Treatment

    Services we provide

     
  • X- Rays

    X-rays of the foot and/or ankle are an important part of our diagnostic capabilities. Our radiology equipment, similar to that used by dentists, is designed to keep your radiation exposure to an absolute minimum. Also, the majority of our x-rays are exposed with you weight-bearing (standing), since this is typically when your symptoms are at their worst. And, for your convenience, modern technology (a high-speed x-ray processor) makes it possible for us to provide your x-ray consultation just ten minutes after your x-ray(s) are taken. We believe that this is far better than having to wait days or even weeks to get an “x-ray report” through. This prevents unnecessary delays in getting the treatment you need.

    When our clinical examination indicates that bone injury, deformity or other abnormality (e.g. bone spurs) or joint degeneration may be the cause of your discomfort, an x-ray assessment is usually recommended. Bone injuries (with or without fracture) could be the result of a sudden traumatic event such as turning your ankle in, dropping something heavy on your foot or accidentally jamming one or more of your toes against a solid object (e.g. bedpost or kerb). Also, bone may succumb to the cumulative stresses of prolonged (and unaccustomed) walking or running in the form of a “stress fracture.” If left untreated, this can progress to a complete fracture requiring six weeks of immobilisation. Early diagnosis and treatment is the best approach.
    Remember, clinical examination creates “suspicion” that arthritis or a spur may be present, the x-ray is required to confirm whether it is or is not present. Effective long-term treatment of your condition is dependent upon an accurate diagnosis.

  • Toe Nail Surgery

    No "Bathroom Surgery"

    Don’t be tempted to “have a go” at treating your ingrown toenail with your trusty nail cutters or scissors. You may end up doing more damage to the area and possibly even spreading the infection that’s already present. The end result is that you may increase rather than decrease the pain you’re experiencing!

    Saltwater soaks

    In order to help clear the area of pus and dried blood (if present), it’s best to soak your toe in lukewarm (not hot!) saltwater for 15-20 minutes once a day. Simply place a teaspoon of table salt in a small container of warm water. After each soaking session, gently dry the area and place an antiseptic (e.g. Savlon) on the area followed by the application of a small piece of sterile gauze and a plaster. As soon as possible, make an appointment to have this treated properly

    Initial Podiatry

    Prior to your initial visit, you’ll be asked to complete a health questionnaire. This is very important, since your treatment may be influenced by your current health and/or medications. The level of treatment you require depends on the severity of your condition. For the most basic painful in-growing toenail (usually a first-time occurrence), the offending spicule of toenail will be removed.

    If the toe is particularly tender, a local anaesthetic will be administered beforehand.

    For those of you with “needle-phobia,” don’t worry—we use a freezing spray to numb the skin prior to the injection of anaesthetic. And forget any horror stories you may have heard about injections directly into the ingrown toenail. This is simply unnecessary and causes needless pain. By knowing the anatomy of the toe, we place the anaesthetic well away from the painful area. Then, once the anaesthetic is in place, you won’t feel any discomfort whatsoever.

    Our philosophy of practice dictates that we will not allow any of our patients to “suffer through” any treatment or surgery. Once the offending nail spicule is removed, we may or may not give you a brief note to take to the pharmacist to get a course of appropriate antibiotics. If this is recommended, it is because our examination reveals significant tissue infection present (or even mild infection in a patient with diabetes or poor circulation)

    Ingrown Toenail Surgery

    Nail surgery is a surgical procedure to remove all or part of your toenail. It is usually required when an in-growing toenail is frequently recurring. This minor surgery is a relatively simple procedure and is permanent solution to the problem.

    Local anaesthetic is injected into your toe and this makes the toe numb, blocking all pain sensation during the procedure. When your toe is numb a band is placed at the base of the toe to help reduce bleeding. The offending piece of nail or whole nail is then removed. To prevent unwanted re-growth of part or the entire nail, a chemical called phenol is applied to the nail germinal matrix.

    Care has to be taken in the first few weeks after the surgery to help prevent infection. The whole procedure generally takes an hour to complete and is an efficient, successful solution, to in-growing nails.

    After the surgery you will need to keep your foot elevated for a few hours and rest. You can return to work or school the following day. It is advised that you refrain from sports and running for at least two weeks. Healing time varies dependant on your age and general health, but it is generally 4 to 12 weeks.

    If you have a chronic, or recurring problem with an in growing toenail, your best option would be to have the offending incurvated nail spicule permanently removed. Imagine, no more painful ingrown toenail again…ever.

  • Doppler Vascular Assessment

    A regular supply of oxygenated blood is required to support and nourish all the tissues in your body. Once oxygen is "attached" to the haemoglobin in your red blood cells (which takes place in your lungs), your heart pumps it through your arteries to the tissues.

    When circulation to an area is diminished, a variety of problems can occur. Muscle cramping (mostly in the calves) when walking may be an indicator of a significantly compromised blood supply.
    Decreased arterial circulation also causes thinning and decreased elasticity of your skin, decreased/absent hair growth and delayed wound healing.

    In fact, it can even decrease your resistance to infection when you've suffered a minor cut or undergone surgery. When your veins (which return deoxygenated or "used" blood back to your heart and lungs for re-oxygenation) are varicosed or otherwise deficient, you may be subjected to excessive swelling or even ulceration of the skin.

    If you are diabetic, it is important to keep a check on your circulation, as diabetes can affect the large and small vessels in your legs and feet.

    If you are a smoker, it would be very beneficial to get your lower limb circulation assessed, as there is a high risk of vessel disease associated with long term smokers.
    We can do this at theFootfix clinic, for a thorough vascular assessment it will take about 40 mins.

     

  • Biomechanical Assessment

    Biomechanics involves assessment of the structure, alignment and function of the feet, ankles, legs, thighs, hips and lower back. The lower extremity is truly an engineering masterpiece. However, when one or more components of the interlinked “walking machine” are misaligned or functioning abnormally, the remainder of the musculoskeletal system needs to compensate in some way. The purpose of this examination is to identify and treat all aspects of any biomechanical abnormality discovered.

    Our biomechanical assessment consists of five segments. First, you lie face down on a flat examination couch with your feet and ankles slightly extended over the edge. Measurements related to your forefoot, mid-foot, rear foot and ankle joints are taken. Next, you’ll be asked to lie on your back, with your head resting on a pillow. In this position, measurements of your anklebones, leg rotation (internal & external), quadriceps (thigh) muscle strength and limb lengths will be made. Other muscle groups will be tested as well. Also, a functional examination of your knee will be undertaken.

    The third segment takes place with you standing barefoot on the floor. At this time, your shoulders, upper back, middle back, lower back and pelvis position will be assessed. Following this, you’ll be asked to step up two stairs onto an examination platform. Here, a series of foot and leg measurements will be made—first from the back and subsequently from the front. Also in this position, several digital video segments will be recorded. Finally, you’ll be asked to walk on a treadmill (at a pace you select) for about 5-6 minutes. During this time, digital video will be recorded from three separate vantage points: from the front, the side and from the back.

    Upon completion of your assessment, all findings will be explained in detail using a combination of demonstrations, diagrams and slow-motion digital video segments. For each abnormality detected, a solution for treatment will be presented. Typically, casting for appropriate custom-made orthotics will follow this consultation.

  • Therapeutic Ultrasound

    Therapeutic ultrasound is a well-established physical therapy modality that can be used to ease pain and promote the healing of a variety of muscle, ligament, tendon or joint problems. It consists of high frequency sound waves (above those we can hear) transmitted into deep heat in the affected tissues. This, in turn, increases the local blood supply to the area-an essential requirement for faster healing.

    Prior to the administration of therapeutic ultrasound, a clear gel is applied to the skin in the treatment area. This is essential to provide effective conduction between the ultrasound head/transducer and the skin surface. Patients typically experience either a comfortable local warming sensation or no sensation at all. To avoid "over-heating" any specific area, the ultrasound head is continuously moved over the treatment site.

    In our clinical experience, we've found that a series of ultrasound treatments can be very helpful for conditions including, but not limited to the following: plantar fasciitis, heel-spur syndrome, muscle spasm, Achilles tendonitis, bursitis, post-injury scar tissue (e.g. following ankle sprains), tendonitis adjacent to the knee joint, tendonitis on the front of the ankle or top of the foot, capsulitis (pain in the ball of the foot) or neuritis.

  • Sports Medicine

    What is Sports Medicine

    Sports medicine is the health care discipline that involves the prevention and treatment of sports injuries as well as the clinical guidance for rehabilitation following an injury. Since all athletic endeavours involve some form of walking and/or running, it seems logical that the sports-oriented podiatrist should be one of the key health care practitioners dealing with sports medicine problems. With a focus on maintaining optimum lower extremity function, podiatric sports medicine places special emphasis on getting the athlete safely back into sport participation as quickly and effectively as possible.

    The human foot is a complex structure that is designed to convert the rotations of the leg and arms into efficient forward motion. Normal walking places a great deal of stress upon the foot as it accepts the body weight from above and it attempts to adjust to varying changes in the walking surface. Jogging and running produce even greater stresses (about three times your body's weight!) and, when normal foot function is not present, overuse breakdown in the lower extremity is likely to repeatedly occur.

    We currently treat a wide variety of sports-related problems encountered by both amateur and professional athletes. These include, but are not limited to the following: foot/ankle strains or sprains; acute plantar fasciitis (pain in bottom of heel); Achilles tendonitis; chronic knee pain; foot pains associated with downhill skiing and running; shin splints, stress fractures; bruised and ingrowing toenails; friction blisters. With a keen interest in fitness and sports participation ourselves, we understand the special needs of athletes at all levels of intensity and commitment.

  • Radial Shock Wave Therapy

  • Injection Therapy

    An injection of cortisone into the joint or around a soft tissue such as a muscle or tendon can give temporary relief from symptoms. Cortisone is a powerful anti-inflammatory medication. When injected into the joint itself or around the inflamed muscle or tendon, cortisone can help relieve the pain. The pain relief is temporary it may only lasts several weeks to months or for some people years. For tendon and muscle problems it treats the symptoms but not the cause of inflammation , identifying the cause of the symptoms is important part of the treatment.
    There is a small risk of infection with any injection into a joint, and cortisone injections are no exception.

    There are also new injectable medications that lubricate the arthritic joint. These medications have been studied mainly in the knee. These injectable medications are trying to replace synovial fluid which may have been lost from the joint space.

    Injection Therapy

    A fair number of soft tissue injuries that remain chronic can respond to soft tissue injections. Therapeutic materials used for injection include:

    • Steroids
    • Traumeel ( Is a Homeopathic preparation ) 
    • local anaesthetics
    • saline
    • Ostenil (Is a hyaluronic acid)
    • platelet rich plasma ( Not performed at Footfix )
    • blood (Not Performed at the Footfix )

    The last two products mentioned are taken from the patient being treated, so no other source of plasma or blood is used. The evidence for this form of treatment is emerging from studies performed in Scandinavia and Australia .

    There are always risks involved with any form of treatment. The more common side effects after an injection include bruising and tenderness for a few days. After a steroid injection, some patients complain of a mild increase in their symptoms for 24 - 48hrs followed by a gradual improvement. The benefits can continue to develop over 6 weeks post injection. There is a rare risk of infection after any kind if injection ( e.g.: blood sample being taken by your Practice Nurse ). We pay close attention to any increase in pain after an injection as well as swelling or redness. Immediate contact with the clinic or your GP ( or Out-of-Hours service ) is advised if this occurs.

     

  • Custom Made Orthotics

    Functional orthotics are custom-made inserts designed to go into your shoes. They are configured based on the findings of a detailed biomechanical assessment (with digital video gait analysis) combined with scans from our newly aquired foot scanner.

    Scan's are the morden day equivalent to Plaster of paris cast's , we simply take a scan of your feet in a non weight bearing / semi non weight bearing position in your neutral position. The Scans are then sent to our laboratory in the USA  at a touch of a button to have your fully functional rigid orthtoic made, along with your prescription for treating your foot or leg condtion.

    The Laboratory adjust with necessary corrections based on your prescription requirements. Then the Computer generates a three dimensional model of your foot from the scans, and gives an exact replica of your feet, ready for the orthotic plates to be moulded to your feet. 

    Some times we do need to cast the feet ,each cast impression is taken with your foot held in its neutral functioning position. Then, the casts, along with a detailed prescription for treating your foot condition, are sent to a specialist orthotic laboratory in the USA. Each cast is filled with liquid plaster-of-Paris and allowed to dry overnight.

    If you require a specialised ankle foot orthtoic called a Richie Brace we will need to cast your foot and lower leg.

    Once the original cast shell is removed, an exact plaster replica of your foot results. Necessary corrections are made in the laboratory based on prescription requirements. Then, the appropriate orthotic materials are vacuum-pressed to this corrected model of your foot. Following a series of carefully monitored finishing steps, your durable (lifetime guarantee) orthotics are complete and ready for dispensing.

    The purpose of functional orthotics is to control/improve the way your feet and legs work. More specifically, they help the bones and muscles of your feet, legs, pelvis and back to function correctly. This reduces the underlying functional abnormality causing your discomfort in the first place. We treat many people with differing conditions , such as plantar fasciitis pain, skiing boots discomfort, running issues , neurological conditions can benefit with orthotic therapy to help stability. Stress areas to the bones , Childrens in-toe walking and out-toe walking. Growth disturbances such as Sever's disease , Morton's neuroma symptoms to name but a few issues.

    Sports orthotics extend to the full length of your foot. As such, they are designed to replace the original foot bed of your running shoe, trainer, casual walking shoe, hiking boot or ski boot. This creates a supporting surface that is configured exactly to the shape of your foot. Dress orthotics are for use in more formal footwear. Therefore, they are narrower than sports orthotics and only extend to the ball of the foot to allow more space in the front of your dress shoe.

  • Diabetic Foot Assessments

    What is Diabetes

    Diabetes is the inability to manufacture or properly use insulin, and it impairs the body’s ability to convert sugars, starches, and other foods into energy. The long-term effects of elevated blood sugar (hyperglycemia) can lead to serious damage to the eyes, heart, kidney, nerves, and feet.
    While there is no cure for diabetes, there is hope. With proper diet, exercise, medical care, and careful management at home, a person with diabetes can avoid the most serious complications and enjoy a full and active life.

    The Diabetic foot

    In 2010, more than 3 million adults in England had diabetes (diagnosed and undiagnosed). Disease of the foot remains a major threat to people with diabetes and is estimated to account for 20 per cent of the total cost of diabetes care in UK. There are 70 amputations a week, of which 80 per cent are potentially preventable. Despite this, in 2007/8 nearly a quarter (23 per cent) of people did not have a foot check” diabetes uk”.

    Fact:

    More than 3000 lower limbs are amputated annually due to complications from diabetes.

    Fact:

    Including a podiatrist in your diabetes care can reduce the risk of lower limb amputation up to 80 percent.

    High levels of blood glucose over a long period of time can result in harm to the body and its functions. In the feet, the nerves and the blood supply may both be adversely affected as a result of diabetes.

    Nerve damage in the feet and legs may cause a loss of sensation. Any trauma or injury to the foot, for example standing on a sharp object, may not be felt and could lead to more serious complications such as an ulcer.

    Diabetes can lead to a restricted blood supply in the feet and legs which may affect the ability to heal if there is an injury to the foot. The feet may appear cold and pulses will be weak if the circulation is poor.

    Today’s Podiatrist: diabetes is a disease affecting many parts of the body; successful management requires a team approach.

    At Footfix our podiatrist’s are an integral part of the treatment team along with your GP, Diabetic Nurse and optician. This teamwork has documented success in preventing amputations.

    The keys to amputation prevention are early recognition and regular foot screenings performed by a podiatrist, the foot and ankle expert.

    Diabetic Warning Signs

    • Skin color changes
    • Swelling of the foot or ankle
    • Numbness in the feet or toes
    • Pain in the legs
    • Open sores on the feet that are slow to healIngrown and fungal toenails
    • Bleeding corns and calluses
    • Dry cracks in the skin, especially around the heel

    Take Action:

    Inspect feet daily

    Check your feet and toes every day for cuts, bruises, sores, or changes to the toenails, such as thickening or discoloration.

    Wear thick,soft socks

    Avoid socks with seams, which could rub and cause blisters or other skin injuries.

    Exercise.

    Walking can keep weight down and improve circulation. Be sure to wear appropriate athletic shoes when exercising.

    Have new shoes properly measured and fitted

    Foot size and shape may change over time. Shoes that fit properly are important to those with diabetes

    Don't go barefoot

    Don’t go without shoes, even in your own home. The risk of cuts and infection is too great for those with diabetes.

    Never try to remove

    calluses, corns, or warts by yourself. Over-the-counter products can burn the skin and cause irreparable damage to the foot for people with diabetes.

    Visit us at Footfix

    Regular checkups by a podiatrist ,at least bi-annually is the best way to ensure that your feet remain healthy.

    Fact

    After an amputation, the chance of another amputation within three to five years is as high as 50 percent.

    Fact

    Care by a podiatrist can lower the risk of hospitalisation by 24 percent for those with diabetes

    It is important for a podiatrist to monitor any deterioration in the nerves or circulation of your feet. This allows you to take the necessary precautions to help avoid any complications

    Common conditions we treat

     
  • Achilles Tendonitis

    What is Achilles Tendonitis?

    It is estimated that Achilles tendonitis accounts for around 11% of all running injuries. The Achilles tendon is the large tendon at the back of the ankle.

    It connects the two muscles gastrocnemius and soleus to the heel bone.
    The Achilles tendon can become inflamed for a number of reasons, the main reason being overuse.

    The Achilles tendon has a poor blood supply and, therefore, it is slow to heal.

    What are the symptoms of Achilles Tendonitis?

    Pain in the Achilles tendon is usually felt during exercise. Achilles pain will gradually come on with prolonged exercise but will go away with rest. Swelling over the Achilles tendon is common, as is redness over the skin. Sometimes a creaking or lumpiness is felt when you press your fingers into the tendon and move the foot.

    In the early stages, the resultant discomfort and limping usually wears off after a few minutes, and the diagnosis can be confirmed by pinching the Achilles tendon between thumb and index finger whereupon at least one tender area should be felt.

    It is very important to distinguish between foot pain caused by Achilles Tendonitis (tendinosis) and the more serious condition of partial or complete Achilles tendon rupture, which requires urgent medical attention (surgery or immobilisation). If the heel pain comes on suddenly while running or is accompanied by weakness, then suspect a full or partial rupture rather than Achilles Tendonitis/Tendinosis and seek medical help quickly. Complete ruptures are less common in distance runners than they are in other sports like Tennis and Squash.

    What are the causes of Achilles Tendonitis?

    It is uncertain what triggers this, but excessive ankle pronation and/or the rapid alteration in calf muscle action as the heel strikes and then toe-off occurs, have both been put forward as possible causes.
    Shoes that are too flat or worn out are thought to be a possible cause, as are shoes that do not adequately cater for the runners’ specific biomechanical needs (e.g. over pronation). Sudden increase in training load (particularly very long runs or speed/hill sessions) and tight calf muscles are both also thought to be potential factors.

    Achilles tendonitis is an overuse injury, and is often a case of ‘too much, too soon’. Running up hills will mean the Achilles tendon has to stretch more than normal during each stride. This will not cause problems initially but the tendon will fatigue sooner than normal. Flat / pronated feet can place an increased strain on the Achilles tendon. As the foot rolls in (pronates) and flattens, the lower leg rotates inwards also which twists and stretches the Achilles tendon.

    What should I do if I have Achilles Tendonitis?

    Probably the most important thing to do is to stop running for a period of at least 7 days when the injury first appears.

    Ice packs should also be applied to the site of the heel pain, as although there is probably no inflammation, this may reduce the extent of tendon degradation.

    Note that it is not generally recommended to take anti-inflammatory medication for this condition. Careful return to a reduced training program can then be attempted.

    An assessment with a podiatrist from Footfix should be sought to review the cause of your Achilles tendonitis and a management plan devised to treat the condition. Your running regime may require modifying, as may footwear.

    What shouldn't I do if I have Achilles Tendonitis?

    ‘Running through’ pain should be avoided. Continuing with the current, possibly harmful training regime that is causing the symptoms is likely to cause further damage and should be avoided.

    Could there be any long term effects of Achilles Tendonitis?

    The worst case scenario is that the tendon snaps. This is also known as a complete rupture of the Achilles tendon. It can occur all of a sudden if vigorous exercise is attempted out of the blue, or it can occur after a long period of tendonitis. A completely ruptured Achilles tendon requires urgent attention.

    Podiatry treatment for Achilles Tendonitis

    Runners with of all types of foot pain should also consider whether a new pair of shoes is required. Shoes wear out and lose their characteristics, but perhaps a change of make and type (motion control?) should also be considered as the cause of the problem.

    We may advocate that a heel-support/ Insole for in the shoe or full custom-made orthotic be utilised to treat Achilles Tendonitis problems. These will help to control excessive force being applied to the back of the heel bone and tendon.

    An orthotic (shoe insert) that reduces the amount of pronation (the foot and leg rolling inwards) can help reduce overstrain on the tendon.

    Acute injuries can be treated with Ultrasound over a couple weeks to help relieve the initial symptoms . We normally see people for one to two treatments a week for 4 to 6 weeks , along with rehabilitation exercises this helps the acute injury.


    If this is a chronic issue which has not resolved for over 4 months or keep reoccuring  then radial shock wave therapy may be of benefit to try and a vascular response to the injured tissue and kick start the wound healing process again. you will require a a session of treatment once a week for 3 to 6 weeks . The healing process then can take up to 12 weeks to kick start a reactive healing response.


    There is a newer form of therapy that involves very high volumes of a dextrose and saline solution being injected into the Para-tendon, which effectively causes a stripping effect of the damaged tendons. This needs to be done under ultrasound guidance .

    The podiatrist can provide footwear advice as to what is suitable for training.

     

  • Ankle Pain

    What is Ankle Pain / Osteoarthritis?

    Ankle Pain / Osteoarthritis is usually considered a type of degenerative arthritis, or wear-and-tear arthritis. Doctors consider Osteoarthritis pretty much the same whether it appears years after an injury to the joint or whether it appears without any history of injury. It behaves more or less the same way.

    Over the past several years, there has been increasing evidence that this is genetic, meaning that it runs in families. Osteoarthritis that occurs without any injury may prove to be related to differences in the chemical makeup of cartilage. People are born with these differences.

    What are the Symptoms?

    Pain is the main problem with arthritis of any joint. This pain occurs at first only related to activity. Usually, once the activity gets underway there is not much pain, but after resting for several minutes the pain and stiffness increase. Later, when the condition worsens, pain may be present even at rest.

    The pain may interfere with sleep. The joint may swell, fill with fluid, and feel tight, especially following increased activity. As the articular cartilage starts to wear off the joint surface, the joint may squeak when moved.

    Osteoarthritis will eventually affect the motion of a joint. The joint becomes stiff and loses flexibility. Certain movements can become painful, and it may become difficult to trust the joint to hold your weight in certain positions.

    The body has a pain reflex such that when a joint is put into a position that causes pain the muscles around the joint may stop working without warning. This reflex can cause a person to stumble or even fall when arthritis affects the ankle joint.

    When Osteoarthritis has reached a very severe stage, the bone itself under the articular cartilage may become worn away. This can lead to increasing deformities around the joint. In the final stages, the alignment of the bones can begin to form odd angles where they meet at the joint.

    What causes Osteoarthritis?

    Injury to a joint, such as a bad sprain or fracture, can cause damage to the cartilage, this can be traumatic in nature, or from abnormal biomechanics of your ankle and foot function.

    The cartilage can be bruised when too much pressure is exerted on it. This damages the cartilage, although if you look at the surface it may not appear to be any different. The injury to the material doesn't show up until months later.

    Sometimes the cartilage surface is damaged even more severely, and pieces of the cartilage are ripped from the bone. These pieces do not heal back and usually must be removed from the joint surgically. If not, they may float around in the joint, causing the joint to catch and be painful. These fragments of cartilage may also do more damage to the joint surface.

    Once this cartilage is ripped away, it does not normally grow back. Unlike bone, holes in the surface are not simply replaced by the cartilage tissue around the hole. Instead the defects are filled with scar tissue.

    The scar tissue that forms is not nearly as good a material for covering joint surfaces as the cartilage it replaces. It just can't support weight and isn't smooth like true articular cartilage.

    When an injury results in a change in the way the joint moves, the injury may increase the forces on the articular cartilage. This is similar to any mechanical device or machinery. If the mechanism is out of balance, it wears out faster.

    Over many years this imbalance in the joint mechanics can lead to damage to the articular surface. Since cartilage cannot heal itself very well, the damage adds up. Finally, the joint is no longer able to compensate for the increasing damage, and it begins to hurt. The damage occurs well before the pain begins.

    In summary, arthritis may come from differences in how each of us is put together based on our genes.
    Or arthritis may develop years after an injury that leads to slow damage to the joint surface. Either way the joint is worn out, and it hurts.

    Diagnosis

    The earlier something is done, the more likely we can help to prevent / slow down the process.

    Following a detailed history, the podiatrists at Footfix will examine the joint and other joints in your feet amd legs. It will be important for us to see how the motion of the joint has been affected.

    The alignment of the joint will be assessed. The nerves and circulation going to the legs and ankle will be checked.

    Your podiatrist will watch you walk to see if you have a noticeable limp or deformity.

    Our podiatrists may also do some weight bearing X-rays to aid in obtaining an accurate diagnosis, prior to the start of your podiatry treatment.

    Treatment for foot and ankle Osteoarthritis

    The treatment of Osteoarthritis of the ankle can be divided into the nonsurgical and the surgical.

    Surgery is usually not considered until it has become impossible to control the symptoms without it.

    Non - Surgical Treatment

    Rehabilitation services, such as those offered at Footfix, play an important role in the treatment plan for ankle joint arthritis.

    Treatment usually begins when the ankle first becomes painful. The pain may only occur at first with heavy use and may simply require the use of mild anti-inflammatory medications such as ibuprofen or alternative homeopathic medicine, ointments to rub over the joints are also useful we also recommend our patients to start a course of chondrotin and glucosamine.

    Reducing the activity or changing from occupations that require long periods of standing and walking may be necessary to help control the symptoms. Using BiofreezeÒ can help to control symptoms as well.

    The main goal of your podiatry treatment is to help you learn how to control symptoms and maximize potential of your joint(s)

    Our podiatrist’s will instruct you on techniques you can use to calm your pain and symptoms. We may advise you to use rest, heat, or topical rubs. Our podiatrist will work with you to improve flexibility, balance, and strength in your legs and feet.

    Braces that reduce the motion in the ankle can also be beneficial in reducing pain. These help to control inversion injuries of the ankle.

    Insoles such as "superfeet" are a good way to try and control the motion in your ankle'sand feet , and they fit inside your footwear.

    Orthotics are special customised bespoke inserts that control the motion of the foot and ankle. We find that most ankle pain sufferers get relief of symptoms by wearing these.

    We may also recommend modifying your shoe to give some relief of symptoms. The rocker sole replaces your normal sole with a rounded one, allowing your foot to roll as you move through a step. This can help take stress off the ankle as you walk.

    Injection Therapy

    An injection of cortisone into the joint can give temporary relief from symptoms of Osteoarthritis. For infomation on injection therapy see treatments provided.

    There are also new injectable medications that lubricate the arthritic joint. These medications have been studied mainly in the knee. These injectable medications are trying to replace synovial fluid, which may have been lost from the joint space.

    Surgery

    Eventually, it may be necessary to consider surgery for Osteoarthritis of the ankle. There are several different types of surgery that can be performed to help with your condition. Many things will determine which procedure your surgeon recommends.

    If you need a surgical referral we can refer you to our Foot and Ankle Surgeon for a private consultation.

  • Ankle Sprain

    What is ankle sprain?

    One of the more common injuries associated with walking or running on uneven surfaces (e.g. open fields, dirt pathways or cobblestone pavements etc.) this can occur frequently and if so can lead on to Chronic ankle pain, which is a long lasting or recurrent sensation of pain in one or both ankle joints.

    What is the cause of ankle sprain?

    It is an inversion sprain of the ankle.
    Inversion refers to an excessive "turning in" motion whereby the arch twists upward and the tissues on the outer side of the ankle are overstretched and injured. The resulting damage can range from a slight strain of the ankle ligaments up to a partial or complete ligament rupture. In severe cases, the lower end of the outer leg bone (the fibula) may be fractured as well.

    Mild inversion injuries of the ankle typically result in a small amount of swelling with a localized area of bruising. In this case, one of the outer ankle ligaments is probably strained, that is stretched without any actual tearing of the fibers. In more severe injuries, there is usually extensive bruising, swelling and pain present. This suggests that one or more of the three main outer ankle ligaments has been sprained (with actual tearing of some of the fibers). If severe pain extends above the ankle area, the possibility of fibular fracture must be investigated by x-ray

    What should I do if I keep going over on my ankle?

    If you have a history of repeated ankle sprains, this may be indicative of some form of biomechanical and/or muscular abnormality. You need to come to footfix for Podiatric assessment and treatment.

    What shouldn't I do I If I keep going over on my ankle?

    If you have chronic problem you should not ignore the problem. You may be causing more damage to your ankle by walking around on it. Your problem may be resolved quickly and easily by your podiatrist at Footfix.

    Could there be any long term effects of a chronic ankle pain?

    There can be long term effects from chronic ankle inversion injuries. The earlier treatment is sought, the less likely that you will experience long term problems.

    Podiatry treatment for a chronic ankle pain?

    The podiatrists at Footfix we will perform a full assessment and, if appropriate, a full gait analysis. You may also be advised on orthotic shoe inserts to correct resolve your pain.

    Acute ankle sprains?

    The immediate treatment consists of restricting your activity to rest the injured ankle. Next, apply cold (ice-pack, chemical “ice pack,” frozen peas or a moist facecloth with ice cubes wrapped in it) directly to the outer side of the ankle for repeated 20-minute-on and 40-minute-off cycles. Third, compress the area with some form of elasticated wrap or tubigrip®.

    Finally, elevate the involved ankle above the level of your heart. This will help to reduce the swelling and pain.

    If a fracture (not displaced or breaking through the skin) of the fibula is diagnosed at the time of your injury, then your ankle (and lower leg) will need to be immobilised for a period of about six weeks. This can take the form of a plaster or fibreglass cast. Alternatively, we prefer using an AirCast® since this is typically more comfortable, conforms exactly to your leg and avoids the excessive skin scaling and dryness associated with other techniques. If the fracture is severely displaced and/or protruding through the skin, an orthopaedic surgeon will most likely need to repair it surgically, followed by immobilisation.

    Ankle injury rehabilitation

    Following the immobilisation of any joint, patients typically experience considerable stiffness in that joint. This can be managed using a variety of physical therapy modalities including exercises, massage, ultrasound treatments and possibly a brief course of oral anti-inflammatory medication. Return to normal activities should be gradual; return to sporting activities should be even more gradual with the use of some form of ankle support in the early stages.

     

  • Athletes Foot

    What is Athlete's foot

    Athlete's foot (Tinea Pedis) is a skin disease caused by a fungus, usually occurring between the toes.
    The fungus most commonly attacks the feet because shoes create a warm, dark, and humid environment, which encourages fungus growth.

    It is most commonly associated with warm moist damp areas, such as swimming pools and changing rooms at gyms. Because the infection was common among athletes who used these facilities frequently, the term "athlete's foot" became popular.

    Other conditions, such as disturbances of the sweat mechanism, reaction to dyes or adhesives in shoes, eczema, and psoriasis, may mimic athlete's foot.

    What are the symtoms of athlete's foot?

    The signs of athlete's foot, singularly or combined, are dry skin, itching, scaling, inflammation, and blisters. Blisters often lead to cracking of the skin. When blisters break, small raw areas of tissue are exposed, causing pain and swelling. Itching and burning may increase as the infection spreads.
    Athlete's foot may spread to the soles of the feet and to the toenails. It can be spread to other parts of the body, notably the groin and underarms, by those who scratch the infection and then touch themselves elsewhere.

    What should I do if I have athlete's foot?

    Tips

    • Avoid walking barefoot; use shower shoes.
    • Reduce perspiration by using talcum powder.
    • Wear light and airy shoes.
    • Change shoes daily to allow them to “air”
    • Wear socks that keep your feet dry, and change them frequently if you perspire heavily

    It is not easy to prevent athlete's foot because it is usually contracted in dressing rooms, showers, and swimming pool locker rooms where bare feet come in contact with the fungus. However, you can do much to prevent infection by practicing good foot hygiene. Daily washing of the feet with soap and water; drying carefully, especially between the toes; and changing shoes and hose regularly to decrease moisture, help prevent the fungus from infecting the feet. Also helpful is daily use of a quality foot powder.

    What shouldn't I do if I have athlete's foot?

    If you suspect that you have athlete’s foot then you should not ignore it in the hope that it will go away without treatment.

    Could there be any long-term effects from athlete's foot?

    Athlete’s foot is not a serious infection and can be treated quickly and easily with the correct advice and medication.

    Podiatry treatment for athlete's foot

    Your podiatrist can advise on the most effective treatment for your symptom’s, Fungicidal chemicals are used for athlete's foot treatment, as well as providing information about how to avoid the problem returning.

    If the infection has caused secondary bacteria infection, antibiotics, such as penicillin, that are effective against a broad spectrum of bacteria may be prescribed.

     

  • Back Pain

    What is lower back pain?

    Lower back pain is sensation of a pain or ache in the back. Back pain may arise during sports, walking, standing or even at rest. Back pain is very common and can affect anyone at any age.
    Lower back pain affects about 80% of the population at some time in life. The connection between abnormal biomechanical foot function and lower back pain is well established.

    What are the causes of lower back pain?

    Podiatrists treat back pain that is caused by abnormalities in foot posture. Excessive foot pronation results in internal rotation of the lower limb. Since the hip bone is attached to the pelvis by an angled “ball-in-socket” joint, internal hip rotation leads to a forward tilt to the pelvis. This increases pressure on the lumbar vertebrae (causing joint inflammation) and shifts the body’s centre of gravity forward. As a result, abnormal muscle tightness (muscle spasm) produces pain in the lower back. Over a period of time, patients develop poor posture as well.

    An altered foot posture and, therefore, altered walking pattern . This can lead to pain. There are lots of other causes of back pain, many of which are traumatic or postural. For these types of problems a chiropractor or physiotherapist is the best person to treat your injury.

    Interestingly enough, insufficient pronation (which decreases shock-absorption during gait) can also cause or aggravate low back pain. Poor shock absorption has a direct effect on low back pain, since it transmits ground contact force directly to the vertebrae and intervertebral discs (the “hydraulic” cushions between the vertebrae). When shock loads are excessive, tissue damage can result.

    What should I do If I have lower back pain?

    Foot posture is often overlooked as a cause of back pain. Many clients with back pain are referred to Footfix following an assessment with our local established network of chiropractors and physiotherapists. If you suspect that you have a back problem that is caused by the posture of your foot during standing, walking or running you should arrange a podiatry appointment as soon as possible to allow you to continue with your normal everyday life without pain.

    What shouldn't I do If I have lower back pain?

    If you have lower back pain you should not ignore the problem as you could be causing damage to your back.

    Could there be any long term effects of a lower back pain?

    If your foot posture is causing your back pain then it is unlikely to get better without treatment.

    Podiatry treatment for lower back pain

    Acute lower back pain

    If your back pain began suddenly and is severe enough to prevent you from pursuing normal activities, you’ll probably be referred to one of the chiropractors we work with regularly. Their first priority will be to reduce the muscle spasm and local joint inflammation in the painful area. A variety of manipulation and/or physical therapy techniques are typically used to help relieve your pain.

    Chronic lower back pain

    If you’ve either had acute pain and it’s feeling better now or a chronic “niggling” lower back pain, the next step is to identify any biomechanical abnormalities present. Recall that any functional problem that leads to excessive pronation (foot rolling in so the arch “collapses”) or insufficient pronation can cause or aggravate low back pain.

    Biomechanical assessment

    The range of motion of the forefoot, midfoot, rearfoot, ankles, knees and hips are measured. Limb lengths are measured to check for significant length differences. Muscular weakness and/or tightness of various muscle groups will be noted as well. This is a one-hour examination that includes digital video gait analysis on a treadmill. You will be given stretching and/or strengthening exercises to do on a regular basis at home.

    Custom-made orthotics

    Following your biomechanical assessment, a plaster of Paris cast impression of your feet (held in their neutral functional position) will be taken. This is then sent to a laboratory that specialises in fabricating custom-made orthotic devices. In approximately three weeks, we’ll contact you for an appointment to fit your new orthotics. An improvement in foot posture helps to reduce stress on the lower back. The podiatrists at France-Shelton Foot Health Centre can also advise on your training regime and footwear

     

  • Bunions

    What is a bunion?

    A ‘bunion’ or hallux valgus refers to the condition in which the big toe is angled excessively towards the second toe, rather than pointing forwards in a straight line. Over time, this excessive angle gives the appearance of a ‘bump’ on the big toe joint. This bump is called a bunion.

    Bunions get worse over time. The bump on the side of the foot gets progressively bigger and the big toe leans even more on the 2nd toe and even the 3rd toe. Bunions usually do not hurt until the deformity is really bad and that is when those people come to the clinic wondering what to do.

    What are the symptoms of a bunion?

    Bunions can appear red and swollen and can sometimes cause pain. The amount of pain often depends on the type of footwear being worn, the amount and type of activity a person does and how excessive the big toe is pointing towards the second toe. Thick, hard skin (callus) or corns may appear over the bunion due to excessive pressure from footwear. It may also be difficult to find footwear that is wide enough to accommodate the enlarged joint.

    Tighter the shoe = more bunion pain. This is probably why most ladies have more pain than men. Also, if you have a job where you stand most of the day, bunions can become very irritated.

    What are the causes of a bunion?

    Of all the things that can cause bunions, we believe and usually see bunions as hereditary than anything else. Look at Mum or Dad, or Grandparents. If you have a bunion, I would put good money on the fact that they probably have one too. This inherited faulty architecture is unlucky, but don’t worry…there is treatment.

    Although bunions tend to run in families, it is the foot type that is passed down—not the bunion. Parents who suffer from poor foot mechanics can pass their problematic foot type on to their children, who in turn are prone to developing bunions.

    Other causes of bunions are foot injuries, neuromuscular disorders, or congenital deformities. People who suffer from flat feet or low arches are also prone to developing these problems, as are arthritic patients and those with inflammatory joint disease. Occupations that place undue stress on the feet are also a factor; ballet dancers, for instance, often develop the condition.

    In addition to genetics, you can also force yourself to have a bunion. You’re probably thinking, “How in the world can I make myself have a bunion?” Well, it’s pretty easy if you are not careful. Pointed-toed shoes are a big cause of bunions. It doesn’t have to be only high-heeled shoes. Most people find out that if they just find some wider shoes, their bunion pain disappears. It’s magic!

    What should I do if I have a bunion?

    If you have a bunion then an assessment at Footfix by our podiatrist’s is necessary. Often bunions can be managed conservatively by podiatrists, though some may require a referral for surgical correction.

    What shouldn't I do if I have a bunion?

    Over time, bunions usually increase in size and become more painful. It is difficult to predict how fast this will occur. Certain types of activity should be reviewed and an alternative form of exercise may be preferable. High heeled and / or poorly fitting footwear should also be avoided as these can exacerbate symptoms.

    Could there be any long-term effects from a bunion?

    There is a danger that the smaller toes may be affected as a result of a bunion, due to the misalignment of the big toe joint. The little toes often change shape or start to overlap. A fluid-filled sac called a bursa may also develop under the skin over the bunion, which can be very painful. Early conservative management with podiatry can help to slow the progression of the condition, though surgery may the preferred option to resolve the problem.

    Podiatry treatment for bunions

    Treat the Cause!

    Mild to moderate bunions that are left untreated are likely to get progressively worse. By identifying any functional muscular imbalance or other biomechanical abnormality (such as excessive pronation or flexible flatfoot) at an early stage, it’s possible to slow down or even arrest the progression of this potentially painful condition. Therefore, we may advise a biomechanical assessment and functional shoe inserts called orthotics.

    At Footfix we usually also take X-rays to examine the bunion. We measure all the angles and can mathematically calculate which stage the bunion is in.

    Our podiatry team can provide advice about suitable footwear.

    Injection therapy may be used to calm the inflamed joints down.

    By periodically having any callus or corn on the surface of he bunion trimmed (and probably padded), you may be able to keep any discomfort they cause at bay. This is not something to try with your handy razor blade at home. This type of “bathroom surgery” is likely to be ineffective at best and may even cause a serious infection. And before you run off to your local chemist for a “corn plaster,” keep in mind that these typically contain an acid. This caustic chemical has no intelligence—it cannot distinguish normal from abnormal skin. Once again, serious ulceration and/or infection may occur.

    Silicone gel appliances can be provided to cushion and protect the bunion.

    If these conservative treatments provide an inadequate level of relief, a surgical referral can be completed by your podiatrist, to a private foot and ankle orthopaedic sugeon.

    90% of people make themselves suffer for years before seeking any treatment for them. Why suffer when you can get them treated now!

  • Calluses

    What is callus?

    Callus is an area of thickened, hard skin that may appear yellowish in colour. It can occur in a number of places on the foot, commonly on the heel area.

    What causes callus?

    There are several causes for callus to form, these include; excessive pressure over bony areas, usually due to transverse frictional pressure, due to poorly fitting shoes and excessive walking or running. However, some people may have a genetic predisposition to excessive production of callus.

    What should i do if i have a callus?

    If you have callus formation then you should arrange an appointment with Footfix.

    Podiatry treatment for callus

    Callus can easily be reduced in a treatment session by our podiatrists using a scalpel blade and an electric sanding band. This pain-free treatment aims to reduce pain or discomfort, restore normal appearance and improve skin function.

    By periodically having any callus debrided, you may be able to keep any discomfort they cause at bay.

    This is not something to try with your handy razor blade at home. This type of “bathroom surgery” is likely to be ineffective at best and may even cause a serious infection.

    And before you run off to your local chemist for a “callus plaster,” keep in mind that these typically contain an acid. This caustic chemical has no intelligence—it cannot distinguish normal from abnormal skin.

    Once again, serious ulceration and/or infection may occur.management of callus at Footfix includes:

    • A thorough assessment to determine the cause of the callus
    • Management / treatment plan discussed with you.

    The management plan may consist of:

    Maintenance appointments to keep the callus reduced

    Use of padding to prevent the pressure

    Footwear fitting advice

    Provision of customised fully functional orthotics or arch supports to relieve the pressure under the foot

    Surgical correction of the bony prominence that may be causing the high pressure area may be advised. If so we will refer you on to our Consultant Foot and Ankle surgeon for a private consultation.

    It is especially important that those with diabetes or poor circulation see a podiatrist for the management of callus.

  • Children's Disorders

    Childrens feet

    Human foot is one of the most complicated parts of the body. It has 26 bones, has ligaments, muscles, blood vessels and nerves. The feet of a young child are soft and pliable; abnormal pressure can cause deformities. The child's feet grow rapidly during the first year, reaching almost half their adult foot size. Podiatrist’s, consider the first year to be the most important in development.

    Some of the most common foot complaints in children are:

    • Verrucae
    • Curly Toes
    • Tip toe walking
    • Flat Feet
    • Painful heels (see Below)
    • Bunions
    • In growing Toe Nails

    Children are assessed with their parents present and advice is given by your podiatrist on the appropriate management for the condition. Correct footwear in terms of fitting and style is very important for children, sometimes orthotics (shoe inserts) may be necessary to manage how the foot relates to the ground and ensure structural safety.

    Heel pain in children

    Although many more adults suffer from heel pain, children do as well. Although the main cause of heel pain in adults is plantar fasciitis, the main cause of peadiatric heel pain is something called Calcaneal Apophysitis, or Sever’s Disease.
    The condition is an inflammation of the growth plate (apophysis) of the heel bone (calcaneus).

    What causes calcaneal apophysitis in children?

    The strong Achilles tendon inserts along the back of the heel and attaches to the bone that is between a secondary growth center of the heel bone. The heel bone has two growth centers. The primary growth center is located in the middle of the heel bone. Growth centers start out as cartilage and then eventually turn into bone as the bone matures. When looking at an x-ray of a growing child you will see two boney islands separated by a boney gap that represents the secondary growth plate (physis) at the back of the heel.In some children (mainly active children), the Achilles tendon will irritate the secondary growth plate and produce pain. It is believed that the cause is due to overuse or micro traumas that the tendon places on the bone during activity. It is more common to see this problem when the child is playing on hard surfaces a lot such as a basketball court or a hard dry sports field. In addition, a tight calf muscle or Achilles tendon will irritate the secondary growth plate more aggressively than a tendon that is not tight.

    What are the symtoms?

    • Pain in the back or bottom of the heel
    • Limping
    • Walking on toes
    • Difficulty participating in usual activities or sports

    The child will complain of pain in the back of the heel during and/or after athletic activities. Along with pain at the back of the heel, the child at times may complain of pain along the bottom of the heel. In addition, the heel pain is aggravated when the back of the heel is squeezed and high impact activities such as running or jumping will aggravate the problem. One or both heels can present pain and the pain may be so acute that the child has a noticeable limp.

    How is calcaneal apophysitis treated?

    Firstly x-rays will be taken to rule out any other causes of heel pain. Other Causes of heel pain in children, include, fractures and tendo-achillies bursitis .For those over 14 over use injuries such as Achilles tendonitis or plantar fasciitis need to be ruled out.

    Advise for peadiatric patients who suffer from heel pain is to eliminate high impact activities for a period of two to four weeks. We get them into a heel lift cup, which is made of soft silicon, and advise them to avoid going barefoot. Gentle stretching of the calf muscle is also helpful as is icing and Biofreeze application. Icing the heel 3 times a day for 20-30 minutes at a time has shown good outcomes.

    In cases where the child has a pronated or flat foot, a custom functional foot orthotic with a heel lift is highly advised. In more stubborn cases, oral and/or topical non steroidal anti-inflammatory medications are helpful and an air cast boot immobilisation has been used.

     

  • Claw Toes

    What is are claw toes?

    A claw toe (Also known as hammered) is a deformity of the lesser toes. The toe that is contracted at the Proximal Interphalangeal Phalanx and Distal Interphalangeal Phalanx joints (middle and end joints in the toe).

    What are the symptoms of claw toes?

    A claw toe will often sit higher than your other toes and it’s ‘claw’ shape will be easily noticeable

    Claw toes are classified based on the mobility of the toe joints. There are two types – flexible and rigid. In a flexible claw toe, the joint has the ability to move. This type of claw toe can be straightened manually.

    A rigid claw toe does not move. Movement is very limited and can be extremely painful. This sometimes causes foot movement to become restricted leading to extra stress at the ball-of-the-foot, and possibly causing pain and the development of corns and calluses.

    What are the causes of claw toes?

    Claw toes result from a muscle imbalance, which causes the ligaments and tendons to become unnaturally tight. This results in the joints curling downwards. Arthritis can also lead to many different forefoot deformities, including claw toes. Claw toes are most common in feet with bunions, and in high-arched feet.

    What should I do if I think I have a claw toe?

    Seeking advice from a podiatrist is helpful. Your podiatrist can advise on appropriate footwear and identify whether conservative treatment is adequate or if a surgical referral is necessary.

    What shouldn't I do if I have a claw toe?

    Wearing footwear that causes the awkwardly lying toe to be subjected to even greater pressure is not advisable, a deep toe box and wide fitting are essential to maintain comfort.

    Are there any long-term effects from claw toes?

    The affected toe often does not have an aesthetically pleasing appearance. Surgery may eventually be required to correct and straighten a claw toe where conservative treatment is not enough.

    Podiatry treatment for claw toes?

    X-rays may be necessary to rule out arthritis, steroid injection may help if there are some degenerative changes within the joint.

    Splints made of rubber or silicone may help control mild cases. Any pain from corns and calluses may be eased by having these removed with a scalpel blade by your podiatrist. Choosing shoes of a more generous fit or with uppers made from soft materials is advisable. Your podiatrist to help reduce symptoms can provide a protective pad over the area.

  • Corns

    What is a corn?

    A corn is a small area of hard skin, roughly round in shape, which press into the skin. They are found over high-pressure areas of the foot, such as a bunion, claw toe or hammer toe.

    What are the symptoms of corns?

    Pain or discomfort may occur and different types of corn appear over various parts of the foot. Corns may be visible in between toes, on tops of toes or on the sole of the foot. Causes for corns to form are similar to those for callus , pressure, footwear and high levels of activity.

    What should I do if I have a corn?

    If you have a corn and require treatment then you should arrange an appointment with Footfix

    What shouldn't I do if I have a corn?

    If a corn is left untreated it will become painful. A corn will not get better on its own unless the pressure that originally caused the corn is removed. If the cause is not removed then the skin will continue to thicken and become more painful.

    By periodically having any corn on debrided (and probably padded), you may be able to keep any discomfort they cause at bay. This is not something to try with your handy razor blade at home. This type of “bathroom surgery” is likely to be ineffective at best and may even cause a serious infection. And before you run off to your local chemist for a “corn plaster,” keep in mind that these typically contain an acid. This caustic chemical has no intelligence—it cannot distinguish normal from abnormal skin. Once again, serious ulceration and/or infection may occur.

    Could there be any long term effects from a corn?

    After some time the body may treat the corn as a foreign body and an ulcer or abscess could develop. These can be serious, especially if they become infected. Infection is a very serious complication for individuals with diabetes, poor circulation and loss of sensation.

    Podiatry treatment for corns?

    Corns are symptoms of underlying problems and, therefore, self treatment should not be attempted as you may make the condition worse.

    Podiatric management of corns at Footfix includes:

    A thorough assessment to determine the cause of the corn

    A management / treatment plan discussed with you.

    Management plans for the treatment of corns commonly consist of:

    Maintenance appointments to keep the corn reduced

    Use of protective padding to prevent the pressure
    Advice about footwear

    Provision of foot orthotics or supports to relieve the pressure under the foot

    Surgical correction of the bony prominence that may be causing the high pressure area.

    It is especially important that those with diabetes or poor circulation see a podiatrist for the management of corns.

     

  • Diabetic Feet

    What is Diabetes

    Diabetes is the inability to manufacture or properly use insulin, and it impairs the body’s ability to convert sugars, starches, and other foods into energy. The long-term effects of elevated blood sugar (hyperglycemia) can lead to serious damage to the eyes, heart, kidney, nerves, and feet.
    While there is no cure for diabetes, there is hope. With proper diet, exercise, medical care, and careful management at home, a person with diabetes can avoid the most serious complications and enjoy a full and active life.

    The Diabetic foot

    In 2010, more than 3 million adults in England had diabetes (diagnosed and undiagnosed). Disease of the foot remains a major threat to people with diabetes and is estimated to account for 20 per cent of the total cost of diabetes care in UK. There are 70 amputations a week, of which 80 per cent are potentially preventable. Despite this, in 2007/8 nearly a quarter (23 per cent) of people did not have a foot check” diabetes uk”.

    Fact:

    More than 3000 lower limbs are amputated annually due to complications from diabetes.

    Fact:

    Including a podiatrist in your diabetes care can reduce the risk of lower limb amputation up to 80 percent.

    High levels of blood glucose over a long period of time can result in harm to the body and its functions. In the feet, the nerves and the blood supply may both be adversely affected as a result of diabetes.

    Nerve damage in the feet and legs may cause a loss of sensation. Any trauma or injury to the foot, for example standing on a sharp object, may not be felt and could lead to more serious complications such as an ulcer.

    Diabetes can lead to a restricted blood supply in the feet and legs which may affect the ability to heal if there is an injury to the foot. The feet may appear cold and pulses will be weak if the circulation is poor.

    Today’s Podiatrist: diabetes is a disease affecting many parts of the body; successful management requires a team approach.

    At Footfix our podiatrist’s are an integral part of the treatment team along with your GP, Diabetic Nurse and optician. This teamwork has documented success in preventing amputations.

    The keys to amputation prevention are early recognition and regular foot screenings performed by a podiatrist, the foot and ankle expert.

    Diabetic Warning Signs

    • Skin color changes
    • Swelling of the foot or ankle
    • Numbness in the feet or toes
    • Pain in the legs
    • Open sores on the feet that are slow to heal
    • Ingrown and fungal toenails
    • Bleeding corns and calluses
    • Dry cracks in the skin, especially around the heel

    Take Action:

    Inspect feet daily

    Check your feet and toes every day for cuts, bruises, sores, or changes to the toenails, such as thickening or discoloration.

    Wear thick,soft socks

    Avoid socks with seams, which could rub and cause blisters or other skin injuries.

    Exercise.

    Walking can keep weight down and improve circulation. Be sure to wear appropriate athletic shoes when exercising.

    Have new shoes properly measured and fitted

    Foot size and shape may change over time. Shoes that fit properly are important to those with diabetes

    Don't go barefoot

    Don’t go without shoes, even in your own home. The risk of cuts and infection is too great for those with diabetes.

    Never try to remove

    calluses, corns, or warts by yourself. Over-the-counter products can burn the skin and cause irreparable damage to the foot for people with diabetes.

    Visit us at Footfix

    Regular checkups by a podiatrist ,at least bi-annually is the best way to ensure that your feet remain healthy.

    Fact

    After an amputation, the chance of another amputation within three to five years is as high as 50 percent.

    Fact

    Care by a podiatrist can lower the risk of hospitalisation by 24 percent for those with diabetes

    It is important for a podiatrist to monitor any deterioration in the nerves or circulation of your feet. This allows you to take the necessary precautions to help avoid any complications

  • Flat Feet

    What are flat feet?

    Plano-valgus foot or Pes planus is the loss of the medial longitudinal arch of the foot. There are various types and causes of flat feet.
    The flat arch does not occur in isolation, but affects the dynamics of the foot. So, patients standing on a flat foot will usually have:
    Valgus position of the heel (turned inwards)

    Pronation of the midfoot, usually referred to as 'hyperpronation' (midfoot turns inwards)

    Valgus (turned out) position of the forefoot.

    In a standing position, the inside of the foot should be raised slightly; this is called the arch of the foot. The height of this arch varies amongst individuals. Where a person has a very low arch or no arch at all, this is referred to as flat feet, fallen arches or ‘pronated’ feet. When someone with flat feet stands, their inner foot or arch flattens and the foot often rolls over onto the inner side, therefore, the sole of the foot is fully touching the ground. Some people do not have any problems with this foot shape; however, it can lead to problems in the feet, ankles, knees, hips and back due to the overstraining of the ligaments and muscles.

    What are the sysmptoms of flat feet?

    Symptoms depend greatly on the severity of the condition. Often people find that their foot is ‘rolling inwards’ or collapsing (known as over-pronating). Common areas for pain are; the inner side of the ankle, the arch of the foot and in the heel, calf, knee, hip and back.

    What are causes of flat feet?

    Often flat feet run in families. You may find that there is an arch present when sitting but when standing the arch may completely flatten and make the leg feel like it is rolling inwards. A number of things can cause the feet to flatten.

    Pes Planus may be divided into:

    • Developmental or acquired
    • Flexible or fixed

    Children

    Pes Planus can be part of normal development: Infants typically have a minimal arch. Many toddlers have flattening of the long arch, with forefoot pronation and heel valgus on weight bearing
    There may be ligamentous laxity, which is probably determined genetically.

    Most of these children spontaneously develop a strong normal arch by around age 6- 10 years of age.

    Abnormal development of the foot, producing pes planus, may be due to:
    Neurological problems e.g. cerebral palsy, polio….

    Bony or ligamentous abnormalities, e.g. tarsal coalition (fusion of tarsal bones), accessory navicular bone.

    A small proportion of flexible flatfeet do not correct with growth. Some of these may become rigid if the pes planus leads to bony changes.

    Adults physiological flat foot:

    There is a lack of normal arch development, probably due to inherent ligamentous laxity.
    Around 20% of adults have pes planus. The majority have a flexible flat foot and no symptoms. However, if there is also heel cord contracture, there may be symptoms.

    Adult acquired flat foor:

    • Loss of support for the arch:
    • Dysfunction of the tibialis posterior tendon - a common and important cause
    • Tear of the spring ligament (Plantar fascia) (rare)
    • Tibialis anterior rupture (rare)
    • A neuropathic foot, e.g. from diabetes, polio, or other neuropathies
    • Degenerative changes in foot and ankle joints:
    • Inflammatory arthropathy, e.g. rheumatoid arthritis
    • Osteoarthritis
    • Fractures
    • Bony abnormalities, e.g. tarsal coalition

    What should I do if I have flat feet?

    If there is no pain present with the condition it is not necessary to do anything, although it may be wise to be proactive in trying to prevent problems from arising rather than reactive and combating these problems when they occur.

    For children it would be best to discuss treatment options with your podiatrist at the Footfix clinic, who can make a decision if it is necessary to treat actively or not.

    If pain occurs during activity, such as sport, or is a part of everyday life, certain treatment options are available. An assessment with your podiatrist is necessary to identify the severity of the condition and the appropriate treatment.

    You may require, x-rays to determine the extent of the problem.

    Orthotics may be prescribed to hold the foot in a stable position.

    What shouldn't I do if I have flat feet?

    Higher levels of activity often make this condition worse, for example running. Continuing with this activity can put excessive stress on ligaments, tendons and muscles and should, therefore, be avoided until treatment has been sought. High heels should be avoided as these place further strain on the foot.

    Could there be any long term effects of flat feet?

    Depending on the severity of your flat feet, various other complaints can develop in both the feet and legs if painful flat feet are left untreated. Flat feet can cause an inefficient style of walking and running, which can overstrain ligaments and muscles. If this is repeated over a number of years, tears in these structures may occur. This may lead to lower leg symptoms and back pain.

    Podiatry treatment for flat feet

    Wearing supportive well-fitted shoes can alleviate aching in the arch of the foot. This, however, may not be adequate and you may require an insole or orthotic to support the arch and reduce the amount of collapsing (pronating). An orthotic is worn in the shoe. Orthotics are specifically made for your foot.

     

     

  • Fractures

    The structure of your foot is complex, consisting of bones, muscles, tendons, and other soft tissues. Of the 26 bones in your foot, 19 are toe bones (phalanges) and metatarsal bones (the long bones in the midfoot).
    Fractures of the toe and metatarsal bones are common and require evaluation by a specialist. A podiatrist from the Footfix clinic should be seen for proper diagnosis and treatment, even if initial treatment has been received in an emergency room. You will require x-rays to be taken for proper diagnosis.

    What is a Fracture

    A fracture is a break in the bone. Fractures can be divided into two categories: traumatic fractures and stress fractures.

    Traumatic Fractures

    Traumatic fractures (also called acute fractures) are caused by a direct blow or impact like seriously stubbing your toe. Traumatic fractures can be displaced or non displaced. If the fracture is displaced, the bone is broken in such a way that it has changed in position (dislocated). Treatment of a traumatic fracture depends on the location and extent of the break and whether it is displaced. Surgery is sometimes required. Signs and symptoms of a traumatic fracture include:

    • You may hear a sound at the time of the break
    • “Pinpoint pain” (pain at the place of impact) at the time the fracture occurs and perhaps for a few hours later, but often the pain goes away after several hours
    • Deviation (misshapen or abnormal appearance) of the toe
    • Bruising and swelling the next day
    • It is not true that “if you can walk on it, its not broken.”

    Evaluation by a podiatrist is recommended

    Stress Fractures

    Stress fractures are tiny, hairline breaks that are usually caused by repetitive stress. Stress fractures often seen in athletes who, for example, too rapidly increase their running mileage. Or they may be caused by an abnormal foot structure, deformities, or osteoporosis.
    Improper footwear may also lead to stress fractures. Stress fractures should not be ignored, because they will come back unless properly treated. Symptoms of stress fractures include:

    • Pain with or after normal activity
    • Pain that goes away when resting and then returns when standing or during activity
    • “Pinpoint pain” (pain at the site of the fracture) when touched
    • Swelling, but no bruising

    Sprains

    Sprains and fractures have similar symptoms, although sometimes with a sprain, the whole area hurts rather than just one point. Your podiatrist at the Footfix clinic will be able to diagnose which you have and provide appropriate treatment. Certain sprains or dislocations can be severely disabling. Without proper treatment they can lead to crippling arthritis.

    Consequences of Improper Treatment

    Some people say that “the doctor can’t do anything for a broken bone in the foot.” This is simply not true. In fact, if a fractured toe or metatarsal bone is not treated correctly, serious complications may develop.

    For example:

    • A deformity in the bony architecture which may limit the ability to move the foot or cause difficulty in fitting shoes
    • Arthritis, which may be caused by a fracture in a joint (the juncture where two bones meet), or may be a result of angular deformities that develop when a displaced fracture is severe or hasn’t been properly corrected
    • Chronic pain and long-term dysfunction
    • Non-union, or failure to heal, can lead to subsequent surgery or chronic pain

    Treatment of Toe Fractures

    Fractures of the toe bones are almost always traumatic fractures. Treatment for traumatic fractures depends on the break itself and may include these options:

    Rest Sometimes rest is all that is needed to treat a traumatic fracture of the toe.
    Splinting The toe may be fitted with a splint to keep it in a fixed position.

    Rigid or Stiff-Soled Shoe Wearing a stiff-soled shoe protects the toe and helps keep it properly positioned.

    “Buddy Taping” Buddy taping the fractured toe to another toe is sometimes appropriate, but in other cases it may be harmful.

    Surgery If the break is badly displaced or if the joint is affected, surgery may be necessary. Surgery often involves the use of fixation devices, such as pins.

    Treatment of Metatarsal Fractures

    Breaks in the metatarsal bones may be either stress or traumatic fractures. Certain kinds of fractures of the metatarsal bones present unique challenges.
    For example, sometimes a fracture of the first metatarsal bone (behind the big toe) can lead to arthritis. Since the big toe is used so frequently and bears more weight than other toes, arthritis in that area can make it painful to walk, bend, or even stand.

    Another type of break, called a Jones fracture, occurs at the base of the fifth metatarsal bone (behind the little toe). It is often misdiagnosed as an ankle sprain and misdiagnosis can have serious consequences since sprains and fractures require different treatments. Your podiatrist is an expert in correctly identifying these conditions as well as other problems of the foot.

    Treatment of Metatarsal fractures depends on the type and extent of the fracture and may include:

    Rest Sometimes rest is the only treatment needed to promote healing of a stress or traumatic fracture of a metatarsal bone.

    Avoid the Offending Activity Because stress fractures result from repetitive stress, it is important to avoid the activity that led to the fracture. Crutches or a wheelchair are sometimes required to offload weight from the foot to give it time to heal.

    Immobilisation, Casting, or Rigid Shoe A stiff-soled shoe or other form of immobilisation may be used to protect the fractured bone while it is healing.

    Surgery Some traumatic fractures of the metatarsal bones require surgery, especially if the break is badly displaced.If this is the case you will need to see a foot and ankle surgeon.

    Follow-Up Care Your podiatrist can provide instructions for care following surgical or non-surgical treatment. Physical therapy, exercises and rehabilitation may be included in a schedule for return to normal activities.

     

     

     

  • Fungal Nails

    What are fungal nails?

    The condition is an infection underneath or lying on the top surface of the nail caused by fungi. When the tiny organisms take hold, the nail often becomes darker in color and foul smelling. Debris may collect beneath the nail plate, white marks frequently appear on the nail plate, and the infection is capable of spreading to other toenails, the skin, or even the fingernails.

    What are the symptoms of fungal nails?

    The nail may appear thickened and discoloured and can sometimes be crumbly The nail can turn white, black, yellow, brown or green in colour.
    If ignored, the infection can spread and possibly impair one's ability to work or even walk. This happens because the resulting thicker nails are difficult to trim and make walking painful when wearing shoes.
    Fungal Nails can also be accompanied by a secondary bacterial or yeast infection in or about the nail plate
    Because it is difficult to avoid contact with microscopic organisms like fungi, the toenails are especially vulnerable around damp areas where people are likely to be walking barefoot, such as swimming pools, locker rooms, and showers, for example. Injury to the nail bed may make it more susceptible to all types of infection, including fungal infection.

    Those who suffer from chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails. Other contributing factors may be a history of athlete's foot and excessive perspiration.

    What should I do if I have fungal nail?

    Prevention

    • Proper hygiene and regular inspection of the feet and toes are the first lines of defense against fungal nails.
    • Clean and dry feet resist disease.
    • Washing the feet with soap and water, remembering to dry thoroughly, is the best way to prevent an infection.
    • Shower shoes should be worn when possible in public areas.
    • Shoes, socks, or hosiery should be changed more than once daily.
    • Toenails should be clipped straight across so that the nail does not extend beyond the tip of the toe.
    • Wear shoes that fit well and are made of materials that breathe.
    • Avoid wearing excessively tight hosiery, which promote moisture.
    • Socks made of synthetic fibre tend to "wick" away moisture faster than cotton or wool socks.
    • Disinfect instruments used to cut nails.
    • Don't apply polish to nails suspected of infection—those that are red, discolored, or swollen, for example

    If you have a fungal nail then you should seek professional advice from a podiatrist.

    Podiatry treatment for fungal nails

    Treatments may vary, depending on the nature and severity of the infection. A daily routine of cleansing over a period of many months may temporarily suppress mild infections. White markings that appear on the surface of the nail can be filed off, followed by the application of an over-the-counter liquid antifungal agent. However, even the best over-the-counter treatments may not prevent a fungal infection from coming back.

    Your Podiatrist at the Footfix clinic can detect a fungal infection early, determine the cause, and form a suitable treatment plan, which may include using topical medication, and debridement (removal of diseased nail matter and debris) of an infected nail.
    Newer oral antifungal's, still have a number of side effects that some people find unacceptable. Your G.p. prescribes these , you may have to have some blood tests to check your liver function. Most G.p’s will not prescribe these without having a positive nail / or skin scrapping done first
    In some cases, surgical treatment may be required. Temporary removal of the infected nail can be performed to permit direct application of a topical antifungal. Permanent removal of a chronically painful nail that has not responded to any other treatment permits the fungal infection to be cured and prevents the return of a deformed nail.

     

     

  • Gout

    What is gout

    Gout is a form of arthritis that occurs as a result of the build-up of uric acid in the body and the joint fluid (hyperuricemia). This accumulation of uric acid typically occurs when the body has difficulty processing certain protein substances called purines (preens) that are found naturally in our diets.

    Purine restricted diet

    The actual build-up of uric acid can result when the body has difficulty eliminating uric acid through the kidneys and urine, or in some cases, when the body produces too much uric acid. The tendency to accumulate uric acid is often hereditary.
    It can, however, skip an individual or even a generation and reappear in the children of someone who has no signs of gout. While it is most commonly seen in males between fifty and sixty years of age, gout does occur in females and in younger males.

    Symptoms

    Gout usually starts with a sudden onset of intense pain in one or more joints, usually the big toe joint of the foot. The pain is accompanied by redness, swelling and warmth over the joint. Typically, the patient does not recall injuring the joint before the pain started. Many patients say they first noticed pain in the middle of the night or upon arising in the morning.

    While symptoms most commonly occur in the big toe joint, any joint may be involved. Other common sites are the instep of the foot, the ankle, or the knee. When the foot is involved, wearing shoes is difficult and painful, as are attempts to move the joint or stand on the foot.

    Diagnosis

    The diagnosis is based on a personal and family history, as well as on the examination, which often finds the classic signs of gout and makes the diagnosis clear.

    Blood tests often are performed to determine uric acid levels and the joint fluid is examined to look for uric acid crystals.

    X-rays also may be performed to examine both the bones and joints to rule out abnormal changes associated with gout.

    Treatment

    The treatment of gout starts with establishing the correct diagnosis. Oral anti-inflammatory medications are most often used to manage the acute attack.

    While over the counter drugs may reduce symptoms, they are rarely strong enough to treat the acute pain, swelling and inflammation.

    An Injection of corticosteroid may help reduce the inflamed toe

    If the gout attack is in the toe, it will typically help to elevate the foot, avoid standing and walking, and wear only a loose slipper until the individual can be seen by one of our podiatrists at the Footfix clinic.

    Gout often can be controlled with proper medication, both when there is an attack and on a long-term basis. It is important that your G.P. establish which of the two primary causes (producing too much uric acid or not eliminating it properly) is involved in order to treat the gout with the appropriate medication.
    If gout attacks continue despite medical treatment, if there are excessive deposits of gouty crystals within a joint, or if arthritis causes continual discomfort, surgical treatment may be necessary to remove the crystals (tophi) and repair the joint.

    Prevention

    Certain foods that are high in purines can increase uric acid levels and thus bring on an acute attack of gout. These foods include red meats, shellfish, beer, red wine and salt. Some medications, such as diuretics (water pills) that are often used to control high blood pressure or reduce swelling, also may cause an acute attack of gout. Stress, infection and trauma also are possible causes.

    Drinking 6-8 glasses of water each day, eating an appropriate diet and evaluating current medications will reduce the likelihood of an attack or lessen the severity should it occur.

    If you have a personal or family history of gout, regular examinations by the Footfix clinic Podiatrists also will help to identify the potential for an attack.

     

  • Heel Pain

    What is Heel Pain?

    Heel pain is a sensation of pain in one or both heels. Pain may arise during sport or afterwards at rest. The pain may arise in various places around the heel area, for example, on the inner side of the heel or the back of the heel or the central portion.

    What are the causes of Heel Pain?

    Heel pain may occur due to a variety of causes. Sporting injuries or other accidents account for some heel pain.

    Although many more adults suffer from heel pain, children do as well.

    The main cause of heel pain in adults is plantar fasciitis.

    The main cause of peadiatric heel pain is something called Calcaneal Apophysitis, or Sever’s Disease. 

    Chronic, heel pain may be associated with localised arthritis or biomechanical abnormality within the foot, ankle or leg.

    Podiatrists treat heel pain that is caused by abnormalities in foot posture. An altered foot posture and, therefore, altered walking pattern can cause strain on certain structures of the heel. This can lead to pain.

    What should I do if I have Heel Pain?

    Foot posture is often the cause of heel pain. If you suspect that you have a heel problem that is caused by the posture of your foot during standing, walking or running you should try as a first line of treatment a good quality insole as we have in our shop follow the link here : footfix.co.uk/shop/Heel-Pain-Plantar-Faciitis

    You could also try stretching exercises for the calf muscle , passively using a dorsal night splint which can be found in here: footfix.co.uk/product/Dorsal-Night-Splint-1

    Topical treatments include the use of Biofreeze or Traumel a homeopathic gel these can be found here : footfix.co.uk/shop/Muscle-Rub

     

    For children we have a good range of quality insoles which help to stabilise the feet and arches and help with heel pain as well as flat feet these can be

    found here :footfix.co.uk/shop/Cildrens-Disorders

     

    If you have tried the steps above , then you should arrange a podiatry appointment at footfix ,as soon as possible to allow you to continue with your normal everyday life without pain.

    What shouldn't I do if I have Heel Pain?

    If you have heel pain it is not advisable to ignore the pain as you may be causing more damage to the heel.

    Could there be any long term effects of Heel Pain?

    If your foot posture is causing your heel pain then it is unlikely to resolve without treatment.

    Podiatry treatment for Heel Pain at Footfix

    Our primary focus at footfix  is managing heel pain that is caused or at least aggravated by some form of biomechanical abnormality.

    The first thing we will do is recommend weight bearing x-rays to rule out any other boney deformity.We do this in our clinic and go through the results with

    you at the time of the x-ray.

    A variety of muscular and/or skeletal conditions within the lower leg, ankle or foot can lead to excessive pronation (flattening) of the foot. This, in turn, causes an abnormal amount of drop in the longitudinal arch of the foot. This is typically assessed during the course of a complete biomechanical examination.
    Heel pain induced by biomechanical abnormality is commonly increased when first getting up, after a prolonged period of time sitting or on first rising in the morning.

    Decreasing local inflammation

    If our initial clinical examination of your heel reveals the presence of localised inflammation, we will advise appropriate measures for reducing this. This may involve a specific oral anti-inflammatory medication regimen or homeopathic regimen, the application of intermittent direct icing and/or a course of ultrasound treatments.

    Biomechanical assessment

    Once the inflammation has subsided, it is important to determine the exact nature of the biomechanical abnormality that is causing the heel pain. The range of motion of the forefoot, mid foot, rear foot, ankles, knees and hips are measured. Limb lengths are measured to check for significant length differences. Muscular weaknesses and/or tightness are noted as well. This is a one hour examination that includes digital video gait analysis on a treadmill.

    Custom made orthotics

    Custom-made orthotics must be based on the findings of a complete biomechanical assessment. Then, a plaster of Paris cast impression of your feet (held in their neutral functional position) is taken and sent to a laboratory that specialises in fabricating custom-made orthotic devices.

    Chronic Heel Pain

    If your heel pain still has not settled with ultrasound therapy, orthotic therapy and muscle strengthening exercises.

    Radial Shock Wave Therapy may be a form of treatment suitable for your condition.
    We are one of a very few practices in the country who have this type of treatment. Please ask our podiatrists about this if you think it may be of benefit to yourself.

    The podiatrists at Footfix can also advise on your training regime and footwear.

     

  • Hallux Rigidus

    Each day, with every step you take, your big toe bears a tremendous amount of stress—a force equal to about twice your body weight. Most of us don’t realize how much we use our big toe. We tend to take it for granted, unless a problem develops.
    One problem that afflicts the big toe is called hallux rigidus, a condition where movement of the toe is restricted to varying degrees. This disorder can be very troubling and even disabling, since we use the all important big toe whenever we walk, stoop down, climb up, or even stand. If you have pain and/ or stiffness in your big toe, you may have this condition.

    What is Hallux Rigidus?

    Hallux rigidus is a disorder of the joint located at the base of the big toe. It causes pain and stiffness in the big toe and with time it gets increasingly harder to bend the toe. “Hallux” refers to the big toe, while “rigidus” indicates that the toe is rigid and cannot move. Hallux rigidus is actually a form of degenerative arthritis (a wearing out of the cartilage within the joint that occurs in the foot and other parts of the body).

    Because hallux rigidus is a progressive condition, the toe’s motion decreases as time goes on. In its earlier stage, motion of the big toe is only somewhat limited at that point, the condition is called “hallux limitus.” But as the problem advances, the toe’s range of motion gradually decreases until it potentially reaches the end stage of “rigidus”. Where the big toe becomes stiff, or what is sometimes called a “frozen joint.” Other problems are also likely to occur as the disorder progresses.

    Early signs and symtoms include

    • Pain and stiffness in the big toe during use (walking, standing, bending, etc.)
    • Pain and stiffness aggravated by cold, damp weather
    • Difficulty with certain activities (running, squatting)
    • Swelling and inflammation around the joints

    As the disorder gets more serious, additional symptoms may develop:

    • Pain, even during rest
    • Difficulty wearing shoes because bone spurs (overgrowths) develop.
    • Wearing high-heeled shoes can be particularly difficult
    • Dull pain in the hip, knee, or lower back due to changes in the way you walk
    • Limping, in severe cases

    What causes Hallux Rigidus?

    Common causes of hallux rigidus are faulty function (biomechanics) and structural abnormalities of the foot that can lead to osteoarthritis in the big toe joint. This type of arthritis—the kind that results from “wear and tear”—often develops in people who have defects that change the way their foot and big toe functions. For example, those with fallen arches or excessive pronation (rolling in) of the ankles are susceptible to developing hallux rigidus.

    In some people, hallux rigidus runs in the family and is a result of inheriting a foot type that is prone to developing this condition. In other cases, it is associated with overuse—especially among people engaged in activities or jobs that increase the stress on the big toe, such as workers who often have to stoop or squat.

    Hallux rigidus can also result from an injury even from stubbing your toe. Or certain inflammatory diseases, such as rheumatoid arthritis or gout, may cause it. At the Footfix clinic our podiatrists can determine the cause of your hallux rigidus and recommend the best treatment.

    Diagnosis of Hallux Rigidus

    The sooner this condition is diagnosed, the easier it is to treat. Therefore, the best time to see a podiatrist is when you first notice that your big toe feels stiff or hurts when you walk, stand, bend over, or squat. If you wait until bone spurs develop, your condition is likely to be more difficult to manage.

    In diagnosing hallux rigidus, we will examine your feet and manipulate the toe to determine its range of motion.

    X-rays are usually required to determine how much arthritis is present as well as to evaluate any bone spurs or other abnormalities that may have formed.

    Treatment

    Non- Surgical Approaches

    If your condition is caught early enough, it is more likely to respond to less aggressive treatment. In many cases, early treatment may prevent or postpone the need for surgery in the future. That’s why it is important to see us at the Footfix clinic when you first begin to notice symptoms.

    Treatment for mild or moderate cases of Hallux Ridgidus may include one or more of these strategies:

    Shoe Modifications

    Shoes that have a large toe box should be worn, because they put less pressure on your toe. Stiff or rocker-bottom soles may also be recommended. Most likely, you’ll have to stop wearing high heels.

    Orthotics

    Orthotic Devices Custom orthotic devices will improve the function of your foot.

    Medications

    Non steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be advised to help reduce pain and inflammation. Supplements such as glucosamine-chondroitin sulfate and some vitamins and minerals may also be helpful.

    Injection Therapy

    Injection Therapy Injections of corticosteroids in small amounts are sometimes given in the affected toe to help reduce the inflammation and pain.

    Physical Therapy

    Physical Therapy Ultrasound therapy or other physical therapy modalities may be undertaken to provide temporary relief.

    When is Surgery Needed?

    In some cases, surgery is the only way to eliminate or reduce pain. There are several types of surgery that can be undertaken to treat hallux rigidus.

    If you require surgery, we will refer you directly to our Foot and Ankle Surgeon for private consultation.

    These surgical procedures fall into two categories:

    Some procedures reconstruct and “clean up” the joint. The surgeon removes the arthritic damage from the joint as well as any accompanying bone spurs and then alters the position of one or more bones in the big toe. These procedures are designed to preserve and restore normal alignment and function of the joint as well as reduce or eliminate pain

    More aggressive procedures are used when the joint cannot be preserved. These may involve fusing the joint, or removing part or all of the joint and, in some cases, replacing it with an implant, such as is done for the hip or knee. These procedures eliminate painful motion in the joint and provide a stable foot.

    The procedure that is used to correct hallux rigidus depends on many factors, including the cause of the condition and the severity, as well as the patient’s age, occupation and activity level.

    If surgery is performed, the length of the recovery period will vary, depending upon the procedure or procedures performed.

     

  • Hammer Toes

    What is Hammertoe

    Hammertoe is a contracture—or bending—of one or both joints of the lesser toes. This abnormal bending can put pressure on the toe when wearing shoes, causing problems to develop.

    Common symtoms of Hammertoe inlude:

    • Pain or irritation of the affected toe when wearing shoes
    • Corns (a buildup of skin) on the top, side, or end of the toe, or between two toes. Corns are caused by constant friction against the shoe.
    • Calluses on the bottom of the toe or on the ball of the foot.

    Corns and calluses can be painful and make it difficult to find a comfortable shoe. But even without corns and calluses, hammertoes can cause pain because the joint itself may become dislocated.

    Hammertoes usually start out as mild deformities and get progressively worse over time.

    In the earlier stages, hammertoes are flexible and the symptoms can often be managed with noninvasive measures. But if left untreated, hammertoes can become more rigid and will not respond to non-surgical treatment.

    Corns are more likely to develop as time goes on. In more severe cases of hammertoe, open sores may form.

    Because of the progressive nature of hammertoes, they should receive early attention. Hammertoes never get better without some kind of intervention.

    What causes Hammertoe

    The most common cause of hammertoe is a muscle/tendon imbalance. This imbalance, which leads to a bending of the toe, results from mechanical changes in the foot that occur over time in some people.

    Shoes that don’t fit properly for example, shoes that crowd the toes often aggravate hammertoes. And in some cases, ill-fitting shoes can actually cause the contracture that defines hammertoe. For example, a hammertoe may develop if a toe is too long and is forced into a cramped position when a tight shoe is worn.

    Occasionally, hammertoe is caused by some kind of trauma, such as a previously broken toe. In some people, hammertoes are inherited.

    Treatment:

    Non-Surgical Approaches

    There are a variety of treatment options for hammertoe. The treatment by your podiatrist at the Footfix clinic will depend upon the severity of your hammertoe and other factors.

    A number of non-surgical measure can be undertaken:

    Trimming Corns and Calluses

    Your podiatrist should do this. Never attempt to do this yourself, because you run the risk of cuts and infection. Your podiatrist knows the proper way to trim corns to bring you the greatest benefit.

    Padding Corns and Calluses

    Here at the Footfix clinic our podiatrists can provide or prescribe pads designed to shield corns from irritation.

    If you want to try over-the-counter pads, avoid the medicated types. Medicated pads are generally not recommended because they may contain a small amount of acid that can be harmful. Ask us about this option.

    Changes in Shoe Wear

    Avoid shoes with pointed toes, shoes that are too short, or shoes with high heels. Conditions that can force your toe against the front of the shoe. Instead, choose comfortable shoes with a deep, roomy toe box and heels no higher than an inch and a half.

    Othotic Devices

    A custom orthotic device placed in your shoe may help control the muscle/tendon imbalance.

    Injection Therapy

    Corticosteroid injections are sometimes used to ease pain and inflammation caused by hammertoe.

    Medications

    Non steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be advised to reduce pain and inflammation.

    Splinting/Strapping

    The podiatrist to realign the bent toe may apply splints or small straps.

    When is Surgery Needed?

    In some cases, usually when the hammertoe has become more rigid, surgery is needed to relieve the pain and discomfort caused by the deformity. We will discuss the options and if necessary refer you directly to our consultant foot and ankle surgeon for a private consultation.

    We need to consider a number of factors that may influence the need for surgery, for example the type of shoes you want to wear, the number of toes involved, your activity level, and your age and the severity of the hammertoe.
    The most common surgical procedure performed to correct a hammertoe is called arthroplasty. In this procedure, the surgeon removes a small section of the bone from the affected joint.
    Another surgical option is arthrodesis, which is usually reserved for more rigid toes or severe cases, such as when there are multiple joints or toes involved.

    Arthrodesis is a procedure that involves a fusing of a small joint in the toe to straighten it. A pin or other small fixation device is typically used to hold the toe in position while the bones are healing.

     

  • In-growing Toenails

     No "Bathroom Surgery"

    Don’t be tempted to “have a go” at treating your ingrown toenail with your trusty nail cutters or scissors. You may end up doing more damage to the area and possibly even spreading the infection that’s already present. The end result is that you may increase rather than decrease the pain you’re experiencing!

    Saltwater soaks

    In order to help clear the area of pus and dried blood (if present), it’s best to soak your toe in lukewarm (not hot!) saltwater for 15-20 minutes once a day. Simply place a teaspoon of table salt in a small container of warm water. After each soaking session, gently dry the area and place an antiseptic (e.g. Savlon) on the area followed by the application of a small piece of sterile gauze and a plaster. As soon as possible, make an appointment to have this treated properly

    Initial Podiatry

    Prior to your initial visit, you’ll be asked to complete a health questionnaire. This is very important, since your treatment may be influenced by your current health and/or medications. The level of treatment you require depends on the severity of your condition. For the most basic painful in-growing toenail (usually a first-time occurrence), the offending spicule of toenail will be removed.

    If the toe is particularly tender, a local anaesthetic will be administered beforehand.

    For those of you with “needle-phobia,” don’t worry—we use a freezing spray to numb the skin prior to the injection of anaesthetic. And forget any horror stories you may have heard about injections directly into the ingrown toenail. This is simply unnecessary and causes needless pain. By knowing the anatomy of the toe, we place the anaesthetic well away from the painful area. Then, once the anaesthetic is in place, you won’t feel any discomfort whatsoever.

    Our philosophy of practice dictates that we will not allow any of our patients to “suffer through” any treatment or surgery. Once the offending nail spicule is removed, we may or may not give you a brief note to take to the pharmacist to get a course of appropriate antibiotics. If this is recommended, it is because our examination reveals significant tissue infection present (or even mild infection in a patient with diabetes or poor circulation)

    Ingrown Toenail Surgery

    Nail surgery is a minor surgical procedure to remove all or part of your toenail. It is usually required when an in-growing toenail is frequently recurring. Minor surgery is a relatively simple procedure and is permanent solution to the problem.

    Local anaesthetic is injected into your toe and this makes the toe numb, blocking all pain sensation during the procedure. When your toe is numb a band is placed at the base of the toe to help reduce bleeding. The offending piece of nail or whole nail is then removed. To prevent unwanted re-growth of part or the entire nail, a chemical called phenol is applied to the nail germinal matrix.

    Care has to be taken in the first few weeks after the surgery to help prevent infection. The whole procedure generally takes an hour to complete and is an efficient, successful solution, to in-growing nails.

    After the surgery you will need to keep your foot elevated for a few hours and rest. You can return to work or school the following day. It is advised that you refrain from sports and running for at least two weeks. Healing time varies dependant on your age and general health, but it is generally 4 to 12 weeks.

    If you have a chronic, or recurring problem with an in growing toenail, your best option would be to have the offending incurvated nail spicule permanently removed. Imagine, no more painful ingrown toenail again…ever.

  • Knee Pain

    What is Knee Pain

    Knee pain is a sensation of pain in one or both knees. Pain may arise during sport or afterwards at rest. The pain may arise in various places around the knee joint, for example, on the outer or inner side of the knee.

    What are the causes of Knee Pain?

    Knee pain may occur due to a variety of causes. Sporting injuries or other accidents account for the majority of acute knee pain. Serious injuries or accidents are best managed by a sports or trauma orthopaedist. Chronic, less severe, knee pain may be associated with localised arthritis or biomechanical abnormality within the lower extremity.

    Podiatrists treat knee pain that is caused by abnormalities in foot posture. An altered foot posture and, therefore, altered walking pattern can cause strain on certain structures of the knee. This can lead to pain.

    What should I do If I have Knee Pain?

    Foot posture is often overlooked as a cause of knee pain. Many clients are referred to us from surrounding Physiotherapists. If you suspect that you have a knee problem that is caused by the posture of your foot during standing, walking or running you should arrange a podiatry appointment as soon as possible to allow you to continue with your normal everyday life without pain.

    What shouldnt I do If I have Knee Pain?

    If you have knee pain it is not advisable to ignore the pain as you may be causing more damage to the joint.

    Could there be any any long term effects of Knee Pain?

    If your foot posture is causing your knee pain then it is unlikely to resolve without treatment.

    Podiatry treatment for Knee Pain

    Our primary focus is managing knee pain that is caused or at least aggravated by some form of biomechanical abnormality. A variety of muscular and/or skeletal conditions within the lower leg, ankle or foot can lead to excessive pronation (flattening) of the foot. This, in turn, causes an abnormal amount of internal rotation of the leg that creates a torque on the knee joint. As a result, there is increased wear and tear on the cartilage behind the kneecap. This is typically assessed during the course of a complete biomechanical examination.
    Knee pain induced by biomechanical abnormality is commonly increased when first getting up after a prolonged period of time sitting and/or when going up and down stairs and hills. This is because the back of the knee cap is under increased compression pressure when the quadriceps (front thigh muscles) contract and the knee undergoes alternate flexion and extension.

    Decreasing local inflammation

    If our initial clinical examination of your knee reveals the presence of localised inflammation, we will advise appropriate measures for reducing this. This may involve a specific oral anti-inflammatory medication regimen, the application of intermittent direct icing and/or a course of ultrasound treatments. A flexible knee brace may also be recommended, depending on the nature of the symptoms.

    Biomechanical assessment

    Once the inflammation has subsided, it is important to determine the exact nature of the biomechanical abnormality that is causing the knee pain. The range of motion of the forefoot, mid foot, rear foot, ankles, knees and hips are measured. Limb lengths are measured to check for significant length differences. Muscular weaknesses and/or tightness are noted as well. This is a one hour examination that includes digital video gait analysis on a treadmill.

    Custom - made othotics

    Custom-made orthotics must be based on the findings of a complete biomechanical assessment. Then, a plaster of Paris cast impression of your feet (held in their neutral functional position) is taken and sent to a laboratory that specialises in fabricating custom-made orthotic devices.

    Chronic Knee Pain

    If your knee pain still has not settled with ultrasound therapy, orthotic therapy and muscle strengthening exercises . Radial Shock Wave Therapy may be a form of treatment suitable for your condition.
    We are one of a very few practices in the country who have this type of treatment. Please ask our podiatrists about this if you think it may be of benefit to yourself.

    Long - term rehabilitation

    A series of strengthening and stretching exercises will be prescribed to help prevent recurrence of the knee pain. Return to normal exercise activities is dependent upon the ability to perform preliminary exercises without discomfort. Then, the return should be “phased in” with only limited amounts at first and gradually increasing as symptoms permit.

    The podiatrists at France-Shelton Foot Health Centre can also advise on your training regime and footwear.

     

  • Metatarsalgia / Ball of Foot pain

    What is Metatarsalgia?

    Metatarsalgia is a common overuse injury described as pain in the front part of the foot (forefoot). It is associated with increased stress over the heads of your metatarsal bones (the ball of your foot).There are five metatarsal bones in the foot , these bones are similar to the "knuckles" on the hand. Each metatarsal serves to distribute the entire weight of the body across the forefoot.

    The forefoot is anatomically composed of bones,ligaments,tendons, muscles,nerves,blood vessels and skin,which all interrelate. each of these components alone may cause a painful condition or in combination at the junction known as the metatarsal-phlangeal joint.

    Metatarsalgia commonly occurs in the area where the second, third and fourth toes meet the ball of the foot (the metatarsal heads).

    What are the symptoms of Metatarsalgia?

    Metatarsalgia causes pain in the ball of your foot that can be worsened by walking or running. There may be a burning or aching sensation in the ball of the foot and some people compare the sensation to ‘walking on pebbles’. The intensity of the pain varies greatly from mild to severe. Shooting pains in the toes, tingling or numbness around the toes, and worsening pain when standing or moving are all common symptoms of metatarsalgia. Symptoms usually develop gradually over a period of months rather than coming on all of a sudden.

    What the causes of Metatarsalgia?

    Metatarsalgia can be caused by a number of different conditions.

    Common causes include:

    Overuse

    For example, in runners and athletes, which can cause some mild inflammation in the metatarsal heads and nearby joints. Other sports such as tennis or sports that involve jumping may also put extra stress on the metatarsal heads and lead to inflammation and pain.

    Wearing high-heeled shows

    This can put extra stress on the metatarsal heads. Footwear that is poorly fitted or too tight may also be a cause.

    Being overweight

    This can put extra stress on the feet in general.

    Callouses

    This is a build up of hard skin which may be diffuse and spread over a broad area or be very localised and deep rooted. Callouses may be due to a structural cause , such as an enlarged metatarsal head , long metatarsal or degenerative change such as rheumatoid arthritis. Functional causes may be due to incorrect way in which you walk , flat feet , loss opf fat pad.

    Having a stiff ankle or Achilles Tendon (the tendon at the heel)

    This can affect the way that pressure is distributed across the foot and may lead to extra stress on the metatarsal heads.

    Morton's neuroma

    This is sometimes called Morton's metatarsalgia. It is a condition that affects one of the nerves that run between the metatarsal bones in the foot (the plantar digital nerves). Symptoms include pain, burning, numbness and tingling between two of the toes of the foot.

    Pes cavus

    This is also known as claw foot. In pes cavus, your foot has a very high arch, which does not flatten when you put weight on your foot. It happens because of an imbalance in the muscles of the foot. It can run in families. Sometimes pes cavus can happen out of the blue but most people with pes cavus also have a neurological problem such as cerebral palsy, spina bifida, muscular dystrophy or polio. Pes cavus can mean that extra stress is placed on the ball of the foot, which can lead to metatarsalgia.

    Hammertoe or Claw toe deformity

    With a claw toe you have an abnormal position of all three of the joints in the toe. The joint with the metatarsal bone is bent upwards, the middle joint in the toe is bent downwards and the end joint in the toe may also be bent downwards. The toe resembles a claw. With a hammer toe, your toe is permanently bent at its middle joint so that it looks like a hammer. There are a number of conditions that can cause these toe deformities. These can include poorly fitted shoes, injury to the toes, bunions and rheumatoid arthritis. Hammer and claw toe can also occur in someone with pes cavus. They can also run in families. These toe deformities can mean that extra stress is placed on the ball of the foot, which can lead to metatarsalgia.

    Bunion (Hallux Valgus)

    A bunion is a deformity of the base joint of the big toe, causing the big toe to be angled towards the second toe. This causes a bump on the side of the foot at the base of the big toe. There is often thickening of the skin and tissues next to the affected joint. The thickened skin and tissues may become inflamed, swollen and painful. Because of the bunion, extra stress is put on the ball of the foot and this can lead to metatarsalgia.

    Previuos surgery to the foot

    For example, previous surgery for bunions.

    Stress fracture of a metatarsal

    A stress fracture is a type of incomplete fracture in a bone. Stress fractures tend to occur as a result of overuse and are known as overuse injuries. A metatarsal stress fracture is a stress fracture in one of the metatarsal bones in the foot.

    Arthritis or gout

    This can cause inflammation of the joints in the ball of the foot or of the big toe and can be a cause of metatarsalgia.

    Diabetes

    This can cause damage to the nerves in the feet and can be a cause of metatarsalgia.

    What should I do if I have Metatarsalgia?

    If you have metatarsalgia then you require an assessment with one of our podiatrist’s at the Footfix clinic. Depending on how quickly symptoms have appeared we will determine the appropriate treatment. Reducing levels of pressure over the area is key and often avoiding certain types of activity for a period of time is necessary.We may do x-rays to chack your bone structure in your foot. For insoles to try your self go to our shop click on this link :footfix.co.uk/shop/Insoles

    What shouldn't I do if I have Metatarsalgia?

    Wearing inappropriate footwear and continuing with high-impact sports will worsen symptoms. Avoiding the activity that places high pressure on the forefoot is very important.

    Are there any long-term effects from Metatarsalgia?

    Continued high pressure on the forefoot may lead to stress fractures of the metatarsals.

    Podiatry treatment for Metatarsalgia?

    Orthotics/Insoles can be provided to improve the function of the foot and redistribute pressure to protect the ball of the foot. Cushioning silicone gel insoles may also provide relief. Advice regarding appropriate footwear with good shock absorption is important. Have a look at our insoles in our shop these are great for relieving foot pressure

    Click here .footfix.co.uk/shop/Insoles

    Injection therapy with a cortisone or homeopathic preparation may also be indicated. Radial Shock Wave Therapy may be applied; also ultrasound treatment with strapping is a good treatment modality.

  • Morton's Neuroma

    What is Neuroma

    A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Morton’s neuroma, which occurs at the base of the third and fourth toes.
    It is sometimes referred to as an intermetatarsal neuroma. “Intermetatarsal” describes its location—in the ball of the foot between the metatarsal bones (the bones extending from the toes to the midfoot). Neuroma's may also occur in other locations in the foot.

    The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates swelling of the nerve, eventually leading to permanent nerve damage.

    Symptoms

    If you have a Morton’s neuroma, you will probably have one or more of these symptoms where the nerve damage is occurring:

    • Tingling, burning, or numbness
    • Pain
    • A feeling that sometimes is inside the ball of the foot, or that there's a rise in the shoe or a sock is bunched up.

    The progression of a Morton's neuroma often follows this pattern:

    • The symptoms begin gradually; at first they occur only occasionally, when wearing narrow-toed shoes or performing certain aggravating activities
    • The symptoms may go away temporarily by massaging the foot or by avoiding aggravating shoes or activities
    • Over time the symptoms progressively worsen and may persist for several days or weeks
    • The symptoms become more intense as the neuroma enlarges and the temporary changes in the nerve become permanent

    Causes

    Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. One of the most common offenders is wearing shoes that have a tapered toe box, or high heeled shoes that cause the toes to be forced into the toe box.

    People with certain foot deformities such as bunions, hammertoes, flatfeet, or more flexible feet are at higher risk for developing a neuroma. Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or racquet sports. An injury or other type of trauma to the area may also lead to a neuroma.

    Diagnosis

    To arrive at a diagnosis, your podiatrist at the Footfix clinic will obtain a thorough history of your symptoms and examine your foot.
    During the physical examination, the podiatrist attempts to reproduce your symptoms by manipulating your foot. Other tests may be performed. X-rays may be required to check on any boney deformity.

    The best time to see the Footfix clinic is early in the development of symptoms. Early diagnosis of a Morton’s neuroma greatly lessens the need for more invasive treatments and may avoid surgery.

    Treatment

    In developing a treatment plan, we will first determine how long you’ve had the neuroma and evaluate its stage of development. Treatment approaches vary according to the severity of the problem.

    For mild to moderate cases of neuroma, treatment options include:
    Padding techniques provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking.

    Icing; placing an ice pack on the affected area helps reduce swelling.

    Orthotic Devices; Custom orthotic devices provide the support needed to reduce pressure and compression on the nerve.

    Activity Modifications Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.

    Changes in Shoe wear; it is important to wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels.

    Medications Non steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.

    Injection Therapy; if there is no significant improvement after initial treatment, injection therapy may be tried.

    Radial Shock Wave Therapy is a newer alternative to injection therapy, your podiatrist will be happy to discuss the alternatives for you.

    When is surgery needed?

    Surgery may be considered in patients who have not received adequate relief from other treatments. Generally, there are two surgical approaches to treating a neuroma—the affected nerve is either removed or released.

    The length of the recovery period will vary, depending on the procedure or procedures performed.

    Regardless of whether you’ve undergone surgical or nonsurgical treatment, your podiatrist at the Footfix clinic will recommend long-term measures to help keep your symptoms from returning. These include appropriate footwear and modification of activities that cause repetitive pressure on the foot.

     

     

  • Osteoarthritis

    What is Osteoarthritis?

    Osteoarthritis is usually considered a type of degenerative arthritis, or wear-and-tear arthritis. Doctors consider Osteoarthritis pretty much the same whether it appears years after an injury to the joint or whether it appears without any history of injury. It behaves more or less the same way.

    Over the past several years, there has been increasing evidence that this is genetic, meaning that it runs in families. Osteoarthritis that occurs without any injury may prove to be related to differences in the chemical makeup of cartilage. People are born with these differences.

    What are the Symptoms?

    Pain is the main problem with arthritis of any joint. This pain occurs at first only related to activity. Usually, once the activity gets underway there is not much pain, but after resting for several minutes the pain and stiffness increase. Later, when the condition worsens, pain may be present even at rest.

    The pain may interfere with sleep. The joint may swell, fill with fluid, and feel tight, especially following increased activity. As the articular cartilage starts to wear off the joint surface, the joint may squeak when moved.

    Osteoarthritis will eventually affect the motion of a joint. The joint becomes stiff and loses flexibility. Certain movements can become painful, and it may become difficult to trust the joint to hold your weight in certain positions.

    The body has a pain reflex such that when a joint is put into a position that causes pain the muscles around the joint may stop working without warning. This reflex can cause a person to stumble or even fall when arthritis affects the ankle joint.

    When Osteoarthritis has reached a very severe stage, the bone itself under the articular cartilage may become worn away. This can lead to increasing deformities around the joint. In the final stages, the alignment of the bones can begin to form odd angles where they meet at the joint.

    What causes Osteoarthritis?

    Injury to a joint, such as a bad sprain or fracture, can cause damage to the cartilage, this can be traumatic in nature, or from abnormal biomechanics of your ankle and foot function.

    The cartilage can be bruised when too much pressure is exerted on it. This damages the cartilage, although if you look at the surface it may not appear to be any different. The injury to the material doesn't show up until months later.

    Sometimes the cartilage surface is damaged even more severely, and pieces of the cartilage are ripped from the bone. These pieces do not heal back and usually must be removed from the joint surgically. If not, they may float around in the joint, causing the joint to catch and be painful. These fragments of cartilage may also do more damage to the joint surface.

    Once this cartilage is ripped away, it does not normally grow back. Unlike bone, holes in the surface are not simply replaced by the cartilage tissue around the hole. Instead the defects are filled with scar tissue.

    The scar tissue that forms is not nearly as good a material for covering joint surfaces as the cartilage it replaces. It just can't support weight and isn't smooth like true articular cartilage.

    When an injury results in a change in the way the joint moves, the injury may increase the forces on the articular cartilage. This is similar to any mechanical device or machinery. If the mechanism is out of balance, it wears out faster.

    Over many years this imbalance in the joint mechanics can lead to damage to the articular surface. Since cartilage cannot heal itself very well, the damage adds up. Finally, the joint is no longer able to compensate for the increasing damage, and it begins to hurt. The damage occurs well before the pain begins.

    In summary, arthritis may come from differences in how each of us is put together based on our genes.
    Or arthritis may develop years after an injury that leads to slow damage to the joint surface. Either way the joint is worn out, and it hurts.

    Diagnosis

    The earlier something is done, the more likely we can help to prevent / slow down the process.

    Following a detailed history, the podiatrists at Footfix clinic will examine the joint and other joints in your feet amd legs. It will be important for us to see how the motion of the joint has been affected.

    The alignment of the joint will be assessed. The nerves and circulation going to the legs and ankle will be checked.

    Your podiatrist will watch you walk to see if you have a noticeable limp or deformity.

    Our podiatrists may also do some weight bearing X-rays to aid in obtaining an accurate diagnosis, prior to the start of your podiatry treatment.

    Treatment for foot and ankle Osteoarthritis

    The treatment of Osteoarthritis of the ankle can be divided into the nonsurgical and the surgical.

    Surgery is usually not considered until it has become impossible to control the symptoms without it.

    Non - Surgical Treatment

    Rehabilitation services, such as those offered at Footfix, play an important role in the treatment plan for ankle joint arthritis.

    Treatment usually begins when the ankle first becomes painful. The pain may only occur at first with heavy use and may simply require the use of mild anti-inflammatory medications such as ibuprofen or alternative homeopathic medicine, we also recommend our patients to start a course of chondrotin and glucosamine.

    Reducing the activity or changing from occupations that require long periods of standing and walking may be necessary to help control the symptoms. Using BiofreezeÒ can help to control symptoms as well.

    The main goal of your podiatry treatment is to help you learn how to control symptoms and maximize potential of your joint(s)

    Our podiatrist’s will instruct you on techniques you can use to calm your pain and symptoms. We may advise you to use rest, heat, or topical rubs. Our podiatrist will work with you to improve flexibility, balance, and strength in your legs and feet.

    Braces that reduce the motion in the ankle can also be beneficial in reducing pain. These help to control inversion injuries of the ankle.

    Orthotics are special customised bespoke inserts that control the motion of the foot and ankle. We find that most ankle pain sufferers get relief of symptoms by wearing these.

    We may also recommend modifying your shoe to give some relief of symptoms. The rocker sole replaces your normal sole with a rounded one, allowing your foot to roll as you move through a step. This can help take stress off the ankle as you walk.

    Injection Therapy

    An injection of cortisone into the joint can give temporary relief from symptoms of Osteoarthritis.

    There are also new injectable medications that lubricate the arthritic joint. These medications have been studied mainly in the knee. These injectable medications are trying to replace synovial fluid, which may have been lost from the joint space.

    Surgery

    Eventually, it may be necessary to consider surgery for Osteoarthritis of the ankle. There are several different types of surgery that can be performed to help with your condition. Many things will determine which procedure your surgeon recommends.

    If you need a surgical referral we can refer you to our Foot and Ankle Surgeon for a private consultation.

     

  • Plantar Fasciitis

    What is Plantar Fasciitis?

    Your plantar fascia is a strong ligament that stretches from your heel to your middle foot bones. It supports the arch of your foot and also acts as a shock absorber in your foot.

    What causes PlantarFasciitis?

    Repeated small injuries to the fascia (with or without inflammation) are thought to be the cause of plantar fasciitis. The injury is usually near to where the plantar fascia attaches to your heel bone.

    You are more likely to injure your plantar fascia in certain situations

    For example:

    • If you are on your feet for a lot of the time, or if you do lots of walking, running, standing, etc, when you are not used to it. (The condition is sometimes called 'policeman's heel', as policemen 'walking the beat' were said to be commonly affected).
    • Also, people with a sedentary lifestyle are more prone to plantar fasciitis.
    • If you have recently started exercising on a different surface. For example, running on the road instead of a track.
    • If you have been wearing shoes with poor cushioning or poor arch support.
    • If you are overweight, this will put extra strain on your heel.
    • If there is overuse or sudden stretching of your sole. For example: athletes who increase running intensity or distance; poor technique starting 'off the blocks', etc.
    • If you have a tight Achilles tendon (the big tendon at the bottom of your calf muscles above your heel). This can affect your ability to flex your ankle and make you more likely to damage your plantar fascia. Often there is no apparent cause for plantar fasciitis, particularly in older people.

    How common is plantar fasciitis?

    Plantar fasciitis is common. Around 1 in 10 people will get plantar fasciitis at some time in their life. It is most common in people between the ages of 40 to 60 years. However, it can occur at any age. It is twice as common in women than men. It is also common in athletes.

    What are the symptoms of plantar fasciitis?

    Pain is the main symptom. This can be anywhere on the underside of your heel. However, commonly, one spot is found as the main source of pain. This is often about 4 cms forward from your heel, and may be tender to touch.
    The pain is often worst when you take your first steps on getting up in the morning, or after long periods of rest where no weight is placed on your foot. Gentle exercise may ease things a little as the day goes by, but a long walk or being on your feet for a long time often makes the pain worse. Resting your foot usually eases the pain.
    Sudden stretching of the sole of your foot may make the pain worse. For example, walking up stairs or on tiptoes. You may limp because of pain. Some people have plantar fasciitis in both feet at the same time.

    How is plantar fasciitis diagnosed?

    At Footfix our Podiatric team  can usually diagnose plantar fasciitis just by talking to you and examining your feet.
    Tests are needed if the diagnosis is uncertain or to rule out other possible causes of heel pain. These can include weight bearing  X-rays of the heel,Or Diagnostic Ultrasound  which are both provided in our clinics.

    What is the intial treatment for plantar fasciitis?

    A combination of different treatments may help. Collectively, these initial treatments are known as 'conservative' treatments for plantar fasciitis,these are things you can do easily without having to come to see a podiatrist .

    Conservative Treatments

    Rest your foot

    This should be done as much as possible. Avoid running, excess walking or standing, and undue stretching of your sole. Gentle walking and exercises described below are fine.

    Footwear

    Do not walk barefoot on hard surfaces. Choose shoes with cushioned heels and a good arch support. A laced sports shoe rather than open sandals is probably best. Avoid old or worn shoes that may not give a good cushion to your heel.

    Pain relief

    Painkillers such as paracetamol will often ease the pain. Sometimes anti-inflammatory medicines such as ibuprofen are useful. These are painkillers but also reduce inflammation and may work better than ordinary painkillers.

    Some people find that rubbing a cream or gel that contains an anti-inflammatory medicine on to their heel is helpful.We recommend a product called Biofreeze , or another prouct called Traumel which is Homeopathic , both are topical , these can be found at this link :footfix.co.uk/shop/Muscle-Rub


    An ice pack (such as a bag of frozen peas wrapped in a tea towel) and held to your foot for 15-20 minutes may also help to relieve pain.

     

    Exercises

    Regular, gentle stretching of your Achilles tendon and plantar fascia may help to ease your symptoms , there is a passive device called a dorsal night splint which can be very effective , please see the link here : footfix.co.uk/product/Dorsal-Night-Splint-1. This is because most people with plantar fasciitis have a slight tightness of their Achilles tendon. If this is the case, it tends to pull at the back of your heel and has a knock on effect of keeping your plantar fascia tight. Also, when you are asleep overnight, your plantar fascia tends to tighten up (which is why it is usually most painful first thing in the morning). The aim of these exercises is to loosen up the tendons and fascia gently above and below your heel.

    Are there any other treatments?

    If the above treatments are not helping to relieve your symptoms, or if you are someone such as an athlete who needs a quick recovery, other treatments are available. There is no one specific treatment that appears to stand out as the best.

     

    Massage and Manipulations

    At Footfix , we can provide functional assessment of muscles and tendons , we may suggest that a course of deep muscle and tendon massage with joint manipulations may be suitable for your heal pain. We would require you to come in once a week for approximately four weeks .

    Heel pads and arch suports / orthotics

    At Footfix we use various pads and shoe inserts/insoles as a first line of treatment , you can easily try these without having to see us they are good quality products follow the link    here :footfix.co.uk/shop/Heel-Pain-Plantar-Faciitis . 

    If you are still suffering we would probably recommend a  custom made orthotics to cushion the heel and support the arch of your foot. These work best if you put them in your shoes at all times. The aim is to raise your heel by about 1 cm. If your heel is tender, a small hole in the heel pad at the site of the tender spot may help. This means that the tender part of your heel will not touch anything inside your shoe. Place the inserts/pads in both shoes, even if you only have pain in one foot. We use Superfeet Insoles as a first line treatment as they are easy and compartively cheap compared to bespoke orthotics. They come in different colours which are a guide to the contour of your foot .

    Steroid injections

    A steroid (cortisone) injection is sometimes tried if your pain remains bad despite the above 'conservative' measures. It may relieve the pain in some people for several weeks but does not always cure the problem.
    We always put the whole foot to sleep so we can inject the area without you having any pain.

    Steroids work by reducing inflammation. Sometimes two or three injections are tried over a period of months if the first is not successful.

    Steroid injections do carry some risks including (rarely) rupture of the plantar fascia.

    Extracorporeal shock-wave therapy

    In extracorporeal shock-wave therapy, a machine is used to deliver high-energy sound waves through your skin to the painful area on your foot. It is not known exactly how it works, but it is thought that it might stimulate healing of your plantar fascia. You will need a minimum of 3 sessions of treatment.

    This procedure is a safe alternative to an injection. You should have a full discussion with your Podiatrist about the potential benefits and risks.

    In studies, most people who have had extracorporeal shock-wave therapy have little in the way of problems. However, possible problems that can occur include pain during treatment, skin reddening, and swelling of your foot or bruising

    Other treatments

    Surgery

    This may be considered in very difficult cases. Surgery is usually only advised if your pain has not eased after 12 months despite other treatments. The operation involves separating your plantar fascia from where it connects to the bone and is called a plantar fascia release. It may also involve removal of a spur on the calcaneum if one is present.

    Surgery is not always successful. It can cause complications in some people so it should be considered as a last resort. Complications may include infection, increased pain, injury to nearby nerves, or rupture of the plantar fascia.

    If you require surgery we will refer you directly to our Consultant Foot and Ankle Surgeon for a private consultation.

     

  • Plantar Warts

    What are Plantar warts?

    Plantar warts are a wart caused by the human papilloma virus (HPV). It is a small lesion that appears on the sole of the foot.

    What are the symptoms of Plantar warts?

    Plantar warts are small, rough, often round, lumps on the skin.
    They may have small black specks within that bleed when the surface is cut or shaved; these are abnormal capillaries or blood vessels feeding the wart.

    A Plantar wart may or may not be painful. They can be spread in showers, around swimming pools, by sharing shoes, etc.

    Plantar warts, can often be differentiated from corns by close observation of the skin lines. Feet, like hands, are covered in skin lines or “fingerprints”. With verrucae, the skin “fingerprints” goes around the lesion. If the lesion is not a verrucae, the fingerprints continue across the top layer of the skin.

    Plantar warts tend to be painful with pressure from either side of the lesion rather than direct pressure.

    Corns tend to be painful on direct pressure rather than pressure from either side. The difference between plantar warts and warts on other parts of the body is that warts are generally outgrowth lesions,

    but on the bottom of the foot, they are pushed inward by the pressure of walking.

    What are the causes of Plantar warts?

    Specifically Human Papilloma Viral infection to the sole of the foot, infection by the virus is possible anywhere on the body and common especially on the palm of the hand. Because of pressure on the sole of the foot, a layer of hard skin forms over the wart.

    The virus may live on the surface of our skin for sometime, without us knowing. Usually we tend to be low in our selves or have a low immune system, which then allows this virus to become opportunistic and then invade the epidermis layer of our skin.

    What should I do If I have a Plantar wart?

    If you have a plantar wart you should arrange an appointment with our podiatrist’s at Footfix for treatment.

    • Avoid walking barefoot in public areas such as showers and public changing rooms.
    • Change shoes and socks daily.
    • Avoid sharing shoes and socks.
    • Avoid direct contact with warts on other parts of the body.
    • Avoid direct contact with warts on other persons.

    Podiatry treatment for Plantar warts

    Since the skin on the bottom of the foot tends to be thicker, the treatment of plantar warts is more difficult. When discussing treatments, no treatment in common use is 100% effective.

    Podiatrists are considered specialists in the treatment of plantar warts. Although immunization is available for the HPV and strains causing cervical cancer, there is currently no vaccination treatment for plantar warts.

    The treatment of warts by keratolysis involves the peeling away of dead surface skin cells with chemicals like trichloroacetic acid or salicylic acid.

    Cryosurgery is a common treatment that works by producing a blister under the wart. It is painful but usually non scarring.

    Surgical excision of the wart is a last resort option but appears to be the most definitive for recalcitrant lesions.

    Here at the Footfix we have extensive training in using these products as well as surgical options concerning warts.

    Patiently waiting may be appropriate since many warts will eventually resolve due to the patient’s own immune system.

    In many cases, the body will become naturally immune to the wart and the verrucæ will fall off, although it can be months to years before this takes place.

    Warts may spread, develop into clusters or fuse to become a mosaic wart. Plantar warts can be painful making it difficult to walk and run.

    Overaggressive treatment may lead to scarring. Others may get infected. If a wart is being treated professionally and does not seem to improve in a reasonable period of time, the growth should be excised.

     

  • Posterior Tibial Tendon

    What is Posterior Tibial Tendon Dysfuction (PTTD)

    The Posterior Tibial Tendon is a strong band of fibrous tissue. It connects the Posterior Tibial Muscle to multiple locations on the inner and bottom sides of the arch. The function of this tendon is to help maintain the arch height (keep it from collapsing), and to help prevent pronation (a rolling out of the foot at the ankle, forcing one to put abnormal amounts of weight on the inner surface of the foot when walking). When this tendon becomes swollen, inflamed, and painful it cannot function properly.

    What are the symptoms of PTTD tendonitis?

    1) Pain and swelling along the inner side of the arch and ankle, and along the course of the tendon. At first, these symptoms are only present with exercise and extended periods of standing or walking. With rest, the pain and swelling will subside. As the inflammation of the tendon becomes worse, the pain will not subside, even with extended periods of rest. In the later stages of this disease, the pain and swelling are almost always present.

    2) Medial Longitudinal Arch starts to fall. This will cause the foot to be flat. In later stages of this condition, the arch collapses completely. When this occurs, the entire foot begins to ache and will feel weak.

    3) Inability to resist pronatory forces. When the tendon is inflamed and painful, it cannot function properly. One of its main functions is to pull on the inner side of the arch and prevent the foot from rolling in (pronation). When it is inflamed, it cannot do this, so the foot begins to roll in, or pronate. In later stages, it appears as if the foot is so collapsed, one is walking only on the inner part of the ankle and arch, rather than the entire foot. This will eventually cause heel pain, ankle pain, shin splints, knee and hip pain, and lower back pain.

    4) Unable to raise up on to tiptoes with out pain. The Posterior Tibial Tendon stabilises the arch and foot, especially when we try to stand on our toes. When this tendon is inflamed, it has difficulty stalibising the foot, so it must work harder to do so. This extra exertion on the tendon's part will cause it to become painful when trying to stand on one's toes.

    What are the causes of PTTD tendonitis?

    Injury. This can occur in the following ways:
    Direct injury to the tendon (such as a blow to the tendon, or a fall resulting in a sprain).
    Micro-trauma. An example would be an overuse injury due to excessive repetitive movements (always running in the same direction on a track with a pitch).

    As people age. The tendons lose their elasticity and ability to glide as smoothly as they used to. Thus, older individuals are more prone to developing symptoms of tendonitis, due to the impaired gliding motion of the tendon. When the tendon no longer functions properly, it becomes swollen, inflamed, and painful. (The cause of these age-related changes is thought to be due to changes in the blood vessels that supply nutrition to the tendons).

    Hereditary Defects are those defects that we are born with, which predisposes us to Posterior Tibial Tendonitis/ Dysfunction:

    Flat Feet place excessive loads or pull on the Posterior Tibial Tendon. As the foot flattens, it stretches this tendon. The tendon, in the meantime, is over-working because it is trying to prevent the arch from collapsing further. This stretching or thinning of the tendon, along with its over-exertion will produce inflammation and pain in the tendon. If the arch is not properly supported, small tears will eventually appear in the Tendon. This will lead to almost constant pain and swelling of the tendon, along with a complete collapse of the arch and foot.

    Pronation is the force that causes the foot to flatten at the arch, causing one to walk more on the inner border of the foot than is normal. There are mechanical reasons for pronatory forces causing the foot collapse. This constant failure of the tendon to prevent pronation causes the tendon to over work. This will eventually result in: swelling, inflammation, pain, tearing of the tendon, and instability of the entire foot.

    An Accessory Navicular Sesamoid (Bone) is a small loose bone that some people are born with. When it is present, it lies in front of the area where the Posterior Tibial Tendon would normally attach to the Navicular Bone. So, instead of attaching to the normal Navicular, the tendon attaches to the Accessory Navicular Bone.

    This prevents the tendon from pulling on the true Navicular and maintaining the arch height and normal foot position. Pain, swelling, and tendon tears occur due to the tendon over-working and trying to accomplish its functions.

    Over weightindividuals place abnormal amounts of weight on the arch, forcing it to eventually collapse, no matter how hard the Posterior Tibial Tendon tries to prevent this collapse. As this tendon over works, trying to maintain the arch height, it eventually becomes inflamed, swollen, and painful. The end results are: Tears within the tendon. A completely collapsed arch. A pronated and unstable foot.

    What should I do if I have PTTD tendonitis?

    An assessment with a podiatrist at the Footfix clinic should be sought to review the cause of your PTTD tendonitis and a management plan devised to treat the condition. Your running regime may require modifying, as may footwear.

    What shouldn't I do if I have PTTD tendonitis?

    ‘Running through’ pain should be avoided. Continuing with the current, possibly harmful training regime that is causing the symptoms is likely to cause further damage and should be avoided.

    Could there be any long term effects of PTTD tendonitis?

    The worst case scenario is that the tendon snaps. This is also known as a complete rupture of the Posterior Tibial tendon. It can occur all of a sudden if vigorous exercise is attempted out of the blue, or it can occur after a long period of tendonitis. A completely ruptured posterior tendon requires surgical attention.

    Podiatry treatment for PTTD tendonitis

    An orthotic (shoe insert) that reduces the amount of pronation (the foot and leg rolling inwards) are the “gold standard” help reduce overstrain on the tendon. The podiatrist can provide footwear advice as to what is suitable for training.

    Radial Shock Wave Therapy may be initiated if you have a chronic condition that requires more intense treatment to get the tendon to heal, along with orthotics to control the pronatory forces.

    Ultrasound therapy can be initiated in the acute stages along with rest ice compression and immobilisation. Once through the acute stages, treating the cause with orthotics will be required.

    Injection of cortisone may be administered to the acutely inflamed tendon to reduce pain and swelling.

    Sports elasticated / neoprene ankle / arch support.

     

  • Rheumatoid Foot

    What is Rheumatoid foot

    Rheumatoid arthritis is a chronic, systemic, inflammatory condition that affects many tissues and organs, but mainly attacks the joints.

    Foot problems commonly develop in people with rheumatoid arthritis. These problems can often be more serious than in a healthy individual.

    Inflammatory arthritis

    There are several different forms of inflammatory arthritis which can affect your feet in different ways.

    • Rheumatoid Arthritis affects many joints in your feet
    • Reactive Arthritis usually affects your ankle or the area around your heel. It may also affect your toes, causing pain and swelling. This is known as dactylitis or sausage toe.
    • Psoriatic Arthritis often causes dactylitis.
    • Gout most commonly affects your big toe joint. It causes severe inflammation and makes your joint red, hot and swollen during an attack, which typically lasts 1–2 weeks. Without treatment, repeated attacks can cause permanent damage to your joint and lead to osteoarthritis. However, gout can usually be well controlled with medications.
    • Ankylosing Spondylitis mainly affects your spine but may also affect your heels.

    Apart from problems in your joints, you may have inflammation and discomfort in the tendons and the other soft tissues in your feet. The part under or behind your heel where the tendons attach to your heel bone (your Achilles tendon) is quite often affected in this way.

    Rheumatoid arthritis can adversely affect tissues, organs and joints in the body. A large proportion of people with rheumatoid arthritis have the disease in their feet. This can cause pain, swelling, deformity and collapse of the structure of the foot. Deformity in the foot can lead to a number of difficulties. Corns and callus may appear over points of high pressure causing pain. Swelling may mean a person can no longer wear their usual style of footwear. The collapse of the structure of the foot may lead to a ‘flat foot’ that does not function well and leads to difficulty walking efficiently.

    Your podiatrist aims to make your rheumatoid feet more comfortable by advising on suitable footwear, treating painful pressure areas with the removal of callus and corns. Orthotics can be provided to support the foot and help it to function better. Each of these things will allow you to remain as mobile as possible.

  • Runners Knee

    What is runner's knee?

    Runner’s knee (patello-femoral pain syndrome) is characterised by pain around or underneath the knee cap (patella) which is brought on by running and relieved by rest.

    What are the symptoms of runner's knee?

    Runner’s knee presents as pain around the front of the knee when running, walking or jumping. Pain often also occurs when getting up from a sitting position, going up and down stairs and when squatting. You may feel grating or ‘creakiness’ in or around the knee. The knee cap may also be painful to touch and move around.

    What are the causes of runner's knee?

    There are numerous causes of runner’s knee. A biomechanical problem, such as poor foot posture, is usually be present. This can lead to abnormal joint forces and altered muscle function. Runner’s knee is very common in those with flat feet. Other factors include poor footwear and obesity , a high Q Angle, weak quadriceps muscles .An increase in activity level, an unsuitable running surface or over-vigorous training regime and a bony or soft tissue abnormality can all also cause runner’s knee.

    What should I do if I have runner's knee?

    An assessment with your podiatrist is required to identify the cause of your runner’s knee. Often successful treatment of this condition requires intervention with orthotics and muscle strengthening or stretching. Any activity that appears to worsen the problem should be stopped immediately.

    What shouldn't I do if I have runner's knee?

    Continuing with vigorous levels of running on unsuitable surfaces should be avoided so that unnecessary damage doesn’t occur.

    Could there be any long term effects of runner's knee?

    If left untreated, runner’s knee may possibly progress to osteoarthritis in the long term.

    Podiatry treatment for runner's knee?

    Modification of your exercise regime can be discussed with the podiatrist. Orthotics (shoe inserts) will be provided by the podiatrist. With runner’s knee, these aim to reduce the amount of internal rotation of the leg bone and provide support for the arch of the foot. This will return the joint forces and muscle function to return to normal.

  • Shin Splints

    What are the symptoms of shin splints?

    Common symptoms of shin splints include aching and / or slight swelling along the shin. The pain is often worse when performing high impact activities which you carry your own body weight. The pain can sometimes make you unable to walk. Eventually you have to stop the exercise.

    What are the causes of shin splints?

    There are a number of causes associated with shin splints , but in reality we really do not know exactly what the cause is .

    The main causes are listed below.

    Stress fractures

    These are an overuse injury. They develop after repeated periods of stress on your bones; for example, running or dancing over a long period of time.

    Medial tibial stress syndrome

    This is inflammation where the tendon attaches to the thin layer of tissue that covers the bone (periosteum).This term is now being used more instead of “Shin Splints”

    Compartment syndrome

    This happens when your muscle swells. Your muscles are enclosed by fibrous tissue which stop them from flopping about in the leg , so if fluid builds up there isn’t any room to expand.
    When the pressure in your muscle increases it causes the symptoms of compartment syndrome.

    True compartment syndrome is an emergency and needs prompt attention.

    Worn out footwear, muscle weakness and running on hard surfaces can all cause shin splints. Shin splints often occur if there has been an increase in running mileage or an alteration in training footwear. It often occurs in those with “flat feet” where the foot and leg roll inwards too much (pronate). This rotation overloads the muscles and tendons in the shin.

    What should I do if I have shin splints?

    If you suspect that you have shin splints you should arrange a consultation to see us at the Footfix clinic as soon as possible to confirm your diagnosis and ascertain the cause of your condition.

    What shouldn't I do if I have shin splints?

    If you have shin splints and you continue to follow the same training regime your condition is likely to worsen, so you should rest prior to your podiatry assessment. ‘Running through’ the pain is not advisable (most people can not any way) as it will cause your shin splints to worsen.

    Podiatry treatment for shin splints?

    Shin splints are common in those with flat feet (also known as pronated feet). If a foot over pronates (rotates inwards), the structures of the ankle and lower leg are stretched and put under stress. Fully functional orthotics (shoe inserts) can help control this over rotation and support the arch, therefore reducing the stress on the muscles and alleviating the pain.