podiatrist – Perform Podiatry

Three Ways Orthotics Will Help The Pain At The Ball Of Your Foot

This article is for you if you have:

Pain at the ball of your foot (forefoot)
Have been wondering if orthotics could help decrease your pain or improve your comfort
Have orthotics but unsure how they are working (and if something could be done to make them even more effective!)

Orthotics have the ability to reduce pain, facilitate the healing of injuries, make walking and running much more comfortable and really add positively to your quality of life. While a lot of expertise and care goes into each orthotic prescription we make, you get given this device that replaces the inner sole of your shoes, without perhaps knowing the inner workings and theory behind it. As you start feeling the difference, you may be left wondering exactly how the orthotics are working and resulting in your symptom relief. Perhaps you know someone whose orthotics haven’t produced the same great results that yours have. Well, today we’re answering all these questions and sharing three ways that orthotics can start helping your forefoot pain today! Here we go…

#1. Orthotics take pressure away from damaged joints, tissues, ligaments and bones

Custom orthotics have features or additions. When we talk about forefoot pain, we often talk about adding an addition to the forefoot and midfoot that will actually remove the regular pressure away from damaged bones and joints – or at least decrease it significantly. Picture this. Your big toe joint is injured. Every time you walk, you put pressure along the whole foot including that joint. You put a big cushion beneath the foot, but not beneath the big toe joint. As you walk and your midfoot is supported and cushioned, the big toe joint drops down in front of the cushion but doesn’t really touch the ground. No direct pressure means no pain. And voila! Of course, it’s a lot more technical than that. You can’t actually put a giant cushion beneath your foot. You won’t be able to walk normally or wear normal shoes so ultimately you’ll put your regular shoes back on and BAM – painful symptoms. Instead, we incorporate this carefully into your orthotics that work with your everyday shoes, through pads and cut-outs and various other techniques we have up our sleeve. And by techniques, we mean evidence-based thoroughly-researched and proven techniques.

#2. Orthotics support the bones and tissues of the arch, stopping their collapse and the narrowing of the space between them

Hold out your hand, bring your fingers flat together, and imagine these fingers as the long bones of your feet. Now, imagine that there is something between the bones. It could be a nerve, ligament, muscle, a common mass like a cyst, or something else. If that structure gets damaged, one of the first things that’ll happen is that it will swell. When it swells, it gets larger and takes up more of that space between the bones. The bones then will rub against it and push on it, it will be sore and painful, and this will continue until you put your feet up and rest. Unfortunately, when you put your feet back on the ground, the process just starts up again until you can relieve pressure away from the area for long enough for it to heal. Sounds pretty hard to keep the foot up when we’ve got jobs and daily tasks where walking is essential, right? Yep! The solution? An addition within the orthotic that supports the foot and opens up the space between the bones. Good amount of space = no direct rubbing = healing can proceed. No magic here, just good ol’ science, precision and biomechanics.

#3. Orthotics help absorb shock and hence the impact forces through the forefoot

To help explain this one, we’re going to backtrack back to physics. Remember Newton’s third law? The one that says that every force has an equal and opposite reaction force? Let’s start here. If you hit your foot hard against the ground right now (please don’t), your foot won’t bounce back. Instead, you’ll feel a force, and maybe some shock or pain, coming back through your foot (the opposite and equal force). Now, imagine this kind of force occurring every time you run or jump. Did we mention that you exert a force equal to three timesyour body weight during running? For some, the force will be transferred effectively through their feet, bones and tissues, and they’ll feel little impact. For others, inefficient gait (movement) will result in much more stress and shock through the feet, which can lead to pains and problems. Here’s where the orthotics come in. Where the biomechanics of the feet are lacking, orthotics can step in and work to absorb shock and ground reaction forces as we take step after step. This can mean a significant reduction of pain and symptoms through our feet, and have us feeling much more comfortable after a long day at work. So there we have it! Just three of the many ways that orthotics can help with forefoot pain, among the variety of other foot and leg pathologies they can help with. Keep in mind that not all orthotics are created the same – each custom orthotic is made following the precise script of the prescribing practitioner – that’s why it’s very important that you see a Podiatrist that specialises in orthotics and lower limb biomechanics. This also explains why orthotics work brilliantly for some people and not so for others – because they weren’t designed or created as optimally as they could be. If you feel like your current orthotics just aren’t doing the job and would like to book in with our orthotic specialists here at Perform Podiatry to have them checked, give us a call on 09 523 2333 or book online here.

Ingrown Toenails: Why it’s time to throw out the home remedies!

We have the pleasure of seeing and treating a lot of ingrown toenails. That’s not sarcastic at all – successfully treating ingrown toenails provides an immense amount of relief to suffering patients and using our skills to do this successfully is something we’re very proud of. There’s a common theme to many of the first visits we have with our patients, however, that we thought we’d shed some light on in case you happen to find yourself in this boat too. This theme is the I-googled-it-so-it-must-work home remedies for ingrown toenails. Now, don’t get us wrong. Some of the strategies you try may well alleviate your pain and have you feeling much better. There’s almost always a catch though: It’s temporary.

Repeated ingrown toenail occurrence

The unfortunate truth is that if you’ve suffered from the terrible pains of ingrown toenails more than once, the reality is that you’re almost definitely going to suffer from them again. One-off ingrown toenails absolutely do occur, but the cause is usually a particular pair of tight shoes that push the nail into the skin and they don’t tend to occur again after you’ve stopped wearing them. Repetitive ingrown toenails are the best indicator that there’s something going on, that the nail has now started growing in an abnormal way that ends up penetrating the skin, and that it’s going to continue to happen.

So, why advise against home remedies?

The first reason is that without knowing exactly what you’re doing, you could be further encouraging the nail to continue to grow in a way that will cause you a tremendous amount of pain. Take the way your nail is cut, for example. If you think that cutting down into the corner and removing the piece of nail will discourage it from growing there again – the reality is the exact opposite. Curving down and removing that painful nail edge will likely encourage the nail to keep curving a growing down – unless you know what you’re doing and understand the characteristics of nail growth. The second reason is that as health professionals, we don’t want you to suffer with ongoing pain. Experiencing pain every 3 months from an ingrown toenail isn’t a great solution in our opinion, and especially not when you can have a one-time permanent procedure that will have you saying goodbye to ingrown toenails for good.

So, what is this procedure?

The procedure we’re talking about is called a partial nail avulsion (PNA). It involves removing a small part of the nail (the part that causes you pain!) and applying a chemical that will stop that small portion of nail from growing back and continuing to cause you grief, over and over again. We love this procedure because:

It’s done simply and effectively in-clinic
It’s completed in 60 minutes (with the procedure time typically around 20 minutes)
It’s performed under local anaesthetic so is pain-free
You do not need to take any additional time off work/school following the procedure & can go home immediately
You don’t need any special boots or braces while the toe heals
The procedure causes very little post-procedure discomfort
We dress your toe, provide you with a take-home dressing pack & re-dressing instructions
We monitor your progress to ensure it’s healing well

While we perform conservative one-off care for first-time ingrown toenails or those with a definitive cause that is not likely to recur, the PNA is our best recommendation for those that are repetitively putting up with and suffering from ingrown toenails. We have tremendous success with the procedure and have prevented hundreds of patients from continuing to regularly suffer. Our team are experts when it comes to ingrown toenails and we love seeing the difference that having this procedure makes in the lives of our patients. For more information about the PNA procedure, click here. To book an appointment, you can give us a call on 09 523 2333 or book online.

About to hit the slopes this winter? This is for you!

Winter is coming! Yep, after a long and hot summer, winter is now just around the corner and with it comes the opportunity to partake in all the best winter sports and activities. We’re not talking about Netball, but the much *chillier* winter sports – including skiing and snowboarding! These brilliant activities are enjoyed by many Aucklanders each year as we make the drive down to Mt. Ruapehu for the weekend or are even lucky enough to fly down to the South Island ski fields. With the fun and excitement, come the massive physical demands, especially on the legs and feet. That’s why we highly recommend having your feet and legs, as well as your ski or snowboarding boots assessed before starting the season so you can continue to feel your best throughout! Here are a few of the ways we can help you have a comfortable ski season:

We can check the size and fit of your boots

If you’re a skier or snowboarder, you’ll be very familiar with the effect that having a pressure point in the boot or ill-fitting boots will have on your feet, pain levels and comfort. When you bring your boots to us, we can check the fit of the boots in combination with any symptoms you’re having (if any), your foot posture, walking style (gait) and any signs of rubbing or a poor fit. We can then look for ways to improve the comfort in your boots, or if you’re after a new pair, let you know what you should be looking out for and feeling for when you’re buying them. Even if you’ve had your boots for years, as our feet can change over time with things like bunions developing or our arches flattening, this can make even your favourite and trusty pair of boots much less comfortable – so don’t be surprised if it feels different from one season to the next! We’re also one of the only podiatry practices in New Zealand with the expertise and facilities to make footwear modifications – though ski boots will need to be assessed on a case by case basis to assess their suitability for any modifications.

We make custom slimline orthotics that can fit comfortably inside your boots

We understand the extreme size constraints that come with ski and snowboard boots – we’ve felt them for many seasons ourselves! These boots struggle to fit regular orthotics without compromising the comfort and space available for your feet. We not only create slimline orthotics that do fit comfortably inside your boots but also make them specifically tailored for your feet to optimise the way you move and help you perform at your best when hitting the slopes. In order to create these custom orthotics, we…

Conduct a comprehensive biomechanical assessment of your feet and legs

This helps us to not only see exactly what’s going on with the movement and function of your feet and legs, but also see how this function is helping or impairing your performance and enjoyment on the slopes. During the assessment, we check your:

Muscle strength in the feet and legs
Muscle and tendon overuse
Available range of motion at your joints, especially any restrictions that are impacting the way your feet and legs move
Your foot posture
The way you walk (gait)
Structural abnormalities
Any areas of high pressure that are or may become problematic
Footwear

We use this to answer why are experiencing certain problems, as well as form a prescription for the right orthotics and other treatment modalities that will help solve your problem. Our team have had decades of experience in sports medicine, orthotic prescription and injury and pain management and prevention when it comes to a variety of sports. We’re proud to serve our local community and be recognised as leaders in the field of Podiatry in Auckland. We’d love to help you have the best winter season in 2018! If you have any questions or you’d like to book an appointment, you can give us a call on 09 523 2333 or book online.

Shin pain when running? You could have shin splints!

As we approach the colder winter climate here in New Zealand, some us will start to struggle when it comes to staying active and continuing, or beginning, our exercise regimes. We don’t blame you – the temperatures are dropping, the rain is starting to set in and the mornings are getting dark. But when you DO find that motivation to go for a run, hit the gym, or engage in your favourite sport, the LAST thing you need is shin and leg pain stopping you in your tracks. Because shin pain affects many of us each year, we thought we’d tell you a little about it and what you can do to treat it and reduce the risk of it coming back or even starting! Let’s start with the basics:

It’s called shin splints

Well actually, it’s called medial tibial stress syndrome if we’re going to get technical. It’s often coined as “too much, too soon” because of the tendency of it develop when people suddenly increase their exercises intensity or duration without working up to it over time.

There’s a reason your symptoms have started

Shin splints would never occur without a cause, which is usually relatively simple to identify when we complete a biomechanical assessment and have a chat through your medical and exercise history. This is especially true if you’re a runner (or are attempting to be one!). Associated causes can include:

Lots of physical activity
Flat feet and pronation
Unsupportive or worn-out footwear
Issues with your foot biomechanics (mechanical functioning of the feet and legs as you move)
Tight or weak muscles

The pain can come and go

For some, the pain, tenderness and swelling around your shins can come and go with activity, as well as being worse in the mornings. Others may instead feel a persisting tenderness and discomfort. The pain tends to affect one leg, but can affect both. Regardless of what you are and aren’t experiencing, if you think you have shin splints or have developed shin pain, come and get it checked.

When it’s not shin splints…

Both stress fractures and compartment syndrome have similar symptoms with pain around the front of the lower leg. That makes it important to get the right diagnosis and treatment from an experienced podiatrist.

It’s about treating your symptoms and your cause

I feel we need to highlight the word ‘your’ because the experience of shin splints can be very different. Some will find it a temporary discomfort, while others may struggle to run and do the things they enjoy because of a crippling pain. That’s why treatment needs to be specific to your clinical assessment, goals, symptoms and circumstances. It also needs to address the initial cause of your shin splints to reduce the likelihood of it happening again in the future. Our podiatrists have years of experience in sports medicine and the biomechanics of the feet and legs, so will give you the best care to optimise your outcomes. Our goal is to help you exceed your goals and get you back to feeling your best! For more information or to book an appointment, you can give us a call on 09 523 2333 or book online

Taking the worry of infection out of pedicures with medical pedicures!

There’s nothing like treating yourself with some well-deserved pampering. Spa treatments, massages, facials… There’s a warm, fuzzy feeling even thinking about taking an hour or two out to relax and be pampered. When it comes to getting your nails done, however, this warm feeling can become a little tainted. This taint comes from seeing the instruments used on your feet, being pulled out of a drawer or a cup, without any signs of sterilization on sanitation, and that uncomfortable thought creeps through your mind… “Who was this used on before me? Were they cut? Did they have any fungal infections or other infections that may spread to me? How hygienic is this really?” If you’ve ever thought this, you’re definitely not alone. We’re absolutely speaking from our own experience from before we got into podiatry and from the feedback that we still regularly receive from friends and patients. And it’s a very fair thought to have. Fungal nail infections are spread through contact. Plantar warts are spread through sharing surfaces like the foot spas and floors you frequent barefooted in a local nail parlour. While these risks are also present at gyms, saunas and the like, the risk is definitely higher at nail salons due to the tools that are used from person to person, without knowing the salon’s hygiene and sterilization protocols. What we do know, however, is our sterilization and hygiene protocols when we perform our medical grade pedicures.

We use an autoclave on every single instrument, before every use. This uses heat/steam to completely sterilise every piece of re-usable equipment that comes into contact with your feet.
Following the best-practice guidelines, the instruments are heated to at least 134 degrees to effectively kill anything that has previously come into contact with the instruments.
We bag and record every single instrument set, the autoclave cycle it went through, the date it was sterilized, and the autoclave’s printout declaring that the cycle was successfully completed.
We don’t open this bag until we’re with you in the treatment room.

And that’s just the beginning. We disinfect all of our surfaces, treatment chairs, floors, and go above and beyond to ensure our hygiene standards are top-notch. This is because our goal is not only to make you look and feel great, but care for your health and well-being. That’s what makes our medical pedicures different – plus the fact that with each appointment, your feet are also being checked by an expert podiatrist and we can make you aware of any risks or things we notice that you may not be aware of. So if you or any of your family would like to have a pedicure without the risk or worry, come in and see our team. You can book by calling 09 523 2333 or click here to book online.

A slight difference in leg length – does it really matter?

A lot of us have heard that it’s not uncommon to have a slight difference in the size of our feet or even legs. We often advise patients to buy shoes to the size of the larger foot so that toes don’t get cramped and cause pain. But when it comes to having a slight difference in the length of the legs, does it make any difference or have any effect on the body? Let’s start with the basics about limb length discrepancies.

What effect does a leg length difference have on a person?

For some, having a small difference in leg length won’t cause any problems, and they may not even be aware of the problem. For others, it can cause painful symptoms, alter their gait pattern (the way they walk), contribute to the development of other complications and negatively impact their quality of life. The extent of the effect largely depends on the measurable difference between the two legs and how the body is functioning (or not functioning) to compensate for the difference.

What causes a difference in leg length?

Differences may be caused by:

Growth abnormalities
Bone injury that results in healing in a shortened position (like a break or a fracture)
Damage to the growth plate during childhood
Bone disease and infection
Neurological conditions
Inflammatory conditions affecting the joints (like arthritis)
Abnormal foot biomechanics
Tightness and contractures of tissues
Ligament laxity and weakness

You’ll notice that some of the above are talking only about muscles and tissues and not the bones – don’t worry, we haven’t made a mistake! This is because differences in leg lengths can have either a structural or a functional cause. Structural differences describe a difference in the bone length of the thigh bone or the shin bone. This can result in a tilt of the hips and affect various joints and bones throughout the feet and legs, as well as the spine. Functional differences describe an observed length difference when standing because of biomechanical issues involving the way the muscles, connective tissues and jones function together. These occur even if the bone length of the shin bone and thigh none are identical. This is often due to muscular contracture, particularly at the hips, as well as ligament laxity or tendon dysfunction that affects one foot more than the other.

What are the symptoms?

Symptoms can vary greatly depending on the extent of the difference and the resulting misalignment of the lower limbs. This position of the bones, joints, muscles and connective tissues will determine what structures are overloaded, stressed, stretched and limited in the way they move. Because of this, it is difficult to pinpoint precise symptoms, but may include:

Altered gait pattern such as limping
Shorter steps on the affected leg
Slower walking speed
Uneven loading and pressure distribution between the legs
Stress fractures
Muscular strain and tendinopathies
Hip pain
Knee pain
Back pain

What should you do?

The first step is to get your leg length difference professionally assessed by your Podiatrist. We measure both structural and functional differences and ensure to get to the root of the problem and can address any factors playing a role in the difference to get the best results for you both now and into the future. After determining the presence or absence of a difference and its extent, we’ll be able to formulate the best treatment plan for you, your age, your symptoms and the risk of future problems. This may include: Orthotics to help correct any functional abnormalities and help bring the limbs into alignment with one another Footwear modification, such as building up one shoe to bring the joints of the lower limbs into alignment Stretching and strengthening tight or weakened muscles to help improve biomechanical function If the case that the difference is severe and cannot be managed conservatively, surgical correction may be required – though this is much less common so don’t worry and just start with getting it checked out, so we all know what we’re dealing with. Either way, our expert team at Perform Podiatry will be right alongside you every step of the way! We specialise in clinical biomechanics and restoring great foot function and health. For more information or to book in, give our team a call on 09 523 2333 or visit us at the One Health building in Remuera, just up from Broadway, Newmarket.

Why Do I Have Heel Pain, Again?

You’ve had heel pain before and were ecstatic when it finally went away. Weeks, or even months, of taking it easy, wearing the right shoes and orthotics, doing the right stretches and following the sound advice of your Podiatrist had paid off. You were able to hit the ground running, literally, without that gnawing pain, dull aches or any discomfort. Life was back to its happy, healthy self.

So what changed and why is the pain back?

Let us first assure you that pain doesn’t come back for no reason or without a cause. It’s also not a case of that it never healed in the first place. Your injury was indeed completely healed if you were able to resume life and daily activities without pain or symptoms. And it can be completely healed again.

However.

Just like how we can throw a ball through a window, repair the window, and throw a ball through it again, we can re-injure the same muscle, tendon, or ligament twice. But this time, there’s usually more to it. When you sustain an injury for the first time, there’s a good chance it could be an unfortunate wrong-time, wrong-place injury. You ran too fast for the ball, tripped over, and snap. Or you went for a 12-hour hike for the first time, something you’re likely never to do again, and your feet flared up from injury. In cases like these, and most accidents, as Podiatrists we look at managing your symptoms, relieving your pain, and helping you get better and heal as fast as possible. But when an injury re-occurs, that’s a red flag for us to further investigate whether there is something else, either intrinsic (to do with your bones, joints, muscles, tissues) or extrinsic (to do with your footwear, with a sport you play and factors outside of your body) that is causing or contributing to your injury.

Usually, there is a cause we can control

This is why it’s important for us to conduct a comprehensive biomechanical assessment. A biomechanical assessment looks at:

Your foot posture
Muscle strength
The range of motion through the joints of your feet
The way you walk (gait analysis)
Structural abnormalities
Footwear assessment
Various other tests depending on the findings

From this, we can deduce likely causes for your heel pain and tissue damage. If you have flat feet, wear footwear with relatively low support, occasionally run and get plantar fascial heel pain, it is likely that the repetitive strain on your fascia from running without support is causing damage and leading to pain. Or it could be that you’re getting the same pain at the back of your heel during soccer season again, when you’re training lots and wearing the same soccer boots that have a low-set heel. These boots will put greater strain on the insertion of your achilles tendon and paired with strenuous activity, can definitely overuse and damage your achilles tendon leading to heel pain.

Treating the cause, not just the symptoms

In these cases and so many more, it’s not just about treating your existing symptoms, but putting appropriate measures into place to stop the pain from coming back. This is one of our key focuses here at Perform Podiatry – preventing re-injury so it won’t keep bothering you in the future. We offer comprehensive biomechanical assessments from expert Podiatrists that specialise in Sports Medicine and Clinical Biomechanics. We’re proud to be trusted by hundreds of patients each month to help them feel great and perform at their best. We often use orthotics to control the movement of the feet and reduce the strain on otherwise overused and tired muscles. We also use strengthening techniques to get you back to your best. If your injuries keep coming back or you’re experiencing any issues with your feet or legs, give us a call on 09 523 2333 and one of our friendly team will be happy to answer any questions you may have!