Achilles tendonitis is an overuse injury that causes pain along the back of the leg near the heel. The pain associated with Achilles Tendinitis typically begins as a mild ache in the back of the leg or above the heel after daily, running or other sports activities.
A bunion or hallux valgus is defined as a deviation away from the midline of the great toe. More commonly described as a bump on the big toe joint, a bunion is caused by a pronated (flat) foot and an excessively flexible great toe joint. When these two conditions exist, the big toe will be called upon to absorb a tremendous amount of weight as the foot pushes away from the ground during walking. Eventually, this forces the toe to deviate or bend towards the baby toe.
Also known as “runner’s knee”, chondromalacia patella is the wear-and-tear on the cartilage of the back of the kneecap caused by abnormal motion of the kneecap. Symptoms include swelling and inflammation of the knee and acute pain radiating from the top of the kneecap. Stiffness can occur after prolonged sitting, and pain can be intense when going up or down stairs.
Short term treatments of regular icing and ultrasound/laser may help to reduce the discomfort, however, other remedies are needed to prevent further problems. A program of stretching and strengthening (especially the quadriceps muscles) can be prescribed. If a biomechanical fault is to blame, then your chiropodist will prescribe you orthotics and a well fitting pair of shoes. As well, a person’s exercise habits should be reviewed and possibly adjusted: hill running, banked tracks, and uneven surfaces may have been contributors.Back to the top
Corn, or heloma, is a buildup of dead skin on the side or on the top of the toe. Corns are usually caused by a contraction or compression of the toes. The toe may have been bent by a biomechanical foot fault, or because of improperly fitting shoes. Corns that occur between toes are called soft or wet corns. Corns can also occur on the bottom of the foot, usually on weight bearing areas.
Since a corn is sometimes caused by undue pressure on the toe joint from ill-fitting shoes, deep shoes will provide more space for the toes and will decrease the amount of pressure and rubbing on these painful areas. Your Chiropodist will painlessly remove the corn / callous formation and prescribe a proper home treatment program of proper shoes, pumice and appropriate cream. Corns are often on ongoing problem that may need to be treated on a regular basis.Back to the top
Foot care is important for everyone, but for the person with diabetes, it is essential. Diabetes affects the nervous system and circulation. It slows the natural healing process, and increases the risk of infection, so that minor injuries may quickly become serious.
The feet are often the first part of the body to be affected by this disease, but serious problems can be prevented by paying careful attention to your feet on a daily basis. Poor foot care can lead to serious problems, and even amputation.
Foot problems are common in people with diabetes. This is why you need to check your feet for cuts, abrasions and signs of irritation everyday and to protect them with proper footwear. When you do not protect your feet properly, infections can develop from minor injuries.
Diabetes can damage nerves in the feet making them less sensitive to pain. This means that you may not feel a minor cut or abrasion until severe infection develops.
Diabetes can cause reduced circulation. This is a problem since proper blood flow is necessary for healing injuries.
Elevated blood glucose can interfere with the body’s ability to fight infection from cuts and abrasions. It also hampers the healing process. You can reduce your risk of infection by keeping your blood glucose under control.
Your Chiropodist will teach you how diabetes affects your feet, and will set up a foot care program for you. Most people with diabetes can care for their own feet. However diabetics with diminished eyesight and neuropathy(loss of sensation) should be seen on a regular basis for evaluation and foot care. To properly care for your feet, you should do the following each day:
Wash your feet with mild soap and lukewarm water. Always check the water temperature with your elbow or another part of your body where sensation is good before putting your feet in.
Never soak your feet for longer than 5 minutes. This dries the skin and makes it more prone to cracking and infection.
Use a soft washcloth to clean your feet thoroughly and get all the soap off.
Use a soft towel to dry your feet, especially between your toes. Never dry or warm your feet by putting them on or near a radiator or heater.
Inspect your heels and the tops and bottoms of your feet for skin irritations or breakdown. Look for sores, cuts, blisters, cracks between the toes and blue, purple or white spots. Be sure your feet feel warm and that there are not any red “hot” spots or swelling. As well, check for irritation or scaling between the toes. If you cannot see the bottoms of your feet, use a mirror. If you are unable to examine your feet yourself, have someone do it for you. Notify your Chiropodist immediately if anything looks unusual.
Apply a water-soluble moisturizing cream to keep your skin soft. This is especially important to dry and calloused skin. Never use cream between your toes or on open sores. Do not use perfumed lotions that contain alcohol.
Gently and gradually rub down corns, callouses and other hard skin with a pumice stone or emery board. This is most effective after a bath or shower.
See your Chiropodist if you cannot examine your feet adequately, have reduced sensation, or if you have poor circulation. Have your Chiropodist remove corns or callouses if they are a problem, never remove them yourself. Also over-the-counter corn and callous remedies contain acid and could burn your skin.
Cut your nails after a bath when they are soft.
To avoid cutting the skin around the toe, trim toenails straight across using nail clippers, or file with an emery board. Do not use scissors.
Carefully file sharp toenails edges to prevent them from cutting into adjacent skin.
If it is difficult to trim your own nails, or if you have reduced sensation or poor circulation, schedule an appointment with your Chiropodist.
Wearing proper footwear is essential in preventing and healing foot ailments. Diabetics and high-risk patients should schedule a footwear education appointment with their Chiropodist. It is also advisable to bring along footwear that you are presently wearing. Sometimes special insoles are made to go into your shoes to make you comfortable and prevent problems.
An infection may be present if you see any combination of these Symptoms:
You may not feel any pain in this area due to the loss of sensation. The first thing you should do is call your Chiropodist. If it is after office hours, call your doctor’s emergency number.
For a minor infection, your Chiropodist will clean the infection and may give you antibiotics to keep the infection from spreading and help heal it. You will need to dress your wound at least once per day. Your Chiropodist will want to see you for follow-up visits to be sure the infection is healing properly.
Prompt detection of an infection in its earliest stages will help to avoid a possible hospital stay. In addition to diabetes, the following conditions are also at risk for severe foot problems and should be seen regularly by a Chiropodist
A Chiropodist can detect a fungal infection early, culture the nail, determine the cause, and form a suitable treatment plan. This may include prescribing topical medication, and debridement (removal of diseased nail matter and debris) of an infected nail. Indeed, debridement is the preferred procedure.
Newer oral antifungals approved by Health Canada may be an effective treatment. They offer a shorter treatment time (3 to 4 months) however current studies show there are many unwanted side effects.
In some cases, surgical treatment may be required. Temporary removal of the infected nail can be performed to permit direct application of a topical antifungal. Permanent removal of a chronically painful nail, which has not responded to any other treatment, permits the fungal infection to be cured, and prevents the return of a deformed nail.
Trying to solve the infection without the qualified help of a Chiropodist can lead to more problems. With new technological advances in combination with simple preventative measures, the treatment of this health problem can often be successful.
Not all shoes are created equal! Everyone’s feet are different. By using specific lacing techniques you can improve the fit of your shoes and help solve some very common problems.
Heel slippage occurs when a narrow heel is in a wide shoe. To keep the heel secure, criss-cross the laces by the conventional method until you get to the second last eyelet. Create a loop by pulling the lace through the last eyelet without crossing over. Use this loop as an eyelet for your last criss-cross and tie.
Tender Toes are often associated with high mileage runners. To alleviate pressure on the toenails and to give the toes more room in the toebox, take the lace on one side and go through each eyelet, with the other end of the lace, run it from the inside front eyelet of the opposite last eyelet.
This can occur when the conventional method of crisis-cross and tie lacing adds extra pressure to a high arch or rigid foot. Redistribute the pressure more evenly on top of the foot by passing the laces under the eyelets rather than crossing the laces over the top of the foot.
If you have a wide foot, skip the 3rd and 5th eyelet. If you have a narrow foot skip the 4th, and 6th, eyelet.
Each Lacing System should match your individual foot requirements.
Onychomycosis is an infection of the bed and plate underlying the surface of the nail, and is caused by various types of fungi, which are commonly found throughout the environment. Fungi do not require sunlight for growth. A group of fungi called dermatophytes easily attack the nail, thriving off keratin, the nail’s protein substance.
Fungal infection of toenails is a common foot health problem. Studies estimate that it affects 3% to 13% of the population. However, because so many cases go unreported, the incidence is much higher than that.
One reason so many people ignore the infection is that it can be present for years without ever causing pain. Its prevalence rises sharply among older adults. Because older adults may be experiencing much more serious medical problems, it is understandable that fungal nails can be passed over as a minor problem.
Whatever the case, the disease, characterized by a change in a toenail’s colour, is often ugly and embarrassing. Nail polish is an easy solution for many women, rendering the problem “out of sight, out of mind”.
In many cases, however, the change in colour is the start of an aggravating disease that ultimately could take months to control. Fungal nail infections are known to Chiropodists as Onychomycosis. This infection then leads to thickening of the nails, which then cannot easily be trimmed and may cause pain while wearing shoes. This disease can frequently be accompanied by a secondary bacterial and/or yeast infection in or around the nail plate.
When the tiny organisms take hold, the nail may become thicker, yellowish brown and foul smelling. Debris may collect beneath the nail plate, white marks frequently appear on the nail plate, and the infection is capable of spreading to other toenails, the skin, or even the fingernails.
Because it is difficult to avoid contact with microscopic organisms like fungi, the toenails are especially vulnerable around damp areas where people are likely to be walking barefoot, swimming pools, locker rooms, and showers. Injury to the nail bed may make it more susceptible to all types of infection, including fungal infections. Those who suffer chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails. Other contributory factors may be a history of athlete’s foot and excessive perspiration.
Because fungi are everywhere, including the skin, they can be present months before they find opportunities to strike, and appear. By following precautions, chances of the problem occurring can be reduced, or even avoided.
What is gout? Gout is thought to be caused in most instances by a flaw in the way the body handles substances called “purines”. Purines are found in many common foods and are broken down into uric acid for excretion in the urine. In normal individuals, the kidneys excrete uric acid as quickly as it is formed.
In patients with gout, uric acid accumulates in the blood, causing intermittent attacks of severe pain in and around joints. Gout is four times more likely to occur in males than in females and authorities believe that gout is inherited. Gout is most likely to occur in the ear lobe or the large lobe.
Many Factors Can Provoke Symptoms:
The inflamed areas become swollen, red, warm and extremely tender. Pain often starts at night and worsens hourly. The big toe is commonly affected.
Hammertoe is a deformity of the second, third, or fourth toes. In this condition, the toe is bent at the middle joint, causing it to resemble a hammer. Left untreated, hammertoes can become arthritic and require surgery. People with hammertoe may have corns or Chondromalacia Patella on the top of the middle joint of the toe or on the tip of the toe. They may also feel pain in their toes or feet and have difficulty finding comfortable shoes.
Causes of hammertoe include improperly fitting shoes and muscle imbalance.
Treatment for the condition typically involves wearing shoes with soft, roomy toe boxes and toe exercises to stretch and strengthen the muscles. Commercially available straps, cushions, or nonmedicated corn pads may also relieve symptoms.
In severe cases, hammertoe surgery may be recommended to correct the deformity. This treatment option would require a referral to an orthopeadic surgeon.
Plantar Fasciitis is a common overuse injury. It is characterized by acute heel pain first thing in the morning or after rest. The plantar fascia is a thick non-elastic band of fibrous tissue that runs from all five metatarsal heads and attaches onto the calcaneus (heel bone).
The problem begins when there is stress applied to the plantar fascia and the fascia pulls away from its weakest insertion, causing microtears. This causes inflammation and thus, pain. A plantar fascial microtear can also occur at mid sole or towards the toes. Since it is difficult to rest the foot, the situation is aggravated with every step taken. The problem progresses rapidly and treatment must start as soon as possible. As the fascia is pulled away from the bone, the body reacts by filling in the space with new bone. This causes the classic “heel spur”. This heel spur is a secondary x-ray finding and is not the problem, but a result of the problem.
Rest is the first and most important part of the treatment. Your feet carry your body weight and with every step the injury gets aggravated. Weight bearing activities should temporarily be put on hold. Long walks or runs should be replaced with swimming or cycling.
Shoes are an important element to the recovery of foot injuries. Supportive athletic shoes, preferably walking shoes, with extra heel cushioning, rigid heel counters and lace up mechanisms provide the support and balance necessary to assist in healing injured feet.
Orthotics are custom plastic devices prescribed by your chiropodist. The orthotics serve to realign your feet and prevent any abnormal compensations due to biomechanical abnormalities. These abnormalities, if left untreated cause “flat feet” or “fallen arches” which result in the pulling of the plantar fascia.
These splints are designed to keep the plantar fascia in an elongated position overnight, therefore reducing the initial stretch that occurs when you take your first morning step.
Laser Therapy is a good treatment option. Photochemical responses or sound waves in the tissue helps to control pain and accelerate healing.
Manual Foot Therapy is a treatment which involves the realignment of the bony structures of the foot, therefore improving lymphatic drainage and blood flow.
A cortisone injection is usually beneficial if the above therapies have not solved the problem. It is a local injection and it is very safe in this area.
The following exercises are designed to strengthen the small muscles of the foot to help support the damaged area. If performed regularly, they will help prevent re-injury.
A heel pad made of felt, sponge or silopos can help to absorb the shock as the heel lands and ease the pressure on the plantar fascia. These heel pads are either pre-cut or have softer material centrally, to deflect pressure away from the painful area. Heel pads and heel cups are available at most pharmacies or in your chiropodist’s office.
Taping your foot to maintain the arch will take some of the tension off the plantar fascia. This will provide short term relief in acute cases.
Your chiropodist may prescribe anti-inflammatory pills. These can play an important role in reducing the inflammation in your foot, however this is not a long term answer.
Surgery is rarely required for plantar fasciitis.Back to the top
Ingrown toenails are one of the more common foot problems treated by a Chiropodist. They can be very painful, sometimes making it necessary to limit activities.
Ingrown toenails are caused by a nail spike which penetrates the skin along the margins of the nail, causing pain. Some ingrown toenails are chronic, with repeated episodes of pain and infection. Pain can be present without infection. If there is infection, the usual signs include: redness, swelling, increased warmth and pain. There also may be drainage of pus or a watery discharge tinged with blood.
Some ingrown toenails only require a local anesthetic and simple procedure that removes the offending piece of nail. Often these will never reoccur again; however, chronic ingrown toenails that are causing repeated irritation and infection require corrective surgery to eliminate this recurring problem. It may involve part of the nail or the whole nail being removed.
The procedure is painless as the toe is anesthetized with a local anesthetic agent. There is minimal post-operative discomfort. The wound heals in about four to six weeks. During this time period it is simply dressed with a topical antibiotic and band-aids. After healing, the nail is normal in appearance and somewhat narrower than before.
Manual Foot Therapy is a treatment which involves the realignment of the bony structures of the foot. Your Chiropodist will perform approximately 9 manipulations leaving your foot feeling significantly more limber. There will be a marked improvement in lymphatic drainage and blood flow.
The full course of treatment usually involves approximately 12-14 M.F.T.’s. It is important to note that motion control footwear and orthotic therapy help to maintain proper bone alignment and are integral component in achieving total foot health.Back to the top
A forefoot neuroma is a benign tumor of abnormal growth on a nerve in the foot caused by an irritation of nerve cells.
Most commonly found between the third and fourth metatarsal (toes), symptoms often include a burning sensation of the foot accompanied by a feeling of pins and needles. Some patients actually experience a “popping” or “dislocation sensation”.
This ailment is usually caused by improper shoes, ie: tight fitting shoes and/or heels that force extra weight onto the forefoot.
If the neuroma is particularly painful, your physician or chiropodist may opt to inject with Cortisone to decrease the inflamed nerve. A metatarsal pad can alter the biomechanics of the foot. This support will widen the space between the third and fourth bones of the foot, thus decreasing the compressive forces acting on the inflamed nerve. However, it’s usually a biomechanical fault of abnormal pronation, in which case an orthotic is prescribed. Where necessary, surgery for the inflamed neuroma involves the removal of the affected portion of the nerve.
Custom foot orthotics are prescription medical devices, designed to adjust and control the functions of the foot and its alignment with the lower leg. They are used to treat/prevent injury-causing motions including excessive pronation (collapsing in) and supination (rolling out) and make standing, walking and running more efficient. Some custom orthotics are designed to redistribute pressure on the bottoms of your feet to alleviate pain from corns, callouses or bony prominences.
Genuine, custom foot orthotics are made by starting with a thorough exam by a qualified Chiropodist, followed by the taking of impressions using plaster of paris, followed by the completion of a detailed prescription form. Your casts and prescription form are then sent to a professional laboratory where your orthotics are made by technicians with appropriate training and qualifications.
Customized devices are relatively new in the market and can be difficult to distinguish from genuine custom ones. They are commonly a product of computerized force platform information and are typically made by modifying and/or adding components to a pre-manufactured insole. Unfortunately, they are often marketing as “custom” and sold at similar prices. One way to tell the difference between custom and customized devices is if a plaster cast of 3D scan cast is not taken of your feet, you won’t be getting genuine custom orthotics. Walking or standing on a force platform with a colourful graphic display is an excellent way to evaluate some aspects of foot function and pressure distribution. In qualified hands, force platforms can be useful diagnostic tools but they are incapable of capturing true, three dimensional impressions of your feet.
Off-the-shelf devices are most commonly found in retail drug, sports and shoe stores as well as some specialty shops. Some foot health care professionals recommend them for minor foot problems. Popular brands sold in Canada include, SpencoⓇ, SuperfeetⓇ and PowerStepⓇ.
If you are having foot and/or leg problems and want to know if orthotics are right for you (and if so, what kind) start by consulting your Chiropodist.
Getting orthotics that are right for you begins with a thorough exam by a qualified Chiropodist. You won’t find these people on infomercials, in the mall or at a consumer show. Minor foot problems can often be treated with an inexpensive off-the-shelf orthotic and/or proper footwear selection and fitting advice. More pronounced/persistent problems usually require a more precise, custom orthotic solution.
Successful foot orthotic therapy requires an experienced Chiropodist’s training and clinical experience combined with a qualified laboratory technical skills and material technology expertise.
Sever’s Disease, also known as Calcaneal Apophysitis, is a painful inflammation of the growth plate in the heel bone. When too much repetitive stress is applied on the growth plate, inflammation develops. It typically affects children between the ages of 9-15 years.
Shin splints are a painful inflammation of the periosteum, the dense layer of connective tissue that lines the bones. It may also be called periostitis. The pain occurs along the inside or outside of the shin bone or tibia.
There are basically two factors causing shin splints. One is over use of the muscles, especially in people who have been sedentary and suddenly take up vigorous exercise. The other cause is pronation or inward rolling motion of the foot. Both these causes result in the muscles along the shin bone to be tightened with a resulting irritation and swelling of the periosteum.
After an assessment by your Chiropodist, a home stretching and strengthening program may be recommended, footwear advice along with custom foot orthotics to optimize or control biomechanical function.Back to the top
Warts are caused by a virus that enters the body through a break in the skin. It is a common organism that we are all exposed to at some point in our lives. The virus grows in warm, moist environments like change rooms and pool areas.
Warts often appear as a thick, tough area of skin. They may also appear bumpy and spongy. Warts do not have roots. They usually have tiny black dots in the center. These are tiny capillaries that supply blood to the wart.
A plantar wart is similar in structure to an iceberg. The part on the surface represents only a small fraction of the entire wart. Often, the portion of wart under the skin is twice as big as the part you see.
The body’s natural immune system can often wipe out a wart without any treatment. If the wart becomes painful is should be treated. Treatment options are varied. Initially you may want to treat the wart using specialized ¨wart removing¨plasters, gel or ointments which are available at drugstores. If the wart does not respond, gets larger, becomes painful, or spreads then you should seek further attention from a Chiropodist.