Among the most common ailments of the foot, plantar fasciitis is primarily due to arch tension. Small, microscopic tears and painful swelling can form within the plantar fascia (the long supportive connective tissue layer within the arch of the foot). This injury usually occurs at its attachment beneath the heel bone. The result is inflammation, stiffness, and discomfort while walking and standing, in particular after rest, and during propulsion (heel lift-off phase of walking). Treatment for this issue involves identifying predisposing postural issues, so that long term strategies to reduce elongation and associated stress on the arch of the foot during walking can be controlled. Taping the foot, footwear changes and gait retraining are often important, and custom orthotics can be very helpful for the long term management of this often debilitating issue. In chronic recalcitrant cases, targeted injection therapy using corticosteroid (Cortisone) can be very effective.
A bunion occurs on the side of the foot, typically at the base of the big toe, or hallux. A fluid-filled sac (Bursa) under the skin can cause a visible enlargement. However, the term is also commonly used to describe a structural, or bony, deformity known as hallux abducto-valgus (HAV). Bunions are often associated with poor foot posture or biomechanical issues such as excessive foot pronation or flexible feet. Bunions can cause significant pain, and are aggravated by activity and tight shoes. Treatment includes footwear modification, addressing underlying biomechanical issues via custom orthotics. Cortisone injection can be very useful where there is a painful bursa present.
A neuroma occurs when a nerve in the foot becomes irritated, and is enlarged by swelling. If its irritation is prolonged, it can become thickened, and cause still more irritation. Discomfort from a neuroma is usually felt on the ball of your foot, and can include shooting pain through the toes and numbness. Treating the cause of the nerve irritation is crucial, by wearing wider shoes and stabilising excessive movement of the bones within the foot via the use of shaped padding or custom orthotics can reduce irritation to the nerve. Cortisone injection can be helpful for recalcitrant cases of neuroma.
Corns & Callouses
These areas of thickened and hardened skin typically develop as a result of pressure, or rubbing over a bony prominence. If it is small and deep, it is called a corn, which more diffused occurrences are referred to as callouses. Treatment involves trimming of the hard dead skin layer and protecting the area from future pressure and rubbing.
Toenail Fungal Infections
Like with most fungi, foot fungi need a warm, moist, and dark environment to flourish – such as the interior of a shoe. A fungal infection can discolour your nails, thicken them, or make them crumbly or loose. There are numerous culprit fungi at work, and the hardness of the nails makes them difficult to treat. Identifying the organism via pathological culture and microscopic examination is critical to confirming a diagnosis, before starting a patient or either topical antifungal treatment after thinning down the nail(s), or prescription or oral antifungal drugs for more significant deeper nail infections or when multiple nails are involved.
Ingrown Toenail (onychocryptosis)
This common ailment can occur for a number of reasons. The sides, or the corners of the toenail will often curve down and put pressure on the skin. This can sometimes pierce the skin, and begin to grow in to the skin, causing redness, swelling, pain, and infection. Reshaping and filing of the nail can often settle this issue but some patients may require a procedure called a partial nail resection, performed under local anaesthesia, to permanently remove the offending nail edges. If bacterial infection has developed secondary to the nail becoming ingrown, prescription of oral antibiotics may be required.
Also known as a claw toe or mallet toe, this occurrence involves imbalance in the pull of the tendons in your toes, resulting in a deformity. The tendon will either pull harder on the top or the bottom, resulting in a pronounced curl. Deep supportive shoes and often custom foot orthotics to attempt to address tendon imbalance can help relieve pain associated with hammer toes.
Warts or Papilloma (Verucca)
Caused by a virus, warts or Verruca, can occur anywhere on the feet. They can cause considerable pain, depending on their location and how much pressure they are exposed to. They are also often confused with callouses or corns, due to the build of overlying hard skin. Traditionally, treatment involves trimming overlying hard dead skin and then killing the skin infected by the virus by means of chemical or freezing techniques. We now offer advanced targeted microwave therapy, utilising the Swift Microwave therapy radio frequency emblation unit. This treatment focuses on immune system modulation rather than traditional, more painful, and destructive treatments. This new high tech treatment is proving very useful for treating children and more stubborn recalcitrant lesion in adults.
Flat Feet (pes planus)
Flat arches are often associated with excessive foot pronation and can lead to chronic soft tissue injury and arthritis, and even stress fractures in athletes or in older patients with osteoporosis. They can be due to a wide variety of biomechanical causes, but are quite treatable once diagnosed. Treatment often includes the prescription of foot orthotics or supports, and also stretch/strengthen regimes and gait retraining.
Athlete's Foot (tinea pedis)
A fungus, Athlete’s foot is a very common skin condition. It can cause redness, peeling, itchiness, and small, fluid-filled bumps. You typically find it between the toes, or on the bottom of the foot. Treatment usually involves topical application of antifungal creams, or in more serious recalcitrant cases the prescription of oral antifungal drugs can be required. Prevention strategies are crucial to prevent recurrence.
Tendinopathies involves pain and sometimes inflammation of one or more of the many tendons within the foot or ankle. Acute tendonitis can occur during a single episode of overload, or chronic overload can cause the tendon to slowly become weakened as it is no longer able to repair micro trauma associated with regular activities. It may then become thickened, or in some cases develop nodules or bumps within the tendon. Tendinopathy, left untreated, can eventually lead to the rupture of the tendon. Identifying and addressing underlying postural or biomechanical issues is crucial in the management of this issue, and progressive loading strengthening regimes +/- prescriptions of custom Orthotics need to be implemented to allow the tendon to become strong enough to be no longer painful.
N.B. Often, when diagnosed foot posture and function, podiatrists often must address biomechanical factors that are contributing to injury in other areas of the body, including the shin, knee, or back.