Tag Archives: podiatrist

Oxfam Trailwalker - my FootDr

Oxfam Trailwalker

Oxfam Trailwalker - my FootDrWell it’s that time of the year again! Oxfam Trailwalker is for a wonderful cause and every year raises much needed funds and awareness. Unfortunately, it also goes hand in hand with some foot and lower limb injuries that could easily be avoided with a little preparation!

So here are 10 friendly suggestions from the team here at my FootDr podiatry to help you get through the hard yards relatively unscathed!

1.      Prepare

First and foremost, prepare your body for the challenge with some training. Covering a distance of 100 km in one hit with no training is a great way to get injured. Start preparing a few months out from the big day by going for regular walks (beginning with a smaller distance for novices) and progressing to a bigger team walk on the weekends (for instance 30 km) over varying terrain. The course incorporates a variety of surfaces and gradients so choosing walking trails that are similar will help you adapt when in the big event! Regular walks will also increase your fitness and get your body comfortable with walking/jogging long distances.

2.       Address any problems early!

If you have had any pre-existing injuries or worries with your walking/jogging style; seek advice on support/guarding against major injury. The team here at my FootDr podiatry centres conduct biomechanical assessments regularly and would only be too happy to advise you on best course of action!

3.       Wear in your footwear!

The shoes you choose to wear for the event should be supportive (adequate cushioning) and suited to your particular foot type.

The shoes should NOT be brand new. New footwear takes time to shape specifically to your foot; wearing them straight up for 100km WILL GIVE YOU BLISTERS.my  FootDr podiatry - blisters

It is best to wear the shoes for a couple of weeks prior to the event for some bigger walks to make them comfortable. Resting the shoes for 3 days prior to the event will also make sure that the rubber in the soles is at it’s full potential!

4.       Stretching

Regular stretching and massage can help keep the muscles pain and injury free. A tight loaded muscle is more likely to suffer injury when fatigued. Keeping flexible will help protect you from major injury; so stretching after warming up during regular exercise and after warming down will go a long way to conditioning yourself for the major walk. Through-out the course there are a number of health professionals including podiatrists and physiotherapists who can help you in the event of minor injury or pain.

5.       Stay hydrated!

In the days leading up to the walk drink plenty of fluids to prepare your body; starting a 100km walk/jog dehydrated will only lead you to fatigue quickly and predispose you to injury. Exercise causes the body to use up it’s water stores whether for fuel or perspiration. There are regular drink stations along the trail walk, do not hesitate to use them!

6.       Blistering!

my FootDr - BlistersThe dreaded blisters will inevitably make an appearance during Oxfam due to the constant friction war of skin vs shoe! There are a number of ways to reduce the friction including good socks, checking you footwear fits correctly and if you are aware of any specific points you are prone to blistering, a few well-placed bandaids or strips of strapping tape can also help to prevent the blisters.

Podiatrists and medical staff will be on-hand at the check points to help relieve any discomfort, but being proactive will help reduce the pain!

7.       Toenails!

Yes Toenails! Cutting your toenails 3 days prior to the event will ensure that they are not too long that they will cause injury but also not too short that they will cause discomfort!

8.      Health Professionals are there to Help

If at some point during the walk you feel you have injured yourself and are in worlds of pain, CONSULT A HEALTH PROFESSIONAL at the nearest check point. Everyone who participates in Oxfam is a hero in their own right, but major injury is not part of the legacy. Seek medical assistance even if you are unsure, it is better to be safe than sorry!

9.      Assess the damage

The finishing point! You will be very tender towards the end of the walk/jog, not only have your muscles and joints in your legs taken a bashing but so have your feet. After finishing the big race, it’s a good idea to assess for any damage and have it seen to- whether it is blood blisters, skin irritation, lost toenails or major callus build up the last thing you want is infected feet!

10.  Recuperation

The following day- you will be sore. It is important to rest and recuperate; basic first aid Rest, Ice, Compression, Elevation is a good treatment for the residual soreness; especially for the feet and legs! So put them up, throw on some ice and rest easy knowing what a great job you’ve done!

If you have any queries regarding footwear advice, biomechanical assessment or injury prevention don’t hesitate to come in and see one of our helpful, friendly podiatrists.

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Spotting a Plantar Plate Tear

Plantar plate tear

Plantar plate tear

One of the most common forefoot complaints that presents to my FootDr podiatry centres is a plantar plate tear.   This is seen most frequently in middle-aged women who present with constant plantar metatarsal pain and swelling extending towards the toes (mostly affecting the 2nd toe).  Often swelling and redness can also be noted across the dorsum of the forefoot along with symptoms exacerbated by extended periods of walking or running and the use of high heel shoes.  As the plantar plate tear progresses, clawing and splaying of the toes is seen.

Early diagnosis and management of a plantar plate tear can often be challenging due to the complex structure and anatomy of the foot.  If necessary, furthe

r investigations can be ordered such as plain x-ray or diagnostic ultrasound to appraise the severity of injury.  However, the early stages of a plantar plate tear are best managed when there is only acute plantar metatarsophalangeal joint synovitis and no instability or deformity (clawing and splayed toes).  Conservative treatments primarily include symptomatic relief through NSAIDs, strapping, off-loading padding, footwear and activity modification.  Subsequently treatment will then focus on the underlying cause of the problem ie pes planus, bunions, hammer toes, mechanical stress.  At myFoot Dr podiatry centres we will perform a thorough physical and biomechanical assessment to determine the best course of action to offload the forefoot and decrease mechanical stresses.  Often a customised, soft, CAD/CAM orthotic device and footwear modifications are recommended that can prevent the problem from progressing.

Occasionally in chronic cases, an orthopaedic appraisal and surgery is recommended.  Generally, most patients are able to return to activity in 1 month of treatment and pain free within 3-4 months.

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Heel Pain in Junior Footballers

Watching a young footy player hobbling off the field is never a good sight to see. One of the most common problems often responsible for this is a type of heel pain known as Severs Disease.

Severs Disease or calcaneal apophysistis affects physically active boys aged 12 to 14 years and girls aged 10 to 12 years, which corresponds with the early growth spurts of puberty.  Symptoms usually come on gradually and can include:

• Unilateral or Bilateral heel pain
• Heel pain during physical exercise, especially activities that require running or jumping
• Increased pain level after exercise
• A tender swelling or bulge on the heel that is painful on touch
• Limping
• Calf muscle stiffness first thing in the morning

So what causes the pain?

During puberty the calcaneus or heel bone consists of two areas of bone known as ossification centres. These two areas are separated by an area of cartilage known as the calcaneal apophysis or growth plate.  This growth plate does not fully fuse together until the foot has finished growing. The strongest tendon in the body the Achilles tendon attaches to the heel bone. It is through that as the body grows and the muscles become stronger the calf muscles that attach to the achilles tendon tighten up and cause more pulling strain around the growth plate on the heel bone. This often results in pain and sometimes inflammation which is known as Severs Disease.

The good news is that in the majority of cases Severs responds very well to treatment.

Treatment typically involves a stretching and or strengthening program to help stretch out the calf muscles and Achilles tendon.  Ice is also recommended to help alleviate pain and is best placed over the painful area immediately after sport. The use of orthotics with a heel raise under both heels is also commonly prescribed and usually results in quick resolution of pain.  In very active kids playing a couple of sports and training several times per week modifying their training load may also be required.

Podiatrists encounter cases of Severs disease daily especially during the footy season and know how best to diagnose and treat the problem.  A my FootDr podiatrist will conduct a thorough assessment of the patient including a hands-on assessment of the painful area, video gait analysis of the way the patient is walking and running and an inspection of the patients shoes and footy boots. This will enable our podiatrist to accurately diagnose the problem and outline the best treatment approach for the individual.

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Barefoot Running

In the past decade somewhat of a “fad” has gained considerable support throughout the health and fitness industries. This is the belief that running barefoot is the be all and end all when it comes to running training. At one end of the spectrum there are barefoot enthusiasts who believe that running barefoot is better for you and running shod causes injuries. On the other hand there are sceptics who will tell you that barefoot running should be avoided at all costs. Unfortunately, as with most issues, these “extremists” gain the most media coverage and therefore it is easy to fall into the trap of believing that you are either a barefoot runner or not. Surely, however, there is a middle ground.

If we look back through the pages of history, humans have been running barefoot for millions of years. Even right up until the 1970’s our most elite athletes were running on nothing more than thin strips of rubber (1). Therefore it can be said that, evolutionarily speaking, we are well adapted to running barefoot. That being said though, as podiatrists, we regularly see patients who have suffered from various injuries by attempting barefoot running. This is not to say that those individuals who run shod are injury free either. What is known is that there is no scientific evidence linking running shoes to injury; conversely, nor that barefoot or minimally supported running prevent injuries or enhances running performance (2). This is obviously contradictory to much of what can be found by a quick Google search of barefoot running!

Running styles differ considerably between shod runners and experienced barefoot. Various studies have concluded that, when running barefoot, we tend to strike more with our forefoot which then allows the ankle joint to absorb the shock generated from impact. When running shod however, we strike with the heel first, relying on the shoes rubber sole and our knees to absorb the impact forces (2, 3). These differences in running styles tend to lead to variances in the injuries sustained by both camps. Often, barefoot runners experience forefoot injuries (eg. sesamoiditis, plantar plate injury, metatarsal stress fracture) and Achilles injuries (eg. Insertional tendinopathy, mid-portion tendinopathy). In comparison, shod runners often present with “shock type” injuries such as Medial Tibial Stress Syndrome. Interestingly, both groups can present with the all too common injury, Plantar Fasciitis.

There are both advantages and disadvantages of barefoot running. Jenkins and Cauthon (4) summarised them nicely as follows:

  • Advantages
    • Changes to runner’s gait – decreased stride length, increased stride frequency, decreased range of motion at the ankle, knee and hip and more plantarflexed ankle at contact
      • This is not necessarily an advantage in itself, however the modifications are partially responsible for further advantages
  • Reduction in impact forces
  • Increased economy of running – some studies suggest that there is a decrease in oxygen consumption when running barefoot due to a reduction in weight
  • Increased proprioceptive ability – theoretically this may reduce the risk of ankle injuries however no studies have confirmed this statement
  • Potential increase in musculature strength – especially that of the intrinsic muscles of the foot
  • Decreased cost – no need for regularly changing footwear
  • Disadvantages
    • Injury from running surface, debris and general hazards
    • Thermal injury
    • Availability of adequate surfaces – no studies have yet determined the optimal surface for barefoot running
    • Exposure to microorganisms/Infectious agents
    • Runners who require mechanical control for existing conditions – an orthotic device dispensed by your podiatrist obviously requires a shoe
    • Potential injury to those with systemic conditions – the best example is a diabetic with peripheral neuropathy. If this individual was to run barefoot, his/her risk for serious injury is greatly increased
    • Potential increased shock at impact – this is particularly the case for those new to barefoot running. If an athlete has run in shoes their whole life it is more than likely they have developed a heel-toe strike pattern. If they were to continue with the same pattern they are at real risk of suffering from a stress related injury

As can be seen, there are various advantages and disadvantages for barefoot running. This is not to say that there is no place for it in a training regime however I think it is clear that it should not be the only modality used. Instead, it is my belief that barefoot running be used as an adjunct; something to enhance what is already being done. I see barefoot running as an exciting addition to training protocols, not a crazy fad that should be ignored or shunned in a hope that it will disappear.

It is important that, if you wish to begin barefoot running, the transition is a gradual one. These days there are many “minimalist” type shoes on the market that offer the protection of a shoe with very little support and cushioning. A slow progression to complete barefoot is essential to ensure that the foot’s structures are able to adapt to the increased loads being experienced.

Readers should be excited at the prospect of further diversifying their training. There are literally hundreds if not thousands of pieces of literature available on the topic. The trick is to decipher what is hype and what fact. And of course, if you have further queries or concerns, consult your podiatrist who will be more than willing to provide their perspective on the matter.

1)      Lieberman, D. (2011) What can we learn about running from barefoot running: An evolutionary medical perspective. Exercise and Sports Sciences Reviews. Retrieved from www.acsm-essr.org

2)      Lohman, E et al (2011) A comparison of the spatiotemporal parameters, kinematics, and biomechanics between shod, unshod and minimally supported running as compared to walking. Physical Therapy in Sport. (12) 151-163

3)      Lieberman, D et al (2010) Foot strike patterns and collision forces in habitually barefoot vs shod runners. Nature. (463) 531-535

4)      Jenkins, D & Cauthon, D (2011) Barefoot running claims and controversies – A review of the literature. JAPMA. (101) 231-246

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Paediatric Lateral Foot Pain – Is It Iselin’s?

Children often complain of aches and pain that settle with little more than rest. However, if you child is suffering from acute pain, or general soreness that last more than 5 days it is wise to have this checked out by a Podiatrist.

Children complaining of pain on the outside of the foot may have a condition known as Iselin’s disease/syndrome. Below is a summary of this often misdiagnosed condition.

Generally children suffering from Iselin’s syndrome will report pain on the outer boarder of the foot, at the prominence known as the styloid process. Some redness and swelling over the area will be present. Barefoot activity, jumping sports and narrow fitting footwear can be aggravating factors. Individual biomechanical factors need to be assessed and treated, as splaying of the forefoot associated with flat feet, and walking on the outside of the feet with high arched/inverted feet are associated with Iselin’s disease.

It has been reported rarely, but is probably more common than appreciated. Clinically it can be confused with tendonitis, ankle sprains, fractures of the 5th metatarsal or even labeled as  growing pains. It appears to be more common in athletically active, older children and adolescents, and more common in males. Early recognition and treatment may prevent long-term complications such as non-union and subsequent pain.

Early treatment often consists of conservative measures – rest, ice, padding, footwear, orthotics, stretching, massage of peroneals, etc. Delayed intervention can lead to continued stress through the fusion of the secondary ossification centre and even non-union. Non-union is usually very painful, and may require surgical excision of the proximal epiphysis or open reduction internal fixation with an orthopaedic screw.

See my FootDr’s website.

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Queensland Bulls use Podiatry to Ensure Peak Performance

my FootDr - Podiatrist for the Queensland BullsThe Queensland Bulls cricket team is already well into their preseason training and are hot favourites to retain the Sheffield Shield in the 2012-13 summer. So too the Brisbane Heat, who despite just falling short of the making the Big Bash finals last year are expecting big things this coming December and January. The squad welcomes back Nathan Hauritz after 6 years playing in Sydney and Usman Khawaja, the exciting left-handed opening batsman has also made the move north inspired by the unique coaching style of Darren ‘Boof” Lehmann. The squad is also bolstered by a number of emerging junior players and a solid list of experienced campaigners including captain James Hopes and veteran wicketkeeper Chris Hartley.

The Bulls squad in preparation for the compacted season ahead undergo a number of medical and fitness assessments and tests. Just like the rest of us, peak foot health is critical for optimal performance and comfort while on the field. Serious and debilitating foot and leg conditions commonly experienced by cricketers include stress fractures, tendonitis, sprains and strains, spurs, joint impingement and contusions. Fast bowlers in particular, can also suffer less serious but equally uncomfortable blisters, calluses and corns, bruised and broken toenails, and even open heel fissures (deep cracks).

my FootDr podiatrists and directors Darren Stewart and Greg Dower have been involved with Queensland Cricket for the past season and were yesterday invited to assess the squad and provide necessary treatment. The assessment of each player involved a thorough history, assessment of their joint and muscle range of movement, postural review, detailed gait assessment both relaxed walking and also the specifics of their playing mechanics, high definition peak pressure mat readings, and a 3D foot profile scan of their feet.

Each player will be provided with highly customised foot orthoses to improve comfort, optimise shoe fit, equalise pressure and overall assist in alignment and efficiency of the feet and legs. Some players have leg length discrepancies, a common anatomical variation, and benefit from having a raise inserted in the sole of the shoe to balance the pelvis and assist in spinal alignment. Both Darren and Greg will be in regular contact with the team physiotherapist and Queensland Bulls legend Martin Love during the season, and attend recovery sessions to provide onsite treatment and advice to the team.

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Sore feet and legs after the Bridge to Brisbane?

my FootDr podiatry Bridge to Brisbane Team

my FootDr podiatry Bridge to Brisbane Team

Were you one of the 40 000 plus Queenslanders who braved the early morning chill to climb the Sir Leo Hielscher bridge and walk or run your way to the RNA showgrounds? This was the 4th time my 11 year old daughter and I have participated, and we love the exercise and carnival atmosphere of one of the Australia’s largest fun runs. We walk and jog the course, enjoy the scenery and make a mad dash for the line to try and improve on last year’s time!

Being a podiatrist, it’s an occupational hazard walking alongside such a large pack of people; I can’t help but to observe the variety or different walking and running styles, choice of footwear to participate in and how people cope with the gradual fatigue that can set in. I suppose in many ways this is a perfect cross section of our community, with elite runners up the front slogging it out for a podium finish, recreational runners just behind and then the weekend hackers (me included) making up the pack.

It amazes me that so many people may not be aware of how their foot and leg biomechanics affect their body’s overall function. So common amongst the participants was some characteristics, that after pointing out to my daughter a few cases of quite profound excessive pronation (the most common form of foot dysfunction, where the ankle leans inwards and the arch of the foot flattens when standing and walking) she started to point them out to me!

my FootDr podiatry Bridge to Brisbane

my FootDr podiatry Bridge to Brisbane

Every day in clinic I assist people recover from biomechanical related foot, leg and hip/back – sometime it can take months to return to normal activities following an overuse injury such as:

  • Plantar fasciitis (pain on the heel or arch)
  • Shin splints (pain typically on the inner shin, but this term encompasses all shin pain)
  • Achilles tendonitis (either at the back of the heel bone or just above)
  • Stress fractures (bone fatigue that leads to a partial break – commonly metatarsal of the forefoot)
  • Anterior knee pain (around or to the side of the knee cap)

Almost all of these conditions can be avoided with awareness of the biomechanical dysfunction and appropriate advice and treatment if necessary. Even being recommended the right type of shoe may be beneficial in some cases.

For those that would like to see what excessive foot pronation looks like check out the following link http://www.youtube.com/watch?v=aQ83QrPKKMU

If you’re feeling more than just muscle fatigue today, or suffer from one of the conditions above you should have your lower limb biomechanics investigated with video gait analysis. A podiatrist competent in assessing and managing sports injuries will then be able to provide you with the advice you need to ensure you run faster next year!

Darren Stewart – Podiatrist (my FootDr podiatry centres)

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my FootDr podiatry and the Steady Steps Program

Podiatrists Darren Stewart recently presented to a group of south side locals on the importance of good foot health and footwear as part of the Steady Steps Program. Margaret Coates, Physiotherapist and Tai Chi instructor runs the Steady Steps program to improve the awareness of people of that factors that influence balance and provide advice which can reduce the incidence of falls.

Falls prevention is a critical issue for our aging population, as one incident of a fall can lead to a loss of confidence and independence, or even a serious fracture or head trauma resulting in hospitalisation. General factors include reduced muscle strength, slowed reflexes, vision impairment, altered cognitive function as well as pain associated with arthritis and other medical conditions.

my FootDr podiatry centres - Steady Steps Program

Darren Stewart with Margaret Coates, drawing the winner the my FootDr podiatry prize from attendees of the seminar (prize includes a 1 hours comprehensive consultation and free New Balance shoes)

“The feet also play a huge role in balance and therefore falls prevention. Foot pain of any type has been identified as a key factor in falls – so that includes everything from a painful corn or callus, right through to tendonitis, heel spurs and bunions. Furthermore, inadequate, inappropriate or ill fitting footwear can greatly decrease an individual’s ability to balance. If you’re not sure if your shoes are right, or you have suffered for foot and leg pain lasting more than a week, get yourself off to a podiatrist ASAP” said Stewart.

For more information on the Steady Steps Program or foot related issues please contact any of the my FootDr podiatry centres.

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my FootDr Podiatrist’s Professional Development – Kinesio Taping

At our quarterly weekend continuing professional development conference, Anouska Edwards (Physiotherapist) presents the theory of Kinesio Taping. K Taping as is often referred to, was developed in the USA over 30 years ago but gained popularity after the 2008 Olympic Games after many athletes were seen donning colourful K taping on the upper and lower limbs.

my FootDr Mackay Podiatrist Christ Watson has K tape applied for Achilles tendonitis

K Tape for Achilles tendonitis

K taping works on a different theory to traditional rigid sports taping, as it is elastic and does not restrict joint movement. Instead, it works by influencing the mechanoreceptors in the skin and increasing microcirculation to injured structures by lifting the skin and improving lymphatic drainage.

We see the benefits to our patients will include optimised recovery from traditional conditions including Achilles tendonitis, plantar fasciitis and medial tibial stress syndrome (Shin Splints). my FootDr podiatrists will also be actively researching the benefits for people suffering from hallux valgus (bunions), forefoot pain including bursitis, hammer toes, generalised metatarsalgia and morton’s neuroma, as well as a renage of other foot pathology.

my FootDr podiatrist Greg Dower presents Anouska Edwards with a small gift.

my FootDr podiatrist Greg Dower presents Anouska Edwards with a small gift.

my FootDr podiatry centres staff would like to thank Anouska Edwards and Rocktape for their time and generous support of our podiatry conference.

 

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Heel Pain in Children

With football and netball season well underway, podiatry clinics around the country will see an influx in children suffering from heel pain. Whilst there are a number of possible causes for these symptoms, the majority of these children are suffering from a condition known as Severs Disease, or as I prefer to call it, Severs Syndrome. Typically this affects girls between the age of 7-12 and boys from 9-15, involved in regular physical activity.

Symptoms include pain at the back of the heel bone near to the insertion of the Achilles tendon which can be present constantly, during, or immediately after playing sport. The most common sports that aggravate these symptoms include soccer, AFL, basketball, netball, athletics and other sports that involve explosive movements like sprinting and jumping.

Severs Syndrome is described as a tractional apophysitis. Traction refers to pulling, and apophysitis relates to inflammation of a growth plate. In Severs Syndrome it is the Achilles tendon that applies the traction on the juvenile heel bone, and the growth plate is irritated by a sheering stress due to one of a number of biomechanical imbalances.

A clinical assessment by a knowledgeable podiatrist is often all that is required to diagnose this condition, although in rare cases where disproportionate pain or swelling is present it may necessitate an x-ray referral directly from your podiatrist. A typical consultation will involve a thorough history of the symptoms and aggravating activity, a review of footwear, physical assessment including joint range of motion and muscle testing, and video gait analysis.

Generally children suffering from Severs Syndrome fit into one of two physical categories;

Mesomorph – Solidly built with strong and inflexible muscles. In this case there is insufficient flexibility at the ankle joint.

Ectomorph – Supple flexible joints result in excessive collapse of the arch of the foot (pronation) when standing or running, which in turn results in a delay in the natural timing of heel lift.

With a skilful assessment of the cause and correct diagnosis, effective treatment in almost all cases is possible. The earlier a correct diagnosis is made and treatment initiated, the less likely the child will require rest from activity. my FootDr Podiatry Centres successfully treat 1000’s of children suffering from heel pain every year.

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