Hammer toes, Claw Toes and Retracted Toes. Hammer toes, claw toes and retracted toes are deformities that affect the little toes and not the big toe. The toes curl over or lift off the ground which creates pressure on the tops of the toes or increased pressure under the ball of the foot causing callus and corns to form. The lesser toe deformities are due to a variety of reasons including neurological deficiencies, muscle imbalances, arthritis or even injuries to particular tendons. The toes often require shoes with a deeper area in the toe box portion of the shoe. Tubes for the toes, little rubber props and even orthotics can help to reduce the stresses through the toes due to the deformity. Morton’s Neuroma A neuroma is thickening of the tissue around a nerve causing nerve related pain in the ball of the foot and into the toes. More often than not it affects the 3rd and 4th toes but the neuroma can be within any of the spaces between the toes. In addition to pain, numbness in the toes may occur or tingling between the toes, shooting pain into the toes or a ‘click’ might be felt under the forefoot. Treatment for a neuroma is aimed primarily at modifying the cause so wearing a wider fitting shoe with a lower heel is ideal. Addressing poor biomechanics with the use of orthotics is also essential as excessive pronation or supination can lead to a neuroma formation. Surgery is also an option but best utilised when conservative management has been unsuccessful. Sesamoiditis Under the big toe joint are 2 small bones that sit within a tendon. They are called sesamoids and, if pressure is increased under the area, can become irritated and create sesamoiditis. Football boots can be an instigator of sesamoiditis due to stud configuration causing direct pressure under the area, as does a particular foot type where the big toe joint sits lower than the other joints known as a plantar flexed 1st ray. When the sesamoids are inflamed, they require offloading. It there is a fracture this can be done with a post operative boot otherwise an orthotic with particular forefoot padding if often sufficient. For any forefoot pathology, a consultation with a podiatrist at Gait Way Podiatry is essential to discuss the appropriate treatment options for you. Related Conditions Arch Pain Are Your Feet Ready For the Jetty to Jetty Fun Run? Bunions Claw Toes Foot Pain Investing in Tradespeople’s Health: Why It Matters Morton’s Neuroma Plantar Fasciitis PROLOTHERAPY Sesamoiditis

Dry, cracked heels can be unsightly, and they can be cause of pain and embarrassment. Cracked heels are caused by dryness or thickening of the skin (callus) which then cracks or breaks under pressure. If this becomes severe enough, then fissures may form. When the skin around the heels becomes thickened and dry, it loses the natural elasticity in the skin, and can split under pressure causing painful and even bleeding heels. This can be made worse in people who have large fatty pad on the sole of their feet, which under pressure requires more elasticity in the skin to expand without cracking. This pressure can be the result of prolonged standing, pregnancy or excess weight. Causes Walking around barefooted or in footwear such as thongs, sling backs or open backed sandals which dries out feet. Standing for long periods 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 to expand more and hence can often crack more. Poor fitting shoes or sandals that don’t support the heels from expanding sideways under pressure. Unhygienic circumstances or conditions. Unhealthy, dry scaly skin that can be caused by climate, such as low humidity during dry summers or cold winters. Medical conditions can also lead to drying of the skin such as: Diabetes where autonomic neuropathy leads to less sweating and thus less moisture. Psoriasis & Eczema. Fungal infections of the foot, i.e. Athlete’s foot. Note: in the elderly, callused heels may be a sign of increased pressure and can be a precursor to a bed sore. These cases should be assessed by a podiatrist before commencing any at home treatments. Treatment The thickened skin needs to be reduced in severe cases prior to using moisturiser. The skin may be so dry that it is almost impossible for moisturiser to penetrate to the skin under the callus. In more severe cases you may need the help of a podiatrist. Podiatrist’s can remove the thick layer of the heel callus fairly simply. This may need to be done regularly, or if you are willing to put the work in you can use pumice stone or an emery board to give you a kick start in the right direction. Once the callus has been reduced, the regular use of a moituriser is recommended. Below are some general guidelines to consider when treating cracked heels: If cracks start to bleed apply an antiseptic to prevent infection and keep clean. Wear closed in shoes and good socks when you can. Drink plenty of water to keep you and your skin hydrated. Investigate the cause of the problem, so this can be addressed. There may be an underlying mechanical reason for the load on the heel. If very painful and bleeding, strapping the heel with a rigid sports tape which may be used to ‘hold’ the cracks together while they heal. Treatment may include gait correction that alters the stresses on the foot. This is achieved by wearing orthotics. Custom orthotics are manufactured at Gait Way podiatry in our on site laboratory. Related Conditions Are Your Feet Ready For the Jetty to Jetty Fun Run? Callus and Corns Cracked Heels Ingrown Toe Nails Investing in Tradespeople’s Health: Why It Matters Moisture Socks National Health Month for Tradies – Protect Your Feet! PODIATRY CARE FOR VETERANS Step Forward: Caring for Your Feet During National Diabetes Week 2024 Step Up Your Game: National Health Month for Tradies

Ingrown toenails or onychocryptosis, is a common occurrence across all age groups. Patients usually present with moderate pain in the affected toe. The condition can progress rapidly with or without infection and severe pain. Many patients tolerate chronic ingrown toenails. Podiatrists are well trained in the latest surgical techniques to treat ingrown nails and can offer great pain relief permanently. Possible causes of ingrown toenails include incorrect cutting, “picking at nails”, hyperhidrosis or sweaty feet, poorly fitting footwear, trauma (ill-fitting footwear), abnormal nail shape (i.e.  involuted nails), obesity, or excessive external pressure. Ingrown toenails can be hereditary. Treatment Ingrown toenails may be managed conservatively to a point. Cutting the nail correctly and trying to repair the growth pattern is always the first option. The use of antibiotics to reduce the infection is essential. Surgical intervention by either a partial or total nail avulsion with the use of phenol proves to be successful. A Partial Nail Avulsion (PNA) is a minor procedure that permanently removes a section of the nail plate.  Basic steps to this procedure are: The procedure is done using local anaesthetic, making it as pain free as possible. The ingrown section of nail is removed, and the nail matrix/root is destroyed using a chemical procedure. This prevents the section of nail from regrowing. No sutures (stitches) are required, and therefore in most cases minimal pain is experienced post-operatively. The patient will be required to return for a couple of dressing changes. Healing time is rapid, with full recovery usually within 1 – 2 weeks. Closed footwear should be avoided on the day of the surgery. There is usually no need to take time off work. Ingrown Toe Nail Surgery Ingrown toenail surgery is to be considered when the infection has been recurrent. Antibiotics are only for the purpose of clearing up the infected tissue that surrounds the nail. An antibiotic cannot remove an ingrown toenail. It is a physical injury to the tissue that surrounds the nail. The toe will only settle down when the nail spike causing the infection has been removed. There are varying degrees of ingrown toenails. The cause of the ingrown toenail must be established before it is surgically removed.  Factors to consider prior to surgical removal are: How often has the incidence occurred? Could it have been as a result of bad cutting? Is it hereditary? The decision to have a surgical removal of a nail will be dependent on the answers to the questions. The age of the patient is very important as it can be a traumatic experience for a child. Only when conservative treatment has failed is surgery to be considered and is considered a last resort. Related Conditions Are Your Feet Ready For the Jetty to Jetty Fun Run? Callus and Corns Cracked Heels Ingrown Toe Nails Investing in Tradespeople’s Health: Why It Matters Moisture Socks National Health Month for Tradies – Protect Your Feet! PODIATRY CARE FOR VETERANS Step Forward: Caring for Your Feet During National Diabetes Week 2024 Step Up Your Game: National Health Month for Tradies

Sever’s disease is a common cause of heel pain in adolescence. Developing, physically active  “kids” are often more prone to this condition. During puberty the calcaneus consists of two developing sites of bone, known as ossification centres. These two areas are separated by an area of cartilage, known as the calcaneal apophysis. The Achilles tendon attaches the triceps surae (calf muscles) to the calcaneus (heel bone). As a child grows the calcaneus grows faster than the surrounding soft tissue, which means the Achilles tendon can be pulled uncomfortably tight. This increase in strain causes inflammation and irritation of the calcaneal apophysis (growth plate) which is known as Sever’s Disease. The pain is exacerbated by physical activities, especially ones involving running or jumping. Sever’s disease most commonly affects boys aged 12 to 14 years and girls aged 10 to 12 years, which corresponds with the early growth spurts of puberty. Symptoms Unilateral or bilateral heel pain Heel pain during physical exercise, especially activities that require running or jumping or are high impact. Pain is often worse after exercise. A tender swelling or bulge on the heel that is painful on touch. Limping. Calf muscle stiffness first thing in the morning. Treatment May Include Strengthening exercises. Exercise and training modification. Orthotic therapy. Ice terapy. Footwear changes (no thongs should be worn). Extreme cases may need casting or specialized night splints which will be determined by the podiatrist. Related Conditions Children’s Foot & Leg Development Flat Feet in Children Hypermobility Ingrown Toenails on Babies & Children Intoeing (Pigeon Toes) Knock Knees School Shoes Severs Disease/Heel Pain Toe Walking Warts on Children’s Feet

Having Diabetes puts one at risk of potentially having foot problems. There are a collective number of reasons that attribute to these concerns. Numbness caused by nerve damage (diabetic neuropathy) this results in a decrease in sensation therefore damage to the foot can occur and not be detected. In addition, poor circulation to the legs and feet reduces the healing process when damage occurs. Wounds that do not heal ultimately become foot ulcers. Diabetic foot ulcers may become infected and can subsequently turn gangrenous because of poor circulation. Non-healing foot ulcers are the most likely cause of amputation in people with diabetes. Why a Podiatrist? Regular foot checks and routine foot care from a Podiatrist is vital in preventing symptoms from developing. Nail care, callous and corn management. Diabetic assessments are performed for neurological and vascular screening to monitor the effects of diabetes on your feet. What is Diabetes? Diabetes (mellitus) is a chronic disease that can affect people of any age. There are predisposing factors for the onset of diabetes such as genetic history, weight, regular exercise, diet and age. Insulin is a hormone that helps the body metabolise sugar in the diet. Depending on the type of diabetes (Type 1 or Type 2) the body either produces less or no insulin (Type 1), or the body tissues are resistant to the effects of insulin (Type 2). This results in elevated blood sugar levels which is the cause of Diabetes. Podiatrists use a simple and painless method to check nerve function in the clinic. Neuropathy results in a decrease in sensation in the feet therefore the body’s nerves in the feet do not function properly. It can be due to poor glucose control or compromised blood flow to the nerves. There are three kinds of nerves:  sensory, motor and autonomic , which will be explained below. Diabetic neuropathy is usually symmetrical and is progressive – it worsens with the duration of the disease. It is often not noticed as it progresses, and it is underestimated and underemphasized. It is one of the main causes of amputations. Sensory Nerves The nerves that respond to touch, temperature, pressure and pain send messages to the brain. When the sensation is altered the message to the brain will indicate that. Sensory neuropathy may result in paraesthesia where the brain interprets ordinary sensations like touch as painful. This is worse at night and at rest and is relieved by movement. Standard tests for sensation will be nearly normal. Sensory neuropathy can also cause anaesthesia where sensations are dulled or not felt at all. This is obviously not painful but position sense and balance are affected. Sensory neuropathy can make injury more likely as your normal protective responses don’t occur (The response reflex is lost). It can lead to an injury not being noticed and therefore not cared for (You could stub your toe, breaking the skin and not feel it, you will only be aware of it when you see the blood). It can stop your immune and repair systems from detecting an injury and coming to fight infection or repair skin properly. Motor Nerves Neuropathy at the motor nerves (These allow movement) can cause muscles to become inactive and waste away. This causes muscle imbalances and bony joint deformities. Claw toes are so common in the diabetic foot as a result of this. Your Gait pattern will change and areas of excessive pressure will be found under the feet. Calluses and corns are the result. Autonomic Nerves The autonomic nerves control the actions that you are not in control of. For example, the beating of the heart. In the feet, they control sweating, blood flow, repair and healing. Loss of sweating leaves feet dry and cracked. This results in cracks in the skin which may become infected. When blood flow becomes impaired to the foot, the required amount of oxygen is not available for tissue repair, this will result in infection. Peripheral Vascular Disease (PVD) Your podiatrist or doctor should assess the arteries in the foot at regular intervals using a Doppler ultrasound machine. Physical inspection of the foot is as important. A foot with poor blood flow will have little hair growth. The skin is frail shiny, pale in color and thin with a loss of fatty tissue below the skin. The pulses are weak. The foot will be pale when elevated and mottled red / purple when hanging down. Cholesterol plaques in arteries are more common in diabetics. This is as a result of fat and glucose being increased within the artery walls. The collagen within artery makes the walls stiffer. Arteries are then more likely to have the irregularities that first allow blood to clot within the vessel. Blood clots within vessels can come loose and cause the death of any tissue downstream of the blockage. Thickening of artery walls reduces blood flow to tissues, which results in a reduction of oxygen to the skin and flesh. This restriction limits antibiotic medicine and white blood cells from getting to the site of infection, therefore the delays in wound healing. This ultimately results in amputation. Structural Problems Common structural problems in the feet are bunions, retracted or clawed toes, prominent metatarsal heads (the knuckles on the bottom of the ball of the foot) and areas of increased pressure that lead to corns, callus or ulceration. Those with diabetes can suffer from glycosylation of collagen. This means that the abnormally high blood sugar causes the soft tissue, muscles and like joint capsules, to stiffen up and contract. This results in pressure areas which ultimately ulcerate. Diabetic Arthritis Charcot’s disease (Neuropathic arthropathy) is almost exclusively to diabetics. It occurs when the nerves that run into a joint lose the ability to report back to the brain and the brain is unable to sense when the joint is being used incorrectly. This can result in the joints, particularly one just below the ankle, being destroyed. There is a long build up to Charcot’s disease but the damage occurs very quickly. A joint can go from working fairly normally to being ruined in one day. With the loss of motor and sensory nerve functions minor traumas such as sprains and stress fractures go undetected therefore untreated, leading to ligament laxity (slackness), joint dislocation, bone erosion, cartilage damage, and deformity of the foot. The bones most often affected make up the midfoot. If you suffer from neuropathy in the feet, you must see your podiatrist and have foot function monitored. If no damage has occurred yet, a foot support called an orthotic can dramatically reduce a Charcot’s episode from occurring. If it is too far advanced, an orthotic can help to make the position in which the foot will be permanently positioned a more functional position. If the foot is already trapped in a compromised position, parts of the foot will be bearing a lot of pressure. A different type of orthotic can be used to make these pressures more normal. What Will the Podiatrist Assess? Foot Pulses – physically or by Doppler ultrasound. Skin – the texture, hair presence, and pressure marks corns & calluses, as well as temperature. Spaces between toes – Tinea (fungal infections) and skin splits. Nails – Ingrown, thickening, discoloration and fungal. Deformity – pressure areas. Footwear – Fitting and pressure. Neurological examination – monofilament assessment (for sensation) and vibration perception. Gait – altered walking patterns create an imbalance resulting in pressure areas. Range of motion – Are the joints in your feet restricted or at risk? Dry skin – leads to cracks and allows bacteria to enter through the skin resulting in infection. Appropriate Footwear Footwear can protect the foot against injury or cause the injury. Shoes should be comfortable straight away. Buy shoes later in the day when your feet are swollen and strained. Have shoes fitted. If sensation is affected, you may not be able to properly assess the fit. Stand when trying on shoes as feet are longer when standing. Expensive does not automatically mean good. Extra depth shoes are available at specialty shoe stores. They are higher in the toe box and heel allowing more room for your feet. Shoes will not stretch on a stitch line. Avoid stitch lines over any bony area, such as joints. Wear a good quality sock when going for long walks and long periods of standing. Do not buy off the shelf orthotics. Have the correct assessment done by your podiatrist. Wear new shoes in slowly. Examine your feet immediately after taking the shoes off for rubbed pressure areas. Feel inside shoes before putting them on. Items may have fallen into shoes (surprisingly common) or shoe nails or lining may be protruding or torn. Throw out socks with holes. Do not repair them. Throw out shoes with holes in the lining. Socks should not be too small or too big. Wrinkles cause blisters. Ill fitting footwear causes problems, too big are just as dangerous as too small. Shoes should allow your foot to move slightly in your shoes. Your toes must be allowed to move. There are various lacing technique to keep shoes snug on feet. Make sure the tongue of the shoe is in the correct position before tying the laces. Do not wear the same pair of shoes every day, alternate them. Thongs, if your foot is working to keep the thong in place, do not wear them. The “to Do” and “Not to Do” for Diabetics Always know your blood glucose levels. Inspect your feet daily. If you are vision impaired try to feel your feet. Wash your feet daily and dry well between toes. Wear appropriate footwear. Have corns and callus regularly removed by your Podiatrist. Wear orthotics correctly if prescribed for you. Look after dry skin with an appropriate moisturizer. Do not use greasy preparations they do not penetrate dry skin. Do not cut your own toe nails if you do not have to. If your nails are not perfectly normal seek advice from your podiatrist. If there are no concerns with your nails, cut the nails following curve of toe, do not cut down the side of the nail. Have a plan of action should a problem develop with your feet. Always inform your carer and your podiatrist, that you have diabetes. Keep blood fats under control through diet, drugs and maintaining healthy weight. Exercise regularly to prevent weight gain and assist in improving circulation. See a podiatrist at least once a year for assessment. Have an eye and kidney examination as they can indicate problems in feet and vice versa. Do Not Smoke. Drink alcohol to excess. Use any chemist preparation to treat corns and callus. They are chemicals that cause burns. Go barefoot. Cut skin on your feet, see your Podiatrist. Do You Have Neuropathy? Beware of temperature extremes. Don’t use hot packs or cold packs, don’t put feet close to radiators or fires, don’t get sunburned and be aware of what surfaces might be hot. Remember how hot the sand used to get when you were a child? Concrete paths, balcony rails etc are still just as hot and can cause a severe burn, even if you can’t feel it. Don’t test water temperature with feet or soak in a hot foot bath. Don’t soak in any foot bath. Do not go barefoot inside or out. Don’t use pumice stones. Be wary of ripping skin with strong sticking plaster. Do not wear thongs. Don’t use garters or socks so tight that there is a visible mark on removal. Inspect shoes before putting on every time. Finally, remember that looking after your feet mostly involves looking after yourself as a whole. Controlling your blood sugar, cholesterol, blood pressure and body weight will have the biggest effect on how you fare in the long term. Why Are Feet Important? People with diabetes are at risk of foot problems due to numbness caused by nerve damage (diabetic neuropathy). With diabetic neuropathy, damage to the foot can occur and not be detected. In addition poor circulation to the legs and feet slows the healing process when damage does occur. Wounds that don’t heal may form foot ulcers (skin sores). Diabetic foot ulcers often become infected and can subsequently turn gangrenous because of poor circulation. Non-healing foot ulcers are a frequent cause of amputation in people with diabetes. What Are the Risk Factors Which May Cause Foot Ulcers? Previous history of ulceration. Poor circulation. Neuropathy. Poor foot care. Foot deformities e.g. claw toes, hammer toes which cause pressure lesions. Unsuitable footwear e.g. shoes that are too tight may rub or cut your feet. How Can You Look After Your Feet Yourself? Wash your feet daily in luke warm water (not hot) with mild soap. Dry them well, especially between the toes. Check your feet daily for cuts, sores, blisters, redness, calluses, or other problems. You may need a mirror to look at the bottoms of your feet. If your skin is dry, rub lotion on your feet after you wash them. Do not put lotion between your toes. Cut your toenails when needed. Cut them to the shape of the toe and not too short. File the edges with an emery board. File corns and calluses gently with an emery board or pumice stone. If you are unable to reach your feet your podiatrist is happy to help. Always wear closed in shoes or slippers to protect your feet from injuries. Wear shoes that fit well and always wear socks or stockings to avoid blisters. Before putting your shoes on, feel the insides for things like gravel or torn linings. These things could rub against your feet and cause blisters or sores. When You Need to See a Podiatrist? 6-12 monthly podiatry reviews are required for patients with no neuropathy. 6 month podiatry reviews are required for patients who have neuropathy but no foot deformities. 2-3 month podiatry reviews are required for patients with both neuropathy and foot deformities. 1-2 month podiatry reviews are required for patients with neuropathy, foot deformities and a history of ulceration. Support and Assistance For general information on understanding diabetes ‘click here’ Newly Diagnosed Type 1 Membership to Diabetes Australia can be helpful for support and information. Click here for their website. Click here for The Queensland based diabetes association website. Support for adults by other adults with type 1 diabetes can be found on the “reality check” website . Newly Diagnosed Type 2 Membership to Diabetes Australia can be helpful for support and information. The Queensland based diabetes association website .

In recent years, shockwave therapy has emerged as a revolutionary treatment in various fields of medicine, particularly in podiatry. This non-invasive technique utilizes acoustic waves to stimulate the body’s natural healing processes, making it an effective option for patients suffering from a variety of foot and ankle conditions. Let's explore how shockwave therapy can benefit individuals seeking treatment for podiatric issues. What is Shockwave Therapy? Shockwave therapy involves the delivery of low and high-energy acoustic waves to the targeted area of injury using a handheld probe. The waves penetrate deep into the tissue, promoting biological responses that aid in healing. This can lead to reduced pain and increased mobility, offering a promising alternative to more invasive treatments. Benefits of Shockwave Therapy in Podiatry 1. Pain Reduction One of the most significant advantages of shockwave therapy is its ability to alleviate pain. By activating the body’s self-healing mechanisms, shockwave therapy can reduce inflammation and promote pain relief for conditions such as plantar fasciitis, Achilles tendinopathy, and other chronic foot and ankle pain syndromes. 2. Enhanced Circulation The acoustic waves generated during the treatment increase metabolic activity in the affected area. This leads to improved blood circulation and the formation of new blood vessels. Enhanced blood flow not only helps in delivering essential nutrients and oxygen to the injured tissue but also aids in the removal of metabolic waste, speeding up recovery. 3. Promotion of Tissue Regeneration Shockwave therapy stimulates the body’s natural healing processes, encouraging the formation of new collagen fibers. This regeneration of tissue can significantly improve the healing of tendons, ligaments, and other structures around the foot and ankle, making it particularly beneficial for sports injuries. 4. Non-invasive and Convenient Many patients seek non-invasive treatments to avoid surgery and lengthy recovery times. Shockwave therapy offers a relatively quick procedure that does not require anesthesia or downtime, allowing patients to return to their daily activities shortly after treatment. 5. Effective for Recurring Conditions For individuals experiencing chronic conditions that haven’t responded well to traditional treatments, shockwave therapy can offer a new avenue for relief. Many practitioners have noted significant improvements in symptoms after a series of sessions, even for previously difficult-to-treat conditions. 6. Minimal Side Effects Compared to more invasive procedures or medications, shockwave therapy has minimal side effects. Patients may experience mild discomfort during the treatment or slight soreness afterwards, but these effects are usually short-lived. Conclusion Shockwave therapy is proving to be a valuable tool in the field of podiatry, offering a safe and effective treatment option for a range of foot and ankle conditions. From reducing pain and enhancing circulation to promoting tissue regeneration, the benefits are clear. If you’re dealing with persistent foot or ankle issues, it may be worth discussing with your podiatrist whether shockwave therapy could be right for you. With ongoing advances in this field, patients can look forward to more innovative treatments that support their journey to recovery.

The calf muscle is comprised of two separate muscles, the larger muscle on the upper half of the rear of the leg called gastrocnemius and a broader flat muscle that lies deeper inside called soleus. The tendon begins just under the belly of the calf muscle and goes all the way down to attach to the back of the heel bone. This can be the site of an immense amount of pain and discomfort. Symptoms usually develop over a prolonged period of time, often the pain is most severe when first getting out of bed in the morning. Although the condition is more common in athletes, it may affect anyone. In chronic cases, which have gone on for a long period of time, there may be a firm, swelling in the tendon which is tender to squeeze. The pain associated with Achilles Tendinitis may affect daily activities. Rest from sporting activities, or any activity which causes pain. Treatment Apply heat and stretch before any activities involving walking or running. Apply ice and stretch after activities. A heel lift placed in the shoes, or the use of shoes with thicker or higher heels. This, however, is only really successful when walking as most of the force on the Achilles tendon which develops when we run occurs when the heel lifts off the ground. Anti-inflammatory medications. Correcting any abnormal foot position. Occasionally a foot which pronates (rolls inward) excessively can contribute to Achilles tendonitis by creating an additional ‘twist’, or torque, in the tendon. Orthoses or more supportive footwear may help in these cases. Strengthening exercises for the calf muscles and tendons (‘eccentric loading’) should be discussed for conservative management.

When we think of Diabetes it is easy to focus on sugars as the biggest concern. But did you know that Diabetes can affect a range of other structures throughout the body including the eyes, kidneys and the feet? Diabetes can have a great impact on the blood supply, nerves and structure of the feet and lower limb if not managed properly. It is important to consider: Diabetic understanding and knowledge Attitudes and behaviours towards Diabetes Appropriate examinations, support and management for Diabetic care Understanding and knowledge about the effects of poorly managed diabetes and the potential for poor circulation, nerve pain or numbness and poor healing. Which is why it is important to maintain general foot care to prevent ulcerations and infections. Attitudes and behaviour surrounding the complications of diabetes and how to appropriately manage it. If you are unsure, contacting a GP is always a great point of call. They will help direct you to a podiatrist and other vital health services that can assist in improving your overall health. Appropriate examinations by a podiatrist are essential for prevention of complications and maintaining healthy feet. We recommend at least an annual check in to make sure there are no complications or changes to your feet. An examination with one of our podiatrists will include tests to assess: Vascular assessment (ensuring blood flow to the feet is adequate) Neurological assessment (any loss of feeling, pins and needles) Musculoskeletal (any toe deformities such as bunions that may be a risk for complications) Skin and nail care (ensuring there are no areas of built up hard skin, cracks or pesky nails that may be causing you grief) Footwear assessment (to prevent any discomfort or rubbing reducing ulceration risk) Support and management another vital part to holistic management of diabetes is education and support. With our regular check ins, we will be happy to discuss any areas of your general foot health as part of the consult as well as providing education on preventing infections and avoiding complications. Some key points are noted below: Checking feet daily for any cuts, blisters, redness, or changes to prevent wounds Washing feet daily and drying feet thoroughly (especially between the toes!) Using talcum powder between the toes to keep them dry and avoid infections Using moisturisers daily on the tops and bottoms of your feet, especially around the heel Daily changes of socks Keeping nails short and avoiding painful pointy edges Wearing shoes at all times, even around the house Knowing and understanding the warning signs of an infection or wound and knowing who to contact for help. Prevent the frustration of having to deal with these complications by booking an appointment with one of our friendly podiatrists at the Gait Way Podiatry team today.

Heel pain is one of the most common conditions treated by podiatrists.  It is often a message from the body that something is in need of medical attention.  Pain that occurs right after an injury or early in an illness may play a protective role, often warning us about the damage we have suffered. Who gets heel pain? The greatest incidence of heel pain is seen in middle-aged men and women.  It is seen in those who take part in regular sporting activities and those who are significantly overweight and on their feet a lot. Heel pain can also occur in children, usually between 8 and 13, as they become increasingly active in sporting activities.  The Causes of Heel Pain The research shows that higher arches or flatter arches, or feet that role in too much, are causes of heel pain.  This can place too much stress on the heel bone and the soft tissues attached to it.  The stress may also result from injury, or a bruise incurred while walking, running or jumping on hard surfaces, wearing poorly constructed footwear or being significantly overweight.  Certain diseases can also contribute to heel pain. Specific conditions Plantar Fasciitis Plantar Fasciitis is inflammation of the plantar fascia, a thick, fibrous band that runs under the foot from the heel bone to the toes. It is a vital structure that makes up the arch of the foot and functions as our natural shock-absorbing mechanism. Unlike muscle or tendons, the plantar fascia is not very elastic and therefore is very limited in its capacity to stretch or elongate. Herein lies the problem: when too much traction is placed on the plantar fascia (for various reasons) micro-tearing will occur, resulting in irritation, inflammation and pain. Plantar Fasciitis usually causes pain under the heel, however some people may experience pain under the arch of the foot. Both heel pain and arch discomfort are related to Plantar Fasciitis, with heel pain being far more common than arch pain. Heel Spur A heel spur is a bony growth at the front/underside of the heel bone. This type of calcification is also referred to a “calcaneal spur” (calcaneus is the anatomical name for heel bone). The reason for the development of a spur is that the body responds to the constant traction and pulling from the plantar fascia away from the heel bone. The fascia itself cannot become any longer, so instead the bone will ‘assist’ the fascia and grow. They can also form on other areas of the body including the posterior (back of) the heel bone also due to the pull of the Achilles tendon at its attachment onto the heel. A heel spur will show clearly on an X-Ray of your foot and this referral for an X-ray may be made if a heel spur is suspected. This is often a factor that is predictive of the long term prognosis of the heel pain; if a heel spur is found, the likelihood of recurrence of pain is high so biomechanical correction will be required indefinitely. Spurs take many years to develop and indicate that there has been tension on the bone for a long period of time. They can worsen if the tension in the fascia (or tendon) is not reduced. It should be noted that a heel spur may be found incidentally on an x-ray but not be producing any pain for the individual. It is however a risk factor for heel pain due to the formation of one being due to tension on the bone so one should be mindful of this as precautions can be made to minimize the risk of the spur becoming symptomatic. Achilles tendonitis Is a common injury in athletes particularly those doing sports involving running and jumping. The Achilles tendon attaches the calf muscles to the back of the heel and can become inflamed with overuse of the calf muscles. The pain is felt either on the back of the heel on the bone or a few centimetres above and may have swelling or thickening felt in the area.  Being a tendon, this injury responds well to stretching and specific exercises. In addition, reducing the load through the tendon with activity modification and orthotic therapy greatly improves the recovery time.  Sever’s Disease In teenagers, pain around the heels is usually a sign of Sever’s disease, a condition caused by the Achilles tendon placing extra strain on the heel bone and swelling in the growth plate around the heel. Sever’s disease will ultimately resolve as the growth plate around the heel bone fully develops and the bones fuse by approximately age 15, but damaging foot problems can develop through altered biomechanics.  Early treatment can relieve discomfort and prevent the incidence of additional injury. Treatment options Early treatment might involve shoe recommendations, taping, icing and anti-inflammatory medication. Other physical therapies may also be used which include shockwave, exercise, stretching and strengthening program and prescription orthotics for long term management. As a general rule of thumb, the longer the injury has been going on without treatment, the longer it will take to recover so it is always advised to have the pain seen to early to ensure a speedy recovery. How do orthotics help heel and arch pain? Any slight alteration to foot posture or function can cause significant discomfort due to increased load through particular muscles/tendon/fascia/joints. To help alleviate foot and lower limb pains, or in some people to prevent the development of potential problems, an orthotic can be prescribed. Your podiatrist will be able to assess if you would benefit from an orthotic device. The assessment will involve observation of the feet and lower limb standing, running / walking and also an examination when non weight bearing to check the joints. From this assessment, the orthotic can be made for the shoe that provides support for the appropriate areas of the feet.

Dreading those first few steps in the morning or at the end of the day?  While the pain is worse first and last thing in the day, it can also be triggered from long periods of standing or when you get up from sitting. Interesting, the pain can be slight to non-existent during periods of exercise. Sounds familiar? You could be suffering from a condition called Plantar Fasciitis . What is Plantar Fasciitis? Plantar Fasciitis is the term that refers to inflammation (“-itis”) of the connective tissue (“Fascia”) under the base of the foot (“Plantar”). It usually occurs at the point where the plantar fascia originates at the heel bone. What causes Plantar Fasciitis? While there may be no obvious cause of the start of Plantar Fasciitis, there are a few factors that increase your risk at developing this condition. Age . Plantar fasciitis is most common (but not limited) to people between the ages of 40 and 60. Exercise . Activities that place a lot of stress on your heel (long distance running, dancing, HIT classes,  jumping) can all be contributing factors. Foot Mechanics . Flat feet, high arches or abnormal walking pattern Weight . Excess weight puts more pressure and stress on all your joints, ligaments and tendons, especially your plantar fascia in your feet. Occupation . Standing on hard surfaces can damage the plantar fascia, so it goes without saying that any occupation that requires long hours of standing or walking are at risk of developing plantar fasciitis. Treatment Where can I get help for Plantar Fasciitis? The big question is: “Should you see a GP, a Physiotherapist or a Podiatrist for plantar fasciitis heel pain?” Just like your dentist specialises in teeth and oral problems, podiatrists specialise in feet and heel pain problems. There are times when Physiotherapists and General Practitioners can work wonders for many problems, but your best first contact is a podiatrist experienced in the treatment of plantar fasciitis. Fortunately, the podiatrists at Gait Way Podiatry have over 45 years of combined experience in the treatment of plantar fasciitis and associated heel pain. Don’t delay, BOOK AN APPOINTMENT TODAY : (07) 3385 0567 The treatment you require depends on what we diagnose, but most common options include exercise, shockwave therapy, mobilisations or orthotics. What can I do at home to help my Plantar Fasciitis? Calf stretches – slow controlled stretches for at least 30 seconds against a wall is a simple yet effective way to help reduce strain on those heels. Footwear change – look to avoid completely flat shoes and those without any cushioning. One with both cushioning, support and a slight heel are ideal. Loose Weight – Weight loss is a great way to reduce the forces on your feet which applied to the heel also. What else could cause this heel pain? Your heel pain could be from a variety of conditions such as a heel spur, muscle tear, tendonitis or bursitis. Each condition needing a different diagnostic assessment and treatment, which is why it’s important to get an expert to diagnose the issue. So, if your heel pain has not responded to traditional therapy, there may be something else that has been missed, and the podiatrists at Gait Way Podiatry are trained to find these problems. BOOK AN APPOINTMENT TODAY: (07) 3385 0567 Our blogs are educational in nature and are not intended as a substitute for medical advice. Because your condition is unique to you, it is recommended that you consult with your health care provider before attempting any medical or therapeutic treatments.

The term “flat foot” refers to a condition where the foot lacks an arch. In children, the arch on the inside of the foot may begin to develop from four years of age, and should be developed by the age of six. Most children will eventually develop a normal arch, however in some children the arch may fail to develop normally. In most children flat feet are asymptomatic, and of no concern. However, over time flat feet may lead to an altered walking pattern; clumsiness; limping after long walks; and pain in the foot, knees or hips. It is therefore important that appropriate treatment commences as early as possible. Causes There are many causes of flat feet.  Below are the most common causes of flat feet Hypermobility Torn muscles in the legs or feet Fracture or dislocation of foot bones Posterior tibial tendon dysfunction Poor foot alignment Injury Less common causes include Charcot foot; a condition found in diabetics Birth defects Tarsal coalition Treatment options Flat feet can be treated with supportive footwear and possible arch padding. More serious cases of flat foot may require orthotics (special shoe inserts) to reposition the bones and joints in the arch of the foot, and surgery may be advised in the most severe cases. Related Conditions Children’s Foot & Leg Development Flat Feet in Children Hypermobility Ingrown Toenails on Babies & Children Intoeing (Pigeon Toes) Knock Knees School Shoes Severs Disease/Heel Pain Toe Walking Warts on Children’s Feet

Warts can occur at any age, but are most commonly found in children. They are caused by a group of viruses called the HPV (human papilloma viruses) and can be found anywhere on the body, with hands and feet the most common spots. As warts are caused by a virus, they are highly contagious. Plantar warts are the common complaint we see as podiatrists, especially common in children. Often mistaken for a corn, a plantar wart is a benign lesion of the outer surfaces of the skin on the foot or toes. Plantar warts are contagious and are spread through direct contact – either with someone that has the virus, or from sharing floors, shoes and socks with someone who has the virus. This means warts can quickly spread through families if care is not taken.  Signs of a plantar wart  Warts and corns can look very similar, and as they have very different treatment requirements, it’s highly recommended having a podiatrist assess and diagnose the condition.  The visible signs of a plantar wart are tiny blood vessels at the base of the wart (which tend to look like small black dots in the centre of the wart). If your wart is causing you pain, discomfort, or is affecting the way you walk, we highly recommend having it treated. Treatment  Contact Gait Way Podiatry and book an appointment with a qualified podiatrist. We will assess the size and depth of the plantar wart and recommend the best type of treatment for you. Preventing Warts Keep your feet clean and dry. Avoid going barefoot, particularly in moist and communal environments. Sporting club showers and swimming pools are prominent places where the wart virus may spread. You are more at risk of being infected if your skin is damaged, wet or in contact with roughened surface. The following may help with preventing warts: Avoid walking barefoot in communal changing or shower rooms. Change shoes and socks daily. Keep feet clean and dry. Check children’s feet periodically. Avoid direct contact with warts on other persons or on other parts of the body. Do not ignore growths on, or changes in, your skin. Visit a podiatrist immediately if you notice and lumps or sores on the feet. Related Conditions Children’s Foot & Leg Development Flat Feet in Children Hypermobility Ingrown Toenails on Babies & Children Intoeing (Pigeon Toes) Knock Knees School Shoes Severs Disease/Heel Pain Toe Walking Warts on Children’s Feet