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Tips for Accurate Foot and Ankle Diagnoses

Tips for Accurate Foot and Ankle Diagnoses

Avoiding Internet Misdiagnoses of Foot and Ankle Ailments

a doctor examining his patient's footA lot of things can go wrong with feet. Thankfully, in most cases we can do something to prevent problems, and help to fix them if they occur. At the Perth Foot & Ankle Clinic, we have some information about a variety of foot problems listed on our Foot Conditions page.

There is some very useful information available on the internet, but please allow us to make a couple of suggestions before you get information online (or anywhere else).

If you have no formal training in medical or related matters, please be careful when evaluating information from academic (or indeed, any) sources. We suggest this because it is easy—especially when reading one or two references—to form a misguided opinion about a particular condition.

For example, we had an internet query regarding a thing called “Hemihypertrophy.” This condition is very rare, and can occur either by itself or in conjunction with various other problems—including a certain kind of tumour. It turned out the person with Hemihypertrophy seemed to have it in isolation with no additional problems, but (of course), the parents were anxious about the possibility of their child developing a tumour.

You really need to take advice from the person who made the diagnosis in this situation, or feel free to get a second opinion on the matter. In particular, we feel that it is never appropriate or, in many cases, even possible, to make a diagnosis over the internet. You really need to see an appropriately-qualified real person to discuss your case.

The bottom line is this: the internet can provide you with a lot of information: some of it may be true; some may be false; some may be presented out of context; or not relevant at all, in your case.

If you still have queries after reading all this, then please feel free to contact us directly, at [email protected].

Foot and Ankle Care and Balance Tips to Reduce Fall Risks

Foot and Ankle Care and Balance Tips to Reduce Fall Risks

“I seem to be more prone to accidental falls.”

Twisted AnkleAging increases the risk of accidental falls. Falls and loss of balance can stem from degeneration of bones and muscles, which leads to compromised joint mobility. Other factors such as visual impairment and illnesses such as diabetes, hypertension and gout may further increase one’s risk for falls.

What are the signs you have a balance problem and increased fall risk?

•           Sensations of falling or floating

•           Dizziness

•           Clumsiness or repeated falls

•           Staggering when walking

Usually, the problem with balance and falls are misconstrued as eye problems as the patients are not able to see where they are going. High blood or low blood pressure with dizziness may also contribute to loss of balance.

How Perth Foot and Ankle Clinic Can Help You

Gait And Pressure Analysis Andrew SchoxWe will undertake a series of steps to help you reduce the incidences of falls and balance issues, and identify the cause and severity of balance and falling problems. We will be asking you about your symptoms to determine whether the imbalance is due to age-related muscular or joint issues or other medical conditions. We will examine:

•           Your feet and ankles

•           The way you walk

•           Your balance and stability

•           Your posture

Our Body-Tech machine allows us to analyse and understand the way that you walk and your balance in detail. This machine uses a unique combination of a treadmill, pressure sensors and slow motion cameras.

One of the initial tests we may perform is the “Get Up and Go” test. This test checks the ability of the patient to stand up from a sitting position, walk and go back to the same sitting position after three meters. The test is assessed from a scale of one to five, with one being normal and five being severe.

Another test we can do is the Tinetti Balance and Gait Test. This 16-item test checks the balance of the patient from walking to turning and the maintenance of their balance capability, even with eyes closed. We can use the results of this test to predict your risk of having a fall.

Recommend Solutions to Reduce The Risk Of Falls

Based on our findings, we will recommend the most appropriate intervention to improve your balance and cut your risk of falling. We can recommend supportive footwear, custom orthotics, and foot and ankle exercises, as well as surgery, if necessary.

We then focus on working on the source of foot pain if there is any. This can be from foot deformities on the toes of the patient and puts their balance off greatly. We also treat calluses or bunions to help the patient deal with pain emanating from the foot.

We also recommend you see your medical practitioner in case there are other medical reasons for your balance problems.

Speak to Us Today and Find Out More

If you feel you have a problem with balance, schedule an appointment with us to receive evaluation and proper intervention. Don’t wait for accidents to happen to get treatment.

Should “RICE” be replaced with “MEAT”?

Should “RICE” be replaced with “MEAT”?

Most people are familiar with the RICE (Rest, Ice, Compression and Elevation) principle for treating sports injuries. It is widely advocated and commonly used for the treatment of acute injuries such as ankle sprains. However some of the medical community are moving away from this principle as it is now thought that this protocol may delay recovery from tendon/ligament injuries. Tendons and ligaments are naturally avascular structures meaning that they have poor blood supply in comparison muscle fibres. Further reducing blood and nutrient supply with the use of the RICE principle may cause delayed healing. Should RICE be replaced with MEAT The doctor who invented the RICE treatment protocol in the 1970s has now stated that the use of ice and rest may delay healing and has recanted its use.
  • Rest (no movement): Movement is required to promote lymphatic drainage (drainage of fluid and waste products) and bring fresh oxygenated blood flow and nutrients to the injured tissue.
  • Ice: There is also a lack of evidence for the use of ice or cryotherapy for soft tissue injuries and Bleakley et al (2004) found that it may delay or slow healing by decreasing the metabolic rate.
Researchers tested whether applications of ice were helpful in recovery after strength training. When the tissue is cooled through icing, peripheral blood flow can be reduced. After the ice is removed, the blood perfusion may then return but the blood vessels may not open for many hours after the ice application. This research found that these fluctuations can cause the tissue to die due to lack of blood flow. It can also lead to temporary or permanent nerve damage.Therefore, ice application does not boost recovery after exercise and can instead cause tissue and nerve damage. Tseng et al (2013) found that topical cooling significantly increased the levels of muscle damage markers in elite athletes as well as causing muscle fatigue. The new injury protocol mnemonic that some practitioners are now in favour of is MEAT. Meat stands for:
  • Movement: It is thought that early movement stimulates healing, promotes nicely aligned collagen fibres and leads to faster recovery times. Kerkhoffs et al (2002) Cochrane review showed that patients improved quicker and had a faster return to activities with functional treatments versus their immobilised counterparts.
  • Exercise: The reasons behind this are the same for movement but establishing an exercise program after the acute injury is important to prevent long term joint instability and improve functional outcomes.
  • Analgesia: Is the use of pain relieving drugs that do not cause delay in healing. Some medications such as NSAIDs have been show to delay or inhibit healing. Acetaminophen can help with pain relief but not block the inflammatory cascade/process, although it does come with risk factors (liver toxicity). Natural pain relieving treatments such as acupuncture/dry needling and low level laser therapy have shown to be very effective at providing pain relief.
  • Treatment: Treatment includes any form of manual or electro-therapy modalities such as myofascial release, ultrasound, low level laser therapy, acupuncture/dry needling and mobilisations. These all promote blood flow, tissue healing and pain relief.
The RICE/ICE principle should still generally be used for acute muscle injuries as there is risk of developing compartment syndrome. Ligaments and tendons are not at risk of developing this pathology. There are elements of both protocols that are beneficial – e.g. compression from the RICE principle is beneficial for lymphatic drainage and reducing oedema but without immobilising the joint. It is important to consider the type of injury and the symptoms that the patient presents with before implementing a treatment plan.


Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sport Med. 2004; 32:251–261. Kerkhoffs GMMJ, Rowe BH, Assendelft WJJ, Kelly KD, Struijs PAA, van Dijk CN. Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults. Cochrane Database of Systematic Reviews 2002, Issue 3. Malone T, Engelhardt D, Kirkpatrick J, Bassett F. Nerve injury in athletes caused by cryotherapy. J Athl Train. 1992; 27(3): 235–237. Tseng CY, Lee JP, Tsai YS, Lee SD, Kao CL, Liu TC, Lai C, Harris MB, Kuo CH. Topical cooling (icing) delays recovery from eccentric exercise-induced muscle damage. J Strength Cond Res. 2013;27(5):1354-61. doi: 10.1519/JSC.0b013e318267a22c
Why Do My Feet Hurt In The Morning?

Why Do My Feet Hurt In The Morning?

Do you hobble around when you get up in the morning (or after sitting down for a while), and then after a few minutes start to feel a lot better?

This sort of pain frequently occurs under the heels, but can be in the back of the ankle, under the front of the foot, or the whole foot can be sore.

The fancy term for this problem is post static dyskinesia. What that means is that your sore feet make it difficult to walk properly.

There are two theories why your feet hurt in this way:

  • When you rest, some tissues in the foot contract slightly, so when you get up again, the pulling causes pain until things loosen off again
  • When using your feet they are being overused or injured in some way. Then when you rest, the injured areas become inflamed, which is the body’s way of trying to repair the injury. The swelling around the injured area is painful when you first walk on it, but this soon dissipates with activity.

What can be done about this?

See your podiatrist, who will determine a diagnosis of this pain and suggest treatment options.

Common ways to help with this pain quickly:

  • Stretching or exercises to help the tight tissues and get muscles working properly
  • Elevating your foot and applying an ice pack over the sore area in the evening or after lots of activity

The long term solution is to work with your podiatrist to fix the underlying cause of the pain so that you can get long term relief.

Women’s Health Week – Women’s Foot Health

Women’s Health Week – Women’s Foot Health

This week is Women’s Health Week. Women tend to suffer from more foot complaints than men. This is often attributed to footwear, in particular high heels (and with good reason!) but other factors can be at play too.

WomensFeetBunions are significantly more common in females compared to males, affecting about 30% of females and are more likely to occur with age. Other common conditions we see in women are neuromas (related to an irritated nerve in the ball of the foot), corns and callouses.

Footwear alone isn’t necessarily the cause of bunions, but they can certainly aggravate them and cause pain. High heeled and narrow shoes can also exacerbate neuromas and make you more likely to get those pesky, painful corns and callous.

Did you know that shoes with a one inch heel increases the load on your forefoot by approximately 22% and a three inch heel can increase the load by a huge 75%? Appropriate footwear is not only essential for keeping feet pain free, but also reducing the occurrence of corns and callouses, as well as helping with stability and making falls less likely.

Feet of WomenWomen are now exercising into their older years, and participating in more high impact and contact sports, which means that they are prone to overuse and impact injuries.

Women are also more prone to osteoporosis (loss of bony mass) and developing stress fractures and fractures from traumatic events. Appropriate weight-bearing exercise can help prevent this.

Your podiatrist can help not only with diagnosis of any injuries or pain in your feet, but also implement an appropriate management program. If your feet are causing you pain or concern, we can help with our team of skilled practitioners.