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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).

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.

Short answer: with difficulty.

Ballet flats are a particular shoe design inspired by the shoes used by ballet dancers. By design these shoes are very minimalist. They do very little to the foot except cover it and come in a wide range of attractive designs. They also tend to be very snug fitting to help them stay on the foot. There is nothing inherently wrong with these types of shoes provided that are fitted properly and are of the right size for the user.

The issue with these minimalist types of footwear is if there is a foot problem that needs some sort of arch support, even on a temporary basis. The main sorts of problems that this might be needed are especially if you are on your feet all day and the feet and legs get very tired. Due to the minimalist nature of the design and the typically snug fit of the footwear, there is not going to be a lot of room in the shoes to do much. Clinically, choices or options can be limited if you spend most of your time in this type of footwear. There is simply no way that a typical foot orthotic is going to fit into these types of shoe. Sometimes a cut down foot orthotic might be able to fit in the shoe. Other times the problem can be managed by changing to a different type of footwear that foot orthotics can easily be used in for a period of time until the problem gets better. It is always best to see a podiatrist and discuss the options that you have if you really do need some sort of support and if it can be accommodated in your ballet flats style footwear.

Arch Support in Ballet Flats

There are a very limited number of ballet flats on the market that do have arch support type designs built into them. However, they are hard to find and may not be suitable for you. There are the instant arches types of self adhesive pads that can be stuck in the shoe to give some sort of support and this is often a good compromise if that is what is needed to deal with your problem. We do use them from time to time when there is no other more suitable workaround to getting support into a ballet flat type of shoe.

Long answer: it can be done, but there has to be compromises made.

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.

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.