CONDITIONS

Achilles Tendonitis

Achilles Tendonitis is an inflammation of the Achilles tendon, usually resulting from overuse associated with a change in playing surface, footwear or intensity of an activity.

Causes

Achilles tendonitis can occur in any sport but is common in sports such as running, jumping, dancing and tennis
A sudden increase in activity or increase in intensity
Poor running technique, excessive pronation of the foot (sometime referred to as fallen arches or flat footed)
Inadequate footwear, poorly fitting footwear or footwear past their best may contribute
In cyclists, the problem may be a low saddle, which causes extra dorsiflexion of the ankle when pedalling and leaves tendon on stretch or tightened all the time
Certain medications can cause inflammation of tendons

Symptoms:

Gradual onset of pain and stiffness over the tendon, which may improve with heat or walking and worsen with strenuous activity
May be worse first thing in the morning and warm throughout the day
Tenderness of the tendon on palpation
Pain on active movement of the ankle joint

Treatment Options:

We aim to treat the cause of your injury and not just the injury itself. To determine the cause, it is recommended that a biomechanical assessment be conducted to highlight any issues that may be causing your pain. During your biomechanical assessment we will discuss the issues behind why you are in pain, which will include a full history of your symptoms and any changes to your lifestyle that may be contributing to your pain. The joints and muscles of the lower limb will then be assessed to discover what is contributing to the injury. Analysis of your posture and foot pressure will also be conducted. After each assessment, a program will be tailored to suit your needs and in some cases bespoke orthotic insoles may be necessary. We have invested in state of the art equipment to make orthotics insoles. These can made at your assessment for you to walk out wearing them and start your journey to being pain free straight away!

Some suggested treatments:

Training modifications
Rest and ice therapy
Stretching and strengthening certain muscle/tendons in the leg and foot
Footwear advice
Orthotic insoles
Surgery in some extreme cases
Kinesiology taping
Lifestyle modifications
Diet that includes anti-inflammatory foods such as whole foods, berries, nuts, fruit and veg

If pain is extremely sore it may not be Achilles tendonitis. More serious Achilles pain could be a tendon rupture. It is rare to have a rupture without suffering any type of Achilles pain prior to the rupture. Ageing is thought to increase the risk of this injury. A simple Thompson test will differentiate between tendonitis and a rupture.

Ankle Sprain

An ankle sprain is an injury to the tough bands of tissue (ligaments) that surround and connect the bones of the leg to the foot. The injury typically happens when you accidentally twist or turn your ankle. This can stretch or tear the ligaments that hold your ankle bones and joints together. All ligaments have a specific range of motion and boundaries that allow them to keep the joints stabilized. When ligaments surrounding the ankle are overstretched, it causes a sprain. Sprained ankles most commonly involve injuries to the ligaments on the outside or lateral side of the ankle.

Causes:

An ankle sprain often occurs when the foot suddenly twists or rolls, forcing the ankle joint out of its normal position. During most sports, the ankle may twist as a result of sudden or unexpected movement and if that movement is excessive it can cause one or more ligaments around the ankle to stretch or tear. Tendons, cartilage, and blood vessels might also be damaged due to the sprain. Sprains are not limited to any age gender or sports.

Symptoms:

swelling
tenderness
bruising
pain
inability to put weight on the affected ankle
skin discoloration
stiffness

Imaging tests, such as X-rays, may also be ordered to rule out a fracture.

Treatment Options:

Treating a sprained ankle is important to promote recovery and to prevent further discomfort. Treatment may differ depending on the severity of the sprain but will often consist of some or all of the following:

Using elastic bandages or a brace to wrap and/or support your ankle.
Using crutches, if needed.
Elevating your foot with pillows while resting or sleeping. This will help reduce swelling.
Medication
Stretching and strengthening when inflammation has reduced
Getting plenty of rest and not putting weight on your ankle.
Ice therapy as often as needed in the early stages of the sprain.
Strapping after injury to assist in ankle stability

Surgery is rare, but it may be performed when the damage to the ligaments is severe or when the injury doesn’t improve with nonsurgical treatment if you are prone to sprain your ankle.

In most cases, an ankle sprain isn’t very serious and will completely heal with proper treatment in a few weeks. The amount of time required for a full recovery will depend on the severity of the sprain. Although pain and swelling will eventually go away, your injured ankle may not be as stable as it once was so it may be necessary to do strengthening exercises and work on your ankle stability. If your foot type is supinated (high arched or you lean more towards the outside of your foot) and has had a number of ankle sprains it may be necessary to wear orthotic insoles that will support the outside of your foot and aim to prevent further sprains.

Arch Disorders

Arch Disorders – The arches of the foot, formed by the tarsal and metatarsal bones, strengthened by ligaments and tendons, allow the foot to support the weight of the body in the erect posture, dissipate shock, adapt to the terrain and assist in pushing the foot forward during gait. The main arches of the foot are the medial (inside of foot), lateral (outside) and transverse (across the foot). This asrch height is different for each person depending on their height, weight and anatomical make up. As podiatrists, the main arch we see issues with is the medial arch and the complications that occur when it is either too high or low. Low arches (sometimes known as fallen arches) are the most common.

Common Issues from Arch disorders:

Excessive inward rolling of the foot (pronation)
Excessive outward rolling of the foot (supination)
Internal rotation of lower leg and knee
Excessive rotation or tilting at the hip
Strain on lower back

These can manifest in a number of ways but the common injuries that are associated with the above are:

Low back pain
Hip Pain
Knee pain
Ankle pain
Bunions
IT band syndrome
Shin splints
Plantar fasciitis (heel pain)
Metartarsalgia
Morton’s Neuroma

Treatment Options:

Each of the above injuries will need to be treated in a number of different ways. We believe in treating the root problem of any injury and as podiatrists we consider some injuries are exaggerated by the arch condition of the foot. If an arch disorder is believed to be contributing to any of the above injuries it is important to address this to compliment your recovery program. This may include stretching and strengthening exercises in the lower limb and the foot, footwear modifications and in some cases orthotic insoless to heel realign the rear foot and support the arch also. We can provide ‘off the shelf’ insoles and make and fit high performance bespoke orthotic insoles to any footwear and for any sport the same day.

If the arch disorder is not corrected then it is likely injuries will return at some point in the future.

Arthritis

Arthritis is a common condition that causes pain and inflammation in a joint.

It affects people of all ages, including children and in the UK, around 10 million people are affected.

The most common types are:

osteoarthritis
rheumatoid arthritis

Osteoarthritis

Osteoarthritis often develops in adults who are in their late 40s or older. It’s also more common in women and people with a family history of the condition. It initially affects the smooth cartilage lining of the joint. This makes movement more difficult than usual, leading to pain and stiffness. Once the cartilage lining starts to roughen and thin out, the tendons and ligaments have to work harder which leads to swelling and the formation of bony spurs, called osteophytes.

Rheumatoid arthritis

In the UK, rheumatoid arthritis affects more than 400,000 people. It often starts when a person is between 40 and 50 years old and affects women more than men. It occurs when the body’s immune system targets affected joints, which leads to pain and swelling. The outer covering (synovium) of the joint is the first place affected. This can then spread across the joint, leading to further swelling and a change in the joint’s shape. This may cause the bone and cartilage to break down.People with rheumatoid arthritis can also develop problems with other tissues and organs in their body.

Symptoms:

The symptoms you experience will vary depending on the type you have. This is why it’s important to have an accurate diagnosis if you have:

joint pain, tenderness and stiffness
inflammation in and around the joints
restricted movement of the joints
warm, red skin over the affected joint
weakness and muscle wasting

Treatment Options:

There’s no cure for arthritis, but there are many treatments that can help slow down the condition. Your GP will discuss your specific treatments needs which may include medication. Treatment for rheumatoid arthritis aims to slow down the condition’s progress and minimise joint inflammation or swelling. To complement this, we aim to treat the effects of arthritis on your lower limb and consider preventative measures to reduce your risk of further complications.

Athlete’s Foot

The affected skin may be itchy, red, scaly, dry, cracked or blistered. The medical name for athlete’s foot is tinea pedis.

Signs and symptoms of athlete’s foot:

It commonly affects the skin between the toes the skin around the rest of the feet. It is not always painful.

Affected areas may be:

dry, red, scaly and flaky
white, soggy and cracked
itchy
sore
covered in small blisters

The infection can spread around your foot and to your toenails (see Fungal Nail Infections box). In severe cases, skin damaged by athlete’s foot can become infected with bacteria. This can lead to cellulitis, which causes the skin to become red, hot and swollen and can lead to other complications.

How do you get athlete’s foot?

It is caused by fungi growing and multiplying on the skin. The fungi that cause the infection thrive in warm, dark and moist places like feet.

You’re more likely to get athlete’s foot if you:

don’t keep your feet clean and dry
wear shoes that cause your feet to get hot and sweaty
walk around barefoot in places where fungal infections can spread easily, such as communal showers, locker rooms and gyms
share towels, socks and shoes with other people
have a weakened immune system
have certain other health conditions, such as diabetes

Treatment Options

Athlete’s foot is unlikely to get better on its own. It can usually be treated using antifungal treatments without needing to see a GP. We sell a range of anti fungal products which work by stopping the fungus causing your athlete’s foot from growing. They come in creams, sprays, liquids and powders, and are used in the following way:

wash and dry the affected skin before applying the treatment, and clean your hands afterwards
treatment should be applied directly to the affected skin and surrounding area
continue treatment after the rash has cleared including spraying in shoes every couple of weeks to reduce risk of reoccurrence

Preventing athlete’s foot

You can reduce your risk of developing athlete’s foot by:

good foot hygiene
drying your feet gently but thoroughly after washing them, particularly the areas between your toes
wearing cotton socks and roomy shoes made of natural materials such as leather – this can allow your feet to “breathe”
wear a fresh pair of socks, tights or stockings every day
change your shoes every couple of days – this allows them to dry out between uses
not walking around barefoot in public showers and locker rooms
not sharing towels, socks and shoes with other people
using talcum powder on your feet to stop them getting sweaty (but not in between toes)
not using moisturiser between your toes, as this can help fungi multiply

Contact your GP if your athlete’s foot doesn’t start to improve after a week of treatment.

Blisters

Blisters are small pockets of fluid that usually form in the upper layers of skin after it’s been damaged. The damage is usually caused by excessive pressure from new shoes, poorly fitted shoes or a sudden increase in exercise. Fluid collects under the damaged skin, cushioning the tissue underneath. This protects the tissue from further damage and allows it to heal. Most blisters are filled with a clear fluid (serum), but may be filled with blood (blood blisters) or pus if they become inflamed or infected.

Treatment options:

Most blisters heal naturally after three to seven days and don’t require medical attention. It’s important to avoid bursting the blister, because this could lead to an infection or slow down the healing process. If the blister does burst, don’t peel off the dead skin. Instead, allow the fluid inside the blister to drain and cover the area with a dry, sterile dressing to protect it from infection until it heals. We may release the fluid using a sterile blade and then dress it to reduce possibility of infection and allow it to heal quicker. We also stock a range of blister prevention plasters/pads and advise on ways to prevent them happening.

It is important to contact your GP if you think the blister is infected. The sign of infection may be

increased pain
recurring
yellow or green pus present
increased heat

Do not ignore any sins of infection as it may lead to further complications.

What causes blisters?

Blisters can be caused by:

friction to the skin
heat – for example, from sunburn or a scald
contact with chemicals, such as detergent or creams
some medical conditions

Prevention:

There are a number of things you can do to avoid getting blisters caused by friction. For example, you can:

wear comfortable, well-fitting shoes
help keep your feet dry with thicker socks or talcum powder
break footwear in gently over a number of days
don’t ignore any signs of pain
use a small amount of Vaseline on areas of increased pressure

PREVENTION IS BETTER THAN CURE!!

Bunion

A bunion is a bony deformity of the joint at the base of the big toe. The medical name is hallux abducto valgus.

The main sign of a bunion is the big toe pointing towards the other toes on the same foot, which may force the foot bone attached to it (the first metatarsal) to stick outwards. This can also happen on the 5th toe referred to as bunionette or tailors bunion.

Other symptoms may include:

a swollen, bony bump on the outside edge of your foot
pain and swelling over your big toe joint that’s made worse by pressure from wearing shoes
hard, callused and red skin caused by your big toe and second toe overlapping
sore skin over the top of the bunion
changes to the shape of your foot, making it difficult to find shoes that fit

Anyone can develop a bunion, but they’re more common in women than men. This may be because of the style of footwear that women wear.

What causes bunions?

The exact cause of is unknown, but they tend to run in families. Wearing badly fitting shoes is thought to make bunions worse and it is thought that people with flat feet are more likely to get them. It’s also thought that bunions are more likely to occur in people with unusually flexible joints, which is why bunions sometimes occur in children.

Treatment options:

Non-surgical treatments are usually tried first, including painkillers, orthotics (insoles) and bunion pads. However, these can only help to reduce the symptoms of bunions, such as pain. They don’t improve the appearance of your foot and the shape cannot be reversed. Surgery may be considered if your symptoms are severe and don’t respond to non-surgical treatments but this can lead to reduced motion in the joint, altered gait and foot function and in some cases there may still be pain.

Prevention:

The best way to reduce your chances of developing bunions is to wear shoes that fit properly. Shoes that are too tight or have high heels can force your toes together. If you have flat feet or fallen arches David can produce custom made orthotic insoles to improve the function of your foot.

Callus & Corns

Callus & Corns are areas of hard, thickened skin that develop when the skin is exposed to excessive pressure or friction. They commonly occur on the feet and can cause pain and discomfort when you walk.

Callus

Hard, rough areas of skin that are often yellowish in colour. They can develop in any area where there is an increase in pressure. The most common areas are:

balls of the foot
under the metatarsals
the sides of the foot
on the toes (under, top or apex)
around the heel

Calluses are larger than corns and don’t have such a well-defined edge. As skin is thickened, it’s often less sensitive to touch than the surrounding skin. They develop when the skin rubs against something, such as a bone, a shoe or the ground and can be painful or pain free.

Other possible causes of include:

excessively dry skin
reduced fatty padding under feet – elderly people have less fatty tissue in their skin

Treating Callus

A sterile blade is used to debride (shave) away the damaged/thickened skin or filed using a water spray drill. As with corns the prime objective is to remove the cause of pressure to the affected area and therefore reducing chance of reoccurrence.

Corns

Small circles of thick skin that usually develop on the tops and sides of toes or on the sole of the foot. The cause is again increased pressure and/or friction. They differ from callus as the nucleus is still present which makes it feel like walking on a stone and usually more painful. However, they can occur anywhere.

Corns are often caused by:

wearing shoes that fit poorly – shoes that are too loose can allow your foot to slide and rub
certain shoe designs that place excessive pressure on an area of the foot – for example, high-heeled shoes can squeeze the toes

Treating corns

Corns on feet won’t get better unless the cause of the pressure is removed. If the cause isn’t removed (ie: tight shoes), the skin could become thicker and more painful over time. We enucleate (dig out/remove) the corn with a sterile blade and/or water spraying drill and offer advice on how to prevent them in future.

We do not recommend corn plasters due to the damage they can do to surrounding tissues.

Preventing Callus & Corns:

Dry your feet thoroughly after washing them and apply a good quality moisturising foot cream (not body lotion).
Use a pumice stone or foot file regularly to gently remove hard skin. If you use a pumice stone, make sure it dries completely between uses and doesn’t harbour bacteria.
Wear comfortable footwear that fits properly. Always shop for shoes in the afternoon, because your feet swell as the day goes on.

Don’t put up with foot pain as if it’s normal!!

Cracked Heels

Dry, cracked heels can not only be unsightly, but can often be source of pain and embarrassment. Most minor cracked heels are able to be treated at home but in some cases you may need to see a podiatrist to get you started. If there is an excessive amount of thickened skin on your heel, that needs to be debrided (shaved off) by using a sterile blade. Ideally, this should be done by a HCPC registered fully qualified and insured podiatrist.

What are Cracked Heels?

Cracked heels are caused by cracking or splitting of the skin. This splitting may be due to dryness or thickening of the skin (callus) that cracks and breaks under pressure. When the skin around the heels becomes thickened or dry, it loses it’s suppleness and elasticity, and can split under simple pressures such as that from walking.

Causes:

Walking around barefoot or in footwear such as flip flops or open backed sandals which dry’s out the feet
Long standing at work or home, especially on hard floors
Increased weight which causes increased pressure on the heels causing callus. With increased weight the heel is also required expand more and hence can often crack more.
Poorly fitting shoes or sandals.
Poor foot hygiene
Unhealthy, dry scaly skin that can be caused by climate, such as low humidity during dry summers or cold winters
Poor nutritional diet.
Circulation problems
Can also be caused by other health conditions such as diabetes, thyroid problems or psoriasis and eczema.
Ageing process with less supple skin and reduced circulation

Treatment Options:

In addition to cleaning the dead dry skin from your heels for you, we aim to treat the underlying causes to your cracking as well as giving you the right advice on how to keep your heels in great condition.

Using a heel balm or oil based moisturiser twice daily. Using a heel balm in the morning is very important as it increases the elasticity of the skin on your heels before you get moving for the day and assists in decreasing the occurrence of cracks.
A pumice stone or a foot file can be used to reduce the thickness of the hard skin.
Wear closed in shoes and good socks when you can.
Drink plenty of water to keep you and your the skin hydrated.
Essential fatty acids within your diet (e.g. Omega 3 fatty acids) and a good diet may assist.
If cracks start to bleed apply an antiseptic to prevent infection and keep clean with a dressing as needed. See your GP or podiatrist if in doubt.

Diabetic Foot

Diabetic foot – Diabetes is a condition where your body has a problem producing or using insulin effectively which can cause blood sugar levels to be too high. This can result in a number of complications around the body especially if the foot and lower limb.

High blood glucose levels can cause damage to different areas of your body and this includes your feet and legs. High blood glucose levels can damage your blood vessels which can affect the blood supply (circulation) to your feet and legs and may mean that less blood gets to your skin, muscles and tissues.

High blood glucose levels can also cause damage to the nerve systems in your body, which stops important messages getting to and from your brain. The nerves in your body that are most likely to be affected are the longest ones – the nerves that lead to your extremities (feet and legs). Nerve damage in this way is called Peripheral Neuropathy.

Damage to sensory nerves:

Inability to feel pain, extremes of temperature and vibration

Damage to motor nerves:

Affects muscles in your feet causing toe joints and bones to change shape

Damage to autonomic nerves:

reduces the amount of sweat that your feet produce, which will make your skin very dry and increase risk of callus, corns and pressure ulcers

Some sensations you may feel if nerves are damaged:

Tingling or pins and needles
Numbness
Pain
Sweating less
Feet may look red and feel hot to the touch
Changes in the shape of your feet
Hard skin
Losing sense of the position of your feet and legs

Some sensations you may feel if blood supply is affected:

Cramp in your calves
Shiny
smooth skin Losing hair on your feet and legs
Thickened toenails
Cold, pale feet
Change in the colour of the skin on your feet
Wounds or sores legs
Pain in your feet

Prevention foot complications:

Preventing foot problems in the future is about being positive and active now, rather than acting only when there is a problem. Preventing problems starts with managing your diabetes well, leading a healthy lifestyle and keeping your blood glucose levels well controlled. By doing this you can prevent or slow down any changes to the nerves and blood vessels that supply your feet and legs. It is advisable that you have a diabetic foot assessment at annually with the NHS. We conduct diabetic foot assessments and can tailor them to fit around your NHS appointments meaning you can have your feet assessed twice a year as changes in the foot can happen quickly.

Washing and moisturising your feet every day will keep the skin supple and healthy, checking them daily will help you to spot any injury or skin damage quickly. Preventing the build-up of hard skin and protecting your feet from injury will keep your feet healthy. Make sure your footwear is suitable and clean and never walk around bare foot.

If you have diabetes, it’s important to try to stop smoking. Smoking impairs the blood circulation which can lead to increased healing time form any cuts or sores.

As podiatrists we don’t treat the condition of diabetes but we play an important role in treating the effects of diabetes and aim to prevent you getting any complications in the lower limb.

Don’t ignore any problems with your feet!

Its far harder to fix a problem after its occurred than to prevent it before it happens!

If in doubt get in touch with us or contact your GP!

Fungal Nail Infection

Fungal Nail Infection of the nails are also known as onychomycosis. The fungi here is similar to the fungi involved in athlete’s foot and in most cases the infection can begin as athlete’s foot (dermatophyte fungi). In athlete’s foot the fungi live in the keratin that makes up the outer layer of the skin, but they can also invade the hard keratin of which nails are made.

Some causes:

Poor foot hygiene
Damage to nails from dropping objects on them
Poor footwear
Contagious so sharing towels/shoes with family members can spread the infection
Poor diet and lifestyle
Poor circulation
People who smoke
Immunosuppressed

Fungal Nail Infection Symptoms:

At the start, there are usually no symptoms. Later the nails may become so thick that they hurt when they press on the inside of a shoe due to additional pressure. The infection can spread across the whole nail or just a part down the side or at the top end. The infected areas turn white or yellowish, and become thickened and crumbly. Not all discoloured nails have a fungal nail infection.

Fungal nail infections are sometimes difficult to trim without professional equipment. We use water spraying drills to reduce the thickness of the nail allowing it to be trimmed, pain free and more effectively. This also ensures the best possible chance for any treatment to penetrate your nail bed where the infection lies.

Diagnosed:

Many nail problems can look like a fungal nail infection – for example the changes seen in psoriasis, or after a bacterial infection or an old injury. The diagnosis of a fungal infection should be confirmed before treatment starts. In most cases your GP will take a piece from a crumbly area of your nail and send it to the laboratory to check if a fungus can be seen under the microscope or grown in culture. This process can take time and be costly so in some cases your GP or podiatrist will prescribe some form of treatment depending on the appearance of the nail and their clinical knowledge.

Treatment Options:

Research suggests that the most effective treatment for fungal nail infections are a tablet (such as Terbinafine) from your GP. The usual adult dose is 250 mg once a day for three to six months for toenails as well as painting a lacquer on during this same period. In some cases this medication can interact with other medicines for other conditions so a tablet is not always prescribed. Treatment success rates are between 60-80%
Natural products such as tea tree oil or certain vinegars are sometimes effective
Nail surgery may be necessary if the nail is painful and a continuing problem. We can perform total or partial nail surgery under local anaesthetic and apply a chemical (phenol) to prevent regrowth of the nail (97% success rate of preventing regrowth). We will work with you through the whole process including dressing appointments until the toe has fully healed
Lead a healthy lifestyle – exercise/ good hygiene and healthy diet
There are a number of exciting new products coming on to the market including laser therapy and clearanail (a drill that drills tiny holes in the nail to allow deep penetration of ointment). Success rates are positive but it is too early to tell if they are more effective than traditional methods.

Any treatment will require patience and consistency on your part to give the nail the best possible chance of recovery. Unfortunately, even when the infection has been cleared, some nails may never gain the same appearance as before the infection.

Gout

Hallux Limitus/Rigidus

Hammer Toe

Ingrown Toenail

Morton’s Neuroma

Osgood-Schlatter Disease

Osgood-Schlatter disease (OSD) is one of the most common causes of knee pain in young people. It is an inflammation of the bone, cartilage, and/or tendon at the top of the shinbone (tibia), where the tendon from the kneecap (patella) attaches. Most often only one knee is affected.