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Podiatrist

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What is a Podiatrist?

A podiatrist is a highly trained professional in the care of the foot and ankle. Podiatrists are concerned with the examination, diagnosis, treatment and prevention of foot ailments by biomechanical, surgical and other treatment methods.Podiatrists are often called upon by health care professionals for consultation and treatment of foot problems.
 

Children and their feet

Children’s feet are different to adult’s in that they are still growing, have mainly cartilage and are a different shape.Because foot and lower limb problems are common in children and should be recognised and treated as soon as possible in order to prevent further complications later in life, it is a good idea to have your child’s feet evaluated by your podiatrist at least yearly.Often children may have foot problems that either do not present with pain, or the child may be too young to vocalise their discomfort, resulting in problems being unintentionally overlooked.

Common foot and lower limb problems in children

If you notice that your child is limping on a regular basis, look for signs such as walking on their toes, in-toeing, out-toeing or if knock knees or bow legs are resulting in abnormal walking. Toes may also be overlapping or underlying which can be signs of an injury or a biomechanical problem.Exercise is both physically and mentally beneficial for children, but encouraging your kids to be active is hard when their feet hurt. Many children experience injuries if they play or stand for prolonged periods, especially on hard surfaces.Since young feet and legs are still growing and forming they are susceptible to growing pains which can be extremely unpleasant. Other problems include flat feet or fallen arches, which should be seen by a podiatrist as soon as possible as if these problems are corrected early, the tendons and muscles grow normally and result in a normal adult foot.Many children experience problems with their skin and nails. As they are more susceptible to fungal infections and often get warts and athlete’s foot, children should wear flip-flops around the pool and showers at school and gym to avoid exposure to these infections.Ingrown toenails are also common in children and can be very painful and debilitating. These may present with redness or pain around the area of the toenail and should be treated by your podiatrist as soon as possible. It is important to learn the correct way to cut nails and take care of young feet and hands.Excessive sweating and smelly feet are also regular problems and can cause embarrassment for children and an unwillingness to participate in activities if it requires having to remove their shoes.Poorly fitting children’s shoes can cause a number of problems in adults, therefore it is vital to ensure that your child’s shoes fit correctly.

Fitting footwear for your child
  • Children should have their feet measured every three months.
  • There should be a thumb’s width between the end of the shoe and the end of the longest toe.
  • The sole of the shoe should be relatively straight rather than curved.
  • The shoe should preferably have laces, Velcro or buckles and should hold the heel firmly in
  • the back of the shoe and not allow the foot to slide forward.
  • The shoe should be flexible across the ball of the foot while the heel counter should be
  • firm and stable.
  • Leather and canvas are a better material - they are more durable and breathe better
  • than synthetic and plastic shoes.
  • Shoes should ideally have round toe boxes to give the toes more room.
  • No shoe should be ‘broken’ or ‘worn in’ - if they do they are either poorly designed or
  • poorly fitting.

Growth of your child’s foot

Children under approximately 18 months grow more than half a foot size every two months. Toddlers between 18 and 24 months grow an average of half a foot size every three months. Children between 24 and 36 months grow approximately half a foot size every four months and over three years old the foot grows at a rate of half a foot every six months.

Tips for parents
  • Inspect your child’s feet regularly.
  • Allow your baby to kick freely so that normal muscle development can occur.
  • Do not force your child to walk - average walking age is 10 - 18 months.
  • Encourage barefoot walking on suitable surfaces (sand, grass, carpets) to stimulate muscle activity and development.
  • Shoe and sock size should be adjusted accordingly as their feet grow.
  • Any complaint should be taken seriously.

It is essential to consult your podiatrist if:
  • Shoe wear is uneven.
  • Lumps or bumps are evident on the feet.
  • Pain in the feet and leg exists.
  • Tripping or falling occurs commonly.
  • Skin or toenail problems are present.
 
DiabetesTreating wounds and injuries

If you stub your toe, get a blister from tight shoes, or step on a sharp object, you probably give it little thought. But if you have diabetes you should seek proper treatment - no matter how small or superficial the wound is. Knowing how to treat minor wounds will help you avoid infection and speed up healing.

Why diabetic wounds can cause problems

Diabetes is a chronic disease where your body can't use glucose, the way it should. It can cause a number of complications, including some that make it harder for wounds to heal. These include:
  • Nerve damage (neuropathy) - When you have neuropathy, you may not feel the pain of a cut or blister until it has grown worse or become infected.
  • Weakened immune system - When the body's natural defences are down, even a minor wound may become infected.
  • Narrow arteries - People with clogged arteries in their legs are more likely to develop wounds, have severe wound infections and have problems healing, as narrowed arteries make it harder for blood to get to the wound to heal it.

How to treat a diabetic wound

As even a minor wound can become infected if bacteria are allowed to build up after injury, take the following steps to avoid infection and promote healing:
  • Clean the wound - Rinse the wound under running water to remove dirt. Do not use soap, hydrogen peroxide or iodine, as these can irritate the injury. Apply antibiotic ointment to prevent infection and cover the wound with a sterile bandage. Change the bandage daily and use soap to clean the skin around the wound. Inspect your wound daily for any signs of infection.
  • See your doctor - Don't take any chances - have your doctor check minor skin problems or areas of redness before they turn into larger problems.
  • Keep pressure off the wound as it heals - If your wound is on the bottom of your foot, a common place for diabetic people to develop calluses and blisters, stay off it as much as possible to give it a better chance to heal.

Foot wounds are dangerous

Feet and ankles are particularly vulnerable to diabetic wound problems. Wound healing below the knee is a different dynamic than in other parts of the body as these areas are prone to swelling which can inhibit healing. 

As people with diabetes are more likely to have calluses, dry skin and nerve damage, it is more difficult for them to avoid foot wounds, which in turn can lead to an increased risk of ulcers and infection. Along with a loss of feeling in their feet, many diabetics also have vision problems, so they may neither feel nor see a small wound until it becomes severe.A wound that becomes serious may do more than cause pain and inconvenience. It may cause so much damage to tissue and bone that amputation becomes the only option.Research shows that an ulcer precedes most lower limb amputations in people with diabetes, which is why it's so important to care for a wound before it becomes serious - or, if at all possible, prevent wounds in the first place.

How to prevent wounds

The best way to avoid problems is to prevent them:
  • Check your feet daily - Look for blisters, calluses, chafing, and redness. This is the single most important thing you can do to avoid diabetic foot problems. If you have trouble seeing, have someone else check your feet every day.
  • Pay attention to your skin - Check for small, seemingly minor skin problems like infected hair follicles or inflamed areas around the fingernails. If you notice a problem, speak with your podiatrist.
  • Moisturise your feet - Use moisturiser to keep the skin on your feet soft and supple, but don't use lotions between your toes because this can lead to a fungal infection. To treat athlete's foot, use a prescription cream antifungal product as they don't leave a moisture residue between the toes.
  • Wear proper footwear - Wearing well-fitting shoes can help you avoid blisters. Closed toe shoes reduce the risk of foot injury, therefore it is advisable to even wear them around the house. If you have trouble finding shoes that fit properly, speak to your podiatrist as you may need a custom-made shoe.
  • Inspect your shoes every day - People with diabetic neuropathy may walk around with a pebble or other object in their shoe without knowing it is there.  You should also check for tears or rough areas on the inside of the shoe.
  • Choose the right socks - Buy socks that wick moisture away from your skin and avoid socks with seams. Socks made specifically for people with diabetes are available in many specialty stores, online and from your podiatrist.
  • Wash your feet daily - After washing, dry your feet carefully, including between your toes.
  • Smooth away calluses - After your bath or shower, use an emery board or pumice stone to gradually remove calluses. Never cut calluses with scissors or a nail clipper.
  • Keep toenails clipped and even - Ingrown toenails can lead to foot problems. Have your podiatrist or doctor check your feet regularly.
  • Manage your diabetes - Preventing serious foot wounds also means keeping your diabetes under control. This includes monitoring blood sugar, blood pressure, and cholesterol levels; eating healthily; taking the medications your doctor prescribes; exercising regularly; not smoking; and having regular medical checkups.

Seniors and their feet

There are many ailments common to seniors citizens that can be effectively treated by a podiatrist, yet these conditions can often go without the proper treatment due to a lack of awareness about podiatric services. 

The older you are the more likely you are to experience pain in your feet, knees or lower limbs, particularly from patients whose employment has involved prolonged periods of standing. This is why for senior citizens the value of podiatry is much more than the removal of ingrown toenails or corns. Problems with our feet can be the first sign of more serious medical conditions such as arthritis, diabetes, and nerve and circulatory disorders. That is why it is important to pay attention to your feet and seek medical attention as soon as you notice a problem.Here are some foot care tips for older people: 
  • Check your feet regularly, or if you are unable to see your feet adequately, ask for help.
  • It helps to keep blood circulating to your feet as much as possible. Do this by putting your feet up when you are sitting or lying down, stretching if you've had to sit for a long while, walking, having a gentle foot massage, or taking a warm foot bath.
  • Avoid pressure from shoes that don't fit right.
  • Keep feet clean, warm and dry. Apply lotion to dry feet and powder to moist feet.
  • Trim toenails straight across, not down into the corners. Avoid cutting nails too short. Nails should never be cut down to the flesh.
  • Avoid exposing your feet to cold temperatures.
  • Don't sit for long periods of time (especially with your legs crossed).
  • Never use commercial corn pads or medicines. They often burn and irritate the skin, causing more damage.
  • Don't smoke because it decreases blood supply and increases the chance of swelling and other circulatory problems.
  • Avoid walking barefoot and wear comfortable shoes that fit well .
 
Podiatry in Sports

Sports Podiatry is the treatment of foot, ankle, knee and leg injuries by altering lower limb function using a variety of methods, including orthotic insoles, footwear and exercises.A sports podiatrist will analyse the way an individual’s foot strikes the ground and evaluate the chain of motion of the major joints in the leg from the ground up in order to determine whether or not there are any biomechanical reasons that may be contributing to an injury.

Biomechanics of running

The term ‘biomechanics’ refers to the way muscles, bones, and joints work together as we move. When applied to the lower limb, we focus on the biomechanics of impact absorption and propulsion.The two terms used to describe the movements associated with the foot and ankle when running are ‘over pronation’ and ‘under pronation’ (supination), respectively.

Over Pronation

Just after the heel strikes the ground when running the foot begins to pronate. Pronation is a movement that occurs as the weight of the runner moves from the lateral aspect (or outside) of the heel to the medial aspect (or inside) of the forefoot. This movement allows the foot and leg to adapt to the terrain and absorb the impact of the foot strike. A certain amount of pronation is necessary to run normally but too much or too little can contribute to injuries. Runners with low arches tend to "over-pronate".When the foot is in an over-pronated position the alignment of three major joints in the foot are less than optimal. This misalignment of the joints causes the foot to become structurally unstable, and, in turn, the muscles, tendons and ligaments of the lower leg are forced to work harder in an attempt to stabilise the foot. This is why over-pronators are vulnerable to ankle injuries. If you are a runner with a visibly low arch or have experienced recurrent or chronic overuse injuries, chances are you are pronating excessively. 

The most common injuries that can affect over pronators are:
  • Shin splints
  • Plantar fasciitis
  • Morton’s neuroma
  • Achilles tendonitis
  • Ankle sprains
  • Knee injury
Under Pronation

An under pronating foot is sometimes referred to as a "rigid lever" because it provides the firm base that pushes us forward after our heel leaves the ground and our weight shifts to the forefoot. A certain amount of rigidity is necessary to generate the force needed to run, but too much can decrease the foot's ability to absorb impact and, therefore, can lead to impact-related injuries. Runners with high arches tend to ‘over-supinate’ or ‘under-pronate’. Runners with a supinated foot type may experience ankle pain. The most severe over supinators tend to have a history of recurrent ankle sprains and/or stress fractures. Runners who supinate excessively require the highest level of cushioning in their running shoes and should avoid shoes with stability features. 

Some of the most common injuries that can affect under pronators are:
  • Calf strain
  • Plantar calcaneal bursitis
  • Bone shin splints
  • Calf strain
  • ITB syndrome
  • Hamstring strain

How do I know if I'm an over pronator or an under pronator?

The most common method a runner can use to determine what foot type they have is to stand on a paper towel with a wet foot. If your foot leaves an imprint of your entire foot, from heel to toe, you probably have a flat foot. If the imprint consists of the heel, the ball and a thin line connecting the two, you probably have a high-arched or supinated foot. This method is accurate if you have an extremely flat foot or an extremely high arch, but is not very accurate for those of us who fall somewhere in between.For most of you, it is more accurate to evaluate your history of running or athletic injuries, and to combine that information with the paper towel test to determine what type of orthotics you need.Remember that with some forms of biomechanical inefficiency, the feet may have a normal arch when standing or walking, but then over-pronate when the forces of running are encountered. So if your foot type looks normal but you are still getting repeated over pronation injuries, please consult your podiatrist.
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