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Gout hurts!

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.

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Heel pain that is worse first thing in the morning?

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.

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How to fix ingrown toenails?

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.

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Can the ‘bunion correctors’ actually correct a bunion?

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.

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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.

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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.

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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.

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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.

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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.

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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.

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