Blog Archives

Flat feet- Children’s feet | The Podiatrist and yourfeetnz

 

podiatrist-podiatry-feet-auckland-caron-orelowitz1.jpg

Children with flat feet, also called pes planus, have a flattening of the arch during standing and walking.

Flat foot is normal in infants and young children. At this age, in the absence of any associated symptoms, treatment is highly debatable.

Flat foot usually naturally corrects itself as muscles strengthen and soft tissues stiffen. The height of the arch in the foot increases with age until about 9 years. The problem is when flat foot persists, spontaneously occurs in older children or later in life, or is associated with pain and disability.

Flat feet can be flexible or rigid, painful or painless and associated with a tightness of the calf muscles (Achilles tendon). The majority of flat feet are painless, but when pain is present it is usually during weight-bearing activities such as walking and running. The pain can be in the sole of the foot, the ankle, or non-specific pain all around the foot area.

 

What causes flat feet?

A complex and sophisticated interaction of bones, ligaments, muscles and nerves within and above the foot defines its anatomy and function. Anything that interrupts the integrity of these structures leading to a collapsed arch can cause symptomatic flat feet.

Examination of the foot begins with an examination of the entire child, because the flat foot may have an underlying cause.

Flat foot can also originate from unusual anatomy such as a tarsal coalition (bones joined together), ligament or muscle damage, restricted ankle movement, outward rotated lower legs, and knock knees (where the legs bow inwards at the knee). Obesity can result in collapse of the arches by the increased load on the foot. If knock knees also develop, the middle of the foot will tend to turn out (abduct). The foot will point outwards when walking, instead of straight ahead, which is inefficient and can cause early fatigue.

Footwear in early childhood has been thought to cause flat foot. It is likely that children who wear shoes, are not physically active and have flat feet will have decreased muscle activation in their feet and thus impaired foot function and weakness.

Some older children and adolescents develop flat feet in the absence of any disorder or associated factors.

 

Does flat foot need to be treated?

Flat feet require treatment only if clearly associated with pain or decreased function. Managing the underlying cause or disease is of highest priority; just treating the symptoms should be secondary.

If flat foot is observed in a child who is overweight and has knock knees, or in a child with excess joint flexibility and poor footwear, each of these factors could be contributing to the symptoms, and each should be addressed.

If a child’s quality of life is affected by how their feet look, feel or function, then the associated issues should be addressed.

For any foot problems, contact The Podiatrist.

http://www.thepodiatrist.co.nz

http://www.kidsnmotion.co.nz

5 quick and easy tips to healthy feet and legs | The Podiatrist and yourfeetnz

one pair has to last a lifetime

There are many causes of leg pain right from muscle cramps and inflammation of tendons to arthritis, varicose veins and nerve damage. Leg pain due to muscle strain following an injury or wearing tight shoes for a long time can be prevented by following few simple tips:

  1. Stretch the leg muscle: One of the most effective ways to prevent leg pain due to a sudden muscle twist or cramp is to stretch the muscle. This not only improves blood flow to the injured muscle but it also helps in reducing muscle tension thereby relieving muscle soreness.
  2. Take a warm shower: If you suffer from leg pain, then take a warm shower to relax the muscles. If taking a bath is not feasible, then placing a heating pad on the affected areas can also help. A heat pack works best if the pain is due to a previous injury as it not only relaxes blood vessels but also improves blood circulation, alleviating leg pain.
  3. Wear a proper fitting athletic shoe: Most people fail to choose the right fitting shoe, which is one of the common causes of leg and heel pain. To get the right fit, determine the shape of your foot using the ‘wet test’. For this, step out of the shower onto a surface that will show your footprint, like a brown paper bag. If you have a flat foot, you will see an impression of your whole foot on the paper. If you have a high arch, you will only see the ball and heel of your foot. When shopping, look for athletic shoes that match your particular foot pattern.
  4. Choose the right sports shoe: Not many people are aware that different types of shoes are specially designed to meet your sports requirement. Did you know running long distances in court-style sneakers can contribute to shin splints? It is important to choose the shoes according to your sport or fitness routine.
  5. Go slow if you are a beginner at the gym: One of the common mistakes that most people commit is to overexert on the first day of the gym, which not only exerts pressure on the knee but also causes muscle soreness and leg pain. The key to preventing leg pain and sticking to your workout routine is to build your fitness level slowly. You can start off with less strenuous workouts and then gradually increase the duration, intensity, and frequency of your exercise regimen.

For any foot problems, contact The Podiatrist.

http://www.thepodiatrist.co.nz

 

Stretch and Stretching | The Podiatrist and yourfeetnz

holding each stretch for 30 secs

Stretching properly is a little more technical than just swinging your leg over a park bench. There are methods and techniques that will maximize the benefits and minimize the risk of injury.

Which muscles should be stretch?

As a general rule; if it’s not tight and it’s not causing you any problems, you don’t need to stretch it. There are a few exceptions to this (such as athletes that require increased flexibility for their chosen sport), but for most people this is a wise rule to follow. So if you perform a stretch and you don’t feel any tension in the target muscle group, this would indicate that you’re not tight in that area.
As you start to notice which muscles are tight and which muscles aren’t, aim to create a balance of flexibility between the front of your body and the back of your body, and the left side of your body and the right side of your body.
For example, if you notice that your right hamstring muscles are tighter than your left hamstrings muscles, work on the right hamstring muscles until you have even flexibility in both

When to Stretch?

Most people understand the importance of stretching as part of a warm-up or cool-down, but when else should you stretch? Stretch periodically throughout the entire day. It is a great way to stay loose and to help ease the stress of everyday life. One of the most productive ways to utilize time is to stretch while watching television. Start with five minutes of marching or jogging on the spot then take a seat on the floor in front of the television and start stretching.

Should I Stretch Every Day?

Firstly, we need to make a distinction between doing a few gentle stretches and doing a more intense flexibility training session. Take regular “Stretch Breaks” throughout the day to keep loose and limber. However, a more intense flexibility training session is another thing altogether.

Hold, Count, Repeat

For Static and Passive stretching, some text will say that holding a stretch for as little as ten seconds is enough. This is a bare minimum. Ten seconds is only just enough time for the muscles to relax and start to lengthen. For any real improvement to flexibility, each stretch should be held for at least twenty to thirty seconds, and repeated at least two or three times.

For all your foot problems, contact The Podiatrist
http://www.thepodiatrist.co.nz

Heel Pain: It may not be Plantar Fasciitis

structure if the heel- calcaneus

Heel pain affects a large portion of the population, often resulting in visits to The Podiatrist. Plantar fasciitis is typically the diagnosis the patient receives during the visit; however, plantar fasciitis is only one potential cause of heel pain. The plantar fascia is a strong, dense strip of tissue that runs from the heel to the ball of the foot. Its sole job is to support the arch of the foot. .
It is easy to see how the plantar fascia may be causing all this pain as the foot impacts the ground when you think about how often the full weight of the body is concentrated on the plantar fascia. This forces it to stretch as the arch of the foot flattens from the full weight of the body, possibly leading to stress where the plantar fascia attaches at the heel bone. If this keeps up, the result can be pain caused by small tears of the fascia.
If it is not the plantar fascia then what else could be causing my heel pain?
Calf muscle weakness (muscles on the back of the lower leg) can result in referred pain directly to the heel.This is seen after someone has changed/added a workout program or modified the type of shoes they wear. This adds additional stress to the calf muscles that they may not have been ready for and lead small areas of irritation in the muscles.>
Calf muscle tightness – this causes the connective tissue surrounding the muscle to pull harder on the Achilles tendon leading to tightness at the heel, possibly resulting in the pain you’re feeling.
Sciatic nerve irritation – the nerve that runs from the low back through the hip and down the leg to the foot can get tight or pinched not allowing the nerve to move easily as you walk. This can lead to irritation of the nerve causing pain that is located at the heel. This is very common for anyone with any history of low back pain or hip pain.
Poor Posture – if you sit slumped forward most of the day the muscles and structures from the back of your neck, upper back, lower back, and hips can get tight and shortened, consequently pulling on the heel.>
Weakness of the muscles around the hip can cause muscles in the leg to shorten to help stabilize, consequently pulling on the heel.>
Why is this so confusing?
It may be hard for you to pinpoint the cause of heel pain yourself because the symptoms are the same for all of the above listed causes. No matter what the cause, you will experience pain on or around the heel when weight is placed on the foot. This is usually worse in the morning, especially with the first few steps after getting out of bed. In most cases, there is no pain at night, but this is not a rule as many of our patients report increased pain at night. Pain of typical plantar fasciitis is typically believed to decrease over the course of the day as the tissue warms up; however, patients have also reported increased discomfort as the day progresses, leading on to investigate other areas as the source or cause. Additionally, prolonged standing, walking, or getting up after long periods of sitting are commonly reported with all of the above causes. Again, the reports can be as varied as the potential causes.
Activities that make the pain worse:
Excessive running or jumping
Changing physical activity (especially for athletes)
High arches, flat feet, abnormal gait
Wearing improper shoes while walking or running
The Steps to Relieve Heel Pain
In most cases, heel pain does not require surgery and can be treated conservatively, but the first step is to obtain an evaluation by The Podiatrist who can help pin point the actual cause of the pain that’s specific to you. It is important to not treat the symptom of heel pain, but to isolate and treat the cause.
The Podiatrist may then recommend treatment , depending on the needs of your particular condition. In extremely painful conditions, your doctor may prescribe anti-inflammatory medications, and in severe cases give you a cortisone shot to address excessive inflammation.
Most people with heel pain get better with the help of The Podiatrist, but don’t wait. The longer you “live” with the pain the longer it may take to get rid of it as your body adapts. Most acute cases (less than 30 days) can get better within 6-8 weeks. Additionally, treatment should include activities that directly address the cause of your heel pain and are designed to include you in the healing process, so your participation is critical.
The Podiatrist specializes in the treatment and management of all foot related problems and will assess what is the cause of your foot/heel pain, not the symptom.
For more information or to find out if you are a good candidate for our services contact The Podiatrist
http://www.thepodiatrist.co.nz

Pediatric Heel Pain- Heel pain in Children

Children are resilient, but when your child begins to complain about heel pain, this must be taken seriously. Heel pain in a child is not normal. There are different causes of heel pain in a child and an adequate physical exam can help determine which type of heel pain is affecting your child.

 

What Is Calcaneal Apophysitis?

The most common cause of pediatric heel pain is calcaneal apophysitis (an injury or irritation to the growth plate of the heel). Typically, this occurs in boys (and girs) between the ages of 8 and 13 who are fairly active children. This is most likely to occur with a rapid increase in activity after a period of rest – such as starting rugby, soccer, netball and any in fact and sport practice after being off for a peiod of time.

Are There Other Causes of Pediatric Heel Pain?

Yes. Calcaneal apophysitis is the most common cause of pediatric heel pain. However, there are other things that can cause the heels to hurt such as stress fractures, growth plate fractures and hematagenous osteomyelitis, an infection of the heel bone.

Causes of Calcaneal Apophysitis

Causes of pediatric heel pain include:

  • Rapid increase in physical activity (sports)
  • Changes in training surfaces
  • Changes in training techniques
  • Changes in shoe gear (or going barefoot) while being physically active
  • A rapid increase in growth over a short period of time

During periods of rapid growth, the bones of the leg grow faster than the soft tissues (muscles, tendons and ligaments) and the stress they place across the growth plate can cause pain and inflammation.

Symptoms of Calcaneal Apophysitis

Calcaneal apophysitis typically affects active boys and girls between the ages of 8 and 13; however, this condition can affect any active child. Early signs and symptoms include:

  • Limping
  • Inability to participate in athletic activities
  • Walking on the toes to keep the heel from touching the ground
  • Pain in the heel that is worse after activity and relieved by resting

Diagnosis

The Podiatrist will start your exam with a thorough history. This will be followed by a physical exam. During your physical exam, The Podiatrist:

  • Pain and tenderness to the area of the inflamed growth plate
  • A tight heel cord (Achilles tendon)
  • Overall foot structure
  • Abnormalities in gait

X-rays may be ordered to detect any underlying bone abnormalities.

Treatment

Calcaneal apophysitis can be easily treated with changes in shoe gear, resting, icing, stretching and anti-inflammatory medications. Sometimes, physical therapy may be necessary, but this is rare.

Many times these types of injuries are unavoidable, but proper athletic shoes, stretching exercises and avoidance of obesity are some of the ways one can prevent an injury to the growth plate.

See The Podiatrist for expert care.

www.thepodiatrist.co.nz

www.kidsnmotion.co.nz

 

 

Quality Paediatric Foot Care at Kids ‘n Motion Podiatry

Kids ‘n Motion Podiatry- Leading Podiatrist in Children’s Foot Problems, invites parents to bring their children into the one of its kind in Auckland- a child specific Podiatry practice. The clinic has a friendly environment and is ideally set up for assessing children of all ages (lots of fun activities). Parents are asked to be cautious of the health of their children’s feet to help maintain a healthy, active life style.

Children with strong, healthy feet avoid many kinds of lower extremity problems later in life. That is why it is important to inspect your children’s feet periodically. If a problem is suspected, I encourage you to bring your children into the clinic for evaluation. It is always our joy to make sure our paediatric patients remain fit, and active with healthy feet.

The size and shape of an infant’s feet change quickly during their first year. Because a baby’s feet are flexible, too much pressure or strain can affect the shape of their feet. It’s important to allow an infant to kick and stretch their feet freely. The Podiatrist also suggests that parents make sure their baby’s shoes and socks do not squeeze the toes, as this can cause painful foot conditions.

For toddlers, it is important to not force them to walk before they are ready. Once walking begins naturally, watch the toddler’s gait. Many toddlers have a pigeon-toe gait, which is normal. Some will initially learn to walk landing on their toes instead of their heels, but most children outgrow both of these problems. The Podiatrist informs parents that conditions detected early can be treated more easily than waiting for pain to occur.

The foot’s bone structure is well-formed by the time children reach age seven or eight, but if a growth plate (the area where bone growth begins) is injured, the damaged plate may cause the bone to grow oddly. With The Podiatrist’s care, however, the risk of future bone problems is reduced.

The Podiatrist urges parents to check their child’s show size often, making sure there is space between the toes and the end of the shoe and that the shoes are roomy enough to allow the toes to move freely. Whether children are experiencing heel pain, knee pain, or any other conditions, The Podiatrist invites parents to bring their children in.

Kids ‘n Motion Podiatry is committed to providing patients with exceptional care.

www.kidsnmotion.co.nz

http://www.thepodiatrist.co.nz

Children’s Feet Require Your Special Attention

Patients often have questions for The Podiatrist if they notice something unusual about their child’s feet or the way the child walks or runs. For many years, the most common pediatric foot problem seen in doctors’ offices has been in-toeing, especially whenever the child is observed while running.

Let’s briefly discuss several of the more common paediatric foot conditions that result in the feet turning inwards, as well as how these conditions can (and should) be managed by The Podiatrist.

A case relating to paediatric in-toeing often begins when the parent reports an abnormal appearance of the child’s foot, an awkward gait or a “clumsiness,” with a tendency to trip or fall. A structural and biomechanical examination of the lower extremities – including watching the child walk – will allow for differential diagnosis and appropriate treatment recommendations. In-toeing is generally caused by the following three conditions, whose corrective timing and treatment considerations vary.

Tibial Torsion

Tibial torsion is a common condition in which the tibia has not completed its external rotation to normal adult position (resulting, therefore, in a lack of normal torsion). The key to diagnosis is the closed-chain postural evaluation. On standing examination, the child’s knees face forward while the ankles and feet turn inward.

The natural history of tibial torsion is a gradual normalization with growth and use of the lower leg muscles. Most cases resolve by 2 years of age, but rotation values continue to increase an average of 1.5 degrees a year up to age 6. By age 7, the vast majority of children have achieved normal adult position.There is a familial tendency among those who fail to reach normal values. When tibial torsion persists, compensatory pronation commonly develops.

Suggested Care:

Parents need to be involved in the care of their children. Train parents to frequently stretch the medial soft tissues of their child’s lower leg. Show them how to strengthen the peroneal muscles (using a home exercise program and an extremity rehab system) when the child is old enough to cooperate sufficiently.

In addition, recommend buying shoes for the child that have flexible soles and good support to decrease pronation stresses. In cases of hyperpronation, individually designed paediatric orthotics should be considered. Finally, recommend beneficial activities and sports that emphasize lower-leg training and coordination (such as soccer)

Femoral Torsion

Femoral torsion is an inward (medial) rotation of the entire lower leg that begins at the neck of the femur. It is a relatively common childhood condition, one which can be recognized by the medial facing of the knee as well as the ankle and foot. With walking, more than 90 percent will resolve by the 8th year.

Any persistence is thought to be due to ligament laxity of the hip joint capsule. In such cases, physical examination will find excessive passive internal hip rotation. Lumbar hyperlordosis, genu recurvatum, and hyperpronation are frequently associated.

 

Suggested Care:

Begin strengthening the external rotator muscles and extensors of the hip by using an extremity rehab system. Parents can passively stretch the hips into external rotation, and the child should be encouraged to sit cross-legged.

Let parents know that shoes with good support are very important. When hyperpronation is noted, individually designed stabilizing orthotics are indicated to prevent further problems. Also, encourage physical activities such as ballet, skating and bike riding – all of which tend to engage the external rotator musculature of the hips.

Metatarsus Adductus

Metatarsus adductus (also known as a “hooked foot”) is a contracture of the medial soft tissues of the foot. This condition has been found to be present in 6 percent of schoolchildren. On examination, the in-toeing can be passively stretched to normal, since there is no bony abnormality associated.

More than 90 percent of infants with this condition will resolve by the age of 18 months. When more than mild adduction persists beyond 1 year of age, a consultation with The Podiatrist or orthopedic surgeon for consideration of casting is appropriate. However, casting and special foot braces are seldom necessary.

Suggested Care:

Instruct parents to massage and stretch the medial soft tissues of the infant’s foot for several minutes following each diaper change. Frequent stretching is the key. Consider an evaluation by a specialist if significant adduction persists beyond 1 year of age, or if the deformity feels fixed and cannot be temporarily reduced with gentle stretching. Orthotics are needed only if mild adduction continues beyond age 7.

Footwear: What to Look for Developing feet require proper footwear. Whenever safety and comfort allow, going barefoot stimulates proprioceptors and encourages muscular coordination and strength. Children’s shoes should have flexible soles to allow for proper foot-joint movement (thick rubber soles may hamper and confine).

Proper shoe sizing and fit are critical, since the developing bones are soft and malleable. Tight, constricting shoes will interfere with normal growth and may result in deformity. Frequent evaluation of shoe size and fit (palpate the child’s foot for pressure points while they are standing with shoes on) is an important concept for parents.

When to Recommend Orthotics

As described above, the majority of paediatric foot problems will resolve with normal childhood activities, exercise and proper footwear. Orthotics are seldom needed in the early years of growth. If excessive pronation associated with in-toeing is seen to persist beyond the age of 7 or 8, or is responding poorly to home care interventions, individually designed stabilizing orthotics are appropriate.

The additional corrective support they provide will encourage normal development while preventing further deformity and reducing abnormal kinetic-chain stresses on the pelvis and spine during formative years. Parents will need to be educated to bring their child in for regular evaluations of orthotic fit and function, since children’s feet can rapidly outgrow any orthotic.

Serving the Next Generation of Patients

Parents need reassurance and appropriate recommendations when they bring in a child with a “foot problem.” In particular, in-toeing can raise concerns in parents and may be frustrating to athletically oriented children. Most of the common causes of in-toeing in children will resolve during normal growth and development, needing only home-care recommendations and monitoring by the family’s chiropractor.

As always, the child’s developing spine should be evaluated and appropriate Podiatic care is recommended. Specific home exercises may hasten the maturation and coordination of the support muscles. In some cases, paediatric orthotics may be needed to provide additional corrective stimulus.

Should you have any questions or concerns, seek professional advice before starting any homecare.

For more information, contact The Podiatrist

www.thepodiatrist.co.nz

www.kidsnmotion.co.nz

 

Did you know that June 1 was National Running Day?

Whether you take a leisurely jog or sprint to the finish line in a marathon, running is great exercise. In fact, running is one of the easiest and most popular sports among non-professional athletes.

Running offers many benefits, including improved cardiovascular and respiratory function, weight loss, reduced cholesterol and increased muscle and bone strength, as well as a healthier mental outlook. But with any sport or activity comes the risk of injury.

Runners of all levels are at risk for significant injuries to their hips, knees, legs, ankles and feet. One of the best ways to prevent injury is to avoid injury. By taking simple precautions and watching for signs of potential problems, individuals can prevent or minimize many injuries.

The majority of injuries are caused by excess — running too far, too fast or too often. In addition to strains and sprains, blisters and cramps, some of the more common injuries include:

· Hip and thigh injuries — Bursitis, stress fractures, and hamstring pulls or tears are typically caused by inflammation and strain from overexertion or
improper running techniques.

· Knee injuries — Patello-femoral syndrome, more commonly called “runner’s knee” is characterized by a dull ache or sharp pain under or around the  kneecap and is often accompanied by a grinding sensation when the knee is bent then straightened. Iliotibial Band (ITB) Syndrome can also produce inflammation and pain in and around the knee.

· Leg injuries — Shin splints or medial tibial stress syndrome is a cumulative but painful condition resulting from too much force being placed on
the shinbone (tibia) and surrounding tissues.

· Ankle injuries – Sprains vary in severity but typically result in pain, swelling and bruising. Achilles tendonitis is a painful inflammation in the back of the ankle, which if left untreated, can lead to a ruptured tendon.

· Foot injuries — Plantar fasciitis, which can cause sharp pain or a dull ache in the bottom of the foot near the heel or in the arch, is typically caused by poor foot structure, inadequate running shoes or a sudden increase in the distance run. Improper shoes and downhill running can also cause painful Runner’s toe.

The good news is that these injuries are treatable, but more importantly can be prevented or minimized by following some basic training guidelines and  running techniques.

Some tips to help you

Invest in a good pair of running shoes. Running in worn out shoes is a prime cause of many injuries. Make sure to replace them when you’ve logged about 600 kms.
Stretch regularly before and after you run to avoid tightening of muscles. Be sure to include stretches for the hips, thigh, hamstring, calf and ankle, as well as the back.

Perform warm up exercises such as light jogging or sprinting prior to engaging in a full run.

Include cross training in your overall exercise regimen to help strengthen a wide range of muscles. Consider activities such as weight-training, swimming,
calisthenics or those exercises that use muscles in slightly different ways.

Avoid overtraining – and overexertion. Doing too much, too soon and too quickly can lead to injuries. A good approach for beginners may be to start with a
run/walk technique, alternating thirty seconds of running with thirty seconds of walking for about twenty to thirty minutes, three times a week. Gradually,
increase the length of running segments while keeping them at a manageable pace.

· Stay hydrated especially in warmer weather. Drink at least 1 ½ cups of water 10-15 minutes before running and every 20 minutes during.
· Run on smooth, even and softer surfaces whenever possible. For example, asphalt roads are a better choice than concrete sidewalks.

· Watch for the warning signs of injury. If you begin to experience pain or swelling, stop running and seek medical attention. Depending on the type and extent of injury, treatment may include RICE – Rest, Ice, Compression and Elevation; taking anti-inflammatory medication (aspirin or ibuprofen); and taking time off from running.

– Seek professional advice from a Podiatrist if you are injured or have any concerns