Our Response to COVID-19

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.

Severs Disease or Calcaneal Apophysitis?

Heel pain in kids is something we see a lot of and something that is quite common. Ask a group of, say around Year 6 school kids, about it and you can assume that they have had it or if they have not had it one or some of their friends have had it – it is that common. The most widely used term for this is ‘Sever’s Disease’, named after Dr Sever’s who first described it. The technical or medical name is ‘calcaneal apophysitis’. At the back of the heel there is a growth plate that growth in children takes place at. The condition is a strain or irritation of that growth plate. The growing area of the bone merges with the rest of the heel bone (calcaneus) in the early teenage years, so the condition does not exist after that age.

The issue with the terminology is firstly there is a movement away from naming conditions after people, so the terms ‘Sever’s’ should probably be dropped because of that. Secondly, there is also the issue of calling it a ‘disease’ when it is not a disease. Using the word disease to describe this problem is nocebic and conjures up all sorts of images in the child’s mind so that should not be used also for that reason.

Typically, the symptoms of this condition are at the back of the heel and are worse during activity. They may be reproduced by squeezing at the back of the heel bone. While this is the most common reason for heel pain in children, there are a number of other less common conditions that will need to be ruled out and it is important to get the diagnosis right in case it is something more serious.

The cause of Severs Disease or Calcaneal Apophysitis is most likely just simple overuse; that is too much activity, especially on harder surfaces. A higher bodyweight and tighter calf muscles may also be an issue that increases the risk for this.

The typical approach to treatment after getting the diagnosis right is just reassurance of the child of the self limiting nature of this condition and load modification of activity levels and lifestyle to keep the symptoms under control. Sometime a cushioned heel raise can be used to protect the area. ICE can be used after sport to help the pain.

What is a plantar plate tear?

The plantar plate is an area on the bottom of the joint capsule that surrounds the joints of the lessor toes. It is a powerful ligamentous structure that provides stability to the joint and serves as an attachment area of other ligaments around the joint. Sometimes that thickened ligament can get strained, which typically gets called plantar plate dysfunction. Sometimes it can progress to a small tear in the structure and can become quite painful to walk on – this is what is known as a plantar plate tear. It is a fairly common musculoskeletal problem seen by podiatrists.

Typically, it is painful under and just in front of the metatarsal head to walk on and to palpate the area. When standing the toe of the affected joint might be slightly elevated. There are some specific tests or movements that a Podiatrist can do to the toe to test the integrity of the plantar plate and to determine just how affected it is. The cause of a plantar plate tear is not that clear but there are a number of factors that do increase the chances of getting it, but mostly is it due to overuse with too much dorsiflexion of the toes (or toes if more than one is affected).

The best way to treat a plantar plate tear is to get the diagnosis right. It is usually fairly obvious clinically, but if it not clear then an ultrasound examination can be used to determine the extent of the tear. The initial treatment approach is to use taping for a plantar plate tear that holds the toe in a plantarflexed position and “rests” the plantar plate by limiting the amount of dorsiflexion of the toe when walking. A metatarsal dome placed just behind the painful area can also be useful to help do the same thing. Stiffer or rigid soled shoes or shoes with a rocker can also be used to help limit the dorsiflexion forces on the toe. If this is done right, the plantar plate tear should generally heal up over a few months. It does not happen quickly and is typically more of a slow and steady improvement over time. We have started using the Fix Toe device lately as it is a more practical approach than having to keep tape or strapping on the toe. If this does not help, and occasionally it dosen’t, then a surgical repair of the tear is indicated.

Foot Pain in Pregnancy

Pregnancy comes with significant body changes, some of which can actually take place in the feet. The added bodyweight, the fluid retention and the hormonal changes increase swelling in the foot and lower extremities, increasing the chances of foot pain and the ligament laxity may result in structural changes to the feet.

Pregnancy and Foot Swelling
There are several factors that contribute to foot swelling during pregnancy. The body produces more blood and body fluids when you are pregnant and also retains more water during the pregnancy. The venous system is also compressed as the pregnancy progresses which impairs blood flow back up to the heart. All of this leads to an increase in foot volume, leading to footwear fitting issues during the pregnancy.

Almost all of the extra fluid is lost with the birth of the child, so this problem tends to be temporary. During the pregnancy, elevating the feet and using compression/support stockings may help with the symptoms. Also, consider the Archie Thongs.

Pregnancy and Ligament Laxity
When pregnant, the hormone relaxin increases to relax the pelvis which is quite normal and is needed to facilitate the birth process. However, that hormone also affects all ligaments in the body including the foot. Combine that with the weight gain and you can see how the foot can be affected. This can decrease the arch height, increase foot pronation and increase the length of the foot. This means, a flattening foot deformity may result in other problems such as bunions, posterior tibial tendon dysfunction, as well as knee and back problems.

Foot orthotics may help protect and support the feet during pregnancy. The use of good and supportive footwear of the right size is also important. The Archies Thongs are particularly useful.

Pregnancy and Foot Pain
Several studies have shown that 40-50% of women have foot pain during pregnancy. This can range from feet that feel achy, especially while standing for long periods of time to more painful conditions, such as plantar fasciitis. The cause of these problems are mentioned above: weight gain, swollen feet and the hormone, relaxin.

The treatment of the foot pain during pregnancy will depend on the underlying cause of the pain. Please talk to your podiatrist about that.

Fat Pad Atrophy

Under the bottom of the heel is a fat pad that naturally cushions us and protects us as we walk. When walking, there is a pressure equal to about 2.5 times body weight on the heel during heel strike, so it should be obvious why we need that fat pad. Without that fat pad there would be very poor shock absorption and this can lead to a number of problems due to that poor cushioning. The most common is simply pain under the heel. This is not a common cause of heel pain, but is an important one as it can often be mistaken for plantar fasciitis and other causes. Often it is easy to diagnose as there is just no cushioning under the heel and you can easily feel the bone.

Causes of Fat Pad Atrophy

The causes are not totally clear. The fat pad does atrophy with age naturally and in some it just atrophies more at a faster rate. Some people just seem to develop this and others do not. It is not related to bodyweight issues. It can occur in a number of rheumatological problems and runners due to the years of pounding on the heel may be at a greater risk for this. Those with a higher arch foot (pes cavus) also get a displacement of the fat pad which can give a similar problem to the atrophy.

Treatment of Fat Pad Atrophy

The only way to treat fat pad atrophy is to replace the fat or substitute for the fat. This can be inserted in surgicaly or a cushioning heel pad in the shoes used that has a similar consistency to the missing fat pad. Cushioned shoes can also be used with or without extra padding. Surgically this can be an injectable fillers or an autograft using your own fat cells.

If you want to know what the best options are for you, please come in and see us.

Does the PediRoller massager really help?

The PediRoller is a massage tool designed by a podiatrist that you roll the foot back and forwards over. It can also be frozen, so if it is cold, then that can be used instead of ice for foot pain. The rhythmic rolling of the foot over the massage roller will help those with things like plantar fasciitis and those tired and aching feet some get at the end of a hard day. The ridges or ribs on the PediRoller really get into the soft tissues to give them a workout.

The feedback that we get from users, is yes they do help. Those who use them do find them helpful. You only need to use them for a few minutes, maybe twice a day and they will give some relief. They will help stretch the plantar fascia ligament and stimulate the circulation. This can only be helpful in making the foot better. If the pain is bad, then putting them in the freezer before use is a great way to get an added advantage from the product.

pedi roller

If you have any questions about this, please ask one of the podiatrists. Croydon Total Footcare does have this product for sale via reception or you can get it online.

What socks should diabetics wear?

Those with diabetes are at a higher risk of developing foot complications. This is because of the higher levels of blood glucose over a longer period of time can damage the nerves and circulation. As a result of this any damage to the foot may not be as easily felt (due to the nerve damage) and any damage that does occur may not heal as well (due to the circulation damage). For these reasons those with diabetes are urged to pay special attention to their feet and seek expert podiatry care for this.

One way to assist in this is with ‘diabetic socks‘. These are socks that are designed and developed with characteristics that can help mediate any damage to the foot that changes in the nerves and circulation may be causing. Probably the most important characteristic is that the sock is not tight so as to restrict circulation. They should be soft so to help absorb some of the ground impacts when walking. They should have no or minimal seams as these can be pressure points. Diabetic socks should also be made of a material that absorb the moisture. They also should help keep the feet warm. All of these characteristics in a diabetic sock can help protect the foot.

At Croydon Total Footcare we can advise you on the best socks if you have diabetes and we do stock a range for your convenience.

Do foot corns have roots?

This is a question we get asked a lot. They don’t. It is a myth that persists.

The reason that it persists is because corns do often keep coming back after we have removed them. They do not come back because we left the “root” there, like the plant analogy that the myth is based on. They come back because the cause of the corn is still there. They only way to stop a corn coming back is to remove that cause. Just removing a corn does not remove that cause.

A skilled podiatrist can easily remove a corn, but as that corn is caused by too much pressure on the area in which it develops, unless that pressure is removed the corn will return. You need to discus it with your podiatrist what needs to be done to either eliminate that excessive pressure or reduce it so that the corn is not so much of a problem.

The reason for that high pressure will vary from “corn to corn”, but it could be from, for example, a hammer toe pushing on tight fitting shoes; it could be between the toes and the alignment of the toes is off slightly, causing high pressure on the spot where the corn develops; or it could be from the shoe pushing on a bunion. The reason for the corn needs to be determined and that reason taken away if the corn is to be stopped from returning.

How that pressure is removed is going to be determined by the reason for the pressure. Was it the shape of the toe? Is there a bit of enlarged bone? Do the shoes not fit properly? Once that has been assessed then advice can be given on the best strategy to remove or lesson that pressure to prevent them from coming back

Bottom line is that corns do not have roots and if anyone asks you if “Do foot corns have roots?”, then tell then they don’t.

Archies Thongs are selling themselves

We have been stocking the Archies Arch Support Thongs in Melbourne from the very beginning. We were one of the early adopters. They are selling like ‘hotcakes’ and walk themselves out the door. With spring here and summer around the corner, how about coming in and getting a pair. We recently had a run of ladies who were pregnant buy them and raved about them. Some are coming in to buy them before heading to Bali for a holiday. Everyone seems to have a reason for wanting a pair. Even our office manager called them “life changing”! Runners and other athletes are finding then great for recovery after a hard worksout. No one seems to be disappointed in these.

What are the Archies Arch Support Thongs?

What is special about these is that they have an arch support built into them. If you need to wear foot orthotics or something simiar, than wearing thongs for an extended period of time can be difficult, so these are a good option when the weather is warmer or you prefer to use this type of footwear. Those who do not need foot orthotics just like the comfort that the arch support feature of these thongs – they just like wearing them. Some of these users of the Archies Thongs say things that they are less tired at the end of the day.

The Archies come in a varity of sizes and colours.

archies stockists in melbourne

Archies thongs design features:

Features and benefits:

  • The Arch Support – Archies Arch Support Thongs have a similar amount of support as most off the shelf orthotics. This may help to support the foot and improve foot posture, thereby potentially reducing the strain on your feet and lower limbs.
  • Comfortable! – The orthotic / arch support found in Archies Thongs combines with a super soft, highly resilient foam to provide an unbelievably comfortable feel, irrespective of whether or not you wear orthotics or have issues with your feet making them the perfect thong to wear when out walking or as a slipper in and around the house.
  • Lightweight – The highly specialised foam material found in Archies Thongs is ultralight in comparison to other orthopaedic thongs which may result in less tired and achy feet at the end of the day, making them the perfect thong when travelling!
  • The Strap is Tight – In thongs with a loose strap, your toes claw down and you do not get the protective support from the arch like you are supposed to. The tighter strap in Archies Thongs may help to reduce toe clawing allowing you to walk more naturally.
  • Construction is one piece – As the thongs are all moulded as one you are far less likely to break the toe pole as you are in thongs with a base and plug configuration.

Croydon Total Footcare is one the biggest stockists of Archies in Melbourne.

Croydon Total Footcare have other recommended footwear brands, so come in and see them.