Bunions appear as a large bump on the inside of the foot at the base of the big toe

They can often be painful when walking and cause skin irritation like callous, corns, and blisters. Larger bunions can make finding suitable footwear difficult. Medically it is referred to as hallux abducto-valgus deformity. This simply means the great toe (hallux) is drifting outwards on the foot. The abducto valgus refers to the angle that the bunion forms.

Causes

Sometimes bunions are genetic. Other conditions that may contribute to their formation are flat feet, hypermobility syndrome, rheumatoid arthritis and the old wives tale of ‘poorly fitting shoes’. Bunions can alter the foot’s biomechanics, which may put increased pressure on other body parts such as the knee, hip and back. Sometimes bunions have osteoarthritis which can restrict the movement at that joint and cause pain.

Treatment options

We recommend appropriate footwear that has enough width and depth to accommodate the bunion. Wearing orthotics can improve the foot alignment and reduce some of the pressure at the bunion. We provide physical therapies such as low level laser therapy to reduce localised joint inflammation and pain; myofascial release to reduce tightness in the muscles supporting the bunion; and clever strapping techniques to provide immediate support. Depending on the severity of the bunion, surgery may be warranted. We can refer you if required.

Flat feet also known as Pes Planus is where the arch of the foot is in complete contact with the ground

The arch plays an important role in lower limb biomechanics; it helps propel the body over the foot during walking whilst also assisting in shock absorption. The muscles and ligaments supporting the arch are stretched in a pes planus foot. This stops the function of the ‘windlass mechanism’, which is responsible for assisting the body to propel forward.

Flat feet in children

It is common for young infants and toddlers to have a flat foot appearance. This is because the arch is not fully developed. During the ages of 4 and 6 the arch will form its shape. If your child is having difficulty walking and experiencing pain, it is important to get a podiatrist to assess them. For example, they may be walking oddly or limping during walking. They may get tired and want to be picked up. The child may also be rubbing their knees, legs, ankles or feet in a sign of pain or discomfort.

Flat feet in adults

Flat feet can be ‘acquired’ as an adult. This is generally due to injury, illness and increased stresses to the foot or from poor biomechanics. It is important to know the foot also changes with age. There are two types of flat feet: rigid and flexible. Other risk factors are pregnancy, obesity, hypertension, diabetes and rheumatoid arthritis. Symptoms of painful flat feet are similar to a child – tired feet, aching, muscle cramps and aches, knee, hip and back pain.

Treatment options

If you are not experiencing any pain or discomfort, then treatment may not be necessary. Usually treatment will be tailored to manage painful symptoms through physical therapies such as low level laser therapy and joint mobilisation. Orthotic devices are effective at improving the foot biomechanics. They help to lift the arch which reduces the strain on the supporting muscles and ligaments. Exercise prescription is often required to strengthen the intrinsic and extrinsic muscles of the foot. A rigid flat foot may require surgery. This is very rare, however your podiatrist will be able to assist in diagnosing this.

Fungal nail problems are caused by a spreading of a fungus under the nail plate and into the nail bed

Different types of fungus can affect the nails including dermatophytes, yeast and moulds. The fungus can infect a broken or damaged nail. It may spread to the nail from a nearby fungal skin infection.

Risk factors

• Having diabetes.
• Having poor circulation.
• Having problems with your immune system.
• Working in a humid or moist environment.
• Excessively sweaty feet/skin.
• Wearing enclosed footwear that has poor ventilation and doesn’t absorb sweat.

Treatment options

Fungal nail infections can be difficult to treat and can reoccur after treatment. Toenails grow quite slowly; it can take a year before the nail appears normal. Specialised topical antifungals are recommended if the infection affects the end of the nail or is superficial. These antifungals may not penetrate the nail plate for some people and therefore, do not work in all cases. Oral anti-fungals may be required if the infection covers the majority of the nail, affects the base of the nail or is deep. These are prescribed by your GP after carefully evaluating your health status as these medications can have significant side effects.

Your podiatrist can recommend topical antifungals and ways to prevent re-occurrence. Podiatrists also have special tools to reduce the thickness of fungal nails. This makes it easier for the nail to absorb topical medications, improves its appearance and provides more comfort to the patient.

An ingrowing nail is a common nail complaint

It occurs when the corner or side of the nail grows into or penetrates the soft flesh. The nail plate may be flat and a sliver of nail will penetrate the skin; or the nails may become curled or pincer like and press against the flesh. Tight fitting shoes, improper nail trimming, fungal nail infections or injury may cause ingrowing nails.

Symptoms

An ingrowing nail may be very painful and present with swelling around the affected nail, redness, pus or even an abscess.

Treatment options

If left untreated, an ingrown toenail can progress to an infection or even an abscess that requires surgical treatment. Conservative care includes cutting/trimming the offending spicule or portion of the nail. Your podiatrist can correctly shape the nail and may use packing under the nail to relieve the pressure from the nail and allow the nail to grow out over the skin. In recurrent or severe cases, nail surgery may be advised as a long term solution.

Stress fractures are incomplete breaks of the bone

There are five metatarsal bones in each foot. A stress fracture of the metatarsal typically occurs over time with excessive weight bearing activity such as running, sprinting, jumping or dancing. It is commonly associated with changes in the intensity of activity (i.e. sudden increase of activity) or changes in the training conditions (such as footwear or surfaces). It may also be caused by trauma such as a poor landing from a jump or landing from a height. Poor calf muscle strength can cause excessive forefoot loading. Fatigue of these muscles may contribute to the development of this condition. It commonly affects the 2^nd and 5^th metatarsals.

Symptoms

The common symptom is pain over the forefoot and it is aggravated by activity such as dancing or running. The pain may not be severe initially but generally worsens with activity. Swelling may be a symptom but will not present in all cases.

Treatment options

The management of stress fractures requires rest from aggravating weight bearing activities for 6-8 weeks. In the initial phase of treatment, an offloading walker is used for 2-4 weeks. Low level laser therapy may be useful in reducing pain and swelling, and increase bony remodeling. Orthotic therapy may be required to help reduce abnormal load from poor foot mechanics. Exercises to improve the function of the intrinsic and extrinsic foot muscles may help to prevent recurrence.

Morton’s Neuroma is a common cause of forefoot pain

It often feels like marble is stuck in the ball of the foot. You may get a burning sensation, tingling and pins and needles in the toes. A Morton’s Neuroma is an irritation of the nerve between two digits, typically between the 3rd and 4th digits. The nerve may be swollen or increased in size.

Causes

There are multiple contributors to the cause, including your foot shape, tight footwear and other diseases such as rheumatoid arthritis.

Treatment options

Initial treatment options include offloading the area with orthotics, and reducing local inflammation through physical therapies such as dry needling and low level laser therapy. The podiatrist will recommend appropriate footwear options. If there is any biomechanical problem that is contributing, the podiatrist will address these with their orthotic prescription or exercise prescription. Usually these options can provide significant relief. Otherwise a cortisone injection may provide temporary pain relief, although this is not a cure. Long-term management for the non-resolving Morton’s Neuroma is ethanol ablation, radiofrequency ablation and neurectomy.

Plantar fasciitis is a common condition affecting the inside of the heel

The plantar fascia is a thick fibrous band supporting the arch of the foot. It is important in movement such as walking and running. The plantar fascia provides stability and shock absorption to the foot, by tightening and relaxing during movement. This reduces tension on other foot structures. Pain usually occurs on the inside of the heel; it is worse when waking up in the morning and after resting. The pain is often sharp however, it can be a dull ache. It usually eases with activity.

Causes

Plantar fasciitis is considered an overuse injury. Certain foot shapes like flat foot and high arch feet increase your risk of developing it. In younger people, it more commonly results from activities such as running and dancing. In older people, it may result from walking in poor footwear. Other risk factors, such as being overweight, a standing job, and tightness in your calf and hamstrings can also contribute to the strain on the plantar fascia.

Treatment options

A full biomechanical assessment should be performed to identify any of the above-mentioned risk factors. Initial management with ibuprofen can provide immediate pain relief. This condition is best managed with a combination of therapies such as self-massage, low-dye taping and strengthening exercises. Soft tissue therapy such as low level laser therapy, shockwave therapy, myofascial release and dry needling. Biomechanical issues can be corrected with footwear modification and orthotic therapy.

Toe deformities make the toes look bent

These deformities affect the lesser toes (2^nd, 3^rd, 4^th and 5^th toes) in the foot. The different names correspond with the different joints in the toes that are affected. Hammer and mallet toes look like the namesake – hammers and mallets. A claw toe is the complete curling of the toe joints.

Types of toe deformity

These deformities may be flexible or rigid. It is important to understand the difference. A flexible deformity is caused by abnormal muscle contracture. If you can imagine a pully system made of muscles attaching to the bones on the top and bottom of your toes. If you pull one side it will move. This pully system is actually your muscles and if one side is too tight or pulling too hard, it will cause the toes to bend (flex). Pressing the toes down and seeing if they straighten can test this. If they do, it is a flexible toe deformity. If they don’t straighten you will have a rigid toe deformity, which is caused by the bones in the toe being fused together in a bent position. Callus can develop on the tips of the toes or on the ball of the foot.

Treatment options

Management is similar to bunions, with appropriate footwear (wide and deep toe box). Similarly, your podiatrist may give you a toe prop to place under the toes and take the pressure off the tips. Any severe callus should be debrided by a podiatrist. For a flexible clawing deformity, orthotic therapy with forefoot padding can help reduce the degree of bending in the digits. Long-term resolution is surgery to straighten the toe out again.

Achilles tendinopathy is a condition that causes pain, swelling, stiffness and weakness of the Achilles tendon

This large tendon joins your calf muscles to your heel bone. Achilles tendonitis should be referred to as Achilles tendinopathy. Tendonitis means inflammation. Research has demonstrated that in most cases of Achilles pain there is little to no inflammation present and treatment measures that aim to reduce inflammation may not be effective. Achilles tendinopathy is commonly an overuse injury. The condition is common in runners and athletes that require a lot of jumping movement such as ballet dancers.

Causes

• Poor footwear.
• Technique error such as a poor running pattern or not putting heels down when jumping.
• Making a change to the training programme such as suddenly increasing the intensity of training.
• Training surfaces.
• Poor biomechanics.
• Weakness in particular muscle groups.
• Poor flexibility.

Treatment options

The principles of conservative care are:

• Manual therapy including low level laser therapy, shockwave therapy, myofascial release, joint mobilisations and taping.
• Addressing contributing biomechanical factors and orthotic therapy may be useful.
• Improving the tendon’s tolerance to load.
• Strength training and correcting training errors.
• Conservative therapy should be instigated for 3-6 months before considering other therapy such as injection therapy or surgery.

A lateral ankle sprain occurs when the ankle rolls towards the outside of the foot and stresses the lateral ligaments

The three ligaments – anterior talofibular ligament, calcaneofibular ligament and posterior talofibular ligament – are often injured or torn in a lateral ankle sprain. Ankle sprains are graded from 1-3 ranging from mild to severe.

Symptoms

A person with this injury will feel pain on the outside of the ankle. The ankle may begin to swell and may form a bruise along the outside ankle and foot. The ankle may feel unstable or wobbly and walking may be difficult.

Treatment options

Rest is recommended in the initial phase and crutches may be needed if walking is very painful. It is advisable to follow the ‘NO HARM’ principle in the first 72 hours – no Heat, Alcohol, Running, Massage. Physical therapy such as low level laser therapy may be useful in reducing the oedema and for pain relief. A compression ankle brace may be used to help support the ankle. Research shows that early mobilisation and the use of specific modalities on ankle sprains results in better treatment outcomes. Appropriate rehabilitation is crucial in preventing re-occurrence and reducing long term ankle instability. For severe ankle sprains or long term ankle instability, a surgical opinion may be needed.

The Flexor Hallucis Longus (FHL) tendon plantar flexes the hallux or big toe

It originates from the fibula bone, runs along the inside of the ankle and inserts into the plantar big toe. Tendinopathy is now the word of choice rather than ‘tendonitis’. Tendonitis refers to inflammation. When examining affected tendons from biopsies, researchers have commonly found little to no inflammation in the tendon. Commonly, FHL tendinopathy will present with pain and/or discomfort around the medial (inner) ankle and foot.

Causes

FHL tendinopathy is typically an overuse injury and is very common in ballet dancers, who repetitively go from flat to en pointe position where extreme plantarflexion is required. Poor intrinsic foot muscle control can cause gripping or curling with the toes, therefore overusing the long flexor tendon. The FHL tendon can also be aggravated by ‘forcing turnout’ and the rolling in of the foot.

Treatment options

• Short term avoidance of aggravating activity.
• Physical therapy including soft tissue release, low level laser therapy and taping.
• Manual mobilisation of subtalar joint.
• Footwear review.
• Orthotic therapy.
• Examination and strengthening of hip abductors and intrinsic foot control.
• Examination and correction of athletic technique.
• In extreme cases, surgical release of the tendon is necessary.

Posterior ankle impingement is a condition characterised by tissue damage at the back of the ankle joint

This is due to the compression of these tissues during maximal ankle plantar flexion. This condition is commonly associated with ballet dancers who require extreme range of motion in their ankle joint to achieve the en pointe position. The impingement may be associated with poor ankle joint mobility causing the tissues to become damaged when forcing the foot to an en pointe position. Soft tissue impingement can be caused by the thickening or irritation of the FHL tendon, posterior joint capsule thickening or synovitis. In other cases, a separate extra bone (os trigonum) may develop or extra bony growth on the talus may prevent the dancer from obtaining full ankle plantar flexion.

Symptoms

People with this condition often feel pain behind the heel or deep behind the ankle joint. The pain is usually worse when the foot is in a maximal plantar flexion position.

Treatment options

Initially, conservative management should be the first line approach. This includes a period of rest and occasionally, an immobilising boot may be required. Physical therapy such as myofascial release, low level laser therapy, joint mobilisation and taping can help settle symptoms. Rehabilitation should address any biomechanical anomalies, muscular weaknesses or poor athletic technique that may be contributing to the development of the syndrome.

In extreme cases or cases that do not respond to conservative care, a surgical opinion may be required.

Severs disease is a common cause of heel pain in the younger athlete

It typically affects boys more than girls between the ages of 9-13. The child may describe pain during activity, with swelling and tenderness at the base of the Achilles tendon.

Causes

• Sudden increases in sports training or other physical activities.
• Poor biomechanics such as flat foot or high arched feet.
• Tightness in the calf muscles and restriction in the ankle joint range of motion may also be a risk factor.

Treatment options

Like treating plantar fasciitis, there is a greater improvement with this condition if a combination of treatment options are used together. It is recommended to modify the activity that is aggravating the pain. Treating any localized pain with soft tissue techniques such as low level laser therapy, myofascial release and dry needling can provide immediate relief. Taping and orthotic therapy can help to address any biomechanical issues. Exercise prescription with either stretching or strengthening can help rehabilitate the Achilles tendon. It is not recommended to do surgery or cortisone injections for this condition.

This condition is medically referred to as medial tibial stress syndrome

The symptoms of shin splints are a diffuse pain along the inside of the shin bone (tibia). The pain usually improves with warming up. If the pain is just on one spot, it may be a stress fracture.

Causes

Several risk factors can contribute to the increased stress on the tibia. These include flat feet, training errors (i.e. too much, too quickly), shoe design, surface type, muscle imbalance, fatigue and decreased flexibility.

Treatment options

Treatment is tailored however, initial management can begin with rest, ice and pain medications. Changing your exercise to cross training activities such as swimming and cycling can help maintain fitness. Treating any risk factors listed above with physical therapies such as low level laser therapy, dry needling and joint mobilisation can reduce tissue stress. Any biomechanical issue can be addressed with orthotic therapy and footwear modification.

When the joints of the body are very flexible or move more than is considered normal for a joint

Hypermobility can present as double-jointedness or loose joints. It can cause pain after activity or at night. Hypermobility syndrome can be isolated or associated with other connective tissue diseases.

Causes

It is believed to run in families, however, the actual cause is unknown.

Symptoms

Some children have no symptoms, others can get mild swelling around joints and muscle pain towards the end of the day. Pain is common in the knees and thighs. Children with hypermobility tend to get regular ankle sprains or injury, often have flat feet and can get very tired. Symptoms can improve with resting and as the child gets older.

Treatment options

Education is provided regarding a good standing and sitting posture. Exercise prescription to strengthen the muscles can be useful to prevent injuries and overuse. Wearing footwear with good stability and arch support as well as orthotic therapy can be helpful to stabilize and support the flexible flat foot.

A muscle cramp is an uncontrollable and painful spasm of a muscle

1 in 3 adults will experience muscle cramps, with some forced to restrict their normal activities. A muscle cramp feels like a significant tightness in the muscle belly of the affected muscle.

Causes

The exact cause is unknown, although, there are several risk factors including:

• Poor physical condition – overexertion of the affected muscle due to poor strength and biomechanics.
• Dehydration – decreased electrolytes in the body to help revitalise the muscles.
• Muscular fatigue – excessive use or inappropriate biomechanics.
• Restricted blood flow – common in those who are at risk of clots/deep vein thrombosis such as those who have recently undergone surgery, are in later stage diabetes or have a larger BMI.
• Nerve condition – pressure from nerves in the spine or hip, or a neurological condition may cause the muscle to activate inappropriately.
• Hormone or chemical imbalances – such as during pregnancy/menstruation or in those with thyroid concerns. It could also be due to your current prescribed medications.

Treatment options

• Targeted strengthening and/or stretching programs to enable efficient biomechanical loading throughout gait.
• Low level laser therapy to allow further stretching of tight musculature. This will help to increase the efficiency of the muscle.
• Dry needling can be utilised to help free pressure points or knots in the muscle.
• Footwear specific to your foot type and footwear education.
• Graduated return to activity exercise program.

Other treatment options

• An assessment for electrolyte imbalances by your GP may indicate that you require mineral or vitamin supplements or a prescription medication.
• Increase your water intake.
• Warm up and cool down when undertaking exercise.
• Review of your current medications by your GP or pharmacist.

Muscle strains are a term given to a torn muscle or ‘pulled muscle’

The cause of this pain can be from a number of different concerns that may result in muscle cramps or spasms, muscle tightness and muscle soreness.

Factors that contribute to pain

Muscle strains usually occur suddenly and are caused from a high intensity exercise or activity such as lifting, pushing, running or jumping. This could be due to a number of different things such as decreased muscular strength or flexibility; inadequate warm up; inappropriate loading, technique or biomechanics; and footwear.

Treatment options

Initially to address the pain, resting from the aggravating activity is recommended. Icing and a short course of anti-inflammatories can be useful. If you can’t take tablets, Voltaren Osteo 12 Hourly gel is great. Taping the muscle may help relieve the tension and add support. A comprehensive biomechanical assessment can identify the underlying biomechanical abnormalities. Your podiatrist will recommend a management program which may incorporate muscle strengthening, low level laser therapy, orthotic therapy and footwear changes.

Diabetes can cause significant complications for the feet and legs

The feet are at risk because diabetes can cause damage to the nerves and the blood supply. The damage is more likely if:

• You’ve had diabetes for a long time.
• You smoke.
• You drink excessively.
• Your blood glucose levels have been too high for a long period of time.
• You’re inactive.

Even if the above factors do not apply to you, this does not mean you will not get nerve damage or reduced blood supply. All people with diabetes should have frequent foot examinations by a podiatrist.

Blood supply

People with diabetes are more at risk of developing blockages in their arteries or hardening of the arteries. Symptoms include:

• Sharp leg cramps in the calves after walking short distances or uphill.
• Cold feet.
• Pale skin colour.
• No hair on the feet.
• The skin may be shiny and taut.
• Cuts or injuries that are slow to heal.

If you have any of these signs/symptoms you should see a podiatrist or health care practitioner for further assessment.

Nerve Damage

Poor blood glucose control can lead to nerve damage. The nerves that are affected are generally your sensory nerves (the ability to feel) and the nerves that supply your muscles. The symptoms are:

• Pins and needles or tingling in the feet and/or legs.
• Numbness in the feet.
• Burning pain in the legs and feet, often felt at night time.

Often the nerve damage goes unnoticed and you may not realize you have nerve damage until you go for a foot check. Nerve damage increases the risk of accidental injury to the feet. This can develop into an ulcer on the bottom of a foot, which can penetrate to the bone. This could lead to osteomyelitis and a chronic infection in the bones and joints. If an infection isn’t treated at the earliest signs, this could result in ulceration (an infected open sore) and eventually amputation (removal of a toe, foot or limb).

If you have diabetes, it is recommended that you have a foot check/assessment at least once a year. If you have any complications, your feet should be checked every 3-6 months. A visit to a podiatrist will also show you how to check and care for your feet.

Fibromyalgia is a generalised pain condition affecting the whole body

It is common to have tender points at several sites of the body and these can change day to day. People with fibromyalgia have chronic fatigue and can have sleeping difficulties. Diagnosis is made from clinical symptoms.

The feet

People with fibromyalgia may have pain on the soles of their feet, particularly along the arch. They have a higher sensitivity to pain with a lower pain tolerance. This can increase painful symptoms that are present. Increased pain in the feet can cause compensatory pain elsewhere, for example, in the knees, hip and back.

Treatment options

Physical activity is recommended for the general maintenance of this condition. Easing into activity is important to start with. Your podiatrist will assist in choosing the right shoes, as this can greatly improve your comfort and support. For painful feet, the use of custom orthotics can improve function in the short term. At Bounce Podiatry, we utilise low level laser therapy and myofascial release to help settle the nervous system.

Gout is an arthritis that can attack the joints very quickly

It is caused by excessive uric acid in the blood stream. The uric acid can form hard crystals in the joints. In the foot, it commonly affects the small joint at the base of the big toe. The toe can look swollen and red; it can feel very painful and stiff. It can also affect other joints, such as the ankle and knees. Gouty attacks can last from a few hours to days and very rarely weeks. Gouty attacks cause significant foot pain, impairment and disability.

Risk factors for developing gout are excessive drinking, being overweight, high blood pressure, abnormal kidney function and certain foods such as meat and fish. Gout affects men more than women.

Diagnosis and treatment options

A descriptive history will hint at the presence of gout. A reliable method for diagnosing gout is joint aspiration, where the fluid is drained from the joint to detect the presence of uric acid crystals. This is performed under a local anaesthetic using a syringe and needle. Your doctor will recommend some lifestyle changes to help prevent any future gout attacks. In an acute gout attack, your doctor may prescribe anti-inflammatories and other medications to decrease the level of uric acid in the blood.

Your podiatrist will discuss appropriate footwear choices with you. These can significantly offload high-pressure areas in the feet, and improve walking and pain levels. Key areas to include are adequate cushioning and support.

Osteoarthritis (OA) is the most common form of arthritis

It is understood to be a form of degeneration within a joint, which is caused from mechanical stress. Symptoms include pain, tenderness, stiffness and mild swelling. The pain is often described as a sharp ache.

Osteoarthritis can affect all areas of the body including the feet, hands, knees, hips and spine. The joints can change shape, often becoming enlarged. In the feet, it contributes to the formation of bunions. Diagnosis is based on history and clinical examination. An x-ray can assist in the diagnosis.

Treatment options

Lifestyle changes are important in the management of osteoarthritis, such as losing weight. Paracetamol is the recommended first line medication. Tailored exercise programs can improve function and pain for OA in the hip and knee. The use of physical therapies such as dry needling and low level laser therapy can reduce localised pain and swelling. Orthotic therapy can be useful to provide cushioning and offloading of painful joints in the feet. Different orthotic wedging can also affect knee and hip osteoarthritis. Your podiatrist will also recommend footwear to assist with foot deformity caused by osteoarthritis and improve function.

Other treatment options include

• Steroid injections.
• Pain medication.
• Surgery – this can be discussed with your podiatrist.

Peripheral neuropathy is a result of damage to your peripheral nerves

These nerves supply to the arms and legs. It usually causes weakness, numbness and/or pain in the hands, feet, arms and legs.

Causes

There are many different causes for peripheral neuropathy. One of the most common causes is diabetes (the high sugar levels cause nerve damage). Other causes include traumatic injury to the nerves, infections, metabolic syndromes, excessive alcoholism, inherited disorders, some medications and exposure to toxins.

Symptoms

• Burning in the feet or hands, especially at night.
• Numbness, pins and needles, tingling in the feet or hands.
• Muscle weakness if the nerves that supply the muscles are affected.
• Lack of co-ordination or falling.

Prevention

• Ensuring your diabetes/blood sugar level is well controlled.
• Avoiding or quitting smoking.
• Eating a healthy diet.
• Getting regular, moderate exercise.

Treatment options

Treatment is often targeted at controlling the symptoms as nerve damage is often irreversible. Treatment includes prescription drug therapy from your GP or specialist. Non-drug therapies that your podiatrist can offer include dry needling/acupuncture, low level laser therapy, TENS and advice on compression therapy (compression garments can help to reduce nerve pain but are not suitable if you have problems with the arterial circulation in your feet or legs).

Peripheral Vascular Disease is the reduced circulation of blood to a body part other than the brain or heart

It is caused by a narrowed or blocked blood vessel. Peripheral vascular disease mainly affects blood vessels in the legs and kidneys, and less commonly in the arms. Narrowing is usually caused by arteriosclerosis. Arteriosclerosis is a condition where plaque builds up inside a vessel. It is also called “hardening of the arteries.” Plaque decreases the amount of blood and oxygen supplied to the arms and legs.

Risk factors

• Smoking.
• Diabetes.
• High blood pressure.
• High cholesterol.
• Heart disease.
• Kidney disease.
• Stroke/CVA.

Symptoms

• Painful cramping of the calves when walking. The pain intensifies with exertion and subsides with rest.
• Skin changes to your legs and feet (thinning, shiny, paleness).
• Weak pulses in feet.
• Reduced hair growth on feet and legs.
• Wounds or ulcers on your feet that won’t heal or heal slowly.
• Gangrene – tissue death when there’s not enough oxygen getting to the tissues.
• Toenails that are thick and opaque.

Diagnosis and treatment options

Podiatrists can perform thorough vascular testing and may be the first health professionals to detect any problems with the circulation. It is important to see a podiatrist for help with general foot care if you’re unable to satisfactorily care for your feet or reach your feet. We can offer advice on preventing wounds and ulcers to the feet through correctly fitting footwear, and advice on preventing trauma to the foot. We can address any biomechanical anomalies that may be overloading a particular area of the foot and subjecting it to excess pressure or friction. We can also offer advice on wound care product selection for any wounds or ulcers.

Rheumatoid Arthritis (RA) commonly affects the foot in up to 90% of sufferers

It can affect all areas of the foot by causing foot deformities such as bunions, claw toes and flat feet. It is common to get joint swelling (synovitis), Achilles pain and arch pain. Sometimes you can get soft lumps known as rheumatoid nodules. There can also be issues with blood flow and nerve damage.

Causes

The inflammatory process RA sufferers experience affect the joints and soft tissue by progressively weakening them. For joints, the inflammation can damage the strong supporting ligaments, which causes the joint to become unstable. This can contribute to changes in the foot shape. The inflammation also affects the tendons; they become weak and begin to stretch. This can make walking or standing very painful and uncomfortable.

Treatment options

Treatment is tailored towards symptom relief and improving function. In the early stages of the disease, wearing supportive footwear and orthotics can improve function and limit disability. Physical therapies such as low level laser therapy are excellent for providing relief for swollen irritable joints. While there is limited research on its effectiveness, our podiatrists have found that myofascial release has led to improvement in people with RA, particularly in pain levels and joint range of motion. As the disease progresses and the foot shape changes, adjustments to footwear choices and orthotics are necessary. For any tendon issues, it is imperative to be given correct exercises to rehabilitate the tendon. It is important to get the RA foot regularly screened for changes in foot shape, biomechanics and skin condition, and to check the blood flow and nerve function.