Tag Archives: chiropodist

We are open! Read how we manage Covid-19 risk.

Although Covid-19 restrictions have eased, we are open, working, and taking appointments for Podiatry and Chiropractic

Covid-19 brought many changes to our lives during the lockdown. Although many regulations have been eased or lifted, wWe are still having to take measures and considerations that will be with us into next year.

As you are reading this we hope you are all well and staying safe.

The purpose of this page is to keep our patients in touch with what we are, and will be doing to ensure they can safely visit the clinic.

We are open and taking appointments for both Podiatry and Chiropractic.

The reception team is waiting to take your call

If you wish to make an appointment for Podiatry or Chiropractic please call 01628 773588 to speak to us or leave your name and number and a short message or email us at info@maidenheadpodiatry.co.uk.

What you can expect from us.

  • You will notice that Reception looks a little different.

  • We have perspex sneeze/cough guards for the desks similar to the ones now commonplace in supermarkets.
  • These stand 750mm high and run the length of the desk and provide protection for both staff and customers alike.
  • Reception is once more being used for waiting – socially distanced of course
  • You must still wear a face mask at all times while in the building – if you are exempt from wearing a facemask you must wear a face shield.
  • We ask you not to use the toilets but if you must, you must.
  • All magazines and newspapers have been removed from the reception area.
  • The water cooler will no longer be available to reduce the risk of cross contamination.
  • Your Podiatrist or Chiropractor will be wearing appropriate PPE.
  • Our receptionists will be wearing masks at all times.
  • All door handles and surfaces will be wiped down after each patient visit.
  • Where there is more than one practitioner working, appointments will be staggered to reduce the likelihood of queueing at the desk.

What we can expect from you.

  • Come in – wear a mask – sanitise your hands and wait, socially distanced, in reception.
  • You don’t have to wear gloves and there are automatic hand sanitising gel dispensers in the entrance lobby and reception area.
  • We ask that patients also wear a face mask at all times when in the building.
  • Wherever possible only one person at a time to attend for an appointment unless a carer, someone in the same bubble, parent or guardian is needed.
  • The contactless limit has gone up to £100. Most people will be able to ‘tap and pay’ thereby removing the need to key in an PIN.

During treatments

  • Appropriate PPE (personal protective equipment) will be worn by your Podiatrist or Chiropractor.
  • Between patient visits additional time is now to be allowed for wiping down and sanitising the treatment room after each appointment.
  • Each room contains an industry-standard air cleaner/purifier to ensure as clean an atmosphere as possible.
  • As always, all instruments are cleaned and sterilised between patients and all consumables are disposable.

All these changes will be kept under constant review.

If you have any special requirements please let us know. If you would like an appointment then please call us 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.

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.

What can you do about smelly feet?

Why do my feet smell?

It is a staple of comedy – cheesy feet, but not much to laugh at if you have smelly feet and you have no idea how to stop it.

No one wants smelly feet and there are simple things you can do to make sure yours stay fresh.So, what can you do about smelly feet?

Hyperhidrosis?

There are more sweat glands per inch in our feet than anywhere else in the body. Their function is to keep the skin moist and supple and regulate temperature when the weather is hot, if you have an unnaturally high temperature or while exercising.

They secrete all the time, not just in response to heat or exercise, like elsewhere in the body.

The average foot has 250,000 sweat glands and the capability to produce half a litre of sweat a day. In most feet, sweat has an important function, when contained within a shoe, with excess evaporating. Open shoes allow evaporation of sweat leading to dry skin, especially in the hot weather of summer.

Bromhidrosis?

Known as bromhidrosis, this where sweaty feet combine with smelly feet at any time of year. This mainly involves apocrine sweat glands found in the armpit, the groin and on the feet. It can be embarrassing and unpleasant for those who have them and those that smell them.

Foot odour is caused by bacteria on the skin breaking down the sweat and releasing an offensive smell and is often influenced by changes in levels of hormones.

Anyone can get sweaty feet, regardless of the temperature or time of year.

However teenagers and pregnant women are more prone due to hormonal changes making them sweat more and changing its composition.

Other factors include

  • being on your feet all day
  • being under a lot of stress
  • hyperhidrosis, which makes you sweat more than usual
  • fungal infections, such as athlete’s foot
  • sweat soaks into shoes and they don’t dry before you wear them again
  • bacteria on the skin break down sweat as it comes from the pores
  • an unpleasant odour is released as the sweat decomposes.

So how can we prevent smelly feet?

There are many things you can try, either individually or in combination. These include –

  • exercise good personal hygiene – wash and dry your feet every day
  • use an anti-bacterial soap on your feet
  • change your shoes regularly and dis-guard old, worn out shoes
  • don’t wear the same pair of shoes two days running – especially important with teenagers
  • change your socks (ideally wool or cotton, not nylon) at least once a day.
  • clean the inside of your shoes regularly with an anti-bacterial solution
  • wrap your shoes inside a plastic bag and put them in the freezer for 24hrs to kill micro-organisms including bacteria

In addition you could also try

  • wiping between your toes with cotton wool and surgical spirit following a shower or bath and after drying them with a towel
  • use a foot spray deodorant or antiperspirant on your feet
  • buy medicated/deodourising insoles for your shoes
  • wear leather or canvas shoes, as they let your feet breathe, unlike man-made materials
  • wear open-toes sandals in summer and go barefoot at home in the evenings

If that doesn’t work?

Smelly feet are a common problem that usually clear up before too long, with care. Sometimes it can be a sign of a broader medical condition and if the condition persists it is advisable to seek professional attention.

If you’re worried that your level of sweating is abnormally high and your feet unusually smelly, see your GP if simple measures to reduce your foot odour don’t help.

If you would like more information or to make an appointment with one of our podiatrists, call us on 01628 773588 or e-mail  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.

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.

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.

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.

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.

Aging Feet?

Aging feet? Do your feet feel like they are getting older before the rest of you? The Podiatrists at Maidenhead Podiatry explain what might be happening.

Older feet naturally develop more problems. The skin tends to thin and lose it’s elasticity. Healing can take longer and wear and tear to the joints over the years may have caused some degree of arthritis.

However painful and uncomfortable feet aren’t a natural part of growing old or something you have to “put-up with”. A lot can be done to improve comfort, relieve pain and maintain mobility.

It’s not too late to start a new routine.

Follow a daily foot care routine and keep on the move. Keeping toenails trimmed and filed will help keep you mobile but you may need help with this from your chiropodist/podiatrist or a friend.

Keep your feet as warm as possible, but not by warming them in front of the fire! Warm stockings or socks can help.

Avoid anything too tight which can restrict your circulation or cramp your toes. Wearing fleece-lined boots or shoes or even an extra pair of socks will also keep you warm but do make sure your shoes aren’t tight as a result. Bed socks are also a good idea.

The older you get, the more you need a shoe which holds your foot firmly in place to give adequate support. Throw out sloppy old favourites as they may make you unstable when you walk.

Look for shoes with uppers made of soft leather or a stretchy man-made fabric which is also breathable. Avoid plastic ‘easy clean’ uppers which don’t allow the foot to breathe and won’t stretch to accommodate your own foot shape.

Many shoes have cushioning or shock absorbing soles to give you extra comfort while walking. When buying shoes, ensure that you can put them on and take them off easily. Check that the heel is held firmly in place – you’ll find that a lace-up or velcro fastening shoe will give more support and comfort than a slip-on.

Your shoes should be roomy enough, particularly, if you intend to wear them everyday. If you suffer with swollen feet, it’s a good idea to put your shoes on as soon as you wake up, before your feet have had a chance to swell.

Exercise can help to keep feet healthy – it tones up muscles, helps to strengthen arches and stimulates blood circulation.

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

How do you choose the right footwear?

At Maidenhead Podiatry, our Podiatrists are often asked, ‘how do you choose the right footwear?’

Keeping your feet healthy is only part of preventing foot problems, is also essential that you wear well-fitting shoes.

So it doesn’t matter if walking, dancing or pounding the pavements is your choice of exercise in 2010, The Society of Chiropodist and Podiatrists offers the following advice to help keep feet fighting fit.

Feet have a rough time of it; we demand a lot of them, they carry us the equivalent of five times around the earth in an average lifetime, and yet we give them less attention than they deserve and we rarely wear the best shoes for our feet.

In an average lifetime, we walk about 100,000 miles, which is tough on our feet. Yet our bodies were designed for moving – not standing still, so walking is good exercise for us and our feet.

Walking helps the muscles and ligaments in our feet to work more efficiently, helping keep them supple and flexible. So whether your job requires you to sit for extended periods, or work from home, try to get up and walk briskly for at least 30 mins every day.

Feet are adaptable and can withstand a lot of pressure before they complain. If you walk a lot it’s important to wear the correct footwear which won’t damage your feet.

Registered Chiropodists/podiatrists will be able to give advice on suitable footwear. They will be able to suggest suitable ‘warm up’ exercises to ease you gently into your chosen sport, and help prevent injury.

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