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Preventing Falls

Preventing Falls

Falls can occur anywhere and anytime but as you grow older you are more risk of falling down during day to day activities and are likely to injure yourself. There are number of reasons for falls in elderly patient’s. As you grow older your vision becomes impaired, your muscles can become weaker and joints stiffer, which can all lead to the risk of falling. Falls can also be a sign of side effects from medications, balance problems and short term illnesses. 

If you have had a fall in the past six months you have a higher likelihood of falling again. Moreover, other factors that can increase the risk of falling include: poor footwear, hazards in your home, poor lighting, chronic diseases and sensory and balances issues.

However, there are number things that you can do to help prevent falls. Here are a few tips to reduce the risk of falling. 

  • Good diet that provides all the vitamins and minerals that you need. 
  • Drink enough water to keep you hydrated
  • Exercise to strengthen muscles and joints
  • Wearing good shoes that are supportive and well fitting. 
  • Avoid walking in socks. 
  • Wearing well-fitting clothing, especially pants. 
  • Decluttering your house to prevent trip hazards (e.g. loose mats, objects in your path). 
  • Using aids to walk/installing grab rails in the bathroom. 
  • Using ramps and other mobility aids if required. 
  • Have good lighting in your house, especially at night time. 

Contact us today for foot problems.

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.



Photo courtesy: Consumer Reports

Gout is a type of inflammatory arthritis, often termed ‘the disease of kings’, caused by the deposition of uric acid (monosodium urate) crystals in tissues and typically the joint fluid. This occurs as a result of excessive production of uric acid by the body, or under-excretion of uric acid by the renal system.

Gout is characterised by four clinical phases: 

1. Phase I – involves the deposition of uric acid with no symptoms

2. Phase II – (further uric acid deposition) involves intermittent acute attacks of pain and inflammation which resolves spontaneously over a period of 7 – 10 days.

3. Phase III – The stage between acute gout attacks and persistent crystal accumulation.

4. Phase IV – If the excessive crystal deposits are not controlled, individuals can transition into phase IV of gout, which is characterised by chronic crystallisation involving numerous joint attacks and the deposition of crystals in joints as well as in soft tissues.

Risk factors:

Men are more likely to develop gout and a family history of gout also increases the risk of developing the disease.

Risk factors for gout includes:

  • Some drugs: e.g thiazide diuretics, cyclosporine, low-dose aspirin
  • Diet that mainly consist of meat, seafood and refined sugars/drinks or alcohol.
  • Other factors that are associated with gout include insulin resistance, metabolic syndrome, obesity, renal insufficiency, hypertension, organ transplantation and congestive heart failure.

Recurrent attacks or flares can also be induced by the use of recent diuretics, alcohol intake, surgery or trauma and recent hospitalisation; initial use of uric acid lowering drugs can also trigger gout attacks in the early periods, however reduce the risk of attacks in the long term.

Signs and Symptoms:

Clinical features of gout include spontaneous onset of intense pain, swelling and redness that most commonly affects the big toe joint (known as podagra). It can also affect other joints of the foot, ankle, mid-tarsal, wrist and knee.  Other problems that can cause similar symptoms include pseudogout, psoriatic arthritis and septic arthrtis.


The standard for the diagnosis of gout still remains removal of the joint fluid and evaluation to check for monosodium urate crystals under a microscope. As gout and septic arthritis can co-exist it is also essential to analyse the joint fluid for bacteria through culture. Radiographic imaging of the joints can show the changes due to a chronic history of gout. Sometimes, evidence of crystals in the joint may be seen, but not always. Recently, ultrasound, CT and MRI are also emerging techniques for the diagnosis of gout.


Treatment of gout can involve drug therapy as well as support and rehabilitation measures. Pharmacological management aims to treat acute gout attacks and also helps to maintain an appropriate level of uric acid in the blood in order to prevent recurrence. The British rheumatology guidelines prefer the use of NSAIDs at a high dosage (given no contraindications to its use) with a treatment period of 1-2 weeks. Therapy starts with high doses of anti-inflammatory medications for the first few days with a decrease in the dosage as the symptomatology subsides. For acute attacks of gout, another drug called colchicine is also used in addition to anti-inflammatory medicine.

Long-term management for gout consists of managing the urate levels and maintaining the concentration below a certain level. However, urate-lowering drug therapy is only indicated in patients who have experienced multiple gout attacks or chronic joint pathology and extensive crystal deposition.

Chronic gout can be painful and significantly reduce the mobility in the joint due to the crystal deposits, and the inflammation and damage caused by this. Orthotic therapy is often beneficial in order to increase the range of motion of particular joints and protect the foot from further deformity that can be caused by chronic gout.

Intoed Gait

Intoed Gait

Do you feel like one of your leg points inwards when you walk, and you often find yourself tripping over? Or do you observe that your child’s feet tends to turn inwards (or perhaps they are clumsy when playing with friends)? This condition is known as in-toeing. In-toeing commonly occurs due to four main factors that stem from either your hip, legs, feet or muscles: 1.    Thighs are turned inwards (femoral anteversion) 2.    Leg is turned inwards (internal tibial torsion) 3.    The front part of the foot turns towards the midline of the body (metatarsus adductus) 4.    Tight muscles in the legs Most children with intoed gait will outgrow it, so in most cases it is something so keep and eye on and manage, but does not usually lead to long term problems. Your Podiatrist will be able to assist you in determining where the in-toeing is stemming from and will be able to provide you with advice regarding non-surgical management of the condition (it is very rare to require surgical treatment). At home there is a few things you can do. If you are worried that your child maybe in-toeing, get them to perform a squat. Firstly, avoid sitting in a W-position but instead start sitting cross-legged to stretch out your hips. We also encourage that you take up activities that position your hips, leg and foot in an outwards position, including activities such as horse riding, ballet and swimming (breast stroke preferred). See your podiatrist today for assessment and further advice. At the Perth Foot & Ankle Clinic we can use our Bodytech gait analysis machine to assess intoed gait and monitor over time.
Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome

Tarsal tunnel syndrome is an unusual condition, where the main nerve in the foot becomes inflamed and entrapped between the structures in the foot. The tibial nerve supplies the skin and the muscles in the bottom of the foot and thus when it becomes entrapped it can cause pain in various locations on the foot. The pain (tingling, numbness or shooting pain) often radiates/moves up or down the leg and bottom of the heel and foot.

Tarsal tunnel syndrome can occur due to numerous factors including but not limited to: flat feet or fallen arches, ankle sprain/ankle swelling, arthritis, diabetes, swollen tendons, ganglion cyst, bone spurs and varicose veins. Diagnosis of this condition, requires thorough clinical testing of all structures of your foot by a Podiatrist. Imaging, including x-rays and ultrasounds do not show nerve entrapment, thus thorough clinical testing is even more important.

Some conservative or non-surgical treatment includes:
1.    Injection therapy with local anesthesia for pain relief and also for diagnosis
2.    Cortisone injection can also be beneficial if there is an inflammatory component associated with the entrapment.
3.    Oral anti-inflammatory medications
4.    Orthotic devices to assist with your foot shape and biomechanics to reduce/prevent the entrapment of the nerve between the different structures in your foot.
5.    Lignocaine patches
6.    Supportive footwear
7.    Taping
8.    Mobilization/manipulation

When is surgery required? Surgery is required if the pain is severe and all other conservative treatment options have failed. A Podiatric surgeon will we able to determine if surgery is necessary and what procedure would be most appropriate for your condition.

Rheumatoid Arthritis and your Feet

Rheumatoid Arthritis and your Feet

What is rheumatoid arthritis and how does it affect your feet?

Rheumatoid arthritis (RA) is a condition where your own antibodies mistakenly attack your healthy tissue, joints, and organs. This is a long-term condition that causes pain, swelling, loss of function, and stiffness of the joints.

In your feet, RA mainly affects the joints, which are specifically designed to absorb shock and ensure efficient movement between bones. When your antibodies attack your own healthy tissues, it causes inflammation. This inflammation in turn results in bone and joint damage, reduced range of motion, joint damage, and deformity. You can also get lumps under your skin called, rheumatoid nodules.

RA affects different people to a different extent, with some people having relatively few problems, and some having more severe cases. It is more common in older people and women, but can affect anyone at any age. It can flare up and settle down at different times.

Rheumatoid vs Osteoarthritis

Rheumatoid arthritis is an inflammatory disease that actively attacks your own healthy tissue. In comparison to this osteoarthritis is a non-inflammatory joint disease, which is caused by wear-and-tear, injury or damage resulting from longer term functional problems with the way you move.

Symptoms of Rheumatoid Arthritis

  • Fatigue
  • Joint pain
  • Joint warmth
  • Reduced joint range of motion
  • Limping
  • Joint deformity
  • Joint stiffness
  • Fever
  • Anaemia
  • Loss of energy

What can you do?

When there is flare of pain and inflammation of the joints it is recommended that you rest joints, however, when the inflammation decreases gentle exercises such as slow walking, yoga, tai chi, and water walking is advised to reduce joint immobility and stiffening.

How can your podiatrist help?

Podiatrists can help in lots of ways for those with rheumatoid arthritis.

  • Footwear advice
  • Suggestions for exercise/stretching
  • Orthotics to relieve pain, keep you mobile and help you to walk better
  • Laser therapy
  • Surgical correction of deformities and rheumatoid nodules.

If you have rheumatoid arthritis, come in and see us to see how we can help.