Common foot issues involve a diverse range of conditions including athletes foot, heel spur, various toenail conditions, as well as related leg pathology such as arthritis, achilles and heel pain, in children as well as adults. The most common foot conditions are listed below.
Plantar Fasciitis (common cause heel pain/arch pain)
Plantar fasciitis is an inflammation, irritation or degeneration of the plantar fascia, a band of tissue under the foot that connects the heel bone to the ball of the foot. It has also been called heel spur syndrome in the past , as the pain was thought to be associated to a heel spur seen often on xray, but current research has generally ruled this out. A common symptom of plantar fasciitis, is pain on standing first thing in the morning, and after rest. Throughout the day, the heel pain will usually return. Causes are usually a combination of poor biomechanical foot function, poor footwear, standing long hours on hard surfaces or acute injury. Treatment by your Cheltenham Podiatrists can include taping, footwear advice, paddings and often orthotic devices that redistribute forces away from the plantar fascia and thus reduce inflammation and pain. Recalcitrant cases can be treated with our new regenerative therapies; Prolotherapy, PRP and Orthokine. Where pain is mainly neuropathic, lyftgots perineurial prolotherapy is a safe, simple and quick solution quick
Achilles Tendonitis is now more accurately known as achilles tendinopathy. There are generally 2 types, at the heel bone-insertional or just above the mid-portion. Usually there is a degree of inflammation and or degeneration. Symptoms include a gradual onset of pain at the back of the heel, stiffness and aching. The tendon is usually tender to touch and may contain lumps known as nodules. Common causes include a sudden increase in activity, overload of the tendon, a change of footwear or training surface, weak or tight calf muscles, wearing high heels, running up hills and over pronation (poor biomechanics). Treatments by your Cheltenham Podiatrist include a rehabilitation program, loading / strengthening program, heel pads or sometimes orthotics. This will improve the strength and reduce the loading of the tendon, and providing relief. For Difficult cases treatment can be combined with the latest in regenerative therapies from Prolotherapy, to PRP and Orthokine.
Heel Pain Children/ Severs Disease
Sever’s Disease is a common cause of heel pain in children. A growth related condition seen most commonly in children aged 5 – 11 years old. The heel pain often increases with activity and some children will even experience pain undergoing regular activities, such as walking. Sever’s Disease is usually relieved by rest. The condition is due to the pulling of the achilles and calf muscle at its attachment to the growth plate of the calcaneous (heel bone) as the legs grow and elongate, resulting in inflammation and pain. The treatment of Sever’s Disease includes paddings, exercises, and sometimes orthotics. It is however a self limiting condition, as the growth plate eventually ossifies.
Bunions (Hallux Valgus)
Bunions are a common problem of the main joint of the big toe. Largely a genetic condition, it may not be particularly painful initially, but once fully developed can cause major foot deformity, including clawed toes,hallux valgus overlapping toes, corns and calluses. If picked up early, podiatry treatment and advice (exercises, orthotics, and footwear consultation)and prolotherapy , can reduce pain, slow down the condition, and help prevent some of the complications. Once the deformity develops osteoarthritis will form aggravating further pain , this can be relieved with Orthokine treatment , in our Regenerative Clinic.
Ingrown nails are nails that have punctured the skin as they grow forward. They are painful usually down the side of the nail, and will be often red, inflamed and may weep. Ingrown nails should not be left untreated as they may become chronically infected, and will often not heal until the nail spike is removed. Cheltenham podiatrists treat the condition by a simple reshaping of the nail edge to remove the sharp spike, or in chronic cases, a very simple nail correction procedure (surgery) can be performed under local anesthetic to prevent future reoccurrence. Or the new BS invisible nail brace is available for simple ,pain free correction.
Corns and Callouses
Corns and calluses are one of the most common problems seen by Podiatrists. Pathologically they are all the same – the skin has thickened in response to pressure. Callous generally refers to a more diffuse thickening of the skin, whereas a corn is a more focal area of callous buildup, and is often more painful. A corn can occur under, and be surrounded by callous. They are both generally painless to remove by your Cheltenham podiatrist and the patient gets instant relief. Sometimes, the podiatrist can use paddings and devices to slow down re-growth by reducing the pressure and or friction that causes them.
Shin Splints is a general term used for shin pain. The most common cause is a pulling of the soft tissue away from the boney sheath. It is characterized by pain along the inner border of the shin, and can occur at the beginning of exercise, during and/or after exercise. Causative factors include biomechanical abnormalities , downhill/uphill running, activity on uneven surfaces , a sudden increase in training, activity on hard surfaces, and inappropriate footwear. Podiatry is an important part of or the management of this condition, particularly to correct foot function and loading ,with orthotic therapy. Treatment may also include stretching exercises, footwear change, night splints, and training advice.
Diabetes can directly affect the feet in various ways. Over time the feet can be prone to detrimental changes, depending on how well blood glucose levels are managed. This includes changes to nerve function (numbness, and strange sensations in the feet), reduced blood flow through the vessels of the feet which compromise lower limb circulation, reduced mobility of joints, and deformity of the foot. In combination, these changes can potentially lead to a much greater risk of trauma, infection, ulceration, and in severe cases, amputation. Attending a podiatrist regularly can reduce the risk of foot complication by monitoring these possible changes. Cheltenham Podiatrists carry out annual Diabetic Foot assessments to monitor the various parameters, and can also perform a Doppler Ultrasound for Arterial Assessments when required, the results are reported to your G.P. and Diabetic Specialist. This helps with the overall management.
At Our Cheltenham ulcer clinic, our podiatrists have years of experience dealing with foot ulcers. Ulcers are often caused by a combination of systemic and local issues, including diabetes (or diabetes related), poor vascular supply, trauma, foot deformity, and/or infection. The causes are established and then dealt with. Treatment in our ulcer clinic will often include offloading of the wound with paddings, orthotics, specialist shoes and specialist dressing, depending on the type of wound. In some cases antibiotics, and/or PACT photodynamic antimicrobial therapy for infective wounds, may also be required. For diabetic and ischaemic ulcers not responding to standard care, another version of PRP(platelet rich plasma)– Platelet rich fibrin bioactive matrix, is now available at Cheltenham Podiatry.It is a new novel application to accelerate wound healing, where a platelet rich clot is applied to the wound, releasing high concentrations of growth factors over 5 days. It is reapplied weekly, and shows promising results. Often our Cheltenham podiatrists will work in conjunction with the G.P, nurses and or vascular specialists to ensure the best outcome. Regular debridement of necrotic tissue may be required weekly.
The lower limb joints are prone to arthritic changes as we age. The knee joint being one of the most common. There are many aggravating factors that lead to arthritis, Both external mechanical forces, and inflammatory proteins(cytokines) within the joint will aggravate pain and inflammation. Thus, best treatment regime involves attending to both these factors.Pain on the inside of the knee joint, at its medial (inside) compartment can be caused by degeneration of the cartilage. There is a growing body of evidence, that lateral foot wedges can reduce mechanical loading and pain with this type of knee arthritis, by redirecting forces away from the damaged area. Biomechanical offloading of the lower limb joints can also be achieved with orthotics or in some cases rocker shoes. These treatments may be further enhanced by combining them with the latest in biological therapies to correct the internal inflammatory environment – Prolotherapy, PRP and Orthokine, the latter of which has a high level of research(level 1 evidence) for greater than 50% reduction in pain for 70 % cases with mild to moderate knee osteoarthritis. These new therapies are safe and effective drug free treatments, performed at cheltenham podiatry under ultrasound guidance. They are safer, and are showing a better longterm outcome than cortisones and other anti-inflammatory medication. They introduce the body’s own healing growth factors and natural anti inflammatory proteins into the joint environment.
Nerve pain causes chronic, disturbing, extreme pain and sensations, and is often due to trauma or damage to a nerve. Often occurring after surgery, tight footwear or may be related to other damaged musculoskeletal tissues. Treatments options have been limited to strong painkillers that can often have unwanted side affects. Lyftgots perineural injection therapy is an exciting and innovative regenerative treatment, it is a form of prolotherapy involving a medical grade 5% dextrose solution. It’s safe , simple, and highly successful for permanent relief of nerve pain. Usually only requiring between 1-3 sessions.