Dr. Robert C. Chelin, DPM, FAAFAS, DAAPM
Aesthetics in Podiatry
2189 Yonge Street, Suite 305
Toronto, Ontario M4S 2B2
416-921-5300
“Reduce pain, increase function and improve the foot’s appearance.”

Dr. Chelin is the Immediate Past-President of the Federation of International Podiatrists (FIP) as well as its Chairman of Economic Development and Website Committees. Chelin has been providing podiatric services to the residents of Ontario, Canada for over 29 years. His practice excels in offering state-of-the-art technology and services such as the use of Hyprocure sub-talar joint implant, Cutera Genesis Plus Laser, Hyaluronate (HA) volumetric fillers, and Extracorporeal Shockwave Therapy (ESWT). Most recently, his practice opened the “Designer Feet Boutique”. Here his team of licensed Estheticians use the latest sterile techniques and high quality foot care and nail products when performing their podiatric medi pedicures.

Eliminate Foot Pain, Increase Foot Function and Improve the Foot’s Appearance

The mission at our "Aesthetics in Podiatry" practice is to eliminate foot pain, increase foot function, and improve the foot’s appearance. A physical exam of my patient’s feet begins with a complete foot physical including an evaluation of their foot mechanics and the environmental factors that their feet are exposed to daily. What I mean by this, is to first evaluate whether their foot deformity is primarily a result of their genetics (extremely flexible foot structure), or primarily, from wearing ill-fitting shoes.

In this case, I will use a bunion deformity, also known as Hallux valgus as an example of a patient’s foot condition. A bunion deformity is an enlargement of bone on the side of the 1st metatarsal head which may also involve the deviation of the big toe. Primarily it is caused by genetic factors. In some cases, ill-fitting shoes can be the cause of a bunion, but in most cases, improper foot wear only exacerbates this genetic disposition.

With a bunion deformity, conservative treatments such as wearing prescription foot orthotics and/or Bunion Aid® bunion splints and switching to proper-fitting shoes can reduce bunion pain and stabilize one’s foot mechanics. If the bunion is painful, an x-ray examination is performed. If the deformity is severe and the degrees of bunion deviation of the big toe is large enough, I will suggest that the patient consider bunion surgery. I will then recommend a procedure or multiple procedures to eliminate the bunion pain, stabilize the deformity, and straighten the big toe for improved foot function and appearance.

Bunion surgery in most cases is successful; but in the end, it is up to my patients to continue with diligent foot care. For example, as part of my post-surgical care package, I include a Post Operative bunion splint that is engineered and manufactured in Germany, the Bunion Aid® Treatment Splint. I recommend that our patients begin wearing it daily after I remove the post-op dressings, usually 4 – 6 weeks after the surgery. This flexible hinged splint will maintain surgical correction while allowing the patient to return to normal activity.

I like to use analogies with my practice when consulting with patients. For example, with orthodontics, once our braces are removed from our teeth, we will continue to wear a retainer for some time to ensure our teeth do not shift back to their native position. It is only natural that with genetic deformities, whether they are deformities of our teeth or feet, our bones, ligaments and tendons want to go back to their native state. That is why it is so important to wear a bunion splint after bunion surgery and perhaps beyond. Post surgical use of the Bunion Aid® Treatment Splint will keep the big toe into the corrected position as well as maintaining the correct metatarsal angle. By doing so, we have a much better chance in preventing the reoccurrence of the bunion deformity.

Dr. Kevin M. Wong, B.S., D.C.
Orinda Chiropractic Center
89 Moraga Way, Suite A
Orinda, CA 94563
925-254-4040
“Supporting your body from toes to nose.”

One of the Best Chiropractors is at the Orinda Chiropractic Center! For the last few years (since 2008), Dr. Kevin Wong has been nominated by KRON4's Best of the Bay TV as one of the "Best Chiropractors in the Bay Area". He has been focused on continuing a standard of excellence that has spanned his almost 15 years of practice. Dr. Kevin is proud to be here to serve your health needs.

His office is centered around delivering top notch, highly personalized patient service and care. Dr. Kevin havs been trained in multiple types of Chiropractic techniques and office treatment procedures to make your visits to the office comfortable and effective. He will tailor a specialized treatment plan to the health condition(s) you have.

A Healthy Gait Cycle Keeps the Pain Away

The average human being knows very little about one of the most important things we do repeatedly throughout the day. It’s called walking. There is a fancy term for walking, called “gait”. It has been and continues to be studied so that we can understand more about how our normal and abnormal gait patterns affect us.

Let’s take an example of a person with a healthy gait pattern. When a human takes a step, it typically lands on its heel. As the foot continues to move forward, it flattens out slightly but the three arches still maintain its flexibility. This is where you might have heard the term “pronation”. Pronation is actually good for the feet and is necessary. In the final phase, the foot has moved forward enough so that the forefoot bends and the toes lift off the ground.

The important thing to understand here is that walking is a symphony of coordinated movements. Each one must happen in sequence and the foot itself must have its support structure intact for us to have normal, healthy walking. In fact, when you are walking well, you hardly even notice. Life is good and you have no pain, so why would you notice normal gait?

Now comes the reality of it. When you look at our society, by and large we tend to wear shoes almost everywhere we go. The advent of wearing shoes in general has caused problems in our feet that have shown up typically as “falling arches”.  All three arches tend to be flatter or fallen in 80-85% of the world’s population.

Have you ever heard someone tell you “I wear really good shoes”? Unfortunately, even the great running shoes people buy with the latest arch technology is not enough to adequately support the feet. Why? Because the feet have three arches that ALL need to be stabilized. Shoes only support one and in rare cases two of these arches. Genetics, weight bearing activities, obesity, injuries and other causes also contribute to fallen arches.

Here is the big picture: As the arches collapse and fall, it changes our normal gait patterns. This causes abnormal or negative stress onto the feet and the joints above.

Let’s go back to our person who is walking but now she is doing so on flatter feet. After stepping on the ground with her heel, the foot moves forward and begins to flatten out (pronate). Someone with arch collapse is going to have a foot that now flattens out too much, or over-pronates. This excessive flattening of the foot changes the way it can support the body.

Amazingly enough, this over-pronation sets up such negative stress on the ankles, knees, hips and lower back that it can lead to pain. It is a commonly known fact that lower back pain has a strong relationship to the health of your foot arches.

So what can be done about it? We know supporting all three arches are important, but before we move into prescribing custom, flexible orthotics, we can implement some useful tools that can provide support and begin relieving pain and pressure immediately.

The Bunion Aid® Medial Mid-foot Brace, by Alpha Orthotics®, is an amazing device which can actually give support to the three arches of the foot in a comfortable manner. The device is easy to put on, and the flexibility of the materials allows for support and comfort. People love not only how the device feels on their feet, but that they are able to wear it in shoes for weight bearing activities.  

For those with bunions, the Alpha Orthotics Bunion Aid® splint, includes the mid-foot brace option and couples it with a big toe extension so that gentle traction can be applied to the inwardly angled toe. The arches are supported and the big toe can be gently straightened over time so it’s a win-win situation.  

With the arches of the foot having so much effect on a healthy gait cycle, take the time to evaluate how they are working. Then implement these simple tools to experience much less pain as we mature.

Dr. Markus Striebeck, DC, DABCO
American Chiropractic Center
San Francisco, CA 94122
415.753.3300
“A Natural Approach to Health”

Dr. Striebeck is known for his gentle touch, great caring character and for being there for his patients no matter when or what. When he assesses a patient, Dr. Striebeck does not see a back condition or a shoulder complaint, he sees a whole person and he gets to know all aspects of the patient, in order to determine all aspects of the patient's life that could have a negative effect of the specific condition as well as their health as a whole.

The Doctor's philosophy is to treat a whole person not just a condition. He strongly advocates the body mind connection and as a result will address all stressors in the patient's life.

-Many people think a Chiropractor is someone who you visit when you have back problems, but Chiropractors treat foot disorders as well. What is the connection between the two?

"Back or foot pain causes altered motions wich lead to more wear and tear in the joints over time. Good alignment and proper motion preserve joint health. Joints don't wear out; they age by injury, poor mechanics and off center motions. With proper alignment and normal compression, any joint can outlive our physical death by a long shot (one study, I believe, one the knee suggests over 250 years)."

-Where do foot problems begin?

"In general, the area of injury creates a weak link. Biomechanically, foot problems often start in the pelvis. The classic example is when the pelvis on one side drops down placing stress over the knee creating pin-pointed pain. The knee is normally located just over the second toe. But instead, this downward pressure causes the knee to roll inward causing pronation, which then places excess pressure on the big toe joint area."

-More specifically, what contributes to the development of bunions?

"There are two basics: Biomechanics and Gravitational Compression, and the combination of the two. For example, in gravitational compression, the weight of the body standing is just the weight of the body. However, while walking, 2.5 X our body weight is being forced onto the foot, and while running 3.5 X our body weight is forced onto the foot. Biomechanically, the interaction of heel stride, mid-stance and toe-off eventually go through the big toe. So if there is any instability and structural changes between the forces and alignment (such as lateral arch collapse), the big toe suffers"

"Sometimes callus on the foot show the area where stresses go and where pressure is avoided (the area next to the callus). Shoes that are too tight or too big can be a factor; in womens' shoes if the heels are more than 2 1/2 inches high, they will create more splaying of the fore foot and may lead to bunions."

-What kind of effects do bunions have on a patient's gait and posture?

"Typical pain behavior which is 'avoidance'. Avoidance results in what I call a 'wobbling' movement that amplifies throughout a patient's gait and posture. So it is important to get the patient back to normal biomechanics as early as possible. For example, once a bunion is developed, it is usually tender to pressure. A patient may inadvertently avoid compression against the toe which will affect the entire biomechanical chain and posture. People with painful bunions are less likely to go for walks; their bunions have a limiting effect on their activity levels."

-What treatments do y ou most frequently use when treating bunions and why?

"Muscle exercises. I work with the lateral muscle, the Adductor hallucis, located between the big toe and the second toe. This muscle atrophies because it is never used. However, it is very hard to exercise correction into the foot because of the gravitational compression that occurs on a daily basis. You pretty much have to train yourself to work this muscle.

I recommend stabilizers that are cast while standing, provide space around the affected area and treat the three arches: medical longitudinal, lateral arch, and transverse arch. I recommend semi –rigid stabilizers for their dynamic support and different types of compression.

I also like the Bunion Aid® Bunion Treatment Splint because it is mobile and introduces a corrective force not unlike a retainer for the teeth. Gradual force over time has a corrective effect if the brace is positioned correctly and the pressure of the brace to the toe is not irritating. I recommend to first wear the brace not weight-bearing, then increase the time gradually and wear it around the house.

Surgery is only the last resort. It is so invasive, and post-surgical trauma can have adverse affects itself."

-People with bunions can mistakenly believe that if they just pull the big toe over laterally in one direction with either wedges, toe separators, or a rigid splint, that it will fix the bunion. Can you comment on this misperception?

"You can provide good support, stabilize the foot and make improvements, but it is very difficult to fix a bunion. From a biomechanical point of view, knees are associated with the fibularis muscles. These two muscles run alongside the lower leg and help flex the foot downward and upward at the outer ankle. If the knee is not moving correctly, the fibular cascades creating a diagonal movement, once again causing the foot to roll inward. Sometimes it is necessary to treat both the foot and the knee."

-As I was reviewing the various bunion splints for our bunion splint buyer’s guide, it appears that most rigid splints only pull the big toe over laterally in one static position, while, Bunion Aid® offers an advantage during the straightening process because it pulls the big toe over laterally through the range of motion of the big toe joint. Is this true?

"I absolutely agree that this is a big advantage and that is why I have added Bunion Aid® as part of my bunion management regiment."