Our educational library is full of carefully selected resources to help educate and inform your patients. Please feel free to print off or refer your patient to any of our information below.
The walk of life
The average person walks about 10,000 steps a day. During a lifetime it is thought that a person has walked enough steps to have traveled around the planet more than 4 times, which is approximately 115,000 miles!
25% of bones in the human body are located in the feet, which are made up from 52 bones.
Need a new pair of shoes?
Shopping for shoes is best done in the afternoon, when your feet have swollen a little. Then you can be sure that your new shoes will fit your feet at all times, and don’t pinch. When trying on new shoes, make sure you stand up and walk about in them to check how supportive and comfortable they are.
Try both shoes on as most people tend to have one foot larger than the other. Therefore you are better to get a pair that fits the larger foot, since shoes are only sold in matched sizes.
The feet can be one of the most indicative signs of an individual’s health. Early symptoms for diabetes, arthritis and circulatory problems can often show themselves initially in the feet.
Beauty is pain
Women suffer from four times as many problems than men. This is believed to be a result of their choice of footwear, which usually consists shoes with narrow toes and high heels.
It is important that women wear correctly fitting footwear as on average they walk 3 miles further every day than the opposite sex.
The feet contain approximately 250,000 sweat glands that excrete as much as half a pint of moisture every day.
In China during the early 10th century, foot binding was seen as a sign of beauty and was practiced by all social classes. Foot binding was a tradition in which the toes were tightly wrapped in cloth breaking the bones and curling the foot under. After a number of years performing this ritual from about the age of 5 onwards, the front and back of the foot would be forced together to give the impression of small dainty feet. Prospective mothers in law would inspect a girl’s feet to see whether she was suitable for marriage to her son.
It is estimated by scientists and historians that the first shoes were created during the ice age 5000,000 years ago and were made from animal skins.
A Philosopher’s thoughts
The ancient Greek philosopher Socrates once claimed “When our feet hurt, we hurt all over”.
How to Wear a Prosthesis
A prosthesis can help an amputee with activities of daily life, but they’re not for everyone. Some people prefer not to use prosthetic devices, but for those who do, there is an extensive variety to choose from.
Work with a certified prosthetist. You will be able to locate one from your doctor, physical therapist, hospital listing, or certifying board.
Decide what is most important to you, cosmetic appearance or functionality. Some prosthetics are more cosmetically appealing, but may allow less dexterity, for example.
Comfort is important. Prostheses are custom designed because the fit depends on many variables. If it doesn’t feel right, let the prosthetist know. Do not allow yourself to be talked into something that you’ll end up not using.
Be realistic. A prosthetic can help you regain functions lost by the amputation, and you may be able to play your favorite sports again. But there may be limitations to what you can do.
Learn to use it properly. Some prostheses, like the electric arm, are complex. If you don’t know how to use it or wear it properly, you won’t get the full benefit.
Keep up to date. There are always new devices coming out. Technology is forever marching forward.
Try out new devices. If you are not totally satisfied with what you have now, there may be another device that will work better.
Tips & Warnings
Choose a prosthetist who is credentialed, who you find easy to work with and who allows input from you. Also make sure to find out what guarantees or warranties are offered in his or her work.
Provided by eHOW by Staff Expert
Q&A About Hip Replacements
Taken From: Pamphlet by: Nat’l Inst. of Arthritis and Musculoskeletal & Skin Diseases | Date: 1/2/2001
What Is a Hip Replacement?
Hip replacement, or arthroplasty, is a surgical procedure in which the diseased parts of the hip joint are removed and replaced with new, artificial parts. These artificial parts are called the prosthesis. The goals of hip replacement surgery are to improve mobility by relieving pain and improve function of the hip joint.
Who Should Have Hip Replacement Surgery?
The most common reason that people have hip replacement surgery is the wearing down of the hip joint that results from osteoarthritis. Other conditions, such as rheumatoid arthritis (a chronic inflammatory disease that causes joint pain, stiffness, and swelling), avascular necrosis (loss of bone caused by insufficient blood supply), injury, and bone tumors also may lead to breakdown of the hip joint and the need for hip replacement surgery.
Before suggesting hip replacement surgery, the doctor is likely to try walking aids such as a cane, or non-surgical therapies such as medication and physical therapy. These therapies are not always effective in relieving pain and improving the function of the hip joint. Hip replacement may be an option if persistent pain and disability interfere with daily activities. Before a doctor recommends hip replacement, joint damage should be detectable on x rays.
In the past, hip replacement surgery was an option primarily for people over 60 years of age. Typically, older people are less active and put less strain on the artificial hip than do younger, more active people. In recent years, however, doctors have found that hip replacement surgery can be very successful in younger people as well. New technology has improved the artificial parts, allowing them to withstand more stress and strain. A more important factor than age in determining the success of hip replacement is the overall health and activity level of the patient. For some people who would otherwise qualify, hip replacement may be problematic. For example, people with chronic diseases such as those that result in severe muscle weakness or Parkinson’s disease are more likely than people without chronic diseases to damage or dislocate an artificial hip. Because people who are at high risk for infections or in poor health are less likely to recover successfully, doctors may not recommend hip replacement surgery for these patients.
What Are Alternatives to Total Hip Replacement?
Before considering a total hip replacement, the doctor may try other methods of treatment, such as an exercise program and medication. An exercise program can strengthen the muscles in the hip joint and sometimes improve positioning of the hip and relieve pain.
The doctor also may treat inflammation in the hip with nonsteroidal anti-inflammatory drugs, or NSAIDs. Some common NSAIDs are aspirin and ibuprofen. NSAIDs also include Celebrex * and Vioxx, so-called COX-2 inhibitors that block an enzyme known to cause an inflammatory response. Many of these medications are available without a prescription, although a doctor also can prescribe NSAIDs in stronger doses.
In a small number of cases, the doctor may prescribe corticosteroids, such as prednisone or cortisone, if NSAIDs do not relieve pain. Corticosteroids reduce joint inflammation and are frequently used to treat rheumatic diseases such as rheumatoid arthritis. Corticosteroids are not always a treatment option because they can cause further damage to the bones in the joint. Some people experience side effects from corticosteroids such as increased appetite, weight gain, and lower resistance to infections. A doctor must prescribe and monitor corticosteroid treatment. Because corticosteroids alter the body’s natural hormone production, patients should not stop taking them suddenly and should follow the doctor’s instructions for discontinuing treatment.
If physical therapy and medication do not relieve pain and improve joint function, the doctor may suggest corrective surgery that is less complex than a hip replacement, such as an osteotomy. Osteotomy is surgical repositioning of the joint. The surgeon cuts away damaged bone and tissue and restores the joint to its proper position. The goal of this surgery is to restore the joint to its correct position, which helps to distribute weight evenly in the joint. For some people, an osteotomy relieves pain. Recovery from an osteotomy takes 6 to 12 months. After an osteotomy, the function of the hip joint may continue to worsen and the patient may need additional treatment. The length of time before another surgery is needed varies greatly and depends on the condition of the joint before the procedure.
What Does Hip Replacement Surgery Involve?
The hip joint is located where the upper end of the femur meets the acetabulum. The femur, or thigh bone, looks like a long stem with a ball on the end. The acetabulum is a socket or cup-like structure in the pelvis, or hip bone. This “ball and socket” arrangement allows a wide range of motion, including sitting, standing, walking, and other daily activities. During hip replacement, the surgeon removes the diseased bone tissue and cartilage from the hip joint. The healthy parts of the hip are left intact. Then the surgeon replaces the head of the femur (the ball) and the acetabulum (the socket) with new, artificial parts. The new hip is made of materials that allow a natural, gliding motion of the joint. Hip replacement surgery usually lasts 2 to 3 hours.
Sometimes the surgeon will use a special glue, or cement, to bond the new parts of the hip joint to the existing, healthy bone. This is referred to as a “cemented” procedure. In an uncemented procedure, the artificial parts are made of porous material that allows the patient’s own bone to grow into the pores and hold the new parts in place. Doctors sometimes use a “hybrid” replacement, which consists of a cemented femur part and an uncemented acetabular part.
Is a Cemented or Uncemented Prosthesis Better?
Cemented prostheses were developed 40 years ago. Uncemented prostheses were developed about 20 years ago to try to avoid the possibility of loosening parts and the breaking off of cement particles, which sometimes happen in the cemented replacement. Because each person’s condition is unique, the doctor and patient must weigh the advantages and disadvantages to decide which type of prosthesis is better.
For some people, an uncemented prosthesis may last longer than cemented replacements because there is no cement that can break away. And, if the patient needs an additional hip replacement (which is likely in younger people), also known as a revision, the surgery sometimes is easier if the person has an uncemented prosthesis.
The primary disadvantage of an uncemented prosthesis is the extended recovery period. Because it takes a long time for the natural bone to grow and attach to the prosthesis, people with uncemented replacements must limit activities for up to 3 months to protect the hip joint. The process of natural bone growth also can cause thigh pain for several months after the surgery.
Research has proven the effectiveness of cemented prostheses to reduce pain and increase
joint mobility. These results usually are noticeable immediately after surgery. Cemented replacements are more frequently used than cementless ones for older, less active people and people with weak bones, such as those who have osteoporosis.
What Can Be Expected Immediately After Surgery?
Patients are allowed only limited movement immediately after hip replacement surgery. When the patient is in bed, the hip usually is braced with pillows or a special device that holds the hip in the correct position. The patient may receive fluids through an intravenous tube to replace fluids lost during surgery. There also may be a tube located near the incision to drain fluid and a tube (catheter) may be used to drain urine until the patient is able to use the bathroom. The doctor will prescribe medicine for pain or discomfort.
How Long Are Recovery and Rehabilitation?
On the day after surgery or sometimes on the day of surgery, therapists will teach the patient exercises that will improve recovery. A respiratory therapist may ask the patient to breathe deeply, cough, or blow into a simple device that measures lung capacity. These exercises reduce the collection of fluid in the lungs after surgery.
A physical therapist may teach the patient exercises, such as contracting and relaxing certain muscles, that can strengthen the hip. Because the new, artificial hip has a more limited range of movement than an undiseased hip, the physical therapist also will teach the patient proper techniques for simple activities of daily living, such as bending and sitting, to prevent injury to the new hip. As early as 1 to 2 days after surgery, a patient may be able to sit on the edge of the bed, stand, and even walk with assistance.
Usually, people do not spend more than 10 days in the hospital after hip replacement surgery. Full recovery from the surgery takes about 3 to 6 months, depending on the type of surgery, the overall health of the patient, and the success of rehabilitation.
How to Prepare for Surgery and Recovery
People can do many things before and after they have surgery to make everyday tasks easier and help speed their recovery.
- Learn what to expect before, during, and after surgery. Request information written for patients from the doctor or contact one of the organizations listed near the end of this document.
- Arrange for someone to help you around the house for a week or two after coming home from the hospital.
- Arrange for transportation to and from the hospital.
- Set up a “recovery station” at home. Place the television remote control, radio, telephone, medicine, tissues, waste basket, and pitcher and glass next to the spot where you will spend the most time while you recover.
- Place items you use every day at arm level to avoid reaching up or bending down.
- Stock up on kitchen staples and prepare food in advance, such as frozen casseroles or soups that can be reheated and served easily.
- Follow the doctor’s instructions.
- Work with a physical therapist or other health care professional to rehabilitate your hip.
- Wear an apron for carrying things around the house. This leaves hands and arms free for balance or to use crutches.
- Use a long-handled “reacher” to turn on lights or grab things that are beyond arm’s length. Hospital personnel may provide one of these or suggest where to buy one.
What Are Possible Complications of Hip Replacement Surgery?
According to the American Academy of Orthopaedic Surgeons, approximately 120,000 hip replacement operations are performed each year in the United States and less than 10 percent require further surgery. New technology and advances in surgical techniques have greatly reduced the risks involved with hip replacements.
The most common problem that may happen soon after hip replacement surgery is hip dislocation. Because the artificial ball and socket are smaller than the normal ones, the ball can become dislodged from the socket if the hip is placed in certain positions. The most dangerous position usually is pulling the knees up to the chest.
The most common later complication of hip replacement surgery is an inflammatory reaction to tiny particles that gradually wear off of the artificial joint surfaces and are absorbed by the surrounding tissues. The inflammation may trigger the action of special cells that eat away some of the bone, causing the implant to loosen. To treat this complication, the doctor may use anti-inflammatory medications or recommend revision surgery (replacement of an artificial joint). Medical scientists are experimenting with new materials that last longer and cause less inflammation.
Less common complications of hip replacement surgery include infection, blood clots, and heterotopic bone formation (bone growth beyond the normal edges of bone).
When Is Revision Surgery Necessary?
Hip replacement is one of the most successful orthopaedic surgeries performed–more than 90 percent of people who have hip replacement surgery will never need revision surgery. However, because more younger people are having hip replacements, and wearing away of the joint surface becomes a problem after 15 to 20 years, revision surgery is becoming more common. Revision surgery is more difficult than first-time hip replacement surgery, and the outcome is generally not as good, so it is important to explore all available options before having additional surgery.
Doctors consider revision surgery for two reasons: if medication and lifestyle changes do not relieve pain and disability, or if x rays of the hip show that damage has occurred to the artificial hip that must be corrected before it is too late for a successful revision. This surgery is usually considered only when bone loss, wearing of the joint surfaces, or joint loosening shows up on an x ray. Other possible reasons for revision surgery include fracture, dislocation of the artificial parts, and infection.
What Types of Exercise Are Most Suitable for Someone With a Total Hip Replacement?
Proper exercise can reduce joint pain and stiffness and increase flexibility and muscle strength. People who have an artificial hip should talk to their doctor or physical therapist about developing an appropriate exercise program. Most exercise programs begin with safe range-of-motion activities and muscle strengthening exercises. The doctor or therapist will decide when the patient can move on to more demanding activities. Many doctors recommend avoiding high-impact activities, such as basketball, jogging, and tennis. These activities can damage the new hip or cause loosening of its parts. Some recommended exercises are cross-country skiing, swimming, walking, and stationary bicycling. These exercises can increase muscle strength and cardiovascular fitness without injuring the new hip.
What Hip Replacement Research Is Being Done?
To help avoid unsuccessful surgery, researchers are studying the types of patients most likely to benefit from a hip replacement. Researchers also are developing new surgical techniques, materials, and designs of prostheses, and studying ways to reduce the inflammatory response of the body to the prosthesis. Other areas of research address recovery and rehabilitation programs, such as home health and outpatient programs.
The NIAMS gratefully acknowledges the assistance of Charles A. Engh, M.D., of the Anderson Orthopaedic Research Institute, in Arlington, Virginia; James Panagis, M.D., M.P.H., of the National Institutes of Health; and Clement B. Sledge, M.D., of Brigham and Women’s Hospital, in Boston, Massachusetts, in the review of this booklet.
Additional information can be found on the NIAMS Web site at http://www.niams.nih.gov/. NIH Publication No. 01-4907
What are “orthotics”?
Orthotics (orthoses) are specially-prepared foot supports. These anatomically molded devices, worn under the heel and arch of your foot to correct skeletal anomalies, do more than “support” your feet. They actually realign them to a natural, “neutral” position to relieve foot, let and back stress, increase endurance, restore critical balance, improve sports performance, alleviate foot fatigue and prevent a wide range of foot problems.
How do I know if I need orthotics?
You definitely need orthotics:
- If you participate in any activity that places stress on your feet.
- If you have an obvious imbalance that causes such symptoms as flat or high arched feet.
- If you have external malalignments such as bow knees, knock knees, pigeon-toes, or “duck feet.”
- If you’ve already developed chronic foot problems, ranging from corns and calluses to arch pain and heel spur pain.
- If your job requires being on your feet for extended periods of time.
How can orthotics improve sports performance?
Athletics make demands on the feet not encountered in normal daily activity. Slight imbalances in the foot not dangerous or detectable under everyday circumstances may render you vulnerable to injury with the extra stress of sports activity. By eliminating the need for your muscles to compensate for these “hidden” imbalances, orthotics reduce fatigue and promote the kind of efficient “muscle memory” that’s crucial to outstanding performance. By aiding your control of foot movement, custom-fitted orthotics also maximize the biomechanical function not only of your feet but of your legs and torso, as well. The difference is often noticed almost immediately, giving you the kind of increased agility, balance, and sure-footed response you never knew were in you.
Do orthotics help people with high arches?
Yes. If you have a “cavus” foot (on with high arches), a functional orthotic will provide a greater contact area for you foot and spread the weight-bearing surface more evenly. This can contribute to the healing of calluses in the foot (hypersupination), improving control and lateral stability.
What causes foot problems?
The primary cause of foot problems and related conditions is skeletal imbalance. Most people have some degree of hyperpronation (flat feet) or hypersupination (high arches). These structural imperfections cause a certain amount of instability during foot function, subjecting the foot to excessive stress and strain that can eventually cause pain and deformities. The greater the imbalance, the earlier these symptoms will become evident a greater their intensity. Orthotics compensate for the inherent imbalances in the foot, improving function and relieving or preventing the appearance of such symptoms.
Does excess weight cause or aggravate foot problems?
Definitely. Additional stress to feet magnifies existing imbalances and increases symptoms. Anyone with a weight problem can benefit from orthotics.
Can foot imbalances cause leg, knee, hip, and back pain – and can orthotics help?
Yes. Poor skeletal structure in the feet puts stress on the entire skeletal system and reduces shock absorption. That’s why you will hear people say, “When my feet hurt, I hurt all over.” Orthotics, by improving foot function, can relieve stress in the ankles, legs, knees, hips, and back.
Do orthotics have any effect on my posture?
Yes. Imbalances in your feet can distort the skeletal architecture of your entire body. While orthotic foot supports will not make a marked improvement in everyone’s posture, they may eliminate posture problems caused by your feet.
What Foot Type Are You?
If you seem to have a biomechanical foot problem, determining your foot type is one of the first tests a foot specialist will carry out at your first appointment. To do this he/she would use either foot impression papers (ink based imprints), a foot impression box (a foam box which forms to the foot) or and advanced PC based foot scanning system.
Another way to carry out this test is to do the Wet Foot Test. This is not as comprehensive as the above tests (especially the computer based system), but is an interesting exercise and may aid you in selecting the correct insoles for minor foot problems.
If you have a painful biomechanical foot problem it is advised that you see a Podiatrist or Physiotherapist.
The Wet Foot Test
This is a simple test to find out your foot type. It can be done at home but should not replace the advice of foot health professional..
All you have to do is wet your feet (after a shower or bath is perfect) and stand on a surface that will leave a visible footprint. Ideal surfaces which will leave a good foot print include: brown paper, toilet paper, a bed sheet or even just the carpet (if its short-pile style). Light blue and beige surface colours seems to provide the best results..
Your footprint should fall into one of three categories.
Flat Foot – The Pronator
The pronator type of foot rolls far inward during the weight-bearing phase of the stride. This foot type is characterized by a very low or flat arch. Heavier people often have feet in this category.
High Arch Foot – The Supinator
The supinator type of foot restricts the impact of the stride largely to the outer edges of the foot. This is often due to a very high, rigid arch.
Normal Foot – Normal Healthy Gait
The neutral type of foot is between the pronator and supinator types. It is the most common foot type. Runners with a neutral type of foot lands on the heel and rolls forward during the gait cycle until the impact is distributed evenly across the forefoot.
Another test to check your foot type and gait, is the shoe examination. Assessing the wear and tear on a well worn pair of shoes is a great indicator of whether you are a pronator, a supinator or have a normal gait pattern.
A small amount of shoe wear along the outside boarder at the heel is normal. If the heel of your shoes is worn on the inside (relative to the outside) you over pronate. Additionally, if the wear pattern shows only wear on the outside edge, you are likely to be a supinator.