Diet key to longer life, even when you're old

Adults ages 70-79 who ate healthy foods had lower risk of death over a 10-year period, study finds 

By Rachael Rettner 

Even in your elder years, eating healthy foods can help you live longer, a new study suggests.

In the study, older adults who ate mainly healthy foods — such as vegetables, fruit, poultry, low-fat dairy products and whole grains — had a lower risk of death over a 10-year period than those who ate less-healthy foods, including high-fat dairy products.

"Some people have suggested in the past that it doesn't maybe matter too much what people eat at an older age," said study researcher Amy Anderson, of the department of Nutrition and Food Science at the University of Maryland. "But our study, and previous studies, support the idea that that older adults can affect their health and longevity by following a dietary pattern that is high in healthy foods."
Anderson and her colleagues examined the eating habits and quality of life of about 2,500 adults, ages 70 to 79, from Pittsburgh and Memphis, Tenn. Participants answered a questionnaire designed to assess their typical diet. They also indicated whether their health was excellent, very good, good, fair or poor.
Story: Being 'chilled out' can increase risk of obesity The researchers grouped the participants based on their diets:

• Those who ate mainly healthy food
• Those who ate mainly high-fat dairy products, such as ice cream and cheese, and had a lower intake of poultry, low-fat dairy products, rice and pasta
• Those who ate mainly meat and fried foods and drank alcohol
• Those who ate mainly refined grains
• Those who ate mainly breakfast cereals
• Those who ate mainly sweets and desserts — such as doughnuts, cakes and candy — and had a lower intake of fruit, fish, other seafood and dark green vegetables

The researchers followed up with the participants for an average of 10 years, during which 739 died. Those in the high-fat dairy product group were 40 percent more likely to die during this time period than those in the healthy food group. Those in the sweets and desserts group had a 37 percent higher risk of death than those in the healthy food group.

Those in the healthy food group also reported more years of healthy life, when they rated their health as excellent, very good or good.

Interestingly, those who ate mostly meat and fried foods and drank alcohol did not have a higher risk of death than those who ate healthy food after the researchers took into account other factors that could affect the results, such as age, gender, race, education, physical activity and total calorie intake. It's possible that eating plant-based foods counteracted the deleterious effects of eating animal fat, the researchers said. Those who consumed meat, fried foods and alcohol also ate slightly more vegetables, fruits and whole grains than those in the high-fat dairy products group and those in the sweets and desserts group.


While previous work has linked diet to length of life, many of these studies aimed to score a person's eating habits based on how well they match up with a specific food regimen, such as the Mediterranean diet. But the new study examined participants' overall diets before classifying them into the appropriate groups.

Since participants all lived in two U.S. cities, the results don't necessarily apply to those living elsewhere, the researchers said. Also, the subjects' diet was assessed just once during the study, and the researchers don't know if eating patterns changed over time, Anderson said.
Those that ate healthy food closely adhered to the current dietary guidelines for Americans, which are aimed at reducing chronic disease, including heart disease and diabetes, she said. It's possible that those in the healthy food group had an extended life span because they had a reduced rate of chronic disease.
The results will be published in the January 2011 issue of the Journal of the American Dietetic Association.

Adults ages 70-79 who ate healthy foods had lower risk of death over a 10-year period, study finds 

By Rachael Rettner 

Even in your elder years, eating healthy foods can help you live longer, a new study suggests.

In the study, older adults who ate mainly healthy foods — such as vegetables, fruit, poultry, low-fat dairy products and whole grains — had a lower risk of death over a 10-year period than those who ate less-healthy foods, including high-fat dairy products.

"Some people have suggested in the past that it doesn't maybe matter too much what people eat at an older age," said study researcher Amy Anderson, of the department of Nutrition and Food Science at the University of Maryland. "But our study, and previous studies, support the idea that that older adults can affect their health and longevity by following a dietary pattern that is high in healthy foods."
Anderson and her colleagues examined the eating habits and quality of life of about 2,500 adults, ages 70 to 79, from Pittsburgh and Memphis, Tenn. Participants answered a questionnaire designed to assess their typical diet. They also indicated whether their health was excellent, very good, good, fair or poor.
Story: Being 'chilled out' can increase risk of obesity The researchers grouped the participants based on their diets:

• Those who ate mainly healthy food
• Those who ate mainly high-fat dairy products, such as ice cream and cheese, and had a lower intake of poultry, low-fat dairy products, rice and pasta
• Those who ate mainly meat and fried foods and drank alcohol
• Those who ate mainly refined grains
• Those who ate mainly breakfast cereals
• Those who ate mainly sweets and desserts — such as doughnuts, cakes and candy — and had a lower intake of fruit, fish, other seafood and dark green vegetables

The researchers followed up with the participants for an average of 10 years, during which 739 died. Those in the high-fat dairy product group were 40 percent more likely to die during this time period than those in the healthy food group. Those in the sweets and desserts group had a 37 percent higher risk of death than those in the healthy food group.

Those in the healthy food group also reported more years of healthy life, when they rated their health as excellent, very good or good.

Interestingly, those who ate mostly meat and fried foods and drank alcohol did not have a higher risk of death than those who ate healthy food after the researchers took into account other factors that could affect the results, such as age, gender, race, education, physical activity and total calorie intake. It's possible that eating plant-based foods counteracted the deleterious effects of eating animal fat, the researchers said. Those who consumed meat, fried foods and alcohol also ate slightly more vegetables, fruits and whole grains than those in the high-fat dairy products group and those in the sweets and desserts group.


While previous work has linked diet to length of life, many of these studies aimed to score a person's eating habits based on how well they match up with a specific food regimen, such as the Mediterranean diet. But the new study examined participants' overall diets before classifying them into the appropriate groups.

Since participants all lived in two U.S. cities, the results don't necessarily apply to those living elsewhere, the researchers said. Also, the subjects' diet was assessed just once during the study, and the researchers don't know if eating patterns changed over time, Anderson said.
Those that ate healthy food closely adhered to the current dietary guidelines for Americans, which are aimed at reducing chronic disease, including heart disease and diabetes, she said. It's possible that those in the healthy food group had an extended life span because they had a reduced rate of chronic disease.
The results will be published in the January 2011 issue of the Journal of the American Dietetic Association.

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Low Vitamin D Levels Common in Breast Cancer

Dec. 14, 2010 (San Antonio) -- More than half of women with breast cancer have low vitamin D levels, British researchers report.

"Women with breast cancer should be tested for vitamin D levels and offered supplements, if necessary," says researcher Sonia Li, MD, of the Mount Vernon Cancer Centre in Middlesex, England. The findings were presented at the San Antonio Breast Cancer Symposium.

Some studies have suggested a link between low vitamin levels and breast cancer risk and progression, but others have not, she says. No studies have proven cause and effect.

Previous research suggests a biologic rationale for vitamin D putting the brakes on breast cancer development and spread, Li says.

Breast cancer cells have vitamin D receptors, and when these receptors are activated by vitamin D, it triggers a series of molecular changes that can slow cell growth and cause cells to die, she says.

Even if it does not have a direct effect on the tumor, vitamin D is needed to maintain the bone health of women with breast cancer, Li says. That's especially important given the increasing use of aromatase inhibitors, which carry an increased risk of bone fractures, she says.

Vitamin D is found in some foods, especially milk and fortified cereals, and is made by the body after exposure to sunlight. It is necessary for bone health.

Dec. 14, 2010 (San Antonio) -- More than half of women with breast cancer have low vitamin D levels, British researchers report.

"Women with breast cancer should be tested for vitamin D levels and offered supplements, if necessary," says researcher Sonia Li, MD, of the Mount Vernon Cancer Centre in Middlesex, England. The findings were presented at the San Antonio Breast Cancer Symposium.

Some studies have suggested a link between low vitamin levels and breast cancer risk and progression, but others have not, she says. No studies have proven cause and effect.

Previous research suggests a biologic rationale for vitamin D putting the brakes on breast cancer development and spread, Li says.

Breast cancer cells have vitamin D receptors, and when these receptors are activated by vitamin D, it triggers a series of molecular changes that can slow cell growth and cause cells to die, she says.

Even if it does not have a direct effect on the tumor, vitamin D is needed to maintain the bone health of women with breast cancer, Li says. That's especially important given the increasing use of aromatase inhibitors, which carry an increased risk of bone fractures, she says.

Vitamin D is found in some foods, especially milk and fortified cereals, and is made by the body after exposure to sunlight. It is necessary for bone health.

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Consumer Reports Warns Pregnant Women Against Canned Tuna

Pregnant women and children have long been warned that they should be wary of eating certain kinds of seafood because of the risk of mercury contamination. It's a real threat — mercury is a neurotoxin, and exposure in-utero at high levels can damage an infant's developing cognitive skills.

Seafood can pose a danger because mercury — usually from the emissions of coal-fired power plants and other industrial sources — can accumulate in the tissue of fish, especially in predators high on the food chain. That includes tuna, and white (albacore) tuna is known to be especially high in mercury. The Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) both recommend that women of childbearing age and young children should eat no more than 12 ounces a week of light tuna, including 6 ounces of white tuna. (More on Time.com: 5 Pregnancy Taboos Explained (or Debunked))

But that may not be safe enough. Consumer Reports tested 42 samples of tuna from cans bought in and around New York and found that white tuna usually contains far more mercury than light tuna — and that women and children should be even more cautious about eating the fish.

After analyzing the tests, the magazine's fish-safety experts concluded that pregnant women should avoid eating all tuna as a precaution. Children over 45 lbs. should stick to no more than 12.5 ounces of light tuna or 4 ounces of white tuna a week, while lighter children should have no more than have 4 ounces or less of light tuna or 1.5 ounces or less of white tuna, dependent on their weight. (Download a copy of the report here.)

Why the stricter warnings? Every sample that Consumer Reports tested had measurable levels of mercury, ranging from 0.018 to 0.774 parts per million (ppm). Samples of white tuna ranged from 0.217 ppm to 0.774 ppm and averaged 0.427 ppm — enough that by eating 2.5 ounces of any of the tested samples, a woman would exceed the daily mercury intake considered safe by the EPA. (More on Time.com: Study: Restless Leg Syndrome During Pregnancy May Recur)

Samples of light tuna ranged from 0.018 ppm to 0.176 ppm. That's low on average, but about half the tested samples contained enough mercury that eating a single can would exceed the EPA's limit for women of child-bearing age.

Indeed, it's the outliers that pose a particular danger, not so much the average. While light tuna especially on average doesn't contain that much mercury, there's the danger of spikes in certain samples — and there's no way for pregnant women to know if the canned tuna they're eating contains unusually high levels of mercury. But the Consumer Reports study shows that it is a real threat that cautious women should take seriously.

Of course, limiting your seafood intake has its own risks. Omega-3 fatty acids — found in fish — are thought to help in developing fetal nervous systems, and they're well-known to reduce the risk of heart attack and stroke. The National Fisheries Institute, a trade group, noted that none of the canned tuna it tested — even the outliers — exceeded the FDA's allowable limit of 1 ppm or more. (That's the point at which the FDA is allowed to pull products from the shelves, though that's never been done.) The group also noted — cheekily — that Consumer Reports had apparently served tuna tartare at its recent holiday party, so it can't be that dangerous. (More on Time.com: Photos: Pregnant Belly Art)

Of course, the FDA's safety limits on mercury have long been considered too lax — and compared to the rest of the world, they are. It will be a long time before we have definitive science on just how much mercury pregnant women can be exposed to without ill effect, but most people would agree that this is a time for the precautionary principle.

Pregnant women and children have long been warned that they should be wary of eating certain kinds of seafood because of the risk of mercury contamination. It's a real threat — mercury is a neurotoxin, and exposure in-utero at high levels can damage an infant's developing cognitive skills.

Seafood can pose a danger because mercury — usually from the emissions of coal-fired power plants and other industrial sources — can accumulate in the tissue of fish, especially in predators high on the food chain. That includes tuna, and white (albacore) tuna is known to be especially high in mercury. The Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) both recommend that women of childbearing age and young children should eat no more than 12 ounces a week of light tuna, including 6 ounces of white tuna. (More on Time.com: 5 Pregnancy Taboos Explained (or Debunked))

But that may not be safe enough. Consumer Reports tested 42 samples of tuna from cans bought in and around New York and found that white tuna usually contains far more mercury than light tuna — and that women and children should be even more cautious about eating the fish.

After analyzing the tests, the magazine's fish-safety experts concluded that pregnant women should avoid eating all tuna as a precaution. Children over 45 lbs. should stick to no more than 12.5 ounces of light tuna or 4 ounces of white tuna a week, while lighter children should have no more than have 4 ounces or less of light tuna or 1.5 ounces or less of white tuna, dependent on their weight. (Download a copy of the report here.)

Why the stricter warnings? Every sample that Consumer Reports tested had measurable levels of mercury, ranging from 0.018 to 0.774 parts per million (ppm). Samples of white tuna ranged from 0.217 ppm to 0.774 ppm and averaged 0.427 ppm — enough that by eating 2.5 ounces of any of the tested samples, a woman would exceed the daily mercury intake considered safe by the EPA. (More on Time.com: Study: Restless Leg Syndrome During Pregnancy May Recur)

Samples of light tuna ranged from 0.018 ppm to 0.176 ppm. That's low on average, but about half the tested samples contained enough mercury that eating a single can would exceed the EPA's limit for women of child-bearing age.

Indeed, it's the outliers that pose a particular danger, not so much the average. While light tuna especially on average doesn't contain that much mercury, there's the danger of spikes in certain samples — and there's no way for pregnant women to know if the canned tuna they're eating contains unusually high levels of mercury. But the Consumer Reports study shows that it is a real threat that cautious women should take seriously.

Of course, limiting your seafood intake has its own risks. Omega-3 fatty acids — found in fish — are thought to help in developing fetal nervous systems, and they're well-known to reduce the risk of heart attack and stroke. The National Fisheries Institute, a trade group, noted that none of the canned tuna it tested — even the outliers — exceeded the FDA's allowable limit of 1 ppm or more. (That's the point at which the FDA is allowed to pull products from the shelves, though that's never been done.) The group also noted — cheekily — that Consumer Reports had apparently served tuna tartare at its recent holiday party, so it can't be that dangerous. (More on Time.com: Photos: Pregnant Belly Art)

Of course, the FDA's safety limits on mercury have long been considered too lax — and compared to the rest of the world, they are. It will be a long time before we have definitive science on just how much mercury pregnant women can be exposed to without ill effect, but most people would agree that this is a time for the precautionary principle.

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Top Spine Surgeons Reap Royalties, Medicare Bounty

Norton Hospital in Louisville, Ky., may not be a household name nationally. But five senior spine surgeons have helped put it on the map in at least one category: From 2004 to 2008, Norton performed the third-most spinal fusions on Medicare patients in the country.

The five surgeons are also among the largest recipients nationwide of payments from medical-device giant Medtronic Inc. In the first nine months of this year alone, the surgeons—Steven Glassman, Mitchell Campbell, John Johnson, John Dimar and Rolando Puno—received more than $7 million from the Fridley, Minn., company.

Medtronic and the surgeons say the payments are mostly royalties they earned for helping the company design one of its best-selling spine products.

Corporate whistleblowers and congressional critics contend such arrangements—which are common in orthopedic surgery—amount to kickbacks to stoke sales of medical devices. They argue that the overuse of surgical hardware ranging from heart stents to artificial hips is a big factor behind the soaring costs of Medicare, the government medical-insurance system for the elderly and disabled.

Medtronic says it can't develop new medical products that improve patients' lives without the help of surgeons. It says the royalties it pays them are legitimate but it doesn't give detailed information about what intellectual property each recipient contributes. It says it doesn't pay its collaborating surgeons royalties on the devices they personally use in their patients, removing any financial incentive for them to do more surgeries than necessary.

Norton's Dr. Glassman cited this policy as a safeguard against any conflict of interest and said the royalties he and his colleagues receive are "legitimate." He added that they inform their patients of their financial ties with Medtronic. Norton Hospital said it has policies "to prevent direct conflicts of interest." The other Norton surgeons didn't respond to requests for comment put to them through Norton and Dr. Glassman.

Using a Medicare database that tracks hospitals' billing, The Wall Street Journal was able to ascertain that Norton is among the most aggressive practitioners of spinal fusion in the country.

Spinal fusion has become one of medicine's most controversial procedures. It involves fusing together two or more vertebrae to alleviate back pain, usually with the help of metal plates, rods and screws implanted in the patient's back. Tens of thousands of dollars of hardware can go into a single surgery.

Medtronic is the biggest maker of spinal implants. Last year, its spine business generated world-wide sales of $3.5 billion, accounting for half of the roughly $7 billion spinal-implant market.

Conservative spine surgeons argue that a spinal fusion is appropriate only for a small number of conditions, such as spinal instability, spinal fracture or a severe curvature of the spine known as scoliosis, and that financial incentives have caused the procedure to become overused. Others say it's a useful tool to treat patients who have debilitating back pain and have tried other options like physical therapy to no avail.

The Journal consulted several experts to determine which back conditions are commonly thought to require a fusion and which are subject to the most debate. The most hotly debated use of spinal fusion surgery centers on patients who merely suffer from aging disks, a condition known as degenerative disk disease.

One health insurer, the nonprofit Blue Cross and Blue Shield of North Carolina, announced in September that it would stop paying for spine fusions performed on such patients beginning on Jan. 1. The insurer said that the procedures are "considered not medically necessary."

The Journal mined hospitals' Medicare claims to see what proportion of fusions performed fall in this category. Due to a three-decade-old court ruling guarding the confidentiality of physician information, the paper is barred from disclosing what it found regarding the five Norton surgeons.

Critics of the court ruling and of the privacy policies of the federal Medicare program argue that making such information public would help taxpayers understand where their money is going, and potentially deter abusive or wasteful practices.

But the Journal is permitted to disclose its findings for Norton Hospital as a whole, where 27 surgeons performed one or more spine fusions in 2008.

At Norton, spinal fusions on patients who only suffered from aging disks accounted for 24% of the 2,475 fusions the hospital performed for Medicare between 2004 and 2008, compared with 17% nationally. This placed it 11th in percentage terms out of 60 hospitals that performed 1,000 or more spine fusions in those years, and fourth in raw count. Norton ranked third nationally in the overall numbers of spine-fusion surgeries.

In emailed responses to questions, Dr. Glassman said he and his four colleagues "do not overuse spine fusion procedures," and argued that the diagnostic codes the Journal based its analysis on "do not convey indication for spinal fusion with the specificity that you are attributing to this data."

Norton Hospital in Louisville, Ky., may not be a household name nationally. But five senior spine surgeons have helped put it on the map in at least one category: From 2004 to 2008, Norton performed the third-most spinal fusions on Medicare patients in the country.

The five surgeons are also among the largest recipients nationwide of payments from medical-device giant Medtronic Inc. In the first nine months of this year alone, the surgeons—Steven Glassman, Mitchell Campbell, John Johnson, John Dimar and Rolando Puno—received more than $7 million from the Fridley, Minn., company.

Medtronic and the surgeons say the payments are mostly royalties they earned for helping the company design one of its best-selling spine products.

Corporate whistleblowers and congressional critics contend such arrangements—which are common in orthopedic surgery—amount to kickbacks to stoke sales of medical devices. They argue that the overuse of surgical hardware ranging from heart stents to artificial hips is a big factor behind the soaring costs of Medicare, the government medical-insurance system for the elderly and disabled.

Medtronic says it can't develop new medical products that improve patients' lives without the help of surgeons. It says the royalties it pays them are legitimate but it doesn't give detailed information about what intellectual property each recipient contributes. It says it doesn't pay its collaborating surgeons royalties on the devices they personally use in their patients, removing any financial incentive for them to do more surgeries than necessary.

Norton's Dr. Glassman cited this policy as a safeguard against any conflict of interest and said the royalties he and his colleagues receive are "legitimate." He added that they inform their patients of their financial ties with Medtronic. Norton Hospital said it has policies "to prevent direct conflicts of interest." The other Norton surgeons didn't respond to requests for comment put to them through Norton and Dr. Glassman.

Using a Medicare database that tracks hospitals' billing, The Wall Street Journal was able to ascertain that Norton is among the most aggressive practitioners of spinal fusion in the country.

Spinal fusion has become one of medicine's most controversial procedures. It involves fusing together two or more vertebrae to alleviate back pain, usually with the help of metal plates, rods and screws implanted in the patient's back. Tens of thousands of dollars of hardware can go into a single surgery.

Medtronic is the biggest maker of spinal implants. Last year, its spine business generated world-wide sales of $3.5 billion, accounting for half of the roughly $7 billion spinal-implant market.

Conservative spine surgeons argue that a spinal fusion is appropriate only for a small number of conditions, such as spinal instability, spinal fracture or a severe curvature of the spine known as scoliosis, and that financial incentives have caused the procedure to become overused. Others say it's a useful tool to treat patients who have debilitating back pain and have tried other options like physical therapy to no avail.

The Journal consulted several experts to determine which back conditions are commonly thought to require a fusion and which are subject to the most debate. The most hotly debated use of spinal fusion surgery centers on patients who merely suffer from aging disks, a condition known as degenerative disk disease.

One health insurer, the nonprofit Blue Cross and Blue Shield of North Carolina, announced in September that it would stop paying for spine fusions performed on such patients beginning on Jan. 1. The insurer said that the procedures are "considered not medically necessary."

The Journal mined hospitals' Medicare claims to see what proportion of fusions performed fall in this category. Due to a three-decade-old court ruling guarding the confidentiality of physician information, the paper is barred from disclosing what it found regarding the five Norton surgeons.

Critics of the court ruling and of the privacy policies of the federal Medicare program argue that making such information public would help taxpayers understand where their money is going, and potentially deter abusive or wasteful practices.

But the Journal is permitted to disclose its findings for Norton Hospital as a whole, where 27 surgeons performed one or more spine fusions in 2008.

At Norton, spinal fusions on patients who only suffered from aging disks accounted for 24% of the 2,475 fusions the hospital performed for Medicare between 2004 and 2008, compared with 17% nationally. This placed it 11th in percentage terms out of 60 hospitals that performed 1,000 or more spine fusions in those years, and fourth in raw count. Norton ranked third nationally in the overall numbers of spine-fusion surgeries.

In emailed responses to questions, Dr. Glassman said he and his four colleagues "do not overuse spine fusion procedures," and argued that the diagnostic codes the Journal based its analysis on "do not convey indication for spinal fusion with the specificity that you are attributing to this data."

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When to Consider Orthotics: Research-Based Recommendations

Sometimes a patient's need for custom-made foot orthotics becomes apparent only after an inadequate response to chiropractic care. Some patients, however, reveal an obvious need, and orthotics should be provided early in their care.

This will allow a good response to adjustments and prevent frustration all around. What follows are some commonly seen patient characteristics that indicate the need for foot orthotics.

History

Back problems worse with standing, walking, running. When a patient reports a link between locomotor activities and their spinal symptoms, this clearly calls for orthotics to minimize the stress being transmitted from the lower extremities to the spine.1

Recurrent ankle sprains. A history of previous sprain injuries to one or both ankles indicates biomechanical instability and probable permanent ligament damage. Custom-made stabilizing orthotics provide the support needed to help prevent re-injury.2-3

Family history of foot problems or surgery. A patient who has family members with foot problems and/or surgery has a much higher probability of the same. Fitting for orthotics may prevent these problems from developing and could help the patient avoid surgery.

Strenuous athletic activities. Those who engage in upright, weight-bearing sports need both shock absorption and foot/ankle stability. Orthotic support can increase performance and prevent injuries in many individual and team sports.4

History of lower extremity stress fractures, recurring shin splints, hamstring strains. Whenever an athlete, whether recreational or competitive, reports symptoms of overuse injury (microtrauma) in the lower extremities, orthotics should be provided. These conditions are closely correlated with biomechanical asymmetries, and require better support and shock absorption.5-6

Chronic knee pain, patellofemoral arthralgia, ACL injury. The knee joint is a sensitive indicator of abnormal biomechanical stress, and these conditions have all been shown to indicate the need for orthotics. Controlling pronation decreases the rotational forces, improving patellar tracking and protecting the anterior cruciate ligament.7

Exam Findings

Postural imbalances (e.g., pelvic tilt, scoliosis, forward head). When a standing structural evaluation discloses any pelvic tilt, a lower extremity asymmetry requiring orthotics for proper correction is likely. Both functional and idiopathic types of spinal curvatures can benefit from the foot stabilization and neurological stimulus provided by orthotics.8 Many postural complexes (forward head is one of the most common) are secondary to poor standing balance and proprioception from the feet.

Gait asymmetry (e.g., calcaneal eversion, excessive pronation, foot flare). Looking for indicators of biomechanical asymmetry while a patient walks will often demonstrate the need for orthotics.9 If the foot and ankle complex is not functioning correctly during the stance phase of gait, this stress is transmitted to the pelvis and spine with every step.

Foot calluses, bunions, hallux valgus. Heavy callousing, bunion development and abnormal alignment all reveal evidence of abnormal or poorly tolerated forces during walking and indicate the need for improved biomechanics and orthotics.10

Lack of an arch (especially unilateral). This is seen during the weight-bearing portion of the exam, when a foot collapses under the weight of the body. A foot without an arch will not function properly and thus requires support.11

Knee instability, high Q-angle, poor patellar tracking. When the knee does not align properly or track correctly, degenerative wear-and-tear and other chronic symptoms will follow. Orthotic alignment is required to reduce the abnormal forces on this complex joint, which must be able to sustain frequent high forces during walking and running.12-13

X-Ray Findings

Scoliosis (functional or idiopathic), widespread disc degeneration. The spine will demonstrate poor support from one of the lower extremities by developing a lateral curvature. Gait disturbances may be one of the causative factors for idiopathic scoliosis. Significant intervertebral disc degeneration is proof of poor spinal shock absorption, and orthotics with viscoelastic properties often reduce symptoms dramatically.9

Unlevel sacral base, sacroiliac joint degeneration. The pelvis shows evidence of inadequate support by the appearance of a tilted sacral base when standing. This is often due to a functional short leg requiring orthotic support.14 Sacroiliac degeneration is unusual; when found, it indicates significant abnormal stresses.

Low femur head, coxafemoral DJD. These conditions are due to either an anatomical or a functional short leg. Degenerative changes in the hip joint have been correlated with the stress of a longer leg. Both will benefit from the improved balance and support provided by orthotics.14

Heel spur, DJD in knees, metatarsals. X-rays of the feet and knees may reveal evidence of long-standing regional stress, such as degenerative changes in weight-bearing joints and connective tissue calcification. Calcium deposited in the calcaneal attachment of the plantar fascia specifically indicates the need for support of the arches of the foot to help reduce shock and symptoms in degenerated joints, and provide arch stabilization.11

Treatment Response

Recurrent subluxations. Making the same adjustment to a patient's spine again and again suggests poor structural support for the region. Orthotics have been used for decades by chiropractors who don't want to continue adjusting the same area and who want to see the adjustment "hold" better.

Unresolving muscle strain, myalgia. Myofascial symptoms not responding to treatment often are a clue to an underlying biomechanical imbalance. Many chronic muscle spasms and strains can be corrected by providing orthotics to support and stabilize.15

Flare-ups, exacerbations. A patient who is feeling better, returns to daily activities, and then suffers a return of symptoms probably needs orthotics. Without proper biomechanical support, these patients find that every attempt to establish normal routines causes a recurrence of their symptoms.

Foot symptoms are only one of the many reasons for supplying orthotics. In fact, the feet are seldom painful in most of the conditions that are clear indicators of an need for orthotic support. All chiropractors must be alert for signs of lower extremity involvement in spinal conditions. The good news is that these conditions can all be helped. Investigation and correction of foot biomechanics can help most patients, especially the recreationally active and the elderly.

Sometimes a patient's need for custom-made foot orthotics becomes apparent only after an inadequate response to chiropractic care. Some patients, however, reveal an obvious need, and orthotics should be provided early in their care.

This will allow a good response to adjustments and prevent frustration all around. What follows are some commonly seen patient characteristics that indicate the need for foot orthotics.

History

Back problems worse with standing, walking, running. When a patient reports a link between locomotor activities and their spinal symptoms, this clearly calls for orthotics to minimize the stress being transmitted from the lower extremities to the spine.1

Recurrent ankle sprains. A history of previous sprain injuries to one or both ankles indicates biomechanical instability and probable permanent ligament damage. Custom-made stabilizing orthotics provide the support needed to help prevent re-injury.2-3

Family history of foot problems or surgery. A patient who has family members with foot problems and/or surgery has a much higher probability of the same. Fitting for orthotics may prevent these problems from developing and could help the patient avoid surgery.

Strenuous athletic activities. Those who engage in upright, weight-bearing sports need both shock absorption and foot/ankle stability. Orthotic support can increase performance and prevent injuries in many individual and team sports.4

History of lower extremity stress fractures, recurring shin splints, hamstring strains. Whenever an athlete, whether recreational or competitive, reports symptoms of overuse injury (microtrauma) in the lower extremities, orthotics should be provided. These conditions are closely correlated with biomechanical asymmetries, and require better support and shock absorption.5-6

Chronic knee pain, patellofemoral arthralgia, ACL injury. The knee joint is a sensitive indicator of abnormal biomechanical stress, and these conditions have all been shown to indicate the need for orthotics. Controlling pronation decreases the rotational forces, improving patellar tracking and protecting the anterior cruciate ligament.7

Exam Findings

Postural imbalances (e.g., pelvic tilt, scoliosis, forward head). When a standing structural evaluation discloses any pelvic tilt, a lower extremity asymmetry requiring orthotics for proper correction is likely. Both functional and idiopathic types of spinal curvatures can benefit from the foot stabilization and neurological stimulus provided by orthotics.8 Many postural complexes (forward head is one of the most common) are secondary to poor standing balance and proprioception from the feet.

Gait asymmetry (e.g., calcaneal eversion, excessive pronation, foot flare). Looking for indicators of biomechanical asymmetry while a patient walks will often demonstrate the need for orthotics.9 If the foot and ankle complex is not functioning correctly during the stance phase of gait, this stress is transmitted to the pelvis and spine with every step.

Foot calluses, bunions, hallux valgus. Heavy callousing, bunion development and abnormal alignment all reveal evidence of abnormal or poorly tolerated forces during walking and indicate the need for improved biomechanics and orthotics.10

Lack of an arch (especially unilateral). This is seen during the weight-bearing portion of the exam, when a foot collapses under the weight of the body. A foot without an arch will not function properly and thus requires support.11

Knee instability, high Q-angle, poor patellar tracking. When the knee does not align properly or track correctly, degenerative wear-and-tear and other chronic symptoms will follow. Orthotic alignment is required to reduce the abnormal forces on this complex joint, which must be able to sustain frequent high forces during walking and running.12-13

X-Ray Findings

Scoliosis (functional or idiopathic), widespread disc degeneration. The spine will demonstrate poor support from one of the lower extremities by developing a lateral curvature. Gait disturbances may be one of the causative factors for idiopathic scoliosis. Significant intervertebral disc degeneration is proof of poor spinal shock absorption, and orthotics with viscoelastic properties often reduce symptoms dramatically.9

Unlevel sacral base, sacroiliac joint degeneration. The pelvis shows evidence of inadequate support by the appearance of a tilted sacral base when standing. This is often due to a functional short leg requiring orthotic support.14 Sacroiliac degeneration is unusual; when found, it indicates significant abnormal stresses.

Low femur head, coxafemoral DJD. These conditions are due to either an anatomical or a functional short leg. Degenerative changes in the hip joint have been correlated with the stress of a longer leg. Both will benefit from the improved balance and support provided by orthotics.14

Heel spur, DJD in knees, metatarsals. X-rays of the feet and knees may reveal evidence of long-standing regional stress, such as degenerative changes in weight-bearing joints and connective tissue calcification. Calcium deposited in the calcaneal attachment of the plantar fascia specifically indicates the need for support of the arches of the foot to help reduce shock and symptoms in degenerated joints, and provide arch stabilization.11

Treatment Response

Recurrent subluxations. Making the same adjustment to a patient's spine again and again suggests poor structural support for the region. Orthotics have been used for decades by chiropractors who don't want to continue adjusting the same area and who want to see the adjustment "hold" better.

Unresolving muscle strain, myalgia. Myofascial symptoms not responding to treatment often are a clue to an underlying biomechanical imbalance. Many chronic muscle spasms and strains can be corrected by providing orthotics to support and stabilize.15

Flare-ups, exacerbations. A patient who is feeling better, returns to daily activities, and then suffers a return of symptoms probably needs orthotics. Without proper biomechanical support, these patients find that every attempt to establish normal routines causes a recurrence of their symptoms.

Foot symptoms are only one of the many reasons for supplying orthotics. In fact, the feet are seldom painful in most of the conditions that are clear indicators of an need for orthotic support. All chiropractors must be alert for signs of lower extremity involvement in spinal conditions. The good news is that these conditions can all be helped. Investigation and correction of foot biomechanics can help most patients, especially the recreationally active and the elderly.

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Winn's goal is to help "Every Cat, Every Day" and we can only do this with your assistance. Stay in touch with our activities and learn how you can become involved in the future of feline health.

Join over 3,000 other cat lovers on our Facebook page.

Follow us on Twitter and help spread the word!

Subscribe to our email newsletter - we promise, no spam :-)
  

Virtual Memorials for special cats loved by special owners

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