Common Conditions

Heel Spur Syndrome or Plantar fasciitis is a common condition that affects the heel and arch area of the feet. It is caused by the plantar structures of the feet being over stretched resulting in tearing, inflammation and pain around the heel and arch area of the foot.

Signs and Symptoms:

• Pain in the heel and arch area
• Pain when getting out of bed in the morning or after prolonged sitting
• Heel spur development (seen on x-ray)
• Pain on exercise (running and prolonged walking)
• Pain on palpation in the heel and arch area (heel feels tender)
  

Treatment

The most effective treatment is Orthotic therapy. Orthotics are used to re-align the foot and relieve the plantar structures from excessive stretching giving them the ability to heal. Orthotics are made at the Total Foot and Ankle Clinic.

Flat feet (Excessive Pronation) is an informal reference to a medical condition in which the arch of the foot collapses, with the entire sole of the foot coming into complete or near-complete contact with the ground.

Flat feet can cause many problems from forefoot, arch and ankle pains, to more leg issues, like knee, hip and lower back pains. Only through assessment, a Podiatrist is able to determine the excessiveness of the flat feet and what problems they may cause.Kids can also suffer due to problems caused by flat feet.

Treatment

People with Excessive Proration (Flat feet) should wear arch supports (known as foot orthotics) to prevent damage to the feet, ankles, legs and knees and to also prevent future complications.

Many kids walk with an in-toe when they start to walk. This is due to an internal rotation of the lower leg bone (tibia). As a child grows, the tibia bone should start to unwind and straighten (This occurs while the growth plates are still open), thus making the knee and the ankle position the same. However due to environmental and other factors, these bones are not correcting themselves enough, thus leaving the tibia bone in an inward position, which in-turn causes the body to try other means of correcting the foot position. The body uses other muscles to correct the child's walking. This in turn gives rise to other complications like growing pains, strained muscles and over compensation issues. Pediatric assessment needs to be conducted to determine the extent of the tibia torsion.

Treatment

There are treatments available, which assist in re-aligning these bones. This can only be done when the child is still young, and the growth plates are still open. Treatment may vary from person to person. Biomechanical assessment is necessary to determine the method of treatment.

Knee pain is a vague statement and can refer to many problems of the knee. The most common being diffused pain around the patella (Known as Patella-Femoral pain syndrome) and knee arthritis. 

Knee arthritis is characterised by a decrease in joint space. This can be a very painful and frustrating condition. Many problems of the knee can be related to the foot and the ankle, as the knee and hip are connected. Through an assessment, it is possible to determine certain aspects of the foot position in relation to knee osteoarthritis.
Patella-Femoral pain syndrome is nominally characterised by general, diffuse knee pains, which get worse during sporting activities and walking up/down stairs. It has a lot to do with mal-alignment of the patella and incorrect knee function.

Through an assessment, causes of these knee problems become clear. Causes may be due to the feet or muscle imbalances of the muscles working around the knee.

Treatment

The foot and knee have a very close relationship, what the foot does will affect knee function. This is best treated by custom inserts which change the position of the foot. This will change the mechanics of the knee and thus, offload the pressure points of the knee and improve its range and quality of motion. Acupuncture also works well in reducing pain in the knee. An assessment is needed to determine the type of insert needed.

Bunions (hallux valgus) are often described as a bump on the side of the big toe. With a bunion, the big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment, producing the bunion's "bump."
Bunions are a progressive disorder. They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which continues to become increasingly prominent. Usually the symptoms of bunions appear at later stages, although some people never have symptoms.
Bunions are most often caused by an inherited faulty mechanical structure of the foot. So normally someone in the family may have them.
Symptoms:

• Pain or soreness
• Inflammation and redness
• A burning sensation
• Perhaps some numbness

Other conditions which may appear with bunions include calluses on the big toe, sores between the toes, ingrown toenail, and restricted motion of the toe.

Treatment

Early treatments are aimed at easing the pain of bunions and stopping the bunions from getting worse, but they won't reverse the deformity itself.  The Mechanics of the foot would need to be addressed and a suitable treatment plan put in place.

An ingrown toenail occurs when part of the nail penetrates the skin, which can often result in an infection. The ingrown nail can also apply pressure in the nail fold area without penetrating the skin - this is not technically an ingrown toe nail, but can also be painful. Pain is the main symptom of an ingrown toe nail.

Causes

• Poor cutting
• Previous trauma
• Foot mechanics
• Footwear

Treatment

Patients should try not to 'dig' out the nail by themselves, they can cause the ingrown to get worse or possibly let it get infected. The main aim of treatment is to be as non-invasive as possible. First line of treatment is to take a small section of the affected nail, clear the side and bandage it with regular packing and dressing. If this small procedure doesn't work, the patient will need to undertake nail surgery known as a Partial Nail Avulsion (PNA). This is where the affected section of nail is removed from the matrixes and cauterised to stop regrowth of that nails side section. Procedure is done under local anaesthetic with antibiotics before and after procedure.

Morton’s Neuroma is characterised by pain and numbness of the plantar aspect of the foot (ball of foot) and numbness between the toes. Most commonly of the third and fourth intermetatarsal spaces, but can occur other places. It is caused by the entrapment of the intermetatarsal plantar nerve which runs between the bones of the foot.
Pain can be localised, or spread out through the foot. Can sometimes feel like walking on a 'marble'.

Treatments Since this problem is caused by the metatarsal bones of the feet collapsing and squeezing the digital nerves. The treatment requires raising and separating the metatarsal bones to free the nerve, and this is done by a device called a met-dome, which sits under the foot. This will relieve the pains and free the nerve from pressure. An assessment is needed to determine the correct position of the dome, to relieve the pressure of the nerve and thus eliminate pain.

Most sporting injuries are caused by underlying biomechanical abnormalities. The following are common:

• Constant lateral ankle sprains
• Achilles tendonitis
• Anterior knee pain
• Constance ‘cracking of joints’
• Ligament weakness
• Unstable running
• Shin splints
• Big toe soreness

All these conditions have underlying causes, rather than the treatment the symptoms, a cause and etiology must be determined and treated accordingly. A full biomechanical assessment will determine these causes

When the body’s biomechanical system is not functioning normally, the body compensates for the abnormalities. This causes muscle imbalances, tearing of fascias and ligaments, muscle strains, degeneration of cartilage, bone mal-alignment and postural changes.

The use of orthotics is common in treating a wide range of lower limb sporting conditions. The main purpose is to realign the body’s biomechanical structures and correct the musculoskeletal disorders of the lower limb.

Achilles tendonitis is inflammation of the Achilles tendon. In most cases, it is a type of overuse injury and is more common in younger people. Professional and week-end athletes can suffer from Achilles tendonitis, but it is also a common overuse injury in people not involved in sport.

Symptoms

Symptoms of Achilles tendonitis include:

• Pain in the back of the heel
• Difficulty walking – sometimes the pain makes walking impossible
• Swelling, tenderness and warmth of the Achilles tendon.

Treatment The aim of the treatment is to the reduce strain on the tendon and to reduce inflammation. An assessment is needed to determine the best action plain for treatment.

Sever’s Condition is a common cause of heel pain, particularly in the young and physically active. It usually develops just before puberty. Boys are slightly more prone to this condition than girls. Physiotherapy can help manage the symptoms of Sever’s Condition so that the young person can continue to engage in physical activity.
Another name for Sever’s Condition is Calcaneal Apophysitis. ‘Calcaneus’ is your heel bone, ‘apophysis’ is where the tendon joins the heel and ‘itis’ means inflammation. ‘Sever’ is the person who first identified this condition.
Symptoms
There are a few signs and symptoms that indicate Sever’s Condition, which may affect one or both heels. These include:

• Pain in the heel or around the Achilles tendon
• Heel pain during physical exercise, especially activities that require running or jumping
• Worsening of pain after exercise
• A tender swelling or bulge on the heel that is sore to touch
• Calf muscle stiffness first thing in the morning.
• A tendency to tiptoe.

Treatments
The main treatments are

• Relative rest and modified activity

Orthotics – inserts worn inside the shoes can take some of the traction pressure off the Achilles tendons.

Shin splints are described as dull pains which occur around the 'shin' bone area, during exercise and prolonged running. This can be caused by over-use of the muscle, compartment syndrome or poor foot posture.

Poor foot posture can give rise to many muscle problems of the lower limb. Sometimes nodules and knots can be felt within the muscles. These are called 'trigger points' and can radiate pain to other areas of the leg. A patient will need to go through an assessment to determine causes and potential problems.

Many people complain they feel 'strange' when walking. This is normally a sign that something is biomechanically wrong. Often patients complain of tightness and cramps in the legs, feeling unstable when walking and tend to favour one leg over the other. This can be due to many causes and abnormalities. A biomechanical assessment needs to be conducted to determine the possible causes and potential problems that may arise later on in life.

This is a condition where one leg is shorter than the other. This can cause lower back pain, pelvic tilt resulting in scoliosis, hip pain due to the longer leg jamming into the hip joint and knee pain, this can even cause mid back and neck pain. By measurement of CT scan, the accurate difference in leg length is determined and the shorter leg is posted to compensate the difference in leg length and realign the pelvis. This figure shows the CT scan of the leg length measurement.

Patients who have diabetes or considered 'high risk' constantly need foot and nail care. This is because incorrect nail cutting can be the cause of ulcerations and infections. Yearly vascular, neurological and motor assessments are conducted on the feet. This is to determine the current health of the feet and to determine what problems the patient may encounter. Patients would normally be referred by their G.P on a Medicare Enhance Primary Care plan (EPC), in which gives patients 5 visits per year on Medicare. Patients need to speak to their doctor if they are eligible. If not, they can attend as a private patient.