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Patient Info

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Common Problems

If you are experiencing any of these symptoms, book your appointment with Step by Step Professional Family Foot Care today!

Achilles tendonitis is a common condition that causes pain along the back of the leg near the heel.

The Achilles tendon is the largest tendon in the body. It connects your calf muscles to your heel bone and is used when you walk, run, and jump.

Although the Achilles tendon can withstand great stresses from running and jumping, it is also prone to tendonitis, a condition associated with overuse and degeneration.

Achilles tendonitis is typically not related to a specific injury. The problem results from repetitive stress to the tendon. This often happens when we push our bodies to do too much, too soon, but other factors can make it more likely to develop tendonitis, including:

  • Sudden increase in the amount or intensity of exercise activity—for example, increasing the distance you run every day by a few miles without giving your body a chance to adjust to the new distance
    • Tight calf muscles—Having tight calf muscles and suddenly starting an aggressive exercise program can put extra stress on the Achilles tendon
    • Bone spur—Extra bone growth where the Achilles tendon attaches to the heel bone can rub against the tendon and cause pain

A bone spur that has developed where the tendon attaches to the heel bone.

Symptoms

Common symptoms of Achilles tendonitis include:
• Pain and stiffness along the Achilles tendon in the morning
• Pain along the tendon or back of the heel that worsens with activity
• Severe pain the day after exercising
• Thickening of the tendon
• Bone spur (insertional tendonitis)
• Swelling that is present all the time and gets worse throughout the day with activity

If you have experienced a sudden “pop” in the back of your calf or heel, you may have ruptured (torn) your Achilles tendon. See your doctor immediately if you think you may have torn your tendon.

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Diabetic neuropathy is nerve damage caused by diabetes. When it affects the arms, hands, legs and feet it is known as diabetic peripheral neuropathy. Diabetic peripheral neuropathy is different from peripheral arterial disease (poor circulation), which affects the blood vessels rather than the nerves.

Three different groups of nerves can be affected by diabetic neuropathy:
• Sensory nerves, which enable people to feel pain, temperature, and other sensations
• Motor nerves, which control the muscles and give them their strength and tone
• Autonomic nerves, which allow the body to perform certain involuntary functions, such as sweating.

Diabetic peripheral neuropathy doesn’t emerge overnight. Instead, it usually develops slowly and worsens over time. Some patients have this condition long before they are diagnosed with diabetes. Having diabetes for several years may increase the likelihood of having diabetic neuropathy.

The loss of sensation and other problems associated with nerve damage make a patient prone to developing skin ulcers (open sores) that can become infected and may not heal. This serious complication of diabetes can lead to loss of a foot, a leg, or even a life.

Causes
The nerve damage that characterizes diabetic peripheral neuropathy is more common in patients with poorly managed diabetes. However, even diabetic patients who have excellent blood sugar (glucose) control can develop diabetic neuropathy. There are several theories as to why this occurs, including the possibilities that high blood glucose or constricted blood vessels produce damage to the nerves.

Symptoms
Depending on the type(s) of nerves involved, one or more symptoms may be present in diabetic peripheral neuropathy.

For sensory neuropathy:
• Numbness or tingling in the feet
• Pain or discomfort in the feet or legs, including prickly, sharp pain or burning feet

For motor neuropathy:
• Muscle weakness and loss of muscle tone in the feet and lower legs
• Loss of balance
• Changes in foot shape that can lead to areas of increased pressure

For autonomic neuropathy:
• Dry feet
• Cracked skin

Treatment
First and foremost, treatment of diabetic peripheral neuropathy centres on control of the patient’s blood sugar level. In addition, various options are used to treat the painful symptoms.

Medications are available to help relieve specific symptoms, such as tingling or burning. Sometimes a combination of different medications is used.

In some cases, the patient may also undergo physical therapy to help reduce balance problems or other symptoms.

At our clinic we see an increasing number of diabetic patents every year. Our goal is to help manage and educate our patients regarding foot care and now relief from peripheral neuropathy symptoms

Principles of Managing Neuropathy at Step By Step
The principles we are trying to achieve with pain free technologies are 1 to repair damaged tissues by increasing circulation by revascularization, improving existing blood flow thus allowing more nutrients and most importantly oxygen to damaged tissue to improve healing, 

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Diabetic Assessment and Treatment On your initial visit the Chiropodist will do a series of exams and tests.
1. A detailed history of your lifestyle
2. Past and current medical status
3. Neurological exam on both feet to determine level of neuropathy
4. Vascular exam to determine status of blood flow
5. Perform a biomechanical and gait exam to determine level of stability
6. Assess your footwear
7. Explain in detail the status of your current foot health
8. Explain to you the best management plan according to the results of the above-mentioned exams / tests.
9. Answer any questions and concerns regarding your foot health
10. Trim toe nails and clean up any callus areas that are present
11. Advise you on do’s and don’ts that pertain to you.

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Lumbo-sacral pain refers to a condition of the lower back caused by over-pronation of the foot. Over-pronation is where the arch of the foot collapses, leaving the foot in a flattened state. This causes the foot to roll inwards in order to gain contact with the floor and support the weight of the body. This bio-mechanical problem leads to bad tracking and misalignment throughout the whole body. Standing for long periods of time can aggravate this condition by causing the muscles in the back to tighten, resulting in stiffness and discomfort.

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A bunion is a bony lump on the inside of the foot next to the big toe. When aggravated, this can cause a bursa, which is a sac of fluid that becomes inflamed, red and sore. Bunions occur when the big toe is forced into a position contrary to its normal alignment. This can occur through continuous standing and walking which weakens the anterior metatarsal arch, causing the foot to become flattened and the big toe joint to project inwards. Pressure placed upon the projecting joint by the shoe, creates a bursa (hollow pocket lined with fluid) that becomes inflamed when aggravated. This lump on the inner foot can become red, swollen and painful if left untreated.

Bunions are common in professions that involve continuous standing and walking, e.g. police, postal workers, hairdressers and waiters. Women tend to be more prone to bunions due to their choice of shoes which are often high heeled, narrow and unsupportive.

Other causes: obesity, flat feet/over-pronation, pregnancy.

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Burning feet is a condition that can occur in many different types of people for many different reasons. It could simply be caused by fatigue, e.g. people who are on their feet all day. Most commonly, burning feet are found in people over the age of 50 and in people with diabetes. Diabetics can be affected by burning feet due to neuropathy (loss of feeling in the feet). There are a number of possible causes for burning feet. Neuromapain (pinched nerve), gout, smoking and vitamin deficiencies are just a few, so treatment varies according to cause. Therefore, accurate diagnosis is essential in preventing further irritation.

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Corns and calluses develop when normal skin activity is over-stimulated resulting in a thickening layer of skin. This over-stimulation can result from congenital, hormonal, occupational and infective factors. A callus is a diffuse area of thickened skin, where as a corn is an area of a callus that has become molded into a nucleus. Corns are commonly found on the balls of the feet, on the tops and in between the toes. They can be very sore if left untreated so it is best to deal with them as early as possible. Corns and calluses are quite common and may be the result of the way a person walks or ill-fitting shoes. Elderly people are more susceptible due to loss of the skin’s protective fatty tissue, but people with certain skin types can also suffer from this condition.

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Dry Cracked Heels are mainly a cosmetic problem, but can become more serious. They sometimes result in heel fissures where the skin cracks and bleeds. This can be very painful. If the problem persists, or if the skin bleeds, it is advised that professional medical advice be sought to prevent the onset of more serious conditions. This is especially important for people with diabetes or vascular problems as the wound could become infected and lead to further complications.

Causes include: hot, dry weather; constantly walking with no shoes or just sandals; inactive sweat glands; and obesity.

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Pes planus, otherwise termed as flat feet, is a bio-mechanical problem experienced by a surprisingly high percentage of the population. Flat feet are a condition where the arch of the foot appears flattened. This causes the foot to roll inwards in order to gain contact with the floor and support the weight of the body and is the main clinical feature of excessive pronation. Pes Planus, or Flat Feet, is very common and can occur in people of all ages. However, older generations can be more susceptible to over-pronation and flat feet because they tend to have lower levels of physical activity and gain weight with age, which can disturb the bio-mechanical balance of the foot.

Pes Planus, or Flat Feet, are most commonly a congenital condition but can also be acquired as a result of the foot being repetitively subjected to hard surfaces, eventually weakening the arch of the foot. In today’s world of concrete and tarmac it is therefore not surprising that this condition is becoming more and more frequent in people of all age groups.

It is important that treatment is sought for these conditions as they can lead to further problems. When the foot’s ability to absorb shock diminishes the foot is subjected to increased pressure, which can cause other foot, knee and back problems.

Other causes of flat feet can include obesity and pregnancy.

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Neuropathy refers to loss of feeling in the feet and can occur as a result of complications in people with diabetes. The most common form of neuropathy is peripheral neuropathy, which occurs when the nerves that run from the brain to the organs, muscles, skin and glands are impaired. This condition can cause inability to feel heat, cold or even pain, therefore diabetics may not be able to feel any cuts or sores on the soles of their feet. If left untreated these minor cuts and sores could get infected and result in ulceration which could lead to amputation. Therefore people with diabetes should perform a daily check of their feet to prevent any problems occurring.

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Diabetics can experience what is called neuropathy, which is when the sensation in the feet is lost. Firstly, this means that any abrasions or cuts to the foot can go unnoticed for days. Secondly, if the sensation and feeling is lost, the foot cannot determine when excessive pressure is being applied to the foot. Therefore, the foot does not adjust itself to deal with the stress, leaving it more prone to injury. Micro vascular disease (small vessel disease) is quite common in diabetics and can lead to the development of ulcers. It is essential that diabetics monitor blood glucose levels, maintain a sensible weight and avoid smoking to reduce the onset of micro vascular disease.

Ulcers or any open wounds should not be left untreated, as they are a common cause of lower extremity amputation. If they are caught in the early stages they can be treated by a Podiatrist/Chiropodist who will use methods such as debridement (surgical removal of dead skin) and will provide padding and orthotic devices (special insoles) to relieve pressure from the ulceration to allow it to heal.

A Chiropodist will also provide information about diabetic foot care.

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Hyperuricemia and elevated uric acid, commonly known as Gout, is a condition that affects the big toe joint. It is caused by increased levels of uric acid in the blood that crystallizes and settles in various joints of the body, usually in the big toe. Gout is widely thought to be hereditary and is commonly associated with males more than females. In previous times, gout was associated with the aristocracy and too much of the “good life”. This was probably quite accurate as gout has now been found to be related to increased levels of purine in the diet, found in such rich foods as red meat, lobster, shell fish and red wine.

As Gout can occur suddenly and can be very painful, the best treatment is often prevention. Contact a Chiropodist to learn more about prevention and treatment.

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This is a common form of arthritis located at the base of the big toe (this joint is called the metatarsophalangeal, or MTP joint). This joint is important to the proper function of the foot, as it needs to bend when the foot is in motion. If this joint begins to stiffen, walking can become a painful experience. The MTP joint has cartilage that covers the bones. Sometimes the cartilage can be damaged by either wear, tear, or injury that leads to the raw bones rubbing together and can create a bone spur (overgrowth). This overgrowth can restrict the range of motion in the toe, resulting in stiffness.

Symptoms of Hallux Rigidus include stiffness in the big toe when walking or swelling around the big toe joint. A bump such as a callus or bunion could also be suggestive of this condition, as can limitation in the range of motion.

Possible Medical Causes: osteoarthritis; trauma; excessive pronation; high arched feet; poor footwear; splitting osteochondritis of the first metatarsal head; gout or pseudogout.

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Hammer Toes are caused by a bio-mechanical imbalance where the muscle structures of the toes are partially, or completely, dislocated. This causes the toes to become bent and crooked and the joints of the toes to protrude. This condition can be hereditary or caused by inappropriate, ill-fitting shoes. Caution must be taken with hammertoes as they can lead to the development of ulcers and infections, which can be especially serious for people with diabetes.

Hammertoes can be very painful, especially if irritated by a tight fitting shoe and can often lead to corns, calluses and sufferers can sometimes experience cramps in their toes and feet.

Causes include: ill-fitting shoes; reumatoid arthritis; pronation (flat feet); high arched feet; hereditary causes.

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There are 3 different types of heel pain: General Heel Pain Syndrome, Bursitis, and Plantar Fasciitis.

General Heel Pain Syndrome is caused by repetitive pressure placed on the heel of the foot when walking, which causes soreness of the heel.

“Itis” usually refers to the inflammation of a certain part of the body. Bursitis refers to the constant irritation of the natural cushion that supports the heel of the foot (the bursa). Bursitis is often associated with Plantar Fasciitis, which affects the arch and heel of the foot.

Plantar Fasciitis is caused by inflammation of the tissues connected to the heel bone, due to excessive pulling and stretching of the fibrous bands that support the arch of the foot. Continuation of this irritation can lead to heel pain, arch pain or a bony growth on the bottom of the heel bone called a “heel spur”. Another condition related to Plantar Fasciitis is swelling on both sides of the Achilles Tendon (see Achilles tendonitis).

Bursitis and Plantar Fasciitis can occur when a person increases their levels of physical activity or when the heel’s fat pad becomes thinner, providing less protection to the foot.

Other causes can include: ill fitting shoes; obesity; biomechanical problems (e.g. mal-alignment of the foot, including over-pronation); gout; rheumatoid arthritis.

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An ingrown toenail is a condition where one or both sides of the nail cut into the flesh of the toe. It can cause swelling, redness or infection and can be very painful. If you are suffering from an ingrown toenail we recommend that you visit a Chiropodist who can treat the nail and prevent further complications. If you are diabetic or have any vascular problems, it is vital that you get treatment for the toenail, as it is prone to infection and if left untreated could eventually lead to loss of a limb.

If the toenail becomes thick and discoloured turning yellow or brown, you may have acquired a fungal infection, therefore it is advised that you contact a Chiropodist for advice.

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Patello Femoral Syndrome, commonly referred to as knee pain, refers to any discomfort experienced between the patella (knee cap) and the femur (thigh bone). Pain is usually a dull ache or alternatively a very sharp stabbing pain that is easily aggravated by physical activity.

Symptoms include a swollen knee and a grinding sensation occurs, accompanied by a clicking noise. Excessive pronation or flat feet are the most common cause of knee pain. Excessive pronation is where the arch of the foot collapses, leaving the foot in a flattened state. This causes the foot to roll inwards in order to gain contact with the floor and support the weight of the body. This bio-mechanical problem affects the positioning of the patella (knee cap), which is subjected to excessive stress, eventually weakening the surrounding muscles and ligaments.

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The metatarsal region refers to the ball of the foot. Metatarsalgia is a burning sensation in the ball of the foot that can be either mild or severe and can sometimes be a recurring problem. Older people are more susceptible to metatarsalgia, as the fat pad protecting the foot thins with age, subjecting the area to more stress. This condition can also be the result of ill-fitting shoes such as narrow women’s footwear with high heels, which force the foot into an unnatural position and exerts more pressure on to the ball of the foot.

Partaking in any high impact physical activity without wearing the correct footwear can also cause this particular condition, as well as other foot conditions such as: arthritis; excessive pronation/pes planus (flat feet), hallux abducto valgus, hammer toes, Morton’s neuroma.

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Morton’s toe is a common foot condition apparent in many people, where the second toe is longer than the big toe (hallux). This can lead to extra pressure being exerted onto the ball of the foot, especially underneath the second toe (second metatarsal head), resulting in a similar pain found with such conditions such as Metatarsalgia. Another problem associated with Morton’s toe is the calluses that form on the bottom of the foot below the second toe.

If you suffer from pain related to Morton’s Toe, seek advice from a Chiropodist, who may recommend an orthotic insole to place in the shoe.

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Sesamoiditis is a condition that affects the ball of the foot. Specifically, Sesamoiditis refers to the irritation of the sesamoid bones (tiny bones that lead to the big toe), which can become irritated and possibly fractured every time you push off the ground with the toes. This condition is often found in people who partake in sports such as dancing or running, where a lot of stress is placed on the ball of the foot.

The pain usually begins as a dull ache but increases with activity to a throbbing sensation in the ball of the foot.

Sesamoiditis usually occurs when an individual suddenly increases their level of physical activity. This places the feet under additional stress as they try to accommodate this change.

A bio-mechanical cause of Sesamoiditis is high arches that cause a person to exert more stress on their forefoot. This increases pressure to the Sesamoid bones.

People with bony feet may also suffer from Sesamoiditis as they have little protective fat on their feet, therefore less shock absorbing qualities.

High heel shoes can also be a cause.

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Shin splints can cause pain in the front lower leg due to minor tearing of the anterior muscle (muscle between mid-foot and knee) from the shin bone. There are two types of shin splints: Anterior Shin Splints located in the tibia (front portion of shin), and Posterior Shin Splints located on the medial (inside) part of the tibia. Overuse, vigorous activity or a sharp and sudden increase in activity can lead to shin splints, therefore exercise levels should only be increased gradually. Running on hard surfaces or physical activity without the use of supportive training shoes increases the likelihood of shin splints, as more stress is exerted on the anterior muscle in an attempt to absorb shock.

People who run on tiptoes or partake in sports that involve a lot of jumping are susceptible to this particular condition, as these activities cause an imbalance in the distribution of pressure and add stress to the joints. Bio-mechanical problems such as over pronation or supination can cause the muscles to exert themselves in order to retain balance. This constant stress can causes the muscles to tear, resulting in shin splints.

Symptoms include: lower leg pain; tender shins; swelling or redness around shin area; lumps covering the bone; pain when toes are pointing towards the floor.

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Feet need to be kept healthy and agile to support the entire weight of our bodies in our day-to-day life. This is why the feet contain 250 000 sweat glands that constantly secrete moisture to keep feet moist, supple and healthy. However, many feet are prone to excessive sweating, which can lead to irritable feet. Sweaty and smelly feet are a common problem that many people encounter at some stage in their lives. However, for some people it can be a persistent condition that can be embarrassing and bothersome.

Today’s footwear consisting of synthetic materials are a primary cause of sweaty feet. Shoes and socks manufactured from man-made materials lead to excessive perspiration and increased bacteria that can result in sweaty, smelly feet and sometimes Tinea Pedis – Athletes Foot.

Sweaty feet can also be triggered by stress, both physical and emotional. Pressure placed upon the foot due to strain or fatigue is a common cause, as is emotional distress and turmoil. Sweaty, smelly feet is also often associated with teenagers and changing hormonal levels, which can lead to over active sweat glands.

However, the reasons are not always this complex. A change in the weather, hot or cold, can be enough to initiate excessive sweating.

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Tarsal Tunnel Syndrome refers to the entrapment of the posterior tibial nerve, which is located on the inside of the foot on the lower ankle. This causes the nerve to become inflamed resulting in a continuous burning sensation that remains even when the foot is rested. Causes include: arthritis; trauma to the foot or ankle; obesity; other stresses to the foot; excessive pronation.

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Plantar warts are warts of the sole or plantar surface, of the foot. Since plantar warts are under pressure they grow inward causing pain. Plantar warts can be differentiated from a simple callus by characteristic dark specks (thrombosed capillaries) in the centre. If shaved, these punctate marks will show pinpoint bleeding. Plantar warts are caused by a virus (human papilloma virus) and as such are contagious. Gym users who go barefoot and do not use rubber sandals in the showers get more plantar warts. The virus is usually found in moist wet areas such as locker rooms, showers, gyms, or poolsides.

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