Author Archives: Dr. Kevin Smith, DPM

Shoe Inserts, Known as Orthotics, Have Come a Long Way

We have all had the experience of having a pebble in our shoe, and we know how much that tiny object can interfere with our ability to walk pain-free.  Switch from a pebble to a condition or injury that causes pain, and you can understand how for centuries, people have tried to figure out how to make walking more comfortable.  Today, orthotics is a professional clinical specialty, where each patient is treated for their specific condition, with a ton of proven science behind each diagnosis and treatment.  But there’s a long history leading up to this point.

In 1780, Swiss doctor Jean Andre Venel set up the world’s first orthopedic clinic to help children with skeletal deformations.  He pioneered the production of various orthotic devices.  The 19th century Welsh surgeon Hugh Owen Thomas developed the method of examination of deformation in a lying position, and is considered the father of orthopedics in the United Kingdom.  The first modern orthotics began to be developed in the early 20th century, assembled from metal components padded with felt, and covered in leather.  In 1906, Dr. William Scholl (yes, THAT Dr. Scholl) introduced a lighter, more flexible metal support called the Foot-Easer.

But this mode of design remained largely unchanged for decades.

Orthotics became more prevalent as a way to help injured veterans of two world wars, as well as polio victims of the 1940s and 1950s.  The demand for corrective shoes was so high that there were close to 1000 different brands.  The advertising campaigns were so outrageous that the Federal Trade Commission had to begin issuing cease and desist orders.  The corrective shoe industry began to fade away.

Then, in 1968, an article was published describing the use of polypropylene to fabricate lower-leg braces for children with spina bifida.  Parents began asking for “plastic braces,” and a revolution was born, not just in the design of orthotics, but in how they were prescribed.  Manuals and textbooks had tended to pigeonhole each patient into a set category.  For each category, there was a device, but the patient and the device were often not well matched.  With new and more specialized manufacturing options, diagnosis and treatment began to focus more on achieving an exact match between the patient’s needs and the device used.

By the late 1970s, jogging became much more popular, and foot orthotics developed even more rapidly, as athletes reported more foot and lower limb injuries.  In the 1980s and 1990s, athletic shoes were developed with features such as flared heels, contoured sole inserts, and underfoot cushioning.

Today, skin-friendly Velcro straps have replaced leather.  Dynamic ankle braces made of light carbon fiber have replaced orthopedic shoes.  Though there are devices available over-the-counter, anyone wanting a solution that will match their specific needs should get a specific diagnosis and proposed treatment.  Dr. Smith offers both ready-made and custom-made orthotics.  To ensure they are as effective as possible, he will prescribe and fit them to you based on your diagnosis, foot shape and other factors.  Remember, foot pain is NOT normal.  An appointment with Dr. Smith is the first step toward feeling better.


Should I wear compression socks?

Compression socks, compression stockings or pressure socks are often used to try to prevent deep vein thrombosis (DVT), a blood clot from forming in the deep veins of the body and usually in the legs.  But are they right for you?


Little was known about deep vein thrombosis (DVT) until the mid-19th century.  Theories were developed to try to explain the phenomenon.  By the 1920s, lack of physical activity, vessel wall alteration and an increased tendency to form blood clots were known as possible causes for this condition.  However, treating this condition was largely a mystery until several breakthroughs, most discovered by accident, revolutionized DVT treatment.  The anticoagulant Heparin, for example, was in wide use by the 1940s.  So, this drug replaced the previously popular, but ineffective, prescription of weeks of bed rest.

Since then, there have been advances in anticoagulants, along with the rise of compression therapy as a drug-free solution.  The idea of using compression bandages to decrease blood pooling in the legs and prevent the problems it may cause actually goes back centuries.  However, its effectiveness was very limited, because it was usually paired with prolonged bed rest.  Compression therapy gained popularity by the 1950s when prescribed at the conclusion of an anticoagulant treatment with more emphasis placed on ambulatory activity, rather than resting.

What do they do?

The way compression socks work is actually quite simple.  Because they have somewhat stronger elastic properties than regular socks, they apply gentle pressure to the lower legs, helping to promote the flow of blood back to your heart.  This helps reduce the pooling of blood in the legs, which can lead to the development of blood clots or lightheadedness when standing up.  They are often used following surgery or other periods of inactivity to promote better overall circulation.  They can also help reduce the pain caused by varicose veins.

Are they for me?

While you can buy socks or stockings with a small amount of compression over the counter, as a medical treatment they should be prescribed and professionally fitted, so they will be the most effective.  This can include taking measurements of your legs when they are the least swollen.  Be sure to wear them as prescribed.  Not wearing them when you’re supposed to can lead to increased swelling, making them difficult or impossible to put back on.  You’ll also want to check them daily for any signs of skin irritation, redness, as well as other color or skin changes. 

According to the Mayo Clinic, there are several risk factors for DVM.  The more you have, the greater the chances of developing DVM:

  • Inheriting a blood-clotting disorder 
  • Prolonged bed rest, such as during a long hospital stay or paralysis 
  • Injury or surgery 
  • Pregnancy 
  • Birth control pills (oral contraceptives) or hormone replacement therapy 
  • Obesity 
  • Smoking 
  • Cancer 
  • Heart failure
  • Inflammatory bowel disease 
  • A personal or family history of deep vein thrombosis or pulmonary embolism 
  • Age 
  • Sitting for long periods of time, such as when driving or flying 

If you suspect you may be at risk, Dr. Smith can help you sort through the factors to come to the right determination of whether compression socks are for you.

4 Common Children’s Foot Health Problems

We regularly blog about podiatric issues in adults, but it is crucial to keep an eye on our children’s foot health too. Many foot issues affecting adults, also happen in children. Some of them occur more frequently, because their bodies are constantly growing. Some of the more common foot issues include; ingrown toenails, plantar warts, flat feet and heel pain.

Ingrown toenails are when the toenail grows into the skin of the foot causing pain and sometimes even an infection. Children may experience this more often, because they tend to wear tight fitting shoes as their feet grow out of their shoes.

A plantar wart is more specifically known as a skin lesion on your foot, which is caused by a virus. It is often mistaken for a callous, because of its similar appearance.  However, the subtle difference is identifiable by the black dots seen in the infected area. The most common spot for this infection is on the sole of your foot, because it is the most prone to micro-trauma throughout the day. Because this virus thrives in warm wet environments, one of the most common methods of picking it up is after walking barefoot at a pool.

Flat feet are also referred to as “Pes planus” and they are defined as feet with little to no arches. Most children experience flat feet due to developmental changes which are likely to be outgrown.  However, you child should be treated by a professional if he or she experiences foot or leg pain, difficulty walking or if one foot is flatter than the other. Many people with this condition experience no negative symptoms, though the condition should be monitored for changes.

Another common issue to look out for is plantar fasciitis. This creates pain on the bottom of the heel after activity or rest. It is even more common among children with Sever’s disease, which occurs in active children age 8-14. Another cause for heel pain is when the calf muscles and Achilles tendon tighten during growth spurts.

It is important to make sure you and your children get these foot problems treated right away if you feel like you may be experiencing any of these conditions. After all they’re using those feet continuously and more use does make problems worse. For more information, click here and even here.

How Sports Injuries Can Affect You Later in Life

For many of us, one of life’s great joys was playing sports in our youth. A lot of you know I’m an avid cyclist and have been for some time now, but there is always the daunting possibility of an injury that can have ramifications decades later. You probably even know someone who played softball or football in high school or college who still has a bad back or knee from an injury that went without proper treatment. Our feet, ankles and knees are particularly susceptible to damage as they carry the weight of the body and act as pivot points when we change direction or are undergoing strenuous activity. Sprains, stress fractures and torn or stretched ligaments or tendons are all common causes of pain later in life.

Sprain Pain

Often considered a common and collateral injury of even mild activity, sprained ankles usually don’t get the attention they should. The ankle is surprisingly vulnerable.  Few of us give much thought to stepping off a curb funny or experiencing pain when playing a sport like tennis. However, according to Dr. Hubbard-Turner of the University of North Carolina, student athletes with chronic ankle instability and sprains were significantly less mobile than their uninjured counterparts. What does this mean? We should get sprains checked out and treated appropriately as soon as possible to prevent an increase of immobility and painful arthritis as we age.

Stress Fracture Detractor

Stress fractures can range from a tiny crack in the bone to heavy bone bruising. Runners, tennis players and yes, even cyclists are prone to these fractures as our feet take a heavy beating during these activities. HealthPlus reports that almost 60% of athletes who have a stress fracture are likely to get another one later in life. Because fractures  are not a full break, it can be tempting to push through the pain. Do not do this, because the fracture can worsen or turn into a full break if put under enough stress for a long enough time. Without proper treatment, stress fractures lead to chronic discomfort, limited mobility and more fractures down the line.

Achilles Tendon

Your Achilles tendon is the band of tissue running from your heel up the back of your foot to your calf.  Sports with highly repetitive actions like basketball and high jump force this tendon to work harder than it is often used to which can lead to tendonitis or ruptures. You’ll know if you had Achilles tendonitis, because the pain radiates down your calf and often causes pain in your heel or on the bottom of your foot. If left unchecked or prevented from heeling properly, you’ll notice the tendon thickening and hardening which reduces mobility and makes walking very painful.

There are many ways new and old sports injuries can be managed and, in many cases, successfully healed. Seeing a medical professional should be your first step in assessing the severity of your injury and what options are available. In some cases, simply resting and icing can suffice but with older injuries it may take a more hands-on approach. Remember pain is not normal, if you’re suffering seek medical attention so you can get on the road to recovery!

3 Ways to Identify Foot Injuries

I like to think of us all as a fine wine: we just get better and better with age! But, unlike wine, there can be a few bumps and hurdles as we move along. For those who are now caregivers for an aging friend or relative, we want to be sure we are as attentive to their needs as possible.  Although, many of us aren’t always sure how to know if something is a minor ailment or needs to be addressed immediately. This month we’ll dive into a few tips you can follow to assess your loved one’s foot and ankle health in order to catch something before it gets out of hand.

How is Their Circulation?

Chronic foot pain is a common complaint as we age. This can range from shortening of the Achilles tendon to flattening of the arch. To make sure there aren’t underlying circulation problems at play you can try a few simple tests.

  • Press gently on some of the capillaries and veins along their feet. Typically, they will return to their normal color within a few seconds.  However, if it takes longer than 3 to 5 seconds, this could be a sign they are suffering from poor circulation.
  • Take a look at the condition of the skin on their feet. How is the color and temperature? If you notice it changing since the last time you checked or the skin is very dry, this could also be a sign of poor circulation.


A large percentage of the U.S. population suffers from diabetes and the chance of it affecting you increase as you age. Neuropathy can manifest as hyper-sensitivity, numbness or ulceration.

This goes hand in hand with the capillary test mentioned above. Gently press along different areas of your loved ones’ feet and see if they experience any abnormal sensitivity or lack of feeling. This can indicate the beginning stages of neuropathy. A healthcare professional has special tools to allow for a more precise measurement.  So, if you suspect neuropathy, you should schedule an appointment right away.

Changing Foot Geometry

Bunions, hammertoes and other prominent bone structures will cause a great deal of discomfort. If left unchecked or proper footwear isn’t implemented, they can cause ulcerations on the feet, changes in gait that will affect the hips and lower back and even increase the chance of balance problems.

  • Consistent visual inspection of your loved one’s feet will allow you to note any changes in their foot geometry. Is their bunion growing? Is their shoe causing callousing or sores due to excessive rubbing?  
  • You can also check their shoes for the wear pattern on the insole. If they are beginning to wear the outside edge of one side of their shoe over the other, this can indicate discomfort and lead to the other issues I mentioned above.

These tests and checks are all preliminary. Only a medical professional can truly identify and diagnose potential health hazards with your loved ones, but these tips can provide a way to help identify the early stages of common foot and ankle ailments before they begin severely impacting your love one’s life or cause further problems down the road.