Conditions

Toe Pain

Rich River Podiatry Foot Pain

First Toe Arthritis

The big toe also called first metatarsolphalangeal joint (MTP) joint osteoarthritis (OA) is a common and painful problem that causes significant disability. In a recent  Australian /UK study 7.8% of those over 50 years of age  suffered from symptomatic pain in first MTP joint. People with this condition also experienced difficulties performing functional weight- bearing activities and worse quality of life compared with those without the condition.

Symptoms
Treatment
Arthritis causes inflammation which may present as swelling and pain around the big toe. The toe may also have restricted upward movement caused by secondary bone spurs or loss of joint cartilage.
Other symptoms of Big Toe Arthritis may include: tenderness, achiness and difficulty walking.
You are more likely to develop osteoarthritis if you have a family history of it or past injury. The risk of OA increases as you get older due to normal wear and tear on the big toe.
Common causes may include: trauma, excessive foot pronation (rolling in) and prolonged weight bearing.
Osteoarthritis is progressive and permanent. At present, little can be done to ‘undo’ damage at the big toe. X-rays may help grade the severity of the damage. Your podiatrist will assess the need for an x-ray.

Short-term First Toe Arthritis treatment may consist of the following:


Avoidance of aggravating activity and running of soft surfaces

Shoes with a stiff or rocker bottom sole

Podiatry treatment may consist of:


Strapping the toe to reduce movement where required

Splints or braces

Custom made orthotics to control foot pronation and reduce the load on the big toe

Anti-inflammatory medication
Referral for surgical assessment and opinion

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Rich River Podiatry bunions

Bunions

A Bunion (Hallux Valgus) is a lateral deviation of the Big Toe at the First Metatarsal joint. They are not growths as is the common misconception; however, do become more prominent as the deformity progresses.

Symptoms
Causes
Treatment
Swelling, pain and redness at the big toe joint may be due to the presence of a bunion. Enlargement of the tissue around the joint may be due to secondary bursitis. The increased pressure under the metatarsal phalangeal joint can also lead to skin lesions like corns and callous. As the bunion progresses, pain across the outside of the ball of the foot may occur due to the improper function of the hallux and shoe pressure.
Pain is typically relived by removing shoes or by wearing open toed shoes or wearing extra depth/width footwear ie. Dr Comfort Footwear or width fittings which vary from C to EEEE width fittings.
Patients with bunions usually have a family history of the condition. Tight footwear and high heeled shoes can apply a force to worsen the position of the toe. Excessive foot pronation (rolling in) and tight calves/ Achilles will also be assessed for by your Podiatrist.
Padding the toe and wearing wide fitting shoes will help reduce pressure on a bunion. Reducing abnormal forces due to poor foot function with orthotics is very important. They will not only improve patient comfort, but can reduce the rate in which the bunion progresses. Surgical opinion can be sort if conservative measures fail.
Curled claw foot

Toe Claw

Bent toes in an odd position known as Toe Clawing, are generally due to tight muscles underneath the foot. Tight or ill-fitting shoes can cause the muscles of the foot to become out of balance.

Categories
Symptoms
Treatment
Hammer toe – the toe bends at the middle joint.
Claw toe – the toe bends at both joints in the toe. This increases the pressure underneath the forefoot of that toe.
Mallet toe – the toe is bent at the last joint closest to the tip of the toe.
Toes that are bent back or sit in an odd position. They are often associated with corns and callous caused by pressure from shoes.
During the ‘push off’ phase of gait the long flexor tendons contract to stabilize the toes. When the foot is overpronated (rolled in) and unstable, the tendons contract excessively causing the toes to claw.
Genetics can play role in some cases of toe clawing; as does trauma, infection, arthritis, and certain neurological and muscle disorders.
Improving foot biomechanics and function via footwear and orthotics is particularly important to prevent progression of deformity. Custom made splinting and specific exercises for the toe muscles can also be beneficial. Small pads can be used under the ball of the foot to help straighten the toes.
A surgical referral may be considered in cases of severe deformity.

Ingrown Toenails

Ingrown toenails occur when a nail edge pierces or presses into the skin. The skin can the become tender, swollen and even infected.

Symptoms
Treatment
The skin can then become tender, swollen and even infected. An ingrown nail can be caused by incorrectly fitting footwear, trauma, abnormal nail shape, incorrect nail cutting technique and toe deformity.
Most cases can be resolved with conservative care. In some severe cases antibiotics and or nail surgery may be required. Very few require surgery and so non-painful conservative care is all that is needed for most patients.
If you think you have an ingrown toenail:
• Warm salt bath daily . Soak for a few minutes.
• Cover with antiseptic dressing
• Keep all shoe pressure off it
• Check your shoe fitting. Avoid narrow shoes you may think are too short or shallow or taper across your toe.
• If there is redness, heat or swelling it is best to book an appointment and get it seen to before it gets worse.
Conservative care is always preferable to having to take antibiotics or have surgery.
If you think you have an ingrown toenail:
• Warm salt bath daily . Soak for a few minutes.
• Cover with antiseptic dressing
• Keep all shoe pressure off it
• Check your shoe fitting. Avoid narrow shoes you may think are too short or shallow or taper across your toe.
• If there is redness, heat or swelling it is best to book an appointment and get it seen to before it gets worse.
Conservative care is always preferable to having to take antibiotics or have surgery.


Heel and Arch Pain

Rich River Podiatry Foot Pain

Plantar Fasciitis

The Plantar Fascia is a thick band of connective tissue that supports the arch and provides dynamic shock absorption.

What Is Plantar Fasciitis?

Plantar Fasciitis is an overuse condition where the collagen of the plantar fascia is damaged. This can occur in the arch or heel of the foot.

Symptoms
Treatment
Pain is usually of gradual onset and can feel like a sharp stab or deep ache, most commonly in the heel of the foot. It is often worse of a morning (first step pain) and settles down with activity as the area warms up. Pain may be present post-activity and after long periods sitting down.
Patients with very high arches or low arches are at risk of developing plantar fasciitis. This can be due to poor shock absorption or increased strain on the plantar fascia respectively. Overtraining, running on hard surfaces, wearing old shoes or tight calf muscles may also contribute.
If inflammation in the heel becomes particularly severe, it may involve nerve components in the region causing pain elsewhere in the heel. Night time pain can also develop in the most severe cases.
Plantar Fasciitis is a persistent condition which can get worse and more difficult to treat the longer it’s present.

Short-term treatment may consist of the following:

  • Avoidance of aggravating activity and running of soft surfaces

  • Correctly fitted running shoes

  • Avoidance of walking barefoot

  • Stretching the plantar fascia and Achilles tendon

  • Icing and massaging the foot with a golf ball.

Podiatry treatment may consist of:

  •Strapping the foot to support the arch

  •Orthotics

  •Cortisone injections

  •Night Splints

  •Anti-inflammatory medication
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Rich River Podiatry Severs

Sever’s Disease

Is your child complaining of sore heels after sport?

Pain in the heel and ankle are very common complaints of growing, active children.  As we want to keep them active, it is important to have these problems assessed and not just dismiss them as growing pains.
One of the most common causes of the heel pain is sever’s disease, or traction calcaneal apophysitis.  This problem usually involves an inflammation of the growth plate in the heel bone called the calcaneus.  The average age is usually between 8-14 years of age.

Symptoms
Treatment
• A child of susceptible age will often have a limp on the affected side after sport.

• Tight calf muscle

• Squeezing of the heel bone is painful.

• Rapid increase in musculoskeletal growth associated with functional inflexibility.

Contributing factors are:
• Growth phase in long bones

• High levels of activity

• Higher BMI (Body Mass Index)

• Poor foot and or lower limb posture function

Treatments generally consist of educating parents and the child to understand the growth plate site.
The aim of treatment is to continue sport involvement . Treatment may involve the following depending on the underlying causes.
 • Relative rest and modifying activity to decrease strain in heel.

 • Stretching of the calf muscles group

 • Checking and changing shoes

 • Assessment of lower leg alignment. Supports if required, may be issued

 • If ankle movement is restricted. Heel lifts for sport may be considered for a period of time.

 • Reducing exposure to high impact activities like jumping when pain is severe.


Ankle Pain

Rich River Podiatry ankle

Ankle Sprains

Ankle Sprains are a common sporting and mishap injury. Usually the injury involves stretching or tearing the outside ligaments of the joint which will happen when the ankle moves inwards. Occasionally the inside ligaments can be injured when impact is high or when the ankle is moved forcefully outwards.

Symptoms
Causes
Treatment
Pain on the outside of the ankle following injury is most common. Bruising and swelling may also be present depending on the severity of the injury. Ankle sprains can also lead to injury of the peroneal tendons on the outside of the ankle, fracture of foot or leg bones and damage to the cartilage and ligaments inside the ankle.
Ankle sprains may occur during sports that involve jumping and side to side movement e.g. Football, basketball, netball and tennis. Mishap injuries can result from falling from a height, tripping over, and the use of high heeled shoes.
  • Rest immediately post injury to allow the area to settle. It is common for swelling to be quite bad.
  • Ice for 20 minutes every 2 hours.
  • Use a bandage to compress the ankle.
  • Elevate the ankle above the level of the heart e.g. lying with the foot propped up.
  • Review by your Podiatrist if you are unable to take weight on the affected leg.
  • If you are unable to take weight on the leg or tolerate it being touched, there may be a fracture in the area which will require x-ray and immobilisation. CAM walker boots can be ordered in by Rich River Podiatry.
Depending on the severity of the ligament injury, a rolled ankle generally takes 3-6 weeks to resolve enough to be pain free. However it is very common for ankle to have poor balance following injury.
Your Podiatrist can guide your return to sport with exercises to develop stability of the joint. This is particularly important in reducing the likelihood of repeat ankle sprains, which reduce the long term strength of the ankle. Your Podiatrist will also be able to provide activity specific footwear advice, to ensure appropriate support.
Sore Ankle 2 SQ

Ankle Pain

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Symptoms
Treatment
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Ankle Sprain SQ

Peroneal Tendinopathy

Peroneal Tendinopathy is the most common cause of pain on the outside of the ankle resulting from overuse. There are two Peronel Tendons that cross the lateral ankle joint to insert to the outside of the foot and under the big toe joint. Damage to the tendons may be the result of acute injury (ankle sprain) by overuse or lateral instability of the ankle.

Symptoms
Treatment
Pain on the outside of the ankle that is aggravated by activity and relieved with rest. Local tenderness directly over the tendons is common with clinical assessment. Resisting the outward movement of the ankle can often reproduce a patient’s symptoms.
Tendinopathy is a broad term that covers painful conditions that cause damage in and around tendons. Latest research suggests this occurs without the presence of inflammation; however inflammation of surrounding structures may occur.

Common causes of overuse in the peroneals may include:
• excessive foot pronation (foot rolling in)

• excessive foot supination (foot rolling out)

• running on a uneven surface

• soft footwear

• tight calves

• sports involving high activation of the peroneals i.e. jumping and side to side movements (e.g. basketball, netball and volley ball)
Initial treatment should involve rest from aggravating activities, soft tissue therapies and massage. Pain medication and bracing of the ankle may also be required in the short term.
Your podiatrist will assess your current running shoes to ensure appropriate support. Lateral wedges can be prescribed to reduce tension through the tendons. Progression to foot orthotics may be needed for long-term support and lateral stability which can be provided by Rich River Podiatry. Ankle exercises will also be prescribed to strengthen the tendons.
Rolling Foot

Tibialis Posterior Tendinopathy

The Tibialis Posterior Tendon functions to control or decelerate foot pronation (rolling in). The tendons are dynamic stabilisers of the rearfoot and help support the arches of our feet. Tibialis Posterior Tendinopathy is the most accurate term to describe overuse conditions of the tendon characterised by tissue damage.

Symptoms
Treatment
Pain occurs on the inside of the ankle that extends towards the middle section of the arch. Swelling may be present in more substantial cases. Local tenderness directly over the tendons is common with clinical assessment. Resisting the inward and upward movement of the ankle can often reproduce a patient’s symptoms. Patients may also have difficulty performing a single leg heel raise.

Injury of the tibialis posterior tendon is usually the result of overuse rather than acute injury. Tendinopathy is a broad term that covers painful conditions that cause damage in and around tendons.
Common causes of tibialis posterior tendon overuse may include:
• excessive foot pronation or inward rolling of the foot when we toe off

• direct or indirect trauma
Non supportive footwear
• inflammatory conditions (e.g. rheumatoid arthritis)
Treatment of tibialis posterior tendinopathy is dependent on the classification (severity) of the injury. Conservative treatment should involve relative rest from aggravating activities, icing and exercises to load the tendon. Pain medication may also be required in the short term.
A custom made foot orthosis may be prescribed by Rich River Podiatry to control excessive foot pronation. In severe cases your podiatrist may recommend a period of immobilisation in an ankle brace or air cast.
Custom footwear assessments and advice will be prescribed.

Knee Pain

Rich River Podiatry Shin

Knee Pain

Patello-Femoral pain is a medical term used to describe all pain at the back of the patella (knee cap) where it articulates with the femur (thigh bone). It is one of the most common knee pain complaints in both active sports people and those who have experienced more wear and tear. The average person walks 150,000 kms plus in a lifetime.

Symptoms
Causes
Treatment
Non-specific or vague pain is often reported. This may be on the inside, outside or at the base of the patella and made worse by activities that load the patellofemoral joint (PFJ). Sitting for prolonged periods and walking up or down stairs usually aggravate the symptoms.
Factors that increase PFJ load lead to the development of pain. These can be intrinsic (belonging inside the body) or extrinsic (outside the body).
Extrinsic factors include: speed of gait, training surfaces and footwear. Training errors are also common such as high training volume, increased speed of running, and running up and down hills/ stairs.
Intrinsic factors are those that impact on the movement of the patella within the femoral groove (patella tracking). These include: muscle weakness or imbalance, increased body mass, abnormal inward rotation of the knee and leg or a pronated foot type.
Treatment of patellofemoral pain involves addressing both the extrinsic and intrinsic cause of pain.
Immediate treatment should focus on the reduction of pain and inflammation including rest from aggravating activity, icing and stretching.

Extrinsic factors must be addressed and modified if necessary:
• Reduce training volume

• Running on soft surface

• Running on flat ground

Intrinsic treatment should occur when symptoms first occur with your Podiatrist and Physiotherapist which may include:
• VMO and glute strengthening

• Footwear and in-shoe foot orthotics
• Muscle assessment, stretch and strengthening
• Soft tissue assessments
• X-rays and further imaging may be required

Shin Pain

Rich River Podiatry Foot shin

Shin Pain

Shin splints or shin pain can be caused by injuries to the muscle along the shin, stress fractures and compartment syndrome.
Shin pain is a common injury that affects athletes who engage in running sports and other activities such as tennis, golf and walking.

Symptoms
Diagnosis
Treatment
Pain is often felt along the inside (medial) aspect of the shin or down the outside (lateral) of the lower leg.
It generally occurs as a result of:
• Sudden increase in the frequency, duration and intensity of activity
• Strongly linked to inappropriate footwear
• Hard training surfaces
• Abnormal biomechanics is a major cause in the development of shin pain
• Over-pronating (rolling in) of the feet, over-striding lower legs, poor running technique all contribute to shin pain.
In order to determine the cause of your shin pain your podiatrist will conduct a full physical, walking and running assessment.
It may also be necessary to undergo specialist diagnostic test such as x-ray, ultrasound and bone scan. It is important we check to ensure there are no tibial stress fractures as his can significantly delay healing and prevent return to activity
Shin pain can be summed up in 4 words, too much too soon?
The initial objective in the treatment of shin pain is to relieve the pain and inflammation. We recommend the use of ice initially and cessation of weight bearing activity.
The underlying cause of your shin pain is established and treated using:
• Ice
• Massage and stretching
• Gait analysis
• Orthotics may be required to correct any detected biomechanical issues that may delay healing

We will then be able to assist you with an ongoing maintenance program to prevent the shin pain from returning.

Skin and Nail

Rich River Podiatry corns

Corns and Callouses

A corn is a small circular thickened lesion in the skin of the foot.
Corns can also occur under the feet due to abnormal alignment within the foot posture.

Symptoms
Causes
Treatment
A corn is different from a callous in that it has a central core of hard callous.
It usually forms due to repeated direct pressure on the skin due to bony prominences. People that have abnormal toe alignment such as hammer, clawed ,mallet toes often suffer from corns because the toes are bent and rub against the shoe (if not deep enough) or result ground forces pushing up into the toe.
 Corns can also occur between toes due to footwear that is too narrow.
There are a number of treatment options for corns and calluses. If they get thick enough to cause pain we will diagnose the cause and recommend a non-painful treatment option that is most appropriate.
It is important to identify the underlying cause of the corn or callus, otherwise they will usually return.
Avoid trying to treat a corn yourself, especially if you have diabetes or poor blood flow. These treatments contain acid and can result in significant chemical burns and infections.
Rich River Podiatry Foot Warts

Plantar Warts

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Symptoms
Causes
Treatment
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Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat.
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Children’s Feet

baby-foot-toes-newborn-feet-infant

Children's Feet

It may be difficult to imagine when looking at a newborn baby that they have around 300 bones and those bones are growing and changing every day. Adults on the other hand have 206 bones.
The process of bone development is called ossification. At birth many of the bones are made entirely of cartilage, a type of connective issue that is tough and flexible. As a baby grows into childhood, much of that cartilage will be replaced by actual bone. As the bones grow, they fuse together and this is why the actual number of bones decrease.
By 18 years of age most of the bones are fully formed but up to that age, children’s feet go through many changes.
As toddlers, children are encouraged to stand and walk at their own pace. They don’t really require footwear indoors and on soft surfaces as it helps promote strong muscles within the feet and legs.
Children go through normal stages of walking with their toes pointing out with knees bent, then toes pointing inwards. These are normal at different ages but if a child is tripping a lot, crying and rubbing legs or complaining of pain, it is a good idea to have your Podiatrist assess them.
As young children’s feet are soft and pliable, prone to damage from abnormal pressures, correct shoe fitting is very important. Children’s feet will grow 2 shoe sizes a year up to the age of four and roughly 1 shoe size a year from then on.
Check small children’s feet at least 1-3 months up to the age of 3 years and then every 4 months up to the age of 5 and then every 6 months from 5 years of age.

Heel Pain

Heel pain can also occur in growing children between the ages of 8-13 as they start to play more sports. If pain is limiting their activity, it is a good idea to have this investigated by Rich River Podiatry. Your Podiatrist can let you know if the heel pain is part of the growing process or injury related and suggest a treatment plan either way.

Warts

Children and teenager’s feet are more susceptible to Warts as their immune systems are still developing. If a Wart is painful or spreading quickly it is highly recommended to have them assessed. They are highly contagious, and it is a good idea to wear thongs in the shower otherwise the rest of the family and friends may contract them.

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