What is dry needling and how it can help you?

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. Read more

Heel pain -Part 3 How Radiology Imaging can Help.

“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-RAY

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

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

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 Scans

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.

MRI

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.

Conclusion:

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)

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Heel Pain in Your Child Could be Severs Disease.

“ 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. Read more

Heel Pain and Plantar Fasciitis. Part 1 – Introduction to Heel Pain

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

– Anti-inflammatories

– Rest

-Straping Read more

Cracked Heels; More than just a Cosmetic Problem?

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. Read more

Avoid Painful Feet this Holiday Season with these Podiatry Tips

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. Read more

Wearing Heels Regularly? Every cm Matters.

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. Read more

What is Radial Shockwave Therapy

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. Read more

Childrens Heel Pain and Sever’s Disease

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. Read more

Which Running Shoe to Buy?

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 ?

Read more