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Bridging the Gap

By Emily Thurlow

With classic Christmas carols softly emanating from a TV across the room and an Irish wolfhound named Veren panting rhythmically a short distance behind her, Barbara Chiampa pedaled a stationary bicycle on a recent afternoon at Mont Marie Rehabilitation & Healthcare Center’s therapy gym.

With guidance from Reliant Rehabilitation physical therapy assistant Tara McCauley, Chiampa was working on improving her balance and walking. After noting improvement in her gait and movement with a handheld assist, Chiampa paused for a few kisses from Veren, a 2-year-old therapy dog.

The staff at the Holyoke facility benefits from the canine too, said his handler, registered occupational therapist Sylvia Korza of Reliant Rehabilitation. “He comes to work with me, and he loves everybody. He’s great for therapy — even the staff. He helps lift everyone’s mood.”

The gym, which was expanded in 2016, features several pieces of equipment dedicated to improving mobility, including parallel bars and practice stairs. Beyond the machines, the therapy gym offers opportunities for McCauley and Korza to customize regimens that are tailored to the specific needs of patients recovering from medical procedures, injuries, or illnesses.

The therapy offered at the center’s gym is one of multiple subacute rehabilitation care services offered at the 84-bed Mont Marie facility, which was built in 1962 and formerly owned and operated by the Congregation of the Sisters of St. Joseph. In 2014, Mont Marie was purchased by Tryko Partners, which is headquartered in New Jersey, and is managed by its healthcare subsidiary, Marquis Health Consulting Services. Mont Marie is one of 10 of Marquis’ facilities in Massachusetts.

In recent years, the licensed nursing facility’s short-term rehabilitation care services have continued to grow, adding new programs and certifications, to meet the growing needs of the community.

A need for subacute or short-term rehabilitative care can emerge after a hospital stay for hip surgery or a stroke, or if an individual needs some physical strengthening or medication management, said Natasha Pieciak, administrator at Mont Marie.

“Baby Boomers are getting older, so as the population ages, there’s more of a demand for supportive services. We’re not a hospital — we’re kind of like a step down; we’re supportive services to bridge that gap between home-care services and the hospital.”

Initially, the 26-bed first floor was dedicated to this service, but it has since expanded to the 29-bed second floor as well. At times, admissions have jumped as high as 50 per month.

“There are a lot of factors that influence this growth,” said Pieciak, who has served as administrator of the center since September 2022. “Baby Boomers are getting older, so as the population ages, there’s more of a demand for supportive services. We’re not a hospital — we’re kind of like a step down; we’re supportive services to bridge that gap between home-care services and the hospital.

“With the aging population, I think these services become more needed out in the community, so we’re here to support people in that way, so they can be successful at home. People want to be at home, so we’re really here to try to support them to get them ready to do that.”

Barbara Chiampa

Barbara Chiampa pedals an exercise bicycle at Mont Marie Rehabilitation & Healthcare Center in Holyoke.

Through Mont Marie’s partnerships with Baystate Medical Center in Springfield and Holyoke Medical Center, as well as referrals from Mercy Medical Center in Springfield and Cooley Dickinson Hospital in Northampton, Pieciak said Mont Marie has been made aware of the growing demand for these rehabilitative services.

“We work closely with our partners within the hospital systems; we collaborate,” she said. “With Baystate, for example, we have weekly calls with their accountable-care organization management team, who will follow a patient from hospital to home, and we communicate with them, and they tell us what they’re seeing, what their needs are. We’re just really building that relationship and working with them to help identify and meet the needs that we’re seeing out in the community.”

“The goal of these specialty programs is to educate and train the residents how to manage and live with their conditions.”

In working with Baystate, Pieciak said Mont Marie has become one of two skilled-nursing facilities that have qualified for a waiver for the three-day requirement under the Medicare Shared Savings Program. The waiver eliminates the requirement to have a three-day inpatient hospital stay prior to a Medicare-covered, post-hospital, extended-care service.

What this means, Pieciak explained, is that, if a patient is in a hospital emergency department but don’t have a three-day stay, instead of going back home and potentially falling or fracturing a hip, they could go to Mont Marie as long as they meet a skilled need.

“This is huge because there’s a gap there,” she said. “Residents would go home and could potentially have worse outcomes. What we’re doing is bridging that gap from hospital to home.”

In addition to physical and occupational therapies, Mont Marie’s subacute rehab offers speech therapy up to seven days a week.


Life Goals

Within its major focus on subacute rehabilitation care, Mont Marie offers three specialty programs: cardiopulmonary, chronic kidney disease management, and heart failure.

“The goal of these specialty programs is to educate and train the residents how to manage and live with their conditions,” Pieciak said.

Natasha Pieciak

Natasha Pieciak says Mont Marie works closely with its partners within hospital systems.

The cardiopulmonary rehabilitation program is physician-led under the direction of a pulmonologist and focuses on helping patients achieve the most active life possible despite any physical limitations and/or cardiopulmonary diagnoses. The program, which is geared toward individuals with diagnoses of chronic obstructive pulmonary disease (COPD), post-lung transplants, emphysema, and acute respiratory failure, offers access to lab and radiology services, tracheostomy care and management, nebulizer therapies, bladder scanning, and several oxygen therapies, including liquid nitrogen.

The renal program is focused on reducing symptoms of chronic kidney disease, increasing a patient’s quality of life, and promoting independence. Mont Marie offers onsite dialysis provided by American Renal Associates, consultative visits by staff nephrologists, diabetic management and education, a monthly support group, and health coaching.

In October, Mont Marie received its skilled-nursing facility heart-failure certification from the American Heart Assoc. (AHA). In order to be considered eligible for this certification, facilities must be located in the U.S. or a U.S. territory and implement a heart-failure program that uses a standardized method of delivering clinical care based on current evidence-based guidelines.

“This was a huge accomplishment,” Pieciak said. “There are very few facilities that are credentialed. The American Heart Association has armed us with innovative methods and additional tools so that we can be trailblazers and give our heart-failure patients the best care.”

The vetting provides an evidence-based framework for evaluating skilled-nursing facilities against the AHA’s science-based requirements for heart failure patients, including care coordination, clinical management, quality improvement, program management, and patient and caregiver education and support.

According to the AHA, nearly one in four heart failure patients are readmitted within 30 days of discharge, and approximately half are readmitted within six months. It has also been suggested that about 25% of readmissions may be preventable.

“We’re trying to get ahead of hospital readmissions,” said Raymonda Sample, the lead for the heart-failure program and unit manager.

With the certification, Mont Marie has been provided with access to centers on treating heart failure and its co-morbidities.

Sample noted that one of the biggest benefits to the staff’s education on the heart-failure program is being able to educate patients on how they can live more independently with fewer flareups of their disease.

To that end, Mont Marie uses what’s called a ‘zone tool.’ The traffic-light color-coded guide indicates an all-clear, or green, when a patient has no shortness of breath; chest pain; swelling of the feet, ankles, legs, or stomach; or weight gain of more than two pounds. It’s time to call a doctor if a patient is in the so-called warning (yellow) zone, when they’re experiencing dizziness; dry, hacking cough; more shortness of breath; uneasy feelings; no energy; difficulty breathing when lying down; swelling of the feet, ankles, legs, or stomach; or weight gain of three or more pounds in one day or five pounds in one week.

A medical alert, or red zone, is when the previous symptoms have been exacerbated and a patient is having a hard time breathing or is experiencing unrelieved shortness of breath while sitting still, chest pain, or confusion.

In addition to this tool, Sample has created an entire guide board for staff that she also uses to educate family members of patients. The tool helps provide a better continuity of care, she explained.

“With this education, we are able to identify how the patient is feeling for the day,” she said. “If say, the patient is in the middle of therapy and they’re feeling short of breath, or telling the therapist maybe they haven’t eaten much in the last couple of days, or not sleeping well — there’s a sort of board out there where you can see the different signs and symptoms of heart failure.”


Safe at Home

Even though a patient has a plan in place to be discharged from the facility following treatment at Mont Marie, care doesn’t end at the door.

“When we discharge patients, we do follow-up calls with the patient just to find out how the transition back home goes, the home care services … we make sure they’re seen by their primary-care physician within 10 days, and if they don’t have a scale, we make sure we send them home with one,” Sample said. “This is so both our patients and the staff recognize the signs and symptoms of heart failure, so we can try to avoid rehospitalization.”

Health Care

The Next Step

By Mark Morris


Jack Jury

Jack Jury says today’s joint-replacement patients experience less pain and a shorter rehab than in the past.

As we age, it’s not unusual for our joints to become worn down from decades of use. For most people, their knees, hips, or shoulders will develop painful arthritis and need some kind of attention.

When a patient suffers from especially severe joint pain, doctors usually begin treatment by recommending physical therapy, as well as pain medications or an assistive device such as a cane or a walker. When these non-operative approaches work, they can provide relief and delay an eventual surgery.

However, “if the pain, function, and quality of life do not improve for the patient, that’s when we recommend joint-replacement surgery,” said Dr. Ben Snyder, an orthopedic surgeon at Cooley Dickinson Health Care.

Nearly 1 million Americans undergo joint-replacement surgery every year, with around 600,000 for knees and 300,000 for hips. According to Snyder, this safe and effective surgery is proliferating because, as people age, they want to remain active through their later years.

In the past, surgeries were often held off until patients were in their 70s because older-model replacement joints would not hold up for more than 10 or 15 years. “But improvements in joint-replacement techniques and technology have increased the longevity of joint-replacement surgery,” Snyder said. “Because of that, we’ve seen a big increase in patients who are 55 to 65 years old.”

A key to success for joint-replacement surgery involves getting patients out of bed and walking on the same day of surgery, Snyder noted. “We find that mobilizing patients early promotes faster recovery, less pain, and fewer complications.”

Andrea Noel-Doubleday, assistant director of Rehabilitation Services at Cooley Dickinson, has been a physical therapist for 25 years. In that time, she said, helping patients with their rehab has improved greatly because it has become a much less painful process for the patient.

Dr. Ben Snyder

Dr. Ben Snyder

“We find that mobilizing patients early promotes faster recovery, less pain, and fewer complications.”

“Joint-replacement surgeries have evolved and become so good that we just guide patients through their exercises,” she said. “For most patients, there isn’t the high level of pain in a rehab like there used to be.”

Less pain also translates to a shorter rehab process. Jack Jury, lead physical therapist at the Rehabilitation Hospital at Mercy Medical Center, said a full knee replacement for many patients is a day-stay surgery.

“They come in in the morning, have their knee replaced, work with us for couple sessions of physical therapy, and then go home the same day,” he explained.

While home exercises and outpatient rehabilitation remain essential, he noted, even they are taking less time. “A few years ago, it was not unusual for our patients to see us for 12 weeks of outpatient therapy. Now, four to five weeks is a long time to work with someone.”


Transition Game

Both Jury and Noel-Doubleday pointed out that rehabilitation hospitals play a key role in the healing process for patients who are not yet ready to move from the hospital directly to their home.

Those patients see people like Nick Rizas, inpatient therapy manager with Encompass Health Rehabilitation Hospital of Western Massachusetts. Rizas explained that patients are usually referred to Encompass because they have chronic conditions (such as obesity, diabetes, and active tobacco use) that make healing more challenging. He also works with patients when they decide to have both knees replaced at the same time.

“When a person is in pain because their knees are giving them trouble, getting both done means they only have to go through the process once,” he said, quickly adding that “this procedure would only happen after a discussion with the surgeon to determine that this is the best course of action.”

Andrea Noel-Doubleday speaks with a joint-replacement patient.

Andrea Noel-Doubleday speaks with a joint-replacement patient.

On occasion, physical therapy plays a role before surgery when doctors recommend patients for a program known as ‘prehab.’ Noel-Doubleday explained that prehab allows patients to increase their strength and become familiar with the exercises they will need to perform to properly heal after surgery.

“It can be hard to go through the exercises when you aren’t feeling great, but it’s worth it,” she said. “By being stronger before the surgery, patients can get back to their normal activity sooner.”

When Rizas does prehab work to help patients build strength in their leg or hip before surgery, he said, “it gives them a running head start on their rehab program.”

Healthy muscles around the joint play an important role in protecting it as well, he added, noting that the hips have a deep socket with lots of muscle surrounding them, while the shoulders have less muscle mass protecting them.

“By being stronger before the surgery, patients can get back to their normal activity sooner.”

“The shoulder socket is more like a golf ball on a tee; it’s much more delicate,” Rizas said. “We have to be more careful when treating a shoulder because the muscles surrounding it aren’t as big as in the hips and legs.”

If a patient needs prehab but has trouble walking, therapists now have the AlterG, an anti-gravity treadmill that supports a person’s weight so they can exercise and build their strength prior to surgery. Noel-Doubleday said the treadmill also helps after surgery.

“If a patient is having difficulty getting their normal walking pattern back, the anti-gravity treadmill helps them get more comfortable and confident with their walking and with their movements before their full body weight is on the joint,” she explained, noting that equipment like this was not available even 10 years ago.



Playing Catch-up

One year ago, when COVID-19 infection rates began to overwhelm hospitals, joint replacements, along with other elective surgeries, came to a halt. Elective surgeries have since resumed, and doctors continue to catch up with what Snyder described as “innumerable joint-replacement surgeries” that were put on hold due to the pandemic.

One sign that joint-replacement procedures are back in business, Jury noted, was the recent addition of two new orthopedic surgeons at Mercy Medical Center.

The joint-replacement rehab areas have all beefed up their screening process as well as implemented all the necessary safety protocols to continue to see patients, Noel-Doubleday said. “COVID changed our routine, but it hasn’t stopped us from doing our jobs. We might work with patients in a different space or alter things slightly, but overall, we’ve made the necessary adjustments.”

As the world starts to emerge from pandemic times, many people are concerned about the “COVID 15,” a popular expression for the weight gained as a result of less activity during a year of being stuck inside. Maintaining a proper weight provides many health benefits, and lessening the wear and tear on the joints is one of them. Physical therapists say it’s a simple matter of biomechanics: the more weight we carry, the more stress we put on our joints.

Snyder recently authored a whitepaper on treating knee arthritis and discussed the relationship between weight and our joints. In the data he cited, for every pound a person loses, the force on the knees is reduced by five to 10 pounds.

Physical therapist Steve Markey

Physical therapist Steve Markey works with a patient on the AlterG anti-gravity treadmill.

Jury said carrying too much weight over time can also throw off structural alignments in the body, which exacerbates the stress on the joints. “We haven’t yet seen the impact from recent weight gains during COVID, and it will probably be years from now until we do.”

When joint-replacement surgery is necessary, Noel-Doubleday makes it a goal to educate patients before the procedure so they know what is involved. Jury makes sure his patients understand what he termed as “a couple important things” to know about joint replacement.

“First, it’s not an easy rehab, by any means,” he said. “But if the patient puts in the effort at physical-therapy appointments and, more importantly, at home with their independent program, they will most likely have a successful outcome.”

He noted that the success rate based on standard outcomes is much better today than it was even five years ago. In turn, most joint-replacement rehab patients these days expect to resume their activities at high levels after surgery. “If you look at walking, the goal is more than comfortably getting around, it’s being able to take a three-mile walk for exercise every day like they’ve done in the past.”

Noel-Doubleday said identifying specific activities patients want to return to is a change from past rehabilitation practices.

“For example, many patients want to resume playing golf or tennis, so we structure the rehab to help them do that again,” she said. “It’s been interesting to see how rehab has evolved like this, and it’s a lot of fun to be a part of it.”

Health Care

Taking Important Steps

By Mark Morris

Dr. Christopher Peteros prepares a patient for laser therapy.

Dr. Christopher Peteros prepares a patient for laser therapy.

Spring weather in New England is a great time to shake off winter’s cabin fever and head outside to take a walk, go for a run, or play a sport. Spring also means an increase in foot injuries from people being too active, too soon.

While overdoing it can cause aches and pains in many areas of the body, it’s easy to overlook our feet, which support everything else and are key to overall quality of life. Those who specialize in this realm of care have a simple word of advice: don’t.

They stress the importance of taking care of one’s feet, listening to them when they are sore and need attention, and fully understanding how it’s not unusual for foot pain to be the cause or the result of other pain in the body.

“Sometimes foot pain causes knee, hip, or back issues, and by the same token, if someone has pain in their knees or back, it puts the foot in an awkward position, resulting in foot pain,” said Dr. Christopher Peteros, a podiatrist with New England Foot Specialists in Longmeadow, who stressed the importance of paying attention to pain, calling it our body’s early-warning system.

“If you feel pain in your foot, knee, or ankle, it’s telling you to stop what you’re doing,” he told BusinessWest. “It’s like the ‘check engine’ light in your car.”

When we walk or run, the foot’s natural movement is known as pronation (the inward roll of the foot) and supination (the outward roll of the foot), both of which move us forward while providing support, cushioning, and balance. Too much or too little of either pronation or supination can cause pain in the feet and other parts of the body.

“I’m not telling people to go walk in the middle of the street, but if you know of a neighborhood with a cul-de-sac or a circular street, those are better choices than sidewalks, which are a harder force on our bodies.”

Terrance McKeon, a physical therapist with Cooley Dickinson Health Care’s Rehabilitation Services in South Deerfield, refers to the foot as the ‘victim,’ because it’s often the one in pain while the culprits can be nearby or as far away as the hip or pelvis. To carry the analogy further, McKeon said that, when investigating the cause of foot pain, the calf muscle is often a prime suspect, because when the calf muscles are tight, the body adjusts by collapsing the foot.

“Your foot tries to maintain balance by unnaturally scrunching the toes,” he explained. “Then the fascia gets stretched, the Achilles tendon gets overstretched, and you may even wiggle your pelvis, all because your calf muscles aren’t letting you get over your foot.” 

Brianna Butcher, a physical therapist at Select Physical Therapy in Enfield, agreed. “When someone walks in with foot issues, the first thing I check is their hips,” she said, adding that, since the glute muscles tend to be weak in many people, it causes more strain to be put on the leg and foot to compensate and maintain balance.

For this issue, we take an in-depth look at what causes foot pain and discomfort and how to prepare your feet for activity.

Walking the Walk

Those who spoke with BusinessWest there are a number of factors that contribute to one’s overall foot health — or lack thereof. These include everything from the level of exercise to the type and condition of the shoes being worn, to the surface that people walk or run on.

Terrence McKeon demonstrates an orthotic insert for a patient.

Terrence McKeon demonstrates an orthotic insert for a patient.

People should be thinking about all of them and making smart decisions, said Butcher, who noted, for example, that serious runners opt for an asphalt road instead of a concrete sidewalk, because the asphalt surface is slightly less harsh on our bodies than concrete.

“I’m not telling people to go walk in the middle of the street, but if you know of a neighborhood with a cul-de-sac or a circular street, those are better choices than sidewalks, which are a harder force on our bodies,” she said, adding that, for those who live near a track, that’s an even better option than walking on the street.

While sidewalks can be too hard on our feet, Peteros said treadmills can create the opposite problem and result in repetitive-motion injuries.

“Some treadmills can be too soft, so as your foot sinks in, it creates an abnormal amount of repeated pronation while the person is walking, which can lead to tendinitis or plantar fasciitis.”

One of the most common causes of foot pain, plantar fasciitis affects the band of tissue that runs along the bottom of the foot from heel to toe. The plantar fascia acts like a shock absorber to support the arch of the foot. Too much strain on it leads to a stabbing pain in the heel.

Many factors can contribute to plantar fasciitis, but it often results from a change in activity levels that puts more stress on the heel. Peteros said likely candidates for plantar fasciitis include the person who hasn’t run in years and then decides to pursue it again, as well as the person who goes on vacation and does more walking than normal while wearing flimsy shoes.

Peteros said a person with plantar fasciitis tends to experience severe pain in the morning after just waking up. The pain subsides a little after moving around, and then, by the end of the day, it increases. He said the pain can move into a cycle that won’t easily go away.

“It’s a very difficult thing to treat in some cases,” he said, “because you’re using that sore foot for every other step you take, unlike a sore hand where you can just carry it around.”  

The first remedy Peteros suggests for plantar fasciitis and other foot injuries is the easy-to-remember acronym RICE: rest, ice, compression, and elevation. People can do this on their own, and in many cases RICE along with good, supportive shoes is enough to solve the problem. If that doesn’t work, he has a variety of treatments to further care for plantar fasciitis.

Anti-inflammatory medicines or cortisone shots are two possible treatment options. While cortisone can be effective for some, Peteros said, he cautions against its overuse because the shots can create ruptures in the plantar fascia instead of healing it.

For several years, he has used laser therapy to treat plantar fasciitis. As an alternative to anti-inflammatory medications, laser therapy uses a beam of light so it’s painless for the patient, works to reduce inflammation, and allows for faster healing. He said the success rate for healing injuries by laser therapy is about 80%.

“Depending on the injury, most patients will need between five and 10 treatments, which take about 10 minutes each. It may not always lead to a cure, but it speeds up the process,” he said.

For chronic foot issues, Peteros also uses shock-wave therapy, which treats plantar fasciitis with sound waves. He said it functions much like the technology that uses sound waves to break up kidney stones, adding that the same company makes the two machines.

When taken care of quickly, he said most people will get great results and no longer need treatment for their plantar fasciitis.

“Some patients may get an occasional flare-up, usually because they did something they shouldn’t have done. The key is to be aware of it, protect yourself, and stop as soon as you feel any pain.”

Getting to the Bottom of Things

That bit of advice applies to all aspects of foot care, said McKeon, who told BusinessWest that, overall, it’s best to best to be proactive and avoid the energetic enthusiasm of taking too much advantage of a nice spring day.

“Your brain says, ‘I used to run five miles a day,’ but when you’ve gone all winter without running even one or two miles, that’s breaking the 10% rule,” he said, explaining that the best way to prevent injury when approaching spring activities is to take it easy in the beginning and gradually increase activity levels no more than 10% a week.

Physical therapists have used the 10% rule for years, and recent studies have supported the idea that the body can react and get stronger from a 10% increase each week for nearly any activity.

“If you can obey the rule, especially for weight-bearing activities like walking and running, you’ll be fine,” said McKeon.

Brianna Butcher inspects a patient’s foot for injury.

Brianna Butcher inspects a patient’s foot for injury.

This can require some pre-planning, he added, noting that simple heel-raising exercises for the calf muscles are a good way to get ready for a walking or jogging routine.

“Strengthening calf muscles is easy because you just go up and down on your toes. Go up on your toes to hit full height, then back down, and do them until you get tired,” he said, adding that the yoga position downward-facing dog is an effective exercise for tight calf muscles. He then stressed that the 10% rule also applies to the stretches.

As essential as good conditioning is to prevent foot injury, these proactive steps can easily be undone by cheap or worn-out shoes — or the wrong kind. McKeon said serious runners should consider new shoes every six months because the foam in the shoe that absorbs the energy of running will lose its ability to bounce back with heavy use.

Peteros also emphasized the importance of protecting the feet with good hygiene and proper shoes. “Whether you are a runner, walker, or any type of athlete, good, supportive shoes are the foundation of healthy feet.”

Peteros recommends shoes designed for the specific activity in mind, with a stiff sole. “If you can bend the shoe in half, it’s not offering support.”

One of the best examples of warm-weather shoes that provide no support are the ever-popular flip-flops. Peteros did not condemn them, necessarily, but referred to them as “purpose-built.”

“If you’re sitting around the pool, or at the beach, or even on your back deck with an iced tea, they’re perfectly fine to wear,” he said, adding that problems arise when people continually wear flip-flops around town, because the feet have to work hard just to keep them on. “Your toes are scrunching as they’re trying to grip the flip-flop, and there’s just no support; they’re actually more trouble than they’re worth.” 

Peteros also mentioned the dangerous practice of people who wear flip-flops to mow the lawn, adding that yardwork is another place where good, supportive shoes matter.

“A lot of people retire their old, beat-up sneakers to wear in the yard, but when you’re doing yardwork, you’re often on uneven ground, when your feet need support the most.”  

A work boot or hiking boot is a great choice for yardwork, he said, because they are lightweight and supportive. Meanwhile, high-top or low-cut shoes are both fine, he noted, stressing that these shoes should be kept just for yardwork; don’t retire them to the yard only after they’ve worn out.

Because every foot is different, people with overly high arches or flat feet often need additional support from custom orthotic inserts. Peteros admits that some people can get good results with over-the-counter insoles and advised that, when shopping for inserts, firmer is better. When a custom orthotic insert is needed, he said the old methods to make them have given way to 3-D digital imaging that results in an orthotic that fits the exact contours of the person’s foot.

“We used to make casts and molds and have people step in foam. I haven’t done those things in at least nine years; it’s all digital now.” 

McKeon said finding the right footwear for those at one extreme or another can be tricky, while people whose feet are more in the middle range may be able to slowly build up strength in their feet and avoid using an insert.

“I tell people that, if they gradually increase their activity levels following the 10% rule, they can improve the strength in their foot,” he explained. “This works well with athletes who don’t like wearing orthotic inserts.”

So, before taking on outdoor activities this spring, remember supportive shoes, the 10% rule, and RICE. You’ll prevent injury to your feet and better enjoy the spring weather.