Category Archives: Foot Care

Ten reasons why your nails might change colour

My toenail is changing colour. What can be causing it?

The function of a toenail is protection of the tip of the toe. If we are lucky, we will progress through life with few changes to their appearance, but that isn’t always the case.

We all have a good idea of what we consider a ‘normal’ nail, but sometimes all or part of the nail can start to change colour. In this blog we look at how and why this can happen.

brown-black discolouration (occasionally red)

Although uncommon, the first condition to eliminate is (subungual – under the nail) melanoma. Speak to your podiatrist or GP if you are concerned. In reality, there are numerous benign causes.

Longitudinal melanonychia

This is a term used to describe a  strong and noticeable pigmented band – normally brown – that runs down the nail from the bed to the tip. This condition normally affects more than one nail at a time.

This is quite common in Black-skinned, Asian, Hispanic, and Middle Eastern individuals who frequently have benign/harmless longitudinal pigmented bands. This is due to the naturally occurring pigment cells or melanocytes that make their skin darker.

The number and width of the bands tend to increase with age.

However, the presence of a new, single – only occurring on one of ten nails –  dark coloured band in an adult could represent a melanoma and should be checked immediately.

There are additional uncommon causes including systemic disease and medication to numerous to list here.

Subungual haematoma (bruise)

Following trauma – kicking something, dropping something on the toe – blood can accumulate in the space between the nail bed and nail plate. It can  also happen following vigorous exercise/dancing when you don’t remember ‘bashing it’.

The discolouration is often accompanied by considerable pain due to the pressure created under the nail. If you visit a Podiatrist as soon as possible after the injury occurs, it is possible to painlessly drain the fluid and bring immediate relief.

Yellow/white discolouration (occasionally orange)

Onychomycosis (fungal nail)

Nail fungus usually cause a yellow-white discolouration, but occasionally it can be black or orange.

Nail fungus usually starts at the tip or sides of the nail and work their way upwards towards the nail bed frequently following trauma.It is very common for patients to report that fthe fungus appeared after damaging the nail.

If caught early, infected nail can sometimes be trimmed away to prevent spread.

If allowed to become established, treatment can be difficult and lengthy. For further information https://maidenheadpodiatry.co.uk/what-can-i-do-about-my-fungal-nail/

Some medications can also produce similar discolouration.

Cream, Dark yellow or white-yellow nails

Trauma

When nails have experienced trauma, the protective mechanism can be triggered, and they increase in thickness. That increase in thickness causes the colour of the nail to darken and take on a changed appearance. The nail will also grow more slowly.

Psoriasis

This condition can occur just on nails with no history or occurrence on the skin. The changes can be similar to, and are often mistaken for, a fungal nail infection and it is important to establish which you have, to allow appropriate treatment

Paronychia

Or infection of the nail bed. This can lead to a change in appearance as pus builds up under the nail. This condition can require release of the pus and prescription of anti-biotics, depending on severity.

Some medications can also produce similar discolouration.

Yellow Nail syndrome

This is a very rare condition characterised by very curved, transversely thickened, smooth, yellowed nails and is associated with lymphoedema, pleural effusion, and (usually) ascites.

White nail discolouration

Minor trauma

A common cause, and tends to produce small localized areas of whiteness, like white spots on the nail.

There are a number of other systemic conditions that can also lead to white nails but they are too uncommon and numerous to be listed here.

Green/blue nails

Pseudomonal nail infection

Pseudomonas infection is often found on the underside of a nail (it can also be found on the skin) which has already lifted, often due to trauma or previous infection. It is characterised by green-blue, or occasionally black, discolouration. This infection is relatively harmless in healthy adults. If you are immune compromised you should seek advice.

Some medications can also produce similar discolouration.

If you would like more information or to make an appointment with one of our Podiatrists, call 01628 773588 and speak to one of our friendly reception team.

Buying new school shoes online? How to measure your children’s feet accurately .

Have your children outgrown their school shoes?

You can measure your children’s feet yourself at home. It doesn’t matter if they are six or sixteen (or sixty), correct fit is important for anyone at any age. Read on.

When children’s feet grow, they grow quickly.

In a child’s first three to four years, their feet grow about two sizes a year, although by the time they are school age, at five years old, it has slowed to around a size a year. Of course, rate of increase varies from child to child.

You can’t currently have feet measured professionally because shoe shops are currently closed and ordering online has become a necessity.

You can take the guesswork out of it by taking measurements at home. Here is how to do it.

It is essential to get your children’s shoe size right first time.

Shoes being too big can be as bad for your children’s feet as being too small.

Of course, every child’s foot is unique, but a well-fitting shoe not only protects foot development, keeping growing feet comfortable and healthy but gives children the confidence as they work and play.

How does home measurement work?

All you need is a printable foot gauge. Click here – and follow the instructions.

  • make sure your printer is set to 100% and not to scale
  • once it has printed use a ruler to check it’s correct
  • place the paper gauge on a flat, hard floor
  • ensure the heel is level with the ‘base line’
  • make sure your child is standing with both feet taking even weight
  • measure both feet, it is common for one foot to be a bit bigger than the other
  • note down the size to their largest toe (this isn’t always the big toe).
  • repeat on the other foot.
  • for the width, cut the width measure off the right side and wrap it around the thickest part of the foot – diagonally from the ball joint on their little toe to the ball joint on their big toe
  • buy a shoe with approximately 2cm growth room

If you don’t have a printer, you can use a piece of A4 paper and a ruler/tape to get the measurements.

What type of shoe should you choose for school?

With children recently spending so much time at home and no time at school they will have been wearing all sorts of shoes, wellingtons, crocs or no shoes at all.

It will be quite a contrast but they will benefit from leather shoes that are supportive, correctly measured, and that fasten securely to the their foot.

It is also a good idea for them to wear them around the house for a few hours in the days leading up to them going back to school.

How to check if your child’s shoes fit correctly?

Once you receive the new shoes – try them on, then –

  • do the check in the afternoon as feet can swell as the day passes
  • fastened them
  • make sure your child is standing
  • ensure the back of the foot is snugly against the heel of the shoe
  • press your thumb firmly down sideways on the front of your child’s shoe to see where their toes are
  • If you can’t feel the toe through the shoe, get your child to wiggle their foot
  • With the foot firmly against the back of the shoe there should be a gap of about 2cm or a thumbs width for growth
  • check the width is just right using a finger and thumb.
  • remember that sizes vary between brands.

Finally, give the shoe a tug as if trying to pull it off. If there is a little give, but it stays on then you know it is fitting correctly. In any case, your child will soon tell you if the shoe isn’t comfortable.

If you would like more information or an appointment with one of our Podiatrists, give us a call on 01628 773588 or email info@maidenheadpodiatry.co.uk.

Are your feet ‘summer ready’?

Summer is here and your feet need to be ready for action.

Now restrictions are lifting we are enjoying more freedom and holidays, even if they are in this country! The weather has generally been warm and sunny, and a walk on the beach in Britain is as good as a walk on a beach abroad.

If you are unsure how your feet can benefit, a great start is to visit to one of our Podiatrists for an assessment, trim and tidy. Get your feet ‘beach ready’!

Whether you need specialist care and advice, or simply removal of corns and callus, come and see us for a consultation. A general consultation can last up to half an hour and can include Doppler, sensation testing and general foot health checks.

We also offer gait analysis, musculo-skeletal assessment and bio-mechanical review as well as everything from verruca treatment to ingrowing toenails..

The blog below gives more information on who we are and what we do.

Have you ever thought about visiting a Podiatrist and wondered what they do?

Ever thought about visiting a Podiatrist and wondered what they do?

As the article suggests, a Podiatrist assesses and treats a wide variety of conditions below the knee. Anyone can benefit, from diabetics to someone who just wants their feet to look good on holiday.

It doesn’t matter if you aren’t going abroad this year, you still want to feel you can step out with confidence.Giveusacall.

Beauty is back

Once you have seen one of our experienced Podiatrists, we have some spectacular treatments to make sure you put your best foot forward for the upcoming season. Our beauty therapist, Carrieann, provides a range of treatments to compliment our Podiatry services.

For more information on the treatments provided by Carrieann, visit. https://skinsensations.co.uk/

Carrieann’s most popular foot treatments are  –

Luxury Pedicure

Treat your feet to some much-needed TLC with our luxury pedicure! Be whisked away from it all with a relaxing foot and leg massage and a deep exfoliation, plus a long soak in one of our massaging foot spas and finishing with a nail paint.

Medical Pedicure/Medi-ped

A medical pedicure – or medi-ped – is starts with a visit to a Podiatrist and ends with a visit to our beauty therapist.

Our medical pedicures are adapted to each client by our Podiatrist so they are tailor-made to suit your needs. You will receive a complete Podiatry treatment followed by all the wonders of our luxury pedicure (above)

Why do it?

Your feet feel good and you feel good. Sore feet can ruin your day, so why wait.

It doesn’t matter if you are walking miles on a costal path or sitting in the sun, relaxing with a good book,you want your feet to be at their best.

We cater for diabetics and a range of foot conditions. We are a Royal College of Podiatry accredited practice and we also offer home visits for those that require it.

Make an appointment

If you would like more information, to speak to one of our Podiatrists, or to make an appointment, call us on 01628 773588 or email info@maidenheadpodiatry.co.uk.

To make an appointment directly with Carrieann, call 01628 779909 and speak to a member of our friendly reception team.

Baby feet, shoes, bare feet and baby-grows

When should a baby start wearing shoes or should they wear them at all?

When it comes to baby feet, socks, shoes, baby-grows and bare feet there are so many questions. What is best? When should a baby start wearing shoes or should they wear them at all? How do you choose the best footwear?

At birth the human foot is not a miniature version of an adult foot actually containing no bones at all but merely consisting of a mass of cartilage, which, over a period of years, ossifies (turns to bone) to become the 28 bones that exist in the adult human foot.

This process is not complete until the late teens or early twenties, so it is crucial that footwear – when worn – is well chosen so it doesn’t compromise and change the shape of the young developing foot.

What is a shoe? and what do we mean by ‘footwear’?

‘Footwear’ in babies means anything that is used to cover the foot regardless of function. For example, in a new born until they start to stand, any foot covering whether it is socks shoes or baby-grow has a primary function of providing warmth.From a functional perspective, shoes aren’t really needed and there are more likely to be disadvantages and problems from wearing shoes than not wearing them – among them, deformation caused by a poor fit, ingrown toenails, and athlete’s foot.

When is a shoe a fashion accessory?

Manufacturers must take some responsibility for encouraging parents to treat their babies/children as fashion accessories and choose shoes on their attractiveness or coolness, rather than their fit or function.

There are exceptions of course. You have to consider the environment the child is in. You wouldn’t want your child walking on the streets or in the park barefoot, where there might be dog poo, dirt and possible hazards like glass would you? So common sense applies.

When to start with shoes

Wearing shoes at too young an age can hamper a child’s walking and cerebral development. Toddlers keep their heads up more when they are walking barefoot, The feedback they get from the ground means less need to look down, which otherwise puts them off balance and causes them to fall over.

Walking barefoot develops muscles and ligaments in the foot, increases the strength of the foot’s arches, improves proprioception (our unconscious awareness of where we are in relation to the space around us) and contributes to good posture.

The more parents know about the structure of children’s feet, the more we can prevent footwear-related damage being done.

What sort of damage?

Research published in podiatry journal ‘The Foot’ in 2007 suggested that structural and functional changes can result from the foot having to conform to the shape and constriction of a shoe, rather than being allowed to develop naturally.

And the younger the foot, the greater the potential for damage.

Not too rigid

Most children’s shoes are like awful little bricks – too stiff, too rigid, with no flexibility at the sole and too much heel raise. This is of particular concern with toddlers learning to walk, because it can cause them to bounce and tip forward.

A completely rigid shoe will restrict movement of the forefoot to zero. Kids this age should be turning cartwheels, skipping, climbing trees, running around. A shoe like this seriously restricts such playful physicality – make it less fun, and less enjoyable.

Size is important

Just as important is choosing the right size socks. Many parents dutifully check the size of their child’s shoes but never consider or know how to check the size of their socks.

How? Take hold of the toe and heel of the sock and without pulling or stretching it should meet around the child’s clenched fist. All socks should be checked regularly due to rapid growth but also because they can shrink during the washing and drying process.

Not to forget baby-grows?

Easily overlooked, baby-grows can place even more pressure on the feet and restrict growth, especially in a rapidly growing child. If you don’t want to replace the baby-grow then cut the seams at the feet to allow the feet to poke out and use socks for warmth.

…and bare-foot?

As a general rule, in the appropriate environment, whenever possible, bare foot is best in at least the first six years of a child’s life. There is no reason why this can’t extend to adults although common sense needs to be exercised with diabetics and anyone with peripheral neuropathy.

If you would like more information, to speak to one of our Podiatrists or to make an appointment then please call Maidenhead Podiatry on 01628 773588.

A guide to verruca treatment

 

At Maidenhead Podiatry and Chiropractic Clinic we are asked about verrucas and verruca treatment so frequently that we have put this ‘Guide to Verruca Treatment’ together to help decide on your best treatment option.

Do I have a verruca?

Many of us have experienced a verruca, usually as a child, or know someone who has.

There are so many opportunities to acquire a verruca from a variety of communal floors such as hotels, swimming pools and the gym.

In a similar way to a parasite, the virus that causes a verruca needs a healthy cell to infect that it can modify without killing it. The virus is quite hardy and can not only survive for months on floors without a host but can survive desiccation and freezing.

Verrucas can’t be ‘removed’ (other than surgically). Your body’s immune system is capable of dealing with them – it just hasn’t – and all treatments hope to stimulate an immune response, allowing the correct antibodies to be produced for a successful resolution.

The virus ‘turns off’ the cellular immune cascade that is a normal response to viral infection, and our treatments aim to turn it back on.

Verrucae are warts.

When they occur on the feet we call them a verruca and when on the hands, we call them warts. They are caused by infection with one or more of the 150-strong family of human papillomaviruses.

They vary in size from a pin-head to covering whole areas of the foot.

The virus infects a cell in the top layer of the skin, the epidermis. Usually the fourth layer, the stratum spinosum, the virus often enters through a tiny scratch or abrasion.

This triggers a rapid growth of skin/verruca cells, forming a harmless lump.

They occur most commonly in children and young adults, likely because this age group spend a lot of time padding around with bare feet, although they can occur at any age.

If in doubt, ask your local Podiatrist.

How do they spread?

They are highly contagious and are transferred by skin-to-skin contact or by walking across the previously mentioned communal surfaces.

And as we don’t like imperfection on our bodies, an increasing number of adults are seeking treatment.

It is estimated that the verruca home treatment market is worth over £5 million a year – despite the fact that none of them work consistently.

Is it a verruca?

Warts on the underside of the foot will appear flat as weight bearing pushes them into the skin. On the top of the foot, or hands they will appear raised.

They may contain little black dots (but not always) which are tiny blood vessels and it is normal that when treated they will bleed. Squeezing them will also likely be painful.

Verrucae generally appear in two forms, a small single lesion with black dots within the central core, and the mosaic verruca, which is a more widespread infection, often affecting both feet and is characterised by clusters of verrucae.

Whichever you have, the treatment is the same.

What can I do?

The best treatment for most verrucae if they are not problematic is to leave them alone and given enough time they will go of their own accord.

They don’t often become painful and without treatment, verrucae usually disappear within two to 18 months as the immune system does its job although in rarer cases they can persist for over twenty years.

But if you have already had them for a number of years and you are experiencing pain from your verruca, they are spreading, or you simply want rid of it, read on.

How are they treated?

Treatments are based on either destroying the infected tissue (e.g. Bazuka, DuoFilm), locally acting poison (e.g. Gluterol) or stimulating an immune response (E.g. Swift, freezing, needling) and fall into – over the counter, old wives tales and professional.

Over the counter.

The over the counter, at-home chemical treatments such as DuoFilm or Bazuka contain salicylic acid which works by forcing moisture into the tissue disrupting viral cell function, and lactic acid, which breaks down the hard skin over the infection.

The active ingredient in Gluterol is Glutaraldehyde which is virucidal and so inactivates the wart virus. Once on the skin, it also acts as an anhidrotic, drying the warts and surrounding skin, thus reducing the spread of lesions.

Whichever one you choose, perseverance is the key as it can take months to work, during which time the verruca may go of its own accord anyway.

The strength of acid used in over the counter products is only up to 24%, but in a clinic, strengths of up to 70% can be used.

Before carrying out any treatment, remove the top layer of hard skin using a foot file to expose the verruca. Remember to wash or discard the file after every use.

Even so the success rate is variable.

Old wives tales.

Old wives tales suggest duct tape, banana and others each of which may work for some people but not others.

Some of the less conventional ideas do have science behind them, others not so much. Self resolution can suggest an unlikely remedy has worked.

Professional treatment.

A Podiatrist can use salicylic acid, cryosurgery, Swift and dry needling among others.

Cryosurgery or freezing undoubtedly can work but it needs to be done in a clinical environment by a podiatrist or a dermatologist as it involves temperatures down to -190oC depending on the medium used.

Swift uses microwaves to raise the temperature in the verruca stimulating a powerful immune response though heat stress reaction.

Dry needling pierces the verruca many times under local anaesthetic to stimulate an immune response. This is thought to work by inoculating the underlying tissue with the virus prompting an immune response.

Lasers can also be used to remove the verrucae by cauterising, but there is little evidence to show this works, and it can lead to scarring

Prevention is also a consideration.

Wear flip-flops in the gym, hotel room or swimming pool to reduce the risk of infection. Avoid walking barefoot on communal surfaces.

To prevent infecting other people cover the verruca with nail varnish or a plaster or wear socks.

If you would like more information on looking after your feet or managing verrucae, or an appointment with one of our Podiatrists at Maidenhead Podiatry and Chiropractic Clinic, call us on 01628 773588 or e-mail info@maidenheadpodiatry.co.uk.

Hot feet? How to relieve the heat.

We have now had several consecutive days with maximum recorded temperatures over 30 degrees centigrade.

Typical of the UK, the heat comes on quickly, with no smooth transition, and then we feel uncomfortable for days while we try to get used to it. And, of course, our feet can feel really hot and throbbing locked in shoes while we work.

What actually happens to your feet?

As temperatures soar, the quarter of a million sweat glands in your feet start working hard. The job of the sweat glands is to make the skin cooler but can leave it damp and a little whiffy. This is often accompanied with swelling.

One of the functions of your skin is temperature regulation. Blood vessels dilate to help heat escape and fluid floods the tissues causing the skin goes pink or red – erythema. If you have a job that involves standing or sitting for long periods, gravity encourages fluid to collect in the lowest point of the body  – your feet, helping to make them feel tired and achy.

Sweaty, swollen feet aren’t just uncomfortable – they also increase your risk of foot health issues, such as blisters, foot odour and athlete’s foot fungal infections.

The fungi and bacteria that cause foot odour just love these moist, warm and dark conditions come with a heat wave.

So, how do you look after your feet in a heatwave?

Simple, reliable ways to cool your feet

At the end of your working day, you get home and your feet are so hot and throbbing that they feel like they might explode. there are some simple choices using items that can easily be found in most households.

• A hot water bottle can be used to cool as well as heat. Fill it with water and crushed ice and sit with your feet on it like a cold cushion.

• No hot water bottle? A cold, damp towel draped over your feet can work wonders.

• If you can, get outside and put your feet up on a footstool. They’ll soon feel cooler and less swollen.

• Peppermint is a popular essential oil to add to a foot spray, with a lovely cooling effect.

• A nice bowl of cold water and ice also goes a long way towards making your feet feel better.

Keep  your feet comfortable

Comfortable feet aren’t something that just  happens, you need to put some work into it.

• Keep your feet clean – wash and thoroughly dry your feet morning and night. This removes or neutralises sweat and odour-causing bacteria and fungi.

• Use antiperspirant on your feet daily to reduce excessive sweating and odour.

• Wear ‘wicking’ socks and change them at least daily. These draw sweat away from the skin which is why they’ve long been favoured by runners.

• Choose footwear made to breathe and if you are at work, buy shoes for comfort, not for fashion.

It is typical of the UK as a nation to grumble about poor weather and then to complain loudly when it improves, but sore feet are no joke. If you are concerned that your foot pain may have a deeper cause, then give us a call. Your first visit includes a consultation, discussion of concerns and the construction of a treatment plan.

Consult a professional.

If you would like more specific advice, if you experience sweaty, smelly or uncomfortable feet, then the first step is to consult a professional for the best advice and a treatment plan.

If you would like more information or to speak to one of our Podiatrists, or to make an appointment, give us a call  on 01628 773588 or email info@maidenheadpodiatry.co.uk.

Shin splints & metatarsalgia – a guest blog by Jeremy Ousey MSc MCPod

Do I have shin splints?

Frequently patients come into clinic complaining of conditions like shin splints and metatarsalgia.

These are two ‘diagnoses’ which are common labels used by many people, healthcare professionals, sports professionals and our friend Geena who works down the club and gets that exact same pain in her foot… We can all be guilty of it, but what do they mean and why is using these terms a problem?

Well… I’m sure we’ve all had that moment where we are laying in a dark room having maxed out on the pain killers we have in the cupboard and hoping that the clock quietens down with its ticking because it’s making that throbbing in our head feel even worse.

Then that thought comes into our head, “what is causing this pain??? Is it dehydration? Is it just a migraine? Maybe I ate something… and that is a stark reality, we can have pain in an area and not realise what’s causing it and while a migraine compared to an achy forefoot (metatarsalgia) is quite a contrast, we wouldn’t want the doctor treating our migraine like a hangover, and even less would we like him to treat our hangover like a migraine!

So why are shin splints, metatarsalgia and arthritis such a series of misnomers? Well, let’s break them down…

Shin splints

Shin splints is a term that gets used so interchangeably that it’s hard to know what people mean, but the commonly accepted diagnosis that it is linked to is “medial tibial stress syndrome”.

This being said, it can be used for multiple tendinopathies, exertional leg pain and even apophysitis (stress/injury to muscle/tendon attachment in children) such as that of Osgood-Schlatter’s.

Medial tibial stress syndrome is really a low grade stress reaction in the tibia that is typically the result of torsional (twisting) forces as the foot, ankle and leg make contact with the ground, ultimately causing a very low grade stress response (the precursor to a stress fracture).

So when its put like that, we’re dealing with a few different potential diagnoses… so if the diagnoses are different, surely the treatment has to be too? Let’s look at metatarsalgia…

Metatarsalgia

Metatarsalgia, when the word is broken down means “pain in the forefoot”. It doesn’t include toe pain, although the pain can radiate into the toes.

Metatarsalgia can be the result of inflamed joints, overloading of tendons, structural anomalies, arthritic changes or swollen, inflamed or trapped nerves. All of these things can cause foot pain, but the treatment for the specific condition should need to be different for each problem.

Arthritis

Arthritis is a highly generic term but in reality has a very specific meaning which varies on context.

There are various types of arthritis – osteoarthritis, rheumatoid arthritis, psoriatic arthritis etc, but quite often a diagnosis of arthritis may be made based off of an x-ray due to a narrowing of the joint spaces – which is actually typical in a huge proportion of the population who are “over a certain age”.

That said, the presence of arthritic changes do not necessarily mean that pain is guaranteed; in fact, there are a huge number of people walking or even running around whose knees are “bone on bone” with minimal or no pain. Equally there are a huge number of people who have joint pain but an x-ray examination shows no signs of that dreaded “wear and tear”.

There is a real paradigm shift going on within healthcare where we are concerned about the language we use and what that language means for our patients.

Equally, there is general misdiagnosis being made by those less experienced in diagnosing foot pain, and as a result I see many patients who go through life suffering with their feet for years until they get the correct diagnosis.

Always make sure that you get a diagnosis when you see a clinician and are not given a generic condition such as shin splints or metatarsalgia… 

About Jeremy Ousey MSc MCPod

Jeremy Ousey  is an HCPC registered Podiatrist and CASE qualified sonographer.

Having worked in podiatric surgical units, physiotherapy and multi-disciplinary practices, he takes a multi-faceted and patient-centred approach to care. With a bachelors in Podiatry, postgraduate degrees in podiatric sports medicine and medical ultrasound and a masters in the theory of podiatric surgery he allows evidence to guide his treatment plans.

Jeremy lectures on heel pain, extra-corporeal shockwave therapy, musculoskeletal examination, treatment of the foot and ankle including management of ankle sprains and verruca needling.

His interests are in the surgical management of skin lesions, nail surgery, musculoskeletal and biomechanical evaluation, acute and chronic sports injuries, tendinopathies, diagnostic ultrasound and surgical management of foot and ankle pathology

If you would like any more information or to book an appointment with Jeremy then please call Maidenhead Podiatry & Chiropractic Clinic on 01628 773588 or email info@maidenheadpodiatry.co.uk

Do you have tiny holes in the skin on the soles of your feet?

Punctate or pitted keratolysis

This is a condition characterised by multiple tiny holes on the top layer of the skin mainly on the soles of the feet. It can also be found between the toes, but usually affects pressure areas, such as the ball of the foot, heels and the pads of the toes.

Often it is accompanied with a distinctive smell.

What causes it?

Puncate or pitted keratolysis is thought to be caused by bacteria. Several species of bacteria are responsible including corynebacteria, Dermatophilus congolensisKytococcus sedentarius, actinomyces and streptomyces.

The small holes, or ‘pitting’ are due to the horny cells (stratum corneum) being destroyed by protease enzymes produced by the bacteria. This process is fed and exacerbated by moist conditions meaning that this condition is often found on sweaty feet.

The bad smell is due to sulfur compounds produced by the bacteria – thiols, sulfides and thioesters.

Who can develop it?

This condition is experienced more by men than women. Any profession where you are constantly on your feet and footwear is worn for extended periods makes the wearer prone to developing it. Examples are soldiers, farmers, industrial workers and fishermen but this list is by no means exclusive.

What is likely to make it worse?

This list isn’t exhaustive but these are some of the main influencers –

  • Hot, humid weather
  • Occlusive, fully enclosed footwear, such as rubber boots or vinyl shoes
  • Excessively sweaty feet (hyperhidrosis)
  • Thickened skin of the soles of the feet (keratoderma/hyperkeratosis)
  • Diabetes mellitus
  • Aging
  • Immunodeficiency

What does it look and smell like?

Puncate keratolysis usually results in very smelly feet This is caused by infection of the soles of the feet. Either the forefoot or the heel or both become white with clusters of punched-out pits.

The appearance is clearer and more dramatic when the feet are wet, such as after a bath or shower, swimming or long periods in the same shoes.

It can affect the fingers but this is very rare. There is a variant where there are more diffuse or wide spread, red areas on the soles of the foot.

The key things to look for are –

  • Mainly affects the soles, forefoot, the heel and pads of toes or all three. Palms are very rarely infected.
  • Presents as  whitish skin surface with clusters of multiple, fine punched-out pits.
  • Pits can often join together to form larger, crater-like lesions.
  • A variant presents with diffuse red areas on the soles of the feet
  • Strong foot odour.

Why would you visit a Podiatrist?

The pits can present a striking and worrying appearance to the soles of the feet, but they don’t usually present with other symptoms such as pain. Occasionally, in chronic conditions, there  can be some itching and soreness associated on walking or standing.

The usual reason for concern is the strong smell that accompanies this condition.

A Podiatrist is trained to recognise this condition but if there is any doubt, skin scrappings and culture are possible to confirm which bacteria are involved.

How is it treated?

There are a number of topical anti-biotics and anti-septics that can be successfully applied, but these are normally only accessed through your GP.

Fucidic acid cream (or Fucidin) can be applied topically and if this fail, Clindamycin can be taken orally. Other medications are available and this would need to be discussed with your GP to decide the best treatment on an individual basis.

How can I prevent it or prevent it reoccurring?

Pitted keratolysis can recur quickly unless the feet are kept dry. the following are some ideas and steps to take to prevent that –

  • Wear boots for as little time as possible
  • Wear socks that allow effective absorption of sweat, ie cotton and/or wool
  • Wear open-toed shoes/sandals whenever possible
  • Wash feet with soap/detergent or antiseptic wash twice daily
  • Apply antiperspirant to the feet regularly
  • Do not wear the same shoes two days in a row allowing them to dry out
  • Nevershare footwear or towels with others.

If you would like more information or to make an appointment with one of our Podiatrists, call 01628 773588 or email info@maidenheadpodiatry.co.uk.

Do I have hammer toes and can they be treated?

What is a toe deformity?

There are various types of smaller toe deformities and depending on shape are classified as hammer, clawed or retracted toes.

There are three small bones (phalanges) in each of your four smaller (lesser) toes. The bones are connected by ligaments, which dictate range of movement and prevent dislocation. Tendons connect muscle to bone within the foot and control movement and provide stability relative to the ground when walking.

Larger muscles and tendons within the leg move the toes. Toe deformities can occur when there is a muscle imbalance within the foot and the leg. Buckling of the toes can be due to external pressures from shoes and direct injury resulting in toe deformity. Inflammatory and neurological conditions can cause toe deformity as well.

What causes the problem?

As with bunions, there is no single cause of lesser (small) toe deformities. They are frequently caused by defective mechanical structure in the foot which can be a result of genetics; certain foot types pre-dispose development of toe deformities.

Changes to lesser toe shape are commonly due to pressure from shoes or the next toe which can result in painful hard skin forming. It is quite common to see corns and calluses around the tips of toes or on top of small toe joints.

Poorly fitting footwear tends to aggravate the problem, squeezing the forefoot, crowding the toes together and worsening the underlying condition, resulting in pain and deformity of the joint. As we get older, toe deformities may progress become more pronounced. Arthritis and trauma can also play a role.

Is it serious?

Many people have pronounced toe deformities that are painless, but can cause problems with footwear, while other, more subtle toe deformities that can be very painful. Although treatment can ease pain, only surgery can correct the deformity.

Sometimes, pressure from adjacent toes can lead a cascade effect resulting in further toe deformities and/or pain in the metatarsals (long bones in the forefoot). For example, when deformity of the small toes is made worse by increasing bunion changes.

Patients who have altered nerve or blood supply to their feet and are assessed as at risk of lower limb loss, often first present with ulcers on their smaller toes. Left untreated, seemingly small issues can progress rapidly to limb threatening problems.

Who gets it?

Anyone, but they tend to be more common in women, likely due to more restrictive footwear. Parents or grandparents have toe deformities, may make you more prone to developing them. Medical conditions such as diabetes or inflammatory arthritis may also lead to development of severe toe deformities as the disease develops.

How do I prevent toe deformities?

Wearing sensible shoes that fit well is a good start. Choose wider shoes that provide toes with room to move and keep your heel height to no more than 4cm. Consider the following –

  • If you do to wear heels, vary your heel heights from day to day, one day wearing low heels and the next day slightly higher heels
  • Avoid backless, high-heeled shoes.as they force your toes to claw as you walk
  • A shoe with a fastening over the instep holds the foot secure and stable reducing the need for you to try to stabilise your foot with your toes
  • With existing toe deformities, try to accommodate your toes by selecting shoes that have a wider/deeper toe-box

Your podiatrist may recommend the following:

  • Conservative or no treatment (you can elect to live with your toe problems)
  • Regular foot-care by a Podiatrist to reduce callus build-up
  • Use of foot cream and topical medication for associated problems
  • Splints, shields, off-loading devices, pads and shoe alterations/footwear advice
  • The opinion of a Podiatric Surgeon

Non-surgical treatments can help relieve symptoms but it is unlikely they can correct the underlying deformity. Your podiatric surgeon will evaluate the extent of the deformity and remodel the shape of your toes, allowing a greater chance of fitting inside an average shoe.

Surgery is complex and intricate as deformities of the small toes can occur in any one of the three joints in each toe and in any direction. There are numerous surgical options for toe deformities and an increasing number of new technologies in surgery for small joints.

The aim of surgery is to address the underlying cause of the deformity to prevent recurrence. As with all surgery, there are risks and complications, and it is important to balance any potential risk against perceived reward when considering foot surgery.

You should certainly consider getting an opinion about surgery or surgical options from a Podiatric Surgeon if you are in pain or experiencing progressing deformity.

When should I see a podiatric surgeon about it?

If you experience any foot care issues which do not resolve themselves naturally or through routine foot care, then ask your Podiatrist to refer you to a Podiatric Surgeon.

Your Podiatric Surgeon will discuss options in a shared decision-making process accounting for your presenting symptoms, age, activity level, occupation and medical history, in conjunction with appropriate imaging. This will help you to make an informed decision on what is best for you.

Podiatrists and Podiatric Surgeons are registered with the Health and Care Professions Council (HCPC). You can check your professional is registered here.

If you would like more information or to make an appointment with one of our Podiatrists, call 01628 773588 or email info@maidenheadpodiatry.co.uk.

Oral medication (terbinafine) has been recommended for my fungal nails – is it safe?

Terbinafine and fungal nails

There are too many topical anti-fungal preparations currently on the market to list them all here. Their success also varies enormously and is covered in another blog. click here to read.

Having visited your Podiatrist or GP and had your nail infection confirmed as fungal, there are three main options.

  • Do nothing
  • Try an over-the-counter or prescription anti-fungal topical application
  • GP prescribed oral medication

There are two mainly used oral anti-fungal medicines – itraconazole and terbinafine. This blog will look specifically at terbinafine (hydrocloride) because at Maidenhead Podiatry we are frequently asked about its potential side effects.

Liver problems were only reported in 0.1% of patients. 1 in 1000; but only 1 in 50,000 to 1 in 120,000 were serious

What is terbinafine (hydrochloride)?

Terbinafine is an allylamine drug, meaning it works by inhibiting squalene epoxidase, an enzyme involved in the synthesis of ergosterol, a component in fungal cell walls.

Terbinafine is available as cream, gel, spray and, of course, tablets for oral administration at the time of writing.

What is the history of terbinafine?

It is used in the treatment of onychomycosis or fungal nails (as well as a range of fungal skin infections). Terbinafine has been available since the early 1990s in the UK and the late 1990s in USA, but there has always been some reluctance regarding its potential side effects particularly those affecting the liver when taken orally.

When terbinafine was first deployed as a new antifungal, the choices for treatment of fungal nails were limited. Topical treatments were often, and remain, disappointing.

Until the 90s, oral griseofulvin and ketoconazole were the oral drugs of choice, indicated for dermatophyte or fungal nail infection, but they were far from effective. Generally, they required long courses with a narrow spectrum of activity leading to many patients giving up when they experienced unpleasant side effects.

The idea of a new, modern, antifungal drug was appealing with subsequent studies suggesting it had twice the success rate of griseofulvin and it became widely used in the treatment of dermatophyte nail infections.

How is terbinafine metabolised?

As with many drugs, terbinafine is metabolised by the liver and excreted by the kidneys, consequently a reduction in function of either of those two organ systems could result in serious problems and correct prescribing is crucial.

Terbinafine is highly lipophilic (combining with or dissolving lipids) and tends to accumulate in hair, skin, nails, and fatty tissue where it inhibits fungal growth..

What about terbinafine and liver damage?

The possibility of liver disease (hepatotoxicity) with terbinafine has long been known and drug manufacturers have highlighting that it should not be prescribed for patients with liver disease. Terbinafine, like nearly all classes of medications, has been shown to be able to induce idiosyncratic liver injury or drug induced liver injury (DILI), but that doesn’t mean it will.

The causes of DILI are many, although pre-existing liver disease may play a part. In otherwise healthy individuals it’s cause and reason for development is unclear, although genetic susceptibility may be responsible. As a consequence, The British National Formulary advises it should not be used in patients with known liver disorders. For those that are prescribed the drug, they should have liver function tests before starting and periodically after 4–6 weeks of treatment to assess liver function.

The test monitors the levels of liver enzymes present in the bloodstream. Elevation of these enzyme levels can signal early changes in liver function. Tablets are often prescribed a month at a time, the next month being prescribed only following a successful test.

Is terbinafine safe?

Hepatotoxicity or liver function problems are rare but the more common side effects in patients taking the drug include

  • gastro-intestinal upset,
  • taste disturbances,
  • headache
  • rashes

Further, liver problems may not be as common as is perceived. A 1996 British study reviewed 9879 patients who had taken the oral terbinafine. Half of these had other illnesses and conditions and were taking other medications at the same time. 14% reported various side effects but only half of these were thought to be related to the terbinafine as reported by their physicians.

Liver problems were only reported in 0.1% of patients. 1 in 1000

(14 cases) of which 10 cases were classified as minor and transient elevations in liver enzymes. In addition, some of these patients were found to have pre-existing history of liver disease (gall bladder disease, alcohol related changes, hepatitis and cirrhosis).

There were no terbinafine associated deaths.

The National Library of Medicine Liver Toxicity Database report on terbinafine shows less than one percent of patients see an increase in liver enzymes in the bloodstream and most resolve with stopping treatment. It estimates the probability of developing elevated liver enzymes levels requiring stopping treatment is about 0.31% for 2 to 6 weeks’ treatment and 0.44% for treatment lasting longer than 8 weeks.

It concludes that clinically apparent liver injury from terbinafine occurs rarely, in around 1 in 50,000 to 120,000 prescriptions.

How do I decide?

Remember,

  • no drug can ever be 100% effective for everyone so success isn’t guaranteed
  • successful resolution doesn’t mean you can’t get it again
  • re-infection within 12 months is not only possible but likely
  • successful resolution must be followed by an anti-fungal regime
  • leaving a fungal nail untreated rarely causes problems

As with most classes of drugs, terbinafine can potentially lead to liver problems. However, the data from the above control suggests that oral terbinafine is safer than perhaps it is perceived, and minor side effects are far more likely for most patients than serious liver damage.

Data from studies suggest the risk of serious liver injury to be between 1 in 50 000 and 1 in 120 000

Despite its rarity, patients taking terbinafine who exhibit any of the symptoms of liver problems (nausea, vomiting, abdominal pain, fatigue, anorexia, general itching and dark urine) should urgently be referred for further assessment.

If you would like more information , or to make an appointment with one of our Podiatrists, call on 01628 773588 or email info@maidenheadpodiatry.co.uk.

What is Diabetes?

At Maidenhead Podiatry we are frequently asked – what is diabetes?

Diabetes is a chronic, potentially debilitating disease.

It occurs as a result of problems with the production and supply of a hormone called insulin.

Insulin is a hormone produced in the pancreas by the islets of Langerhans which regulates the amount of glucose in the blood.

In type 1 diabetes the body either produces no or insufficient insulin and in type 2, or late onset diabetes, the body can’t use the insulin it produces effectively.

Type 1 diabetes is sometimes called insulin-dependant, immune-mediated or juvenile onset diabetes.

It is caused by an auto-immune reaction where the body’s defence system attacks the insulin producing cells.

The reason this happens isn’t understood but explains why the onset of diabetes often follows illness.

It can affect people of any age but usually occurs in children or young adults.

Type 1 diabetics need regular injections of insulin to control the level of glucose in their blood.

Type 2 diabetes is also known as non-insulin dependant or late onset diabetes.

Generally speaking type 2 diabetics do not usually require insulin injections but instead control their blood glucose through diet, medication and exercise.

Type 2 diabetes is most common in people over 45 years old who are also overweight however the prevalence of type 2 diabetes in adolescents and young adults is dramatically increasing.

Similar to older-onset type 2 diabetes, the major predisposing risk factors are obesity, family history, and sedentary lifestyle.

Onset of diabetes at a younger age (defined here as up to age 40 years) is associated with longer disease exposure and increased risk for chronic complications.

Young-onset type 2 diabetes also. affects more individuals of working age, accentuating the adverse societal effects of the disease

Furthermore, evidence is accumulating that young-onset type 2 diabetes has a more aggressive disease phenotype.

This can lead to premature development of complications, with adverse effects on quality of life and unfavourable effects on long-term outcomes, raising the possibility of a future public health catastrophe.

Some pregnant women develop a third type called gestational diabetes.

It develops in 2-5% of pregnancies but usually disappears post-partum.

Having gestational diabetes means an increased risk of type 2 diabetes in later life.

Impaired glucose tolerance means blood glucose levels above what is considered normal but not high enough to be diagnosed with diabetes.

Although there is a high risk of developing type 2 diabetes and so significant changes to lifestyle including diet and exercise are strongly encouraged.

Type 1 diabetes

Recognising type 1 diabetes is important and the onset of symptoms can often be rapid and include

  • abnormal thirst and dry mouth
  • frequent urination
  • extreme tiredness and lack of energy
  • constant hunger
  • sudden weight loss
  • slow healing wounds
  • recurrent infections
  • blurred vision

Type 2 diabetes

These symptoms can also occur in type 2 diabetes but are often less obvious as the onset is usually more gradual and therefore harder to detect.

When it is finally  diagnosed it may have developed several years earlier with complications already present.

With impaired insulin production and action, sugar remains in the blood causing hyperglycaemia or raised blood sugar and it is this that can cause short and long term issues which can compromise health and lifestyle.

In the longer term, living with diabetes can lead to complications and a diabetic should always be mindful and aware of changes in their health.

Changes to the feet can take place with loss of sensation called neuropathy and reduction in peripheral circulation which in turn can lead to compromised healing.

The Podiatrists at Maidenhead Podiatry regularly perform diabetic foot checks for patients including

  • Visual health check
  • Skin colour and condition
  • Nail health
  • Pulse testing using Doppler
  • Sensation testing using 10g filament
  • Fine sensation testing using 128Hz tuning fork
  • Hot/cold temperature distinction

Early diagnosis and changes made to lifestyle and environment can significantly lessen the impact type 1 diabetes and those same changes in an adult can dramatically reduce the risk of developing type 2 diabetes.

There are many misconceptions about diabetes.

  • Anyone and everyone is at risk
  • Diabetes hits all populations regardless of income or social status
  • Diabetes is becoming increasingly common
  • More than 240 million people have diabetes worldwide
  • 380 million will have developed it by 2025
  • In Asia, Middle East, Oceania and Caribbean up to 20% of people are diabetic
  • Diabetes affects all age groups
  • Diabetes affects women proportionately slightly more than men
  • Up to 80% of type 2 diabetes is preventable

Ask us for a free copy of Diabetes : understanding your test results.

If you would like more information about foot care at Maidenhead Podiatry or to make an appointment to see one of our podiatrists please call 01628 773588 and speak to one of our reception team.

Your feet are amazing, don’t ignore them!

Don’t ignore your feet

When we are standing, running, walking and exercising, we take our amazing feet for granted. We use them in almost every activity, from walking to skiing, from football to rugby, from jogging to swimming.

What do you know about your feet?

For most of us, our feet are just something we walk on, just the point of contact between our body and the ground, but read on for some fascinating foot facts.

Animals are classified as plantigrade or digitigrade, depending on how much of their foot they walk on.

  • Plantigrades walk on the whole of their feet (such as people, bears, baboons, alligators and frogs).
  • Digitigrades walk on their toes (such as dogs, cats, birds and dinosaurs).

A biped is an animal with two feet (from the Latin bis, “twice”, and pes, “foot”).

Feet have many functions throughout the animal kingdom, not just locomotion.

  • Gannets use their webbed feet to incubate eggs,
  • butterflies ‘taste’ with their feet
  • elephants ‘hear’ through the soles of their feet, picking up vibrations from the ground
  • Geckos feet are sticky to allow them to ‘stick’ to surfaces
  • Ostriches only have two toes, but combined with long legs, can reach 40mph
  • Horses are the only animal with only one ‘toe’
  • mosquitos have scaled feet to allow them to land on water
  • crocodiles webbed feet take them from water to land
  • flying lemurs have toes that act like suction cups

As humans, we use Podiatrists (Chiropodists) to ensure good and continuing foot health. From a legal and registration point of view, the terms Chiropodist and Podiatrist are interchangeable and both or either require registration by the HCPC – The Health Care Professions Council.

The word Chiropodist comes from the Greek ‘cheir’ meaning hand, ‘pod’ meaning foot and ‘ist’ the person who practices.

The term originated in England around 1785 largely to describe ‘corn cutters’ in an attempt to separate the emerging profession from its perceived humble roots, but is not widely recognised internationally. Therefore, the change to ‘Podiatrist’ in the mid 1990s.

Podiatrist comes from the Greek ‘pod’ meaning foot and ‘iatreia’ meaning healing, thus, one who heals feet.

A Podiatrist will not only treat your feet and lower leg, but will advise and educate you on the best way to look after your feet.

Many people ignore their feet while pounding the treadmill or cross training, but they can be considered the very foundation of physical well-being.

  • One quarter of the bones in the body are found in the feet and ankles
  • Most movement begins in your feet and much like the foundation of a building they determine stability
  • Perhaps the most neglected yet complex structure in the body
  • A marvel of biomechanics
  • When feet are strengthened it increases and reinforces whole body balance and core stability.

Almost eight out of 10  American adults have experienced a foot problem, according to a 2014 survey by the American Podiatric Medical Association (APMA). The poll also revealed that 25% of adults were unable to exercise because of foot pain.

Many foot injuries are due to overuse, or trying to do too much with too little support.

Toes don’t need to have the dexterity of fingers but some dexterity is important and the muscles of the feet need to have strength.”

It is easy to exercise your feet.

  • Try picking up a duster, towel or marbles with your toes and strengthen the muscles that build arch strength
  • Stand on one foot for 10 seconds is a good way to build core strength. If it becomes too easy then do it with your eyes closed. This is useful in preventing falls in the elderly
  • spread, point and individually lift your toes
  • roll a tennis ball or drinks can underfoot
  • stand on tiptoe to strengthen your calves

Feet are integral to every movement and improving their fitness can only be beneficial.

many aspects of footcare can be tackled at home, but sometimes it is best to seek professional help and advice to determine the best way forwards.

If you would like more information about Podiatry or to make an appointment with one of our Podiatrists to discuss your treatment options, call 01628 773588 or e-mail info@maidenheadpodiatry.co.uk.

Biomechanics and musculoskeletal assessment – a guest blog by Jeremy Ousey MSc MCPod

Biomechanics and musculoskeletal assessment

As part of working in private practice I regularly visit online forums for patients with common conditions – such as plantar fasciitis, Morton’s neuroma and shin splints.

I frequently read statements similar to “my friend said I need a biomechanics assessment” or “you need to go to the musculoskeletal clinic” or “find someone to do a musculoskeletal assessment”.

Great buzz words that sound impressive and potentially complicated – but what do they actually mean? What is involved?

As a professional who does both musculoskeletal and biomechanical assessments I know what they mean to me, but what do they mean to my patients?

Certainly, when your pain is a mystery and it isn’t getting better, you need to see someone who has a special interest and intimate understanding of the form and function of the body. It can sound like there’s some mystical excitement and curiosity about the process but these assessments can provide the answer to your problems.

What is the difference between musculoskeletal and biomechanical?

Musculoskeletal assessments

These are primarily focussed on the diagnosis and treatment of a condition.

Your clinician will identify the region of the body affected and then palpate (manually explore) the structures in that area to see if they can reproduce the pain. Once identified, and depending on the level of pain, they can then test the joints, muscles and tendons supporting it to see how normal function has been affected.

Musculoskeletal assessment typically involves taking a clinical history, clinical assessment with palpation, clinical tests and may utilise diagnostic tests such as imaging, injections and trial interventions.

Conditions that are likely to benefit most from a musculoskeletal assessment are:

  • Plantar fasciitis and heel pain
  • Morton’s neuroma and metatarsalgia
  • Achilles tendinitis

Biomechanical assessments

These are more movement focussed and look at the way that your appendage/limb/body moves and functions.

It doesn’t necessarily look for the specific anatomy causing pain but the interaction of your body as a whole, the idea being that more global information can be integrated to identify the mechanical source of your pain.

A biomechanical assessment may involve the use of gait and movement analysis and occasionally force plates and in-shoe pressure analysis (however this is rarely required). Conditions that lend themselves to biomechanical assessments are:

  • Shin pain (shin splints)
  • Recurrent stress fractures
  • Tendon pain when running
  • Knee pain
  • Hip pain
  • Arthritis

When is each used?

This is where science and art meet.

Musculoskeletal assessment tends to be used to inform the need for a biomechanical assessment.

The musculoskeletal assessment looks to present a diagnosis for the pain, identify what may be related to and causing that pain, and then to strengthen or offload associated structures reducing pain and promoting healing.

Biomechanical assessment focuses in on the movements of the body and how they might cause pain.

Biomechanical assessment is most effective when one gets the same recurring pain that is not due to lifestyle choices or where the pain that you get is not enough to stop the activities you enjoy (such as running) but is enough to reduce that enjoyment.

What is the outcome of each assessment type?

Well, the outcomes can be quite similar. The recommendation following either assessment can include

  • Semi-bespoke or prescribed bespoke orthotics
  • Rehabilitative stretches and exercises.
  • Footwear advice or modifications
  • Prescription medication
  • Advice on taping and braces
  • Gait re-training.

Does it matter which assessment you book for?

Only if the clinic you go to labels them differently, however the clinician that you see should be able to perform both and direct your appointment as required.

It tends to be that the majority of people have an appointment that combines both, depending on time. This allows for components of each to be used as is necessary.

My advice however would be that starting with an initial consultation with a specialist and then allowing them to guide you in the direction will give you the best results.

About Jeremy Ousey MSc MCPod

Jeremy Ousey  is an HCPC registered Podiatrist and CASE qualified sonographer.

Having worked in podiatric surgical units, physiotherapy and multi-disciplinary practices, he takes a multi-faceted and patient-centred approach to care. With a bachelors in Podiatry, postgraduate degrees in podiatric sports medicine and medical ultrasound and a masters in the theory of podiatric surgery he allows evidence to guide his treatment plans.

Jeremy lectures on heel pain, extra-corporeal shockwave therapy, musculoskeletal examination, treatment of the foot and ankle including management of ankle sprains and verruca needling.

His interests are in the surgical management of skin lesions, nail surgery, musculoskeletal and biomechanical evaluation, acute and chronic sports injuries, tendinopathies, diagnostic ultrasound and surgical management of foot and ankle pathology

If you would like any more information or to book an appointment with Jeremy then please call Maidenhead Podiatry & Chiropractic Clinic on 01628 773588 or email info@maidenheadpodiatry.co.uk

Thinking of going back to high heels?

High or low heels?

Now that we have had the first relaxation in the rules that will, in time, lead to us returning to socialising as we knew it, we now have the prospect of returning to wearing high heels.

At Maidenhead Podiatry, our Podiatrists are regularly asked about the long term effect of wearing high heels and it is assumed we will disapprove, but that isn’t necessarily the case. So, here is the low down on high heels.

On the streets of towns and cities all over the country, during lockdown, people have made walking part of their daily routines. Choice of shoes for the task are practical and comfortable, with modest heel, laces and good foot support.

Why would you go back to heels?

There are many reasons for wearing high heels and although they are often worn for work, many reserve them for socialising. Of course, wearing heels can make you feel good, and they can have several effects on not just the foot,

The negative effects of wearing high heels are mostly temporary if they aren’t worn for too long.

Although a modest heel helps the feet work more efficiently, high heels cause you to walk with your weight on the balls of your feet.

How do heels change things?

It is estimated that for each inch of heel, the load on the ball of the foot increases 25%. Therefore, a three-inch-high increases the load by 75% over wearing flats.

Existing (foot) problems that can worsened by high heels include

  • neuroma
  • hammertoes, callous and corns, which are thickened, tough spots on the skin.
  • muscle and joint pain.The body has to adjust for an unnatural gait leading to compensation pain.
  • tightness in your calves and put yourself at risk of knee problems, low-back pain, and even neck and shoulder pain.

However as Podiatrists we are not completely against high heels. For everyday use, shoes with heels that are an inch to an inch and a half are fine. If you wear shoes with a heel of two inches or more, limit wearing them to a few hours, such as at an evening event or a wedding.

When you get home at the end of your day massage your feet and give your calves a nice long stretch too. Also, regardless of whether they have heels or not, always rotate your shoes so you’re not wearing the same pair day after day, This will make sure your feet and calves aren’t moving in the same position for long periods of time.

But I still want to wear them

If you are determined to wear heels then there is a way of telling which heel height could be ideally suited to you – it all comes down to the shape of your feet.

Surprisingly, some women are more suited to wearing skyscraper-high, while others will suffer after mere moments with the lowest of heels.

There is a tongue in cheek way to work out which category you fit into, with a three-step formula to quickly calculate your ideal heel height. Measurement is based on the flexibility of a curved bone that connects the foot and the leg – the talus.

If the talus tilts downwards when you are holding your leg out straight and relaxing your foot, then you have a lot of mobility and can wear high heels with ease, if it doesn’t, then you just aren’t cut out for wearing them and there’s nothing you can do about it.

So how do you measure your ideal heel height?

  • without shoes and sitting, hold your leg straight out in front of you keeping your foot relaxed. If your foot sits at a right angle to your leg without dangling then you have less mobility and will be more comfortable in a pair of flats. However, if the top of your foot follows the line of your leg and your toes pint, then you are a natural heel wearer.
  • to find your ideal heel height, get someone to place a tape measure from your heel in a straight line on the floor, then place a pencil at the ball of your foot at right angles to the tape.
  • Wherever the tape measure hits the pencil reveals your ideal heel height.

This simple formula can make footwear purchases more comfortable, although you still shouldn’t wear them all the time.

If you would like more information or to make an appointment with one of our Podiatrists or Chiropractors, give us a call on 01628 773588 or email info@maidenheadpodiatry.co.uk.

Wherever the beach, make sure your feet are ready!

 

British beach or foreign beach, make sure you are ready.

It is a strange time at the moment. After so long being told to stay at home we are finally seeing an easing of the lockdown restrictions and that means there is a strong prospect of us heading to the beach this summer.

Of course, we don’t know if it will be a British beach or a foreign one, but the preparation and the wish to look your best is the same.walking on a beach

The Podiatrists at Maidenhead Podiatry have put together a number of summer foot-care tips, to help get your feet in shape for the beach or just a summer at home.

  1. Trim your toenails for summer 

    – Use proper nail clippers and cut straight across following the contour of the toe, not too short, and not down at the corners as this can lead to ingrown nails. File them, if it’s easier.

  2. Go barefoot

    – Go barefoot or wear open-toed sandals whenever you can in the hot weather (except when you’re in a communal shower or changing area) to help stop your feet getting sweaty and smelly.  Go bare foot as much as possible at home.  If you have diabetes, poor circulation or are taking anti-inflammatory drugs ask advice first from your Podiatrist.

  3. Forget flip-flops

    – Don’t be tempted to wear flip-flops all through the summer. They don’t provide support for your feet and can give you arch and heel pain if you wear them for too long. (Fit Flops, however do offer some degree of support).

  4. Change socks daily

    – If you have to wear socks in hot weather, change them once a day and choose ones that contain at least 70% cotton or wool to keep your feet dry and stop them smelling.

  5. Remove hard skin

    – Hard, cracked skin around the heels is very common in summer, often caused by open-backed sandals and flip-flops rubbing around the edge of the heel. Use a foot file or emery board (pumice stone is horribly unhygienic) to gently rub away the hard skin, then apply a rich moisturiser such as aqueous cream or E45 to soften the skin.

  6. Banish blisters –

    Blisters strike more often in hot weather and are caused by rubbing, especially between the toes if you’re wearing flip-flops with “thongs”. If you do get a blister, don’t put a plaster over it.  Leave it to dry out on its own.

  7. Buy shoes carefully

    – Always buy work shoes late in the afternoon. Shoes bought in the morning are often too small by the end of the day as your feet swell as the day passes.

  8. Ring the changes –

    Wear a variety of different sandals and shoes during summer to help prevent cracked heels, hard skin and blisters. Wear shoes with leather or Gortex uppers. Hard leather shoes retain more moisture than more porous softer leather shoes. In general natural materials such as cotton and wool are far better for your feet because natural fibres provide a “wicking” effect which absorbs moisture and keeps the feet cool as your perspiration rapidly evaporates. Better still, some man-made socks wick sweat away from the skin providing a constant dry layer next to the skin. Change your socks or hosiery at least every day and take spare socks in case it needs to be more often.

  9. Watch out for foot infections – 

    The floors of communal showers and changing rooms at open-air and hotel swimming pools are hot spots for infections such as athlete’s foot and verrucas. Don’t wander around public pools barefoot. Protect your feet by wearing flip-flops in the changing room and at the pool edge.

  10. Get help if you need it – 

    Basic hygiene and nail cutting should be all you need to keep your feet healthy. Wash feet every day and dry properly between the toes, especially after swimming or using the gym.

feet in the water on a beachThe best start is to to visit a professional. If you would like your feet examined, assessed and treated by one of our Podiatrists, call us for an appointment on – 01628 773588 or email – info@maidenheadpodiatry.co.uk

If you would like more information about Poidiatry then visit – http://maidenheadpodiatry.co.uk/treatments/podiatry/

 

Caring for your feet and back during pregnancy

How do you care for your feet during pregnancy?

At Maidenhead Podiatry & Chiropractic Clinic we find foot and back care during pregnancy is often overlooked with treatment only being sought towards the end of term, and frequently only because backs seize up or feet can no longer be reached.

Our Chiropractors have a special interest in back and skeletal issues associated with pregnancy. This includes pre and post-partum.

Many changes occur during pregnancy but with forethought and planning they can be anticipated and managed as well as possible during this wonderful time. 

What changes?

Pregnancy means many changes in a woman’s body and there are common changes that develop over the nine month term.

Of these complaints, usually ignored, are changes to back, feet and foot pain.

A woman’s centre of gravity moves forward during pregnancy due to the natural weight gain. This leads to a new weight-bearing stance, leaning backwards to counter-balance the swelling abdomen, adding pressure in the back, knees and feet.

Back and foot care during this period is important and sometimes something as simple as exercises or a set of orthotics – specialist insoles – can bring relief and make life easier.

What are some of the common problems?

Common foot problems experienced by pregnant woman are over-pronation (rolling the foot inwards), oedema (swelling), and the build up of hard skin (callous) or corns as a direct consequence of increased pressure and friction.

This can lead to back an hip pain as well as pain in the heel, inner arch, or the ball-of-the-foot.

Many of these issues can be well managed at home with exercise, stretching and basic foot care. But sometimes it is best to seek the advice and treatment of a professional.

The roll of hormones

Relaxin is a hormone produced during pregnancy by the ovaries and placenta with important effects in the female reproductive system in preparation for childbirth, including relaxing the ligaments in the pelvis to facilitate birth.

This can increase back and hip pain leading to discomfort and soreness with standing and walking. Something our Chiropractors are familiar with and can provide comprehensive advice on treatment and management.

Relaxin also relaxes ligaments in the feet contributing to changes including pain and broadening of the foot. Changes to the shape of the feet during pregnancy are often permanent. Speak to one of our Podiatrists about managing foot pain.

Other changes

Many women may also experience leg cramping and varicose veins largely due to the temporary weight gain of pregnancy.

Because of this, it is important to learn more about back and foot health during pregnancy to help make this nine month period more comfortable.

If you would like more information or to make an appointment with one of our Chiropractors or Podiatrists, call Maidenhead Podiatry on 01629 773588 or e-mail info@maidenheadpodiatry.co.uk.

Need help with your feet or back – use our search bar.

Use our search bar the find what you are looking for

Many people visit our website for help or information on Podiatry or Chiropractic.

Both Podiatrists and Chiropractors offer a range of treatments and skills to benefit their patients but sometimes all you need is to be informed.

Below we describe what Podiatry and Chiropractic are and explain many of the treatments and services we offer but if you know what you are looking for then use the search bar in the top right hand corner of the screen.

A large part of what we provide for patients is help, advice and education and this website contains information on definition, diagnosis and treatment of a wide range of conditions and all can be accessed through the search bar.

It doesn’t matter if you are looking for something specific or just curious. Give it a go. Find what you are looking for in our education pages and previous blogs. Click on the search bar.

Podiatry

Podiatry is defined as the diagnosis and treatment of foot disorders; however, we assess, diagnose and treat from the knee down. We also treat warts on hands.

Chiropractic

Chiropractic is the management consists of a wide range of manipulative techniques designed to improve the function of joints, relieve pain and ease muscle spasm.

Chiropractors don’t only treat backs and can help with any soft-tissue or structural issues.

What is Podiatry?

Podiatry like many health care professions has general practitioners and specialists.

A general practitioner will treat anything from corns to verrucas and from plantar fasciitis or heel pain to ingrown toenails. We are all licenced to use local anaesthetic, perform minor surgeries such as ingrown nail removal and dispense antibiotics, if and where appropriate.

We provide vascular assessment and diabetic screening as a matter of course when requested or required. We have Podiatrists with special interests in areas such as diabetic care and biomechanical assessment and gait analysisGait analysis includes being filmed on a treadmill followed where appropriate by prescription of custom moulded orthotics together with an integrated exercise and rehabilitation program.

Seven Podiatrists and two Chiropractors trained in using the latest treatment and cutting-edge technology for a range of common conditions.

Cutting edge technology

Shockwave, which is a percussive mechanical treatment for chronic, or long-term, soft tissue pain such as heel pain, Achilles pain, hip pain and of course plantar fasciitis although it can be used anywhere in the body. It is used by both Podiatrists and Chiropractors

We were one of the first clinics in the country to use Swift, a microwave generator for the treatment of verrucas. We also offer salicylic acid, freezing and needling.

We offer all general foot care too including fungal nails, athlete’s foot, splits, fissures and infections. We also provide foot care in nursing and care homes as well as a domiciliary/home visiting service.

Contact us

Hopefully you have found what you are looking for but just in case you haven’t, give us a call on 01628 773588 and let us educate you. To find us follow the map and directions or put SL6 5FH into your sat nav.

We have our own free car park directly outside the clinic. Our premises are disabled friendly with no door thresholds and easy access throughout the ground floor. Let us know if you have any special requirements.

If you would like more information or to make an appointment give us a call on 01628 773588, and speak to one of our friendly receptionists or arrange a call back from one of our Podiatrists or Chiropractors.

And, we will of course cut your toenails too.

What is gout and do you have it?

Do I have gout?

Arthritis is a disease of the joints which results in them to become inflamed and stiff.

There are three main types of arthritis – Rheumatoid arthritis, Osteo-arthritis and the less common form, Gout.

What is gout and what causes it?

Gout is the result of too much uric acid in the body leading to a build-up in the blood. Small crystals can form, collecting in the joints causing irritation and inflammation, which can be painful and severe.

Is it serious?

Apart from the severe pain that gout can cause, most other side effects of gout are rare but can include kidney damage because crystals form to create kidney stones which are known for being extremely painful to pass.

Who gets it?

1 in 200 people are affected by gout. More men than women are affected and it tends to appear in middle age but can run in families.

How do I know I have it?

The main symptom of gout is waking during the night with an acute throbbing pain in the big toe, which is also swollen. Usually only one of the big toes is affected. The pain lasts for a few hours and usually subsides not returning for a few months.

If it is more persistent, pain may be constant accompanied by swelling, redness and heat. If symptoms are persistent a visit to your GP is needed as they can be controlled by medication.

How do I prevent it?

You can reduce your chances of having attacks by leading a healthy lifestyle by:

  • Maintaining a healthy weight
  • Eating a healthy diet including what you drink (i.e. avoiding too much alcohol or fizzy drinks)
  • Making sure there is plenty of Vitamin C in your diet.

What are the treatments?

Gout can be controlled and regulated with anti-inflammatory drugs, which your GP will be able to prescribe, and these will alleviate the attack over 24 hours or so. Anti-gout medications are usually only taken during pain episodes.

When gout strikes, it helps to elevate your leg to reduce swelling together with the application of ice or cooling lotions while waiting for your medication to take effect.

Your podiatrist will also be able to increase comfort through advice and adapting your existing footwear with orthoses or other specialist insoles to help redistribute pressure away from the affected joints.

Made-to-measure shoes can also be prescribed and your podiatrist will be able to advise you on the correct type of shoes to wear and where to obtain them.

They can also provide protective shields for your toes or padding to relieve pressure and thereby reducing friction. Any secondary problems like ulcers or corns can also be treated.  They can also refer you to a specialist for more serious cases.

When should I see a Podiatrist?

If you experience any foot care issues which do not resolve themselves naturally or through routine foot care within three weeks, it is recommended to seek the help of a healthcare professional.

To talk to a podiatrist (also known as a chiropodist) – https://maidenheadpodiatry.co.uk/what-is-a-podiatrist/ – about the options available regarding treatment, you can contact an NHS Podiatrist or a private practice Podiatrist.

In both cases, always ensure that any practitioners you visit are registered with the Health and Care Professionals Council (HCPC) and describe themselves as a Podiatrist (or Chiropodist).

In the NHS, through your GP, Specialist teams of rheumatologists, podiatrists, physiotherapists and occupational therapists, along with specialist nurses, will provide the most effective care and treatment for patients with arthritis, especially those with rheumatoid arthritis.

To contact an NHS Podiatrist, please contact your GP practice for information on an NHS referral (in some areas you can self-refer).

If you would like more information or an appointment with one of our Podiatrists give us a call on 01628 773588 and speak to our reception team.

Snap-shots from the history of footwear

We are constantly being told of the importance of shoes and, more to the point, the importance of the right shoes.

It can be a dry subject so here are some fun facts, interesting snippets and snap-shots from the history of footwear.

The Ancient Egyptians used to paint the picture of their enemy on the sole of their shoe so that they stamped on them when they walked and today in parts of the Middle East, throwing your shoe at someone is considered a gross insult.

The Romans are thought to have been the first to make left and right shoes, previously both had been the same, and they coloured them according to rank.

In the thirteenth century shoe/boot makers were called ‘Cordwainers’, named after the fine, hard wearing goatskins that came from Cordova in Spain.

‘Cobblers’ at this time did not make shoes. They bought up old ones and re-made them for re-sale, the same materials being used repeatedly. Hence the term – ‘cobble something together.’

Although now seen as a sign of femininity and glamour – a pair of high heels was once an essential accessory for men.

The history of footwear is inextricably linked with the history of transport. In every century before the last two, the most common way of moving from one place to another was either walking or riding.

In previous centuries, horse-riding was almost exclusively a male pursuit and this had a profound effect on the design of men’s shoes. Men’s high heels helped keep the foot in the stirrup and helped control the horse during hard riding. They couldn’t be functional if the heel was too narrow or tapering, as it would tend to snap; and if they were too high, walking was difficult.

Therefore, the design was a response to practical need. They had to be dual-purpose, suitable for riding and convenient for walking. By the middle of the nineteenth century, improved coach design and development of the railways meant there was less demand for a boot primarily designed for riding and so the design changed again.

Some diminutive men through history also used them to make themselves appear taller, even the odd film star today.

During the same period surviving women’s shoes suggest they were not made to be worn outdoors. When women travelled, they went by coach or, in the seventeenth century, sedan chair.

Therefore, women’s high heels had little to do with practicality. Indeed, at the court of Louis 16th, women wore such extreme high heels that they could only walk with a stick and could not tackle stairs without assistance. 

Of course the shoes described were the preserve of the wealthy. For the majority of people, footwear was chosen for practicality. Boots that kept the water out and the warmth in. Shoes and boots that were worn until worn out, often passed down from the wealthy to their servants as long as they weren’t too elaborate.

Fashions also varied from country to country. One example is the way the french revolution swept away all fashion and fripperies. Shoes became plain flat and without heels. The fashions that would give even the most masculine man a strangely female gait were replaced by that allowed walking to be natural and easy for the first time in generations.

Today’s shoes are a progression and natural development of earlier styles and continue to change year on year.

‘Shoes can lift the spirits, delight the sole and give confidence to the insecure’. Colin McDowell – Shoes, Fashion and Fantasy

Shoes develop with contemporary fashion moods and designers play with scale, proportion, colour, texture and function. What is most important is that they are comfortable, supportive and fit for purpose.

If you would like more information or an appointment with one of our Podiatrists then call Maidenhead Podiatry on 01628 773588 or e-mail us on info@maidenheadpodiatry.co.uk.

Do you have small bumps around your heels?

Do you have small bumps around your heels?

Many people are concerned that they have small lumps around the circumference of their heels.

Although they can appear alarming they are known as piezogenic papules are quite harmless and in the main, painless.

They comprise soft, compressible lumps, often on the back and round the side of the heel  and commonly on both feet.

A determining feature is that they vanish when the foot is off the ground.

What causes them?

The cause is small herniations in the fatty tissue of the heel(s) breaking through tiny tears in the fascia (retaining connective tissue) of the heel under load, which is why they are invisible when the foot is lifted from the floor.

Piezogenic papules are more likely in the young and athletic and tend to occur more commonly in females than males.

People who have the connective tissue disorder, Ehlers-Danlos syndrome (EDS) are more susceptible, as are those who stand for long periods of time such as shop workers and hairdressers.

Athletes such as long distance runners may well develop piezogenic papules.

Why do some people get them and not others?

They are not age or race specific.

Weight is sometimes a causative factor.

Ranging from 2 mm to 2 cm in size, they are usually pain free.

Occasionally they can be painful if nerves herniate through the fascia together with the fatty tissue.

Painful papules are usually larger than 2cm, are less frequent and usually linked to a history of long periods of standing.

What can I do?

Painful piezogenic papules require some change in lifestyle, reducing weight bearing exercise and where appropriate, reduction of body weight.

Compression stockings can assist by preventing the herniations in the first place, while heel cups or taping may help relieve pain.

A visit to your Podiatrist will guide you towards a tailored solution, from exercise to orthotics.

When the papules are painless benign neglect is the best policy.

If you would like more information or an appointment with one of our Podiatrists at Maidenhead Podiatry, call us on 01628 773588 or e-mail info@maidenheadpodiatry.co.uk.

Swift - Effective micro-wave verruca and wart treatment

Ten things you need to know about Swift verruca treatment

Ten things you need to know about Swift verruca treatment.

  1. Swift verruca treatment is a new technology, developed in the UK, which has been licenced for the general treatment of verrucas and warts in Podiatry.

swift

Verruca is the Latin word for wart. There is no difference between a verruca and a wart and the terms are interchangeable usually depending on location.

There are approximately 150 different human papilloma viruses (HPV) some rare, others more common, causing warts on different parts of the body.

HPV have been with us for thousands of years and are highly adapted to human skin and mucosa.

Warts/verrucas may have many presentations and can appear on any epidermal surface.

They are generally transmitted via direct contact, but may also transmit indirectly, however, the virus will not affect tissues deeper than the basal (bottom) layer of the epidermis.

At Maidenhead Podiatry, our Podiatrists may treat warts/verrucas on the hands and feet.

  1. Swift verruca treatment uses microwave energy delivered through a special probe applied to the skin to treat the affected tissue.

2

Microwaves work by generating heat in the wart/verruca, focused under the probe, to a maximum depth of 5mm.

Microwaves love water and when the electric field is applied, local water dipoles (H2O) try to align with field but lag slightly behind causing collision between molecules and therefore generating heat.

  1. Who can benefit from Swift verruca treatment?

Swift_Slider_web2

Almost anyone who has stubborn warts and verrucas can benefit from Swift.

There are contra-indications to Swift but outside these anyone who has warts/verrucas on their hands or feet can benefit.

Precautions

If any of the following apply to you, speak to your Podiatrist before treatment –

  • Metal pins, plates or replacement joints in the foot or ankle
  • Pacemaker
  • Neuropathy or poor peripheral circulation
  • Poor or limited healing capacity
  • Immune suppression
  • Pregnancy or breast feeding. It is known that verrucas and warts can increase in size during this period
  • Low pain threshold
  • Young children – treatment on children under ten years old may not be appropriate for a number of reasons which one of our Podiatrists will discuss with you during your consultation.
  1. Can anyone have Swift verruca treatment?

1.1

With a few exceptions, (see above) most people with verrucas and warts should be able to have this treatment.

Your Podiatrist will carry out assessment prior to treatment and advise you accordingly.

Swift is suitable for most people with few exceptions, although the purpose and reason for a consultation prior to treatment is to identify anyone for who it may not be appropriate. One of our Podiatrists will discuss any concerns with you.

  1. What will the wart/verruca look like after it has been treated and how quickly will it work?

3

Immediately after the treatment there will be no change to the appearance of the wart/verruca.

A change should start to show after a few days.

Swift works by prompting an immune response and time is needed for the process to gather pace.

That is why there is a gap of at least two weeks between treatments.

As regression is established the verruca will shrink in from the edges at the same time as reducing in thickness – or ‘debulking’.

The dermal ridges or ‘fingerprint’ of the underlying tissue will gradually re-establish itself as the verruca resolves.

A follow up visit will allow one of our Podiatrists to evaluate any changes and make a decision on whether or not you require another Swift application. 

  1. How many Swift verruca treatments will I need?

Case-Study-2.3

This depends on how you respond to treatment.

Some resolve within three treatments but more may be needed particularly with large or multiple lesions.

These can be from 14 days to over a month apart depending on progress. Your Podiatrist will discuss this with you.

When the virus enters the skin, some people’s immune systems immediately respond by producing antibodies and killing it dead. Others don’t and a verruca forms.

However, the necessary immune response can still happen at any time, and, days, weeks, months or years later, the verruca can suddenly disappear.

This is why your GP will tell you to leave it alone and it will go away in time.

Having a verruca does not mean there is anything wrong with your immune system.

Swift is designed to prompt that local immune response for the body to heal itself.

Swift treatment results in a degree of localised tissue damage prompting a healing response part of which is antibody recruitment.

It is also thought to stimulate heat stress protein production which is known to prompt a strong healing response.

Patients who are immune-suppressed are at risk of developing multiple, resistant lesions, which are difficult to treat. 

  1. How does Swift verruca treatment work?

Case-Study-1.3

Swift treatment consists of timed bursts of microwaves, usually up to five seconds.

Large and multiple sites can be treated during each appointment.

The microwaves are applied through a specialised applicator direct to the wart/verruca. Your Podiatrist may prepare the site by gently shaving off overlying dead skin with a scalpel.

Treatment is applied in timied bursts and can be applied to one or multiple sites with a short pause between each application. The number of sites to be treated can be discussed with one of our Podiatrists. 

  1. Does Swift verruca treatment hurt?

As with many treatments for skin lesions, some discomfort, even pain may be experienced during treatment.

Sensation varies from person to person but most people undergoing Swift describe it as similar to a prick with a needle although some may find it more painful.

Swift is applied for up to 5 seconds at a time and any discomfort usually lasts 1-2 seconds then quickly subside and disappear. 

In rare cases some minor discomfort or tingling may be experienced for 24hrs before dissipating completely.

  1. What can I do after Swift verruca treatment?

Normally any pain or discomfort ends as soon as the treatment is finished but it is possible there may be some minor discomfort.

However one of the great things about Swift is there is no broken skin, also no dressings and no need to keep it dry.

Therefore you can do anything you wish. Swim, shower, run, jump and play.

  1. Does using swift verruca treatment mean that the verruca won’t come back?

iStock_000003869273XSmall (2)

Once the wart/verruca has gone, it is usually gone for good.

However, even though Swift works by prompting an immune response and production of the appropriate antibodies communicating a degree of immunity, there can never be a guarantee that you won’t catch another at some point in the future.

Swift is now in use at Maidenhead Podiatry.

For more detailed information on verrucas and other verruca treatment options in general click here and for (dry) needling click here.

If you would like more information on Swift in particular or verruca treatment options in general, to speak to one of our Podiatrists or to make an appointment please call 01628 773588 or e-mail Maidenhead Podiatry on info@maidenheadpodiatry.co.uk

Choosing your baby’s first shoes

Choosing your baby’s first shoes is such an important purchase.

The Podiatrists at Maidenhead Podiatry are often asked for advice on children’s foot wear and what to look for when buying their baby’s first shoes.

As parents know, most babies don’t stay in one place for very long.

What a fascinating place the world is, particularly if it’s all new to you……and then you learn to crawl.

First things first

 

By about four months most babies start to rock and roll, first from their side to their back, and back again.

Soon after they’ll start to lie with their upper body supported on one or both hands – all the better to see the world around them.

Next, they learn to sit.

At first, they can stay in place when you put them down for just a few seconds before tumbling back, but later they’ll be able to sit up for themselves as their muscles strengthen and coordination improves.

Babies then work out that by pushing down with hands to raise their upper body, they can pull themselves along.

Later, their legs join in too and then they’re off.

Crawling

At high speed too – they can crawl 400m in the time it takes you to drink a cup of tea.

Obviously not all babies are the same and some don’t crawl, instead they perform a rather curious bottom shuffling.

Don’t use a baby-walker – your baby will stand when they’re ready and baby-walkers won’t make it any sooner.

In fact, badly adjusted baby-walkers are thought to hinder development.

Cruising

“Cruising” comes between crawling and walking.

Having pulled themselves up on the furniture children slide their hands to one side, then their feet. This allows them to move their whole body.

To stay upright they will always keep either two hands and one foot or two feet and one hand in place.

At first they crawl when confronted with a gap between furniture.

However, as they grow they learn to cross by moving their feet into the gap and letting go to totter to the next support.

Walking

Between 9 and 18 months old, most children learn to walk, depending on development of muscular strength.

But don’t hurry them or become anxious – your child is an individual and will walk as soon as they are ready.

First steps on a very long road.

First shoes

As soon as your child can take a few steps unaided then they are ready for their first pair of real shoes.

When choosing your child’s first shoes try and find a shop with a trained fitter.

Then look for these features in the shoes you choose –

  • close cropped soles to prevent tripping
  • space for movement and growth built in
  • soft leather uppers for cool comfortable feet
  • light, flexible soles to aid development of walking
  • whole and half sizes and a choice of widths to find the correct fit
  • fully adjustable fastenings
  • padded ankle for protection and support

At this age most children learn to run and perform little standing jumps.

Once they reach this stage you will need shoes that can take some punishment and still look good.

Infant shoes need room to grow without sacrificing fit.

Toddler

As your child grows, you will pass many other milestones together. First birthday, first words, as well as other occasions.

While all this is happening your child’s feet and their walking continue to develop all the time.

By the time your child is a fully-fledged toddler they will clearly walk very differently from when they took those first steps.

Arms are no longer used for balance so they can be used to pick up (and throw down!) things that catch their eye.

Knees and feet now point forward as the hip joints are fully in place.

Ankles and knees now flex too, reducing the shock that leads to head movement and, in turn, tumbles.

However walking is still flat footed (which is what can make can make toddlers look clumsy) so light and flexible soles are still vital.

Don’t be concerned by their feet appearing ‘flat’ at this age as it is all part of  a developing foot.

If you would like any more information or to make an appointment with one of our Podiatrists call 01628 773588 or e-mail info@maidenheadpodiatry.co.uk.

Red, itchy toes? Could it be chilblains?

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Do you have chilblains?

Cold weather always brings an increase in enquiries prompted by cherry red, itchy and sometimes, weepy toe tips. With temperatures due to dip below -7degreesC this week we have already seen an increase in concerned callers.

Our Podiatrists at Maidenhead Podiatry understand many people suffer from cold feet in winter, but not all develop chilblains. A question regularly asked is ‘why do I have chilblains? What have I done wrong?’ But is isn’t a matter of doing anything ‘wrong’, some people are simply prone to them due to genetics or poor peripheral circulation.

Of course, not everyone with poor circulation develops chilblains but it can make you more susceptible.

What do chilblains look like?

Following exposure to the cold chilblains appear as small itchy, red swellings on the skin of the tips of the toes and/or fingers. They can appear in a little as a couple of hours and can become increasingly painful. They normally start as small cherry red dots or patches which can slowly increase in size with a slight feel of firmness. It is possible that they will swell, form small blisters, and may weep before drying out leaving cracks in the skin, exposing the foot to the risk of infection.

They normally occur on tips of toes, particularly the smaller ones, but can also appear anywhere on the foot, on fingers, face, especially the nose, and the lobes of the ears. They can also occur on areas of the feet exposed to pressure, for example, on a bunion, heel or where the second toe is squeezed by tight shoes.

Chilblains are usually caused by the skin’s abnormal reaction to cold although exposure, damp or drafty conditions, dietary factors and hormonal imbalance can contribute.

If the skin is chilled, and is then followed by too rapid warming next to a fire or hot water bottle, shower or bath, chilblains may result.Frozen leaves

Who is most at risk?

This condition mainly affects young adults working outdoors, in cold places, or people who do not wear socks or tights during .colder weather. Too often, even in cold weather, patients attend Clinic wearing light footwear with no socks leaving their feet vulnerable to extremes of temperature.

Also susceptible are elderly people, and those whose circulation is less efficient that it used to be, people who don’t take enough exercise, and those suffering from anaemia.

Chilblains can develop at any age and frequently skip a few years before reappearing predictably in cold weather.

What causes chilblains?

When the toe and skin is cold, blood vessels near the surface vaso-constrict or get narrower. If the skin is then exposed to heat, or experiences a rapid change in temperature, the blood vessels become wider or dilate.

If this happens too quickly, blood vessels near the surface of the skin can’t always handle the increased blood flow and this can cause blood to leak into the surrounding tissue, which causes the swelling and itchiness associated with chilblains.

What are the symptoms?

With the onset of the cold weather, chilblains will be experienced as burning and itching on their hands and feet. On entering a warm room, the itching and burning is intensified. There can be swelling or redness, and in extreme cases, the surface of the skin may break, with sores (ulcers) developing.

If in doubt – seek professional advice and visit your Podiatrist.

foot in snowHow long do chilblains last?

Some come and go over a few days, others can persist for a couple of months at a time, only disappearing with warmer weather. Chilblains are virtually unknown in warmer climates but Britain’s cold damp winters are ideal for encouraging their appearance.

How do I prevent chilblains

This isn’t as easy but try to keep your body, feet and legs at an even temperature. This is especially important if your circulation is poor and you have limited mobility. Your whole body, rather the just the feet, needs to be kept warm. No matter how it might look, trousers, long johns, long boots, long socks tights and leg warmers  all help.

Do chilblain creams help?

Most chilblain creams work by counter-irritation. This means they use a different sensation, such as heat, to distract the brain from the itching and pain. Generally though, although they can bring relief they aren’t treating the underlying condition and have little influence on the length of time the chilblain is experienced.

If  chilblains have developed what can I do?

Whatever you do, don’t scratch them. Soothing lotions such as witch hazel or calamine, which can be bought from your local pharmacy, will take away most of the discomfort.

Cover them with a loose, dry plaster and wear warm socks.

If the chilblain has ulcerated, apply an antiseptic dressing. If you have diabetes or undergoing medical treatment, have the ulcer assessed by your GP or Chiropodist/Podiatrist.

Ultimately, time and warmer weather will bring lasting relief, and in the worst cases, a move to warmer climes will provide permanent relief.

If you would like more information or an appointment with one of our Podiatrists, call Maidenhead Podiatry on 01628 773588 or e-mail  info@maidenheadpodiatry.co.uk.

Feet and pregnancy

How your feet change during pregnancy

How can you look after and care for your feet during pregnancy?

At Maidenhead Podiatry we find foot care during pregnancy is often overlooked with treatment only being sought towards the end of term, and frequently only because feet can no longer be reached.

Anti-natal classes provide lots of information and education about the changes to your body during pregnancy but they rarely include the changes that can take place with your feet     

Why do the feet change?

Pregnancy means many changes in a woman’s body and there are common changes that develop over the nine month term. Over the course of a pregnancy the body produces increasing amounts of the hormone relaxin.

Relaxin is a hormone produced during pregnancy by the ovaries and placenta with important effects in the female reproductive system in preparation for childbirth, including relaxing the ligaments in the pelvis to facilitate birth.

The action of relaxin on the soft tissue support structures of the feet combined with gradual weight gain can lead to foot pain as ligaments in the feet relax contributing to changes including pain and broadening of the foot.

Changes to the shape of the feet during pregnancy are often permanent.

This means that your favourite shoes may not fit your any more once you hear the pitter patter of tiny feet.

How do feet change?

A woman’s centre of gravity moves forward during pregnancy due to the natural pregnancy weight gain in the area of the pelvis and abdomen.

This leads to a new weight-bearing stance and often changes the way you walk, adding pressure in the hips, knees and feet. Often a simple set of orthotics can bring relief and make life easier but professional guidance is recommended.

Other common foot problems experienced by pregnant woman are over- pronation (rolling the foot inwards), odema (swelling), and the build up of hard skin (callous) or corns as a direct consequence of increased pressure and friction.

This can lead to pain in the heel, inner arch, or the ball-of-foot, often worse in the mornings on rising or after periods of rest such as sitting and having a coffee.

Many women may also experience leg cramping and varicose veins largely due to weight gain.

Because of this, it is important to learn more about foot health during pregnancy to help make this nine month period more comfortable.

What can you do and what can we do for you?

Some of the changes are inevitable but there are things you can do to accommodate your feet and make them more comfortable including –

  • put your feet ‘up’ when you can
  • wear shoes that allow for the changes
  • avoid heels
  • avoid flat shoes – a modest heel will be most comfortable
  • use foot cream regularly to keep the skin supple
  • visit a podiatrist for general footcare and nail cutting

A visit to a podiatrist will ensure you are doing the best to care for your feet and you will be given advice on how to continue that care before and after pregnancy.

At Maidenhead Podiatry we can treat and tidy the feet removing hard skin and callus and trimming and burring the nails. We can also give advice on bio-mechanical and gait changes and foot wear choices.

In addition, one of our Chiropractors, Lucy Steele‘s passion lies in the care of pregnant women, babies and children, and most of her post-graduate training has been in these areas. So, if back and/or pelvic pain is your problem Lucy will be pleased to help..

If you would like more information or to make an appointment with one of our Podiatrists, or Chiropractors call Maidenhead Podiatry on 01629 773588 or e-mail info@maidenheadpodiatry.co.uk.

What is a Podiatrist?

What is a Podiatrist and what can they do for me?

This article will guide you through the many and varied aspects of Podiatry and help you find the foot care that suits you best. To assist in stopping the development of preventable foot problems and advise you in self care.

To offer a better understanding of the foot care options available to an individual we have split this blog into sections starting with the simplest or self care and escalating to the most complex or podiatric surgery as an end point.

  • Self care and footwear

 

Not everyone needs to become a patient. Many foot conditions can be safely and appropriately managed with the right equipment, skills and confidence.

Many foot health advice leaflets are available through the NHS and the Society of Chiropodists and Podiatrists and your Podiatrist will be happy to give you advice and guidance.

Poor choices in footwear can cause significant foot problems and seeking and following advice to make good choices of appropriate footwear can prevent development of new conditions, aggravation of existing ones and prevention of falls. Again, your Podiatrist will be happy to give you advice and guidance.

  • Footcare

Simple footcare is defined as nail cutting and skin care including the tasks that healthy adults would normally carry out as part of their daily personal hygiene routine.

Of course this doesn’t apply to everyone but it is an important aspect of footcare that ensures many individuals check their feet regularly while still mobile and pain free.

For those who do attend clinic regularly for simple footcare, examination of the feet during a routine appointment acts as an early detection system ensuring prompt intervention and prevention of developing more serious foot health problems.

PODIATRY

  • Core Podiatry
  • Nail surgery
  • Warts and verrucas
  • Fungal nails
  • Long term and neurological conditions

 

Core Podiatry is defined as ‘the assessment, diagnosis and treatment of common and more complex lower limb pathologies associated with toe nails, soft tissues and the musculo-skeletal system with the purpose of sustaining and improving foot health. (Farndon 2006).

The main foot conditions affecting older people (as opposed to children) requiring core podiatry are -nail problems, corns, callus, toe deformities, and falls prevention.

These conditions can be managed successfully by Podiatrists in the NHS and Private practice using a range of treatments including sharp debridement (scalpel), pharmacology (creams, tablets, steroid injection) and therapies (often in conjunction with footwear advice and and prescription of orthoses where appropriate0.

Although the call for Nail surgery is small – approximately 8 per 1000 GP patients – there is certainly a need for an effective, non-recurring treatment.

Since the 1970s partial or total nail avulsion has become a standard Podiatry procedure where part (the sides) or all of the nail are removed painlessly to the nail bed under local anaesthetic to resolve recurring problems with ingrown nails.

The likelihood of regrowth is reduced to almost zero (0.5%) with the application of  phenol to the nail bed.

Warts and verrucas are small skin growths caused by the human papilloma virus. Verrucas are warts on the feet, common in children and although harmless they can be painful.

Most verrucas will clear up without treatment within two years but there are numerous treatments available through your Podiatrist including

Fungal nails are very difficult to treat successfully. There are numerous topical applications available as well as GP only prescribed oral medication. Your Podiatrist will discuss your best options and agree a treatment plan.

Long term and neurological conditions include conditions such as Diabetes, rheumatoid arthritis, stroke and Parkinson’s and a Podiatrist’s management often involves management and prevention of potential escalation of foot problems.

Core podiatry is essential in maintaining the integrity of the feet of people whose medical condition places them at risk of developing complex problems.

Falls prevention. Foot problems in older people are often associated with impaired balance and mobility and where there is a history of multiple falls there are usually more foot issues.

The existence of a corn, bunion or poor footwear choices are often at play and podiatry intervention can moderate the risks.

ORTHOTICS

  • Orthotics, footwear and Musculo-skeletal provision
  • Podopaediatrics
  • Sports injuries
  • Footwear

Orthotics, footwear and Musculo-skeletal provision. Bio-mechanics and bio-mechanical assessment are an essential part of podiatry provision and the discussion of findings and correction of underlying issues with orthoses can have positive implications across the breath of podiatry services.

Many patients present with musculo-skeletal pain caused by bio-mechanical problems which can involve foot, knee, hip and lower back affecting gait (the way they walk).

Often the most cost effective and appropriate treatment is the provision of orthoses (specialist insoles) which modify and correct the bio-mechanical problem.

There are a number of different orthoses that can be prescribed by your Podiatrist depending on presenting condition and patient need. Orthoses range from a simple heel raise or cushioned insole to specific complex custom devices.

Podopaediatrics focuses on provision of Podiatry for children. This ranges from treatment of warts and verrucas to early identification of foot deformities. From gait assessment to prescription of orthoses.

Sports injuries often occur due to abnormal rotation and deformation of joints and/or muscles. Podiatrists target improvement and resolution through bio-mechanical assessment and prescription of orthoses combined with strengthening exercises and footwear.

Footwear choices can directly affect foot conditions. Podiatrists offer advice from correct choices when buying shoes to measuring for custom made footwear depending on requirement.

SPECIALIST PODIATRY

– relates mainly to long term conditions and may or may not be provided within a general podiatry clinic.

  • Diabetes
  • Systemic musculo-skeletal disorders
  • Dermatology
  • Advanced technology

Diabetes care is one of the basic provisions of any Podiatry practice and your podiatrist can offer regular foot health assessment as part of good diabetic control and patient education.

Early detection of foot problems can ensure correct management and reduce the likelihood of critical long term changes.

Systemic musculo-skeletal disorders such as rheumatoid arthritis (RA) increase the need for a range of basic foot care services. Up to 90% of people with RA have some kind of foot involvement sometimes leading to the formation of callus corns and occasionally ulceration.

Early Podiatric intervention can improve long term outcomes.

Dermatology can be considered part of core Podiatry as many of the common skin problems seen on the feet are amenable to Podiatric treatment. From tinea pedis (athlete’s foot) to melanoma.

From verrucas to cellulitis you can ask your Podiatrist for advice.

Advanced technology is becoming more a part of day to day Podiatry provision. At Maidenhead Podiatry we use Swift – a microwave treatment – for verrucas, Shockwave for chronic soft tissue pain and Cryopen for freezing warts and verrucas.

EXTENDED SCOPE PRACTICE

Podiatrists who work in extended scope practice usually work in the NHS although they can be available in larger private practices and have undertaken additional training in their clinical areas  and may actively engage in the following –

  • non-medical prescribing
  • requesting blood tests
  • requesting scans
  • interpretations of test results
  • injection therapy
  • advanced vascular investigations

PODIATRIC SURGERY

Podiatric surgery is surgical treatment of the foot and associated structures carried out by a Podiatric Surgeon often as a day case and under a local anaesthetic.

In Conclusion good foot health has a fundamental link to health and well being. Poor foot health can have a significant impact on mobility, independence, and quality of life.

If you would like more information or to make an appointment with one of our experienced Podiatrists then give us a call today and make an appointment on 01628 773588 or email info@maidenheadpodiatry.co.uk and help lay the foundations of a healthy lifestyle.

 

 

 

Referred pain, compensation pain and ingrowing nail pain.

What is causing your foot pain?

Our blogs this month have looked at some of the causes of foot pain.

Now, in the last of this series of blogs we look at some of the causes of foot pain not already covered.

Referred pain

This is where the cause of pain isn’t where the pain is experienced.

Sometimes, pain in the feet isn’t due to a local problem. For example, pain can be referred from the lower back. A bulging disc or degeneration of the spinal structures can lead to pressure on the nerve as it exits the spine. Although the compression is in the back, the pain is experienced in the foot. This is why your Podiatrist or Chiropractor will always take a comprehensive history into account during assessment.

There are many causes of referred pain which is why it is important to disclose full history during your consultation.

Compensation pain

This is where the pain is experienced because you are compensating for pain or mechanical malfunction somewhere else. For example, you have a painful corn on your foot. You have tried over the counter products but they haven’t worked. The pain is still there so you don’t put as much weight on the painful area. You are compensating for the pain this is called pain off-loading.

It is an autonomic response the body uses to protect itself. That is why we limp when our foot hurts. It is an autonomic response we can’t control. When we limp though we use the rest of the body in a way it isn’t used to. This can cause muscles elsewhere to fatigue and become painful. That is why when we limp we can find it can make our backs ache.

Your Podiatrist or Chiropractor will also take compensation pain into account during your consultation.

Ingrowing or ingrown nail pain

Ingrown or ingrowing nails come with different degrees of pain and tissue involvement. Some are quite mild with relatively little discomfort. When they are more serious they are often associated with pain and soft tissue structure changes. These changes can include infection, hyper granulation, redness, swelling, and heat.

If you are experiencing any of these changes then it is a good idea to seek professional advice.

It is important that you don’t try and treat this yourself. There are many reasons for ingrowing toenails. First among these is poor nail cutting. This can be compounded by trying to self treat and making things worse. Shoes are the only item of clothing we wear on a daily basis and never clean. The inside that is. When did you last clean the inside of your shoes? This can result in a microcosm of potential infection. Add a cut, scratch, or open skin to the warmth and moisture of the inside of a shoe and infection is often the result.

Remember – pain is a warning – don’t ignore it. If your toes start hurting and you suspect an ingrown toenail seek help from a professional.

Other causes of pain

This list is not at all comprehensive. There are too many other causes of foot pain to be covered here. These include but not exclusively:

  • fracture
  • stress fracture
  • dislocation
  • soft tissue injuries
  • infection
  • skin infection and neuropathic changes
  • verrucas

What can I do about my foot pain?

If you are experiencing foot pain and you would like more information give us a call on 01628 773588 and make an appointment with one of our Podiatrists or Chiropractors.

If you would like a comprehensive biomechanical assessment including gait analysis and custom orthotic prescription and manufacture, do give us a call on 01628 773588.

For more information visit www.maidenheadpodiatry.co.uk.

If you would like to know more about how we are risk assessing and managing our Covid-19 click here.

Why do I have localised foot pain?

Why do I have pain in specific parts of my foot?

This is where the pain is usually sharp or persistent and is often focused on a single point or area.

Toes

Our nails tend to grow more slowly and more thickly as we get older. This is often a result of reduced circulation and years of bashing them against the inside of the end of shoes which make them thicken.

Nails

Nails are protection for the end of a toe. Trauma or repeat stress stimulates the body’s protective mechanism making the nails thicker so they offer more protection. This increases the pressure on the end of the toe and makes the sore and the nails harder to cut. One person in 50 will develop a condition called onychogryphosis. A thickened nail that looks like a ram’s horn – unsightly and painful when pressing against shoes.

This can occur at any age but is more likely as we get older.

What’s the best technique for nail cutting?

Use a file and a good pair of nail clippers on thick nails. Clippers are sharper and have a different cutting action to scissors which can split the nail. Have a bath first and, if you have a partner, and good eyesight, you can always cut each other’s toe nails.

What can we do for you?

People with onychogryphosis benefit from visiting a Podiatrist.

Thickened nails often need to be reduced and shaped with an electric file before they can be cut. This reduces discomfort, pressure and maintains the foot in better condition and prevents it from getting worse.

Why do I suffer joint pain?

One person in six over 50 will develop osteoarthritis in the mid-foot. According to a recent study at Keele University’s Arthritis Research UK Primary Care Centre. Osteoarthritis is characterised by inflammation around the joints, damage to cartilage and swelling, which causes pain, stiffness and restricts movement. Sometimes it causes bony bumps on the top of the foot. It is possible to develop osteoarthritis just in the feet.

What can I do about osteoarthritis pain?

The foot comprises 26 bones, 12 of which are in the mid-section. A big hip joint is well designed to take the whole body weight but that same weight has to go through each individual bone and small joint in the mid-foot. Risk factors include genetic predisposition, injury to the area and overuse.

Runners and people who stand for a living are more likely to develop problems. Good trainer-type shoes will help to minimise stress to the feet.

Losing weight can ease pressure on joints as well as judicious use of orthotic insoles.

What can your Podiatrist do for foot pain?

If you have pain in the mid-foot or the arch, see one of our Podiatrists for assessment and treatment plan. Advice will usually consist of management and guidance on footwear, padding and exercise but may include onward referral to an orthopedic consultant.

Is my pain due to corns or verrucas?

Commonly found over a joint surface, between the toes or on the sole of the foot, corns are a common cause of pain. They are usually caused by pressure and friction. Corns are areas of callous with a hard central portion that focuses pressure on the underlying structure and can cause momentary, eye-watering pain when compressed. They are formed of dead skin and have no blood supply.

A verruca is different because it is a viral infection of the skin and has a blood supply. Verrucas can also cause pain because they are also rich in nerve tissue. This means that when they are compressed – they hurt!

What is the treatment for corns?

Your Podiatrist can remove your corn completely but if the pressure and friction remain, they will grow back in time. Shoes are a common cause of corns and a change of footwear type can bring relief. Appropriate padding can also help.

Verrucas present a different problem and some treatment options can be found here.

What else could be causing my foot pain?

There are other possibilities including trauma, bruising, Morton’s neuroma, or a foreign body such as a piece of glass or an embedded hair.

If you would like more information, or to make an appointment with one of our Podiatrists, call Maidenhead Podiatry on 01628 773588 or e-mail info@maidenheadpodiatry.co.uk.

Foot in vice

Why do I have pain in the arch and big toe?

What is the cause of my arch and big toe pain?

At Maidenhead Podiatry and Chiropractic Clinic, our Podiatrists are often asked about foot pain located in the inner long arch or inside of the foot. The pain often associated with pain in the large/big toe joint. It can also radiate up the leg.

When do I get the pain?

When exercising, the pain often doesn’t come on straight away, but can develop some time after starting. What can be happening, halfway through a round of golf or some miles into a walk, is that the small supporting muscles of the foot become fatigued. It may come on more rapidly with high impact exercise such as running. Inflammation may be involved meaning that the pain worsens the day following exertion.

Where do I get the pain?

Pain or discomfort can manifest along the inside of the foot or the inner longitudinal arch. It can also be associated with pain the base of the big toe and into the joint.

Because the discomfort of the foot is usually due to mechanical changes this can refer to compensation pain up the leg and into the knee, hip, or back.

Why do I get the pain?

If you ‘overpronate’ it causes medial or inward rotation of the lower leg, which can cause stress at the knee, misalignment of the hips, and resultant lower back pain. The degree of ‘pronation’ can vary from person to person and used to be known as ‘flat feet’ although the actual cause is more complex. As the muscle fatigue, this allows the arch to over-extend further stressing the support tissues and increasing discomfort.

Think of your feet as the ‘foundation’ for the rest of the body. Ensuring your feet are correctly aligned allows the rest of the kinetic chain or biomechanical relationship between the feet and the rest of the body to function efficiently. Big toe joint pain can be due to a number of reasons including inflammation, arthritis, and poorly fitting shoes.

What can I do about it?

What is most important with any foot pain is to ensure a correct diagnosis. This ensures targeted and appropriate treatment. This starts with a bio-mechanical assessment.

The assessment focuses on structure, alignment, strength, and starts with the foot. This includes pelvis, hips, knees, feet and their relationship, as pain in one area can result in or cause weakness or a structural problem somewhere else.

A biomechanical assessment is essential where there is a pain in the feet or lower limbs but no cause has so far been established. Sometimes simple recommendations on footwear can make a huge difference especially sports shoes. Simply tying shoelaces properly can dramatically increase the support offered to the foot by a shoe. There are many different ways to lace a shoe. For ideas and a bit of fun, click here for lacing ideas.

Pain in the large toe can be associated with this but can also be due to shoe pressure on the inner edge of the apex of the toe.

Buy shoes that have a square toe box to reduce this pressure.

What can we do about it?

Podiatrist Jeremy Ousey has a special interest in bio-mechanics There are numerous choices following a biomechanical assessment. The outcome of the assessment determines the appropriate treatment. If the mechanics of the foot are contributing to injury or pain, orthotics or custom made insoles are prescribed, moulded from a foam impression of the feet.

The orthotics are prescribed in conjunction with exercises and a carefully constructed rehabilitation plan. Footwear is also considered and recommendations made.

Topical treatments such as Shockwave can be very effective in the treatment of foot and lower limb pain.

If you would like more information or to make an appointment with Jeremy  Ousey call 01628 773588 or e-mail  info@maidenheadpodiatry.co.uk.

Why do I have heel pain?

What is causing my heel pain?

At Maidenhead Podiatry our Podiatrists are regularly asked about heel pain which is often at its worst first thing in the morning or when walking after a period of rest.

The first part of the gait cycle, where your foot has its first contact with the ground, is called ‘heel strike’.

During walking and running your heels repeatedly hit, or strike, the ground with considerable force.

For correct function they need be able to absorb the impact and provide a firm support for the weight of the body through the gait cycle.

There are various types of heel pain.

Some of the most common are heel spurs, plantar fasciitis, heel bursitis and heel bumps (Haglund’s)

As heel pain is often associated with inflammation it means that the pain can worsen with rest.

This is why can can be at its most painful when we first get out of bed or when we have been sitting having a coffee and stand to walk.

“Pain is a warning – don’t ignore it!”

Heel spurs

These can generate pain but they are the most commonly misdiagnosed form of heel pain.

You can have heel spurs with no pain and pain with no heel spurs.

Even when pain is caused by heel spurs the pain may not persist even though the spurs do.

If you do have heel spur pain it is usually felt on standing, particularly first thing in the morning when you first put your feet on the floor from bed.

It is not uncommon, though tends to occur more in the over forty age group.

There is nothing to be seen on the heel but a deep localised painful spot can be found in or around the middle of the heel pad.

It is often associated with a spur of bone sticking out of the heel bone (heel spur syndrome), however approximately ten per cent of the population have heel spurs without any pain.

A clear diagnosis requires imaging, usually either X-ray or ultra-sound.

Plantar Fasciitis

Often similar in symptom to heel spurs, pain is usually experienced more to the inside of the heel around the insertion of a muscle called Anterior Tibialis towards the back of the inner arch.

This condition is often associated with over-pronation (rolling the foot inwards) during standing, walking and running.

Pain can also be due to inflexible calf muscles and repeat stress injury.

It can also be due poor footwear choices, old unsupportive shoes and injury, among other causes.

Diagnosis is often achieved with bio-mechanical assessment, with treatment through prescription of specialist custom insoles (orthotics) and the implementation of a rehabilitation and exercise programme.

Shockwave is also very effective treatment for plantar fasciitis.

Heel Bursitis

A bursa is a fluid filled sack the body uses for cushioning or padding, often under tendons.

When a bursa experiences trauma of repeat stress it can swell, leading to bursitis.

Pain can be felt at the back of the heel during ankle movement and there might be a swelling either side of the Achilles tendon.

Pain may also be felt deep inside the heel when it makes contact with the ground and can feel like a deep bruise.

Treatments can include rest, stretching exercises and orthotics.

Heel Bumps

These bumps are also known as Haglund’s Deformity.

This is recognised as a firm bump or enlargement of the bone on the back of the heel where the Achilles Tendon attaches.

Haglund’s are often associated with bursitis.

They are often caused by rubbing of the shoe heel counter and can be quite painful especially during exercise.

Treatments include changing or modifying footwear, stretching and ultimately, surgery.

What can you do for yourself?

Stretching can help with heel pain but it is dependant on knowing the cause so that your self-help is appropriate.

If pain persists consult a Podiatrist for assessment and a treatment plan.

Alternatively, you can speak to your GP who can arrange imaging, physiotherapy and if the pain persists, steroid injections.

Remember – pain is a warning – don’t ignore it!

What can we do for you?

Successful treatment is always based on accurate assessment.

We offer bio-mechanical assessment, gait analysis, custom orthotics and Shockwave – where appropriate.

More information is available on our website.

To make an appointment with one of our Podiatrists please call 01628 773588.

 

Why do I have foot pain?

Why do my feet hurt?

In a series of blogs this month we will look at the causes of foot pain. There are many reasons why anyone can experience different levels and types of foot pain.

Sharp or dull, bruised, or persistent, pain is a warning – don’t ignore it!

This list is not exhaustive but deals with some of the main reasons for calls to Maidenhead Podiatry and Chiropractic Clinic.

Ankle/heel pain

This is a very common condition and is often worse in the mornings getting out of bed, or after brief periods of sitting such as having a coffee. Plantar Fasciitis is widely known and there are numerous treatments available from stretching to insoles, from steroid injections to Shockwave Pain can also be caused by heels spurs, heel bursitis, Haglund’s deformity, and Achilles tendinopathy among others.

Arch and large toe pain

Pain is also often experienced along the inner arch of the foot and into the large toe joint although it can be in either of both. Arch pain can be due to changes in the strength and position of the foot and custom insoles following biomechanical assessment may be the best solution. This is common in runners and can be linked to over-pronation. Large toe joint pain can be due to ill-fitting footwear in the past and is often associated with enlargement of the joint and bunions. It can also be due to arthritic changes.

Localised, specific pain

This is where the pain is usually sharp and persistent, focused on a single point. Commonly found over a joint surface, between the toes or on the sole of the foot, the most common cause is corns. Corns are areas of callous with a hard central portion that focuses pressure on the underlying structures and can cause momentary eye-watering pain. Verrucas can also cause pain because they are rich in nerve tissue. This means that when they are compressed – they hurt! There are other possibilities including trauma, bruising, Morton’s neuroma, or a foreign body such as a piece of glass or an embedded hair.

Referred pain

Often pain in the foot or feet doesn’t have a local origin. Pain can often be referred from higher up a nerve but be experienced in the extremity. A common origin of referred pain in the lower back. Damage, degeneration, or repeat stress in the back can lead to the impingement or compressing of a nerve root leading to a reaction in the foot or lower leg.

Our Chiropractors or our Podiatrists will include this in their initial assessment as they form a treatment plan.

Ingrown nails

Anyone who has had an ingrown nail will know how painful they can be. This is where the nail grows painfully into the side of the toe, often made worse by shoes pressing. This can be caused by picking and tearing the nail, poor cutting – usually down the side, or simply be due to bad luck. Some toes are shaped in such a way as to make ingrown nails almost inevitable where others will never experience it. Ingrown nails vary in severity from constant soreness to infected and weeping.

Maidenhead Podiatry and Chiropractic Clinic offer a comprehensive ingrown nail treatment service, no matter the condition.

Compensation pain

Pain in the foot causes a person to walk differently or limp to take the load off the painful area. This is the body’s autonomic response to pain. This response is designed to protect the painful area. However, this in turn places increased stress on other structures that have to compensate for the change. In this way, a pain in the foot can cause pain elsewhere such as in the lower back, hip, and knee.

Other causes of pain

This list is not comprehensive and there are many other causes of foot pain. These include:

  • fracture
  • stress fracture-dislocation
  • soft tissue injuries
  • infection
  • skin infection
  • neuropathic changes

Remember, pain is a warning don’t ignore it!

Give us a call!

If you are experiencing foot pain and you would like more information give us a call on 01628 773588.

To make an appointment with one of our Podiatrists or Chiropractors, please give us a call on 01628 773588.

If you would like a comprehensive biomechanical assessment do give us a call on 01628 773588.

For more information visit www.maidenheadpodiatry.co.uk.

If you would like to know more about how we are risk assessing and managing our Covid-19 click here.

In our lifetime we walk over 100,000 miles! Are you ready?

In an average lifetime, it is estimated that we walk about 100,000 miles / 160,000 km.

Just think about that for a moment. One hundred thousand miles! At Maidenhead Podiatry, our Podiatrists are often asked “how does walking affect my feet?”

What are the benefits?

Walking helps the ligaments, tendons, and muscles in our feet to work more efficiently and helps maintain suppleness and flexibility. Walking at a brisk pace for regular exercise helps condition your body and improves overall cardiovascular health in the same way as running and jogging. However, compared with running, walking carries a significantly lower risk of injury.

What can I do?

So even if your job involves sitting in the office or at home, try to get up and walk briskly for at least 30 minutes every day. Consult your Podiatrist if you start to develop any pain when walking, or consider a visit before embarking on a new walking program.

Feet are adaptable and will withstand a lot of pressure before they complain. If you enjoy walking, it’s important to wear the right footwear, which doesn’t damage your feet.

What about footwear?

The key to keeping your feet healthy and comfortable, regardless of the type of walking you do, is wearing properly fitting shoes or boots.

When buying walking shoes, try several different brands, styles, and most importantly, sizes. Remember, your feet can expand as much as half a size during the day, so buy shoes in the afternoon or early evening when your feet are at their largest. This will help protect them as they expand during your long walks. Also, wearing the same type of socks when fitting shoes that you wear when you walk will help you choose the right shoe and once you have made your purchase – take care of them.

What else should I think about?

If you are going on a long walk, prepare well ahead. Wear your shoes for a ‘trial walk’ and build up the distance gradually; don’t try to complete the London Marathon on your first trip! It’s also a good idea to pay a visit to your local HCPC – registered podiatrist who will be able to give advice and treat any corns, callus, or any foot issue you may have.

Take some first aid supplies, like plasters or antiseptic cream, on your walking trip in case of accidents. It’s also a good idea to put rub Vaseline/petroleum jelly between your toes to prevent chafing.

So, let’s get started

Begin at a slow pace and gradually increase the speed of your walk. This will give the muscles, bones, tendons, and ligaments that make up your feet the chance to get gradually used to the activity. If you experience any discomfort or foot pain, then it may be an indication that something is wrong. In many cases, early diagnosis can prevent a small injury from becoming a larger one. You are never too old to start!

Here are 10 tips to bear in mind:

  • When buying shoes, wear the same socks that you will wear when walking.
  • Try on at least four or five pairs of shoes.
  • Don’t walk too far in new shoes.
  • Put on and lace both shoes of each pair and walk around for a minute or two.
  • Good foot care is essential in keeping your feet comfortable and fatigue and injury-free.
  • If you experience any sort of foot pain, consult a Podiatrist.
  • Build your distance up gradually.
  • Before and after you walk, go through a warm-up and stretching routine.
  • Look after your feet and you too will cover at least 100,000 miles!

For more information on walking or any other foot care issue, or to make an appointment with one of our Podiatrists, please call 01628 773588, or email info@maidenheadpodiatry.co.uk.

What is plantar fasciitis?

Plantar fasciitis is inflammation of the plantar fascia, a thin layer of tough connective tissue supporting the arch of the foot.

Repeated microscopic tears of the plantar fascia cause pain, usually in the heel and is one of the most common foot disorders encountered by Podiatrists.

It has been estimated that over two million people each year receive treatment for heel pain, which affects as much as 10% of the population during the course of a lifetime and is present in both the athletic and non-athletic.

Heel pain can affect anyone from the age of 8 to 80, but generally affects those over 40 years of age and does not seem to be gender specific and affects both feet in up to a third of cases.

How do I know if I have plantar fasciitis?

To be sure, visit a Podiatrist and discuss your symptoms for an accurate assessment.

However the following is a guide to the classic symptoms of plantar fasciitis and gives an idea what your Podiatrist will ask about.

A careful description of the pain is essential including time of day when pain occurs, current footwear, activity level both at work and at leisure, and any history of injury.

The most commonly stated complaints are pain on getting out of bed, after a long period of sitting, and at the beginning of weight-bearing activities such as walking.

The most severe pain in the morning occurs within the first 50–100 steps and then decreases for ordinary walking.

As the day progresses, pain gradually increases continuing even after physical activities have ceased.

Pain frequently originates in the underside of the heel, sometimes slightly towards the inner side, but may not have a clear focus.

Frequently there is no clear ‘event’ which started the pain.

The pain may be worse when the area is cold or contracted.

The nature of the pain has been described as burning, aching, and occasionally stabbing.

Runners may experience pain at the beginning of the run going off during the activity, and increasing afterwards at rest.

What causes it?

There are a number of possible causes for plantar fasciitis and they often work in combination.

Tightness of the foot and calf, improper athletic training, stress on the arch, weakness of the foot, flat foot, and inappropriate shoes that don’t fit and don’t offer good support are potential causes.

Certain play or work actions or overuse (running too fast, too far, too soon) may hurt the plantar fascia.

People with low arches, flat feet or high arches are at increased risk of developing plantar fasciitis.

What do I need to do to treat it?

Symptoms usually resolve more quickly when the time between the onset of symptoms and the beginning of treatment is as short as possible.

If treatment is delayed, the complete resolution of symptoms may take 6-18 months or more.

Typically treatment begins by correcting training errors, rest, use of ice after activity, shoe evaluation, a stretching (see bottom of page) and strengthening program and orthotics.

Shockwave can bring rapid relief when recovery is delayed.

(Radial) Shockwave is a tried, tested and well-researched treatment used in physiotherapy since the 1990s.

It has gained popularity in podiatry due to its effectiveness.

Of all these stretching and increase in flexibility of the calf or calves is the most important and is key to a successful resolution.

What is an orthotic?

An orthotic is a specialised insole designed to make the foot operate in a neutral position.

For people suffering with plantar fasciitis the insole will correct the pronation which is commonly associated with the condition.

Pronation is the rolling inwards of the foot during walking or standing which can exacerbate the condition.

Depending on the degree of correction required, there are a number of options available, from off the peg – one size fits all, heat mould-able to cast orthotics.

Your Podiatrist will discuss with you the best option to suite your condition.

How long will it take for it to go?

There is no set time for this condition to be corrected. Some people make surprisingly quick recoveries, while others notice a slower but steady progress.

Shockwave can bring rapid relief when recovery is delayed.

As a guide, between one and three months, but if you are unsure whether your progress is sufficient, speak to your Podiatrist to see if your treatment plan can be adjusted to help.

Which stretches will help?

Stretching is an essential part of the recovery process. Here are some ideas –

Stair stretch –
  • Stand on the bottom riser of your stairs and hold on to the banister for balance.
  • Move your foot backwards until only the balls of your feet are on the stair & your heels are in fresh air.
  • Slowly lower your heels until you feel the stretch in your calves.
  • Hold this position for a slow count of six.
  • Do not bounce at the bottom of the stretch as this will not improve flexibility.
  • Return to your original position and repeat ten times.
  • For best results this exercise is best performed slowly and carefully.
Standing stretch
  • Stand an arms-length from a wall.
  • Place your right foot half a metre behind your left.
  • Slowly and gently bend your left leg forward.
  • Keep your right knee straight and your right heel on the ground.
  • Hold the stretch for 15 to 30 seconds and release. Repeat three times.
  • Reverse the position of your legs, and repeat.
  • Do not bounce at the top of the stretch as this will not improve flexibility
Seated Towel Stretch
  • Fold a towel lengthwise to make an exercise strap.
  • Sitting, place the folded towel across and around the arch of each foot in turn.
  • Grab the ends of the towel with both hands.
  • Gently pull the tops of your feet toward you at the same time trying to straighten your leg.
  • Hold for 15 to 30 seconds.
  • Repeat three times.

If you would like to make an appointment for a bio-mechanical assessment call one of our receptions on 01628 773588 or if you would like more information or further explanation please call to speak to one of our Podiatrists.