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Ankle-foot Orthosis (AFO)

Ankle-foot Orthosis (AFO)

Photo credit: AliMed

Solid AFOs

Ankle-foot orthosis (AFO) are braces for the lower leg and foot that are often prescribed to patients with gait abnormalities. They are lightweight plastic braces composed of a plastic material that can be secured to the calf with the use of a strap; this strap also runs along and under the foot. The foot itself sits in a comfortable, accommodative shoe, AFOs possess a characteristic L-shape, which in effect assists by holding the foot and ankle in the appropriate position when performing certain tasks. Individuals suffering from disorders that severely affect muscular function, i.e. stroke, spinal cord injuries, cerebral palsy and polio patients have a greater need for such devices in order to remedy irregularities that may occur in movement, especially during gait. AFOs can work in two ways: either correctly positioning a limb with contracted musculature in the normal position or supporting wasting or weak limbs.

Articulated/hinged AFOs

Articulated or hinged AFOs are made up of two separate components that are not continuous with each other but instead “articulate” with one another with a hinge mechanism. While the components themselves are composed of plastic, the joints/hinge are usually made with metal or other composite materials. The hinged moment present in these AFOs allows unrestricted and free movement of the ankle joint. These AFOs are often prescribed to reduce the rigidity in movement so that patients can perform daily tasks (e.g. walking up the stairs or rising from a chair).

Richie braces

A Richie brace is a custom ankle brace that is made after taking a cast of the patient’s ankle and foot. This type of brace is used to treat chronic conditions of the foot and ankle where the muscles are not working effectively or there are structural problems. It can be used for a number of conditions including drop-foot, ankle injuries, severe flat foot, and tendon damage. It is a lightweight design that is preferred by patients who are very active. It comes with leg uprights for maximum support, and as it is custom-made it perfectly fits the ankle joint axis of the patient’s foot. Moreover, it has an orthotic base that is also specifically moulded to your foot. As with all AFOs they do need to have good quality shoes that they can fit into – shoes with an adjustable strap, wide heel cup, and stable back and base are preferred. This brace provides a wonderful non-surgical option to complex pathologies of the leg, foot, and ankle.

Overall, the ankle foot orthosis is an efficient therapy for weakness in the lower extremity musculature and can effectively help weak muscle groups in the leg. A thorough assessment is necessary to ensure that the AFO chosen successfully remedies the given condition. Our team at the Perth Foot & Ankle Clinic are experienced in the use of AFOs and Richie braces. 

Köhler’s Disease

Köhler’s Disease

Photo credit: Fixmyfeet.co.za

Köhler’s disease is a condition that impacts a bone on the inner arch of the foot. This bone is called the navicular. This relatively rare disorder of the foot typically affects males more than females and occurs between the ages of 2 and 10 years of age with a peak occurs during the ages of 3 to 7 years. It is not fully understood why this condition occurs. Some researchers suggest that it is caused by excessive strain on the navicular bone, while others believe that it is caused by injury/trauma to the area. As a result of this, the blood supply to the bone get compromised as the child is growing. This leads to loss of blood flow (ischaemia) to navicular resulting in progressive degeneration of the bone. If not treated promptly, the bone can become permanently deformed. The signs and symptoms of Köhler’s disease can differ, but they generally include:
  • Redness around the inside of the foot, near your arch
  • A swollen foot
  • Tenderness/pain along the inside of the arch
  • Pain worse if putting pressure on the affected foot
This is an uncommon condition that warrants proper diagnosis, care and management. Generally, it does resolve on its own. It is important not to aggravate the condition as it can lead to complications later on in life. If the condition is very severe (as determined by X-ray/CT scans) then a fibreglass cast or moon boot may be required in addition to other treatment options. See our Podiatrists here for more information regarding this condition.
Arthritis of the Foot and Ankle

Arthritis of the Foot and Ankle

Arthritis is term to describe a range of conditions that affect the joint in your body. Arthritis can occur in one joint or it can occur in many joints. Moreover, it can affect the big joints of the body such as the knee or it can affect the small joints such as in the foot. Arthritis is often classified into two basic categories, which are inflammatory and non-inflammatory arthritis. As arthritis can affect the foot and ankle, it can often lead to difficulty walking and conducting various activities overall reducing your quality of life. Types of Arthritis
  Osteoarthritis Rheumatoid Post-traumatic Gout
  • Degenerative wear and tear.
  • Usually affects 1 joint initially.
  • Damages the cartillage causing bone rubbing on bone.
  • Autoimmune disease where our antibodies attack the synovium (thin lining around the joints).
  • Cause damage to the bone, cartillage, ligaments and tendons.
  • Arthritis occuring following injury to the area. Such as dislocation and fractures.
  • Wear and tear of the cartilage over time.
    • Deposition of monosodium urate crystals due breakdown of a substance called Purine, which is naturally found in the body.
Risk Factors
  • Obesity
  • Age
  • Family history
  • Diabetes
  • Genetics
  • Infection
  • Family history
  • Smoking
  • Obesity
  • Trauma, fractures, dislocation
  • Diet
  • Obesity
  • Certain medications (diurectics, low dose aspirin)
  • Family history
  • Trauma
  • Painful joints.
  • Slow developing.
  • Stiffness of the joints.
  • Asymetrical joints affected.
  • Restricted motion
  • Painful joints
  • Significant deformity
  • Symmetrical joints affected
  • Heat and swelling present around the joints.
  • Restricted motion.
  • Painful joints
  • Restricted motion
  • Stiffness in the joints
  • Intense pain of the joint
  • Redness
  • Swelling
  • Restricted motion

Imaging and tests for Arthritis

X-rays can provide information about your bones and the alignment of the bones. If arthritis is present, X-rays may show joint space narrowing, fractures, osteophyte formation and changes in the alignment of the joints.

Blood tests can show any inflammatory markers that can help diagnosis between different types of arthritis.

Other types of medical imaging, such as bone scans, CT scans and MRI imaging can be used to determine more details about bone and joint changes.

Treatment for Arthritis 

Arthritis cannot be cured but there are treatment options to help relieve pain and discomfort, as well as to improve mobility

Conservative treatment for arthritis includes:

  • The use of medications to reduce the inflammation and/or pain in the joints.
  • Medicines that specifically target inflammatory arthritis can slow down or in some cases, halt the progression of the condition.
  • Reducing or modifying activities that aggravate the condition and your discomfort
  • Performing non-weight bearing exercises such as swimming or cycling to increase strength and support your joints, as well as increasing range of motion.
  • Losing weight and maintaining a good diet.
  • Orthotics to assist with the pain, deformity and functional problems related to the joints
  • Other assistive devices such as braces and ankle foot orthoses

Surgical treatment:

If arthritis leads to significant disability then surgical options can be considered. The surgical treatment is dependent on the arthritis and the location of the disability. Your podiatric surgeon can explain your options.

What can I do for a Bunion?

What can I do for a Bunion?

What is a bunion?

Bunions are a lump at the big toe joint, they are a very common problem affecting women more than men. All bunions are different, some bunions can be extremely painful, make footwear difficult to fit and reduce your balance. There is a strong genetic link, so if a family member has a bunion, you may develop one also. How you walk and the footwear you choose may also contribute to the development of a bunion.

What does a bunion look like?

  • A bony bump on the side of your forefoot, at the base of your big toe 
  • Pain at this joint – the discomfort may come and go, it can feel painful, achy, stiff, tingling or burning.
  • Swelling around the joint and redness from footwear rubbing
  • Hard skin on the side of the big toe
  • Overlapping or pushing against the 2nd toe


What can I do to treat my bunion?

While you can often live with bunions, they can be painful, uncomfortable and unsightly. If your bunion is affecting your daily activities or sport, then there are conservative treatment options to help manage your bunion.

  • Changing your shoes to something with more room for your toes
  • Padding, taping or splinting your foot
  • Using shoe inserts (orthotics), to relieve the discomfort caused by a bunion.
  • Doing foot exercises and stretches to reduce and relieve pain.
  • Toe wedge to separate your 1st and 2nd toes


Do I need bunion surgery?

If you have explored your conservative treatment options then surgery is recommended for correcting the bunion deformity permanently. The operation involves realigning the big toe joint and soft tissue, then securing the bone with a screw/k-wire. You need to be prepared to rest and recuperate, but there is usually minimal discomfort and you can walk straight away in a postoperative shoe. The outcome of the surgery is a functioning big toe joint, with improved stability and appearance.

what is a bunion credit tread labs

What is a Ganglion?

What is a Ganglion?

Ganglion Cyst on Foot by Wikipedia

A Ganglion is a harmless fluid filled sac, which commonly appears on the wrist, hand, ankle or foot. The fluid inside a ganglion may have leaked from a nearby joint or it may be the result of a weakness or bulging in the sheath that surrounds tendons. You can feel the fluid move around inside the sac. Sometimes they occur after an injury, but often there is no known cause.

Ganglions can be painful, but lots don’t cause any problems. The swelling can slowly increase, or they can appear quickly out of nowhere. Sometimes a ganglion will disappear on its own without any treatment, but also they can reappear later on!

Although ganglions are mostly harmless it is still best to get them checked by your podiatrist or doctor. An ultrasound investigation will usually be ordered to confirm the ganglion and its size. There are three treatment options:


    • Monitor – ganglions can disappear without any treatment. If you are lucky, your ganglion will disappear on its own!


    • Aspiration – This involves removing the liquid from the ganglion by using a needle to draw out the fluid. A steroid is often injected after this and the area strapped or splinted. This can be repeated if the fluid returns.


    • Surgery – Ganglions can be surgically removed. Surgery is usually performed when the ganglion is painful or is interfering with movement.


Aging Skin

Aging Skin

Skin will change in appearance as people get older. Aging skin is normally more noticeable on the face and hands. Spending long periods outdoors and having fair skin can result in premature aging of the skin.

Smoking increases your risk of damaging the skin quality, narrowed blood vessels reduce the amount of oxygen and nutrients reaching the skin cells.

skin agingNormal skin changes with aging

  • Thinning of the skin
  • Lines and wrinkles
  • Less resilience to shearing forces and more prone to injury
  • Thinning hair
  • Nails grow slower
  • Reduced blood supply
  • Reduced fat stores – particularly the hands and feet
  • Skin is dry
  • Uneven skin pigmentation – freckles, moles, skin cancer

Preventing or Reducing your skin from aging

  • Sun protection at all ages (sunscreen, hat, long sleeves)
  • Reduce outdoor activities during the middle of the day
  • Do not smoke
  • Avoid exposure to pollutants where possible
  • Exercise regularly
  • Eat a balanced diet including fruit and vegetables

The skin on your feet as they get older

The skin on your feet is like the skin elsewhere on your body, except that you walk on it (so there’s extra pressure) and we wear shoes for much of the time. Follow these tips for looking after the skin on your feet:

  • Wear shoes that fit properly and are fit for purpose (for example, don’t go jogging in dress shoes!).
  • Use socks made of natural materials, such as cotton or wool.
  • Use a moisturiser regularly on your skin, including your feet.
  • See your podiatrist if:
    • your nails are thick, long or you can’t look after them, see your podiatrist for regular treatment.
    • you have thick skin, callouses or corns
    • Your skin looks or feels abnormal. There are often simple treatments available which can help (for example, treatment for fungal skin infections).

There are many conditions which can affect your skin. Consult a health professional if you have any queries or notice anything unusual with your skin.