Ingrown toenails are probably not as common as you think. The most common cause of pain down the side of a toenail is a condition called onychophosis which many people mistake for an ingrown toenail. A true ingrown toenail is when a sharp edge or piece of the nail penetrates the skin to become “ingrown”. This typically becomes red and inflamed and runs of the risk of infection developing. Onychophosis is a callus or a corn that develops down the side of the nail from pressure between the nail and the skin. Typically the nail is curved and there is quite a lot of pressure there. Because of this pressure, the skin thickens up to protect itself, but becomes so thick it forms a painful callus or a corn. Both an ingrown nail and onychophosis cause pain down the side or edge of the nail. That pain is due to the pressure, but one is due to the nail penetrating the skin and the other is due to the pressure on the skin, so you can see why they may often be confused.

An ingrown toenail is treated by a podiatrist skillfully removing the piece of nail that has penetrated the skin. In the long term it may need a minor surgical procedure for a more permanent solution if the condition continues to occur. For an onychophosis, this is where the practical skills of a good podiatrist shine in being able to skillfully debride the callus and corn and file the nail away from the painful area. Like an ingrown nail if this becomes an ongoing problem, minor surgery can be used to remove the edge of the nail to prevent it from being a long term problem.

If you have any pain down the side of the nail, whether it be an ingrown toenail or an onychophosis, then come in an dsee us to discuss your options.

Tutankhamun was the 13th pharaoh of the 18th Dynasty of the New Kingdom of Egypt who lived over 3300 years ago and Joseph Goebbels was a Nazi politician in Germany and the chief propagandist for the Nazi Party, becoming Hitler’s Minister of Propaganda from 1933 to 1945. They both allegedly had a clubfoot.

A clubfoot is deformity that is present at birth and occurs 1 to 4 times per 1000 births which makes it a reasonably common issue at birth that obstetricians and midwives routinely screen for it. With a clubfoot one or both feet are rotated in an inward and downward direction. Almost all cases are picked up at birth and treated promptly. Initially they are treated with serial casting to slowly move the foot back into a more normal position. Those that are more rigid and more severe may need a surgical correction.

Most cases respond without any issues and they do not have problems. Some do develop some problems that may show up later in life. These kinds of issues are related to something like the foot not being “100% corrected” following birth, but being say, “85% fixed” which is fine, but over the years of weightbearing and activity there may be some issues with things like aches in some of the joints due to the alignment or maybe things like painful calluses under a metatarsal heads due to too much pressure there. These are quite manageable with inserts in the shoe to change the weightbearing and there are options to deal with the painful calluses. Please get in touch with us if you have any of these long term problems that may be due to a corrected clubfoot when you were a baby.

There is a lot of confusion and debate about Tutankhamun’s clubfoot and Goebbels’ clubfoot. There is no doubt that Tutankhamun did have a genetic disorder (he had a cleft palate), but there is debate if the deformity of his foot due to damage that occurred to the mummy, so the clubfoot could just be a postmortem artifact. Goebbels’ variously described his foot deformity as being due to an infection, an accident or polio. Under German Nazi law, it was possible that his clubfoot was one of the genetic diseases that required compulsory sterilization, so he would not want to be included in that.

There is no such thing as the best running shoes. You will see all over social media recommendations from people as to what is the best running shoes. It usually turns out that this is the running shoe that they are wearing. Just because that running shoe works for them does not mean it will work for you. The person giving advice in social media has no idea of the characteristics of your foot and your running gait and what your goals and aspirations are, yet they still think they can advise you without knowing that. Even worse, are those who take that anonymous advice.

Every runner is different. They have different running techniques and they have different foot structures and functions. They also have different goals with what they want from their running and they run different distances on different surfaces. To get the best running shoe for you, all of that information needs to all be taken into account. All running shoes are different. Each running shoe has different design characteristics. Those design characteristics or features need to be matched to the characters of the individual runner to get the “best”. On top of that, each brand uses a different set of lasts that the running shoes are made on, so they will vary somewhat in shapes, which need to be matched to the shape of your foot.

Rule number one is that do not try to fix what is not broken. If you are running in a particular shoe and that shoe is working for you, then do not try to change it.

If you are starting from scratch, then get yourself along to a specialty running shoe retailer who has all the knowledge and try out several different brands and models. They will generally recommend several different shoes after getting your goals and aspirations and looking at your gait and foot structure.

We will also occasionally make recommendations of specific running shoes as some shoes have a certain characteristic that is beneficial for your particular clinical problem. For example, the Brooks Adrenaline has a 12mm drop (heel is 12mm higher than the forefoot) which is some people that may be indicated to help with their problem. Others will benefit from a running shoe that has a 0mm drop. The Hoka brand of running shoe has a rocker type action in the forefoot that will benefit those with pain in their big toe joint.

There is no such thing as the best running shoe. There is such as thing as the running shoe that best works for you.

An ancient practice in China was to bind the foot of young girls to stop them growing. They were tightly bound and it was painful. In that culture at the time a smaller foot was considered more erotic and a higher price could be demanded by the brides family prior to marriage if the feet were smaller. The practice was barbaric, disabling and brutal and was widely practiced, especially in rural China. The practice was banned many years ago and is no longer done. There are still some older Chinese women alive in remote rural areas who were subjected to this as children.

Chinese Foot Binding

Once this was done, there was no treatment for the pain and the best option for them was to keep the feet bound. Chinese food binding has also been shown to affect cortical issues in the brain.

While this practice has ended in China, a number of social anthropologists have drawn parallels between Chinese foot binding and the practice of women wearing tight fitting shoes in today’s society. Both practices are argued as being something that is done to please the male members of society and both practices are harmful and brutal to the foot.

Obesity has become a significant risk factor for so many medical conditions that is becoming much more common. A few years ago it was estimated that 67% of the Australian population over the age of 18 were either overweight or in the obese category. This has major public health implications.

The risk for so many different medical conditions is increased by being overweight. Foot problems are no exception. It should be obvious that carrying more weight than necessary is going to increase the chance of getting a whole range of different foot problems as well as making existing foot problems more severe.

A recent study has shown that a simulated reduction in weight loss improved the symptoms in the foot for those with arthritis. There is a high correlation between plantar fasciitis and the body mass index reported in another study. This goes to show just how important keeping weight under control is for preventing foot problems (and a multitude of other health problems) and the importance of loosing weight to help recalcitrant foot problems (and a multitude of other health problems).

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.