Treating Heel Pain

We diagnose and treat the following common podiatry complaints:

Athletes Foot

Athletes Foot (Tinea Pedis) is a common fungal infection of the skin caused by the tinea pedis microbe. The signs of this complaint include itchiness, redness and peeling skin between the toes. Tinea Vesiculare is another fungal complaint of the foot that often presents with small blisters under the arch of the foot.

We provide the following solutions:

  • Recommend appropriate antifungal medication to remove the complaint
  • Advice to prevent the reoccurrence of this complaint
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Bunions

Bunions (Hallux Abducto Valgus) refer to the deviation of the great toe towards the outside of the foot. This deviation occurs from the great toe joint and causes the foot to become broader and the great toe does not function properly. Discomfort often occurs secondary to footwear pressure on the bunion prominence or due to degenerative changes in the great toe joint itself.

Causes of bunions include: genetic predisposition, poor footwear and hypermobile, flattened feet.

We provide the following solutions:

  • Antinflammation advice
  • Footwear advice
  • Night splinting to improve joint position and reduce discomfort
  • Forefoot padding and strapping techniques and
  • Use of orthotics
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Calluses

Calluses (Hyperkeratosis) is a build up of thick skin on the foot caused by friction in high pressure areas of the foot. This complaint is often accompanied by corns and can be mildly uncomfortable to painful and debilitating. Calluses often appear on the bottom of the foot around the forefoot, as well as the heel and around the sides and tips of the toes. If Calluses are left untreated, they can interrupt the blood (vascular) supply to the area and ulceration may result. It is recommended that people with diabetes are regularly screened and treated accordingly to prevent the development of a callus that can cause ulcerations.

We provide the following solutions:

  • Complaint removal
  • Advice to prevent the reoccurrence of this complaint
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Cavoid Feet (High Arches)

High arches is a common term used to describe a foot that supinates or rolls out too much at the ankle and midfoot. The arch height in these individuals is much higher off the ground than what is considered average. A client with high arches will have bulging at the outside of the ankle joint, a high instep and a greater wear pattern on the lateral or outside of their shoe.

High arches can lead to problems such as chronic lateral ankle sprains, peroneal tendonitis (a tendon that runs down the outside of the ankle and into the foot), balance problems, midfoot aches and pains, poor shock absorption during gait leading to foot, knee and lowerback problems.

Footwear choices are very important when dealing with high arch foot problems, and the correct orthotics are essential. Orthotics for high arches need to be very precise to get good results and have been shown to improve postural stability/balance, reduce the incidence of ankle sprains and help prevent injury if used correctly.

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Corns

Corns (Heloma Dura & Heloma Molle) are painful lesions/spots of thickened skin on the foot caused by friction in high pressure areas of the foot.

Hard Corns (Heloma Dura) appear on the top and sides of toes often secondary to footwear pressure and also along the bottom of the foot. Soft Corns (Heloma Molle) in most cases appear between the fourth and fifth toes. These have an unbearable stinging sensation and are extremely uncomfortable.

If Corns are left untreated, they can become very painful and may interrupt the blood (vascular) supply to the area and cause an ulcer. It is recommended that people with diabetes are regularly screened and treated accordingly to prevent the development corns that can cause ulcerations.

We provide the following solutions:

  • Complaint removal
  • Advice to prevent the reoccurrence of this complaint
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Cracked Heels

Deep cracks, bleeding and pain in the heel are signs of heel fissures. These are caused by thick and dry skin.

We provide the following solutions:

  • Remove the dry, cracked skin
  • Prescribe appropriate emollients to relieve the complaint
  • Advice to prevent the reoccurrence of this complaint
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Flat Feet

Flat feet is a common term to describe a foot that pronates or rolls in too much at the ankle and midfoot. The arch height in many of these feet is lower to the ground than what is considered average. Looking at these feet it is often apparent that a large bulging is present at the inside of the ankle joint. All feet pronate and flatten, it is how the body naturally absorbs shock/pressures from the ground as you walk. However, if the foot flattens too much or at the wrong time during the natural walking cycle, this can be problematic. An important point is that a foot can appear to have a normal arch height when a person is standing, but still pronate or flatten excessively. A podiatrist is trained to assess this.

Flat / excessively pronated feet are associated with a number of lower limb overuse syndromes/pains including heel pain, ankle pain and shin pain. However, having a flat foot or a foot that pronates excessively is not a problem on its own, it is a combination of the flat foot and the activity level/type that may cause injury or pain. If you have a flat foot and you are suffering symptoms related to the flat foot, that is when treatment should be initiated in most individuals. Having said that, there are a category of clients who do display foot mechanics so extreme that we recommend treating a flat foot in the absence of symptoms, particularly if they choose activities that put them at greater risk such as running, football, netball etc. This judgement is made based on a thorough walking/running biomechanical assessment in conjunction with a clients own activity levels and types.

Appropriate footwear and orthotics are very helpful at managing any negative effects of a flat foot. Both not only solve many acute injuries, but can also promote a lifetime of comfort when exercising while also reducing the chance of an injury reoccurring.

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Forefoot Pain

Metatarsalgia / bruised metatarsals / stress fractures.

Symptoms often include localised sharp shooting pain in the long bones or the balls of the feet. Pain is often greatest when walking barefoot or on hard surfaces, such as tiles or concrete. The region can be hot to touch and pain is worse during and after activity. If a stress fracture is present pain may prevent further activity.

Symptoms occur when the outer layer of bone becomes inflamed and damaged when exposed to excessive, repetitive stress. This may occur when the metatarsals lengths are uneven or too prominent (as in the case of higher arched people), when damaged areas may be made more prominent due to footwear choices (high heeled shoes increase stress on the metatarsals), if the forefoot is too flexible and not adequately absorbing weight- bearing pressures or the fat padding in the forefoot may be atrophied or inadequate to protect those bones.

We provide the following solutions:

  • Treatment to remove the pressures from the bones that are causing repetitive stress. This may require temporary forefoot padding and strapping techniques.
  • A client may also be prescribed orthotics with appropriate forefoot padding or we may take a selection of a clients own footwear (high heels) and place forefoot protection in the shoes for pain relief. Different regimes are necessary for different clients.

(a) Mortons Neuroma (Neuromas)

Neuromas in the foot are a benign enlargement of the digital nerves that often affects the nerves between the 3rd and 4th digits. Symptoms usually include burning, shooting pains in the toes with some numbness. Pain is often worse when wearing footwear and walking.

Neuromas can be associated with hypermobility (excessive flexibility) of the foot joints. Excessive movement of the joints in the forefoot results in bones rubbing the nerves and causing them to get thicker. As the irritation persists, the nerve continues to enlarge and symptoms become more intense and occur more frequently.

We provide the following solutions:

  • Temporary forefoot padding and strapping techniques can help in the short term
  • Long term treatment using precise orthotic therapy has proven to be an effective method of controlling symptoms
  • In some cases, surgical removal of the neuroma is required

(b) Sesamoiditis

This is a painful inflammatory complaint that affects the two small bones directly under the big toe joint. This is caused when the joint is exposed to too much pressure and is a common complaint among physically active clients and clients with high arches or dropped metatarsal.

We provide the following solutions:

  • Pressure removal i.e. temporary forefoot padding and strapping techniques and use of orthotics and footwear
  • Advice to prevent the reoccurrence of this complaint
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Fungal Toenails

Fungal toenails (onychomycosis) are thickened, discoloured nails with debris/buildup beneath them. This is a very common complaint among senior clients.

This complaint can be confused with a thickened toenail (onychogryphosis/onychauxis). This complaint is caused by damage to the nail bed secondary to trauma of some type. The treatment of this complaint is different, therefore the correct diagnosis is essential.

We provide the following solutions:

  • Determine the appropriate antifungal medication to remove the complaint
  • Advice to prevent the reoccurrence of this complaint
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Heel Pain/Plantar Fasciitis

Plantar Fasciitis / Arch Pain / Heel Spur

Once referred to as a 'heel spur', this is not a bone injury but a soft tissue injury to the plantar fascia, a band of tissue that runs under your foot from your heel to the toes. The plantarfascia acts as a rubber band to absorb shock as you walk and stand, constantly elongates and contracts. This constant stretching can result in a tear in the soft tissue, most often at the heel. Pain is often greatest in the morning or after periods of rest. It is common in those with a flattened arch as the stretching on the plantar fascia is more significant but it can occur in any foot type. This problem is often misdiagnosed and confused with a heel fat pad syndrome. Both are treated differently so correct diagnosis is very important.

Sports and activity related injuries treated most often by podiatrists are called overuse/repetitive strain injuries. The development of these injuries is usually a combination of two or more of the following:

  • Sudden change in the sport/physical activity level
  • Sudden change in the sport/physical activity type
  • Poor muscle flexibility
  • Poor muscle strength
  • Inappropriate footwear for the sport/physical activity
  • Foot/ankle biomechanics

We provide the following solutions:

  • Anti inflammation advice
  • Strapping techniques to achieve immediate relief
  • Advice in relation to appropriate stretches
  • Advice in relation to appropriate strengthening
  • Biomechanical assessment and treatment using orthotics as necessary
  • Advice in relation to footwear
  • Advice in relation to activity types and return to activity levels after the injury has repaired

Fat Pad Syndrome (Bruised Heel)

We provide the following solutions:

  • Anti inflammation advice
  • Strapping techniques to achieve immediate relief
  • Appropriate cushioning to protect the heel bone
  • Advice in relation to appropriate stretches
  • Advice in relation to appropriate strengthening
  • Biomechanical assessment and treatment using orthotics as necessary
  • Advice in relation to footwear
  • Advice in relation to activity types and return to activity levels after the injury has repaired

This is heel pain that tends to be isolated to the heel bone itself. The pain can often be isolated to the middle of the heel bone with pressure. Pain is greatest when standing for long periods, especially on hard surface without shoes on. The problem is caused by too much stress to the heel bone itself, often because the existing fat pad begins to atrophy and fail to absorb shock as well as it once did. The problem often presents with plantar fasciitis, but requires a different approach to achieve complete resolution so correct diagnosis is important.

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Ingrown Toenails

An ingrown nail (Onychocryptosis) will occur when a portion of the nail forms a jagged edge (spicule) and begins to protrude into the surrounding tissue as the nail grows. Ingrown toenails are one of the most common reasons a client seeks the services of a podiatrist. They may occur as a result of poor nail cutting, direct trauma to the area, running in poorly fitted footwear or they may be due to a genetic predisposition which means the nails are too wide or too curled (involuted).

Ingrown toenails should be treated as quickly as possible as infection often occurs. Whilst antibiotics may sometimes be required, antibiotics alone are generally not a long term solution for the problem. The nail spicule must be removed, as leaving it will not allow the wound to close and the area is likely to become infected or painful again.

We provide the following solutions:

  • Removal of the spicule. Following this, nail retraining is required to help the nail grow out past the skin fold or the problem will reoccur some months later. Thus, retraining of the problem nail is a vital part of solving the problem permanently.
  • In persistent and severe cases nail surgery or a partial nail avulsion may be required. This is a minor surgical procedure conducted under local anaesthetic in the podiatry rooms. A narrow problematic portion of the nail is removed using a strong alcohol solution to prevent any nail regrowth in the problem area. This is a permanent solution and has a success rate of over 95%.
  • We also offer advice to prevent recurrence of the problem.
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Plantar Warts

Verrucae pedis (plantar warts) are benign lesions that occur on the bottom of the foot in both children and adults. They are caused by the Human Papilloma Virus (HPV), which is one of the more common viruses and is the same virus that leads to warts on the hands and other areas. The virus is believed to be transported via water molecules and transmitted to others through tiny cuts and breaks in the skins surface. Walking barefoot in public amenities, locker rooms and swimming in public swimming pools are among the more common reasons people come in contact with the virus.

They can be painful and feel like a rock under the foot when walking if they are on a pressure point of the foot. Their appearance is also quite unpleasant with a plantar wart having a cauliflowered appearance with tiny pigments throughout. The full extent of a plantar wart extends deep below the skins outer layer and explains why these lesions on the foot are more difficult to treat than a wart that appears on the hand.

We provide the following solutions:

  • Sydney City Podiatry has a strict veruccae/wart treatment protocol developed over many years of sucessful treatment. We use a combination of three different techniques which evidence based research and our own experience has demonstrated to be most effective. This treatment regime is repeated once a month until resolution. Cryotherapy (liquid nitrogen) is one of the three techniques employed and is very effective when combined with all three treatments. In most cases, the sooner the wart is treated after it appears the quicker it will resolve.
  • Advice to prevent the reoccurrence of this complaint.
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Sports & Activity Injuries

Many sports injuries treatment and physical and activity related injuries are caused by the overuse and repetitive strain to the foot and lower limb.

The development of these injuries are often related to the following:

  • Sudden change in the sport/physical activity level
  • Sudden change in the sport/physical activity type
  • Inappropriate footwear for the sport/physical activity
  • Poor muscle flexibility
  • Poor muscle strength
  • Foot/ankle biomechanics

Click Here for more information on Sports & Activity Injuries

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