Which is better?
Do you suffer from debilitating heel pain that you have been trying to get rid off for months?
Are you trying to find out what possible options you have for treating persistent heel pain?
Well, before you decide on a certain course of action, have a read of this little blog, it might just be what you’re looking for!
For long, it has been a highly debated topic amongst health professionals as to whether corticosteroid (also known as “cortisone”) injections really do help your heel pain, or just masks the symptoms. Another area of debate has been as to what is more effective; corticosteroids injections or radial shockwave therapy sessions?
With a plethora of research behind radial shockwave therapy and corticosteroid injection, a study was performed comparing the results of both these treatment options. Through this blog, we will discuss the major findings of this article in hope of making your heel pain come to an end.
Firstly, let’s do a basic comparison of the science behind these two treatments.
Cortisone is a hormone that is naturally produced by your body’s adrenal gland as a response to stressful situations. Cortisone injections contain a synthetic version of this substance and are administered by a needle directly into the injured plantar fascia ligament, or into the side of the heel. The aim of this injection is to act as an anti-inflammatory booster, which aims to decrease inflammation around the plantar fascia ligament (which commonly causes the heel pain) ultimately to provide pain relief. As good as this option may sound; it is not a solution for the root cause of the pain, but merely a band-aid solution. Corticosteroid injections do not help every patient suffering with heel pain. Some people will experience significant, temporary pain relief while others will not experience any benefits at all. The long-term effects of cortisone use are not well documented, but some studies indicate that it can result in deterioration of tendons and cartilage.
Radial shockwave therapy is a treatment modality involving the practitioner using a hand-held probe and targeting the painful area (in this case, the heel). The probe delivers a very high amount of energy in the form of pressure and sound waves, which expand as they enter the foot. These sound/pressure waves aim to stimulate tissue healing and increase blood flow to the problem area. This process promotes healing.
Comparing the two methods; radial shockwave was found to be more effective as it delivers the treatment for a longer duration of time and aims to heal the affected site by promoting blood flow.
The following excerpt was taken from a podiatric journal review,
“Authors of a randomized study, published in the Journal of the American Podiatric Medical Association, focused on 72 patients with plantar fasciitis, who received either radial shockwave therapy once a week for three weeks or corticosteroid injections. Researchers found the radial shockwave patients experienced “significant improvements” in measures such as Visual Analog Scale scores, Foot Function Index scores, heel tenderness and plantar fascia thickness, and maintained those improvements at follow-up exams. In comparison, the study notes the patients in the corticosteroid group saw improvements in the same measures but did not maintain the improvements during follow-up at one, three and six months.”
Furthermore, shockwave addresses the root cause of plantar fasciitis, not just the pain, according to Nicholas Romansky, a Diplomate of the American Board of Foot and Ankle Surgery. He states that shockwave therapy is treating pain at the insertion and connective tissue, restoring the elasticity of the tissue, and relieving stress on the fascia (ultimately relieving the heel pain).
Thinking of other benefits, Shockwave therapy is non invasive and reduces the risk of infection encountered by syringes. There is also a decreased chance of patient phobia with shockwave compared to cortisone injections. With cortisone injections, there is a maximum number of 3 treatments per year (per injury site), which strictly cannot be exceeded.
In summary, cortisone treatments may be used for very short term relief (a quick fix), but not in the long term and do not address the root cause, whereas shockwave therapy can be used as many times as needed and aims to reduce inflammation by promoting oxygenated blood flow to the area.
Dr Jessica Shehata (Podiatrist)
Have you recently noticed some changes to your toenails that don’t look too good?
Are you wondering what it could be?
Have you now become a victim of the dreaded “fungal toenail infection”?
Is it possible that your nails might not be infected with fungus, but could possibly have something else wrong with them? After all, a lot of nail conditions can present very similarly.
Let’s look at a few classic examples of nail conditions that may be mistaken for fungal nails:
Skiing and snowboarding is without a doubt a popular recreational sport amongst Australians. Whether you are a novice or experienced, the cold effects us all equally and may often affect the alignment and movement of your feet which can highly influence your skill on the slopes. Below are pointers for preparing for the ski season:
- Use a fresh clean pair of socks every day
Using dry, clean socks daily will ensure you keep your skin with minimal maceration (build-up of moisture particularly in-between the toes). This will reduce the risk of blisters and skin infections such as tinea. If you have the tendency to get sweaty feet, the apply powder on your feet prior to wearing the socks.
Are you a regular victim of the infamous plantar wart? Has a single, occasional wart become a cluster of warts? Are your warts causing you a lot of pain and making it hard to walk?
There are in fact some remedies that may be able to alleviate the symptoms associated with plantar warts that you could give a try in the comfort of your own home.
Let’s start off with a quick refresher of what exactly a wart is:
A wart is a “generally” identified as skin growth that can have many different appearances however the vast majority show a raised, cauliflower-like shape. Warts may have roughened shiny upper patch of skin that bleeds when removed. For most people warts can be unsightly or embarrassing, but rest assured warts are not caused by frogs or toads (as once commonly thought). They can become painful if left untreated.
In the words of John Snow, ‘Winter is coming!’ Long gone are the days of thongs, sandals and bare-foot behaviour. With the onset of colder temperatures, people look to enclosed shoes for warmth, comfort and support. There are however, a number of factors that need to be considered when choosing footwear for the colder days and nights. Making correct and appropriate footwear choices does become increasingly important in ensuring that your feet remain problem free.
In terms of winter-style shoes, let’s look at a few different ways your fashion-crazed ballet flats, heeled fur booties and formal business shoes may impact your foot health;
What comes to mind when you think of the common side effects of smoking?
Typically, most of us think that smoking only affects our heart and our lungs, right?
I’m sure you wouldn’t think that smoking affects your feet?
Even if you do not own a pair of Skechers shoe, chances are you have heard of the brand or know someone who wears them. They have become a very popular style of shoe purporting to offer cushioning and comfort for wearers. Below are some of the most common reasons why they have garnered the support that they have:
· Lightweight flexible synthetic mesh upper with no stitching accommodates different shaped feet.
· Wide fitting style ensures that your little toe or bunion does not feel cramped against the material.
· Cushioned and lightweight thick memory foam, contours to your foot adds to the feeling of comfort.
Do you have an event that you’re going to this weekend?
Can’t find a comfy pair of heels to match that gorgeous red dress?
Do you always get blisters when wearing your favorite pair of peep toes?
Firstly, what is a blister?
A blister is a small pocket of fluid (pus)that develops on the top layers of the skin, which most of the time is clear in colour, but at other times may contain blood (also known as a “blood blister”).
I have stubbed my toe! Could it be broken?
You’re in a rush to do something in the house and as you are taking those corners like a Formula One driver, you underestimate the size of your feet. SMACK! Straight into the furniture. You freeze, go into a fetal position and see the stars and planets. “WHAT THE!” you cry out.
Almost every person has stubbed their toe at some stage of their life. In most cases, the trauma is nothing more than a knock to the joints although the pain might make you feel as if you have broken a toe. But how can you distinguish if serious toe damage has been done? It can often be difficult distinguish a stubbed toe from a broken toe — especially considering that there are so many nerve endings in the feet.
What is Dry Needling?
Dry needling is an effective and efficient technique for the treatment of muscular pain and myofascial dysfunction. Dry Needling is a form of intramuscular stimulation, a technique developed by Dr. Chan Gunn in the 1970’s and is extremely effective for relaxing overactive or excessively tightened muscles, which contain what we know as “knots”.
Muscular knots are scientifically known as myofascial “trigger points”. Technically speaking, there are no physical knots within muscles, but science defines a trigger point (TrP) as a small area within the muscle band that is very tightly contracted (shortened), an isolated spasm. These small areas have altered blood supply, which irritates the muscle even more. The presence of multiple trigger points with a muscle belly causes pain and dysfunction on varying levels.
Are you all too familiar with that exquisite smell that comes up when you take your shoes off? Are your feet always sweaty? Do you get embarrassed to take your shoes off when you go to the podiatrist? Why is it that your feet are always extra sweaty and smelly? Surely there must be some way to fix this? Luckily for us all, the solution to this problem is actually quite simple and it all starts with you and in the comfort of your own home too.
Firstly, let’s look at a few causes of smelly, sweaty feet:
– Excessive perspiration (sweating)
– Bacterial growth on the surface of the feet
It is hard to deny, our feet are important. Not only do they help us ambulate around but they also form the base of our body and work to help keep us upright. As we get older, so do our feet and as they do, there may be issues arising which may require assistance and care to keep us happy and healthy.
Podiatrist will often look at a persons feet and obtain a good insight into the general health of the patient. Factors such as skin texture, skin colour, thick or discoloured nails, uncomfortable or tight feeling skin or generalised pain in the legs of feet can be indicative of problems not often easily observed. Conditions commonly seen in the elderly population such as arthritis, diabetes or circulatory problems can easily cause any of the mentioned symptoms. This is why, much like a classic car, the older we get the more specialised care we need to keep our body healthy. Some common podiatry problems seen in the feet of elderly patients includes:
“I have a heel spur”
You have heel pain and you have seen the doctor for their opinion and advise. They refer you on to get an Xray which shows a heel spur and there you have it “you have a heel spur”. This term is overly used and incorrectly used to diagnose heel pain. A heel spur appears on an X-ray as a pointed bony growth projection at the heel bone. They develop over a long-period of time, well before you had any heel pain. Infact studies have shown 30% of the population have a heel spur without any heel pain.
What images should you consider when you have heel pain?
X-rays use a small amount of radiation to visualise the skeleton. It is not safe for pregnant women.For the purpose of heel pain, common reasons for requesting an X-ray would be suspicion of a calcaneus (heel) fracture, stress fractures (in some cases not evident in early stages) and size of heel spur. I personally do not often refer for an X-ray in the early management phasto investigate a heel pain because it is uncommon to have fractures or stress fractures, and the heel spur is rarely the cause of your pain.If your heel pain has developed very suddenly, from trauma, high impact activity then it would be wise to get an X-ray to rule out any injury to the bone.
A podiatrist can issue a referral for an X-ray and which are bulk billed in most places.
Ultrasounds are non-invasive and have no radiation. A gel compound is used to transmit sound waves to visualise soft tissue on the spot. Ultrasounds are very dependent on the sonographers skills and knowledge of the feet. Unfortunately, this is rare to find. Unlike an X-ray which a practitioner can view independently of the radiologists report, an ultrasound relies very heavily on the report. I’m very fortunate to have an excellent radiology centre (Shire Medical Imaging at 30 Gibbs St, Miranda) nearby that an do exceptional ultrasounds at bulk billing rates. Ultrasounds are often used to investigate heel pain because you can assess the plantar fascia and other soft tissue structures.
Common heel pain conditions that may require ultrasound would be; Plantar fasciitis, plantar fascia tear, neuritis, muscle atrophy, muscle tear, bursitis.
A podiatrist can issue a referral for an Ultrasound and you should enquire if the radiology centre bulk bills.
Bone scans are requested when you query the bone being the cause of the pain. It safely uses a very small amount of radioactive dye to help diagnose problems with your bones.
Specifically, this test is done to reveal problems with bone metabolism. Bone metabolism refers to the process in which bones break down and rebuild themselves. New bone formation is part of the healing process when bones are injured or broken. The bone scan is a good way to view and document abnormal metabolic activity in the bones.
In regards to heel pain, a bone scan might be requested because an X-ray did not show any abnormalities and you still query the bone being injured. The bone scan will be much more reliable to identify a calcaneus (heel) stress fracture, fracture or other heel bone abnormlaity.
A podiatrist cannot refer for a bone scan. They will advise you to see the doctor to get a referral.
CT, or CAT scans, are special X-ray tests that produce cross-sectional images of the body using X-rays and a computer. CT scans are also referred to as computerized axial tomography. CT Scans are used when the bone requires are a more accurate assessment. CT scans are not usually requested for heel pain because the heel bone is not usually the primary cause of pain. But in cases where there is a high probability of the heel bone being injured or having abnormalities, then it would be advantageous to have a CT scan.
A podiatrist cannot refer for a CT scan. They will advise you to see the doctor to get a referral.
Magnetic resonance imaging (MRI) is a scan that uses a magnetic field and radio waves to take pictures of the soft tissue. It is radiation-free. An MRI scan is often used when other types of imaging, such as X-ray, CT or ultrasound are not providing adequate answers.
It can identify very small tears or injuries which could be missed by an Ultrasound. MRI would only be requested if the area of suspicion is soft tissue. In cases where bone is suspected, then a CT scan or bone scan would be requested.
A general practitioner and a podiatrist are not able to refer you for an MRI. You must see a specialist.
Heel pain is not simple and often I find people visit a doctor, get and X-ray and have the label “heel spur”. This is rarely the case. Inflammation of the plantar fascia is usually the cause of the pain and a very good ultrasound will help identify this. More expensive images such as MRI are usually limited to cases that do not respond in a timely manner or for pre-surgery screening.
Dr Vanessa Hadchiti (Podiatrist)
“ um, Dad, my heels hurt!”
An all too common phrase heard by parents. With many school kids starting a new season of soccer in the last few weeks, parents often encounter complaints from their kids about general aches or pains. Whilst many of these are dismissed as such, it is often important to consider why exactly the discomfort is occurring. Whether from repetitive impact of sports or inappropriate footwear, children’s joints, muscles and ligaments are undergoing vast changes which may result in pain or irritation arising in certain parts of the body. One of the most commonly complained about region by kids, is painful heels. Whilst the cause of heel pain in kids can have a range of causes, one of the more common conditions is Severs Disease.
Are your toenails or fingernails looking a little different lately? Are you noticing changes that include any of the following?
- Colour change: Your nails may change colour to a greenish, yellow or brown colour. In some cases, there may appear to be red or white spots underneath.
- Surface changes in the nail bed: Sometimes ridges or grooves in your nails, or what we call “pitting”, which look likes small pinprick holes also known as “oil-drops” on the surface of the nail plate.
- Build-up of debris: This can look like chalky-white debris building up into the sides of the nails. Sometimes this extra debris can cause some pain and discomfort, because this process can cause the nail to lift.
- Nail thickening, brittleness and breakage
- Nail separating from the nail bed
- Pain and tenderness in the nails (especially in the fingernails)
Diagnosing heel pain is not that simple even for the medical practitioners as a lot tiny soft tissue structures are located in the area. So “googling” and self-diagnosing can be very risky and lead you to many ineffective internet purchases. Although I do not advocate self-diagnosis, I do want to support and assist many of those who feel stuck and are struggling to get results. This blog discusses some basic tips on how to help identify the cause of your pain which may give you a better direction of management.
With winter around the corner, many patients often present to podiatry clinics range of conditions that are commonly seen during the colder months. In the following series of blogs, we will highlight a number of commonly seen problems that can arise during this time. This week’s blog will focus on dry skin.
A factor that most people do not consider, is that the human skin is an organ capable of miraculous feats. Not only does it provide a barrier that protects internal organs from infection and damage, but it also plays a big role in the regulation of internal systems. It is on this note, that the skin can be used as a methods of screening for potential problems both internally and externally in the body. Because of the skin’s ability to react and respond to external influences, it is no surprise that the texture of skin can change with changing environments. Dry skin often occurs during winter because of the low environmental humidity. This lack of humidity results in physiological changes in the skin cells that results in water being lost. The body is unable to naturally replenish this lost fluid and this can lead to potential problems that will be highlighted below.
You either have heel pain or know someone that does, because it is very common. In fact, there are facebook pages and groups created for communities to discuss how their managing their heel pain and provide support to each other. It is the most commonly presented soft tissue pain to podiatrist, well at least for myself anyway. If you “Dr Google” this condition you will be overwhelmed by the number of treatments available and the testimonials from #1 best sellers guaranteed to treat heel pain or your money. Unfortunately, there is no guaranteed single treatment for heel pain otherwise, every podiatrist would be utilising it. There are many medical treatments available as listed below
Athlete’s foot, often referred to as tinea pedis, is a fungal infection of the skin that appears fairly commonly (but not exclusive to) in the feet of active people. The infection causes irritation and itching or the skin, often resulting in people scratching the area which can cause pain or the fungus to spread. The fungus species commonly implicated in the infection is the Trichophyton family. The fungus itself thrives in warm, humid environments such as in shoes and sweaty socks/feet. The fungus is pesky and able to survive on a number of different surfaces, which is the reason why some people get their infection from walking around barefoot on floors such as communal showers, changing rooms and pools.
In our podiatry clinic, we often have new patients who come for initial consultations and ask whether they can use their Medicare cards or whether we bulk bill consultations. The reality is, Podiatry as a speciality within the health sector is still developing and undergoing legislative changes. As such, the Medicare rebates are limited for Podiatry as they are for many other Allied Health professions.
Some patients are able to have a portion of their consultation fees subsidised through Medicare, if they have an Enhanced Primary Care (EPC) plan referral from their doctor.
Cracked heels, often the bane of people’s existence and can cause people to hide their feet away from embarrassment. Whether from a personal perspective or comments made from others, cracked heels can impact on a person’s confidence and self-esteem, often opting to put into storage ones favourite pair of sandals. We all see commercials of model-esque feet and advertisements for various products that promise smooth, silky heels, however the truth of the matter is a little more complex than they would have you believe. Cracked heels can be caused by a myriad of different problems, some more serious than others. Some heel cracks (or fissures technically), do not cause any discomfort whilst others can become painful and infected if neglected long enough. So in short, yes, cracked heels are indeed more than just a cosmetic problem but to understand why, we need to delve a little bit deeper into the issue.
Often the size of a grain of salt, corns can cause considerable pain for to a person. People who suffer from corns can describe a range of symptoms which includes feeling:
‘Pain on pressure when either walking or wearing certain shoes’
‘Like I am walking on small pebbles or stones underneath my foot’
When I often explain to patients exactly what corns are, they are amazed that something that small can be the cause of so much pain. But why exactly are corns so painful? The answer to that question lies in the shape of the corn.
A common question I receive from patients who present with joint pain is ‘Do you think I have arthritis?’ Whilst on some occasions the observation proves to be an accurate diagnosis, the use of the umbrella term ‘arthritis’ to describe joint related problems does not factor in the inherently different natures of the two most common forms of arthritis; osteoarthritic and rheumatoid.
This blog will focus on bringing to light some major differences between the two forms of arthritis and should in no way be taken as an exhaustive list. As with any other foot or lower limb related concern, specialist advice should be sought to ensure proper diagnosis and treatment is applied to the case in question.
Your feet are vital. Not only do they carry the weight of your body and help you ambulate around, but they also help your joints function in a way that is most beneficial to your overall body health. So its easy to see how badly affected your life can be if your feet are painful and no time is this more obvious than during the holiday season. Heading into the shops for Christmas shopping can put considerable strain on your feet as you often can spend countless hours walking on unforgiving terrain, not to mention all of the additional weight bearing activities that need to be done to make sure everything is ready.
Have you ever experienced a soreness underneath the ball of your foot that was often hard to describe? Did the sensation feel like a burning hot press up along the inside of the bones of your foot? Has it left you hobbling or altered the way that you walk? If your answer is yes, then it is quite possible that you may have experienced an injury to an often overlooked structure called the ‘plantar plate’. In this blog, we will look at what makes this structure so vital to the functioning of the foot and how potential injuries can come about and what can be done about it.
The use of heels in an everyday setting has been a common trend amongst women for years. Work, social and personal requirements have all contributed to increasing use of high heels. Whilst most clinicians and most research all agree with consistent use as being detrimental to foot health, most people I see in a clinical setting do struggle to see the effect that wearing heels often will have on their feet, they certainly can feel it.
Clogs or also commonly recognised as the brand ‘Croks’ have become a very common footwear for adults and gradually they have streamed to every age, even to one year olds. Clogs have become very popular due to their convenient and practical use. Just as thongs (flip-flops) are regularly used in Australia, even though they are not suitable for feet, so have clogs become injected into our everyday life.
Usually made of rubber fabric, they can slip on and off easily and can be used on wet surfaces. Clogs are commonly used by professions such as theatre nurses and kitchen staff for their practicality. But why do so many podiatrist advised against clogs? Clogs are an exaggerated shoe without coherence to normal foot motion. They are bulky, lack heel support and modify a walk to almost a shuffle like appearance.
Calf muscle tightness is a problem. Whether patients are able to appreciate the effect of tight calves or not, they most certainly can feel them. The clinical reality is that some patients who present to a podiatry clinic complaining of musculoskeletal pains often show very clear signs of calf muscle tightness. Very few however, are able to draw a link between their presentation and the tightness of their calves. The calf muscle is actually made up of two separate muscles, the gastrocnemius and soleus, which form one functional compartment. The calf muscles join at their end to the Achilles tendon which forms a connection between your foot and leg. The calf muscles act on the ankle joint to place the foot in a downwards (plantarflexed) position which brings the ball of the foot into contact with the ground and shortens the Achilles tendon. Overly tight calf muscles can predispose patients to injury as well as affect the way their feet and lower limbs function and consequently can affect other parts of the body as well.
What causes tight calves?
Tightness in the calves can have many causes. Some range from external influences such as wearing heels, excessive sports training or internal influences such as genetics.
- Extensive use of high heels keeps the Achilles in a shortened state whilst reducing the distance between muscle fibres of the calf muscles. Keeping the Achilles in this shortened state can eventually make wearing flat shoes painful as patients will be forcing their Achilles to move from a short state to a lengthened state quickly.
- Exercising without stretching the calf muscles will cause retraction of the muscle fibres during the recovery phase. Repeating this will eventually lead to tightness through the calf muscles and not only reduce the range of motion of the ankle but also predispose the athlete to potential injury.
What are some consequences of tight calves?
- Inflammation of the Achilles and other compensatory tendons.
- Shin splints and potential shin stress fractures.
- Inflammation of the patella tendon.
- Knee pain.
- Back pain.
- Heel pain/plantar fasciitis.
- Pain underneath the ball of the feet which may involve bony swelling.
- Reduced ankle and toe range of motion which will affect a patient’s gait.
- Predisposition to muscular tears during sport.
- May predispose a patient to developing bunions (hallux valgus).
- May result in callouses and corns on the feet due to overload of certain parts of the feet during weight bearing activity.
What are some calf stretches that can help loosen my calf muscles?
There are a number of calf stretches that can be utilised to reduce the tension through the muscle fibers. The golden rule for any stretch is hold for 30-60 seconds, repeat 3 times, once or twice a day.
- Standing Calf Stretch
- Stand in front of a wall and place your hands on it. Move one foot behind you an keep the toes of the trailing leg always pointing forwards. Keeping your heel of the leading leg on the ground, lean forward towards the wall slightly bending at the leading knee. Hold this position when you feel the stretch.
- Off a step
- Place the ball of the foot on the edge of the step and slowly lower yourself until you feel the pull in the calf. You can do one or both feet depending on the level of your balance and co-ordination
- Calf Stretch Using a Belt/Resistance band
- Place the towel/belt/band around the ball of the foot and straighten the knee. Pull the sides of the strap with equal force towards you moving the toes towards you in the process. Hold this position for 30 seconds. Slowly bend the knee whilst maintaining the tension on the straps. Hold for a further 30 seconds.
Dr Anel Kapur (Podiatrist)
On an almost daily basis I encounter patients who present to me with some form of foot or lower leg pain. Some cases have involved a traumatic episode whilst others appear to have come out of the clear blue sky. Pain is often a very good indicator that something in the body may not be quite right and will push people to seek answers. More often than not, this may be due to an overload of joints, tendons, ligaments or muscles however other factors such as arthritis, soft tissue injury or fractures may also be the cause. Of the mentioned factors, it is often stress fractures of bones that go unnoticed and misdiagnosed leading to prolonged pain and time for recovery. The following will be a brief introduction into what stress fractures are and what you need to know to help you make an informed decision of when the pain is more serious and requires an assessment.
It is the time of the year that people actively start coming in to have fungal toenails treated with summer around the corner. It is concerning how often people are presenting with this problem. I have been working for over 14 years and i don’t remember fungal toenails being such an issue 10 years ago. Could it be due to the rise of pedicure salons popping up everywhere and being used so frequently ? Maybe.
First line treatment
People with fungal toenails are often bombarded with many pharmaceutical treatment options and it can be very confusing as to what will work best. Ranging from $5 to $100, it can be an expensive exercise if you do not pick the right one. Topical products from the pharmacy (lacquer, cream or solution) can be effective. But it is not uncommon for people to be spending alot of money and time treating a nail which they suspect is fungal but infact it is not. It can be nail trauma from footwear, nail psoriasis or simply thick nails. It is vital to speak to a podiatrist before you begin any treatment so you can confirm it is fungal.
Moreso, not all fungal infections are the same. It can be under the nail (subungual), through the nail (nail plate) or on the surface of the nail (superficial). Depending on the level of infection, will determine which type of treatment is most suitable.
Infections can be dermatophytes (most common), candida or non-dermatophyte infections. A pharmacist or an individual will find it very hard to figure this out. It is important to know as different treatments have different strengths on certain types of infection.
If topical pharmaceutical treatment is pursued, it is vital that a podiatrist cleans and files back the the nail in order to increase the absorption rate of the topical products helping to improve the outcome.
Second line of treatment
Laser treatment has been a growing choice over past five years due to its convenient method. It delivers heat to the nail killing the fungus. You generally require 2-3 treatments about a month apart. Although it is more costly than topical treatments, we have found it is becoming the more popular choice due to people failing to diligently apply a topical treatment on a regualr basis for an extended period. Laser treatment has about a 70-80% success rate. We carefully select our candidates for it, as not all people are suitable for it, and in some cases if the nail is too far progressed, we can guage if laser is not likely to work. It is important that you only see a podiatrist for this treatment, as correct medical advise and podiatry treatment is in adjunct to laser.
Third Line of treatment
If the above fails, then you could consider oral medication. Oral medications are usually taken for a period of 3months and have approximately atleast 80% success rate. I prefer to reserve this option as last resort because the medications is strong on the liver. Your doctor would be the prescriber of this treatment and they would assess if your medically suitable for the treatment.
The take home message is that fungal toenails are not as simple as the commercials display them. It is important you see a podiatrist for a professional and experienced opinion before you begin treatment. Avoiding unnecessary costs and time.
Dr Vanessa Hadchiti
In this blog i have decided to write about pain in-between the toes as a few patients have presented this week with using acid patches on the sore area in an attempt to self-treat but causing more harm then good. A corn is technically keratin which is the most upper layer of the skin. It has no blood or nerve supply. When excess pressure is applied on the skin, particularly over joints, it leads to excess keratin in order to protect the site from breaking down. This extra keratin can taken different shapes and size depending on the direction and size of the pressure. A corn is simply excess keratin but it presents in the shape of a small cone with the sharp point being deepest. It can sometimes be confused with a wart due to the round shape you see on the surface. When corns occur between the toes, they can be very painful because it feels like having a splinter in your skin wedged. Inter-digital corns often present in winter due to frequent use of closed-in shoes.
Children’s bodies are medically considered to be very elastic. Their bones, ligaments, and muscular structures are far from set in stone. This is often a blessing and a curse in terms of their development as something as simple as the style of sitting that your child adopts can impact on the way their young bodies develop. The position often observed and well documented to cause issues is referred to as the ‘W-sitting’ position.
What is ShockWave Therapy?
Shockwave therapy (SWT) is an innovative, safe, and effective method to treat musculoskeletal pathologies.
The term “Shockwave therapy” refers to mechanical pressure pulses that expand as a wave within the human body.
The Swiss DolorCast machine creates these shockwaves/pressure pulses by producing acoustic wave energy which is delivered via the hand held gun to the body region experiencing pain.
It is a well observed and well documented fact that poorly fitting footwear can cause foot problems to arise in people who previously had no foot troubles. Whilst fact remains, people often still persist with shoes that are either too narrow or too small for their feet and often present to podiatry clinics with a number of different problems. Some of the most common problems I have seen in patients who have presented to the clinic are listed below and have often had footwear choice as major contributing factor to the development of problems.
High blood pressure (referred to as hypertension) has become a very common medical condition affecting patients of all ages. Patients are often diagnosed by their doctor who may prescribe a number of treatments for reducing the blood pressure levels. This may include lifestyle changes and/or medication. Hypertension brings with it a number of potential health issues however most people tend to overlook the effect that blood pressure has on the lower limbs. Often, symptoms identified in the lower limbs by podiatrists may help the diagnosis of hypertension and thus should not be ignored.
‘I noticed my nails grow slower during winter’, is a comment that I commonly hear from patients who present to our podiatry clinic for regular treatments. Most people have ideas as to why they notice a decreased rate of growth in the colder months, but what are some of the concrete reasons as to why nail growth might slow during winter time? Some of the main reasons involved with reduced nail growth can be seen listed below.
In my 14 years of experience as a podiatrist, I can say that the most rewarding treatment is for ingrown toenails. I say this because they are such a painful condition, and within 10min you can have the sharp pain gone. Ingrown toenails can present from a little bit of inflammation to severe over-sized fleshy infected ingrowns. But no matter how small or big, you can always walk away with relief.
What causes ingrown toenails ?
Ingrown toenails are caused when the side of the nail is applying too much pressure on the skin leading to inflammation. The pressure can be caused by a nail spur caused by incorrect cutting, or by an involuted nail (curly edge) , or by tight footwear, or by trauma. Once the inflammation occurs, it gets further agitated by the nail and more inflammation occurs. If the skin surface is broken then a secondary bacterial infection may occur.
In my years of sports experience, sprains of the big toe joint, a condition commonly referred to as ‘turf toe’, was one of the more commonly occurring injuries among my team mates. Though most sports men and women simply attempt to ‘run it off’ the injury is one that can potentially become quite painful and debilitating which can affect both sporting performance and quality of life. In this blog I will present some information about what ‘turf toe’ is and how it can be addressed.
What is turf toe?
As previously mentioned, turf toe is an injury to the big toe joint which may or may not include a sprain injury. The injury often occurs when the toe is bent upward excessively (hyperextended) thus damaging the joint itself. The injury can occur on basically any playing surface but has a tendency to occur more frequently on artificial playing fields. The condition can be caused by direct injury such as jamming the toe or forced hyperextension as a result of pressure on the players calf. Sports that are often associated with an increased risk of turf toe includes; football, soccer, hockey, gymnastics, dance and certain athletics events.
Laser treatment for onychomycosis (aka fungal toenails) has been around for several years. After its success in the U.S.A, it eventually made its way to Australia. Podiatrists at first were hesitant on using laser treatment but it didn’t take long before some leading podiatrists proved that it’s safe and effective, and putting smiles on people’s faces. Soon the treatment became more available and almost accessible in all parts of Sydney. In the Sutherland shire, we are the only clinic to provide the treatment.
The treatment has been available at our clinic since December 2014, and its popularity is growing. The treatment is scientifically proven to be effective in about 70% of cases. Our clinical experience with the treatment has also displayed similar results.
Often another concern for parents is the positioning of their child’s knees. The two primary concerns that present to podiatry clinics are genu valgum (knock knees) and genu varum (bow legs). The point that most parents do not know is that a child may naturally find their knees in either position at different points in time. As their hip, abdominal, thigh and leg muscles develop, the knee position will generally stabilise to a neutral position however in some people an abnormal alignment may persist.
Genu Varum (Bow legs)
This positioning is often first noticeable in children aged up to 2 years of age. This abnormality is characterised by a prominent bowing between the two limbs. It is seen in both boys and girls and will usually correct itself by 4 years of age, often to form a partially knock knee position. If the abnormality persists past the 4 year age cut off, physical therapies, orthotic devices and further investigation may be warranted
Genu Valgum (knock knees)
As the child grows, the original genu varum position will change to a genu valgum position. This will further correct to the normal (rectus) position by the time the child reaches early adulthood. Girls are often more affected than boys. Knock knees are characterised by a decreased distance between the knees. A distance of about 8cm is considered normal. The abnormality is considered to be physiological meaning that the abnormality will spontaneously correct itself by 14-16 years of age. Physical therapies, orthotics and surgery may be indicated if the alignment issue persists past the cut off age for improvement.
However, it is highly recommended that if you have any concerns about your childs knees, it is always best to get a personalised podiatry opinion.
Dr Anel Kapur (Podiatrist)
Concerns about the normal development of the lower limbs as a child grows is often the primary reason parents bring their kids to a visit to the podiatrist. The fact is that many of the perceived ‘abnormalities’ may be within the normal parameters for the childs age. The continually changing bodies of children will often correct any abnormal alignment issues that arise during their growth cycle. The most concerning variants include genu varum (bow legs), genu valgum (knock knees), intoeing, out toeing and flat feet. Below will be a brief explanation of the normal development of these most commonly occurring variants. If your child shows characteristics outside of those listed, an appointment with the podiatrist may be warranted.
In toeing is often characterised by inward pointing toes. It is much more common than out toeing and can often be responsible for recurring falls in children due to tripping. Boys and girls are equally affected.
1. Metatarsus adductus
Is a congenital deformity of the forefoot in which the metatarsals deviate towards the body midline causing in-toeing. It predominately occurs in males and is first noticed in the first year of life. Most cases resolve spontaneously by age 10-12 however severe deformities may require an initial treatment which may consist of strapping and/or casting of the feet in the neutral position.
2. Internal Tibial Torsion
This is often the most common cause of in-toeing usually seen in children between the ages of 2 and 4. It occurs in both boys and girls and often the presenting sign is clumsiness and repeated falls either at home or in the playground. A physical assessment will often show an abnormal thigh foot angle. This abnormality usually corrects itself by age 8 through physical therapies such as stretching. If the condition persists past the age of 8 or an assessment shows a thigh-foot angle of more than 15 degrees, surgery may be indicated.
3. Increased femoral internal rotation
This abnormality is usually observed in early childhood and is particularly severe between the ages of 4 and 7 years. It has been shown to have a very strong genetic link with mainly girls being affected. The classic signs that are presented include the patella (knee caps) facing inwards (a situation known as ‘squinting patella’) and these children are often seen sitting in the typical W sitting position. An assessment would involve assessing the hip range of motion of the child to look for any abnormalities in range of motion. Similarly as with increased tibial torsion, increased femoral internal rotation settles by 8-10 years of age. Orthotics and physical therapies may be helpful in improving gait parameters. Educating parents and children on importance of avoiding W-sitting is another vital step to reduce internal rotation. Surgical intervention may be indicated if no improvement is seen pst the age of 12.
If this is all too complicated, don’t hesitate to see our Podiatrist for a personalised professional opinion.
Dr Anel Kapur (Podiatrist)
It’s that time of the year, where parents are trying to organize their children for school and shopping for new school shoes can be often a confusing and daunting experience. So i have decided to give some handy tips on how to fit your child correctly. Before proceeding, i will point out some interesting facts about children’s feet which will help put things in perspective.
As you can see, it’s almost impossible to keep up with growing feet, not to mention it’s costly. But knowing this, here are a few personal pointers from me:
1. Don’t over-estimate your childs shoe size.
Remember, the movement and comfort of a childs foot is no different to an adult. So it wouldn’t be comfortable for an adult to wear a shoe two sizes too big, not mention how it would change your walking manner also. So bare in mind, that a child also requires a reasonably fitted shoe. A thumb width (approx 1cm) between end of toe and shoe , whilst standing is a general guide. This allows ample space for the big toe to move and to also grow. I prefer to suggest to parents to buy a cheaper shoe with correct size and change half year, then to buy an expensive shoe that way too big at the beginning to guarantee a full year use.
2. Attempt to buy soft leather upper.
Children are every active, especially boys. They are in school shoes more than 30hours per week and so its important the shoe has a breathable fabric. This reduces the likelihood of tinea, athletes foot and other possible skin infection occurring. Not to mention avoiding the smelly feet.
3. Ensure the shoe has a very sturdy heel counter.
Children sit, walk and run with their shoes, so they get a very good beating. If a heel counter is not very sturdy, meaning it shouldn’t be easily bent left to right, then you ensure a very good stable grip on your child heel . This reduces over-pronation (flat feet) and possible heel pain (severs disease).
4. Ensure the shoe cannot bend in the arch
Shoes should be easily bent in the arch. They should only bend at the ball of the foot. If the sole isnt very sturdy, it risks losing its support after a few weeks leading to increased strain on the feet and possibly pain.
5. Attempt to buy lace-up shoes
A school shoe should be treated just like a sport shoe, and the use of laces helps to constantly ensure a secure grip that is adjustable throughout the year. If your child however has a very bad habit of not tieing up laces, then the next best option is velcro. This is good for children between ages 5-8 as they don’t have good skills of tieing laces properly.
6. Flat shoes only.
I have seen the trend of low to medium heels in school shoes amongst school girls. And although we all would like a bit of extra height, using heels on a daily basis shortens the calf muscle and modifies the gait, causing long-term damage to the feet.
7. Thick rubber sole
A school shoe requires good shock absorption just like a school shoe, so its important that thin soles, commonly found in the trendy ballet flat style shoes, is avoided. This is harmful to the feet.
Good luck shoe shopping, and if in doubt, come and see us for personalized advise.
Dr Vanessa Hadchiti (Podiatrist)
The human feet are an ingenious piece of natural engineering. They are capable of incredible feats and have adapted to enable humans to conduct bipedal locomotion (walking on two feet) effectively and efficiently. Feet are vital for everyday life and are also prone to change and damage. As they are constantly under periods of change, stress and come into contact with various microorganisms, the world of the human foot can make for some interesting characteristics. Below is a list of some facts about the human feet ranging from the weird to the wonderful:
– The human foot contains 26 bones, 33 joints, over 100 ligaments and 19 muscles.
– 25% of the bones in the human body are located in the feet.
– The human feet have over 250 000 sweat glands.
A heel spur is a bony protrusion that develops beneath the heel bone. Bony spurs often develop in areas where there is excessive tension, or pulling force, on a bone where soft tissues attach to it. A thick band of soft tissue, called the plantar fascia, attaches to the heel bone and runs across the bottom of the foot to support and stabilize the arch. When there is excessive strain on the plantar fascia, it exerts tension on the attachment site at the heel bone and over time this causes the bone to react by developing a heel spur.
What is the difference between Heel Spurs and Plantar Fasciitis?
Plantar Fasciitis affects the plantar fascia (the thick band of soft tissue that runs along the arch of the foot from the heel to the toes) itself, whereas Heel Spurs occur on the heel bone to which the plantar fasciia attaches. Heel Spurs can develop as a result of chronic Plantar Fasciitis. Patients often confuse heel spurs with plantar fasciits because they make a trip to the Doctor and following an Xray identify a heel spur. This is rarely the diagnosis of the pain, but rather a co-incidental finding.
What causes Heel Spurs?
Over time, if the plantar fascia continues to pull on the heel bone, eventually a heel spur will form. The plantar fascia exerts excessive tension on the heel bone primarily due to abnormal foot function or foot posture. The same factors that contribute to plantar fasciitis, also contribute to the development of a heel spur. These factors include:
- Abnormal foot posture – if your feet roll in too much (pronate), the soft tissues beneath your feet become overworked and overstretched causing inflammation and pain.
- Muscle Tightness – Tight calf muscles can result in excessive stress being placed on the plantar fascia.
- Unsupportive footwear with poor shock absorption
- Increased Body Weight
- Increased Activity Levels
- Hard Surfaces – walking on hard surfaces (cement or hard-tiled floors) can aggravate heel pain.
What are the signs and symptoms of Heel Spurs?
Many people have heel spurs but may never experience any heel pain and are usually unaware they have a heel spur. In most cases, the heel spur itself is not the cause of the heel pain. The inflamed and injured plantar fascia, or plantar fasciitis, is the most common cause of heel pain. When the heel spur is first forming there may be some bone marrow oedema and this may cause some pain, but once the heel spur has formed this pain resolves. The symptoms of heel spurs are the same as the symptoms of plantar fasciitis:
- Pain in the morning on the first few steps when you get out of bed
- Pain and stiffness (or hobbling) when you start to walk after sitting for a while
- Increasing pain in your heel towards the end of the day
- A ‘bruised’ feeling or dull ache beneath the heel
- Tired feet and legs by the end of the day
- Pain beneath the heel when walking on hard, unforgiving surfaces (eg cement floors or tiles)
How are Heel Spurs diagnosed?
A Heel Spur, or plantar fasciitis, is usually diagnosed after taking a history and performing a physical examination. The physical examination includes:
- testing your muscle strength
- assessing your joint range of motion
- checking your foot posture
- Analysing your gait
- testing your ability to perform pain provocation tests
If you have a heel spur this can be seen on a plain foot xray.
Plantar fasciitis can be seen on a soft tissue ultrasound.
How are Heel Spurs treated?
Heel pain is the most common complaint of patients attending the Clinic and we find that over 90% of the time, it responds well to our treatment program and surgery is almost never required.
Remember, most often its the inflammation of the plantar fascia that is causing the pain, not the heel spur. So treatment is directed at the plantar fascia.
Treatment aims to reduce inflammation of the soft tissues that attach to the heel and to improve the alignment and function of your feet. Depending upon the individual contributing factors, treatment may include a combination of the following:
- Rest from aggravating activities and applying ice massage to the heel 3 times daily to reduce inflammation
- Strapping the foot with sports tape can help to reduce excessive strain on the plantar fascia and provide some pain relief
- Orthotics for your shoes – to improve your foot posture and reduce strain on the plantar fascia. Research indicates in cases of mechanically induced heel and arch pain, the most effective treatment is quality custom-made foot orthotics. Orthotics are made from a 3-D scan of your feet and are prescribed specifically to help reduce tension on the plantar fascia and to restore normal joint alignment and function
- Modify footwear – changing to a high quality, stable shoe will help to absorb shock and support and stabilise the foot
- Home Exercise Program – calf muscle and arch stretches are integral to improving foot function and reducing the strain on the plantar fascia. Improving the strength of the foot muscles also helps to support the plantar fascia
- Joint Mobilisation – in addition to a stretching program, joint mobilizations can help to improve flexibility
- Massage Therapy – can be a helpful adjunct to your treatment
- Dry Needling or acupuncture of trigger points in the muscles of the lower leg and foot can assist in reducing pain and improving muscle function and flexibility
- Medication – in some cases a short course of anti-inflammatory medication may also be required to help reduce acute inflammation
- Weight loss if required
The longer heel pain is left untreated, the more difficult it becomes to alleviate with conservative care by your Podiatrist. If heel pain is not treated early cortisone injections, night stretching splints or cast immobilisation may be required.
What should I do if I have heel spurs or heel pain?
You should see your podiatrist as soon as possible if you suspect you have heel spurs or plantar fasciitis.
The onset of painful joints in the feet and lower limb often has a myriad of potential causes. The nature of the pain, history of injury or trauma, pre-existing as well as current medical conditions all have to be considered when identifying and diagnosing joint pain. Some of the pain can be attributed to arthritic pain which has many varying causes. One of the common forms of arthritis in the joints is due to a condition called gout. Gout is often identified by joints that are swollen, hot and extremely painful to touch. The onset is often very sudden and takes the sufferer by surprise. Most of the joints in the body can be affected though the feet are a very common place to develop symptoms. Modern research shows that gout is much more common in men than in women.
Ankle sprains is an injury that often occurs when the ligaments connecting the bones of the foot and ankle either stretch or tear (partially or completely). This type of injury is often associated with athletes that are involved in side to side motions such as quick changes in direction or speed. People who suffer such an injury usually feel instant discomfort at the level of the ankle and depending on the severity of the injury, associated swelling and/or ankle weakness.
Types of ankle sprains
There are 3 different types of ankle sprains which are identified by the nature of the injury alongside which structures are affected. These types include:
– Inversion sprain: often referred to as ‘rolling your ankle’. This is perhaps the most common type of ankle injury and occurs when the foot turns inwards as a results stretching and/or tearing the ligaments located on the outside of the ankle.
– Eversion sprains: occur when the foot turns inwards often causing injury to the ligaments located on the inside of the ankle.
– High ankle sprains: are the least common type of ankle injury but often are the most serious. It can involve either the inversion or eversion type and occurs when the foot is forced upwards or the leg severely twisted with the foot positioned on the ground. The injury can cause damage to a ligament called the syndesmosis, which connects the two leg bones together and can take quite a while to heal if damaged.
Ingrown toenails are very common and extremely painful. For those that have been unfortunate enough to experience them, will know how memorable the pain can be. However, most don’t actually know that treatment is quick and instant relief is provided. Most people struggle with trying to cut it out themselves causing further infection and bleeding. A pedicurist is definitely not the place to get treatment, as one patient told me this morning “I went to a pedicurist because i didnt know about podiatrists “.
An ingrown toenail is simple an inflammation of the skin beside the toenail, and can sometimes also have an infection. Most common causes are nail spurs caused by trauma and incorrect cutting of the nail, or oddly shaped toenails. What i want to focus on today is the oddly shaped toenails that keep causing an ingrown toenail. This nails tend to be either fan-shaped or very curved caused pressure on the sides. The treatment that i often recommend to this presenting problem is to either attend periodically (every 6-8weeks) for regular re-shaping of the nail or have a permanent procedure, called partial nail avulsion (“nail surgery”). The latter option is what i will focus on today, as many do not know what it entails.
Pain and discomfort in the younger population is often times associated with body changes and development. A lot of this pain is often dismissed by parents and guardians as ‘growing pains’ that passes as the child develops. Heel pain is particularly common in active kids. Sever’s disease (also known as calcaneal apophysitis) is a commonly occurring condition in the young and active portion of the population. Males are often more prone to developing the condition than females and the symptoms usually arise prior to puberty. Sever’s is often characterised by ongoing episodes of heel pain which are alleviated by rest and exacerbated by periods of weight bearing activity such as school attendance or participating in sports or social activities.
Building better Glutes – Part 2.
The gluteus medius should be considered in every running injury. This muscle is under-appreciated by runners or active people because it isn’t large or is well known for producing tone and bulk. This muscle is very much like the tow bar or tow ball between a car and a trailer, without it being secured properly, the weakness in the link jeopardizes the stability of the trailer.
During running, the role of the gluteus medius is to ac as a pelvic stabiliser. So for example, whilst your running and on the right leg, it stops the left side pelvis from tilting down tilt more than seven to eight degrees from parallel to the ground. If the gluteus medius is not functioning well enough to achieve this control, the athlete is said to have a ‘Trendelenburg gait’. Often, but not always, you may see the same weakness in walking (producing a waddling motion or, in extremis, a limp), and the dysfunction will then be more marked when they run.
Neuroma’s are commonly occurring causes of foot discomfort and pain in people who perform extensive weight bearing activities such as sports or work. A neuromais a thickened bulge on the nerve branch which may be caused due to constant compression of the nerve involved. A neuroma that most podiatric patients present with is called Morton’s neuroma and occurs between the 3rd and 4th metatarsal bones in the foot. Patients will often describe an uncomfortable pain occurring between the bones in the ball of the foot which can be exacerbated when pressure is applied. The discomfort can become quite debilitating if left unattended.
What causes a Morton’s Neuroma to occur?
Morton’s neuroma is often caused by compression of the nerve in the foot. This compression can be caused by either structural abnormalities or certain behaviours.
Some common physical traits associated with increased risk of neuroma include:
– Flat feet or highly mobile/flexible feet
– Genetic predisposition.
Metatarsalgia is a broad term to generally describe inflammation and pain of the metatarsal bones in the foot. This is a common problem occurring with overuse injuries often seen in people who participate in high impact sports or people who spend extended period of time performing weight bearing tasks with unsuitable footwear.
Pain, whether localised or diffuse, is the primary symptom of this condition. The pain is often isolated to the ‘head’ of the metatarsal bones and can be aggravated with weight bearing or direct palpation. The fact that the pain can be debilitating, it can result in the sufferer altering their walking patterns which can trigger other overuse issues including bursitis or stress fractures. The ‘overuse’ nature of the condition means that symptoms may not arise immediately rather they build up over a period of weeks to months before becoming noticed.
Did you know that there are a number of different shoe lace techniques appropriate for each foot type. Here at The Podiatry Centre, we are aware that feet are as unique as the patients we see. So above is a lacing chart from our good friends at the Athletes Foot showing a number of ways in which your laces can help your shoes better accommodate your foot type.
For patients with a generally high arched foot. They may feel pressure through their instep due to the traditional lacing technique. The Volume Lacing technique aims to reduce pressure from above the top of the instep.
During an assessment of a patient, i often have to check if the glutes are activating. In almost 90% of cases, i find people fail this test including runners, gym-goers, athletes, and fit-people. Everyone understands the concepts of exercising your glutes (butt muscles), but no one seems to understand that they need to be activated. This means people are doing the exercises and movements to focus on strengthening the butt, but in fact their not even switching it on to get the muscle working properly so they end up with tight hamstrings and hip flexors.
What Glute activation ?
Glute activation is simply firing of the glute muscle in a timely manner whilst performing the relevant exercise that utilises it such as, lunges, squats, lifts etc. We are very familiar with the glutes for many reasons: aesthetic (eg bikini bottom) , strength (eg burpees and dead lifts) , speed (running) , performance (ballet), balance and co-ordination (gymnastics). So we appreciate why they need to be strong and in a good condition. However, not many know that the glutes are not actually switching on in a timely manner to get the most out of their exercises.
What is it ?
Shin splints are common among runners and individuals who participate in any activity which involves running. This overuse injury usually develops gradually over a period of weeks to months but may occur after a single, excessive bout of exercise. Individuals typically complain of pain in one of two locations: the lower inside half of the leg and, less commonly, the upper outside portion of the leg. Shin splints, also known as medial tibial stress syndrome, are an inflammation of the soft tissue surrounding the bone lining of the tibia at the origin of several leg muscles.
What causes it?
Excessive running, improper conditioning programs and overpronation (flattening of the arch) are common causes of shin splints because of the stress they cause to the medial structures of the lower leg. This stress may cause microtears and inflammation in the soft tissue (periosteum) attached to the tibia. Muscle weakness, non-supportive shoes, running hard on surfaces and overtraining can also be contributing factors. Patients will usually notice the pain when they start exercising and it decreases or goes away as they continue to exercise. They will usually tell you the pain is worse after they stop exercising or it will hit them the following morning. If strain continues in this area for an extended period of time, it is possible for microfractures (stress fractures) to form along the tibia. There typically isn’t a sudden break of the bone but usually patients will relate a gradual increase in pain until it becomes quite severe.
Pain in the shin area may be coming from the lumbar sacral spine, a muscle imbalance, uneven leg length or compartment syndrome. Typically, abnormal biomechanics, such as overpronation (excessive flattening of the foot), can cause these posterior shin splints
Running on hard surfaces and a flatfoot condition may be initiating factors as well. However, more often than not, this condition is a simple result of over-training or improper training.
What are calluses and corns?
Calluses and corns are areas of thick skin caused by pressure or friction. It is a normal reaction by the body to produce thick skin when pressure is applied, in order to prevent itself from breaking down. However, this thickness can cause secondary pain by applying pressure on the soft skin around it. Corns and callouses are made of keratin, just like our hair and nails, so they dont actually have feeling. There is no nerve or blood supply to these lesions. The pain is caused by the pressure they apply to the soft skin.
Callouses are usually a patch of thickened skin which will be yellow in colour. They are caused by sheer forces on the skin.
Corns can be soft (between the toes) or hard (top of toes or sole of foot). A corn will usually appear as small seed size patch of hard skin. It occurs when there is torsional forces on the skin, which is why it becomes like cone shaped lesion. It hurts when direct pressure is applied.
A common occurrence in people and often is a cause for much discomfort is the blister. Blisters are small fluid filled sacs that form in the epidermal (upper levels) of the skin as a response to pressure, sheer forces or trauma. Blisters can be painful, uncomfortable and in some cases can become the portals of infection or further tissue injury. Most people regularly pop and drain blisters which usually alleviates some discomfort however using unsterile techniques or instruments to lance the existent blisters can predispose the person to developing a skin infection. If the blister is left unpopped, the body naturally reabsorbs the fluid and the skin dries and flakes off.
Toe deformities are becoming more prevalent due to lifestyle and shoe characteristics. Though most people are quick to diagnose misshapen toes as ‘hammertoes’, there in fact are four different types of toe abnormalities. These include:
- Hammer toes
- Claw toes
- Mallet toes
- Retracted toes
Whilst there is an appreciable difference in the abnormal alignment of each type of deformity the causative factors and consequences are generally the same.
The hammertoe deformity is possibly the most common misalignment condition that affects the smaller toes. The condition is characterized by contraction of the toe to a position that can cause pressure spots to form due to shoe pressure whilst walking. Whilst the deformity itself is not life-threatening it can become worse and more painful altering the biomechanics of the feet in the process.
Lesser toe deformities are generally progressive and whilst they cannot be stopped, the speed of onset, progression of condition as well as symptoms caused can be controlled.
Part of my job when dispensing orthotics to patients, is to educate them on the type of shoes that fit orthotics as is can be often confusing as to what to buy and what to avoid. Fitting orthotics in sport shoes, or lace-up shoes is often a straight forward process with no difficulty. However, orthotics that have to be used in work or casual footwear is often confusing as they vary so much. I have written this article as a guide to assist those who use orthotics, and need professional advise and guidance on what features to look for in a casual or work shoe to comfortably fit orthotics.
What are bunions?
Medically referred to as “hallux abducto valgus”, bunions are a relatively common deformity found in the fore foot area which is usually characterised by a prominent ‘bump’ and deviation of the big toe from its original position. The condition can lead to painful motion of the joint when walking or difficulty when wearing or fitting shoes. The condition can occur at any point of life but research does show an increased incidence rate in people over 45 with females also being more likely to develop a bunion. A patient may present to a clinic with or without pain. Those who have discomfort, generally describe a pain centralised to the big toe joint. Aching pain may also be described with irritation from footwear on the prominent bump. Patients may report that physical activity may make the bunions feel worse and thus may limit their physical activity levels.
It can be a very confusing and over-whelming experience trying to shop for a running shoe. Its great that running shoe companies are offering such a wide range of shoes with technical features, but in-turn this has left the public feeling even more confused as to what shoe they should get. We hear your struggles and understand that you may also not be in expert hands when getting fitted. Hence we have created a shoe table (Updated 2015) that compares different shoe brands. Some may know what they require but others don’t. If you don’t , then see a podiatrist for an expert opinion. Selecting a shoe is not simply about your arch height or shape. It is actually a bit more complicated. Shoes vary in their shape, density, elevation pitch, cushion, and weight. Patients often ask me “What brand do you recommend ?” and I often reply ” Its not about what brand is the best, but what shoe is most suitable for you ?” . Podiatrist will determine the most suitable running shoe for a person by asking the following questions:
– What is the frequency, mileage, speed, surface of you running ?
-What injuries have you incurred in the past ?
-Do you have any current or past foot or leg pain ?
-What shoes are you currently wearing and why ?
-What is the weight and build of your body ?
-Are you using orthotics and why ?
What is an Ingrown Toenail ?
Ingrown toenails are a very common condition that presents to the podiatrist. An ingrown toenail is a very lay term that a person uses when they feel pain on the side of the toenail. This typically will involve inflammation, swelling and infection. However, this isn’t always the case. Sometimes there is neither redness nor infection, which can suggest another reason for the pain.
How does an ingrown toenail occur ?
An ingrown toenail is caused by the nail piercing the skin beside it leading to inflammation. If the skin is broken, this can lead to a local infection also.
Common causes of ingrown toenail are:
- Incorrect cutting of the nail, leaving it too short or with a sharp corner or leaving a nail spicule.
- Tight footwear can cause the nail and the skin to be pressed firmly together
- Curved toenail can predispose you to an ingrown due to its odd shape
- Trauma through sports or hitting a hard object with your toe
- During a re-growth of a new nail
- Pedicure salons can cut nails incorrectly, leaving you with a sharp corner or nail spicule
What are plantar warts?
Plantar warts (Verruca pedis), are contagious skin lesions that are caused by the Human Papilloma Virus (HPV). The lesions themselves are often only limited to the upper layers of the skin but with persistent infection can infiltrate deeper layers of the skin resulting in an increased level of discomfort. While warts can occur on many regions of the body, the ones that occur on the soles of the feet can become painful because of the actions of standing and walking.
What do plantar warts look like?
Plantar warts come in different varieties and can appear either individually or in clusters. The general appearance of warts resembles that of a cauliflower plant protruding from the skin. They can appear skin coloured making them harder to identify or covered by an overlying layer of thickened skin (callous) which adds to the discomfort when weight bearing. Some warts can have small brown or black dots which indicates small blood supply to the overlying viral tissue.
CrossFit is a fitness phenomenon that has taken the athletic community by storm. It is a regimen of constantly varied, functional movements performed at high intensities within a communal environment.1 CrossFit incorporates a variety of exercises into daily workout routines. These exercises include biking, swimming, rowing, gymnastics and plyometrics to name a few.
The effect of diabetes on the feet and lower limbs has been well established both in literature and in clinical studies. Changes in the body can ultimately impact both the larger and smaller arteries in the lower limbs. Calcification of arteries as well as formation of thrombi (Blood clots) may lead to further problems that can end in death. As such, ankle systolic blood pressure measurements have been an important process in evaluating and monitoring lower limb arteries for onset of diseases such as peripheral arterial disease and critical limb ischaemia. Currently the most widely accepted method of assessing this is the Ankle Brachial Pressure Index (ABPI). Though this method is effective in identifying blockages in blood flow, recent studies have shown it to be unreliable in elderly patients, those with diabetes or chronic renal failure because the peripheral arteries may be incompressible as a result of calcification or blockages in these smaller arteries.
What does the systolic toe pressure machine detect?
The newest technologies look to assess the systolic blood pressure in the toes as well as toe pressure indices. The readings are usually taken at the hallux. The results of these studies can be used to identify or screen for a number of medical conditions including:
- Blockages in large and small blood vessels
- Arterial insufficiency
- Cardiac dysfunction
- Ischaemia/intermittent claudication
- Necrosis and amputation risks.
Steps to care for your feet and keep them healthy
Having looked at the potential risks to the feet of a person with diabetes, this final installment will look at appropriate steps to take to keep the feet healthy and safe from potential injury and/or complications.
The Diabetes Association of Queensland has presented a 5 step protocol towards attaining healthy feet. The steps follow the below:
Wash and dry you feet daily ensuring that you dry well inbetween the toes. The best way to do this would be to use a towel.
Prevent the skin on your feet from getting dry by rubbing moisturiser daily. Moisturisers like sorbolene, vitamin E and aloe vera creams are a good way of maintaining moisture. It is important to remember however not to put moisturiser inbetween the toes as this region should be as dry as possible. Wearing socks also helps keen the skin from becoming dry.
What is Plantar Fasciitis?
In the running community, plantar fasciitis is the primary cause of pain in the heel and affects as much as 10% of runners.
As you run, the Achilles tendon works with plantar fascia (a thick band at the bottom of your feet) to help store energy. Due to its strong attachment with the base of the toe, the fascia stabilizes the forefoot and helps while push off. Unfortunately, stress on the heel causes tear of the fascia, inflammation and pain while running or walking.
Diabetes and associated foot complications
Building on our first piece on diabetes and their effect on feet, this week’s blog will focus on bringing light to some possible foot complications that may occur as a result of diabetes and some warning signs to look out for.
Diabetes can cause damage to your nerves and blood supply, putting your feet at greater risk of damage. This risk is only increased if the diabetes has been long standing, is poorly controlled (blood sugar levels are too high) or if the person is inactive or smokes. Changes in the blood that occurs from diabetes makes the feet and lower limbs more prone to infections and poor healing wounds. The fact that diabetes can also cause a loss of sensation in the feet, small and apparently harmless cuts can go unnoticed and with periods of weight bearing can break down and form ulcers that heal very slowly.
There are a number of signs and symptoms that need to be addressed immediately and others that can be taken care of regularly with the help of a podiatrist.
Some complications that require urgent medical attention include:
Sutherland to Surf Foot Tips !
By wearing two layers of sock if the shoe fits. This helps by allowing the friction to be taking place between the two layers of socks rather than your skin and sock.
Apply a generous amount of foot powder or talcum powder on your feet prior to putting the socks on. Ensure you apply between the toes. This helps by reducing the amount of sweat and moisture that will occur on your skin, reducing the chance of getting a blister.
Wear a bandaid or blister dressing on areas which you have previously developed blisters on.
How to Keep Nail Fungus Away
The best way to fight nail fungus is to prevent it in the first place. Once the fungus gets under the nail it can be difficult to remove simply because of its location. The nail will turn a white or yellow colour and it may take prescription medication to destroy the fungus present. There are many who turn to a podiatrist in order to get proper treatment.
However, preventing the condition from occurring in the first place will save you a trip to the doctor or having to get medication to cure the condition. Here are a few tips to help keep your nails clean and clear of a fungus infection.
How to Prevent Nail Fungus from Occurring
While you may not be able to provide each toe or fingernail with 100% protection, you can go a long way towards creating an environment when the fungus will have a difficult time entering the nail.
How To Prevent Bunions
The feet are very often a part of the body that we routinely forget about. Despite the fact that we all spend inordinate amount of time on or feet, very few of actually take the steps to ensure that hey stay healthy through all of that wear and tear. For most people, the only time that they will ever actually visit a podiatrist is when they develop a problem that causes pain or discomfort in the feet. One of the most common complaints are bunions, which is actually something that can be avoided by following a few simple tips.
While you may have heard about bunions, you may not know exactly what they are. Believe us, though, if you do have the misfortune of having a bunion develop, you will know all too well the pain that they can deliver. A bunion develops when the joint in the big toe becomes inflamed, which generally happens when the soft tissue surrounding that joint are put under continued stress. This often happens when wearing footwear that is too tight, or is sharply pointed at the toe. The more often you wear the wrong types of shoes, the more likely you are to experience the pain of a bunion.
Part 1 : Diabetes and Peripheral Neuropathy
As a lead into the start of Diabetes Awareness Week (July 12-18), we here at The Cronulla Podiatry Centre will have a three-part blog aimed at bringing awareness of the effect of type 2 diabetes on not only the feet but to the quality of life of those with the condition. Type 2 diabetes, often referred to as a ‘lifestyle disease’, is the most common form occurring when the pancreas does not produce enough insulin required by the body. Diabetes Australia estimates that 1.1 million Australians currently suffer from type 2 diabetes with 280 new cases reported every day.
Part one will look at a phenomenon called diabetic peripheral neuropathy.
What is diabetic peripheral neuropathy?
This is a complication of uncontrolled diabetes which results in nerve damage in the feet.
Radial Shockwave Therapy (RSWT)
Radial shock wave therapy (RSWT) has revolutionized pain management in soft tissue pain, and is an emerging technology in aesthetic dermatology too. The procedure is non-invasive and performed in the clinic.
In pain management RSWT is usually applied weekly with minimum 2-3 treatment sessions. Approximately 80% of all patients report a substantial improvement of the clinical situation already after the second treatment session. According to the most recent studies, this is a positive sign for the prognosis of the treatment outcome. Therefore, it is possible to foresee the treatment outcome after only two treatment sessions, but not before (EMS publication 2011)
Pregnancy triggers many different changes in a woman’s body. Many women have common complaints throughout their pregnancy. One of these complaints, often overlooked, is foot pain. Due to the natural weight gain during pregnancy, a woman’s center of gravity is completely altered. This causes a new weight-bearing stance and added pressure to the knees and feet.Two of the most common foot problems experienced by pregnant woman are over- pronation and edema. These problems can lead to pain at the heel, arch, or the ball-of-foot. Many women may also experience leg cramping and varicose veins due to weight gain. Because of this, it is important for all pregnant women to learn more about foot health during their pregnancy to help make this nine month period more comfortable for them. Two of the most common foot problems experienced by pregnant woman are over-pronation and edema. These problems can lead to pain at the heel, arch, or the ball-of-foot. Many women may also experience leg cramping and varicose veins due to weight gain. Because of this, it is important for all pregnant women to learn more about foot health during their pregnancy to help make this nine month period more comfortable for them.
Over-pronation and swelling are a very common foot problem experienced during pregnancy. Over-Pronation, also referred to as flat feet, is caused when a person’s arch flattens out upon standing and their feet roll inward when walking. This can create extreme stress or inflammation on the plantar fascia, the fibrous band of tissue that runs from the heel to the toes. Over-pronation can make walking very painful and can increase strain on the feet, calves and/or back. The reason many pregnant women suffer from over-pronation is the added pressure on the body as a result of weight gain. Over-pronation is also very prominent in people who have flexible, flat feet or in people who are obese. Oedema, also referred to as swelling in the feet, normally occurs in the latter part of pregnancy. Edema results from the extra blood accumulated during pregnancy. The enlarging uterus puts pressure on the blood vessels in the pelvis and legs causing circulation to slow down and blood to pool in the lower extremities. The total water fluid in the body remains the same as before pregnancy, however it becomes displaced. Sometimes extra water is retained during pregnancy, adding to the swelling.
Treatment and Prevention
There are effective ways to treat both over-pronation and oedema during pregnancy. Over-Pronation can be treated conservatively with “ready-made” orthotics. These orthotics should be designed with appropriate arch support and heel posts to correct the over-pronation. Proper fitting footwear is also very important in treating over-pronation. Choose comfortable footwear that provides extra support and shock absorption. It is important to treat over-pronation for pain relief but also to prevent other foot conditions from developing such as Plantar Fasciitis, Heel Spurs, Metatarsalgia (pain in ball of the foot), Arch pain and/or Bunions. Oedema in the feet can be minimized by the following methods: Elevate your feet as often as possible. If you have to sit for long periods of time, place a small stool by your feet to elevate them. Wear proper fitting footwear. Footwear that is too narrow or short will constrict circulation. Have your feet measured several times throughout your pregnancy. They will probably change sizes. Wear seamless socks that do not constrict circulation. You may find open toe footwear more comfortable as your feet get more swollen but if you have foot pain, this can also increase it due to lack of support. If in doubt, speak to the podiatrist for more personalized advise. If you are driving for a long period of time, take regular breaks to stretch your legs to promote circulation. Exercise regularly to promote overall health; walking is the best exercise. Drink plenty of water to keep the body hydrated. This helps the body retain less fluid. Eat a well-balanced diet and avoid foods high in salt that can cause water retention. Swelling is normally similar in both feet. If swelling is not symmetrical in both feet, this may be a sign of a vascular problem and a doctor should be contacted immediately.
By Anel Kapur
Proprioception is our sense and awareness of the position of our body parts and is closely linked to balance. Having good proprioception helps to reduce the risk of injury. Located within the muscles, tendons, ligaments and other soft tissues of the body, are tiny sensors which relay information about joint position, pressure and muscle stretch to the brain. These proprioceptors are specialised sensory receptors on nerve endings within these structures. Once the proprioceptors have sent information to the brain, the brain then reacts, making changes to the body’s position, as required. When you incur an ankle sprain, you have over-stretched the tiny tendon and muscle fibers that also then cause damage to the sensory receptors, leading to a delay in the message being sent to the brain. It has been found that doing ankle proprioceptive exercises actually reduces the risk of incurring another ankle sprain. This is even more important for those who have had multiple ankle sprains.
You don’t have to put up with heal pain – especially when it can be such a simple and inexpensive fix!