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Case Study 4 Orthotics and Orthopedic Shoes – Adult Acquired Flat Foot

By jake | Case Studies

Reason for attending the office: This patient attended for a checkup of an unrelated issue and it was during this first visit that the chiropodist noticed an abnormal left foot position.  After questioning the patient, the foot had been getting gradually flatter and on assessing and pressing the foot (called palpation), the chiropodist was able to determine there was a damaged tendon – something called Posterior Tibial Tendon Dysfunction which had led to weakness and the acquisition of an adulthood flat foot.

Agreed treatment:  The chiropodist arranged an ultrasound scan via the patient’s physician – this confirmed the suspected tendon damage with tearing.  A short-term plan was agreed which included the assessment of gait and biomechanics in order to accurately prescribe both custom orthotics and appropriate orthopedic shoes.  A medium-term plan was implemented with the patient’s physician to include a review with orthopedics so that the possibility of surgical management could be discussed as a medium-to-long term measure.

Alternative Treatment Discussed:  Additional and supplemental treatment is available and included Low Level Laser Therapy, Ultrasound therapy, extracorporeal shockwave therapy or possible cortisone injection therapy to site of maximal tenderness. 

Outcome: Orthotics and orthopedic shoes aim to offload the injured tendon by reducing forces acting on the foot, muscle and tendon.  The photographs and video below show the outcome of an effective foot orthotic and orthopedic shoe on adult acquired flat foot.

Timeframe:  After 5 months, the patient is wearing the orthopedic shoes and running shoes and medium/long term awaits the outcomes of an orthopedic surgical treatment plan.

Conclusion: This is an example how chiropodists are able to pick up on problems, act quickly to help in their assessment, diagnosis and treatment before they have a major impact on the patient’s life or lifestyle.  We aim to help keep patients mobile and active so that they decide for themselves the right time for any future elective orthopedic surgery.

Please note that in most evidence hierarchies current, well designed systematic reviews and meta-analyses are at the top of the hierarchy, with single case studies, expert opinion and anecdotal experience at the bottom. 

Case Study 3 Ingrown Toenail

By jake | Case Studies

Reason for attending the office: This patient attended complaining of a right big toenail that was curling, getting worse over the prior 3-4 years.  There was pain on pressure on the tip of the right big toenail and the pain was exacerbated by the nail curling.  

Agreed treatment:  On assessing this troublesome nail it became apparent that the patient was suffering from an involuted toenail – a type of ingrown toenail where the edges of the nail curve downwards to much.  The patient was already trying to manage the painful curling nail with frequent pedicuresAfter discussing treatment, it was mutually agreed that a nail surgery procedure would the best curative long-term treatment option.  This minimally invasive procedure is carried out in the office under surgical conditions to permanently remove the problem portion(s) of an ingrown toenail.  The aim of this treatment was to remove the problematic curling edges of the toenail, leaving the healthy central nail intact, and to prevent the problematic parts of the nail regrowing.  This procedure suited the patient due to the ease of treatment and minimal discomfort.

Alternative Treatment Discussed:  The option of frequent, professional nail care in our office by a chiropodist to try and minimize recurrent and ongoing pain could be an option.  The patient elected to opt for a more permanent solution rather than committing to a frequent chiropody care visit.

Outcome: Total healing following the procedure was 22 days.

Timeframe: At 4 ½ Months a cosmetic review was undertaken and the result was pleasing and the toenail was looking cosmetically good.

Conclusion: This is an example of how we aim to remedy a painful, deformed, infected or troublesome toenail using common nail surgery procedures and techniques.

Please note that in most evidence hierarchies current, well designed systematic reviews and meta-analyses are at the top of the hierarchy, with single case studies, expert opinion and anecdotal experience at the bottom. 

Study 2 Onychomycosis – Fungal Nail

By jake | Case Studies

Reason for attending the office: This patient attended complaining of a nail that had recently gone ‘funny’ on the right big toe.  Careful assessment revealed a fungal toenail infection.

Agreed treatment: After discussing treatment options which include taking pills, painting on medication and laser surgery for fungal nails, it was mutually agreed that ‘fenestration’ would the best initial treatment option.  A simple procedure is carried out with a sterile medical tool to make tiny little hollows in the fungal nail. The aim of this treatment is to allow a prescribed liquid antifungal to then wick through the hollows and reach the infection.  This procedure suited the patient due to the ease of treatment and minimal discomfort.

Alternative Treatment Discussed:  It was discussed that layered treatment may be needed which could include the use of other modalities such as fungal nail laser surgery and the use of pills.  A layered approach to treatment can help with aims of obtaining some cosmetic improvement and/or a reduction in fungus.


Outcome: At follow up a marked clinical improvement was noted.

Timeframe: The usual timescale for a large toenail to grow from bottom to top is usually about 12 months.  


Conclusion: This is a good example of how treatment can be layered for fungal nail infection.  Whilst this nail responded well to fenestration and topical treatment some infections may require the use of other modalities such as fungal nail laser surgery and / or the use of pills.

Please note that in most evidence hierarchies current, well designed systematic reviews and meta-analyses are at the top of the hierarchy, with single case studies, expert opinion and anecdotal experience at the bottom.

Study 1 Wart

By jake | Case Studies

Reason for attending the office: This patient attended complaining plantar wart that had been on the bottom of the right foot with a secondary cluster under the ball of the foot for some time. It measured the size of a quarter and the patient said it had been present for ‘many, many years!’ The patient had been having a series of treatments every 2-weeks over several months prior to attending and wanted to consider more radical treatment.

Agreed treatment: After discussing options including surgical and non-surgical interventions it was mutually agreed that ‘needling’ would the best initial treatment option. A needling procedure is carried out under sterile surgical conditions painlessly whilst numb under local anaesthetic. The aim of this treatment is to trigger the bodies own immune response – boosting the patients own body to fight off the infecting wart virus infection. This procedure suited the patient as there are generally rapid recovery times, minimal discomfort and prior treatment had failed to impact the condition.

Alternative Treatment Discussed: It was discussed that further treatment may be needed which could include the use of other surgical modalities such as laser surgery and the use of acids or caustics amongst others.

Outcome: Following needling other treatment modalities were then utilised to achieve a complete resolution for this patient including the use of special chemical compounds applied directly to the wart, Laser Surgery and a prescription of a topical cream to boost the immune response.

Timeframe: 18 months to resolution

Conclusion: This is a good example of an ‘intractable’ plantar wart infection which unlike typical plantar wart infections, does not respond quickly to typical treatments. An 18-month timeframe was not unrealistic in the management of this case.

Please note that in most evidence hierarchies current, well designed systematic reviews and meta-analyses are at the top of the hierarchy, with single case studies, expert opinion and anecdotal experience at the bottom.

Leg Length Discrepancy

By jake | News

Limb Length Discrepancy

Limb Length Discrepancy (LLD) is when there is a difference between the lengths of the legs.

A difference approximating 10mm can have a great effect on posture and function. The extent of the problem will also be determined by the activity of the patient. The difference affects the gait of a person but disturbs the whole biomechanics of the lower limb and possibly causes pain and discomfort in the lower back, hips, knees, and feet.

Most of cases the difference in limb length is small and it is difficult to appreciate the effect on appearance and function.

Classification of LLD

Structural or anatomical

Differences in leg length resulting from inequalities in osseous (bone) tissue.

Functional or apparent

Unilateral asymmetry of the lower extremity due to soft tissue.

What can cause LLD?

  • Unknown abnormalities
  • Fractures and Traumas
  • Degenerative Disorders
  • Legg-Calve-Perthes Disease
  • Infections
  • Cancer
  • Soft tissue contractures and laxity.

The most accurate method to identify LLD is through radiography. But a podiatrist can also measure limb length with a tape measure. Two common points are the anterior iliac spine (pelvis) and the medial malleolus (ankle bone).

Two factors dictate if intervention is needed or not: the magnitude of the discrepancy and whether it is attributing factor causing pain or discomfort.

Treatment

Non-surgical intervention:

  • Shoe adaptations
  • Heel lifts
  • Heel lifts in combination with orthoses.

Surgical intervention:

  • Shortening osseous tissue either by resections or stopping bone growth.

If you believe you have LLD or an asymmetrical foot posture/gait you may want to book in an appointment with a podiatrist here at The Footcare Centre who can assist, treat, guide or refer you. To book an appointment call 905-357-0214.

This blog has been written by Steven Castillo Pinel and is not necessarily the opinion of The Footcare Centre.

Plantar Fasciopathy

By jake | News

This blog discusses briefly the common condition plantar fasciopathy and the treatments that can be utilized at the various stages of the condition.

PLANTAR FASCIOPATHY

In our clinic, we see a lot of patients that present heel pain. There can be many different causes to heel pain, but one of the most common ones is plantar fasciopathy.

Plantar fasciopathy (PF) is a generalised definition to describe the overuse and inflammation of the plantar fascia.

What can trigger this inflammation?

As we are quite active and move about, we are constantly applying pressure on the plantar fascia and sometimes excessive pressure can instigate the micro trauma of the plantar fascia. Activities such as starting a new sport or going to the gym can trigger this. Stretching is advised especially when we have tight posterior muscles and soft tissues of the legs, such as the calf muscles and the Achilles tendon. A tight calf will mostly lead to a tight fascia, which could turn into PF.

Not just activity can cause PF, but weight gain and excessive load on the feet can play an important role.

The first acute initial inflammation is called Plantar Fasciitis. After repetitive stress and microtraumas to the heel and a long period lasting over 6 weeks can be described as Plantar Fasciosis.


Plantar Fasciitis

Plantar Fasciosis

Duration of pathology

Less than 6 weeks

More than 6 weeks

Symptoms

  • Intense pain
  • Heat
  • Swelling
  • Pain at the end of the day
  • Pain After Sitting Or Resting
  • Pain
  • Swelling

Treatment

  • Rest
  • Taping
  • Icing
  • Avoid Heat
  • Orthotics
  • Low Level Laser Therapy
  • Heat
  • Manual Therapy
  • Orthotics
  • Foot Exercises
  • Supporting Shoes
  • Low Level Laser Therapy
  • Shockwave
  • Steroid Injections

Our Chiropodists here at The Footcare Centre are experienced with dealing with Plantar Fasciopathy. If you do think you present this pathology, we would be most happy to guide you through the right treatment. To book an appointment call 905-357-0214 or book online.

This blog has been written by Steven Castillo Pinel and is not necessarily the opinion of The Footcare Centre.

Family Foot Care

By jake | News

What is Family Footcare?

Here at The Footcare Centre, we do not only want to care about our patients’ feet, but we also like to make sure our patients’ family’s feet are also being looked after too. This is true family foot care.

The comprehensive services we offer are key to our success. The Footcare Centre provides a comprehensive one stop shop for all your foot and ankle problems as well being an orthotic centre which is foot specialist/chiropodist led.

We see all generations with differing pathologies at the practice ranging from babies all the way through to active adults to the elderly with some of our patients remaining maintaining foot health well over their 100th year.

If you are a patient with us and you see or feel something not quite normal, be sure to talk to us. If your family or friends have any questions regarding how they can self refer to join the office we would be happy to help. We thank you for passing our details on and we would be most happy to see them and help.

At The Footcare Centre, we also have gift cards for you to give to someone special. These gift cards can be used against all treatments, services and sundry items that are available here at the office.
To book an appointment call 905-357-0214 or click here to book online

Spring……

By jake | News

This blog contains information and advice as we transition our feet from winter conditions to spring/summer conditions.

After a long winter full of rain and snow, spring has finally sprung and it’s now time to change our footwear and give our toes some fresh air.

During the colder months our feet are protected and snugged into our boots and winter shoes, and if our shoes aren’t properly fitted, our feet could suffer from corns and callus. As we change into our sandals, corns can improve on their own as our toes have more space but rubbing can lead to blisters even if our sandals are broken-in and familiar to our feet. It is important to check there are no pebbles in the shoe and not to go on long walks with shoes or sandals that haven’t been worn in months. Old and worn-out shoes that might feel comfortable might not give the support that your feet need.

We might also want to buy new shoes for the warmer months. There can be quite a difference in sizing from one manufacturer to another, so it is important to try all shoes properly before buying. Our feet swell up during the day, so trying and purchasing shoes in the evening or late afternoon will give you a more accurate width of our feet. If you wear orthotics, inserting the orthotics into the shoes you want to buy would be a great idea for no unfortunate surprises when trying them at home, so be sure to take these with you.

We must also be aware of fungus and verrucae (Plantar warts) around changing rooms. It is nice to freshen up in pools and gymnasiums, but it is important to wash and dry our feet and to look out for signs of athlete’s foot (itchiness and dryness).  Wearing flip-flops or sandals in these common spaces is a great preventative method.

As mentioned above, it can be nice to walk around barefoot, but not wearing shoes can lead to catching infections. Injuring, cutting and getting splinters can be caused by walking barefoot as our feet aren´t protected. It is best to take extra precaution and avoid any injuries especially if you’re diabetic.

It is always nice to go on walks and to become more active as the days are longer in the warmer months. But it is vital to make sure you are wearing supportive footwear and it is best to build up on exercise as we can cause strain in our joints and muscles in our legs and feet.

Warmer weather can cause our feet to get dry, specifically around our heels.  It is important to moisturise daily our feet with Urea based cream such as Dermal Therapy, Urisec or Uremol.

Our Chiropodists here at The Footcare Centre will always care and treat feet of those patients. To book or to make an appointment to get your feet sorted for spring please call 905-357-0214 or book online

This blog has been written by Steven Castillo Pinel and is not necessarily the opinion of The Footcare Centre.