Do you have an ongoing problem with an ingrown toenail?

An ingrown toenail is due to a combination of a curved shape to the nail, poor cutting technique and pressure on the toe from the shoe. Many cases can be managed with conservative care periodically and that combined with good self-care can often take care of it. For some, that is not enough and something more drastic and radical seeds to be done to prevent it from becoming such a regular problem.

If you are in that latter category where the problem is ongoing, then please come in and discuss it with us. A minor surgical procedure under a local anaesthetic can remove the side of the of the toenail that is causing the pain and an acid is used on the growing area of the nail to prevent that side or edge of the nail from growing back. Healing afterwards is usually uneventful, but we do like you to wear an open shoe or sandal for up to a week and keep it dry for at least a few days so that it heals up properly. The worst that can usually happen is that a phenol burn may take a little longer to heal (phenol is the chemical that we use to destroy the growing area of the nail so it does not grow back). Please come in and discuss your options if you have this problem.

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What is the difference between a hallux valgus and a bunion?

Sometimes the terms that get used medically, hallux valgus (or hallux abducto valgus) and bunions are used to describe the same thing when they aren’t.

A bunion is the enlargement that occurs on the big toe (hallux) joint, or technically the first metatarsophalangeal joint. Hallux valgus is when the big toe angles in a valgus direction, which is towards the outside. There is debate about if this is valgus or abductus (hence the term hallux abducto valgus and which one occurs in which direction, but that can wait for another day).

Basically, a bunion is the lump and the hallux valgus is the deformity.

So, yes they are not the same thing, but a bunion almost always occurs with a hallux valgus and they are both parts of the same problem.

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The Effectiveness of the urea based creams

We use a lot of the urea-based creams, specifically the Walker’s brand. We have found it very effective for the dryer skins and the Walker’s comes in two concentrations (15 and 25), so we can choose which is more effective.

Urea based creams have been widely used for since the 1940’s to treat dry skin and conditions like psoriasis and dermatitis. It has next to no side affects, though an allergic reaction is a rare one. Below a concentration of about 20 (ie the Walker’s 15) the action of the urea is to act as a humectant, which means it helps the skin retain moisture. Above a concentration of about 20 (ie the Walker’s 25) it causes a breakdown of proteins in the skin and the dry skin can flake of and soften the skin. We will often choose to use one or the other depending on the clinical needs. Varying the use of the two can prove to be quite effective.

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Foot Pain and Menopause

Pain in the foot does have a higher incidence after menopause. This study in a group of women in Spain looked at the foot-related quality of life issues surrounding menopause and found that, yes, there is a poorer quality of life-related to foot pain after menopause. There are a number of physiological changes during the ‘change of life’ that affect foot pain in menopause. These changes include:

  • Changes occur to the properties of the soft tissues. For example tendons become stiffer and this increases the risk for injury to those types of structures.
  • Osteoporosis is much more common after menopause to the changes in the different hormones. This makes the bones ‘softer’ and more likely to have a bone stress injury, a stress fracture or a fracture.
  • there are changes to the hormone control of the small blood vessels and this can predispose to issues with the circulation as the circualtion reacts sluggishly and differently.
  • After menopause, there is almost always in increase in weight. This increase puts more load on the foot and increases the risk for developing a wide range of foot problems.

Menopause on its own does not cause foot pain. It is the physiological changes that happen during menopause that increase the risk for a lot of different types of foot problems. We can help with those foot problems.

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Runners Should Rotate Their Running Shoes

The type of running shoe is a key decision that any runner needs to make. The good (or bad) news is that runners should have at least two pairs of running shoes and rotate them on different days. This study shows that runners who use more than one pair of running shoes are less likely to get an overuse injury.

Probably the most likely reason for this is that different running shoes will stress a different set of tissues differently. For example, running shoes can come with different ‘drops’. This is the height difference of the midsole between the heel and forefoot. Some running shoes are 10-12mm, some are 8mm and a few are down to zero. It is not hard to see that running in a 10mm drop running shoe one day and a 0mm drop running shoe the next day how the load or forces on the calf muscle are going to be different.

Moving the loads around like this can be important in preventing injuries by stressing tissues differently from day to day. The best way to do this with running shoes would be to make sure that the design features in the 2 or 3 or more shoes that you run in a very different from each other. Also, it is important that you spend time to adapt to any new running shoe so the body gets used to them, especially if they have design features that you are not used to running in.

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Archies Footwear for Children

Archies Footwear are a thong or flip flop that have an arch support built into them. We are one of the largest Archies stockists in Melbourne and have the full range of sizes and colours. It is exciting that the Archies are now available in children’s sizes. Besides being functional and helpful, they are also really cute.

Pretty much anyone who tries the Archies on in the clinic, buys them. They really are that good and comfortable. They are also functional and have a useful arch support for those that need them. This can make them particularly useful for kids. Please come in and give them a try.

archies thongs smelbourne
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Ingrown Toenail or Onychophosis?

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.

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What does Tutankhamun and Joseph Goebbels have in common?

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.

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What is the best running shoe?

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.

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The Brutality of Chinese Foot Binding

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.

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