Total Care Podiatry

What are they?

There are 3 types of toe deformities that are very similar – hammer toe, mallet toe, and claw toe. Additionally, there can be occasions where the lesser toes may overlap. These conditions can either be flexible (your joint has the ability to move) or rigid (your joint has very limited and/or no ability to move). Each of these conditions has unique characteristics in relation to how the toes bend and the degree of deformity; however they share similar symptoms and treatment methods.

Toe deformities are among the most common toe problems. Although both men and women are at risk, women are 5 times more likely to experience a toe deformity than men (often a result of improper footwear). Also, the chance of suffering from a toe deformity increases by 2 – 20% with age.

What causes toe deformities?

There are many, many causes but some of the most common include:

• Weakness in a muscle near the arch of the foot. This results in the long toe muscles on the top of the foot helping to do its job.
• Shoes shorter than your toes, making them bunch up.
• Shoes too loose around the instep. Clawing the toes will make the foot thicken up and hold on to the shoe better.
• Strokes or any disorder causing weakness in muscles.
• A bunion encroaching into the space of the 2nd toe.
• Arthritis affecting the body as a whole

How is it treated?

No matter what the cause of the toe deformation, shoe fit is important for comfort. Shoes that cover only the toes and leave the instep bare are the worst style as the shoe has nowhere to hang onto except the toes. A shoe that fits well around the instep will stop the foot from sliding into the end of the shoe when you are walking downhill or downstairs and makes it possible for the shoe to stay on easily without relying on being tight around the toes.

Often there is a mechanical reason for the toes clawing that the podiatrist can address directly. The podiatrist can remove any corns or callus forming from the toe deformity. Protective devices are available and have variable success depending on the cause of the problem. More can be done to help a toe that can still be straightened out rather than one that is locked into a clawed position so don’t delay in seeking help.

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?

A neuroma refers to the thickening or enlargement of nerve tissue, which is often caused by irritation or compression of the nerve. This compression causes swelling in the nerve and can lead to permanent nerve damage.

A Joplin’s Neuroma is an entrapment of the nerve travelling along the bottom and inside area of the big toe.

A Morton’s Neuroma causes pain in the ball of the foot that shoots out to the 3^rd and 4^th toes. The 2^nd and 3^rd toes can also be affected. The pain is typically worse when standing an walking and relieved by rest. Discomfort may be felt as a burning pain, deep achy pain, constant burning, radiating pain, electrical pain, or numbness. Others may describe the sensation of feeling as though their sock is bunched up under the ball of their foot or feeling like they’re walking on a lump or a ball.

What causes them?

A Joplin’s Neuroma may be caused by abnormal pronation, or may be associated with a bunion formation.

The exact cause of a Morton’s neuroma isn’t always known, although a number of problems can contribute to the formation of a neuroma.

High heels, particularly those over 5cm (2″), or shoes with constricting, pointed, or tight toe boxes can cause compression (for this reason, women tend to suffer from a Morton’s neuroma more often than men).

Conditions such as a high-arched or flat foot, bunions and hammer toes can lead to a neuroma being formed. These foot types can lead to instability around the toe joints, which can cause the beginnings of a neuroma.

Other causes include sporting activities, such as running or racquet sports, which can involve repetitive irritation to the ball of the foot.

How are they treated?

The treatment options for a Morton’s neuroma can differ according to how long you’ve had the condition and its severity. Identifying the neuroma in its early stages will help to avoid surgery.

The most important action is correct diagnosis ususally requiring a diagnostic ultrasound to differentiate a neuroma from other conditions that can produce similar symptoms.

Early treatments will concentrate on trying to relieve and reduce pressure on the area around the neuroma. This may consist of:

1. A simple change in the style of shoes you normally wear. Wide-toed shoes may be recommended.
2. Padding to provide support for the arch of the foot may be advised to take pressure away from the nerve.
3. Anti-inflammatory drugs (NSAIDs) and a course of steroid injections can help ease acute pain and inflammation.
4. Orthotics will help the foot to function so that the pressure is in the correct structure at the proper timinds, relieve abnormal stress on the affected area.
5. If the neuroma is small, cortisone injections or repeated injections of alcohol can also be beneficial.

In more severe cases, where early treatment options haven’t worked, surgical options may be considered. Surgery to remove the inflamed and enlarged nerve often takes up to 30 minutes and can be performed on an outpatient basis.Recovery generally takes less than four weeks and surgery is successful in 80% of cases.

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.