We are now a year into this pandemic. What a year it has been!

One thing that has changed for a lot of people is our exercise habits. Due to the various stages of lockdowns, some people have started exercising more and some have started exercising less. This has led to some interesting outcomes with regards to getting an injury from that. My co-host on PodChatLive, Ian Griffiths, was the first one to use the word “coverload” to describe some of the problems that are being seen.

The human body is remarkable and can adapt to exercise loads that are put on it, providing those loads are increased slowly and gradually and the body is given enough rest to adapt to those loads. If there is insufficient time given for the body to adapt then an overuse injury is often the result from those loads being too high for the body to take.

What is happening in those who might, for example, run 2-3 times a week start running 6-7 times a week during a COVID-19 related lockdown as we are generally still allowed to exercise. That can be too much for the body to handle as not enough time was given for the body to adapt to the increased loads, so on overuse injury might result; ie coverload.

On the other hand some people exercised less during the lockdowns as, for example, the gyms were closed. This meant that the tissues in the body de-adapted to the exercise loads. After the lockdown was over they went back to the gym and started exercising body parts that were not yet ready to take the loads that were being applied, so an injury might result; ie coverload.

All this means that you need to make sure that your body is given time to adapt to any increasing load that is place on it. Be careful and take you time. Don’t be a victim of coverload.

A new school year is starting soon and so is that tradition of getting the new school shoes for the year.

back to school shoes

As the feet of children are still growing, they are malleable which means that getting the fit of shoes wrong can result the potential of affecting the normal development of the foot and lead to problems later in life. The role of the shoe is to protect your child’s feet and ensure that normal development can happen. This is even more important for school shoes, since your child spends so much time in them. To ensure that their shoes do fit properly, make sure you have your children’s feet measured regularly for length and width each time you buy shoes.

Specifically, the toe area of the shoe should allow your child’s toes to move freely about and not be squashed from the top or the sides by the shoes. Make sure there is around 1cm growing room between the end of the child’s longest toe and the top end of their shoe. The shoe should fit comfortably around the back of the heel as well and be too loose or too tight.

Going to a specialty footwear retailer to have shoes fitted by a store that offers trained assistants can also help ensure that your child gets the correct size and shape of shoe.

When should you seek advice from a podiatrist?

A podiatrist can help ensure your child’s school shoes are fitted correctly. An evaluation by a podiatrist is also recommended if you notice changes happening, such as uneven shoe wear on the heels or if there is pain in your child’s feet. You should also consider getting the help of a podiatrist if you notice your child walks on their tip toes, or their walk does not look the same on both feet and legs; or if you have any other general concerns about your child’s foot health.

Burning feet is a common issue that we get asked about and it is often hard to get to the bottom of and difficult to deal with as it will often not be apparent what is causing the symptoms. The burning feet syndrome is frequently characterised by the sensation of burning and a heavy feeling that occurs within the legs and feet. In the past, it was first described by Grierson in 1826 who had been the first person to report the signs and symptoms of burning feet. An even more comprehensive account was written about by by Gopalan in 1946, so for a while the burning feet syndrome has also been often known as Grierson-Gopalan syndrome.

There is normally not any specific cause of burning feet and the cause is often not found. It might be connected with nutritional or endocrine causes such as a vitamin B insufficiency, the painful neuropathy occurring in diabetes, in those with kidney failure especially if on renal dialysis, or with hypothyroidism. The could be a local pinched or irritated nerve problem. Burning feet tend to be more common in people older than 50 years but it could and does come about at all ages. The signs and symptoms are typically characterised by way of burning sensation, a heaviness, a numbness or a boring ache that occurs predominantly in the foot. It tends to follow a ‘sock’ distribution rather than be patchy. In most cases it is just on the bottom of the feet but may ascend to affect the top of the foot, ankles or up the lower legs sometimes. The forearms and palms of the hands are typically not impacted, but when they can be, then this really needs to be investigated further. Sometimes people may possibly report ‘pins and needles’ or tingling kind of discomfort in the feet rather than just the ‘burning’. Normally, the symptoms are usually a whole lot worse during the night and are somewhat improved throughout the day time. They’re also not really made worse with an increased levels of activity or standing which may signal a musculoskeletal condition as opposed to the neural involvement in burning foot syndrome. Evaluation of your feet and legs by a health professional frequently locates no objective signs and symptoms. A range of investigations, especially blood tests are generally often carried out to look for any of the particular problems that might cause the condition.

The therapy for burning feet syndrome will either have specific measures which can be aimed at what’s causing it (eg diabetic neuropathy, pinched nerves, thyroid conditions) and general steps that can be useful in most cases. These common options range from the using of open and comfortable shoes, perhaps those having arch supports, as well as wearing natural cotton socks might possibly be somewhat helpful. Relief from the signs and symptoms may be obtained by immersing the feet in chillier water for around 15 minutes. It’s also vital that you steer clear of exposing the feet to sources of heating. There are pharmacological therapies that include tricyclic antidepressants and other drugs such carbamazepine and gabapentin which can be used in the more significant conditions. You will find side affects associated with these drugs, but they are essential at giving reduction to the symptoms when it’s necessary. Despite having the usage of drugs, the treating of the symptoms could be a tough and some individuals will have to be evaluated by a specialist pain facility and presented strategies to help live with the pain sensation.

Short version: no

Long version: no, they don’t.

do circulation boosters really work

There are several brands of the so-called ‘circulation boosters’ on the market that make cautious claims about boosting the circulation. The claims are made with caution as there is no evidence that they actually do. You often see them being promoted on the morning TV shows, in infomercials and commercials with celebrity endorsements (I have certainly lost respect for those that do endorse the circulation boosters). The concept behind a circulation booster is that it uses electric muscle stimulation to contract and relax the muscles, thereby increasing blood flow to your legs and feet. They may well do that for the short time that you are using that device, but the effect will last no longer. If you really want to boost your circulation then get out and go for a walk. That will do substantially more for improving your circulation than spending money on one of these devices.

The electrical stimulation may prove usual for some people with some type of neurological pain in their feet, so there is no shortages of testimonials that they “work” as they could help some of these problems. They do not help by improving the circulation. Despite the length of time that these have been on the market there is a distinct and obvious lack of scientific and medical research supporting their use.

Another way of looking at it, why are all the vascular surgeons not recommending the circulation boosters for their patients? There is a reason for that.

There is also a reason why so many are being sold second hand on eBay and Gumtree. That is because the circulation boosters no not really boost the circulation and so many are selling their devices.

Here is one of the many things that we can do with the Archie arch supporting thongs that so many people like. Craig is demonstrating a MOSI foot orthotic modification that can be made to the thongs. It is a bit on the technical side as it is designed for podiatrists to watch, but hopefully you get the gist of what he is talking about.

Watch the video on the Archies MOSI:

As an aside, we do stock the Archies in the clinic and the range has just been updated with the smaller size 4’s being added and two new colours: tan and peach.

Short answer: with difficulty.

Ballet flats are a particular shoe design inspired by the shoes used by ballet dancers. By design these shoes are very minimalist. They do very little to the foot except cover it and come in a wide range of attractive designs. They also tend to be very snug fitting to help them stay on the foot. There is nothing inherently wrong with these types of shoes provided that are fitted properly and are of the right size for the user.

The issue with these minimalist types of footwear is if there is a foot problem that needs some sort of arch support, even on a temporary basis. The main sorts of problems that this might be needed are especially if you are on your feet all day and the feet and legs get very tired. Due to the minimalist nature of the design and the typically snug fit of the footwear, there is not going to be a lot of room in the shoes to do much. Clinically, choices or options can be limited if you spend most of your time in this type of footwear. There is simply no way that a typical foot orthotic is going to fit into these types of shoe. Sometimes a cut down foot orthotic might be able to fit in the shoe. Other times the problem can be managed by changing to a different type of footwear that foot orthotics can easily be used in for a period of time until the problem gets better. It is always best to see a podiatrist and discuss the options that you have if you really do need some sort of support and if it can be accommodated in your ballet flats style footwear.

Arch Support in Ballet Flats

There are a very limited number of ballet flats on the market that do have arch support type designs built into them. However, they are hard to find and may not be suitable for you. There are the instant arches types of self adhesive pads that can be stuck in the shoe to give some sort of support and this is often a good compromise if that is what is needed to deal with your problem. We do use them from time to time when there is no other more suitable workaround to getting support into a ballet flat type of shoe.

Long answer: it can be done, but there has to be compromises made.

Do you have restless legs syndrome? It is a miserable condition to have and we see it in multiple patients that we see (though they have come to us for another reason). We can only empathise with the impact that it has on their sleep and quality of life.

Restless Legs Syndrome is a nerve condition that is typically characterised by annoying sensations within the lower limbs and the compelling need to slowly move the legs, commonly only when attempting to rest. This peculiar feeling, often in the calves, is explained as a form of a cramp, ache or simply a creeping, crawling sensation. Some compare the sensation to being like shooting darts of electricity, and even invasive bugs inside the legs. These feelings range in extent from uncomfortable to irritating to agonizing.

One of the most unique feature of the condition is that lying down and seeking to relax leads to the restlessness. Because of this, a lot of people with restless legs syndrome experience difficulty going to sleep and also remaining asleep. Left untreated, the disorder results in lethargy and day time weariness.

Individuals with restless legs syndrome sense unpleasant sensations within their lower limbs, particularly if seated or lying down, together with an hard to resist urge to move the legs. These types of feelings commonly take place deep within the leg, typically between knee and ankle; and less often, they will appear in the feet, thighs, arms, and even the hands. Although the symptoms can happen on just one side of the body, they generally impact both sides. Since moving the lower limbs reduces the discomfort, individuals with restless legs syndrome generally keep their lower limbs in motion to attenuate or stay away from the sensations. They may pace the floor, constantly moving the legs while sitting, and move when in bed.

A lot of sufferers notice the feelings of restless legs syndrome being much less apparent during the day and more noticeable later in the day or at night, primarily during the start of sleep. For some people, the symptoms disappear by early morning, allowing for more refreshing sleep at that time. Other triggering situations are periods of inactivity such as long car trips, sitting in a movie theatre, long-distance flights, immobilisation in a cast, or relaxation exercises.

The cause is unknown but people with a family background of restless legs syndrome make-up about 50% of the cases, and sufferers with reduced iron ranges or anaemia, chronic diseases for example kidney failure, all forms of diabetes, Parkinson’s disease, and peripheral neuropathy, some women who are pregnant during the last trimester and people taking particular prescription drugs are most often more prone to to be affected by restless legs syndrome.

Restless legs syndrome can impact anyone of any age, although the problem is much more frequent with advancing age. This happens in both genders, even though the occurrence may be somewhat higher in women. At times individuals will experience spontaneous reduction on symptoms over a duration of weeks or months. While uncommon, spontaneous improvement following a number of years may take place. In the event that these improvements come about, in most cases during the early stages of the disorder. In most cases, however, sensations are more serious over time.

The clinical diagnosis of restless legs syndrome might be hard to establish. Doctors must depend mostly on the sufferer’s descriptions of symptoms and details using their medical history, including earlier health conditions, family history, and also present prescription drugs. Patients might well be inquired about how often, length, as well as the intensity of sensations along with their inclination toward day sleeping patterns and sleepiness, disruption of sleep, or daytime function. In case a persons history is an indication of restless legs symptoms, clinical assessments can be implemented to eliminate other issues and confirm the diagnosis of restless legs syndrome. Blood tests, assessments to measure electrical signals in the muscles as well as nerves, and other assessments in order to look at muscle signals with the legs may be suggested. These kinds of tests can easily document any accompanying injury or disease in the nerves or neural roots or some other leg-related motion disorders.

Heel pain is the most common musculoskeletal problem seen by podiatrists. The most common cause of that heel pain is a condition known as plantar fasciitis. The problem with it being so common is that everyone is an expert on it and everyone has there own magic cure for it that they think everyone should use. There is no shortage of advice for people on how they should treat plantar fasciitis in social media, in eBooks, on YouTube and on forums. Every time you see someone ask how to get rid of plantar fasciitis you get plenty of advice of what worked for them, therefore you should try it. However, for each recommendation of a particular treatment that gets given, there is another person says that it did not work for them. Many of the treatments that you see recommended can not possibly work, but those people swear by it.

The issue is that the symptoms of plantar fasciitis always get better over the long term anyway, so did it get better because of the treatment or did it work as it was about to get better anyway? You only have to look at the placebo or no treatment groups in the published clinical trials on plantar fasciitis to see that there is always an improvement in that group. That improvement is because of natural history of the condition. This means that any treatment that does get used for plantar fasciitis really needs to have been shown to have done better than doing nothing or compared to a placebo in a clinical trial before we can say that it does definitively work.

Another way of looking at this is that if you have 100 people with plantar fasciitis and do nothing for them, then after, say 6 weeks, let say 30% of them are better naturally. What if you gave those 100 people a useless treatment? After 6 weeks with that useless treatment, 30% of them will be better because of that natural improvement. However, those 30 people will be totally convinced that the treatment worked when it had nothing to do with it. It will be very hard to convince them otherwise.

In clinical research, it will take, say 200 people and randomise them into two groups (so that each group has the same characteristics such as age, weight, duration of symptoms etc). One group (of about 100) will get the actual treatment being tested and the other group (also of about 100 people) will get a placebo or useless treatment or left alone. After the, for eg, 6 weeks, say, 30% of that placebo or no treatment group would be better, but so would 30% of the group that got the treatment being tested get better because of that natural history. What is needed in clinical research to show that a treatment works, is that is there more than 30% better in the group getting the treatment?

Can you see how treatments that might not work might appear to work by people who used them? It can be so deceptive. That is why we only use treatments for plantar fasciitis that we are confident do better than a placebo because the published scientific research tells us that they are better than doing nothing.

Around April 2020 when the COVID-19 pandemic was at its peak in Europe there were increasing reports of what appeared to be chilblains on the feet appearing with a very high frequency in those infected with the novel coronavirus. The mass media caught on to these reports and a lot of attention has been paid to these so-called COVID toes.

Chilblains are reasonably common in the colder climates anyway, and it was not clear what the significance of them appearing so often in those with COVID-19 was as it was winter in the northern hemisphere when these media reports started to appear. Since those initial reports, there have now been a number of published studies on COVID toes and chilblains. That has not necessarily led to an increased understanding of the problem with mixed results and commentary in the medical literature. The reason for this is that it could be due to one (or both) of two possible explanations:

  • the chilblains could be part of the pathophysiology of the coronavirus infection. Chilblains are well known as a problem with the small blood vessels and how they react to the cold, so the inflammatory process of the infection could affect the way the blood vessels react, causing the chilblain. COVID-19 has been well documented as affecting the vascular system, so the chilblains could be due to this mechanism
  • the higher incidence of the chilblains may actually not be directly related to the COVID-19, but may be due to lifestyle changes that happened during the lockdown associated with the pandemic and it was those lifestyle changes that predisposed to the chilblains. Spending more time in centrally heated houses rather than outdoors in the colder climates could be a factor in the increased prevalence of chilblains.

While it’s not clear if its both or either of the above, COVID toes are definitely a thing. If you have chilblains and you do not normally get them or if you have them and there is something out of the ordinary with them, then it might pay to get that investigated further. Regardless of the cause of the chilblains, the management is the same and the feet need to be protected from the cold and the application of creams to stimulate the circulation in the small blood vessels is important.

There is an old quote I often use about gout: put your finger in the vice grip and tighten it as hard as you can, that is rheumatism; give it another half turn, that is gout. The message of the quote is that gout really hurts, it is really painful, exquisitely painful. That is the hallmark of gout. Gout most frequently affects the big toe joint of the foot and if you only have minor pain, then its probably not gout.

A red, hot, inflamed, swollen big toe joint is probably gout. However, it could be due to other things as well. The most important of those is an infection in the joint, which is really serious as it needs to be diagnosed and treated urgently to prevent any destruction in the joint from the infection and the inflammation and to prevent the infection spreading.

Gout occurs when uric acids crystals deposit inside the joint because it is the body’s way of getting rid of the higher levels in the blood. It does not work out too well and that uric acid causes the painful inflammatory reaction in the joint. The uric acid comes from purines, so the best way to treat gout over the longer term is to reduce the dietary intake of food that are higher in that (eg alcoholic beverages; some fish, seafood and shellfish, including anchovies, sardines, herring, mussels, codfish, scallops, trout and haddock; some meats, such as bacon, turkey, veal, venison and organ meats like liver) or use drugs that help the body to get rid of the purines (drugs to block uric acid production such as allopurinol and febuxostat or drugs that improve uric acid removal by the kidney such as probenecid and lesinurad).

Other drugs such as colchicine and anti-inflammatory drugs are also used, more in the short term to help with the pain. ICE packs over the joint too can also help.

Gout is not really a condition of overindulgence or lifestyle as is portrayed in the stereotypes, it is mostly a condition of genetics with lifestyle and diet only playing a smaller, but still important part. This historical perception of gout is a barrier to proper care and management. Those with gout have been shown to have a poor adherence to the correct medication routine and this is hampering the management, so please follow the medical advice for the treatment.