Plantar Fasciitis is a very painful  inflammatory condition affecting the thick band of connective tissue known as the “Plantar Fascia”, that runs from the heel bone to the heads of the metatarsals (base of toes). This fascia helps to maintain the longitudinal arch of the foot and helps in shock absorption when we are on our feet. 

Some thickening of the fascia and loss of elasticity may also occur with the inflammation as a response to injury.

It affects both sexes and any age group but onset is most common between  40 – 60 years of age and approx. 1 in 10 people will suffer from Plantar Fasciitis at some stage in their lives.

Different Factors

A number of different factors can contribute to plantar fasciitis, including being overweight, working in a job which requires you to stand for several hours a day, if you have flat feet, or alternatively a high arch. Other contributing factors can be as diverse as wearing high heels and then switching abruptly to flat shoes, taking up a new form of exercise, continually wearing shoes that are worn out and have weak support, having an abnormal walking position, or having a tight Achilles tendon.

Symptoms

Pain is usually worst upon weight-bearing first thing in the morning or after a period off of the feet. It usually begins to ease once the sufferer has been on their feet for several minutes.

Treatment Of The Condition

There are no quick fixes for this condition and resolving it can take many months, but generally the sooner the sufferer gets it properly diagnosed and commences treatment then the sooner it should respond.

Icing the area and/or the use of oral or topical anti-inflammatory agents will help.

Stretching exercises, massage, ultrasound, strapping and over-the-counter orthotics or gel cushions may all be useful. In some cases where faulty foot mechanics are the cause of the problem then custom made orthotics may be necessary.

A Podiatrist will be able to direct you as to the best way forwards.

It should be noted that Cortisone injection and surgical intervention should only be considered if all else fails and in the case of cortisone, it must be used no more than once or twice because overuse will cause a weakening and thinning of the fascia.

The human body is a phenomenal piece of natural engineering. However, because the human body is such a complex piece of biological equipment, it’s not uncommon for diseases and certain medical conditions to affect parts of our body which at first glance seem completely unrelated.

In the case of diabetes, for example, it’s widely accepted that diabetes itself can lead to significant problems with not just our metabolism but our feet also. This is because diabetes causes reduced blood flow to our extremities which in turn can lead to degradation of the nerves in our feet. This degradation is referred to as sensory diabetic neuropathy and is estimated to affect 10% of all diabetics at some point.

Sensory Diabetic Neuropathy Symptoms

Sufferers of sensory diabetic neuropathy most commonly experience a lack of sensation in their feet. This is a cause for concern due to the fact that reduced sensitivity often leads to injuries. Moreover, because these injuries go unnoticed, they can quickly develop into serious ulcers and infections.

In the very worst case, diabetic neuropathy can lead to a ‘foot attack.’ This is where a serious infection takes hold and can in the very worst case lead to lower limbs needing to be amputated.

How To Prevent Serious Foot & Lower Leg Problems

The good news is that the majority of amputations are completely avoidable. The key is for diabetic patients to practice better day to day foot care and seek medical attention at the first sign of swelling, reddening or any kind of foot injury.

In the UK, the NHS recommends that sufferers of diabetic neuropathy have annual foot health checks. However, patients exercising their own due diligence day to day is just as important. In this case, small things like setting an alarm or placing a reminding sign somewhere in your home is a great way to get into the habit of regularly checking your own feet.

Of course, some patients will have trouble checking their own feet. In this case, it’s important to have a carer or family member do this for you and should problems arise, to seek medical attention as soon as possible.

WHAT ARE VERRUCAE?

Verrucae are benign tumours caused by the Human Papilloma virus (HPV). The most common warts (aka “Verrucae” on feet) are the subtypes HPV1, 2 and 4.

HPV1 infection is responsible for the largest, most painful type of verruca. They do not go deepest into the tissue, but the skin cells involved become filled with fluid which in turn creates pressure in these cells so that when the infected area is trodden on, the pressure from the fluid and our body weight makes the verruca feel painful.

HPV2 infection gives rise to “MOSAIC” Verrucae, so called because of the classic mosaic pattern with many individual lesions contained in one capsule. These contain less fluid so tend to be less painful.
HPV4 infection results in multiple small verrucae.

HOW DOES INFECTION OCCUR?

To become infected with the HPV virus, all that is needed is an abrasion of the epidermis (outer layer) of the skin, however this need not be a deep or clear cut, even a knobbly or rough tile or surface will cause a minor abrasion that is not visible to the naked eye but will allow infection to occur. Once in the epidermis, the virus can remain dormant for up to eight months, so if you wonder how you became infected if e.g. you haven’t been to the swimming baths for ages, there is your answer! As our skin cells follow the normal pattern of dying and being shed, so the virus is shed within them and waits to adhere to a new host.

HPV virus is present virtually everywhere on surfaces that people touch. Once within the epidermis, the virus replicates itself thus causing a proliferation of “prickle cells” which cause the epidermis to take on the warty/verruca appearance.

HOW DOES THE VIRUS AVOID THE IMMUNE SYSTEM?

There is very limited, if any, release of viral proteins meaning that there is very little, if any, antigen that can be presented to the host’s immune system. Also, the epidermis has no blood supply and as the virus doesn’t venture beyond this skin layer, the immune system (via the blood supply) is unable to detect it. The virus is also able to induce an altered local immune response by activating cells that suppress an immune reaction within the body.

WHAT IS “DRY NEEDLING” ?

Dry needling is where the area of the foot that carries the lesion to be treated, is anaesthetised, usually by a Tibial Nerve Block, so that 1 or more verrucae can be punctured with a hypodermic needle 100’s of times, forcing cells containing the HPV virus into the blood stream of the host thus enabling the body to detect the viral infection and formulate an immune response which will then clear the verrucae/warts.

Obviously the anaesthetic procedure is slightly uncomfortable, but once this has taken effect, needling is no more painful post treatment than many standard procedures such as freezing or caustic (acid) therapy, but the beauty is that only 1 or 2 lesions need to be treated even if there are multiple infected areas, because if the immune response is initiated then all lesions (caused by the same HPV type) will disappear regardless of whether they are on the hands, feet or both.

In theory if the person is exposed to the same HPV sub-type in the future then they should have immunity against it.

POST-OP PROCEDURE.

A sterile dressing is applied immediately post-op along with suitable padding to deflect weight bearing (depending on the location of the treated area), then a return visit is arranged 1 week post-op for dead tissue removal. The area is reviewed 8 weeks later by which time progress will be apparent if the treatment has worked. Full resolution should be apparent between 8 and 16 weeks.

NB: If resolution hasn’t occurred after 16 weeks then a second treatment should be considered.

The patient is able to resume all normal activity 24 hours post-op, having kept the area dry during that initial 24hrs.
Paracetamol is usually totally adequate as the pain management of choice if any discomfort is felt post-op. Aspirin is not advised as it discourages clotting.

AM I SUITABLE TO RECEIVE DRY NEEDLING?

Most people would be totally ok to receive needling therapy but patients who take e.g. Warfarin or other anti-coagulants, patients who are pregnant, patients who are immuno-compromised and the very young would be advised to try other forms of therapy.
Any patient considering needling therapy should desist from other forms of verruca treatment for 8 weeks before under-going the procedure.

SUCCESS RATES.

Documentary evidence claims success rates ranging from 50 – 69%, which is easily comparable to freezing or caustic therapy, but the real bonus is that if multiple lesions are present then they don’t all need to be treated. Also, the time factor means that the patient doesn’t need to keep applying home treatment and/ or visiting a Podiatrist with great regularity.

The cost of Dry Needling initially appears expensive but it must be compared to the overall cost of multiple trips to a Podiatrist and any home treatments involved.

Richard Harris is able to provide this treatment if required via INSTEP of Oakham. For more information please call 01572 759209

Massage has been used as a physical therapy for thousands of years and anyone who engages in physical activity for sports or fitness, regardless of age, fitness level or intensity of training, can benefit from sports massage.

Sports massage involves the manipulation of the soft (connective) tissues to benefit those who engage in any form of physical activity.

NB: Connective tissues are those that haven’t hardened into bone and cartilage such as skin, muscles, tendons, ligaments and fascia (which encases the other soft tissues).

Sports massage can be used:

• Pre-event to prepare the body tissues for activity which in turn alerts the brain that activity is imminent thus stimulating the body to be ready to “perform” under increased physical demands.
• Post-event massage helps to remove toxins from the tissues that occur as a result of the physical demands placed upon them (e.g. lymph and lactic acid, Carbon Dioxide) and reduces discomfort from DOMS (delayed onset muscle soreness) which results from strenuous exercise.
• As a general regular therapy because Sports massage also relieves muscle tension and pain and helps improve posture and flexibility and helps soft tissue repair after injury.

Many of the aims of Sports massage such as injury prevention/recovery and post-exercise recovery are quite different from other forms of massage.

Your Sports Massage Therapist will have acquired an in depth knowledge of the 10 major systems that function in the body: Skeletal system, Muscular system, Cardiovascular, Respiratory, Digestive, Nervous, Excretory(urinary), Endocrine(Hormonal), Integumentary(skin, hair, nails etc), and Reproductive system.

He or she will also have spent multiple hours on the practical aspects of Sports massage so that the client gets the greatest benefit possible from the treatment provided.

CONTRAINDICATIONS OF SPORTS MASSAGE:

If the client is feeling unwell or running a temperature because massage can will increase the circulation of toxins in the body. Exercise and massage should be avoided to allow the body time to recover.

Open wounds, recent bruising, acute muscle tears, sprained ligaments, chilblains, burns and sunburn must all be avoided in the initial (acute) healing phase.

Skin infections, Tumours, Thrombosis, Phlebitis (inflamed veins), 1st 16 weeks of pregnancy when the lower back and abdomen should be avoided.

In  June 2017 Richard Harris, already an HCPC reg. Podiatrist/Chiropodist, undertook and passed, with a MERIT, his written and practical examinations in Sports Massage at Loughborough University where he had been undergoing training in this discipline. He is now able to offer this service, by appointment, either at his INSTEP clinic on John Street in Oakham or as a domiciliary (visiting) service.

Please contact us via telephone or email for more information.

Richard Harris is able to provide this treatment if required via INSTEP of Oakham. For more information please call 01572 759209

Here at Instep Podiatry Rutland we are pleased to introduce “FOOT BALANCE”, a foot analysis system that allows us to identify a person’s foot type quickly and accurately, which in turn enables us to demonstrate to the patient the potential impact that poor foot alignment can have on the body.

The system also allows us to accurately mould light weight, low bulk 100% custom orthotics there and then, thus ensuring a fast and efficient turn-around time so as to enable the patient to start to feel the benefits of orthotic therapy much quicker than conventional casting/impression taking.

If the patient wishes, they can enter their email address on to the system and a break-down of their analysis will be sent direct to them.

BACKGROUND: FootBalance was founded in 2003 by a Finnish Physiotherapist who specialized in Podiatric medicine and who wished to develop better, modern treatments so as to try to improve the foot health of some of the 13 billion feet walking the planet. It has grown rapidly and is now available in more than 50 countries.

Independent research from the University of Salzburg (Austria) and University of Jyvaskyla (Finland) has confirmed that FootBalance custom orthotics have the potential to prevent injuries.

DID YOU KNOW: Over 75% of the population suffer from some degree of foot malalignment that has the potential to cause injury or discomfort elsewhere in the body e.g. in the feet, ankles, knees, hips, lower back etc. With this in mind, the aim of FootBalance orthotics is to restore the feet to a ‘neutral’ stance and control (possibly problematic) excess movements as much as possible during the gait cycle.

The orthotics have a flexible core which allows the normal desired foot functions of shock absorption, adaptation to uneven surfaces, and basic body propulsion to continue, whilst seeking to limit any excess movement, as previously mentioned.

FootBalance orthotics come in two grades: MEDICAL and SPORTS.

Medical orthotics come as “Black”, “Gold” or “Silver”, all having wipe- clean antibacterial top covers as standard and have a life span of 1 – 2 years depending on body weight and usage i.e. someone who treks 100’s of miles each week would theoretically wear them out soonest.

BLACK: Cost £120 per pair including moulding,  any modification, and fitting. These are the most bulky as they offer maximum control due to more rigidity and padding.

Gold and Silver retail at £100 per pair including everything as above. Both are more flexible and less bulky (still padded for comfort), the difference is Gold are more slimline to allow fitting in to e.g. dress shoes. Both can be used in sports shoes if desired.

All of these orthotics can be cut down and bevelled to be used as a ¾ length device if required.

SPORTS ORTHOTICS: £80 including adaptation e.t.c., they fit in to virtually all sports footwear and have a lifespan of approx.. 9 – 12 months depending on body weight and activity levels. This is incidentally how frequently it is recommended that runners seek new shoes !. They have an antifungal wipe -clean top cover and excellent cushioning.

It is not usually recommended that these sports orthotics are used as a ¾ length device but it isn’t unheard of.

We believe that FootBalance orthotics offer a quick, cost effective solution to problematic or potentially problematic gait abnormalities, especially when compared to the cost and time factor involved with more traditional bespoke orthotics.

Please feel free to pop in to “Instep” to enquire about a free FootBalance gait analysis.

Podiatrists are able to deal with many sports related problems affecting the foot, lower limb or even lower back (which can be a result of problems lower down the skeletal system) and Richard’s interest and training in Biomechanics and Sports massage make him well equipped in this discipline.

This blog is designed to give the reader a brief insight into the mechanics of a sports injury generally, the most common causes, the anatomy of a sports injury, how to try to avoid injury and the way to best recover from that injury.

A SPORTS INJURY is basically any form of stress inflicted on the body during physical activity that stops the musculoskeletal system (bones, muscles, ligaments, cartilage) from then being able to function properly. It usually results in pain, swelling, tenderness and limitations of use.

Injuries are classified as “ACUTE” which are the result of a sudden traumatic event e.g. fractured metatarsal, pulled hamstring, or “CHRONIC” which usually result from overuse and wear and tear over a period of time e.g. bursitis, tendinopathy.

COMMON CAUSES OF INJURY:

Repetition is a major cause of injury, as is using a poor technique or simply wearing inappropriate footwear. Other common causes can be:

* Failure to warm up making the muscles more prone to strain

* Excessive body loading i.e. applying forces to your body tissues which they are unprepared to deal with (lifting too heavy weights, running too far etc..)

*Overtraining increases the risk of chronic injury.

*Inappropriate equipment usage exposing the body to shock or inadequate support.

*Muscle weakness or imbalance which stresses opposing muscles and can lead to a loss of strength in the body.

*Accidents, often from impact or collision.

*Joint laxity e.g. hypermobility

*Lack of flexibility which limits the body’s capabilities due to limited joint range of motion.

*Genetic factors which are unique to all of us and influence the shape and structure of our musculoskeletal systems.

*Recurring injury which makes the body prone to other injuries.

ANATOMY OF A SPORTS INJURY:

The musculoskeletal components are listed here with their function and potential injuries:

*Skeletal muscles produce force and movement, the muscle fibres can be torn (“strained” or “pulled”) to various degrees of severity.

*Tendons connect muscles to bones and help produce movement. They can be strained or ruptured (complete tear) or suffer a tendinopathy which is pain caused by overuse or repetitive motion.

*Ligaments connect bone to bone and give joint stability by limiting joint movement. Prone to overstretching (sprain) or tears.

*Bursae: small fluid filled sacs that reduce friction. They allow muscles and tendons to glide over bone. Bursitis occurs from overuse or infection.

*Cartilage is a smooth fibrous covering over bone ends at the joints. It aids movement, shock absorption and impact. It can become torn or worn and heals slowly and poorly due to a poor blood supply.

*Joints are capsules (encompassing all of the above elements except muscles) which can become partially or fully dislocated.

*Bone fractures and breaks can damage surrounding soft tissues.

AVOIDING INJURY:

First and foremost age and the basic fitness level of any individual will influence their ability to enjoy energetic pass-times but the benefits of exercise to any off us is well known (reduces heart disease risk, reduces blood pressure, reduces cholesterol etc.) but we must make sure that we take any steps possible to reduce the risk of injury.

If an individual had an underlying health condition it would be necessary to visit e.g. their GP as a precaution before starting a new sport or regime. If a person is starting from a position of low general fitness and/or obesity it is vitally important that any new exercise is built up gradually to avoid injury but also so as not to kill the initial enthusiasm! “NO PAIN NO GAIN” is a great maxim but at what cost ? “SOFTLY- SOFTLY” is a better initial approach.

Any training regime should be formulated to meet the demands of the chosen sport e.g. distance running will require stamina training, weight training needs muscle strength.

*OVER-TRAINING prevents proper body recovery and increases likely injury.

CHOOSING THE RIGHT EQUIPMENT is a must: footwear must be sport specific and provide adequate support and cushioning, clothing should be suited to the purpose, equipment such as rackets, bikes etc. should be fitted to the individuals weight and body dimensions.

RESTING and refuelling are as important as the training itself, without these the body cannot repair from exercise and come back stronger and therefore if a person is injured often a complete break is the only way to guarantee no delay in recovery. Refuelling correctly is vital so diet must be tailored to the training programme: Glycogen is burnt by the body during exercise so pastas and wholemeal bread are great pre-exercise whilst nuts and dried fruit or energy bars are great during exercise. Post exercise protein and carbs are essential for body repair and should be eaten within 2 hours of exercise.

HYDRATION is also massively essential pre, during and post exercise.

A GOOD WARM UP prepares the body for exercise and reduces injury risk, it should be as sport specific stretch and movement wise as possible. It should include CARDIO WORK for approx. 10 mins. e.g. jogging/skipping to increase the heart rate and blood flow, LOOSENING EXERCISES e.g. hip, ankle, shoulder rotations etc. 5 – 10 mins, STRETCHING of various muscle groups e.g. hamstrings.

WARM DOWN post exercise is just as important in injury prevention as it restores the body gently to a pre-exercise state, aids repair and lessens muscle soreness. This should include gentle jogging and walking for 5 – 10 mins and static stretching to relax muscles and tendons, stretching each muscle group for 20 – 30 seconds.

RECOVERY FROM INJURY:

* Sharp pain: usually signifies an acute injury, Dull nagging pain usually signifies a chronic injury.

Soft Tissue Injuries (damage to muscles, tendons, ligaments, joints) will swell because of internal bleeding so the RICE (rest, ice, compression, elevation) protocol is essential initially.

* A break will take approx. 6 weeks to heal but soft tissue will take at least 12 weeks.

* Obvious Bone injuries would require immediate medical attention.

* Head injuries and other acute collision injuries, first aid or medical attention may be necessary.

Acute Injuries: Rest the injury, Ice the injury for 20 -30 mins every 2 hours for 1st 3 days, Compression should be applied e.g. tubigrip to reduce swelling, Elevation also reduces swelling.

Once the rice procedure has been administered, from about day 7 onwards or once swelling has subsided sufficiently, very gentle mobility exercise and stretching can begin on the affected area.

Advice from Podiatrists, Physios etc. can be useful (both in acute and chronic cases) especially with rehab and injury prevention going forwards and obviously sometimes further intervention via orthopaedic specialists etc. might be needed depending on injury severity. MRI scans, x-ray etc. can sometimes also be indicated.

Chronic Injuries: Rest and Ice are still good, but the treatment will involve a prolonged series of physical therapy and specific exercises to get mobility back to the affected part, sports massage breaks down scar tissue and aids repair. Often orthotics can be beneficial depending on the nature of the injury.

COMMON SPORTS INJURIES seen by Podiatrists are Shin Splints, Lower Back Injury, Tendonopathies (Achilles, Peroneals etc. ) Ankle Sprains, Runner’s Knee, Plantar Fasciitis, Metatarsal Fracture to name but a few !!

This would depend on the nature of the condition that the individual is seeking advice or treatment for, but there are some cases where it would be fair to say that the Podiatrist would be the first choice whilst in other cases the GP should be consulted first.

All GP’s will have a particular specialist area and also a broad knowledge base about a massive amount of other medical conditions but one shouldn’t expect them to be as well versed as any particular health professional who has trained and practices daily in one specific discipline. That is why if you do use your GP as a “first port of call” they will often advise that you seek treatment from the relevant health professional that they feel would best be suited to your particular complaint.

Below are several examples of perhaps “PODIATRIST FIRST”:

If a person were suffering from a suspected INGROWN TOENAIL then it would be far better to see the Podiatrist, more often than not GP’s will prescribe antibiotics and say that will do the trick which unfortunately not true. Whilst the antibiotics will quell any infection in the short term, the nail will continue to grow and pierce the flesh so the problem gets progressively worse in the medium term and if infection returns before the problem is resolved then the patient will need more antibiotics before the potential minor surgery under local anaesthetic can be performed. Incidentally surgery is the usual final outcome due to the delay and resultant increase in pain etc..

Corns/Callus : No need to bother the GP with this, it basically needs removing by the Podiatrist.

Orthotic provision : A podiatrist should be specifically trained to analyse gait problems and have the ability to prescribe the right orthotics for the condition presented. Often we receive referrals from other health professionals such as Osteopaths and Physiotherapists who have realised there is a gait problem causing a knock-on effect further up the frame and want us to have an in-depth look and prescribe accordingly.

VERRUCAE: At one time GP’s often ran Verruca or Wart clinics but this isn’t often the case now so better to visit a Podiatrist for diagnosis and treatment.

PLANTAR FASCIITIS: GP’S will often prescribe anti-inflammatory medication and maybe suggest cortisone injections, there is nothing wrong with this approach except that cortisone only masks the problem for a while but it doesn’t usually cure it. This condition needs more detailed treatment and advice for both the cure and future prevention so ideally the Podiatrist would be the first port of call.

Instances where the GP would be the best initial option would be for example in cases such as potential melanoma or deep vein thrombosis. These types of problem definitely warrant confirmation or referral via the GP to the appropriate specialist consultant who would then instigate the appropriate treatment. That is not to say that we as Podiatrists cannot identify these types of problems correctly, we often do, but even then our course of action would be to direct the patient towards their GP for confirmation and referral.