Podiatry

Podiatry

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At Bodycare Podiatry our personalised approach to diagnosis and management of your foot condition is aimed at ensuring a prompt return to your sport, work or improving your overall health.

Sports and Biomechanics

Podiatrists assess, diagnosis and treat any musculoskeletal ailments of the foot, ankle and lower leg related to weight bearing activity. Foot malfunction can extend as far as the knee, hip and lower back. From elite athletes, recreational participants, and to those who spend a lot of time on their feet, the correct foot and leg alignment is crucial in keeping you active and performing at your best.

Musculoskeletal and biomechanical assessment involves identifying the specific anatomy in question and finding the key underlying risk factors contributing to the injury. Video treadmill gait analysis is used to identify specific functional anomalies both walking and running.

Treatment may include stretching and strengthening programs, modified training programs, appropriate footwear changes, orthotic therapy, and possible referral to other highly trained health care professionals, such as Physiotherapists and Sports Physicians.

Bodycare Podiatrists Specialise in:

SHOCK WAVE THERAPY (NEW to Bodycare Podiatry)

The latest technology in shock wave therapy delivers high-energy pressure waves to damaged tissue via the skin. This activates your body’s self-healing process where pain occurs and increases metabolic activity through increased circulation.

Ask your Podiatrist whether shock wave therapy will accelerate your healing!

Achilles tendinopathy

Achilles tendinopathy is a broad term that covers painful conditions that cause damage to the Achilles tendon, characterized by a focal loss of normal fiber structure. The two main areas of damage are the Achilles midportion and the Achilles insertion. The cause, symptoms and treatment of each condition may differ and they will therefore be described separately.

Symptoms

Midportion

Pain in the Achilles tendon that can be of sudden or gradual onset. Severity of the pain is widely varied causing minimal to severe disability. With clinical assessment, pain is commonly felt with palpation or squeezing the Achilles approximately half way up the tendon.

Insertional

Pain is located at the base of the posterior heel given the close relationship between the insertion of the tendon, the bursa at the back of the heel and the heel bone. There may be a bony prominence and inflammation at the site.

Causes

Injury of the Achilles occurs when the load applied to the tendon exceeds its capacity. This may occur in a single episode or over a period of time i.e. with overuse. Latest research suggests this occurs without the presence of inflammation; however inflammation of surrounding structures may occur, particularly with insertional tendinopathy.

Common causes of overuse in the Achilles may include:

  • years of running
  • increase in training or activity (speed, distance and gradient)
  • decrease recovery time between runs
  • excessive foot pronation (inward roll)
  • running on a cambered surface
  • soft footwear
  • calf muscle weakness

 

Treatment

Midportion

The focus of treatment for midportion tendinopathy is to strengthen the tendon and promote healing. The following may be prescribed by a podiatrist:

  • Heel drop exercises
  • Nitric oxide donor therapy (GTN patches for 12-24 weeks)
  • Soft tissue therapy and electrotherapy (including shock wave therapy)
  • Orthotics to correct foot posture
  • Sclerosing injections and surgery

 

Insertional

Isolated treatment for insertional tendinopathy is less successful than for midportion tendinopathy.
However, combined exercises and injections may be useful.

Treatment for insertional Achilles tendinopathy should focus on unloading the region. This may achieved by wearing heel lifts worn inside both shoes and/ or with the use orthotics to correct foot posture. Night splints may also be used to maintain the ankle at 90 degrees during sleep.

Other treatment may focus on symptoms arising from the retrocalcaneal bursa, including:

  • Non-steroidal anti-inflammatory medication
  • Cortisone injections into the bursa
  • Surgery in the presence of a Haglund’s deformity or bursitis when conservative measures fail

For chronic pain tendon pain for longer than three months shock wave therapy may be recommended to promote healing of the tendon. Shock wave therapy is new to Bodycare Podiatry.

Big toe arthritis

Osteoarthritis is the most common type of arthritis involving wearing of the cartilage between bones. The big toe or “hallux” is a common site of osteoarthritis in the foot. It generally starts slow, but worsens over time.

Symptoms

Arthritis causes inflammation which may present as swelling and pain around the big toe. The toe may also have restricted upward movement cause by secondary bone spurs or loss of joint cartilage. Other symptoms may include: tenderness, achiness and difficulty walking.

Causes

You are more likely to develop osteoarthritis if you have a family history of it. The risk of OA increases as you get older due to normal wear and tear on the big toe. Common causes may include: trauma, excessive foot prontation (rolling in) and prolonged weight bearing.

Treatment

Osteoarthritis is progressive and permanent At present, little can be done to ‘undo’ damage at the big toe. X-rays may help grade the severity of the damage. Your podiatrist will assess the need for an x-ray.

Short term treatment may consist of the following:

  • Avoidance of aggravating activity and running of soft surfaces
  • Shoes with a stiff or rocker bottom sole

Podiatry treatment may consist of:

  • Strapping the toe to reduce movement where required
  • Splints of braces
  • Custom made orthotics to control foot pronation and reduce load on the big toe
  • Anti-inflammatory medication
  • Cortisone injections into the joint to reduce inflammtion
Toe clawing

Bent toes in an odd position are generally due to tight muscles underneath the foot. Tight or ill-fitting shoes can cause the muscles of the foot to become out of balance.

Toe clawing can be broken down into three categories:

Hammer toe– the toe bends at the middle joint (most commonly at the second toe).
Claw toe– the toe bends up at the joint in the ball of the foot where the toes meet the foot. The toes then bend down at the middle and end joints.
Mallet toe– the toe is bent at the joint closest to the tip of the toe.

Symptoms

Toes that are bent back or sit in an odd position. They are often associated with corns and callous caused by pressure from shoes.

Causes

During the ‘push off’ phase of gait the long flexor tendons contract to stabilize the toes. When the foot is overpronated (rolled in) and unstable, the tendons contract excessively causing the toes to claw.

Genetics can play role in some cases of toe clawing, as does trauma, infection, arthritis, and certain neurological and muscle disorders.

Treatment

Restoring foot biomechanics and function via footwear and orthotics is particularly important to prevent progression of deformity. Small pads can be used under the ball of the foot to help straighten the toes. Bodycare Podiatry also has a range of gel toe cushions to prevent rubbing on shoes leading to corns and callous.

A surgical referral may be considered in cases of severe deformity.

Ingrown toe nails

The medical term for an ingrown toenail is onychocryptosis.  They occur when the side or corner of the nail grows into the skin at the side of the toe. This is most common at the big toe, however can occur on any toe.

Symptoms

Pain at the nail edge in response to light pressure may indicate an ingrown toenail. Pressure from bed covers may cause pain at night and make getting to sleep difficult.

Causes

Ingrown toe nails arise from abnormal nail growth, poor cutting technique, or direct trauma to the nail.
They may sometimes occur after complete loss of a toenail if growth of the new nail is affected.

Treatment

Conservative podiatry treatment involves gently removing the ingrown piece of nail or ‘nail spike’ with nail clippers. Antibiotics may be required if the toe is infected.

For painful nails local anesthetic may be used to numb the toe before the nail edge is cleared. If the ingrown piece continues to grow back your podiatrist may recommend a surgical procedure call a ‘partial nail avulsion’.  This allows the ingrown edge to be permanently removed and is performed in the podiatry treatment room.

Medial tibial stress syndrome (shin splints)

‘Shin splints’ is an umbrella term for lower leg pain that occurs below the knee. Medial tibial stress syndrome is a more accurate term to describe pain originating from the inside of the leg. It is a common cause of leg pain in runners due to increased stress and muscle traction on the inside of the tibia.

Symptoms

Patients will experience diffuse pain across the inside boarder of the shin which usually decreases with warming up. Sharp pain at a very specific point and that does not go away with rest may indicate a stress fracture.

Causes

Factors that cause increased strain on the shin include: excessive foot pronation (flat feet), inadequate stretching, worn shoes, muscle fatigue and training errors. MTSS can often be summarized by four words: too much, too soon.

Treatment

Treatment for medial tibial stress syndrome is based on symptomatic relief, identifying risk factors and treatment of pathology. Symptomatic treatment consists of:

  • Rest, ice and anti-inflammatory medication
  • Avoidance of aggravating activity and running of soft surfaces
  • Cross training (swimming or cycling)
  • Correctly fitted running shoes (ask your podiatrist)

Treatment for risk factors may be:

  • Correcting training errors
  • Strapping the foot to support the arch
  • Orthotics
  • CAM boot or immobilization (resistant cases)

To treat pathology and stimulate healing the following may be considered

  • Shockwave therapy (new to Bodycare Podiatry)
  • Massage and dry needling
  • Injection therapies
Peroneal tendinopathy

Peroneal tendinopathy is the most common cause of pain on the outside of the ankle resulting from overuse. There are two peroneal tendons that cross the lateral ankle joint to insert to the outside of the foot and under the foot at the base of the first toe. Damage of the tendons may the result of acute injury (ankle sprain) or by overuse.

Symptoms

Pain on the outside of the ankle that is aggravated by activity and relieved with rest. Local tenderness directly over the tendons is common with clinical assessment. Resisting the outward movement of the ankle can often reproduce a patient’s symptoms.

Causes

Tendon injury may be the result of overuse i.e. over training or acute injury. Tendinopathy is a broad term that covers painful conditions that cause damage in and around tendons. Latest research suggests this occurs without the presence of inflammation; however inflammation of surrounding structures may occur.

Common causes of overuse in the peroneals may include:

  • excessive foot eversion (outward roll)
  • excessive foot pronation (inward roll causing the tendons to press together)
  • running on a cambered surface
  • soft footwear
  • tight calves
  • sports involving high activation of the peroneals i.e. jumping and side to side movements (e.g. basketball, netball and volley ball)

Treatment

Initial treatment should involve relative rest from aggravating activities, soft tissue therapies and massage. Pain medication and bracing of the ankle may also be required in the short term.

Your podiatrist will assess you current running shoes to ensure appropriate support. Lateral wedges can be prescribed to reduce tension through the tendons. Progression to foot orthotics may be needed for long term support and lateral stability. Ankle exercises will also be prescribed to strengthen the tendons.

For chronic pain tendon pain for longer than three months shock wave therapy may be recommended to promote healing of the tendon. Shock wave therapy is new to Bodycare Podiatry.

Plantarfasciits

The plantar fascia is a thick band of connective tissue (collagen) that starts from the heel and inserts into the toes. It supports the arch and provides dynamic shock absorption. Plantarfasciits is an overuse condition where the collagen of the plantar fascia is damaged in the absence of inflammation. This can occur in the arch or heel of the foot.  The condition can therefore be more accurately referred to as plantarfasciosis.

Symptoms

Pain is usually of gradual onset and can feel like a sharp stab or deep ache, most commonly in the heel of the foot. It is often worse of a morning (first step pain) and settles down with activity as the area warms up. Pain may be present post-activity and after long periods sitting down.

Causes

Patients with very high arches or low arches are at risk of developing plantarfasciitis. This can be due to poor shock absorption or increased strain on the plantar fascia respectively.  Over training, running on hard surfaces, wearing old shoes or tight calf muscles and Achilles tendons may also contribute.

Treatment

Plantarfasciits is a persistent condition which gets worse and more difficult to treat the longer it’s present.  Short term treatment may consist of the following:

  • Avoidance of aggravating activity and running of soft surfaces
  • Correctly fitted running shoes
  • Avoidance of walking barefoot
  • Stretching the plantar fascia and Achilles tendon
  • Icing and massaging the foot with a golf ball

Podiatry treatment may consist of:

  • Strapping the foot to support the arch
  • Orthotics
  • Cortisone injections
  • Night splints
  • Anti-inflammatory medication

Chronic pain for longer than three months may also benefit from

  • Shockwave therapy an FDA approved treatment for plantarfasciits (new to Bodycare Podiatry)
Ankle Sprains

Ankle sprains are a common sporting and mishap injury. Usually the injury involves stretching or tearing the outside ligaments of the joint which will happen when the ankle rolls inwards. Occasionally the inside ligaments can be injured when impact is high or when the ankle is moved forcefully outwards.

Symptoms

Pain on the outside of the ankle following injury is most common. Bruising and swelling may also be present depending on the severity of the injury. Ankle sprains can also lead to injury of the peroneal tendons on the outside of the ankle, fracture of foot or leg bones and damage to the cartilage and ligaments inside the ankle.

Causes

Ankle sprains may occur during sports that involve jumping and side to side movement e.g. Football, basketball, netball and tennis. Mishap injuries can result from falling from a height, tripping over , and the use of high heeled shoes.

Initial treatment

  • Rest immediately post injury to allow the area to settle. It is common for swelling to be quite bad
  • Ice for 20 minutes every 2 hours
  • Use a bandage to compress the ankle
  • Elevate the ankle above the level of the heart e.g. lying with the foot propped up
  • Review by a health professional (e.g. Podiatrist or Physiotherapist) if you are unable to take weight on the affect leg
  • If you are unable to take weight on the leg or tolerate it being touched, there may be a fracture in the area which will require x-ray and immobilisation. Bodycare Podiatry has CAM walker boots available onsite.

Depending on the severity of the ligament injury, a rolled ankle generally takes 3-6 weeks to resolve enough to be pain free. However it is very common for ankle to have poor balance following injury.
Podiatrists and physiotherapists can guide return to sport with exercises to develop stability of the joint. This is particularly important in reducing the likelihood of repeat ankle sprains, which reduce the long term strength of the ankle.  Your Podiatrist will also be able to provide activity specific footwear advice, to ensure appropriate support.

Bunions (hallux valgus)

Bunions or hallux valgus are a lateral deviation of the big toe at the first metatarsal joint. They are not growths as is the common misconception; however do become more prominent as the deformity progresses.

Symptoms

Swelling, pain and redness at the big toe joint may be due to the presence of a bunion. Enlargement of the tissue around the joint may be due to secondary bursitis. The increased pressure under the metatarsal phalangeal joint can also lead to skin lesions like corns and callous. As the bunion progresses, pain across the outside of the ball of the foot may occur due to the improper function of the hallux.

Pain is typically relived by removing shoes or by wearing open toed/ wide fitting footwear.

Causes

Patients with bunions usually have a family history of the condition. Tight footwear and high heeled shoes also apply a force to change the position of the toe. Excessive foot pronation (rolling in) and tight calves/ Achilles will also be assessed for by your Podiatrist.

Treatment

Padding the toe and wearing wide fitting shoes will help reduce pressure on a bunion. Correction foot function with orthotics is very important. They will not only improve patient comfort, but can reduce the rate in which the bunion progresses. Surgery is the only way to ‘correct’ a bunion via reconstruction of the first metatarsophalangeal joint. Ask your Podiatrist whether surgery is right for you!   

Corns and calluses

Excessive pressure on the skin may cause a thickening of the outer layer which presents are corns or calluses. A callus is a diffuse area of thickened skin, whereas a corn is more localized and conical in shape. Both are common overlying bone prominences of the feet or between the toes where pressure in high. Excessive perspiration or moisture can lead to ‘soft corns’.

Symptoms

Skin lesions on the feet or toes that cause pain with direct pressure may be to a corn or a callus.

Causes

Factors that contribute to increase pressure causing the skin to thicken include:

  • Abnormal foot anatomy such as clawed toes, hammer toes and bunions
  • Footwear that is too small or too tight
  • High heeled shoes
  • Abnormal gait and foot posture

Treatment

Involves lightly and painlessly debriding the circumscribed corns and diffuse area of callus with a scalpel.
Treatment is then aimed at offloading the area to reduce pressure and prevent the corn or callus growing back.

Footwear must be well fitted with enough room for the toes to ‘wiggle’.

Podiatrists may use:

  • Padding to offload boney prominences
  • Protective digital coverings
  • Silver nitrate which is corrosive and destroys skin cells
  • Orthotics for long term pressure relief
Patellofemoral Pain Syndrome

Patellofemoral pain is a medical term used to describe all pain at the back of the patella (knee cap) where it articulates with the femur (thigh bone).  It is one of the most common knee complaints in both active sports people and the elderly

Symptoms

Non-specific or vague pain is often reported. This may be on the inside, outside or at the base of the patella and made worse by activities that load the patellofemoral joint (PFJ). Sitting for prolonged periods and walking up or down stairs usually aggravate the symptoms.

Causes

Factors that increase PFJ load lead to the development of pain. These can be both extrinsic and intrinsic.

Extrinsic factors include: body mass, speed of gait, training surfaces and footwear. Training errors are also common such as high training volume, increased speed of running, and running up and down hills/ stairs.

Intrinsic factors are those that impact on the movement of the patella within the femoral groove (patella tracking). These include: muscle weakness sand/or imbalance, inward rotation of the knee and leg, high knee valgus and a pronated foot type.

Treatment

Treatment of patellofemoral pain involves addressing the both the extrinsic and intrinsic cause of pain.

Immediate treatment should focus on the reduction of pain and inflammation including rest from aggravating activity, icing and stretching.

Extrinsic factors must be addressed and modified if necessary

  • Reduce training volume
  • Running on soft surfaces
  • Running on flat ground

Intrinsic treatment should occur early on with a health professional and may include:

  • Improved soft tissue compliance
  • Patella taping and braces
  • VMO and glute strengthening
  • Footwear and in-shoe foot orthotics
Morton’s Neuroma

Morton’s interdigital neuroma is a swelling or irritation of a nerve usually between the third and fourth metatarsals of the foot. It can often be associated with intermetatarsal bursitis, which may also cause compression of the nerve.

Symptoms

Patients may describe a burning pain that extends from the forefoot to the toes. There may also be associated pins and needles or numbness. Symptoms are generally made worse with the use of tight shoes.

Causes

Excessive foot pronation can contribute to hypermobility of the metatarsal heads and impingement of the nerve. Tight shoes and stiletto heels also increase the load applied to the forefoot and compression of the nerve.

Treatment

Initial treatment includes icing and avoiding the use of tight and occlusive footwear. Padding applied to the metatarsals can help to spread the load and redistribute pressure across the forefoot. In chronic cases injections of local anesthetic and cortisone may be used in conjunction with padding. The use of foot orthotics is often very important if excessive foot pronation is identified by your podiatrist as a likely cause.

Plantar warts

Plantar warts are warts that occur on the bottom of the foot. They are very common and are produced by an infection of the skin by the human papillomavirus (HPV). They can affect anyone but are very common in children 12-16 years of age.

Symptoms

Plantar warts can often be painless but may be tender in areas of pressure or friction. Firm bumps on the foot with dark spots (blood vessels) and a ‘cauliflower-like’ appearance may indicate a wart.  Several warts may fuse together to form a mosaic wart.

Causes

The human papillomavirus infects only the superficial layers of the skin and produces a thick callous-like growth. It spreads via direct contact.

Risk factors include: the use of public showers, skin cuts and a weakened immune system.

Treatment

Plantar warts can be treatment in many different ways including home remedies.  In some cases they may resolve by themselves, but treating them is preferred to prevent further spread of infection.

Multiple treatments may be required to ensure complete resolution of the wart. Podiatry wart treatments include:

  • Silver nitrate which is corrosive and destroys skin cells
  • Cryotherapy (liquid nitrogen) to freeze the wart
  • Salicylic acid to burn the wart
  • Cantherone plus which forms a blister under the wart and cuts off its blood supply
  • Percutaneous needling, in which the wart is repetitively needled under local anesthetic to disrupt pathological tissue and induce bleeding

Other end stage treatments may include:

  • Laser treatment to destroy the wart
  • Curettage (cutting the wart out)
  • Skin patches and medication to create an immune response
Stress fractures

A ‘stress fracture’ is a micro fracture or small crack in a bone due to repetitive loading, often by overuse. The applied load is less than that required for a single fracture. They are most common in weight bearing bones of the foot and leg, and result from impact forces or the action of muscles pulling across the bone

Symptoms

Patients with a stress fracture may experience localized pain and tenderness over the fracture site that generally improves with rest. Swelling may also be a feature of a stress fracture and pain at night is a common compliant. The most common bones affected are the tibia, metatarsals, fibula and navicular.

Causes

Stress fractures are cause by force place on a bone overtime that are greater than the bone can bear. Most commonly this is a result of overuse in athletes, but may also be due to environmental factors such as the use of high heeled shoes. Conditions that weaken bones including osteoporosis will also be considered by your podiatrist.

Treatment

The majority of stress fractures heal within six week. Treatment generally requires the avoidance of weight bearing activity. CAM walker boots are often used to immobilize and offload the bone. These allow the patient to continue to weight bear.  Crutches may be prescribed early on in your recovery

CAM walker boots are available on site at Bodycare Podiatry

Tibialis posterior tendinopathy

The tibialis posterior tendon functions to control or decelerate foot pronation (rolling in). The tendons are dynamic stabilisers of the rearfoot and help support the arches of our feet. Tibialis posterior tendinopathy is the most accurate term to described overuse conditions of the tendon characterized by tissue damage.

Symptoms

Pain on the inside of the ankle (behind the ankle bone) that extends towards the insertion point at the top of the arch. Swelling may be present in more substantial cases.  Local tenderness directly over the tendons is common with clinical assessment. Resisting the inward movement of the ankle can often reproduce a patient’s symptoms. Patients may also have difficulty performing a single leg heel raise.

Causes

Injury of the tibialis posterior tendon is usually the result of overuse rather than acute injury. Tendinopathy is a broad term that covers painful conditions that cause damage in and around tendons. Latest research suggests this occurs without the presence of inflammation; however inflammation of surrounding structures may occur.

Common causes of tibialis posterior tendon overuse may include:

  • excessive foot pronation (inward roll)
  • excessive walking, running or jumping
  • direct or indirect trauma (i.e. eversion sprain)
  • inflammatory conditions (e.g. rheumatoid arthritis)

Treatment

Treatment of tibialis posterior tendinopathy is dependent on the classification (severity) of the injury. Conservative treatment should involve relative rest from aggravating activities, icing and exercises to load the tendon. Pain medication may also be required in the short term.

A rigid custom made foot orthotic may be prescribed to control excessive foot pronation. In severe cases your podiatrist may recommend a period of immobilization in an ankle brace or air cast.

For chronic tendon pain for longer than three months shock wave therapy may be recommended to promote healing of the tendon in the absence of tendon tears. If the tendon ruptures and conservative measures fail surgery may be required.

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