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Pounding Pavement by Heel or Toe

Heel strike or toe strike?

With the fall marathon-training season in full stride, it is time once again to argue about running form. How a runner’s foot should strike the ground incites passionate debate among athletes and coaches, despite scant persuasive evidence to support either position.

But a noteworthy new study may help to quell the squabbling, by suggesting that each style of running has advantages and drawbacks, and the right way to run almost certainly depends on what kind of runner you already are.

For the new study, published in June in Medicine & Science in Sports & Exercise, researchers at the Tampere Research Center of Sports Medicine in Tampere, Finland, began by using motion capture technology to determine the running form of 286 young adults from the area who played team sports. None competed in distance running. All wore their normal running shoes during testing.

The testing showed that 19 of the women and 4 of the men struck first with their forefeet while striding.

These small numbers tally with other reports, most of which have found that an overwhelming majority of modern runners, whether male or female, slow or swift, are heel strikers. In a telling study published in May in The International Journal of Sports Physiology and Performance, almost 2,000 runners participating in a recent Milwaukee Lakefront Marathon were filmed midway through the event and their form analyzed. About 94 percent proved to be heel strikers, including quite a few of the fastest runners.

Similarly, when researchers in New Hampshire studied middle-of-the-pack runners during a marathon there, they found that almost 90 percent were heel-strikers according to filming conducted six miles into the event. Interestingly, of the remaining 10 percent, most had shifted to a heel-strike form when filmed again near the race’s end, as they tired.

Regardless, some running coaches and other experts question the wisdom of heel striking, noting that when runners don’t wear shoes, presumably the most natural way for humans to run, many, although not all, adopt a forefoot-strike running style. This suggests, enthusiasts say, that forefoot striking is the inherently right way for humans to run.

If so, however, forefoot striking should lessen the odds of a running-related injury. And it was that possibility that the Finnish researchers hoped to explore.

So they next matched the 19 forefoot-striking female runners with an equal number of female heel strikers of similar age, height, weight, and running pace. (There were too few forefoot-striking men to include them.)

The women were fitted with additional motion-capture sensors and filmed again while running. They also underwent measurements of leg and hip strength.

Plugging the resulting data into formulas validated in other experiments, the researchers determined just how much force the women were creating with each stride and, of greater interest, where that force was hitting hardest.

In general, the knees, ankles and Achilles’ tendons are the sites of most running-related injuries, previous studies have found. And in this experiment, many of the women runners jarred their knees, especially when they landed on their heels. That running form resulted in about 16 percent more force moving through the knee joint than when women landed near their forefeet. The elevated forces were particularly evident along the heel strikers’ kneecaps and the medial or inside portion of their knees, where the joint is known to be particularly vulnerable to overuse injuries.

But the forefoot strikers’ legs were not immune from force. They simply absorbed it differently, with almost 20 percent more force moving through their ankles and Achilles’ tendons than among the women who hit with their heels.

In essence, the findings show that you can’t escape the cumulative impact of running, however you stride, said Juha-Pekka Kulmala, a Ph.D. student, now at the University of Jyvaskyla, who led the study. Hit with your heels and you stress your knee, possibly leading to conditions such as patellofemoral stress syndrome. Strike near the ball of your foot and you’ll jolt your ankle and Achilles’ tendon, potentially increasing the risk of such injuries as Achilles’ tendinopathy, plantar fasciitis, and stress fractures of the foot.

There is, in other words, no one invariably right and painless way to run.

However, Mr. Kulmala said, the results also indicate that strategically altering how you land could be advisable for some runners. “People suffering from knee problems can benefit from forefoot striking,” Mr. Kulmala said. “Those who have Achilles’ tendon complaints can benefit from rearfoot striking.”

Switching form is not simple, though, as countless runners who have tried will attest. “I think that experienced runners are able to change stride pattern” relatively easily, Mr. Kulmala said. “But nonexperienced runners find it more difficult.” Consider contacting a local coach for advice, and have an obliging friend or spouse film you running, so you can document how your foot hits the ground. Incorporate any changes slowly, Mr. Kulmala cautioned.

And if you have little experience with injury and are comfortable with your stride, then by all means, stick with it, as is. The best running form, Mr. Kulmala said, is any that keeps you moving regularly.

Source: http://well.blogs.nytimes.com/2013/10/16/pounding-pavement-by-heel-or-toe/?_php=true&_type=blogs&emc=eta1&_r=0

 


 

Query: Intractable Dorsal Nerve Pain

How would you handle pedorthically?

I have a patient with nerve pain on the dorsum of her feet that is palpable in the first-4th innerspaces and extends just proximal to the metatarsocuneiform joints. The pain follows the pattern of the medial, intermediate, and lateral dorsal cutaneous nerve. She has no history of lower back pains or problems.  She has had no success with acupuncture.
 
I have tried Gabapentin, Lyrica, Cymbalta, and Savella with no relief. The patient had some relief with oral methylprednisone 5-10 mg, but it started to wear off over time, with the pain returning. Biomechanical taping and orthotics offered no relief. A BK cast to one LE offered no relief. She has had some minor relief with Lidoderm patches and pinpoint cortisone injections (those the injections gave her relief for only one week at best). I have also tried a compounding pharmacy topical medication for nerve relief, all to no avail. This condition has been ongoing for the past 3 years. Any suggestions about alternate therapy or injection therapy is welcome.
 
Randy Lisch, DPM,  Austin, TX

"I have come across a patient with almost the same diagnosis, with nerve damage at the dorsal aspect of the 3rd, 4th, and the 5th met shafts as well as the corresponding proximal phalanges. I fitted him with extremely soft leathered shoes, generously giving him adequate room, PLUS a rigid rocker sole to prevent the shoe from bending, and to minimize creasing over the affected area. We tried one pair. It worked. We subsequently added rockers on all his shoes."

Majid Fentas, C. Ped @ Eneslow
Shoes recommended with high toe boxes and soft leathers: Attiva, Mephisto, New Balance.

 

"I would play with the lacing on the shoes to see if there's a way to avoid pressure on the nerve."

Sarah Goldberg, C. Ped, EPI Educational Director, Eneslow

 

Source: http://www.podiatrym.com/search3.cfm?id=27143


 

Wearing Heels May Have Severe Consequences on Your Feet

By: Jill Urban for NY1 News 02/21/2014

Although they make your feet look good, wearing heels may actually have severe consequences for the health of your feet. NY1's Jill Urban filed the following report.

They're feminine, sexy and offer a whole lot of height.

Many women are high on heels, but they neglect to realize that over-wearing them can be a step in the wrong direction.

"Women do love their high heels, and rightfully so. They make a leg look fantastic. However, there are certain consequences with wearing high heels," says Dr. Thomas Goldman, a podiatrist from Mount Sinai Beth Israel.

Goldman says he often sees those consequences, like hammer toes, bunions, nerve and tendon issues, back pain and arthritis, just to name a few. Even with the fear of surgery, he knows that many women still won't bid those babies farewell. So NY1 stopped by Eneslow Shoes in Manhattan, where he offered some advice on how to have this fashion fix without a problem.

First, the incline is an anatomical disaster, so he says let your foot lay low.

"Stick with a two-inch heel. When you start getting up above that, try and wear a platform type of heel that raises both the front of the foot and the back of the foot. This gives the image of a higher heel. However, it keeps the foot in a more optimal anatomical position," Goldman says.

Try to switch to lower shoes when you can. Also, go to a store where you can be measured for the perfect fit.

"When they get measured for a high heel, they should be measuring from the heel to the ball of the foot, not from the heels to the toes. When they get measured from the heels to the toes, this causes issues with shoe fit, and the comfort drops dramatically," says Goldman.

He also suggests looking for a wider heel that's located directly under the heel for better support and weight distribution. Also, check for cushioning at the ball of the foot and support for the arch.

If all this has you willing to trade in those heels for a pair of flats, you need to be careful, too, because some flats fall flat.

"So on the other end of the spectrum, flat, flat shoes, which don't offer much support, this is not good for the lower back. It strains the arch and can create Achilles tendinitis from another way," says Goldman.

You need to find the right balance, so before you foot the bill for another pair of shoes, just remember the impact they'll have on your feet, because no matter how sexy the shoes, you won't look so sexy if you're hobbling around in them.

Source: http://www.ny1.com/content/lifestyles/wellness_report/203998/wearing-heels-may-have-severe-consequences-on-your-feet


Query: Crossover 1st and 2nd Toes in 14 Month Old

Crossover 1st and 2nd Toes in 14-Month OldMy patient is a 14 month old male, sent by the pediatrician for crossed 1st and 2nd toes. He recently started wearing shoes, and he seems uncomfortable when the shoes are on. The parents moved him into larger shoes, but he slides out of them.
 
According to the pediatrician, the child is otherwise healthy and has had normal childhood development and reached milestones appropriately. I'm looking for appropriate treatment ideas, or where the child can be referred for appropriate treatment

Picture: Crossover 1st and 2nd Toes in 14-Month Old

Answer: The good news is most toddlers do not need shoes to ambulate. If shoes are needed to protect feet from the elements, there are high toe box shoes distributed by Markell (http://www.markellshoe.com) and other vendors. Sandals will help free his toes from pressure and shear.
 
If we can help please let me know.
 
Robert S. Schwartz, C. Ped.
Eneslow Pedorthic Enterprises, Inc.
470 Park Avenue South @ 32nd Street, Front 2
New York, N. Y. 10016-6819
212-477-2300 x 207; Fax 212-353-2876
rss@eneslow.com
www.eneslow.com

Source: http://www.podiatrym.com/search3.cfm?id=27143

 


Query: Partial Plantar Facial Tears

Does anyone have any pearls for treating partial plantar facial tears? These patients are usually in agony with high levels of pain. I have dabbled in PRP and amniotic injections, but I have concluded that results are mixed. I have referred patients to colleagues for radio frequency ablation, also with mixed results. Is there someone with a treatment protocol with more consistent results?
Jeffrey Kass, DPM, Forest Hills, NY, Jeffckass@aol.com
 
Answer: Try a rigid rocker sole shoe with full contact footbed with relaxed support under the arch that allows ambulation with virtually no demand for foot and ankle motion in the sagittal plane. There is an increased demand on proximal joints and muscle groups. Broad base of support to reduce frontal and transverse forces will help. The focus is on the angle of rocker at the moments of contact and propulsion to reduce sagittal forces during their highest demand periods.
 
If we can help please let me know.
 
Robert S. Schwartz, C. Ped.
Eneslow Pedorthic Enterprises, Inc.
470 Park Avenue South @ 32nd Street, Front 2
New York, N. Y. 10016-6819
212-477-2300 x 207; Fax 212-353-2876
rss@eneslow.com
www.eneslow.com

Source: http://www.podiatrym.com/search3.cfm?id=27143


 

Compression therapy is gold standard of care for chronic venous leg wound treatments, Johns Hopkins Review

December 23, 2013

A systematic review of 60 research papers focused on the treatment of skin ulcers suggests that most are so technically flawed that their results are unreliable. And even of those that pass muster, there is only weak evidence that some treatments work better than standard compression therapy or special stockings.

The research review team, led by investigators at the Johns Hopkins Evidence-Based Practice Center and the Johns Hopkins Wound Healing Center, noted than an estimated $25 billion is spent annually in the United States treating chronic skin wounds related mostly to poor blood circulation, disorders known as venous ulcers. Their prevalence is rising along with rates of diabetes and obesity, and the review was undertaken in an effort to inform physicians about the treatment options.

In 2011, the Agency for Healthcare Research and Quality awarded the Johns Hopkins Evidence-Based Practice Center a $475,000 project to carry out the research, which was led by Gerald Lazarus, M.D., founder of the Johns Hopkins Wound Healing Center and professor of dermatology and medicine at Johns Hopkins Bayview Medical Center; and Jonathan Zenilman, M.D., scientific director of the Wound Healing Center and professor of medicine and chief of the Division of Infectious Diseases at Johns Hopkins Bayview.

The research review team began by identifying 10,066 citations that were possibly related to wound care. They found that only 60 of these papers specifically addressed their questions about the effectiveness of treatments for chronic venous leg ulcers.

For the study, the investigators analyzed clinical outcomes involving wound dressings, antibiotics and venous surgery. Overall results found that dressings that used living human cells increased wound healing. Results suggested that cadexomer iodine and collagen may also increase healing, says Lazarus. “That doesn’t mean that other types of dressings don’t work. It just means that there is no evidence yet on which treatments work the best,” says Lazarus. Support stockings, he adds, must for now remain the standard of care for treating chronic venous ulcers.Compression Hosiery for men and women

Lazarus says the review also showed evidence is inconclusive about using systemic antibiotics unless there are demonstrated signs of infection. And it is also inconclusive about such surgical treatments as radiofrequency ablation, endovenous laser treatment and sclerotherapy helped healing, although surgical correction of underlying pathology did decrease recurrence of ulcers.

“There is a critical need for well-designed research studies to compare the current minimally invasive surgical interventions to the gold standard of care, compression therapy,” he says. The Johns Hopkins researchers enlisted input from a panel of 14 experts in wound care in their review of the data.

Chronic wounds are a global problem, the researchers say. In addition to obesity and diabetes worldwide, skin ulcers occur as a consequence of neurological problems, rheumatological illnesses, blood vessel inflammation and infection. Non-healing wounds cause not only pain, but also loss of mobility and a general decline in physical and emotional well-being. Patients can become disabled, unable to work and dependent on care from others.

Lazarus says, “The review should serve as a means to bring the wound healing community together to improve the situation.” Christine Chang, M.D., MPH, medical officer of the Center for Outcomes and Evidence at the Agency for Healthcare Research and Quality, adds, “Our hope is that this evidence report provides patients and providers with the best information available to make well-informed decisions about care.”

The Johns Hopkins Wound Healing Center is located at Johns Hopkins Bayview Medical Center and specializes in diagnosing and treating chronic wounds, preventing wound recurrence and preserving limbs. Other investigators included Eric Bass, M.D., MPH, director of the Johns Hopkins Evidence-Based Practice Center; Fran Valle, DNP, MS, CRNP, assistant professor of nursing at the University of Maryland; Nisa Maruthur, M.D., MHS, assistant professor of medicine at The Johns Hopkins University; and Mahmoud Malas, M.D., MHS, FACS, associate professor of vascular and endovascular surgery, director of endovascular surgery and director of the Vascular and Endovascular Clinical Research Center at Johns Hopkins Bayview Medical Center.

Source: http://www.hopkinsmedicine.org/
Compression Hosiery @ Eneslow: Aetrex, Jobsts, 2XU.


 

Eneslow Celebrates 105 Years of Service

We Congratulate our Senior Team for over 145 Years of Continued Eneslow Service!

Wednesday, December 18, 2013
Dann Francis

Eneslow Excellent Service Awards 12-2013Every Wednesday at Eneslow's 470 Park Avenue South location, the Wednesday morning meeting commence at 9:00am. The purpose of this meeting is to discuss case studies, developing technologies, new footwear and advancements. It is also where vendors have an opportunity to visit and discuss with us current and new footwear, orthotics, etc. And most of all, how as a team we can better serve the public's needs. Whether it would be footwear, orthotics, or even shoe and coat drives for the less fortunate.

This morning was a celebration.

It was a morning of recognition as Eneslow honored 5 Senior members for their years of Excellent Service to Eneslow's Customers, Medical Prescribers and fellow staff members. Receiving this great recognition are Carlos Rivera, C. Ped. (20+ years); Raul Davila, C. Ped. (30+ years); Rocco Sena, Technician (30+ years); German Jaramillo, Master Technician (25+ years); and Robert S. Schwartz, C. Ped. and President (40+ years).

"As we enter into a new year, we will continue our commitment to serve our community."

From left to right: Carlos Rivera, Rocco Sena, Robert S. Schwartz, German Jaramillo, Raul Davila.

 


 

Happy Feet delivered in the "Grand Central" Neighborhood!

From Eneslow: Sarah Goldberg and Alan Rodesma.

The Eneslow team of Sarah Goldberg, Alan Ledesma, and Dann Francis joined with "Our Hearts to Your Soles" founder Matthew Conti and his team from Weill Cornel Medical College to help distribute shoes for men and women at the Grand Central Neighborhood Social Services located at 120 e 32nd St., NYC. It was a great feeling to be able to deliver "Happy Feet" to so many people who otherwise would continue wearing footwear that was already falling apart in this extremely cold weather. The boots and shoes were happily donated by RedWing Shoes.

Please remember that we are collecting gently worn shoes and coats to help continue the gift of giving to those in need. Help to keep someone warm and HAPPY!


Query: Bunion With Overlapping 2nd Toe

Re: Bunion With Overlapping 2nd Toe
From: Robert S. Schwartz, C. Ped rss@eneslow.com

The patient is a 43 year old female resident in a nursing facility. She is a former heroin user who has pain upon ambulation and difficulty wearing shoes. She has a callus submetatarsal 2. My first instinct was to amputate the second toe and address the bunion with an Austin, but the patient is totally against amputation. She doesn't walk around a lot in the nursing home. If I could trust her, I might consider a base wedge and head procedure, but I don't trust her to not bear weight, and she is really not able to use crutches (she suffered a brain injury when she was shot two years ago). I may try to do a 2nd met head resection and pin the toe, along with an Austin. Any suggestions?

Answer: The attached picture represents the type of sandal/open toe footwear that will accommodate her deformities, allow for pain free walking and provide a practical solution for her lifestyle. The vamp should have a soft upper to accommodate bunion and flap Velcro style closure on the lateral side; The rearfoot can have a closed back with quarter strap, or double instep uppers like Birkenstock Arizona or Finn Comfort Jamaica. The insole should include dispersion for 2nd met; rocker sole design will allow propulsion without undue force under 2nd met.

Disclosure: Robert S. Schwartz, C. Ped. Is president of Eneslow Pedorthic Enterprises, Inc. Eneslow manufactures and sells custom made footwear at their premises in NYC.


Source: http://podiatrym.com/search3.cfm?id=67268


The Good Old Days of Retail are Ahead of Us, Not Behind Us

http://www.linkedin.com/today/post/article/20130812124907-48342529-the-good-old-days-of-retail-are-ahead-of-us-not-behind-us 

Several years ago I started reporting about an emerging trend that is now in full bloom. It’s called showrooming and is the practice of selecting and examining products in a physical store but then purchasing those products online, either while in the store using a smart phone or later at home. Thanks to the dramatic and exponential advances in processing power, storage, and bandwidth, combined with smart phones enabled with the latest barcode and QR code readers, this trend is picking up steam and has been hurting the brick-and-mortar stores quite severely. Despite this trend, Apple stores, which ironically sell smart phones and tablets, are always crowded. But wouldn’t it be just as easy for customers to buy from Apple online and never go to an actual Apple store? Of course, the answer is yes. So why are they crowded? And why are companies like Amazon thinking about opening their own retail stores?

The answer is, Apple stores are not boring. These stores have employees that are passionate about what they sell. They have salespeople that understand the products and what they have to offer. They have an inviting environment, complete with a place for the kids to play so the parents can have some uninterrupted shopping time.

Apple, and stores like them, is helping us realize that the good old days of retail are in the future, not in the past. Right now, it’s possible to reinvent retail to make it an exciting and engaging place. Of course, this does not mean you have to copy what Apple is doing. Rather, it’s time to take what you do to the next level. Don’t adopt what Apple is doing; adapt what Apple is doing!

For example, let’s take something that’s going out of style — something that people think won’t exist in the future — and that is branch banks. I’ve spoken with many banking CEOs and they’re worried about their branches. Sure, some banks are opening branches, but many are closing them. As such, bankers wonder if there will be a branch bank in the future or if electronic banking will make them obsolete.

Think about it... when was the last time you went into a bank? I don’t mean using an ATM; I mean when you actually went inside the bank to do some business? Chances are it’s been a while.

Could a branch bank do something that gets their location packed with people eager to do business with them? Of course! In fact, The Royal Bank of Canada tried an experiment to Apple-ize their branches. Guess what happened? They’re now loaded with new customers, current customers, and prospects. They’re busy. Customers are engaged. And their employees are excited. There’s no more making an appointment to see someone, no more boring atmosphere, no more stoic employees who act as if the customer just interrupted their day, and no more emotionless transactions. They made the bank “the place” to be.

You can do the same. Sit back and take a look at the emotion of your store. When a customer walks in, does it seem like they’re going into a time machine backwards? Of course, if you’re selling something that relates to the past or is nostalgic, that’s okay. But it’s not an excuse to have a boring store with unengaged staff. Additionally, selling historic or nostalgic items is not what the majority of businesses are about. You want to make your store a place people actually want to be in. How?

  • Have some things for the kids to engage with while their parents shop, such as interactive toys or mounted tablets with games to use.
  • Make sure your employees understand that if they’re excited, the customer will get excited. Likewise, if they’re bored, the customer will be bored. And if they’re stoic, the customer will be stoic.
  • Train your employees in new and better ways of engaging with customers. After all, if you train them the way they’ve always been trained, they’ll continue to do what they’ve always done.

The key is to change the emotion, build excitement, and make visiting your store something people actually look forward to. Don’t just give customized help—give personalized help. That’s how you secure more business.

Personalized help is about building relationships. That means your salespeople aren’t just salespeople; they’re trusted sales advisors. As a result, customers seek out your staff for help—some even text their trusted advisor in advance to let them know they’re on their way. That’s how you create customer loyalty.

If Apple can have a loyal following of customers who see their stores as a place they want to go to shop, you can too. So look at what Apple does and ask how you could adapt that. Then, take it to the next level. For example, maybe you can’t have everything in stock, but by having kiosks and tablets available that can be locked in, you can easily let people have access to the entire inventory you don’t have in stock so they can purchase it on the spot and have it delivered to their home in 24 hours. If Amazon can deliver it to their home that fast, so can you.

So let’s not assume that the good old days of retail are in the past. I think we’re in the process of transforming retail, and that the good old days of retail are yet to come. Let’s create those days today. ###

DANIEL BURRUS is considered one of the world’s leading technology forecasters and innovation experts, and is the founder and CEO of Burrus Research, a research and consulting firm that monitors global advancements in technology driven trends to help clients understand how technological, social and business forces are converging to create enormous untapped opportunities. He is the author of six books including The New York Times best seller Flash Foresight.


 

Paving the Path for the Application of Biomechanics and Orthotics in Foot Care: Justin Wernick, DPM

Content provided by The O&P EDGE

Few names in the world of podiatry and biomechanics are as well known as Justin Wernick, DPM. His career as a practitioner, innovator, lab owner, and international academic lecturer spans more than five decades.

Early Loss Leads to Determination

Wernick was born in 1936 in the Crown Heights neighborhood of Brooklyn, New York. His early childhood was marked by loss. His mother died when he was three years old. He then went to live with his grandparents, who also both died when he was young—his grandfather when Wernick was six years old and his grandmother two years later. After that, he was raised by an aunt. He speaks of the lesson that he learned from these early losses with his characteristic pragmatism. “It made me realize that there was no one there for me,” Wernick says. “I would have to take care of myself.”

Wernick says he was “an average student, set to graduate with poor marks” and limited prospects. However, he remembers being impressed by the local chiropodist, who seemed to be “well organized and successful.” That physician gave him information about the pathway to podiatry school. Wernick says he discovered that if he could earn credits in biology, physics, and chemistry at Long Island University (LIU), Brooklyn campus, he would be able to transfer to the LIU College of Podiatry, Harlem, New York (now the New York College of Podiatric Medicine (NYCPM), which was under the administration of LIU, Brooklyn, at the time. No one in his family had gone to college, and despite the fact that there were no funds readily available, he began his college education with the clear goal of pursuing a career in podiatry. He enjoyed his three years at LIU and did well in his undergraduate studies, particularly in biology. During the school year, he worked the 6–10 p.m. shift at the post office to pay the $12 per credit tuition, and during the summers he worked in the Catskills’ resorts as a waiter.

After his third year of podiatric study, Wernick says he realized that he wanted to be a surgeon, so he applied to the pioneering podiatric surgical residency program at Civic Hospital, Detroit, Michigan, directed by Earl Kaplan, DPM. It was the only program of its kind in the country at that time, and there were only two residency slots available, neither of which was offered to Wernick. He says he was crestfallen when he learned that he had not been accepted. Despite the setback, his hard work and dedication paid off when he graduated in 1959 with a doctor of podiatry (PodD) degree from M.J. Lewi College of Podiatry—the former LIU College of Podiatry, which had been renamed after the affiliation with LIU ended in 1957.

Launching a Podiatric Career

Having completed his studies, Wernick was required to complete mandatory national service, so he joined the Army Reserves at Fort Dix, New Jersey. In April 1960, he commenced his professional career covering a very busy chiropody practice in Midtown Manhattan, New York. He and his wife were living with his mother-in-law when he found a built-out office for rent in Seaford, Long Island, New York.

He opened his practice in January 1961, willing to tend to any foot complaint for $5 a visit. In that first year, he grossed a meager $3,000, which left little for salary. Around that time, Gouverneur Hospital, Manhattan, was opening a new podiatry clinic. Wernick began working there part time to supplement his income. He and his wife were living in a rental studio when their daughter was born in 1963. Eventually they bought a house in Massapequa, Long Island, which was set up with a private physician’s office. He was now working at three practices and beginning to do well financially.

New Theories Lead to Innovative Foot Orthotics

A major turning point in Wernick’s views of podiatric practice came in 1963 when he first heard Merton Root, DPM, speak at a podiatry conference. Root, a podiatrist from San Francisco, California, was part of a physicians group that was developing new theories regarding foot function and pathology. Prior to this, little was understood about foot function and the internal joint relationships. Rather, feet were examined statically and characterized and treated based on descriptions of outward appearance, such as fleshy, high arched, or flat.

Wernick with his daughter, Elissa Wernick, who is a podiatrist as well. Photographs courtesy of Justin Wernick.

Wernick intuitively realized this new science, although complex, was worth understanding. After that meeting, a group of podiatrists invited Root back to New York so they could learn more. They had to pay his airfare and expenses, but he agreed. They flew him out about every three months, persistently asking him questions, tape recording his sessions, and then debating the answers among themselves. Wernick says, “We realized there was a cohesiveness and science to the orthopedics, more than had been taught up to this [point]. It included a basis for measurement, and it was also predictive.”

As the New York group’s understanding developed, they began to experiment making the new style of functional foot orthotics from an acrylic material called Rohadur. Wernick and his colleagues began taking patients’ plaster casts non-weight bearing with a neutral reference position. Gait, which had previously been ignored, also became part of their treatment equation. They started to see results. However, there were no labs making these devices, so they had to fabricate the orthotics themselves.

Soon Wernick was being invited to share his knowledge, and he started to lecture informally to podiatry groups. He also began working closely with Sheldon Langer, DPM, whom he had met in the study group that he was running, and they covered for each other at their respective private practices.

Wernick says that in 1968 he and Langer decided it would be beneficial to teach someone else how to manufacture the new type of orthotics. Because Wernick was lecturing nationally, and they wanted to avoid any appearance of impropriety, they named the business Langer Acrylic Lab. In 1969, each invested $5,000 to build and outfit a small garage behind Langer’s house, where they worked at night. The business plan was simple, Wernick says: “Train one technician, get a few podiatrists to send us their work, and that way we could pay [the technician] and have our own devices made.” From this humble beginning, Langer Biomechanics was launched.

Academia and Growing Business Ventures

Wernick’s academic career continued to grow as he became a member of the faculty at his alma mater in 1969 and began to teach biomechanics. Together, Wernick and Langer attended conventions, demonstrated casting techniques, and slowly converted the profession. There was a clear market for functional orthotics. In the early 70s, they moved to a larger facility and hired more skilled technicians to run the lab. This freed them to travel and educate new customers. They began the Langer Newsletter, a technical bulletin that furthered the science and understanding of biomechanics. They continued to expand the business and sought newer materials to work with. Through testing, they eventually developed and trademarked the polyethylene Sporthotic®. They also introduced the material Professional Protective Technology (PPT) from Rogers, headquartered in Rogers, Connecticut, to the profession, and became the exclusive distributor.

The arrival of the American running boom in the mid-70s coincided perfectly with the advances in the understanding of biomechanics and orthotics in the podiatric sphere. There was an explosion in demand for sports medicine, and podiatry and orthotics were seen as critical components in keeping runners injury free. They started receiving calls from all over the country seeking referrals for a sports podiatrist, which led Wernick and Langer to become involved in the early development of the American Academy of Podiatric Sports Medicine. They also frequently ran weekend seminars with top faculty that attracted more than 400 attendees.

Langer Acrylic Lab continued to grow, eventually expanding nationally with locations in California and one in Chicago, Illinois, as well as a larger facility in Deer Park, New York. With the backing of an investor from the United Kingdom, they opened a facility in England in 1980, and also added sales offices in Japan and Israel. While the company was successful, its rapid growth came with challenges in the form of competition from offshoot labs and debt used to fuel growth.

Wernick and Langer continued pursuing new technology in the orthotic and podiatric industry with the development of the Electrodynogram (EDG), an in-office gait-analysis instrument that used seven plantar foot sensors, and the Langer TRAFO, a tone-reducing AFO for children with cerebral palsy. There was also a plan to open TRAFO clinics across the country, but expansion required additional funds in the form of outside investors. This drove the decision to first cede 10 percent of the company to a venture capitalist and then to take the company public in 1984. At that point, the company had grown from a small backyard venture, and Wernick had persevered from a student working part-time jobs to pay tuition to a businessman with a 20 percent interest in a company valued at more than $17 million.

The 1980s saw changes in the business climate for orthotics as physical therapists and chiropractors entered the arena and competition from smaller labs intensified, driving down profit margins. The financial constraints of the situation caused them to close down the Chicago location, and Wernick says it led to additional tensions between the partners, ultimately resulting in Langer leaving the company. Wernick describes this as “the most stressful period of my life.”

By the 2000s, Wernick had scaled back his involvement in the day-to-day operations of the lab. He had remained active with lecturing throughout his business ventures and podiatry practice, as well as maintaining faculty status at NYCPM, eventually becoming the chairman of the department of orthopedics. He also joined the staff of Eneslow Pedorthic Institute, New York, New York, as the medical director, where he had taught classes beginning in 1999. He officially retired from academia in 2012 after 44 years of providing education.

While he no longer actively practices, Wernick says he passionately believes in the value and significance of foot care. “By caring for feet you can genuinely change people’s lives. Foot health directly affects quality of life.” For those interested in providing foot care, his advice is simple, “Find an area of expertise, develop yourself, and market it. There are well over 300 million Americans…600 million feet! There is plenty of potential and opportunity to find a niche. But you must be able to demonstrate your value.”

Wernick’s long career and his dedication to his profession demonstrate the lesson he says he learned in childhood, “No one is going to do it for you.”

Séamus Kennedy, BEng (Mech), CPed, is president and co-owner of Hersco Ortho Labs, New York, New York. He can be contacted via e-mail at seamus@hersco.com or by visiting www.hersco.com



Where Did All the Pears Go? How Your Body Shape Determines Your Metabolic Destiny

JJ Virgin
Fitness/Nutrition Expert, Author of NY Times Bestseller The Virgin Diet.

A recent study in the Journal of the American Society of Nephrology showed that among other health problems, apple shapes have a greater risk of kidney disease.

"We found that apple-shaped persons -- even if totally healthy and with a normal blood pressure -- have an elevated blood pressure in their kidneys," said researcher Dr. Arjan Kwakernaak. "When they are also overweight or obese, this is even worse."

The study caught my attention because it shows once again obesity's wide-range damage, but also because the terms "apple" and "pear" have fallen out of favor. Today we're more prone to say someone has a "potbelly," "beer belly, or "gut." I don't hear too many fruit-shaped descriptions for overweight people.

Once upon a time, however, we had both shapes wandering about. If you're not familiar, apple-shaped people store fat above their waist with skinny legs and visceral fat that surrounds their internal organs, inflicting serious metabolic havoc.

Pear-shaped folks, on the other hand, have what's called subcutaneous fat directly under their skin that typically hangs out on their hips, thighs, and butt. In other words, pears store this less-harmful fat below their waist -- think J-Lo or Kim Kardashian as modernday pear shapes.

Over the years, I've noticed pear shapes have largely disappeared. A 2007 study in the journal Obesity (Silver Springs) showed that among middle-aged Americans, 50 percent of men and 70 percent of women now exceed the waist circumference threshold for abdominal obesity. In other words, the majority of them fall into the apple category.

I'm seeing a lot more apples these days, and the repercussions aren't pretty. I don't just mean aesthetically, even if an ever-expanding midsection isn't exactly a pleasant picture.

The Journal of the American Society of Nephrology study mentioned inflammation and insulin resistance as key culprits for increased kidney disease. Actually, they contribute to pretty much every problem with apple-shaped people.

Take insulin resistance. A 1999 study in the Journal of Clinical Endocrinology and Metabolism found apple shapes more prone to insulin resistance, setting the stage for diabetes. Another study that looked at Asian Indians in the journal Diabetes Care also showed visceral fat increases your diabetes risk.

Insulin resistance is a key component of metabolic syndrome, a nasty cluster of issues that also includes high blood pressure and increased cardiovascular issues. Apple-shaped folks are more prone to these issues as well as Alzheimer's and several cancers.

Chronic inflammation also contributes to about every disease on the planet. Being overweight exacerbates that problem, since fat cells are highly inflammatory.

Fortunately, no one is doomed to remain apple-shaped. These seven strategies help balance your blood sugar and optimize fat-burning hormones to make you lean, muscular, and healthy:

1. Start every morning with a protein shake. Breakfast is my favorite meal (said no one ever). Morning franticness means you're likely to grab a low-fat muffin (an "adult cupcake") with your grande dark roast as you race to your office. A sugary breakfast will crash your blood sugar and send you racing for a late-morning pick me up. Opt instead for a quick, delicious protein shake. One study in The American Journal of Clinical Nutrition showed a high-protein breakfast curbed hunger far better than carbohydrate-heavy "diet" cereals and low-fat muffins. Load plant-based (but not soy) protein powder with frozen berries, kale, chia or flax seeds, and unsweetened coconut or almond milk for a fast, filling meal that keeps you focused for hours.

2. Make your meals the right combo. A big bowl of pasta is a glycemic nightmare that puts you on a metabolic roller coaster that crashes with cravings, hunger, and storing fat. Focus instead on lean protein, healthy fats, loads of leafy greens, and slow-release high-fiber carbs that balance your blood sugar and keep you full for hours.

3. Address food intolerances. Highly-reactive foods create inflammation and numerous symptoms as well as stall fat loss. One recent study in The Journal of Nutrition Biochemistry found a gluten-free diet helps reduce inflammation and insulin resistance so you burn fat faster. Try an elimination diet and remove gluten, soy, dairy, and other highly reactive foods for three weeks. You're likely to notice a big difference on the scales and with your skinny jeans.

4. Drink up. Optimal hydration keeps your metabolic machinery running smoothly. While your body is about 70 percent water, dehydration can drop it to 40 or 50 percent. Keep a canteen and sip throughout your day, beginning with 16 ounces upon waking and ending with a glass of water before bed. The only time I don't want you drinking is during meals, when too much liquid can dilute your stomach enzymes that break down protein. Otherwise, drink away! If you're not overly fond of water, keep spa water in your fridge with orange, lemon, or cucumber slices.

5. Get seven to nine hours of sleep every night. Besides making your morning miserable, sleep deprivation knocks your fat-burning and other hormones completely out of whack. Everything -- and typically, everyone around you -- suffers. A study in the Journal of Applied Physiology found sleep deprivation contributes to insulin resistance, weight gain, and eventually diabetes. Aim for at least seven hours of high quality, uninterrupted sleep every night. Power down the hour before bed by turning off electronics, taking a hot bath with some chamomile tea, and unwinding with deep breathing or meditation.

6. Chill out! Stress makes you fat in more ways than you might imagine. Sure, a high-intensity blowout with your partner might lead you to the double-fudge brownies, but stress also raises cortisol, which does two things really well: this hormone breaks down muscle and stores fat. A study in the journal Obesity (Silver Springs) found something you probably know too well: Stressful life events raise cortisol and trigger stress eating, leading to fat gain. Stress management is not a luxury, so take some me time with a massage, lunch with your bestie, or maybe just a walk around the block with your dog.

7. Burst to blast fat. Could too much gym time be making you fat? I know it sounds crazy, but over-exercising or doing the wrong kind of exercise could raise cortisol and become counter-productive. Skip the elliptical machines and aerobics classes (those went out with legwarmers!) for burst training, which involves high-intensity 30-60 second blasts of exercise intermittently with one- to two-minute rest periods. A study in the Journal of Obesity showed that burst training's benefits included reduced insulin resistance, increased glucose tolerance, and enhanced fat metabolism. You don't need special equipment to do burst training. A hill or even the mall or hotel staircase makes a perfect place to blast fat.

References


 

NY Podiatrist Recommends Barefoot Therapy at Home

No matter who walks (or limps) into her office at Midtown Podiatry with a foot injury, Dr. Emily Splichal offers the same prescription: barefoot therapy. “When I send patients to physical therapy, on [the prescription] I’m saying, ‘Must be barefoot.’ It’s the foundation of every patient’s rehab,” Splichal said.

For patients who don’t require physical therapy, Splichal has them brush their teeth while barefoot and balancing on one leg. “When people think about barefoot, they think about running,” she said. “But I don’t want them to — I want them to think about training, rehab, performance.” Splichal recommends strengthening the foot and ankle via a series of at-home exercises — done barefoot, of course.

Source: Christine Lin, Epoch Times [6/19/13]





 

 2nd Avenue Restaurant And Retail Week Kicks Off Saturday

Dozens Of Businesses To Participate; Runs June 1 - 8

NEW YORK (CBSNewYork) - 2nd Avenue Restaurant and Retail Week starts Saturday to help businesses struggling from the subway construction.

Discounts and specials will be offered by 27 restaurants and 30 retailers of businesses and will run through June 8. They run from 66th Street to 97th Street.

“It has been our objective to help those businesses that are already here to survive,” Nancy Ploeger, President of the Manhattan Chamber of Commerce, told WCBS 880′s Monica Miller.

LINK: See The List Of Businesses

The excavation of the 2nd Avenue Subway has made restaurant and business owners on the Upper East Side dig deep into their pockets to survive.

“Next door to me is a stationery store and a kitchen store and all I hear them do is cry,” said Bob Schwartz on Friday. He owns Eneslow Shoes between 78th Street and 79th Street.

He said the ongoing construction is stopping the foot traffic he needs.

“I love this 2nd Avenue Restaurant and Retail Week. It’s strong in that it’s focusing in on this corridor that’s really hurting,” he said. “We need this construction to be over.”

The MTA’s Dr. Michael Horodniceanu said the current stretch of the subway project won’t be done until December 2016.

“We are trying to not just have helped the businesses survive, but prosper,” he said.

Many business owners hope that, when completed, the subway will be good news for them.

350,000 people are expected to use the line, designated the T, on day one, according to a federal estimate.

Reference: http://newyork.cbslocal.com/2013/05/31/2nd-avenue-restaurant-and-retail-week-kicks-off-saturday/

 



As Subway Construction Continues, Struggling 2nd Avenue Businesses Try to Stay Afloat

5.31.13 at 3:37pm by Stephanie Colombini

The 2nd Avenue "Restaurant and Retail Week" runs June 1-8, 2013.

Shops and restaurants along Manhattan's 2nd Avenue are calling on customers to step through the scaffolding and take part in the avenue's Restaurant and Retail Week which starts tomorrow.  

Businesses have been suffering due to construction for the 2nd Avenue subway line.  They'll be offering specials and discounts as incentives for customers to help keep them alive through 2016 when construction's expected to wrap up. 

Bob Schwartz owns a shoe store on Seventy-ninth Street, close to one of the MTA's primary construction tunnels.  He says the biggest problem for local business is the lack of street traffic.

It's not 'Let's go for a stroll on 2nd Avenue!  We'll go for a stroll on the cross streets, let's go over to the park"...There's nobody walking up and down 2nd Avenue right now."

Schwartz is also the chair of the 2nd Avenue Steering Committee and works with local merchants to boost the economy throughout the area.   He says the construction's been tough on his business, but he's doing okay because most of his customers are referred to the shop.  According to Schwartz, places that rely heavily on passers-by for customers like stationary and hardware stores have it the worst.

"It's such a struggle as they go through their numbers, borderline staying in business."

Schwartz says the potential success once construction's finished should be well worth the wait.  The MTA estimates the Second Avenue subway line will transport over two hundred thousand commuters per day once up and runnning.

Reference: http://www.wfuv.org/node/43313




Small Business Saturday Lets the Locals Shine

By Kristen Meriwether
Epoch Times Staff

Robert S. Schwartz, president of Eneslow Pedorthic Enterprises Inc. sits at his store with an employee in Midtown Manhattan, N.Y., on Nov. 21. (Amal Chen/The Epoch Times)

Robert S. Schwartz, president of Eneslow Pedorthic Enterprises Inc. sits at his store with an employee in Midtown Manhattan, N.Y., on Nov. 21. (Amal Chen/The Epoch Times)

NEW YORK—While the big box stores get all the attention for rock bottom bargains on Black Friday and the Internet grabs eyeballs for slashed prices on Cyber Monday, there are deals to be had in between—and local deals at that.

Enter Small Business Saturday; an initiative to give local economies a holiday spark by supporting locally owned small businesses.

“It is important to support our small businesses. They support us all year long,” said Congresswoman Carolyn Maloney during an event at Eneslow Shoes on Tuesday. “They are the backbone of the economy. The majority of new jobs are created by small businesses in our country.”

For small businesses, copying the big box stores and offering steep discounts is impossible and not the major driver for success. Unlike Black Friday deals, the selling point isn’t the lowest price on an goods, but the intangibles a big box store can’t offer.

Money is not the only incentive. It has to be constantly reminding the consumer why we are here and why they need to shop in our store.

—Bob Schwartz, president of Eneslow Shoes

“They love the personalized service they get when they go to the shop up the street,” said Patricia Norins, spokesperson and adviser for Small Business Saturday (SBS). Norins said small-store owners often refer to their customers by name and can offer individual attention and holiday shopping advice because they have known the customer for years.

Eight-year client Adie Rogula is helped by Eneslow Pedorthic Enterprises Inc. employee Steven Tlumack in Midtown Manhattan on Nov. 21. (Amal Chen/The Epoch Times)

Eight-year client Adie Rogula is helped by Eneslow Pedorthic Enterprises Inc. employee Steven Tlumack in Midtown Manhattan on Nov. 21. (Amal Chen/The Epoch Times)

SBS was created in 2010 by American Express to address the most pressing needs of small-business owners: higher demand for their products or services and more customers. The credit card company is offering a $25 statement credit when consumers enroll with their Amex card and spend $25. In addition 40,000 winners were selected to receive a $25 gift card, hopefully to be used Saturday.

In just its third year, the holiday, which falls on Nov. 24 this year, is gaining momentum. For the first time, the U.S. Chamber of Commerce rallied 50 of its members, including the Manhattan Chamber of Commerce, to drum up support.

“We want the small businesses to survive,” said Nancy Ploeger, president of the Manhattan Chamber of Commerce. “We feel very badly about the storm and all the small businesses that have been harmed throughout New York and New Jersey. We encourage local communities to shop at those stores as well.”

Bob Schwartz, president of Eneslow Shoes, said that in addition to personalized service, shopping locally owned means keeping the money in the neighborhood.

“It is in all of our best interest,” Schwartz said at his Upper West Side store on Tuesday. “If you live locally, but shop via the Internet, all those sales tax dollars are going to somebody else.”

Local tax revenue gets spent on such things as infrastructure improvements, police, fire, and schools.

A view of the Eneslow Pedorthic Enterprises Inc. store in Midtown Manhattan on Nov. 21. (Amal Chen/The Epoch Times)

A view of the Eneslow Pedorthic Enterprises Inc. store in Midtown Manhattan on Nov. 21. (Amal Chen/The Epoch Times)

 

Next Step

To help engage more customers, and compete with the incredible volume of deals consumers are enticed with on Black Friday, locally owned businesses are starting to offer more deals on Small Business Saturday.

“In the past, small business were not keen on offering discounts,” Norins said. “That is not what they are known for. They create their niche on the customer service side of the business.”

Norins reports that 67 percent of the small businesses that have chosen to participate in SBS will offer discounts. The results: shoppers are actually budgeting money for the event.

According to American Express, of the consumers who shopped on SBS last year, 70 percent of them plan to spend an average of $100 on the 24th. The SBS Facebook page has 3.1 million fans.

Long Term Business

But, Small Business Saturday is only one day, and Schwartz believes small businesses need to offer incremental marketing and add value to keep people coming back.

“Money is not the only incentive,” he said. “It has to be constantly reminding the consumer why we are here and why they need to shop in our store.”

In addition to the credit Amex is offering, Schwartz is giving an additional $25 gift card to his customers who buy at least $100 on Saturday. For the first 20 customers who purchase at his store on Nov. 24, Amex is providing an additional $25 gift card, an incentive given to businesses like Eneslow Shoes who are being affected by the Second Avenue Subway construction.

But the biggest incentive Schwartz can offer holiday shoppers is the thing his business has been known for, for over 100 years—high quality customer service.

“The great thing about Eneslow is our people are seasoned professionals committed to a career in helping people. That is what has kept us alive,” Schwartz said.

Reference: http://www.theepochtimes.com/n2/united-states/small-business-saturday-lets-the-locals-shine-317625.html



Mohsin Hamid

By KATE MURPHY

Published: March 23, 2013 

Mohsin Hamid, a Pakistani writer, is the author, most recently, of “How to Get Filthy Rich in Rising Asia.” The film adaptation of his best-selling book, “The Reluctant Fundamentalist,” will be in theaters April 26.

 
  Diego Ibarra Sanchez for The New York Times

 

READING I’m often reading multiple books at the same time. They are for different moods. It’s kind of like surfing the Web and having multiple windows open at the same time, only in a much slower fashion. I’ve just begun “Basti,” a novel by one of the great Urdu-language fiction writers, Intizar Husain. “Basti” means village, so I suspect it will have to do with a village as a microcosm for India and Pakistan’s partition and the different religions that used to coexist within them.

And I’m about halfway into “Lightning Rods,” by Helen DeWitt, which is also fiction. It’s a story told in business-ese about a man who comes up with the idea that he should install women in offices whom men can have sex with, thereby reducing the risk of sexual harassment. Thank goodness it’s written by a woman. I think it would be less appealing to read if it were written by a man. It’s just outrageous and really quite unusual. I think and hope that it’s a very sharp critique of sexual politics and market-based economy gone mad.

LISTENING John Lee Hooker is one of my all-time favorites. I’ve been listening to him since I was a teenager growing up in Pakistan and got into the blues. In a weird way, Lahore is a big river city like the various American cities that have to do with the Mississippi. Blues territory, in other words. The blues is pitched with the emotions and resonance and feeling of a lot of Punjabi folk music, which is what I grew up with.

WATCHING “Zero Dark Thirty.” It’s a very well-made film. But I didn’t particularly feel there was a humanization of Pakistan and that part of the world. Of course, there needn’t be. So I guess on its own terms, it was a successful film, but perhaps its success was in a direction that was different from my own sensibilities.

FOLLOWING 3QuarksDaily.com. I think it’s one of the most interesting aggregator blogs out there. It puts together stuff from art, science, philosophy, politics, literature. It’s a completely international, cosmopolitan place to get information. It’s become my entry point to reading on the Web.

CUSHIONING I tend to walk a lot — an hour and a half every morning. At some point I developed a pain in my foot. I was in New York and went to this really great shoe store called Eneslow on Park Avenue South, and the salesman recommended these Birko Balance cork inserts to put in my shoes. They are just fantastic — a real walking enabler.

COMPUTING I’m pretty Appled up: iPhone, iPad, Air. Kind of disturbed by that, actually. I fell in love with the underdog and now they’ve become this world-dominant thing. It was like I was rooting for the 13 colonies and somebody handed me the United States superpower.

Reference: http://www.nytimes.com/2013/03/24/opinion/sunday/mohsin-hamid.html?_r=0


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