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General Foot Care and Treatment

When our feet suffer wear, they cannot be replaced like a pair of shoes.

Our feet are often the most neglected and forgotten part of our bodies. Research has shown that people are more likely to have serviced their car than to have had their feet checked by a podiatrist. Yet our feet are our main mode of transport, carrying us on a journey of 128,000 kilometers, or even more, in a lifetime – the equivalent to three times around the world.

Who are podiatrists?

Podiatrists are university-educated foot health professionals. They diagnose and treat foot and lower-limb conditions of all types, including those related to underlying medical conditions, such as diabetes.

Why do feet need expert care?

Our feet are very complex – they house a quarter of the bones in the body, as well as a network of muscles, ligaments and joints. They are also vulnerable to injury and disease; there are over three hundred identified foot ailments. When our feet suffer wear – by the age of fifty, our feet can lose up to half of the shock-absorbing capacity of the natural foot pad – they cannot be replaced liked a pair of shoes.

Feet at risk

Some feet have special needs – children’s feet, sporting feet, working feet, mature feet and feet affected by disease can be affected in the following ways:

• Children's Feet - Children’s feet are still forming and are quite fragile. They can be damaged quite easily by shoes and socks that are too small. Early examination of children’s feet is a preventative measure. Uneven shoe wear, skin rashes, lumps or bumps on the feet, pain in the feet or legs, frequent tripping and falling are signs of potential problems.
• Sporting Feet - Sporting activity – walking, running, jumping – places greater demand on the body than normal day-to-day activities. While running, your feet can absorb up to three times your body weight. Not surprisingly, injuries to the foot and lower limb make up a large proportion of sporting injuries. Podiatrists understand the structure and movement of the foot and lower limb; therefore, they can diagnose foot conditions and recommend appropriate footwear and training regimens.
• Working Feet - Working feet can cover as many as 24 kilometres in a day as well as absorbing heavy loads associated with walking, lifting, running and jumping on and off machinery or in and out of cars. Nearly 20 per cent of all workplace injury claims relate to injuries to the feet and toes, and research has shown that workplace foot problems, including those related to ill-fitting or inappropriate footwear, are common.
• Mature-age Feet - By the time we reach the age of 50, our feet may have covered 86,000 kilometres, making them more prone to injury and disease. Clinical studies also show that, by 50, we are 80 per cent more likely to develop arthritis in the foot and ankle, as well as being 100 per cent more likely to develop toe and joint deformities.
• Unwell Feet - People with diabetes are at a greater risk of developing serious foot problems because they are more likely to experience reduced blood circulation and nerve degeneration in their feet and legs, causing a decreased ability to fight infection. All these factors contribute to a reduced ability to heal wounds. Regular visual foot checks are vital for foot health, and Diabetes Australia recommends that people with diabetes see a podiatrist at least once every 12 months.

How diabetes can affect your feet

Your feet are supplied with blood to keep them healthy. They also have lots of nerves that act as a communication and warning system. For example if you have a stone in your shoe, the nerves in your foot will send a message to your brain letting you know they are in pain or discomfort. However if your diabetes is poorly controlled for a long period of time this can lead to nerve damage.

Nerve damage may mean that you no longer notice a stone in your shoe, due to loss of feeling in your feet. This can result in an injury or wound you cant feel and possibly an infection.

If you have poor circulation, any injuries, wounds or infections to your feet such as cuts, burns or blisters will take longer to heal. This is due to less blood flowing to your feet to assist in healing any damaged tissue.

When you have nerve damage and or poor circulation, you will need to take extra care to protect your feet from injury and wounds. Many foot problems in people who have diabetes occur when injuries and wounds, as well as infections go unnoticed and untreated, or when healing is delayed due to poor circulation. This can result in serious ulcers and in sever cases amputation of parts of the foot.

Development of children’s feet

Children’s feet differ from those of adults, as they are not yet fully formed. At six months of age the foot is still mostly cartilage; in fact, the last bone doesn’t begin to form until children are about three years old. By 18 years, most of the bones are fully formed.

Babies

Baby feet only need protection in the cooler weather. Grow suits with feet, socks or small, soft natural fibre shoes should be used to keep little feet warm and should always be loose around your baby’s feet.

Making time for your baby to kick freely will help with the development of the muscles in the legs and feet.

Walking

Children usually begin to walk at any time between 10 and 20 months of age. It is important to remember that each child is unique and will move through the developmental stages at their own pace. Children also roll, crawl, walk and run in their own time; there is no evidence to support the view that the use of Jolly Jumpers or baby walkers will help this to happen early. These types of equipment may put additional pressure on feet that are not yet ready for taking weight.

When your child first begins to walk, shoes should only be used when protection is needed from the ground. Allowing children to go barefoot or to wear very soft shoes helps the foot to typically develop and assists in strengthening muscles.

Sometimes children walk with their feet pointed inwards (in-toeing) or outwards (out-toeing). In most cases, these variations in walking are normal. Most children will grow out of these walking styles by the age of two; however it can sometimes take until the age of 12. If your child is not keeping up with their friends, a podiatrist may be able to assist.

Children under the age of three may sometimes walk on their tip toes and this is a typical developmental stage. Any child over the age of three and still walking on their tip toes (toe walking) should be assessed by a podiatrist.

Growing feet

A child’s foot grows in length and changes in shape with growth. Arch development is an individual thing and arch height or a lack of an arch does not always indicate that a child will have problems with their feet. If your child has pain or has one flat foot that differs from the other foot, a podiatrist can assist.

Due to rapid growth in length and width while young, frequent changes in the size of shoes and socks may be necessary. Do a size check at least every one to three months up to the age of three, every four months up to the age of five and every six months from five years.

Heel pain

Heel pain may also occur in growing children, usually between the ages of 8-14, and may be worse during or straight after sporting activities.

If your child is experiencing pain at the back of the heel that has limited their activity or causes them to limp, a podiatrist can help. Your podiatrist will be able to determine whether or not the heel pain is related to the developmental process and give advice about ways to alleviate symptoms.

Foot health and ageing

As our feet grow older, they naturally develop more problems. But painful and uncomfortable feet are not something you should have to put up with.

A lot can be done to improve comfort, relieve pain and keep you on your feet for life.

Mirrors of health

The condition of our feet often provides early indications of conditions such as diabetes, arthritis or circulatory disease. For this reason, the human foot is sometimes called the ‘mirror of health’.

Look out for warning signs such as dry skin, brittle nails, burning and tingling sensations, feelings of cold, numbness, and discoloration. Seek the opinion of your podiatrist when any of these problems occur.

Foot problems can be prevented

As we age, our feet tend to spread and we lose the fatty pads that cushion the bottom of our heels and the balls of our feet. If we are carrying extra weight, our bone and ligament structure may also be affected.

Many people, including older people, believe it is normal for feet to hurt, and resign themselves to enduring foot pain that could easily be treated.

There are more than 300 different foot conditions. Some are inherited but for older people most stem from the impact of years of use. However, even in your retirement years, many foot problems can be treated successfully and the painful conditions relieved.

As you get older you should have your feet measured more frequently, rather than presuming your shoe size remains constant. Dry skin and brittle nails are other conditions older people commonly face.

Taking good care of your feet has many benefits, including: Increasing your comfort, limiting the possibility of additional medical problems, reducing your chance of hospitalisation due to infection, and keeping you active and mobile.

Keep them walking

Mobility can be a problem for older people, but with basic foot care and prompt attention to any problems, getting around shouldn’t be difficult.

Podiatrists in hospitals, community health centers, nursing homes and private practices provide services designed to help keep older people on their feet.

Nail care

Keeping nails cut and under control will help keep you mobile. Unfortunately, many elderly people find cutting toenails problematic, due to poor eyesight or difficulties in bending down.

If you can cut your toenails yourself, make sure you trim them just short of the end of the toe, using a strong pair of nail clippers. After clipping, smooth the nails with a file or emery board, using downward strokes.

Your podiatrist will be able to cut even heavily overgrown or thick nails painlessly, and provide advice on appropriate self-care.

Heel pain

Heel pain is one of the most common conditions treated by podiatrists. It is often a message from the body that something is in need of medical attention. Pain that occurs right after an injury or early in an illness may play a protective role, often warning us about the damage we have suffered.

Who gets heel pain?

The greatest incidence of heel pain is seen in middle-aged men and women. It is seen in those who take part in regular sporting activities and those who are significantly overweight and on their feet a lot. Heel pain can also occur in children, usually between eight and 13, as they become increasingly active in sporting activities.

The causes of heel pain

It is thought that higher arches or flatter arches, or feet that role in too much, are causes of heel pain. This can place too much stress on the heel bone and the soft tissues attached to it.

The stress may also result from injury, or a bruise incurred while walking, running or jumping on hard surfaces, wearing poorly constructed footwear or being significantly overweight.

Certain diseases an also contribute to heel pain.

Complications

Heel spur

One factor sometimes associated with heel pain is the heel spur, a bony growth under the heel bone. There are no visible features on the heel, but a deep, painful spot can be found in or around the middle of the sole of the heel.

Approximately 10 per cent of the population may have heel spurs without any pain.

Heel spurs result from strain on the muscles of the foot. This may result from biomechanical imbalance, a condition occurring in many people.

Plantar fasciitis

Both heel pain and heel spurs are frequently associated with an inflammation of the long band of tissue that connects the heel and the ball of the foot. The inflammation of this arch area is called plantar fasciitis.

The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.

Other causes of heel pain

• Excessive rolling in of the feet when walking.
• An inflamed bursa (bursitis); a small, irritated sack of fluid at the back or under the heel.
• A neuroma (a nerve growth).
• Other soft-tissue growths.
• Heel bumps, or ‘pump bumps’, a bone enlargement at the back of the heel bone.
• Bruises or stress fractures to the heel bones.

Common problems for sports & recreation workers

Sports and recreation work – including participation in professional sports, personal training, coaching or teaching, and umpiring – involves increased force and pressure on the feet that can lead to injuries requiring specialist treatment.

Sports podiatric injuries come in two forms:

• Overuse injuries caused by repeated pressure on tendons and joints; and
• Biomechanical injuries caused by incorrect movement patterns. Biomechanical injuries are often impacted by overuse problems as athletes may be changing the way they walk, run or jump to compensate for an existing injury, thereby causing further damage.

Risk factors

Poor foot mechanics

When you run your feet and legs are exposed to dramatically increased stress forces which can be magnified by incorrect foot mechanics. Pronation is the term used to describe feet that are excessively rolled inwards, whereas supination is the term used for feet that roll outwards. Pronation and supination are normal and necessary parts of walking and running. Problems tend to arise when people have excessive amounts of each, or remain pronated or supinated for too long. These situation can result in increased stress and strain on bones, joints, muscles, tendons and ligaments, thus a predisposition to injuries.

Incorrect footwear

Buying the wrong shoe for your workplace conditions, activity, body mass, and foot mechanics can increase the chance of injury.

How to reduce your risk

The most prevalent sports injuries include shin splints, runner’s knee, Achilles tendonitis, corns and bunions, through to postural issues and lower back pain. Runners also complain of thickened nails that may be ingrown.

These problems can be avoided by:

Wearing supportive shoes

Different kinds of exercise may require different kinds of shoes – you should choose your shoes based on the primary activity you will be performing when wearing them.Shoes should be immediately comfortable and not require breaking in.

Your shoes should have sufficient room at the toes (about the width of your index finger when you’re standing up) and not compress the sides of your feet.

If your job involves a lot of running, your shoes should be designed to absorb impact forces.

Your shoes should include features to help control biomechanical problems. Aim for a sturdy heel box, good arch support, and appropriate cushioning.

Stretch

A proper warm-up is crucial to the prevention of many sports & recreation work-related injuries. The body needs time to adjust to each new activity, particularly if it involves sustained pressure or impact. A full warm-up and cool-down before and after each session can go a long way to keep you on your feet.

The RICE protocol

If you do injure your feet or lower limbs at work, it’s important not to ignore the pain. Follow the RICE protocol and seek medical attention.

• Rest: stop work immediately
• Ice: place an icepack on the injured area
• Compression: wrap the injured area to reduce swelling
• Elevation: keep your leg raised so the foot is above waist height

Taking Care of Your Feet at Work

Your feet can take a pounding in the workplace. The daily demands of your job may include walking, standing for long periods, lifting and jumping on and off machinery. While you are working your feet may absorb up to three times your body weight and working feet can travel up to 24 kilometres a day!

The work environment itself can create health risks for your feet. Hazardous conditions, such as oily and slippery floors, wet conditions or extreme heat or cold – put feet at risk of injury and can lead to foot problems.

Podiatrists are highly-skilled health professionals trained to prevent, diagnose, treat, and rehabilitate medical and surgical conditions of the feet and lower limbs.

Footwear

Our feet bear an enormous burden of daily living as well as carrying the weight of our body. Shoes play a vital role in supporting our feet, as well as in protecting them from external dangers.

The ideal shoe

There is no such thing as the one perfect shoe. Feet come in many shapes and sizes, and are involved in many different activities. When buying new shoes, it’s important to ensure:

• They fit properly.
• They are supportive for the kinds of activities you engage in.
• They do not cause damage to you feet or hurt in any way.

The importance of a good fit

Choosing shoes that fit well is an important part of caring for your feet. Finding the right fit may mean you have to try a few different styles to accommodate your individual foot shape. Because feet are rarely the same size, it is important that you it your shoes to your larger foot. An experienced footwear sales person can help you with this. Since most shoe manufacturers have their own size range, you should make decisions on what feels right, rather than simply based on the shoe being the “right size”.

People who have misshapen feet from an injury or medical condition, such as arthritis or diabetes, may require shoes with extra depth or width. Some people may require orthoses (inserts). Occasionally, a custom-made shoe will be most suitable. The APodC endorses Ascent Footwear’s IIFit service.

Shoe buying tips

When buying new shoes, keep in mind the following:

Materials

Leather is generally preferred for shoe uppers, however synthetics developed with specific beneficial properties, eg. stretch, may be preferable for some foot deformities. Synthetic or rubber are best for the sole as they are often more durable, shock absorbent and provide better grip.

Security

All shoes, especially walking shoes, should be secured on the feet with laces, straps or buckles. If your feet have to work to hold your shoes in place, your foot muscles may be strained.

Shape

Pointy shoes can make your toes “claw”. This may affect overall body posture. Clenched toes can also cause rubbing, leading to corns and calluses. Broad-toed shoes allow the toes more room and can help prevent pressure injuries.

Also check the following:

• The heel of the shoes is less than 2.5cm (high heels increase pressure on the ball of the foot).
• Your shoes have well-padded sole. A cushioned sole absorbs shock and reduces pressure on the feet.
• Your shoes are made from a material that breathes – fungal infections like tinea love a warm, moist environment. Absorptive socks can also help draw moisture away.
• Your shoes protect you from injury – your feet must be protected from your immediate environment. People with reduced sensation or circulation problems need to be especially careful they do not injure their feet.

Footwear at work

If you work in a field that increases the chance of you injuring your feet then safety shoes are vital. Safety shoes and boots protect your feet, help prevent injuries and reduce the severity of injuries that occur in the workplace.

Some tips:

• Your toes should not touch the end of your shoes or you may damage your nails and toes – you need a gap of about 1cmfrom the end of your largest toe to the shoe.
• Shoes should also be broad enough and deep enough. If you can see the outline of your feet pressing against your shoes, they are probably too narrow.
• Don’t buy shoes that need breaking in. Shoes should be immediately comfortable.
• Shop for shoes later in the day – most feet tend to swell during the day and it is best to fit shoes when your feet are largest.

Nail surgery

Surgical procedures are commonly performed by podiatrists to treat recurrent nail problems, such as ingrown nails. An ingrown toenail is a nail that has pierced (or is pressing against) the adjacent skin of the toe causing pain and inflammation and sometimes infection.

Surgery may be required when an ingrown toenail repeatedly gets infected, is painful, the sufferer is unable to wear shoes or the condition inhibits work, sport or other activities.

Nail surgery performed by podiatrists

One of the most common nail procedures is partial nail avulsion. The procedure is usually performed in podiatrists’ rooms and the patient is able to walk immediately afterwards.

What does a partial nail avulsion involve?

The procedure itself is generally performed under local anaesthetic via injection to the toe to numb the area. The anaesthetic will most often wear off in about an hour.

Once numb, a tight elastic ring called a tourniquet is applied to the toe to control bleeding and the area is prepped to minimise risk of infection.

The portion of nail to be removed is then gently lifted and resected, generally without the toe being cut or stitched. Both sides of the entire nail may be removed this way. A chemical is used to assist in preventing nail re-growth.

Once the procedure is completed, the tourniquet is removed and a sterile surgical dressing is applied. The patient is able to walk immediately afterwards, however assistance getting home is strongly recommended.

What happens after the procedure?

Re-dressing at home and a few consultations with your podiatrist may be required following the procedure.

Minimal pain relief medication is required – you can discuss this with your podiatrist.

What are the potential complications?

All nail procedures have been associated with a slight chance of recurrence. Infection whilst the wound is healing can also be an issue.

Your podiatrist can advise you and manage these and other complications that may occur.

All surgical procedures have some risks of complication; however, this procedure is associated with a low rate of complications. Again, you should discuss this with your podiatrist.

How your podiatrist can help

Regular visits to your podiatrist can manage and prevent ingrown toenails, alleviate pain and help keep you on your feet and mobile.

Prescription Orthoses

What are foot orthoses?

Foot orthoses are shoe inserts designed to support, align or improve the function of the foot. They are commonly referred to as ‘orthotics’ and fit comfortably inside your shoes.

There are many different types of orthoses. The orthoses recommended by your podiatrist are prescription devices, custom-made to suit your individual needs and biomechanics (the way your body moves).

Who wear orthoses?

People of all ages with a variety of foot and lower leg problems wear orthoses.

Sportspeople are often prescribed orthoses by their podiatrist to help maximise their performance, as well to address biomechanical problems.

Anyone suffering from a chronic foot or lower limb condition that is limiting their mobility or independence may benefit from wearing orthoses.

When are orthoses used?

Your podiatrist may prescribe orthoses for your particular foot problem after a comprehensive assessment, taking into account your own biomechanics, footwear and occupational and lifestyle factors.

Orthoses provide valuable long-term solutions in the treatment and prevention of corns, calluses and ulceration by redistributing the pressure of the body’s weight on the feet.

Orthoses can also help with rehabilitation of acute and chronic foot conditions such as tendonitis, recurrent ankle sprains, and stress fractures by providing consistent postural control.