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When the Wrong Running Shoe is a Problem

When the Wrong Running Shoe is a Problem

Running shoes

This middle aged gent presented to the clinic after visiting two other podiatrists and yet was still plagued with foot pain.

He is a fit and healthy man with no prior foot or ankle injuries. He has been training for the last 6 months for a local marathon. He developed right lateral foot pain approximately six weeks ago. There was no proceeding injury or ankle sprain. It became progressively sorer the more he continued to train. He sought treatment with a podiatrist who recommended custom orthotics. This made the pain worse. He tried them for several weeks and the pain persisted. The advice from the second therapist was to continue with the orthotics and stop running. He ceased running but the pain returned once he went back to running.

By this point this gent was quite exasperated about the pending race and he was still plagued by foot pain. My examination of his foot revealed very little. There was no pain on palpation of any bone or joint or soft tissue. There was no pain on passive or resisted movement of the foot and ankle. There was no swelling or bruising. Medical history was unremarkable. The patient pointed to the area of the dorsal cuboid area and described the pain as a deep aching pain. He had no pain in the foot during the day at the office.

Upon further questioning it was revealed that he had purchased new shoes two weeks before the pain started. He describes his old pair of shoes as being ‘cheap and old’ department store running shoes and decided to treat himself to better shoes. Looking that the shoes they were evidently a stability or anti-pronatory type shoe. A quick gait assessment showed that this gent has a fairly ‘neutral foot type’ with bilateral lateral ankle instability.

The immediate thought was he was experiencing lateral column overload from the anti-pronatory shoes. He did not bring in his orthotics for assessment but it is not difficult to surmise that these were likely contributing to the lateral foot overload. There was not a significant amount of over-correction present in the shoes but it was enough to be causing pathological loading changes in the foot.

I suggested he go and change his footwear back to a neutral runner with an even medial and lateral sole. I was pleased to have a phone call to say that all his pain had ceased and he was back to training full steam.

It is important to note that sometimes footwear can play a big role in contributing to injury and conversely reducing the risk of injury. If you suspect your shoes are contributing to your pain or need a footwear review we can assist and give advice on what sports shoes you should be looking for in future.

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.

Wart is this on my foot? – Verruca Pedis

Wart is this on my foot? – Verruca Pedis

foot wart

Plantar warts, medically termed verruca pedis, are painful, solid and thickened lesions that are caused by the Human Papilloma Virus (HPV). If the wart is located on the bottom of the foot, warts can be extremely painful and it can sometimes significantly affect a person’s quality of life.

Warts can be contracted or transmitted when an individual comes into direct contact with the virus when the outer layer of the skin becomes damaged. Sometimes, these warts can resemble calluses or corns. This is because, its location on the plantar aspect of the foot subjects the lesion to increased pressure and forces. Hence, it is necessary to seek professional assistance in order to determine the correct diagnosis and thus the correct treatment option for the lesion. Typically, warts can resolve on their own, it usually takes from a few months to 2 years to completely disappear. Often the pain can be unbearable for some (because of its location on the sole of the foot), in which case other treatment options may be required.

Treatment for plantar warts:

  • If the wart isn’t bothering you, you can simply wait for resolution
  • Topical acids for plantar warts
  • Cryotherapy for plantar warts (this can be slightly painful)
  • Laser plantar wart removal
  • Wart surgery/curettage

Advice we give regarding warts:

  • Make sure you don’t pick at or scratch your warts
  • Cover the wart with medical tape to prevent spreading
  • Avoid sharing articles of clothing that have come into contact with the lesion
  • You can use a small corn pad (which fits the wart’s diameter) to offload the area.

Do I need surgery for my wart?

Wart surgery (curettage) is required if the wart is persistent, has been present for several years, is not responding to other treatment, is extremely painful or you require quick plantar wart removal. At the Perth Foot and Ankle Clinic we can perform the surgery here at our clinic in our operating room. The surgery typically involves numbing the area with local anaesthetic, after which one of our Podiatrists will remove the wart in a sterile manner; we also use a small amount of chemical to destroy any remaining wart tissue to reduce the risk of recurrence. Speak to one of Podiatrists if you require further information.

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.