Total Care Podiatry

Many people, at some time in their life, experience a period of lower back pain. Ongoing back pain can be really debilitating, so if you experience lower back pain frequently, even if it is not severe, it should be addressed before it does become so.

There are many causes of lower back pain. These include structural misalignment, hereditary disorders, disc degeneration in the spine, nerve damage, muscle imbalance and dysfunction of the lower back / pelvic region caused by poor timing or function of the feet and legs when walking. Very often it is a combination of a number of these factors and that’s why if only one area is treated the condition improves but doesn’t completely resolve.

Timing issues of foot function

Walking should be a fluid motion from the time the heel hits the ground to the point where we step forward and off the foot. Sometimes, if the forefoot and especially the big toe joint becomes jammed, the forward movement is blocked for a very short time, forcing other joints to compensate. The blockage is not significant in itself, but it recurs with every step and this repetition, in a normal day’s walking, is enough to place the strain and stress on the muscles and joints leading to inflammation and increased risk of injury. You can test this out yourself by starting to walk and then stopping just before you step off. Be careful you don’t fall over!

Poor function of the foot due to excessive rolling-in (pronation)

If your foot works in an excessively rolled in position, especially as it lifts off the ground, it causes the leg to remain in an internal rotator position, resulting in a forward tilt of the pelvis which in turn increases the curvature of the spine and places strain on the muscles and ligaments of the lower back.

Poor function of the foot due to leg length difference

Most people have a slight difference in the length of each leg but if this becomes marked through dysfunction of the pelvis or injury and sometimes surgery, (for example hip surgery), it will force the foot to compensate. Usually this causes one foot to function rolled-in and the other to function in a rolled-out position. This places strain on the foot, leg and pelvis and may result in a pelvic tilt and twisting of the spine, placing strain on the associated muscle and ligaments.

Treatment options

In cases where you suspect the way your foot and leg works is having an impact on your lower back pain, it is best to have the podiatrist work together with the health professional of your choice. This may be your osteopath, physiotherapist, chiropractor, myotherapist or massage therapist. Marked improvements can be achieved over time when working with other health professionals to address the issues occurring around the lower back such as joint dysfunction and muscle imbalance.

At Total Care Podiatry the podiatrist will ascertain what dysfunction is occurring in your feet, how this is interacting with the muscles in your back, pelvis and legs and will see what areas in your lifestyle may be placing you at risk of continuing the injury; Eg your sport, posture and even footwear.

Total Care Podiatry aims at a thorough diagnosis and careplan to address complex conditions such as lower back pain. We often use orthotics to assist the foot to place the body weight through the foot so that it is in the right place at the right time. These orthotics significantly improve the foot and leg function which inturn can make a marked difference in the pain you have. This and other treatment stratergies working together with you and other health professionals can offer a complete resolution or at least a significant improvement.

WARNING : This information is for educational purposes only and is not intended to replace professional podiatric advice. Treatment will vary between individuals depending upon your diagnosis and presenting complaint. An accurate diagnosis can only be made following personal consultation with a Podiatrist.

What is it?

Achilles Tendinopathy refers to the degeneration of the tissue making up the Achilles tendon, with the loss of normal fibre structure.

It can present as an acute condition, meaning it occurs over a period of a few days, following an increase in training, or chronic, which occurs over a longer period of time. In addition to being either chronic or acute, the condition can also be either at the attachment point to the heel or in the mid-portion of the tendon (typically around 4cm above the heel). Healing of the achilles tendon is often slow, due to its poor blood supply.

What causes it?

An Achilles Tendinopathy is typically an overuse injury. Too much too soon is the basic cause of overuse injuries, however below are some other factors that can contribute to developing the condition:

• Increase in the frequency and intensity of activity
• Reduced recovery time between exercise and activities
• A change of footwear, or in the surface that you train on
• Weak calf muscles
• A decreased range in motion at the ankle joint, often caused by tight calf muscles
• Type of activity and exercise done, e.g. Running up hills will stretch the Achilles tendon more than normal on every stride. This causes the tendon to fatigue quicker, which leaves it more prone to injury.
• If your feet pronate or roll inwards when running. This can increase the stress on the tendon through twisting and ‘abnormal’ strain.
• When heels are worn regularly they can cause the Achilles tendon to shorten, then when flat shoes are worn for exercise the tendon has to stretch further than normal under increased stress causing the likelihood of injury to be higher.

How is it treated?

There are a number of things that can be used to treat Achilles Tendinopathies:

• rest and cold therapies to reduce any associated swelling or inflammation
• wearing a heel raise to reduce the strain on the tendon
• taking a prescribed anti-inflammatory medicine to releive any associated inflammation
• taping of the ankle and foot
• proper diagnosis of foot function addressed  with orthotics to address abnormal function
• ultrasound treatment
• surgery is sometime indicated if conservative treatments fail.

WARNING : This information is for educational purposes only and is not intended to replace professional podiatric advice. Treatment will vary between individuals depending upon your diagnosis and presenting complaint. An accurate diagnosis can only be made following personal consultation with a Podiatrist.

What is it?

Metatarsalgia is a common overuse injury described as pain in the forefoot that is associated with increased stress over the metatarsal head region. Metatarsalgia is often referred to as a symptom, rather than as a specific disease.

What causes them?

Common causes of metatarsalgia include:

• metatarsophalangeal synovitis
• avascular necrosis
• sesamoiditis
• inflammatory arthritis
• Morton’s neuroma
• Prominent metatarsal heads
• Hypermobile foot joints
• Excessive pronation
• Forefoot equinus

Each is diagnosed separately, often with the aid of X-rays and diagnostic ultrasound. Diagnosis is the key to ensuring the treatment matches the actual condition

How are they treated?

Once the cause of the metatarsalgia is known the appropriate treatment can be given. These may include:

• Trailing Felt padding to offload high pressure areas, which when successful will be replaced with an insole of some type.

• Orthotic devices to aid the foot to function correctly thus normalising the forces.

• Short-term relief may be from the removal of callus or corns under the metatarsal area.

• Footwear advice and footwear modifications

• Splinting all movement to completely rest the tissues

WARNING : This information is for educational purposes only and is not intended to replace professional podiatric advice. Treatment will vary between individuals depending upon your diagnosis and presenting complaint. An accurate diagnosis can only be made following personal consultation with a Podiatrist.

What is it?

This is a common condition of runners, which occurs when the cartilage of the patella (kneecap) softens, and the cartilage found under the patella become rough. Discomfort and often grinding or crunching sensations can be felt in the knee joint. This condition can affect any age group.

The condition may be referred to as ‘Runner knee’, Patellofemoral Syndrome, or Chondromalacia Patella.

What causes it?

This condition develops overtime from the poor tracking of the patella over the knee joint. This can occur because a number of factors, including:

• excessive pronation, or flattening of the foot as you run or walk
• poor, structurally unsupportive footwear
• mechanical conditions including wide hips (especially in females) knock knees, patella alta (high  patella) and subluxating patella
• weakness of the quadriceps muscles, especially the VMO (Vastus Medialis Oblique Muscle) which runs along the inner aspect of the thigh and connects at the knee specific types of training and exercise, e.g. downhill running, or running up stairs as part of training

How is it treated?

The simplest and most effective treatment plans often involve:

• rest
• specific leg muscle stretches to decrease pressure and strain on the kneecap
• strengthening exercises to the quadriceps muscles to improve the control of the kneecap as it    glides over the knee joint
• proper diagnosis of foot function, addressed with orthotics to correct abnormal function
• avoiding particular exercises
• physical therapies can also help, such as ultrasound, patella mobilisation, and strapping.

WARNING : This information is for educational purposes only and is not intended to replace professional podiatric advice. Treatment will vary between individuals depending upon your diagnosis and presenting complaint. An accurate diagnosis can only be made following personal consultation with a Podiatrist.

What is an ingrown toenail?

An ingrown toenail is where the edge, or corner, of the toenail grows into the adjacent skin (the skin next to the edge of the nail) and pieces the skin, causing the toe to become red, swollen and tender (inflamed).

Ingrown toenails are common, with the big toe most likely to be affected on one, or sometimes, on both sides. The toenail curves and cuts into the skin, causing the toe to become tender and painful, particularly when you walk on it. If left untreated, the toe can become infected.

What causes them?

Ingrown toenails can be caused by a number of things:

• The most common causes of ingrown toenails are badly cut toenails and toenails that are picked, leaving jagged and sharp edges.
• Tight fitting shoes – wearing shoes that are too narrow, or too short,, can crowd your toes and cause your toenails to curve into your skin.
• Excessive sweating or poor foot hygeine – if the skin on your toes and feet is warm and moist, you are more likely to develop an ingrown toenail as the soft skin is easily peirced by the nail edge.
• Injury – such as stubbing the toe, or dropping something on it, can cause an ingrowing toenail to develop.
• Genetic factors – your risk of developing an ingrown nail can be increased by genetic factors, such as the way that you stand, the way that you walk, or having a naturally curved, or fan-shaped toenail.

How can it be treated?

It is best to treat an ingrown toenail as soon as you notice the symptoms. If caught early enough, your podiatrist may recommend the self-care advice listed below to prevent it from getting worse.

Soak your foot in warm water 3-4 times a day.
Use a cotton bud to gently push the skin away from your toenail.

Wear comfortable shoes with enough space around your toes.

Take painkillers, such as paracetamol, or ibuprofen, to relieve any pain. Children who are under 16 years of age should not take aspirin.
If your symptoms persist, your podiatrist will be able to remove the small part of the nail that is digging into your skin. As your toenail grows back, a piece of cotton wool or foam can be placed under your nail in order to prevent it from growing back into your skin. The cotton wool should be changed daily.

If your nail is infected, you may be prescribed a course of antibiotics.

Nail surgery

If your toenail does not improve your podiatrist may recommend that you have part, or all, of or your toenail surgically removed.

The most common surgical procedure for treating ingrown toenails involves only removing part of the toenail. This is called partial toenail avulsion. The edges of your toenail are cut away to make the toenail narrower.

Once the anaesthetic wears off, your toe may be very tender. You may need to take a painkiller, such as paracetamol or ibruprofen, and wear soft or open-toed sandals for about a week or so.

WARNING : This information is for educational purposes only and is not intended to replace professional podiatric advice. Treatment will vary between individuals depending upon your diagnosis and presenting complaint. An accurate diagnosis can only be made following personal consultation with a Podiatrist.