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.

Do you have pain under the heel that is worse in the morning and gets a bit better after you have taken a few steps?

If you do then there is a very high probability that you have plantar fasciitis and that pain is called ‘post static dyskinesia’. While there are many other causes of heel pain and some other causes that can cause that post static dyskinesia, plantar fasciitis is by far the most common cause of the first step pain in the morning or after prolonged rest. As with all types of problems, getting the diagnosis correct before time, energy and money is spent on a treatment is important.

Plantar fasciitis is the most common musculoskeletal problem that we see at Croydon Total Footcare and it can range from a minor annoyance all the way to quite a severe disability that is so painful that doing things like going to work is difficult.

The plantar fascia is a very strong ligament like structure on the bottom of the foot that is a flat sheet connecting the heel bone to the toes, so its primary function is to support the arch of the foot. Anything that puts too much strain on that plantar fascia, such as being overweight or having high sports activity levels or being on your feet all day on hard concrete floors, can increase the risk for getting it.

Our approach to plantar fasciitis is to get the diagnosis right first and make sure that it is actually plantar fasciitis that we are dealing with. Then there some advice re the initial pain relief with the use of education, ice and maybe strapping to settle it down. Then the longer term strategy is needed. This might involve foot orthotics to prevent the load in the plantar fascia and an exercise or loading program to make the plantar fascia stronger so it can take the loads. Each approach is likely to be different between individuals and that is a discussion that you need to have with one of our podiatrists.

Ingrown toenails can become a real problem and they tend not to fix themselves. A true ingrown toenail occurs when a spike, sharp corner or edge of the nail actually penetrates the skin (becomes ingrown) and can become swollen and infected. A lot of people have pain down the edge of the nail that is not technically an ingrown nail but it is a spike, sharp corner or edge of the nail pushing on the skin, but not actually penetrating the skin. In some cases, a corn or callus may even form down the nail sulcus from that pressure from the nail. We see a lot of ingrown nails at Croydon Total Footcare.

What can be done for an ingrown toenail?

This will depend on what exactly is causing the pain, if the nail has penetrated the skin and just how far down the side of the nail the problem is. The podiatrist will meticulously remove the offending piece of nail and smooth the edge of the nail. If it is deep and maybe infected, a local anaesthetic may be needed.

If the nail is very curved and goes deep down the side, this may be an ongoing problem, so a minor surgical procedure may be needed to remove that side of the nail and a chemical used to stop that part of the nail from growing back. This is often the case if the nail progresses to this stage:

If the nail looks like that, the only solution is the removal of the edge or bit of the nail that has penetrated the skin. Not topical cream or antibiotic is going to take that bit of nail away.

What can you do to fix an ingrown nail?

If it looks like the picture just above, then there is not much you can do, so come in and see us before it gets any worse.

If the nail is not infected, the the best thing that you an do for it is to NOT cut down the egde as that can leave a sharp corner or spike and it could become worse. If you are able to use a nail file to keep the edge of the nail smooth, then that may help.

Your best option is to probably come in and let us have a look at it, clear out the edge of the nail to relieve the pain and discuss the different options you have for the long term and what else you could do to manage it yourself.

These are splints or braces that you are supposed to wear at night and are claimed by those who sell them to correct the bunion (or more appropriately called ‘hallux valgus’). If you look at the pictures of them, it is easy to see how they might do that. The question then becomes, do bunion correctors work?

Thinking about the physics and biomechanics, it is easy to see how the brace could try to correct the position of the toe during the night. The only problem with that thought is that the next day you have all the forces of weightbearing and the footwear pushing the toe back the other way. It is probably likely that those forces easily overcome any correction that may have occurred over night, at least theoretically.

What does the actual evidence say? One study has shown that they do actually work. They showed an improvement of a few degrees after a few months of use, which seems a good outcome. However, what the study did not show (and no other study has looked at) is that if there is any more improvement if it is used for longer or if the improvement is maintained if use of the bunion corrector is stopped. Based on this it is hard to give advice on if the bunion correctors do work at improving the angle of the big toe. That does not stop a lot of people asking if they work in forums and Q & A groups online.

Having said that, that does not mean that they do not have there uses. However, that use often has to be combined with the use of exercises and footwear advice. They can be particularly helpful at increasing the mobility of the joint and that can have a significant impact on the ‘aches and pains’ coming from inside the joint that can be common in those with bunions. We do have these available if you think you would benefit from them and please do not hesitate to contact us if you have any issues with bunions.

Running shoes are probably the most important piece of ‘kit’ that a runner has. Running shoes can also be expensive and if you are not using the right running shoes, this may increase the risk for an injury and may affect performance. Running shoes can ‘wear out’ and need replacing.

How often should a running shoe be replaced?

There is no hard and fast rule to answer that question. Some runners wear out there shoes a lot quicker than others. You do often see advice that they should be replaced every 350-500 miles or 550-800 kilometers, but that is not based on any actual evidence, but still could be a good guide.

Probably the best way to know when a running shoe should be replaced is to listen to your body. How do the shoes feel? Are they starting to interfere with the way you are running? Do you feel like an injury might be starting? Above all, use your common sense.

When you get your new running shoes

As running shoes wear out, there are going to be very subtle changes in the way that you run. They will be so subtle that you probably will not necessarily notice them, but your body will adapt and be used to those changes. When you get your new pair of shoes, there can be a problem as you will suddenly be changing that way you were running in the older worn out shoes. This can cause an injury if you are not careful. You should only do a few shorter runs in the new shoes initially to allow your body to adapt to the new shoes before using them for most of your runs.

If you have some questions about running shoes

Please do not hesitate to get in touch with us. Craig has had a lot of experience with running shoes and has recently completed the New York Marathon.

As the weather has started to cool for winter we have started to see some chilblains as it is that time of the year. That can also be a bit misleading as chilblains are not technically due to the cold weather, but are due to how the small blood vessels in the foot respond to the changes in temperature from cold to being warmed up.

Chilblains are typically red painful and itchy spots on the toes and other areas of the foot (though they can less commonly also affect the hands, ears and nose). They only appear in the colder climates and are pretty much unheard of in warmer climates. They typically occur when the foot has been cold and is warmed up too quickly for the small blood vessels to react to that change in temperature. This releases chemicals that cause the itch and creates an inflammatory reaction leading to the chilblain. They can become quite painful and break down which might lead to an infection. Repeated exposure to the cold may lead to the chilblain becoming chronic.

The best way to deal with chilblains is to prevent them from happening in the first place. This means making sure the foot does not get cold, so keep on warm socks and closed in shoes. If the foot does get cold, then make sure it is warmed up slowly. Do not put a very cold foot in front of a heat source – warm it up slowly.

If a chilblain does occur, then protect it. Keep it warm. Use some gentle rubbing of it with a cream to stimulate the circulation. Please give us a call and come and see us if you are troubled with chilblains. There is plenty we can do and plenty of advice that we can give.

You can read all the latest research on chilblains at Podiatry Arena, Craigs blog post on beetroot and chilblains as well as an episode of PodChatLive on chilblains.

COVID-19 has certainly been a major upheaval in everyone’s lives and in too many cases having tragic consequences. We have all had to adapt to the short term impacts of this on our lives and there will be long term changes in our lives as a result of this.

We have had a number of calls if we are still open (we are) and we certainly understand people’s reluctance to go anywhere unless they really have to. Our priority is your and our health and safety. We know that people with foot pain need to be treated. At Croydon Total Footcare we have always had a high standard of infection control to protect our patients and us. Since the COVID-19 outbreak, we have implemented new safeguards such as protective screens, adjusted appointment book scheduling to ensure there is no patient to patient contact and the increased use of personal protective equipment. We are also asking people to remain in their cars in the parking area if we already have someone in the clinic.  Our stringent sanitisation of all shared surfaces has also been increased.

For those who just need advice, a second opinion or simple follow-up we now offer a telehealth service, so this can be done over a video call. Most health funds are paying for this, at least in the short term. Please contact us for more on this.

At Croydon Total Footcare we are following all the guidance given by the Victorian Government and the Australian Health Profession Regulatory Authority as well as advice from the Australian Podiatry Association. You can rest assured that we are giving your (and our) safety the highest priority so we can better manage your foot problems. Please give the clinic a ring if you have any questions.

Stay safe.