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Conditions Treated:

The human foot is a biological masterpiece.  It comprises an intricate combination of 26 bones, 33 joints, over 100 ligaments, and a network of tendons, nerves and blood vessels working together to establish the graceful synergy that is walking and running.


Biomechanical anomalies in the feet lead to overuse of muscles and strain on ligaments and tendons both in your feet and further up your body.  Below is a short list of such injuries as well as other common causes of aches and pains.
 

Biomechanical Podiatry

 
 

Heel & Arch Pain (including Heel Spurs & Plantar Fasciopathy)

Heel and arch pain are the single largest causes of foot discomfort.  The pain usually presents as a result of faulty biomechanics (i.e. poor foot and leg alignment) when standing, walking or running.  Pain is typically worse in the morning or after periods of sitting, and often subsides after hobbling around for a few minutes. Then, if you spend enough time on your feet the pain returns.

 

Heel and arch pain is commonly attributed to damage to a structure, that runs the length of your arch, called the plantar fascia.  The plantar fascia is an incredibly strong connective tissue that attaches to the toes at one end, and to the bottom of the heel at the other (this is where heel spurs occur). 

 

Heel spurs are very common and very real but are generally not the cause of pain.  It is the plantar fascia that causes the spur and the pain.  So, if we fix the plantar fascia the spur will remain where it has generally already been for years without you knowing it.

 

Along with faulty biomechanics, many other factors can overload the plantar fascia and heel bone, such as poorly constructed footwear, being overweight, muscle imbalances or weaknesses, or a change in circumstance, whether sporting, occupational or living.

 

Despite the numerous factors that can trigger heel and arch pain, the one similarity that develops is the difficulty the body has in healing the injury without additional assistance.
 
Wollongong Podiatry will assess your standing, walking and, if needed, running gait closely to determine why the damage occurred in the first place.  An appropriate treatment plan will then be instigated to rectify the cause, not just to relieve the symptoms.
 
In essence, the plantar fascia needs to have the amount of daily stress on it minimised, and any causative factors addressed.
 
 

Forefoot Pain (including Neuromas & Burning Soles)

The term, metatarsalgia, is often used to describe pain in and around the balls of the feet, including "burning soles".  This term is not specific and can imply pain caused by many different pathologies, such as neuromas, inflamed nerves, stress fractures, damaged ligaments and inflamed joint capsules.

 

Wollongong Podiatry can determine the actual cause of the metatarsalgia clinically or by referral for appropriate x-rays or ultrasound.  Once a diagnosis is confirmed, the cause needs to be determined.  The cause may be faulty biomechanics (i.e. poor foot and leg alignment), or specific trauma.  Once this is determined then an appropriate treatment plan can be instigated.

 

Despite what anybody else has told you, most cases of burning soles or balls of the feet are treatable; and at times quite quickly!
 
 

Fallen Arches & Flat Feet

The term "Flat Feet" is a broad term used to describe feet with a low arch.  The term has developed a bad reputation over the years.  This is not 100% warranted.  Some people with flat feet just have an anatomically low arch - i.e. the bone structure of their foot is such that it presents a low arch or flat foot.  In such instances, these people may never have any problems related to their flat feet. Or at least, they are no more susceptible to injury than people with a neutral arch profile.

 

The real issue with flat feet comes when a person has a neutral or high arch profile when non-weight bearing, but a flat foot upon standing.  The flattening of the arch usually occurs due to the heel and mid-foot rolling inwards.  This is called pronation.

 

Pronation should occur each step when the heel hits the ground, to absorb shock.  But when the foot pronates too far it causes excessive strain on several structures within the foot, contributing to the devlopment of bunions, hammer toes, heel spurs, arch strain and neuromas.  Excessive pronation can also cause pain within the ankles, shins, knees, hips and lower back.

 

The single biggest job of your podiatrist is to determine what is causing the excessive pronation.  A failure to do this will decrease the chance of any treatment working. 
 
Wollongong Podiatry focuses on treating the cause rather than just attempting to relieve the pain.
 
 

High Arches

High arches are often thought of as a great alternative to flat feet.  However, high arched, or cavoid, feet cause plenty of their own problems.  A high arched foot is unstable as the body is balancing on just a small surface area of the foot, that being the heel and the ball of the foot.  This causes strain on the muscles in the lower limb as they try to stabilise the body on the foot.

 

High arched feet often lead to clawed toes, as the toes grip the ground to increase stability.  The clawed digits can then cause fore-foot pain such as neuromas, corns and inflamed joints.

 

High arched feet can also cause jarring through the limbs, hips and into the lower back.  Many people with high arches do not pronate when their heels hit the ground. This lack of shock absorption results in impact injuries further up the body.

 

Your podiatrist can help to support your high arched feet, increasing their stability and decreasing the strain on the foot and lower limb.  Your podiatrist will also advise on appropriate shoes to help absorb shock whilst walking and exercising.
 
 

Shin Pain (including Shin Splints)

Shin splints are caused by overloading, and consequential tissue damage, of either or both the tibialis anterior and tibialis posterior muscles and tendons.  Both muscles attach to the shin bone, or tibia, which is why pain is often felt along the shin bone itself.  Faulty biomechanics (i.e. walking or running technique), footwear, body weight or just a change in routine can cause overuse of these muscles and tendons.

 

Shin splints are a painful injury that needs to be managed not only physically but also mentally.  This is because pain usually occurs at the onset of walking or running but then eases after a few minutes and the shins actually feel good.  It is at this point that the damage occurs.  By the time the shins come to hurt again the damage has been done.

 

Your podiatrist will look after the physical treatment of the shin splints by addressing the cause.  However, you need to have the mental strength not to push too hard whilst the shins feel good.  This sounds ironic and it is.  But it is also why shin splints are a curse to walkers and runners alike.
 
 

Stress Fractures

Stress fractures are an overuse injury that can occur in several of the 26 bones of the foot, or the long leg bones.  They are caused by repeated stress to the bones, as opposed to other fractures that occur due to a sudden, severe impact.  This repeated stress can be due to an increase in exercise level, worn out shoes, abnormal walking or running pattern, or tired muscles.  As muscles tire they absorb less shock each step, meaning more force is applied directly to the bones of the foot and leg.  Similarly, a worn out shoe will absorb less impact and thus increase stress on bones.

 

Pain will usually occur during activity and, unlike an inflammatory injury such as tendonitis, will remain through the duration of the activity.  The most important aspects of treatment for a stress fracture are rest and removal of all impact from the bone, generally for 6 to 8 weeks.  Stress fractures do not simply go away. 

 

Your podiatrist can help ascertain the cause of a stress fracture and devise a treatment plan to address the cause.  Following recovery, a very controlled return to activity is required to allow the bone to re-strengthen and adapt to the force being applied to it.
 
 

Arthritis

Each foot has 33 joints that move, to some degree, each and every step.  It is commonly known that athletes who play contact sports can suffer from arthritis in their joints later in life.  Well, your feet play a virtual contact sport each and every step of the day.  They pound the pavement when walking and running.  They get hit by rocks and sloping ground.  They kick sides of tables and beds. 

 

Using this analogy, it is easy to appreciate that feet, like knees and hips, succumb to joint damage/arthritis.  It is important to know what form of arthritis is affecting your foot.  Your podiatrist can determine this and advise on how to minimise discomfort in the affected joints.
 
Wollongong Podiatry cannot cure arthritis but it can help make each step of the day more comfortable.
 
 

Balance & Instability

Unfortunately as we get older our balance and stability decreases; and it only takes one misplaced foot or one crack in the footpath to cause a fall and injury.


It may sound obvious but your feet and your shoes are your connection between yourself and the ground.  Any faults in either of these can increase the risk of a fall.  Orthotics are often used to aid stability.  Your podiatrist can ensure you have the right combination of footwear and orthotics (if required) to help keep the body where it is meant to be, upright.

 

Ankle Pain

Your ankles are the all important link between your vertically aligned body and your horizontal feet.  They allow us to walk and run by fluently transferring forces and energy between the foot and leg.


Most of the major muscles that control foot movements are situated in the leg. The tendons of these muscles travel on all sides of the ankle and attach to various bones in the feet.  These tendons can cause ankle pain when they are overworked.


Similarly, the bones about the ankle joint are subject to tremendous force each and every day and can become damaged over time.


These are just two of many causes of ankle pain.  Your podiatrist can assess and determine the cause of ankle pain, and implement a treatment plan to relieve the pain.

 

Knee Pain (including ITB syndrome, Runners Knee & Patella Femoral Syndrome)

Knee pain is an overwhelmingly common cause of discomfort.  There are many causes of knee pain, including osteoarthritis, damaged cartilage, iliotibial band friction syndrome, patella femoral syndrome and Osgood-Schlatter disease, to name just a few.


Osteoarthritis within the knee occurs due to prolonged stress on the knee joint over many years.  The alignment of the knee often changes over time to become bow-legged or knock-kneed.  Treatment of severe osteoarthritis of the knee joint often involves a total knee replacement.  Earlier, or more conservative, treatment of an arthritic knee involves orthotics to reduce the stress on the poorly aligned knee.  This may not be a cure but it can provide great pain relief and enable a much more active life.


Damaged, or torn, cartilage is a common cause of knee pain.  Treatment usually involves removal of the damaged cartilage by a surgeon.


Illiotibial band friction syndrome occurs when the ITB becomes inflamed from rubbing against the femur (thigh bone) on the outside of the knee.  Pain usually increases during activity.  Treatment is often a two part process.  The first is to have a sports physiotherapist or massage therapist provide deep tissue release of the ITB.  Stretches are also important but less immediate than deep tissue release.  The second phase of treatment is to have your podiatrist address any biomechanical faults, such as excessive pronation, that contribute to ITB friction syndrome.


Patella femoral syndrome, also called runner's knee or chondromalacia patella, occurs when the patella, or kneecap, does not track or move properly within its groove at the front of the knee joint.  Pain often occurs when going up or down stairs, or when you stand up after periods of sitting.  At times the knee feels like it wants to give way.  The function of your feet has a huge impact on the development of patella femoral syndrome.  Therefore, correction of any poor alignment or function is a large, but not exclusive, part of treatment for patella femoral syndrome.  Other aspects of treatment are required to address muscular imbalances in the quadriceps, or thigh, muscles.


Osgood-Schlatter disease is a common condition suffered by active children between the ages of 11 to 15.  It is often passed off simply as growing pains.  Whilst the condition is associated with growth, it is very much a real ailment that requires careful management and treatment.  Please refer to the paediatric section for further details on Osgood-Schlatter disease.

 

Hip Pain

There are many different forms of hip pain and several ways in which your feet can influence the function of your hips.  For instance, excessive pronation, or rolling in of the heel/ankle, causes internal leg rotation, which places strain on the hip joint. 


Pronation also causes the pelvis to drop on that side, making that leg functionally shorter.  If there is unequal pronation in both feet the pelvis will be out of balance, causing distraction of one hip joint and compression of the other.


Now, just to confuse you a little bit, unequal pronation from the left foot to right foot can be a sign that one leg is longer than the other, and can actually help keep your pelvis balanced.


Your podiatrist can assess whether your hip pain is due to one leg being truly longer than the other, or if the function of your feet are causing hip malalignment.  A comprehensive computer gait analysis can also identify muscle imbalances around the hip. 


Depending on the cause of your hip pain your podiatrist will either outline a treatment plan to reduce hip malalignment and consequential discomfort or they may refer you to a sports physiotherapist or osteopath to address any muscular or structural imbalances.  At times, both are required.

 

Back Pain

Back pain is one of the most common ailments in the human body.  The back, and more specifically the spine, is a complicated network of nerves, joints, muscles, tendons and ligaments.  The back is expected to cope with enormous stress each and every day.


By no means can all back pain be attributed to your feet.  But poor functioning feet can place extra stress on your back, as can a leg length difference or muscle imbalances whilst standing, walking or running.


A comprehensive computer gait analysis can help identify weaknesses or faults that will need correction to reduce the force placed on your back, and therefore address the pain.  Treatment of back pain regularly requires input from several different professionals, such as podiatrists, physiotherapists, osteopaths, etc.


 

Leg Length Differences

Leg length differences are more common than we think.  In fact, most of us will have one leg slightly longer than the other.  But the human body is extremely adept at compensating for this and many of us will pass through life without any complications of a longer leg.


However, the greater the difference in the length of your legs, the greater the compensation that is required, and the greater the chance of developing pain.  This pain can occur in any of the structures that help to adjust for a longer leg, such as the feet, ankles or knees.  If the body cannot compensate enough for a leg length difference, then pain can be felt in any of the above mentioned joints as well as the hips and back.


It is also important to note that there are two different types of leg length differences.  The first is where the actual length of the bones in the legs is different.  This is an anatomical leg length difference. 


The next is where the length of the bones are the same but due to one of them being bent, twisted or poorly aligned, they function as if they are different in length.  This is called a functional leg length difference.


Now to top it all off there may even be a combination of the two types of leg length difference.  Thorough assessment by your podiatrist, often incorporating computerised standing or walking analysis, can help identify the influencing factors and therefore determine the correct approach required to alleviate the problem.


Back to Biomechanical conditions

 

In-Toeing (Pigeon Toed)

The term in-toeing, or being pigeon toed, refers to when your feet point inwards when standing or walking.  It is very common for children to start walking in a pigeon toed manner.  In most instances this corrects itself naturally, or with conservative management, in the early years of growth.  When the pigeon toed alignment persists into adolescence and adulthood it can be difficult to correct. 


The in-toe position of the feet can be caused by an internal twist, or torsion, of the thigh or shin bones, or by a muscular imbalance.  If the cause is muscular, gradual improvement with a stretching and strengthening program is attainable.  If the cause is bone malalignment, significant improvement will be limited and management of the in-toe position is required.


Your podiatrist can distinguish between the various causes of the pigeon toed foot position and advise on what treatment or management is required.


Back to Biomechanical conditions

 

Achilles Tendon & Calf Pain

The achilles tendon attaches the large, strong calf muscles below your knee to the back of your heel.  It is an extremely strong tendon that is exposed to enormous stress every day.  When this stress becomes too much for the tendon, painful inflammation develops.


Pain is usually felt first thing in the morning or at the onset of activity/exercise.  The pain often subsides after several minutes of activity, once the tendon is warm.  At this point the tendon feels good.  But this is when the tendon is damaged.  By the time pain is felt again the damage has been done.  This is why achilles tendonopathy is often referred to as the scourge of the athlete.

Careful management of achilles tendonopathy is required to enable complete recovery and re-strengthening of the tendon.


Along with providing detailed and strict advice in the treatment of achilles tendonopathy, your podiatrist needs to assess the cause of the damage.  At times it is purely an increase in activity that becomes too much for the tendon.  In other instances, there are biomechanical faults or tight muscles that need to be addressed to allow recovery to occur.


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