Painful bump at the back of the heel bone?

Its called a Haglund’s deformity or a pump bump. Ice skaters call it a Bauer bump (after the most popular brand of ice skates).

Everyone has some amount of enlargement at the back of the heel bone. Some just have more or less than others. It is a natural and natural variation. However, those who have a larger bump are going to have problems with pressure from the shoes, especially if the nature of the footwear used is rigid (eg ice skates). This then becomes painful and a swollen bursitis may develop, resulting in the problem of Haglund’s deformity.

The best way to treat a Hauglund’s deformity is to get out of the shoes that are causing the problem. If that is not possible, then try to get into footwear that is not rigid and somewhat flimsy in the heel counter.

Felt padding can be used to make pads the shape of a horseshoe or a donut with a hole in it to get the pressure from the shoe off the painful area. There a also silicon gel Haglund’s protector pads that are a sleeve around the ankle that can be worn under the socks can be used to prevent friction.

If you have a problem with pain at the back of the heel and its not getting better, please give us a ring and we can help.

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Pain down the outside of the foot in a child

There are many different causes of pain down the outside of the foot and one of those rare causes in children is a condition called Iselin’s disease. There is a growth plate at the base of the fifth metatarsal bone that the peroneal tendon from the leg attaches to. This means that this growth plate is subject to a lot of pressure from the tendon, especially if the child is active in sport. Overuse of this area can result in an inflammation or irritation of that growth plate, resulting in the Iselin’s disease. Age 13 years is the most common time for this and it affects bots just as much as it affects girls.

The pain of this usually starts slowly and gets worse with increased sports activity. There may be some swelling in the area and the pain may be making the child limp. Palpation of the base of the fifth metatarsal about midway down the outside of the foot is painful or tender. X-rays may need to be done to confirm the problem and rule out other potential causes of pain in the area.

The most effective treatment for Iselins disease is simply rest. This means reducing the amount of sport or total rest. This may need to be done in a moon boot if the pain is bad enough. It can take 4-6 weeks of this type of rest for it to improve enough for the levels of exercise to be gradually and slowly increased.

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We now have the Archies Slides

We have been a stockist of the Archies Thongs since the very beginning and they have proved to be very popular. Pretty much everyone who tries on a pair buys them. However, that type of footwear is not necessarily for everyone, so we are please that we now have the Archies Slides in stock. We managed to sell quite a few the day that the first box arrived!

They are currently available in 4 colours: black, peach (orange), tan and white.

Please come in an check them out. We are only in Croydon on Monday, Tuesdays and Thursdays. And we also have a lot of stock of the Archies thongs and the children’s sizes.

We are one of the biggest stockists of Archies slides in Melbourne!

archies slides
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Shooting pains around the big toe

Do you have shooting pains around the big that radiate forward from the side of the big toe joint into the big toe? If you do, then you might have what is called a Joplin’s Neuroma.

There is a nerve (the medial plantar digital nerve) the goes over the side of the big toe joint. This nerve can have a lot of pressure on it if you have a bunion or use tight fitting footwear. This irritation of the nerve can lead to the formation of a neuroma, the Joplins Neuroma.

The typical symptoms are a shooting and radiation pain over the joint and into the big toe.

The treatment approach to this problem is to get the pressure off the irritated nerve. This will involve wider fitting footwear and the use of padding to keep pressure off the joint. If those measures are not helpful, then a surgical removal of the neuroma might be needed.

If you have any shooting pains around the big toe joint, them come in and see us and we should be able to help.

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What is a Tailor’s Bunion

A Tailor’s Bunion is the bunion that occurs at the base of the little toe. It is called a Tailor’s bunion because it used to be assumed that it was more common in the Tailor’s who used to sit cross legged while they did their work. This sitting position put a lot of pressure on the outside of the foot wear this small bunion occurs. It is also called a bunionette as it is widely considered to be the smaller cousin of the typical bunions that occur at the base of the big toe.

The cause of a Tailors bunion is most likely die to poorly fitting footwear causing pressure on the fifth toe in those who a hereditary predisposition. The symptoms are an enlargement of the bone at the base of the first toe that may become inflamed and be painful when wearing shoes that press on it.

To treat a Tailor’s bunion make sure you are wearing roomy, comfortable shoes with a wide toe box can alleviate pressure on the painful area and provide relief. Barefoot can be best or something like the Archies will allow you to walk around without any pressure on it. Any shoe that puts any pressure on the joint are best avoided. High heel shoes will also increase the pressure on the problem and are best avoided. There are protective pads and corrective pads can help reduce friction and protect the affected area. The pads can be placed on or around the enlarged joint to straighten the toe and protect the bunion for friction.

If these approaches with good shoes and different paddings are not helpful, then surgery is really the only other option to get rid of a Tailors bunion.

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Do you need toe straighteners?

Toe straighteners or toe correctors or toe spacers or toe braces or correct toes or whatever you want to call them are being used more often than in the past. They come in a variety of different designs and types with a lot of variation between them.

The purpose of these toe straighteners are to obviously straighten the toes! As you can see above, the left one tries to straighten them by pulling down on the toe from above whereas the one on the left tries to straighten and separate the toes to spread them. This spreading is particularly helpful if you spend all day in tight footwear. As to which toe straightener you should use, it could depend on the nature of the problem that we are trying to correct. The one on the left will also fit better into the shoes whereas the one on the right will only fit into shoes that have the room. It may be better to use the one on the right as more of a night splint.

The main use for these toe straighteners are to use on toes that are cramped into shoes all day. They are helpful for hammer toes and claw toes and the one on the right can be particularly useful for conditions like a Morton’s neuroma.

At the end of the day, if you wear shoes, you will probably benefit from one or both of these types of toe straighteners to counter some of the forces that the shoes apply to the foot to deform them. Get in touch with us if you want more advice on this.

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What is Sesamoiditis?

Under the big toe are two small bones called the sesamoid bone. These are embedded in tendon in the same way that the patella bone is in the from of the knee. The function of the sesamoid bones (and the patella) is to give the tendons are more efficient lever to move the joint. As these bones are under the big toe joint, they are subjected to a lot of force when walking and playing sport. Sports like tennis where you need to use the big toe joint to pivot on put an enormous amount of force on them. If these loads are too high, you can end up with a condition called sesamoiditis in which these small bones and the structures around them become inflamed. Wearing higher heels shoes also puts pressure on the sesamoid bone and so does having to stand all day at work, especially on hard floors.

The symptoms of sesamoiditis are gradually increasing levels of pain under the big toe joint. If you palpate where these bones are they can be quite painful. Sometime the bones are very prominent because there has been some atrophy of the fat pad. On occasion, especially if the onset of pain is acute there might be a fracture of one or both of the sesamoid bones. There are a number of conditions that can affect the big toe joint such as gout or osteoarthritis that also needs to be taken into account when assessing someone with pain in this area.

Once a sesamoiditis has been diagnosed then sesamoiditis treatment usually starts with some sort of reduction in activities or modifying them if that is possible. Getting into well padded and cushioned footwear is also a useful idea. There are adhesives felts that can be stuck on the foot to get pressure off the painful are. Pads an also be used on insoles in the shoes. Over the long term foot orthotics with pressure relieve are usually very helpful.

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Medical Conditions Affecting the Foot

When you first come to us we will be asking questions about your medical history and what medicines that you might be taking. Periodically when you come to see us, we will update this information. Sometimes you may wonder why this information is relevant and what it might have to do with your foot and what we do. It is relevant and important as it might impact on what is the cause of your foot problem and it may impact on how and what we do to treat your foot problem.

The obvious one is diabetes. Diabetes increases the risk for a lot of foot problems due to its effect on the nerves and blood vessels. Not only does diabetes increase the risk for foot problem, it also affects how problems with the foot heal up. We really do need to know if you have diabetes and how things are going with it so we can assess how it affects your feet.

It may not seem relevant, but thyroid disease is another one. Over and under activity of the thyroid glad can cause issues with the feet. For example, under-activity can lead to dryer skin that can lead to painful cracks around the heel.n

Coeliac disease is another one that you might well wonder what it would have to do with the foot when the disease is a problem with gluten damaging the villi in the gastrointestinal tract. Coeliac disease does affect the foot. There have been a number of case reports of chilblains in those with celiac disease and it can also cause an enthesopathy in the foot and affect the nerves to the foot. This means that something that may seem to be so unrelated to the foot and problems with the foot may need to be considered when assessing a foot problem.

When you get asked about your medical history and symptoms and the drugs or medicines that you might be taking, then there is a good reason why we might need that information. It may not seem relevant to you, but it could well be a factor in your foot problem and may be a factor that needs to be taken into account when we recommend the best approach to treat your problem.

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Arthritis of the midfoot

Pain in the midfoot, just in front of the ankle is a reasonably common problem. One of the more common causes of that pain is osteoarthritis, the so called ‘wear and tear’ arthritis. The symptoms typically start out with a mild ache in the midfoot. Often that can be helped with a some mild anti-inflammatory drugs and wearing more supportive footwear. Later as the osteoarthritis progresses the pain can become more constant and become a real problem. The pain is typically deep within the midfoot or arch area of the foot and is made worse after activity.

One of the biggest risk factors for osteoarthritis is obesity and that is true for midfoot osteoarthritis, so loosing weight is a good approach to dealing with the symptoms of osteoarthritis. You should raise this with your general medical practitioner about how to approach that.

The use of a cream like fisiocrem that give a deep heat feeling is often advised as well as mobilisation exercises. There are different exercises for both stretching and strengthening the muscles around the midfoot that can be helpful. Anti-inflammatory drugs are also more helpful as the pain gets worse.

Another approach can be to use the shoe stiffening inserts for midfoot osteoarthritis. These are thin and very rigid carbon fibre plates that help stiffen the footwear to make it more rigid. Some people find that wearing more rigid or less flexible shoes are more comfortable, so in these cases they will often benefit from these types of rigid plates.

Foot orthotics for midfoot osteoarthritis are most commonly used to give some support and stability to the midfoot and arch. This is usually very helpful at helping with the symptoms and increasing the ability to walk without any pain. Custom made foot orthotics are generally a better option for managing this.

If you have pain in your midfoot, then give us a call for an appointment and we can certainly help and discuss your options..

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What chilblain cream do we use?

Chilblains are a relatively common vasospam of the small blood vessels in the toes that create a reddish or bluish lesion that can be itchy and painful. They typically occur in the cooler climates and that chilblain season is coming up. There are a number of things that can be done to prevent and treat chilblains. This include protecting the feet from the cold, not warming them too quickly after they become cold, and using creams that can help to stimulate and the circulation as well as sooth them when they occur.

There are a number of different creams, lotion, potions and ointments on the market that can be used for chilblains and every single one of them can probably produce some pretty convincing anecdotes and testimonials about how good they are. For us as clinicians it can be a bit of a problem to know which one to recommend in the context of them all claiming to be the best and each one of them having some support. There is no research that has been done to show which one is the best chilblain cream to use. We have some experience with some of them and that results of that experience is a bit mixed. The problem is that one cream that works for one person may not necessarily work for the next person. So any recommendation for a cream to use for chilblains is going to have to be for one that is more likely to affect a lot of people and be a good place to start. One thing I did notice is that when you see questions asked of a group of podiatrists, there will be a number of different recommendations given, but also the name “Akileine Akilwinter Chilblain Cream” does keep coming up and recommended more often than others, so that is now the one that we typically use first.

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