Plantar fasciitis is one of the most common injuries relating to the foot, it is said to occur because of chronic overload resulting from a combination of lifestyle factors or exercise. It can affect both the elderly and athletic population. Recent studies propose the condition resembles more of a tendinosis labelling it plantar fasciosis which implies degeneration within a tendon without inflammation.

Anatomy

The plantar fascia is a piece of fibrous tissue that originates from the heel and extends towards your five toes.

Function

The plantar fascia functions a bit like a pully during gait and is placed under tension when the big toe dorsiflexes. This then shortens the distance between the heel and the toes raising the height of the arch. Therefore, it is particularly common in runners and dancers as these activities require maximum dorsiflexion of the
big toe.

Symptoms

Symptoms are often associated with pain in the heel that can radiate along the arch of the foot. Pain is often worse first thing in the morning when you get out of bed or after a period of rest. As the injury progresses the symptoms are said to worsen resulting in increased difficulty weight bearing.

Other common conditions affecting the heel

Although plantar fasciitis is the most common type of heel pain, it is important not to overlook the
other frequently seen conditions.

  • Fat pad contusion (a bruised heel).
  • Medial calcaneal nerve impingement.
  • Lateral plantar nerve entrapment.
  • Tarsal tunnel syndrome.
  • Bursitis.

Treatment

A thorough assessment of your heel pain is important before deciding on a management plan.
Treatments often involve a combination of:

  • A period of rest from activity.
  • Calf and plantar fascia specific stretches.
  • At home foot mobilisation exercises.
  • Footwear advice
  • Progressive program targeting intrinsic foot
    muscle strength and activation.
  • Calf strengthening exercises.
  • Extracorporeal shockwave therapy.
  • Case-dependent; a combination of strapping and
    orthotic therapy.

If you are suffering with heel pain, it is important to seek advice and receive a diagnosis early as the prognosis is far better when caught early.

Book in for an appointment today!

It’s January and the hustle and bustle of Christmas, New Year and the summer holidays are nearly behind us. It’s time for the munchkins to go back to school when peace and quiet will resume.

At Up and Running Podiatry we are frequently asked:

What Are The Best Shoes To Buy For School?

This is an important consideration… to put it into perspective your youngsters will attend school approximately 180 days a year, from 8am until 3pm each day. Therefore roughly 1260 hours of every year are spent in school shoes. Based on that figure alone it is probably a good idea that they fit well and are comfortable.

This time of year can be busy with lots to consider and organise from new uniforms to stationary, the list just goes on…

To make buying school shoes a little easier we have put together a few useful tips to look out for when shopping.

ascent school shoes boysascent school shoes girls

How To Find the Right Fit

It is important to have your child’s foot measured; most stores will stock a Brannock which will measure the length and width of your little ones foot to a T.

  • Ensure at least a thumbs space between the big toe and the end of the shoe.
  • To make sure the shoe is wide enough, remove the inner sole from the shoe and ask your child to stand on it. If the foot fits within the confinement of the inner sole it is wide enough.
  • Look out for slipping at the heel, to avoid this make sure the shoe has laces or a form of fixation on the top of the foot.

Additional Features:

Material – Look out for shoes made of leather, this is the most breathable.

Back of the shoe or heel counter – The back of the shoe should hold its shape and not fold in on itself when bent.

Flexibility – Look out for shoes that flex too much in the middle of the sole. The shoe should only flex at the toes.

Some school shoe brands that we frequently recommend are:

Image result for clarks shoes logo australia   Image result for ascent shoes logo australia      Related image

The Ascent school shoes, in particular, are modelled off the support and cushioning found in a running shoe. Therefore designed to outplay and outlast!

BOYS SCHOOL SHOES

– Ascent Apex Max

– Ascent Scholar

– Clarks Dayton

– Clarks Stanford

Senior school

– Bared Aluminum

GIRLS SCHOOL SHOES

– Ascent Eve

– Ascent Scholar

– Ascent Adela Buckle

– Clarks Ingrid/ Indiana

Senior School

– Bared Plover

“Good shoes take you good places”

Now that we know how to get our feet summer ready, we can talk a little more on the specific features to look for in more open styles of footwear (i.e. summer shoes).

What Footwear is Comfortable for Summer

Many people who suffer from debilitating foot conditions shudder at the thought of walking barefoot or in thongs/ sandals. Let’s start here (or at the top) and work back. If your foot orthotics are the only things getting you through a day on your feet there’s good news, they can stay there!

Orthotics can most certainly be used inside sandals but there’s a key feature to look out for.

Closed Heel Sandals

A ‘closed heel’ is vital to ensure your orthotic will stay under your foot and not slip out at the shops!

The remainder of the sandal can be as ‘open’ as you like provided there’s a means of adjustable fixation (buckle or Velcro for example).  

Some sandals have a ‘sunken’ heel to achieve a similar level of security so these may work for you also.

 Men’s and Women’s Teva closed heel sandals.

Image result for Men’s Teva closed sandal    Related image

If you looked at these photos and said to yourself, “but I only need something to slip on for the beach” then don’t panic… we’re here to help you too!

Orthopaedic Slip-Ons

Orthopaedic style thongs are becoming more popular in footwear stores as consumers look for an alternative. Popular brands include Orthaheel and Fit Flops.

Orthopaedic style thongs - Orthaheel

 

These thongs have thicker midsoles (the part of a shoe that provides support and cushioning) and are not designed to replace the need for an orthotic, but rather complement the use of one!

For example, if you were suffering from heel pain and spent all day in your shoes and orthotics but came home at the end of the day and to walk around barefoot, do you think this might cause a problem? If you answered yes, then you’re probably right!

Now, if you slipped on a comfy Orthaheel thong that accommodates your arch and lifts your heel slightly, are you likely to get better faster? Again, the answer is probably yes!

“Hang on a minute… I don’t wear or orthotics at all… and I don’t even have foot pain?”

That’s great! You’re the final demographic of the population to tick off. Put simply, there’s a lot of people out there that don’t require the level of support of the aforementioned options. But that also doesn’t mean you should neglect your feet!

Sandals with Natural Foot Positioning

If you want something comfortable, neutral (i.e. it accommodates your natural foot position), but still supportive, Birkenstocks could be for you.

Birkenstocks summer shoes


If the “Jesus style” slip on doesn’t cut it for you and you’re more of a Havaiana style guy or girl, we have just the solution for you.

Contoured Flip Flops

‘Archies’ thongs are designed by a physiotherapist and are the most aesthetically pleasing flip-flops on the market! Their contoured arch, elevated heel height and tight toe piece tick all the podiatry boxes.

We’ve been getting around in these for the past two years now and we haven’t look back! Nor have the hundreds of patients we’ve fitted them too!

Archies flip flops

Archies are stocked at our Port Melbourne and Elsternwick clinics so please give us a call on 1300 185 335 if you’d like to give them a try! 

We’ve had a taste of the warmer weather in Melbourne and we can already hear our patients shouting from the rooftops, “what do I wear on my feet?”

It’s a great question and a tricky variable we as podiatrist have to consider year to year. We tackle comfortable summer footwear for sore feet in a different blog but let’s first provided you with some tools to prep your feet. 

Why?…

Because summer is often associated with overuse injuries on the feet and ankles (think plantar fasciitis and Achilles tendinopathy).

How To Prepare Your Feet For Summer

Overuse injuries occur when a body tissue is subjected to a load higher than the capacity of that tissue (or what it can handle).  

To break it down… if your foot has been housed in a warm enclosed shoe all winter with a comfy orthotic, only to be let free for hours on end in a lesser-supportive rubber style thong all summer, then the load (or strain) applied to the muscles and ligaments of your feet is very different i.e. rapidly increased!

So what can we do?

Start introducing your summer footwear slowly. People who holiday overseas in the middle of the Australian winter can be at more risk of injury due to the abrupt introduction of lesser supportive footwear.

It’s a bit like turning up to your favourite running event, having sat in front of the TV for training!

Strengthen Your Feet

Now, not all summer footwear options are bad, they just take a bit of getting used to and good foot ‘strength’. We recommend starting but using your thongs, sandals or similar in an evening around the home, before building slowly over the weekends (a few hours at a time).  

Wait a minute… you can strengthen your feet I hear you ask?

Yes, like any other muscle in the body our feet can be strengthened to better cope with lifestyle demands. But before strengthening your feet it’s important we ‘free them up’ and show them a bit of TLC.

Feet Strengthening Exercise

Using a lacrosse ball (as demonstrated in the below video) is vital for ensuring the muscles of your feet are mobile and dexterous. Shoes and orthotics are very important for many patients, but they also lead to the four-layered compartments of foot muscles becoming compressed together. Freeing these muscle groups daily will also lead to a reduction in arch cramping, which we often see more of during summer.

Now to get strong…

This requires time and a lot of patience but it can be done! A simple in-home exercise is to ‘activate’ your arches. It can help to draw a little circle at the highest point of your arch (we can it the navicular) and imagine a piece of string ‘lifting’ the high point.

You can achieve this by also driving your big toe joint into the ground without curling the toes as demonstrated below. If this is repeated regularly throughout the day, over time your feet will be ‘popping’ with muscles you never knew you had and they will get stronger!  

 

Relieve Muscle Cramps During The Warmer Days

Here are a few things you can do:

1.  It’s very important to stay hydrated on warm days because our muscles become dehydrated when we sweat a lot.

2. Water is great day to day, but if your exercise a lot consider an electrolyte replenishing drink to top up some of the key salts in your muscles.

3. Magnesium spray and baths are also growing in popularity. We’ve tried both and while they don’t eliminate muscle soreness completely, they do help to reduce fatigue. 

  1. We are expert health practitioners who can assess, diagnose, treat and manage conditions of the lower limb, foot and ankle.
  2. We can treat tendon, bone, muscle, ligament and nerve.
  3. We can refer for X-ray, Ultrasound and MRI.
  4. We can prescribe you with rehabilitation programs for tendon, bone or muscle injuries of the lower limb, foot and ankle.
  5. We can assess your gait– this is the way you walk, run or move during sport and relate this to your presentation/injury.
  6. We can provide you with return to running programs or return to activity schedules to help you back after injury. We can also help to provide feedback and techniques to improve your running efficiency.
  7. We are qualified and experienced to perform nail surgeries and wart curettage in the clinic.
  8. We work along side other medical and health professionals to achieve the best patient outcomes.
  9. There are many areas of podiatry from wound care, sports, general care and paediatrics. We treat a wide range of patients from young children to the elderly.
  10. We undertake 20 hours of professional development as a minimum each year to ensure that we learn new skills and our knowledge on the latest research and treatment protocol is up to date.

 

If Game of Thrones has taught us anything about winter it’s that we need to prepare…luckily for us though it’s not 7 seasons worth of an imminent approaching winter, we’ve only got to get through 90 days. Whether you’re waiting on the train platform, gearing up for the morning cycle or trying to decide between shorts or long compression for the frosty morning run, there’s no denying winter is truly upon us.

Winter warmth, where your feet are concerned, has its own struggles- extra layers… extra layers jammed into shoes making them tight, sweaty feet…sweaty feet that lead to the ‘please don’t make me remove my shoes’ smell (yeah, we know you know it)… so what do you do when the temperature drops?

1) Avoid synthetic materials in your socks such as nylon or mixed blends. Try to stick to cotton or wool where possible, these materials will also help with warmth and breathability, ensuring a good balance of comfort without the sweat. If you need a tad more, you could consider a technical sports sock such as steigen, lightfeet or experia.

2) Check your shoes. In winter we know we generally will wear a thicker sock and after coming out of the sizzling summer where we likely danced around in thongs and sandals our feet don’t generally cope all too well when they’re compressed again. Making sure you’ve got adequate ‘wiggle’ room around your toes will help to avoid involuted nails from pressure, corns and inter-digital maceration

3) Keep an eye out for circulatory signs such as purple/blue, white or red toes or tender, itchy, blister looking lesions on the ends of your digits. These could indicate circulatory conditions such as chilblains a symptoms of Raynaud’s phenomenon. This is generally more of a nuisance rather than a serious medical condition. It’s important that you keep extremities warm or consistently at a similar temperature. If the lesions become tender or break the skin, it’s advisable to seek medical or podiatry services.

4) Consider the use of anti-perspirant creams to reduce the amount your feet sweat. There are a range of products on the market that can help achieve this from creams to foot soaks. This can be beneficial if you are finding that your feet are becoming odorous from excessive moisture or that the skin is becoming macerated between your digits. These can be used for long and short term periods.

5) To avoid having to wear socks to bed, heat up a wheat pack before you go to bed and place it under the blankets where your feet would stay. This is a great easy way to warm up the bed and avoid the excess layers or heated blankets.

Whether it is your first time running or you are returning to running from a long lay-off, there are a number of things which can go wrong in the initial few months.

Here are a few handy tips to get you up and running whilst minimising the risk of injury:

  1. Start from the beginning

One of the most common mistakes a runner returning from time off makes, is to go straight back to where they left off in their training. With breaks from training our bodies lose aerobic capacity as well as conditioning of muscles, tendons, ligaments and joints to withstand the load of running.

Each one of us is affected by this differently based on our history and whether we have had weeks, months or years off from our training.

It is important to start with the basics! Don’t be afraid to start with a 45 minute walk to re-condition some of the soft tissue structures. From here you can build into a bit of light running, which takes us to our next top tip! Gradually increasing our running whilst maintaining good technique will stimulate our nervous system, building stronger neural pathways to the muscles we need to be firing.

 

  1. Gradually increase load

Whether you’re a beginner going for your first run, or Mo Farah training for double Olympic gold medals, a gradual increase in load is essential for any athlete.

Training load should only ever be increased in 10% increments and should only be applied to one of: distance, time, intensity, or weight. Implementing this principle when developing your training program is one of the best ways to reduce the risk of injury or burning out.

If you’re unsure of the best way to develop a training program for yourself, enlist the help of a running coach. Chris from GO Run Australia will have you sorted!

 

  1. Regularly use self-myofascial release & stretching

Runner or not, we have all felt muscle tightness at some stage in our lives. There are many causes of this feeling of muscle tightness or soreness including training load, running mechanics, our jobs or footwear choices.

Stretching our muscles and using foam rollers or massage balls helps to free up our muscles for activity. Making these simple exercises a part of your daily routine will get you feeling much looser and ready to smash your next training session.

 

  1. Get Strong!

Thousands and thousands of steps every day! Up to 3 times our body weight can be transferred through our lower limb with each step taken while running. Without the necessary strength, these steps can start to add up and take a load on our bodies. A great way to keep yourself healthy and active is to mix up your running with a couple of days of strength training.

Target the muscles around your hips and core as well as building up the 20 tiny muscles in each foot and 13 bigger muscles which cross each ankle. It wouldn’t hurt to keep that upper body working too.

You’ll discover another level of confidence with your new and improved biceps, and might even find you’re smashing your old PBs!!

…Don’t worry, strength training shouldn’t affect your weekly mileage. It is there to compliment your running program, so if you are too sore to run after your strength session then you’ve done too much!

 

  1. Wear the right shoes

We have some of the best athletes in the world leading marketing campaigns for different sports and running shoe brands. We also have these brands using terms like “motion control”, “neutral” and “cushioned” in their categorisation of footwear.

So how do we know which runner best suits us?

Without delving too deep into the categorisation of footwear, it is important to assess an individual’s running mechanics and gait pattern to tailor shoe options for them. From here we should be fitted up properly for our footwear to ensure it is the correct length and width fit as well as the overall feel of the shoe.

Generally speaking a runner should last approximately 600 – 800kms and should be updated after this period. If possible it is also useful to transition between a couple of different pairs of runners for different training types.

Ever heard someone use the phrase ‘my Achilles heel’ and wondered where it comes from?   

 

achilles-image

 

In Greek mythology, when Achilles was born it was foreseen that he would die at a young age. His mother became worried at such a prediction and took Achilles to the River Styx which had been said to offer powers of invulnerability.When Achilles was washed with the water his mother Thetis held him by his heel which was therefore untouched of the water. Later in life Achilles was shot at by a poisonous arrow which became lodged in his heel killing him, this is where the expression ‘Achilles heel’ originated from and is now known as an area of weakness.

 

 

 

However let’s not confuse the phrase ‘Achilles heel’ with the Achilles tendon itself, the Achilles tendon also known as the calcaneal tendon is not a weak tendon at all, it is in fact one of the thickest and strongest tendons in the body, albeit one of the most commonly injured.  But why is that? The Achilles tendon has to absorb some of the highest loads in the body.

 

First and foremost, what is Achilles Tendinopathy and how do you know if you are suffering with it?

 

Achilles tendinopathy impacts people from all aspects of life. It is most commonly diagnosed in the middle portion of the tendon, however it can also occur where the tendon itself inserts into the calcaneus (heel bone). The exact cause continues to be studied however it is important to note that it is not as a direct result of inflammation rather a failed healing response.

 

Symptoms are generally gradual in onset making it easy to ignore, however if caught early the prognosis is better so it is important to visit your podiatrist for an assessment and diagnosis.

Some examples of common symptoms include:

 

  • Morning stiffness and tenderness which may warm up as the day goes on or with use.
  • Swelling.
  • Pain during or after running.

 

What are the risk factors?

Sports Medicine Australia outlines the following causes which may lead to excessive loading of the tendon.

 

  • Exercising on hard or uneven surfaces.orthotic-correction
  • Changing surfaces, for example going from running on the road all the time to suddenly exercising on grass or astro
  • A drastic increase in training load, intensity or frequency. A 10% increase each week is advised.
  • Incorrect or inappropriate footwear.
  • Biomechanical problems such as reduced ankle joint range of motion.
  • Foot structure and mechanics.

 

Successful treatment relies on an early and correct diagnosis. There are a number of treatment modalities out there however conservative treatment is indicated as the initial strategy. Conservative measures include:

 

  • Identification of risk factors and symptoms.
  • Exclude rupture.
  • Modify activity and load.
  • Non-steroidalanti-inflammatory (case by case).
  • Footwear modification and assessment.
  • Orthosis intervention/ heel raises.
  • Eccentric exercises.
  • Stretching and strength training.
  • Biomechanical assessment.

 

Other conservative measures include topical glycerol trinitrate patches, extracorporeal shock wave therapy, corticosteroid injections, platelet rich plasma injections, night splints and massage.

If you are being held back in training or life by pain in your Achilles and you are unsure whether you have Achilles tendinopathy and want to hear more about the current treatment options, get in touch and book an appointment today by visiting

www.upandrunningpodiatry.com.au.

There is no shortage of brands, shapes and designs when it comes to performance running socks. Being the resident long distance plodder I was tasked with the responsibility of finding the best fit for the patients of our clinics.

A bit of background. I have run several half marathons and two full marathons. As a result, I have tried everything on my feet from k-mart bought cotton sports socks to the high end ‘technical’ running socks with price tags to match. The options are endless and I’m here to narrow your focus and possibly lend a gentle hug just like a good sock does to your foot.

Put simply, those that spend more time on their feet are prone to blisters. From this, performance running socks were born. (For more information on blister prevention see  BLISTER MANAGEMENT 101

steigen-socksA good sock is one that reduces friction and moisture to prevent blisters… but where to start?

Participating in the Melbourne Marathon festival again this year I eagerly awaited the virtual event show bag. Being a podiatrist I gravitated to all things feet and what caught my eye was the bright colours and different lengths of the ‘Steigen’ performance socks. We always tell our patients it’s not about colour, rather function… but let’s be honest, if something looks good we’ll wear it!

I went to the event expo on the Friday night to collect my race bib and wandered down to the Steigen tent. Mesmerised by all the colours it wasn’t long before one of the staff members kindly offered to help. I played it cool not declaring my background as a podiatrist because I was generally interested in what he had to say. To summarise- Steigen socks work off the principle less is more!

– A thin lightweight material for breathability and moisture transfer.
– High pressure areas are reinforced with a second layer under the heel and at the toes.
– 20% ‘Italian’ Lycra enables a more conformed fit through the arch to prevent pockets of air forming
– Four different lengths are offered for individual preference.

and most importantly…

Not only are they extremely comfortable (road tested at two half marathons in the last month with not a single blister!) but they are one of the cheapest options available. At $18.95 per pair or three for $50 at Up and Running Podiatry, we can’t recommend them highly enough. Gone are the days of spending $30 + on your socks when we can keep it local, support an Australian based company and avoid admitting the pain of de feet.

Bon Jovi might have sung about shocks to the heart but we think if he knew about extracorporeal shockwave therapy he might have sung about how shocks to the muscles and tendons could be the answer we’ve all been searching for with chronic musculoskeletal injuries.

Shockwave therapy is a treatment modality used to treat muscles, tendons (and more recent research suggests bone and other soft tissue lesions) to remove them out of the chronic stages of inflammation and bring them back into the acute stage where the body can reset and heal.

Shockwave utilises sound waves to create this therapeutic effect. A shockwave is a single acoustic pressure pulse, which causes a rapid rise to the peak pressure and then a rapid decline below ambient pressure… Enough of the physics…essentially the sound wave that is produced by the shockwave machine can pass the sound barrier and penetrate through to the tissue being treated causing a response within the cells.

Foot Shockwave

The therapeutic effect at the tissue is caused by the formation of cavitation bubbles these microscopic bubbles start a cascade of events at a cellular level, which leads to an interruption and reversal in the chronic pain pathway. The cavitation bubbles start by increasing blood flow. Shockwave causes substance-P a peptide released by our bodies, to be inhibited. Substance-P is responsible for pain transmission along our nerves. This is why shockwave can have an instant therapeutic effect post treatment as it acts on the fibres of the nerves that are responsible for transmitting the pain signals to your brain.

The number of treatments is indicated by the condition being treated and the initial response to treatment, all of our practitioners have been trained to assess, diagnose and treat all conditions of the musculoskeletal system of the lower limb and foot using shockwave therapy.

Shockwave can be beneficial for the following conditions and can also be the missing link to helping you avoid a cortisone injection:

Plantar fasciitis, Achillies tendinopathy (insertional and midportion), Posterior tibialis tendinopathy (stage dependant), peroneal tendinopathy, Medial Tibial Stress Syndrome, generalised shin pain, patella tendinopathy, Osgood Schlatter Disease, Calf tightness and trigger points along any muscles.

Book in for an assessment today to see if shockwave is the missing piece in your recovery!