appreciate the flex and stretch of material that make up the upper as well.

Lacing For Common Fit Issues

Heel slipping because of a narrow heel and wide forefoot?
Do your toes go numb when your shoes are laced?
Do you need more space for the big toe because of bunions, arthritis or gout?

Changing your lacing technique can go a long way with comfort and fit, allowing for more space in the shoe for areas of high pressure or friction. In clinic we often see patients who loosen their shoes to accommodate for any of the above issues. Although a loose shoe relieves pressure, it also reduces foot security and the overall function of the shoe.  Loose footwear can lead to tripping, toe clawing as toes work harder by gripping to hold the shoe on, calf and arch discomfort from the improper/overuse of the long toe flexors, it can also increase inversion ankle sprains as the foot slides more easily within the unsecured and unstable shoe. If lacing techniques do not seem to make a difference, then re-consideration of the width, depth, last, style and size of the shoe is necessary.

What About Off-Set or Shoe Drop?

Off-set of this shoe is 16 mm-10 mm = 6 mm.

The off-set or shoe-drop is the difference between the amount of material under the heel and the amount of material under the forefoot (front) of a shoe. The material in-between is classified as the midsole of a shoe. Commonly shoes incorporate more material under the heel in order to help absorb the impact of landing as we heel strike. This absorption helps our bodies with the distribution of force as we make contact with the ground. In other words, it eases the initial impact on the joints and tissues of the feet and lower legs.

The recommended off-set for footwear will vary between different activities. For instance, running shoes may range from 8 mm to 12 mm off-set, while fitness and training shoes, court shoes and cleats will range from 0 mm to 4 mm off-set. Protection from injury and optimal performance are considered when shoes are designed with or without an off-set.

Clinically, the off-set is also important to consider when making recommendations for our patients who are dealing with specific injuries, present with an anatomical or structural need and for assisting/complementing neurological conditions. If you have a goal to reduce your off-set, this can be done strategically and via the assistance/guidance of a gait and lower limb specialist.

Foot and Lower Limb Mechanics

Do you supinate (foot rolls out) or overpronate (foot rolls in) upon landing?
Do you have an abnormal alignment of the lower leg, knees and feet? Bowlegged, knock-kneed, or leg length difference?
Do you notice that the wear pattern on the bottom of your shoes are different left to right? Maybe there is excessive wear on the sole of each shoe?
Do you have any chronic injuries that do not seem to resolve with replacing footwear?

If you answer yes to any of the above questions, consider getting a second opinion from a Pedorthist before committing to a shoe. Biomechanical anomalies and functional restrictions can impact how a shoe will interact and respond to your specific mechanics. During your assessment bring older footwear for us to evaluate the wear patterns, ask any questions you may have, and tell us your goals! We are here to help find a shoe that will  work best for you, your mechanics and activities.

Stay tuned for our analysis of walking vs. running shoes; and a list of some of our favourites!

The First Ray – Controlling the Structural Integrity of the Foot

The medial longitudinal arch (inside arch) is the main shock absorbing structure in the foot. The ability of the arch to shock absorb is dependent on the amount of movement from the bones that make up the first ray.

What is the first ray?

The first ray is the segment of the first metatarsal bone, first cuneiform bone and the joint between them.

Function of the First Ray

As the weight of the body transfers forward in walking, the calcaneus (heel) and the heads of the metatarsals (ball of the foot) are pressed to the ground which creates lengthening and flattening of the arch. This motion causes the first ray to drop. In perfect or text book gait, as we continue to step forward the body’s momentum and muscle contractions function to pull the arch up, re-stabilizing the first ray.

However, the majority of patients we see present with first ray dysfunction, where there is an opposing force and undesired motion that cause the first ray to remain in a dropped position. This reduces motion and load through the joints. Here’s the kicker, the motion and load must occur somewhere – and more often than not, improper load occurs through joints that cannot tolerate it.

There are many muscles that support and affect function on the first ray. Therefore, dysfunction to first ray mechanics can cause and affect new and pre-existing injuries or can be as a result of them.

Common injuries or presentations where dysfunction of the 1st ray is present

  • Bunions
  • Hallux Valgus
  • Arthritis
  • Hallux Limitus
  • Sesamoid injury
  • Plantar Fasciitis
  • Knee pain
  • Hip Pain

How can you improve first ray function?

Plantar Fascia Pain Explained

As Pedorthists, this condition represents a major portion of our daily schedule. We are here to tell you that your condition (although experienced by many) is unique, just like you and should be treated as such!

When you experience heel pain what is the first thing you do? Well if you are reading this page you either consulted “Dr. Google” or “Dr. Word-of-mouth”. Since there is so much information about Plantar Fasciitis we wanted to give you a resource that can help answer questions you are likely to have. In this article we will define, describe and outline symptoms and treatment options you may not know.

What is it?
Who does it affect?
How long does it last?
How do I treat this?
Will it come back?

Without further adieu, here are your answers:

Plantar Fasciitis is the term used to describe heel pain caused by the inflammation of the plantar fascia. The plantar fascia is the fibrous band that runs along the bottom of your foot and connects your heel bone to your toes.

The condition is most prevalent in middle-aged people as aging tissue and overuse tendencies are greater. However, it may also occur in individuals who are on their feet a lot; such as servers, retail associates, factory workers, or athletes, just to name a few. Plantar Fasciitis can affect one foot but can also be found to affect both feet to varying degrees.

Symptoms and Patterns of Plantar Fasciitis

  • Stabbing or burning pain that’s usually worse in the morning
  • Pain with rising following prolonged periods of rest
  • Once you’ve taken a few steps, the pain normally reduces
  • Pain often returns after long periods of standing
  • This cycle often repeats, creating repetitive strain to the tissue
  • On occasion the inflammation can be caused by a sudden tear in the plantar fascia such as after an accident or “overdoing it” during an activity
  • The acute phase of Plantar Fasciitis can last for 4-6 weeks if left untreated

What many people don’t realize is there are different stages of injured tissue. The suffix describes the stage of the injury. The suffix “itis” refers to the inflammation process of the injury (pain, heat, swelling, redness). When pain persists or becomes more of a chronic condition the suffix “osis” or “opathy” is used to describe degeneration of a tissue which has failed to heal.

Plantar Fasciosis or Plantar Fasciopathy is the term used to describe heel and/or arch pain caused by overuse, degeneration and lack of healing to the plantar fascia tissue. This condition develops over time and after inflammation has decreased. If left untreated, Plantar Fasciosis and/or Plantar Fasciopathy can last for months or even years.

Symptoms of Plantar Fasciosis/Fasciopathy That Differ From Plantar Fasciitis

  • Pain when climbing stairs or rising onto your tiptoes
  • Mild to moderate pain in the heel during activity with an increase in pain following activity
  • Throbbing heel pain at the end of the day
  • Chronic swelling in your heel that doesn’t seem to go away or has been present for a prolonged period of time


Common Causes of Plantar Fascia Conditions

Increased physical activity and overload is the most common contributor to damage of the tissue

    • Plantar Fascia conditions are common for individuals that participate in long-distance running, jogging, walking or stair climbing. Activities such as these can place too much stress on your heel bone and the soft tissue attached to it, especially as part of an aggressive new training regime. Even household exertion, such as standing on ladders, moving furniture or large appliances can trigger irritation to the tissue and create pain.

Poor footwear choices

    • Inappropriate shoe choice for the activity or a broken down shoe is often a major contributor. Shoes that are thin-soled, loose or don’t fit properly, lack arch support or the ability to absorb shock will not protect your feet. Improper shoes can cause added stress to your heels.

Abnormal walking patterns

    • Instability, or compensations from other injuries can negatively affect heel injuries.

Flat feet (over-pronation) or high arched (rigid feet)

    • Foot type can negatively affect gait patterns (the way you walk) which can lead to added stress and force on the plantar fascia causing injury and pain.

Limited ankle dorsiflexion caused by a tight Achilles tendon and calf muscles

    • The gastrocnemius is thought to be the only contributor of calf tightness. Based on gait mechanics and muscle contraction throughout the gait cycle, the Soleus muscle is what we like to call the “unsung hero”. Based on its location, activation and muscle fibers, the condition of this muscle can play a major role in Plantar Fasciopathies. Another known contributor is weakening of the toe flexors (flexor digitorum brevis) and of the peroneals (peronus longus specifically). These muscles are housed deep in the calf, contribute to ankle range of motion and play a significant role in arch mechanics and lower limb stabilization.

Repetitive stress with muscle dysfunction

    • Pressure and strain on your feet from long hours of walking or standing such as a standing desk, factory or retail workers can lead to stress, tension and increased force through the foot joints, muscles and plantar fascia. An increase in activity or change in activity such as painting, gardening, climbing ladders or hiking on uneven terrain can also be a potential cause.

Recent weight gain

    • The extra weight and hormone changes that occur with excess weight can be a contributing factor. This increase in load to your feet and plantar fascia can cause excessive strain and damage to the tissue.


    • Involves excessive pull on the plantar fascia. This can include stepping of a curb, step or tripping suddenly


    • Certain types of arthritis can cause inflammation in the tendons which can affect the bottom of your foot, which may lead to Plantar Fasciitis.


    • There may be a link between Plantar Fasciiopathy and Diabetes. More specific research is still required, but there could be a correlation between degenerative changes in tissues due to compromised blood supply.


Treatment and Prevention

Activity modification

    • Reduce the activity or at the very least the intensity of the activity that caused the problem in the first place. We’d like to note this can often be temporary! We want you to be active, but first and foremost, pain reduction and healing is the goal. You don’t want things to get worse!

Orthoticsfootwear modifications improve function

    • Provides correction to abnormal walking patterns and to limit excessive pronation which reduces the amount of strain on the tissue. In high arched rigid foot structures orthotics act to minimize destructive forces placed on immovable joints and act as a shock absorber for the tissues of the foot. Custom made or over-the-counter orthotic options are available.

Replace your shoes

    • Updating your footwear with appropriate shoes for your personal biomechanics and activity can yield immediate results. Get rid of your worn down or inappropriate shoes. Wearing sensible shoes is an integral part of every treatment and prevents excessive unwanted forces from being placed on the fascia as well as other parts of the body.

Mobility, strength and stretching

    • Improvement in ankle range of motion with mobility exercises. Focusing on stretching of the Achilles tendon, calf muscles and plantar fascia. Additionally target muscle strengthening for the improvement of lower leg, calf and foot function. These activities are imperative to promote correct alignment and function of the tissues as they heal. These activities should be done every day.

Gentle massage

    • Massage of the plantar fascia helps to promote blood flow and healing in the area, and can coincide with the strengthening and stretching exercises.

Icing for Plantar Fasciitis

    • Effective in reducing pain and inflammation in Plantar Fasciitis. Using a frozen water bottle, gel or ice pack for 10 minutes on then 10 minutes off. Repeat 2x. When your skin starts to feel numb, it’s time to give your body a break.

Heat for Plantar Fasciosis

    • Using a wheat bag may be used to assist with the rehabilitative process once inflammation has been ruled out.

Foot compression sleeves such as the FS6

    • The FS6 Foot Compression Sleeve can provide some relief to the healing plantar fascia. They can be worn on one or both feet and be utilized daily as an added layer to a treatment plan.

Night splint stretching therapy

    • Using a night splint will allow a gentle stretch to the affected tissue, allowing it to heal in a lengthened position. We prefer the rigid splint over a sock style as the sock can hyperextend the foot at the metatarsal joints, which can lead to injury and strain. The firm splint can be modified to stretch the forefoot as needed. We recommend the M2 Night Splint.

Maintain a healthy weight

    • This will reduce strain and abnormal forces to the bones, joints and ligaments of not only your feet, but your whole body.


Alternate Therapies

These therapies can be beneficial treatments as well. They should be performed by qualified professionals such as a Chiropractor, Physiotherapist, Osteopath, RMT or Sports Medicine Physician. Be sure to research each therapy and professional before you decide.

  • Acupuncture and dry needling
  • Massage
  • Taping
  • Ultrasound
  • Shock wave or laser therapy
  • PRP (Platelet-rich plasma) treatments

Consistency is key. Once the pain from Plantar Fasciitis or Plantar Fasciopathy is gone, it is human nature to stop exercises and treatment plans. It’s important to continue on with the rehabilitation of the fascia for several months.

Can the pain come back?
The simple answer is yes.

However, adopting the rehabilitation routine as a regular part to your day, activities and lifestyle can improve your outcomes.

Plantar fasciitis
Mohammad Ali Tahririan, Mehdi Motififard, Mohammad Naghi Tahmasebi,1 and Babak Siavashi2
J Res Med Sci. 2012 Aug; 17(8): 799–804.

Plantar fasciitis: A review of treatments
Luffy, Lindsey MSPAS, PA-C; Grosel, John MD; Thomas, Randall DPM; So, Eric DPM
Journal of the American Academy of PAs: January 2018 – Volume 31 – Issue 1 – p 20-24

Whittaker GA, Munteanu SE, Menz HB, et al.
Foot orthoses for plantar heel pain: a systematic review and meta-analysis.
Br J Sports Med 2018: 52: 322-8

Sullivan, J et al. Musculoskeletal and activity – related factors associated with with plantar heel pain.
Foot and Ankle International 2015, Vol 36 (1) 37-45

Walking Shoes

Best Long Distance Walking Shoes 2019

“Best Long Distance Walking Shoes 2020,” Outside Buzz (blog), January 31, 2020, accessed 2019,

Walking is one of the most refreshing activities in human life. Many of us walk for recreational purposes, Body exercise and others walk to a certain destination for reasons better known to them. It all doesn’t matter what kind of walking you are doing, the fact is that you need to have good walking shoes.

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