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What is plantar fasciitis?

Plantar fasciitis (PLAN-tur fas-e-I-tis) is one of the most common causes of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia).

Plantar fasciitis commonly causes stabbing pain that usually occurs with your first steps in the morning. As you get up and move more, the pain normally decreases, but it might return after long periods of standing or after rising from sitting.

Plantar fasciitis is more common in runners. In addition, people who are overweight and those who wear shoes with inadequate support have an increased risk of plantar fasciitis.

Symptoms

Plantar fasciitis typically causes a stabbing pain in the bottom of your foot near the heel. The pain is usually the worst with the first few steps after awakening, although it can also be triggered by long periods of standing or rising from sitting. The pain is usually worse after exercise, not during it.

Causes

Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. If tension and stress on that bowstring become too great, small tears can arise in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed, though in many cases of plantar fasciitis, the cause isn’t clear.

Risk factors

Though plantar fasciitis can arise without an obvious cause, factors that can increase your risk of developing plantar fasciitis include:

Age. Plantar fasciitis is most common between the ages of 40 and 60.

Certain types of exercise. Activities that place a lot of stress on your heel and attached tissue — such as long-distance running, ballistic jumping activities, ballet dancing and aerobic dance — can contribute to an earlier onset of plantar fasciitis.

Foot mechanics. Being flat-footed, having a high arch or even having an abnormal pattern of walking can affect the way weight is distributed when you’re standing and put added stress on the plantar fascia.

Obesity. Excess pounds put extra stress on your plantar fascia.

Occupations that keep you on your feet. Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces can damage their plantar fascia.

Complications

Ignoring plantar fasciitis may result in chronic heel pain that hinders your regular activities. Changing the way you walk to minimize plantar fasciitis pain might lead to foot, knee, hip or back problems.

More information

Please call us on (02) 4658 2188 for more information or to make an Appointment

Sprained Ankle

Diabetes and Feet (by diabetes Australia)

Looking after your feet

• When you have diabetes you need to take care of your feet every day
• Having diabetes can increase your risk of foot ulcers and amputations
• Daily care can prevent serious complications
• Check your feet daily for changes or problems
• Visit a podiatrist annually for a check up or more frequently if your feet are at high risk

Why?

Your feet are at risk because diabetes can cause damage to the nerves in your feet, blood circulation and infection. Having diabetes can increase your risk of foot ulcers and amputations. This damage is more likely if:

• You have had diabetes for a long time
• Your blood glucose levels have been too high for an extended period
• You smoke – smoking causes a reduced blood flow to your feet, wounds heal slowly
• You are inactive.

Daily checks

It’s important to check your feet every day.
If you see any of the following- get medical treatment that *day *

• Ulcer
• Unusual swelling
• Redness
• Blisters
• Ingrown nail
• Bruising or cuts

If you see any of the following- get medical treatment within 7 days

• Broken skin between toes
• Callus
• Corn
• Foot shape changes
• Cracked skin
• Nail colour changes

Nerve Damage

Poor blood glucose control can cause nerve damage to feet. Symptoms include:

• Numbness
• Coldness of the legs
• A tingling, pins and needles sensation in the feet
• Burning pains in the legs and feet, usually more noticeable in bed at night.

These symptoms can result in a loss of sensation in the feet which increases the risk of accidental damage because you can’t feel any pain. An injury to the feet can develop into an ulcer on the bottom of a foot which can penetrate to the bone. This could lead to infection of the bone (osteomyelitis) and a chronic infection in the bones and joints. If an infection isn’t treated at the earliest signs, this could result in ulceration (an infected open sore) and eventually amputation (removal of a toe, foot or limb).
See your podiatrist, doctor or Credentialled Diabetes Educator if you have any of these symptoms.

Blood Supply

Poor blood glucose control can cause a reduced supply of blood to the feet. This makes people with diabetes more prone to infection following any injury that breaks the skin. Signs of poor blood supply include:

• Sharp leg cramps after walking short distances or up stairs
• Pain in the feet, even at rest (often in the early hours of the morning)
• Feet feeling cold
• Feet looking a reddish-blue colour
• Cuts which are slow to heal.

See your podiatrist, doctor or Credentialled Diabetes Educator if you have any of these symptoms.

Checking your feet

There are two types of risk to feet, high risk and low risk. Knowing the risk and taking care of your feet can prevent serious problems like ulcers and amputation. A doctor, podiatrist or Credentialled Diabetes Educator can carry out an easy and painless check on your feet to determine whether your feet have a low or high risk of developing more serious problems.

Low risk
Low risk feet have normal sensation and good blood flow. However it is important to know that low risk feet can become high risk feet without symptoms, so regular checks are still as important.

High risk
People who have had a foot ulcer or amputation in the past have a high risk of complications. Feet with calluses or deformities like claw toes also have increased risk if poor feeling and/or decreased blood flow are also present.
If your feet are at high risk, you should have them checked by your doctor or a podiatrist every 3 – 6 months. In some cases you may be referred to a specialist or high risk foot clinic.

The check-up will include looking at the following:

• Blood flow to the feet (circulation)
• Feeling and reflexes (nerves)
• Unusual foot shapes (including bunions, claw toes and hammer toes)
• Toenails
• Dryness, calluses, corns, cracks or infections.

People with diabetes who have misshapen feet and nerve damage are the more likely to develop:

• Ulcers from too much pressure over some areas of the feet
• More corns and calluses due to too much pressure on one area and can be avoided with some changes.

Seek your podiatrist’s help to remove calluses or corns before they become ulcers as these can become infected, risking amputation.

Caring for Your Feet

In addition to regular checks ups with a podiatrist you should also:

• Seek more information about how to care for your feet from a podiatrist or Credentialled Diabetes Educator
• Have your feet checked at least once a year by your doctor or other health professional
• Know your feet well – wash, dry and check your feet every day. Check for redness, swelling, cuts, pus discharge, splinters or blisters, being especially careful to look between toes, around heels and nail edges and at the soles of the feet. If you have difficulty with your vision get someone to check for you
• Cut your toenails straight across – not into the corners – and gently file any sharp edges. If you can’t properly see or reach your feet to cut your toenails, ask someone to do it for you
• Moisturise your feet daily to avoid dry skin
• Never use over-the-counter corn cures
• Cover your feet with a clean sock or stocking without rough seams
• Don’t wear tight socks or stockings
• Protect your feet in a shoe which fits well – the right length (a thumb width longer than your longest toe), width and depth – and has been checked for stones, pins, buttons or anything else which could cause damage
• Keep your feet away from direct heat such as heaters, hot water bottles and electric blankets
• Get medical advice early if you notice any change or problem

Injuries

If you find an injury including a cut, blister, sore, red area or open crack, immediately:

• Wash and dry the area
• Apply good antiseptic e.g. Betadine
• Cover with a sterile dressing, available from pharmacies.

If any injury does not improve within 24 hours, make an urgent appointment to see your doctor to avoid serious complications.
Seek urgent medical advice for even the mildest foot infection, including any sore, open wound or crack which is oozing, contains pus or any type of discharge or which does not heal within a week.

Podiatry

Podiatry is a field of healthcare devoted to the study and treatment of disorders of the foot, ankle, and the knee, leg and hip, collectively known as the lower extremity.
Some area health services and local councils offer subsidised podiatry services. Phone your local hospital, council or community health centre to find out more.

Rebates

• Medicare may provide a rebate on podiatrists’ fees if you have a chronic condition and are referred by your doctor.
• Department of Veteran Affairs (DVA) gold card holders are entitled to free podiatry services from private podiatrists.
• Private health funds cover some podiatry services.

More information

Please call us on (02) 4658 2188 for more information or to make an appointment

Biomechanical Assessment

Athletes Foot

What are flat feet?

In a person with fallen arches, one or both feet may be flat on the ground, and shoes may wear unevenly, especially on one side, or they may wear out more quickly than usual.

Many people with fallen arches have no symptoms, but some may experience pain in their feet and even their back, depending on the cause.
Symptoms can vary and generally depend on the severity of the condition.
Some people have an uneven distribution of bodyweight and find that the heel of their shoes wears out more rapidly and more on one side than the other.

The most common symptom of flat feet is pain. Pain may occur in the feet, if the connecting ligaments and muscles are strained.
It may also present in the:

• Inner side of the ankle, and possibly swelling
• Arch of the foot
• Calf
• Knee
• Hip
• Back
• Lower leg area

The abnormal stresses on the knee and hip may result in pain. This is likely if the ankles turn inwards. Flat feet can also lead to pain in the low back.
There may also be stiffness in one or both feet.

Who gets flat feet?

In a human foot, there are 26 different bones, held together by 33 joints and over 100 muscles, tendons and ligaments.

The arches give spring to the step and distribute body weight across the feet and legs. The structures of the arches determine how a person walks. They need to be both sturdy and flexible to adapt to various surfaces and stress.
Causes of flat feet include:

• Genetic factors, as flat feet can run in families
• Weak arches, where the foot is visible for example, when sitting, but the foot flattens onto the ground when standing
• Foot or ankle injury
• Arthritis or rheumatoid arthritis
• Damage, dysfunction, or rupture of the posterior tibial tendon
• Nervous system or muscle diseases, such as cerebral palsy, muscular dystrophy, or spina bifida
• Tarsal coalition, where the bones of the foot fuse together in an unusual way, resulting in stiff and flat feet. This is most commonly diagnosed during childhood

People are more likely to develop flat feet if they have obesity or diabetes, or during pregnancy.

Flat feet can develop as people age. Daily use can cause the posterior tibial tendon to weaken. This tendon is the main support structure of the arch of the feet.

The tendon can become inflamed after overuse, known as tendinitis, or be torn. Damage to the tendon may cause the arch shape of the foot to flatten.

Flat feet can happen because of a developmental fault that occurs during childhood, or that develops with age, or after pregnancy.

Some people appear to have a very low arch or no arch without ever experiencing problems. Fallen arches or flat feet only need attention if they lead to discomfort, if they indicate another underlying disorder, or if they can lead to future pain elsewhere in the body.

Flat feet in children

Children and infants often look as if they have flat feet. The arch is usually there, but the feet are still forming. In time, the arch will appear as normal. The extra fat on an infant’s foot may also be hiding the arch.
Having apparently flat feet during early childhood does not mean that the person will always have flat feet.

However, if a child has flat feet because of incorrect bone development or another disease such as spina bifida, the underlying cause will need to be addressed.

More information

Please call us on (02) 4658 2188 for more information or to make an appointment

What are ingrown toenails?

Ingrown toenails occur when the edges or corners of your nails grow into the skin next to the nail. Your big toe is most likely to get an ingrown toenail.
You can treat ingrown toenails at home. However, they can cause complications that might require medical treatment. Your risk of complications is higher if you have diabetes or other conditions that cause poor circulation.

Causes

What causes ingrown toenails?
Ingrown toenails occur in both men and women. According to the National Health Services (NHS), ingrown toenails may be more common in people with sweaty feet, such as teenagers. Older people may also be at higher risk because toenails thicken with age.

Many things can cause an ingrown toenail, including:

• cutting toenails incorrectly (Cut straight across, since angling the sides of the nail can encourage the nail to grow into the skin.)
• irregular, curved toenails
• footwear that places a lot of pressure on the big toes, such as socks and stockings that are too tight or shoes that are too tight, narrow, or flat for your feet
• toenail injury, including stubbing your toe, dropping something heavy on your foot, or kicking a ball repeatedly
• poor posture
• improper foot hygiene, such as not keeping your feet clean or dry
• genetic predisposition

Using your feet extensively during athletic activities can make you especially prone to getting ingrown toenails. Activities in which you repeatedly kick an object or put pressure on your feet for long periods of time can cause toenail damage and increase your risk of ingrown toenails. These activities include:

• ballet
• football
• kickboxing
• soccer

What are the symptoms of ingrown toenails?

Ingrown toenails can be painful, and they usually worsen in stages.
Early-stage symptoms include:

• skin next to the nail becoming tender, swollen, or hard
• pain when pressure is placed on the toe
• fluid building up around the toe

If your toe becomes infected, symptoms may include:

• red, swollen skin
• pain
• bleeding
• oozing pus
• overgrowth of skin around the toe

Treat your ingrown toenail as soon as possible to avoid worsening symptoms.

More information

Please call us on (02) 4658 2188 for more information or to make an appointment

What are Corns and Calluses?

Our feet play an important role in keeping us mobile. When we walk or stand, our feet carry the burden of our body weight as well a bearing the various pressures of movement and constraints of our footwear. Sometimes pressure placed on the foot becomes out of balance and extra friction falls on a particular area of the foot. When this happens, the body may respond to the pressure by producing thickened areas of skin. These hard patches of skin are called calluses and are part of the body’s defence system to protect the underlying tissue. If the cause of the pressure is not relieved calluses can become painful.

If the pressure becomes concentrated in a small area, a hard corn may develop. Sometimes the pressure of the corn or callus may produce inflammation which can result in acute pain, swelling and redness. Sometimes soft corns may form between the toes where skin is moist from sweat or inadequate drying. These appear white and rubbery, they can also be caused by excessive friction.

Corns and calluses are most often found on the balls of the feet or the top of toes. They can also be found on heels and even along the sides of your toenails.

What causes corns and calluses?

Calluses and corns are generally symptoms of underlying problems and in some cases, early warning signals of more complex foot disorders. Because they are caused by continuous pressure in one particular area, they may indicate abnormalities or deformities in your bone structure, or the way you walk.

Often calluses and corns can be caused by ill fitting or inappropriate foot wear.

Who gets corns and calluses?

Almost everyone! In fact calluses and corns affect more people then any other kind of foot problem.

Some people have a natural tendency to develop calluses because of their skin type. For instance elderly people have less fatty tissue and elasticity in their feet and because of this lack of padding, calluses may form on the bottom of their feet. Also people who work in occupations that require them to spend a lot of time on their feet are prone to developing calluses.

How to treat calluses and corns

The most important thing to remember about treating calluses and corns is to never do it yourself with out seeing a podiatrist first. Because calluses are generally symptoms of other problems, it is important to have a podiatrist examine your feet to work out what could be causing the pressure.

Over the counter remedies such as corn ointments or plasters generally only treat the symptoms not the actual problem and its cause. Also they can easily damage the healthy skin surrounding the corn if not used properly. Commercial preparations should only be used with professional advice.

Warning!

It is important that you never cut corns or calluses yourself. In the warm, moist confines of enclosed shoes, infection can easily develop and small cuts can quickly become serious wounds.

Preventing corns and calluses

The best way to prevent the development of calluses and corns is to pay attention to your feet, when you feel there is extra pressure on specific areas. Properly fitting shoes are essential, especially if you spend long periods of time on your feet. Its also important that you never wear other people’s shoes. Using a moisturiser daily will help keep your skin supple.

Don’t forget these problems are caused by pressure. If you feel you may be developing a callus or corn, or you already have one, the best thing to do is to seek advice and treatment from your podiatrist.

More information

Please call us on (02) 4658 2188 for more information or to make an appointment

Pediatric Check-up & Treatment

Footwear Advice

Other various foot pathologies and conditions