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Cerebral Palsy and Toe Walking

Cerebral Palsy and Toe Walking

Photo credit: BabyCenter.com

You may notice that your child is walking on their toes or tip toeing around the house. However, there is usually no reason to worry as some children may just like to walk on their tip toes (while pretending to be a ballet dancer, for example), whereas others may just have tight calf muscles causing them to have a bouncy gait.

However, you should talk to your podiatrist if:

  • they always walk on their toes and have stiffness in their muscles
  • they uncoordinated
  • this is accompanied by delayed development in their motor skills
  • there is a waddling gait or a lot of stumbling

Cerebral Palsy

Cerebral palsy is a condition or group of disorders, present at birth (congenital) or acquired, which adversely effect the movement, muscle tone and balance of a child. Cerebral palsy occurs due to damage to the brain centre that control the movement of muscles. There are other factors that can cause cerebral palsy such as:

  • deprivation of oxygen at birth (asphyxia) or reduced oxygen levels in the womb or during birth
  • womb infections leading to abnormal inflammatory response, which can cause an
  • autoimmune attack on the developing baby’s nervous system

Other causes include:

  • placental pathology
  • inborn errors
  • genetic causes

Risk factors for cerebral palsy are premature delivery, coexisting at birth abnormalities, growth restrictions in the womb and excessive multiple pregnancies.

Types of cerebral palsy

Spastic hemiplegia – one arm and one leg are affected on the same side of the body.

Spastic diplegia – both legs or both arms are affected.

Monoplegia – only one leg or one arm is affected.

Quadriplegia – both legs and both arms are affected. Sometimes, the muscles of the trunk, mouth, tongue and windpipe are also affected making it difficult to eat and talk.

Triplegia – both arms and one leg or both legs and one arm are affected.



Orthotics can help prevent functional problems from getting worse and allows the passive correction of the deformity in a non-rigid spasticity; they also provide stability during gait and assist with function. Orthotics do not necessarily have to extend above the knee, but their main function should be to provide joint and foot alignment.

Ankle Foot Orthoses / Ritchie Braces

AFOs (ankle foot orthoses) or other products, such as Ritchie Braces can also be recommended if they have excessive calf muscle tightness. A solid AFOs ensures foot control and helps the ankle joint. Also, they increase side-to-side stability and help the foot with ground contact. Research has shown that these braces reduce the high impact forces early in children with spastic diplegia.

Physical Therapy

Physical therapy helps maintain balance, with postural exercises being the most effective. Furthermore, lower extremity exercises such as Theraband calf muscle exercises can also help increase the muscle strength. Presently, physical therapy options include: neuro-developmental therapy, sensory integration therapy, bracing, stretching and pressure point stimulation.

Intramuscular Injections

Newer treatment types include intramuscular injections for spasticity. Injections include local anaesthesia in order to block the nerve supply to the muscle and reduce spasticity. Botulinum (the same thing used for “botox” injections) can also be used for intramuscular injection to block and release the muscles. This helps to relieve spasticity.

What Next?

If you child has a problem with walking or if you just want your child checked to see if their function is within normal limits, see our podiatrists today for a thorough assessment and discussion of options.

Foot Posture and Back Pain

Broadway Burrard ChiropraticBack pain is present in around 18% of the general population and is highly preventable in most cases. You are at more risk of developing back pain, especially lower back pain, if you are: female, getting older, obese, have a lower...

Tinea pedis/Athlete’s foot

Tinea pedis, also known as athlete’s foot is a skin infection that is caused by a fungal infection. It usually presents as red, macerated, peeling or flaky skin in-between the toes or soles of your feet. The fungal infection typically grows in areas that are warm and...

Why Do My Nails Looks Funny?

Why Do My Nails Looks Funny?

See the podiatrists at the Perth Foot & Ankle Clinic now if your nails don’t look right. We can diagnose and treat a variety of nail condition.

What are nails?

Nails are a bit like little claws. They are made of a tough protein called keratin (as is hair, horns and hooves). A nail consists of the nail plate (the bit you can see), the nail matrix (where the nail grows from), and the nail bed underneath. Nails start to develop in the womb. Fingernails start to develop in the embryo at 10 weeks and toe nails at 14 weeks. They are completely developed by 32 to 36 weeks. In young children, the nails are thin and flexible. In older people they can often get thicker and stiffer.

Why do we have nails?

The nails protect the ends of the fingers and toes (also known as digits), help with precise movements (by supporting the soft part of the digits), and are handy for gripping things (think of picking up something very small), scratching and scraping. CLOSEUP FEET

Causes of funny looking nails

Nails can look abnormal for a variety of reasons:
  • Fungal nail infections. Nail fungus can cause discolouration (usually white or yellow) on the surface or underneath the nail.  Sometimes part of the nail can separate from where it attaches to the toe underneath. The technical name for this is onycholysis. Eventually the nail can thicken and become flakey. Read more about fungal nail infections here.
  • Lines and ridges. These are common and are usually normal. They may worsen during pregnancy. A large groove down the centre of the nail can be caused by a habit of repeatedly rubbing or scratching the nail (a bit like the habit of picking the nails). A horizontal ridge across the nail (also known as a Beau’s line) may form as a result of an illness, infection or previous chemotherapy.
  • Senile nails. As you age, the nails may become thickened, brittle and develop ridges and separation of the nail layers at the end of the nail. This is not a disease, but is one of the signs of ageing, although not all people develop such nails as they get older.
  • Whitish or yellowish nails. These can occur due to onycholysis in the absence of fungal nail infection, although persistent onycholysis can make the nails more susceptible to fungal infection, as the separated part of the nail is a good place for fungi to get underneath the nail.
  • Red or black nails are usually due to a haematoma, or blood under the nail, which occur from trauma such as kicking or dropping something on the nail. The discoloured area will grow out with the nail and be trimmed off as you trim your nails. If you have a black spot under your nail that was not caused by trauma, you may want to see a health professional to check that it is not due to a skin cancer. A simple biopsy can help to determine the cause.
  • Green or other coloured nails. These can be caused by a bacterial infection (the green type is usually caused by a bacterium called Pseudomonas aeruginosa), which grow under a nail that has partially separated from the nail bed.
  • Pitted nails.  These may be associated with psoriasis or other skin problems that affect the nail matrix, the area under the skin just behind the nail.
  • Swelling and redness of the skin around the nail is called paronychia. This is an infection of the skin at the bottom of the nail (cuticle). Sometimes this happens quite quickly, and is usually caused by an infection. If it happens over a longer period of time, it may be caused by chronic irritation of the nail, and this may lead to an infection too, as the nail and skin around it is more susceptible to infection if it is irritated over time.
  • Chronic nail trauma occurs from ill-fitting shoes and work boots, or sports which involve repeatedly starting and stopping, kicking, and long distance running. This trauma can cause permanent damage to the nail and matrix, which can mimic the appearance of fungal nails.

What should I do if my nails don’t look right?

See your Podiatrist or GP, who can help to work out why your nails don’t look right, and suggest possible treatment options for you.
What to Do If You Have Suffered a Sporting Injury

What to Do If You Have Suffered a Sporting Injury

Types of Foot Sporting Injuries and How We Can Help You Recover From Them

Sporting injury is a blanket term for anything concerning injuries that are experienced during or after playing any sport or exercise. They can occur at any time, whether running a marathon, playing a round of tennis, or even doing yoga. These injuries can happen because of an accident but more often than not, because of poor form, wrong equipment, overextending the body, and performing without warming up or conditioning the body for exercise. In other words, a huge percentage of being able to prevent a sporting injury is well within the control of the athlete or any person leading an active lifestyle.

What Are the Signs of an Injured Toe, Foot or Ankle?

  • Bruising, tenderness, swelling, or inflammation in the affected area
  • Arch or heel pain
  • Ingrown, discolored, or crumbling toenails
  • Calluses and bunions
  • Itching, stinging, or burning sensations on the soles of the feet or between the toes
  • Lower back pain
  • Shin, knee, and hip pain
  • Mild to severe foot/ankle pain
  • Instability and difficulty moving your foot or ankle
  • You heard a popping sound in the affected area during the injury

Sports Injury

What We Can Do to Help With Your Sporting Injuries

No matter the sport, we can all agree on one thing: almost all of it involves our feet. This is why when it comes to an active lifestyle, whether you’re an athlete or a person committed to doing regular exercise, podiatrists play a big role in maintaining your performance and preventing sporting injuries. Here are ways we can help you:

Diagnose and Treat Existing Symptoms and Problems

An injury is not always a cataclysmic event that instantaneously happens. More often, injuries can be traced from a simple problem such as a bunion or an ingrown toenail, which forces the body to compensate to mask the pain. We conduct a complete physical examination and interview our patient to identify possible injuries and to also check for certain conditions that may increase your risk for injuries. As part of this process, we may use our new Body-Tech machine, which uses a combination of a treadmill, pressure sensors, and slow motion video to analyse the way you walk or run, your stability and your posture. We then recommend the best treatment options based on the findings. Some treatment options include anti-inflammatory treatments, massages, physical therapy, orthotics, and recommending appropriate footwear and exercises to promote recovery and prevent future injuries. We also use a Thor Medical Laser to help treat injuries and speed up recovery and rehabilitation. Football Injury

We Go Beyond the Feet

Contrary to popular belief, podiatrists don’t just assess your feet. We understand the correlation between the body’s posture and alignment and the direct effect of these to one’s feet. Anything that’s not right on the body impacts the feet and vice versa. For example, we study how a runner’s form and how this impacts the feet. A wrong landing of the foot can lead to serious problems such as sprains. We evaluate such conditions and help you achieve the proper posture and alignment to prevent pain and injuries.

We Provide Preventive Maintenance

Aside from treating sports injuries, we help prevent future injuries and maximise performance by correcting existing problems and educating patients on the best exercises, therapies, and footwear for their activities.

Don’t Hesitate to Get in Touch and Find Relief

Think you may have sporting injuries or are prone to sustaining one? Schedule an appointment with us to get proper evaluation and care. Contact us today on (08) 9316 3010 for more information.
What Is a Gait and Pressure Analysis Treadmill?

What Is a Gait and Pressure Analysis Treadmill?

The Body-Tech Gait and Pressure Analysis Treadmill: A Better Method for Foot Health

We are very excited to announce that we are the first clinic in Western Australia to have a Body-Tech gait and pressure analysis treadmill! (as of July 2016)

What Is a Gait And Pressure Analysis Treadmill?

This is the latest in foot analysis technology, allowing us to look at your foot position, balance and stability when you are standing, walking or running. What Is a Gait and Pressure Analysis Treadmill Essentially, it allows us to scientifically and accurately make an assessment of your posture. It means that, as podiatrists, we can provide you with even better recommendations for treatment options, or to improve your day-to-day lifestyle or if you’re the sporty type, better performance or helping you minimise or recover from injuries.

Who Can it Help?

The treadmill is suitable for all ages and all walking/running abilities. But the people who will get the most benefit from it are:
  • Those who suffer from foot, ankle, leg and back pain
  • Athletes looking to improve their running technique
  • Those who feel unstable when they walk
  • People recovering and rehabilitating after injury or surgery
Using this technology, we are able to easily evaluate your:
  • Posture & balance – focusing on the ankles, knees, hips and back
  • Pressure under your feet in all phases of gait and running
  • Gait – video analysis of your movement and posture
  • Foot roll – assessing if your feet roll inwards or outwards
  • Need for prescription orthotics

Posture Analysis

Overview of How it Works

The machine gives us a lot of information about your gait, posture and balance. With pressure analysis, we look at pressure and variations in the amount and distribution of pressure through the bottom of your feet as you walk or run. This can indicate faulty biomechanics which can lead to injury, or areas of overloading which might lead to pain, corns and callouses. The video analysis allows our podiatrists to capture how your foot moves and functions when walking or running. We can even compare how your biomechanics change when wearing different footwear. This video assessment can be repeated to document your progress when recovering from an injury or foot surgery. (After all, you can’t improve what you can’t measure!).

Gait Analysis

Prevention Is the Best Medicine

Research tells us that, every year, at least one in three people over the age of 65 has a fall. And the number of sporting injuries that could have been easily prevented is countless. Every step you take requires your foot and ankle to adjust to the ground and any changes in terrain. The body – tech will allow us to assess your balance, and by strengthening and stretching your muscles, we can monitor your improvement. An assessment of your balance and stability can save you from long-term injuries caused by falls or sporting incidents. Make an appointment today with The Perth Foot & Ankle Clinic and prevent injuries and improve your lifestyle. Our new Body-tech treadmill will be used in our specialised bio-mechanical consultations and as part of our custom orthotic prescriptions. We want to see the sparkle in your eyes and the swing in your gait!
What Foot Problems Can Orthoses Treat

What Foot Problems Can Orthoses Treat

How Orthoses Help Treat Your Foot Problems

Foot orthoses (also known as functional orthoses or orthotics) are devices that fit into shoes under your feet in order to improve your foot function. They are used to treat pain from various sources, improve your foot function, gait and posture, and may prevent the progression or development of a number of foot and lower extremity conditions. They work by realigning joints, and making you walk, run, function and stand better than you do without them.

What Foot Problems Can Orthoses Treat?

There are a lot of problems that can be successfully treated with foot orthoses. These include:
  • Pain relief from many conditions, including plantar fasciitis, heel spur syndrome, achilles and other tendon problems, shin splints, flat feet, knee pain and back pain.
  • Rehabilitation after fractures, sprains and other injuries.
  • Preventing or halting deformities, such as bunions and hammer toes.
  • Treatment of problems in children, including flat feet, in-toed gait, Sever’s disease, Osgood-Schlatter’s disease and others.
  • Relief of everyday foot pain and foot fatigue in older people and those with arthritis.
  • Prevention of sporting injuries.

What’s the Process?

Your podiatrist will start with a thorough history and assessment of your problem, and will decide whether orthoses will be a suitable treatment option for you. If you proceed with orthotic therapy, you will have an assessment of the way you walk, and various tests of your muscles, joints and other tests as required. We may use specialised computer equipment as part of this process, such as dynamic plantar pressure assessment, which measures the pressure under different parts of your feet many times a second. Once your assessment is complete, your podiatrist will either take a 3D computer scan of your feet, or take a plaster cast of your feet. This is combined with a prescription from your podiatrist and is sent to an orthoses laboratory, where your orthoses will be made. We then see you to fit your new orthoses and then you go through a follow up program, during which we monitor you as you get used to them. Sometime during this period, we will make adjustments to your orthotics, or give you stretches and exercises, if required.

Custom-Made Foot Orthoses Versus Off-the-Shelf Insoles

You may have seen off-the-shelf insoles at the local pharmacist or advertised elsewhere. These may be helpful in some cases, and our podiatrists may sometimes use them for temporary problems or to aid in diagnosis. Custom made orthoses are precisely and scientifically designed for your feet and your problems, and are quite different to off-the-shelf insoles. As a comparison, think of custom orthoses as being like prescription eyeglasses, rather than using a generic pair of glasses from the pharmacist.