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His brother has very flat feet and wears orthotics, so I thought I’d get him checked too. He doesn’t get any pain though. I hope that’s okay that I’ve brought him in?
You wouldn’t believe the number of parents I see who are almost embarrassed to have made an appointment for their little one because they’re not sure if they should have.
Little people get pain as well. DON’T wait till your child is in pain to look after them
After chatting to them about why they are uncertain, the most common thoughts floating through a parent’s minds tend to be:
• Is he too young to come in for an appointment? I’m not sure what a good age for this is.
• He doesn’t actually get any pain so I’m not sure if I need to have him looked at?
• I think I might be over-thinking this because it’s only a small thing I’ve noticed!
• This might just be a normal part of her growing, I’m just not sure what’s normal!
These are all very valid thoughts and concerns, and are completely NORMAL!
Unless you’ve undertaken a 4-year podiatry degree and then had at least a few years on top of that working particularly with kids, then there’s not a single person in this world that can expect you to know what is and isn’t normal and when to bring your little one in.
That’s PERFECTLY okay – we’ve taken care of that hard “qualification” stuff for you!
Let me quickly clear up a few of the burning questions:
1. There is NO such thing as too young. We see kids as early as 12 months old – from the moment that they start walking! You’re actually doing us a favour – firstly because the younger we start treating, the better (and faster!) the results tend to be, and secondly because if we have to wait before we start treating, we are able to see and track the progression and changes in your child’s feet. I often ask if the foot was like this a year ago and am often greeted with ‘I honestly don’t know’. The more pieces of the puzzle we have, the more specific we can get in our treatment plan.
2. Pain is NOT the only indicator that something’s wrong. Parental instincts are a powerful thing – if you notice that something is odd, or isn’t quite right, there may well be something going on that needs to be addressed. Don’t doubt yourself!
3. A small thing may indicate something bigger happening. You’re not over-thinking anything at all – everything has a cause, and sometimes something as seemingly small and resolvable as a little bit of in-toeing can actually be a result of a structural foot abnormality that needs correction before it gets worse or weakness in the core muscles that need strengthening to correct and aid normal development.
I think the BIGGEST thing that I want to emphasise here is that we LOVE that you bring your child in at an early age! We LOVE that you just want to get their feet checked to make sure everything is progressing normally. We LOVE that you want to be as proactive as us and prevent any problems from developing instead of having to fix a painful foot after the pain has already started. We will NEVER think it was a bad idea to bring your little one in.
Kids are at the centre of what we do – it’s WHY we come to work – and nothing makes us happier than seeing happy, healthy and active children running around our practice and tearing up our toy box (literally, we have a drawer filled with toys now).
Nina Lansdowne
A Step Ahead Foot + Ankle care
Penrith, St Marys and soon to come to a suburb near you!
A Step Ahead Foot and Ankle care have founded “My Kids Foot Doctor” a clinic specifically geared towards treating Kids feet. We see dozens of kids a day, unlike other practitioners who see your Grandma’s toe nails and the occasional kid we see these balls of fun all day every day.
Our clinics are set up with kids in mind we have big toy boxes, Ipads, TV’s coloring in and lucky dip boxes. Our practitioners are the kind that sit on the ground and chat to your child, who laugh, may wear silly glasses and love handing out chocolate WE LOVE SEEING KIDS!
What does this mean? It means we have built up an enormous amount of experience with kids because we get to see them ALL the time! If we can help you with your little one, if you have a nagging doubt or worry please call our helpful team on 96732987 we’d love to help!
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“Ok so I went to the guys down the road.” Say Lee my Triathlon loving patient says to me. “It’s just really sore here under my second toe, they said it was a Neuroma but they have been trying to fix this for weeks, no months and it’s just not getting better” !
Callous on my foot, Numb toes and this V developing – A runners trifecta!
The pain that Lee was chatting about was not a surprise to me and nor what I noticed on her foot. She had developed a small V between her 2nd and 3rd toe, had pain under the ball of her foot and had developed a small amount of callous around the same area. Yup I’d seen this many times before!
If she wore tight shoes, high heels or bike shoes in her case she found the pain got worse. If she ran a lot while it may have got numb for a while at the end of the race it got sore! Over time she noticed the split or V sign getting worse.
On seeing this her GP suggested Metatarsalgia, which for years has been a reasonable diagnosis and what most would suggest this may be, However it’s NOT. The “other guys down the road” AKA another group of Podiatrist, had diagnosed a Morton’s Neuroma, again this is a common misdiagnosis. Often radiologists will under ultrasound call this a Neuroma because these two conditions can look strikingly similar. The scan or ultrasound the Radiologist undertakes is only as good as the information provided to them though your diagnosis in the clinic get it wrong and so will they!
After a bit of pushing and prodding, and watching Lee walk again on our Video walk / run analysis equipment I was now sure what we had BUT I wanted to get another set of eyes to have a look so off she was sent to see a particular radiologist we use all the time. He sees our patients very specifically because he is overly experienced in looking at FEET!
On the report there it was “A plantar plate disruption between the 2nd an 3rd Metatarsal heads.”
So we started Lee on a series of Deep connective tissue massages with our Podiatrist, renewed her orthotic insoles and arranged for her to get some new trainers on our advice.
6 weeks later and BOOM Lee was about to start running again! “I won’t be going elsewhere again” she said and this time I believe her!
BB’s looking super clever in Bright red Red Foo frames! No BB doesn’t wear glasses!
Brenden (AKA BB)
A Step Ahead Foot + Ankle Care
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“I didn’t think it was a big problem, I mean she trips over but I thought she was just a bit uncoordinated. Her Dad wanted me to get her checked out so here I am!”
In toeing , kids tripping, being a little uncoordinated and making kids smile!
Wow, this is an all too common sentence we hear from mums and dads!
After a thorough bio-mechanical examination “walk, run, posture assessment”, and some experimentation with the clinic whoopee cushions, we popped young Jessy on our state of the art dart fish gait (Run / walk) analysis system and there it was.
“Wow I didn’t realise her foot turned in THAT much!” said mum.
As In-toeing and Metatarsus Adductus is something we see and treat daily (I saw it 3 times just yesterday!), we had to hide the smiles on our faces. We knew we could get Jess to comfortably run and play sport again without tripping! about 40 mins later, armed with some detailed footwear advice, and a copy of her 3D laser scan for her Orthotics/Insoles in her hands, mum and Jess left the clinic with some answers.
See you in 2 weeks for your Orthotic Fit Jess!
Brenden Brown (BB)
A Step Ahead Foot and Ankle Care,
Founders of My Kids Foot Doctor!
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“I don’t think that space between my toes has always been there” is surprisingly a very common phrase to hear from our patients, especially when describing some pain at the front of the foot.
That’s exactly what Lydia came to us with yesterday, after having hoped the pain around the ball of her foot – that started for no particular reason that she can remember as is often the case – would go away on its own – but it keeps getting worse!
V sign of plantar plate disruption
I’m going to be very frank.
Nope, it’s likely NOT “just the structure of your feet now”, and if you’ve never noticed it before, it very likely “hasn’t just always been like that” – sadly far too many of my patients tell me that this is what they’ve been told by other health practitioners, GP’s and relatives alike, and it’s just not true.
The actual truth: It totally DOESN’T have to stay that way and you DON’T have to put up with frustrating pain that limits everything from general walking to exercise to social outings and everything else we love about life!
Hang on, what makes me so sure??
I couldn’t even tell you how many people I’ve diagnosed and treated with exactly these and other symptoms of a plantar plate injury, ranging from days after pain starting to unfortunately years down the track.
Injuries to your plantar plate are very commonly misdiagnosed and left untreated – you’re not alone there! But it can definitely be fixed – we do it every day! So we have a great, thorough treatment plan that has been tried and tested over many years and hundreds of patients with this exact problem.
The tools in our tool box range from a series of deep connective tissue massage, to 3D-designer laser-scanned custom orthotic insoles (super fancy I know!), to strapping and footwear changes and stretches and everything in between!
Do it – join our healthy, happy and active team of fully recovered patients – give our friendly team a call on – getting rid of pain like this is why we love what we do.
A Step Ahead Foot + Ankle care
Penrith, St Marys and soon to come to a suburb near you!
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Standing occupations and what happens to feet!
Busy looking people!
Most of us stand or walk everyday but amongst us there is a proportion of our population that do it more than others. We are talking to you Nurses, Builders, Hairdressers, Concreter’s, Teachers, process line factory workers and Check out operators and, and, and and! You guys know more than anyone what a toll standing for hours can do to your feet. Below is a very quick description of some of the more common problems you may have suffered and things we as foot specialists see day in day out and help to treat.
Plantar plate tears / injuries / dysfunction
Is this you? (What it can look like)
• Do you have pain in the ball of your foot? Is it worsened when you stand or possibly wear shoes?
• Have you developed the feeling of a lump or a little pea under the ball of your foot?
• Is there dry hard skin (callus) developing under the ball of your foot?
• Have you noticed a small (or large) gap developing between your toes that resembles “V”? This is often the 2nd and 3rd toes, but it maybe any?
• How did it happen? Do you remember tripping falling and developing a pain in your forefoot (ball)? NO you DO NOT have to have had an accident!
• It may have developed slowly over time with no memory of a painful incident.
We see this many times a week and sadly we often see it misdiagnosed and therefore treated as the wrong problem. It can be misdiagnosed as a Mortons Neuroma or at times when people aren’t sure of things (and for many years) some practitioners diagnose Metatarsalgia .
Remember “Grandma’s feet? You know the ones where her big toe had formed a bunion and the next two toes popped up and crossed over each other? Yes those feet you wished you would never get, and swore you would never let it happen to you! Guess what without having it treated pronto –they soon may be yours!
Correct Diagnosis
A big part of this problem is misdiagnosis! You cant diagnose this if you don’t see a stack of it. As a clinic we will always send you for a Ultrasound BUT not just to anyone! Some radiologists commonly miss this and sadly are not familiar with the condition. Make sure when you are referred to get a diagnosis the radiologist knows and has diagnosed Plantar plate tears before!
Clinically your podiatrist should be able to see this quickly but it can be tricky and some Pods are more equipped for general nail care. Choose someone who sees this regularly! ASK!
Treatment
Strong supportive footwear is a key here! Shoes should be solid on the base not bend or twist. Cushioning this condition with fancy air bubbles WILL NOT fix this!
Orthotics (Custom made) – Well-made and designed orthotics will assist poor foot posture and correct alignment. They cannot come out of a packet and fix this, they need to be designed to help address this.
Soft tissue therapy – This condition is often slated straight to surgery STOOOOOOOOP! Unequivocally this condition has a good prognosis with conservative therapy trail first! We see this condition many times a day and get great success. Now we realise not all Pods do soft tissue like we do (Come on pods get to it!) but this is really necessary to go hand in hand with your Orthoses. Orthoses alone WILL NOT fix this. If your Pod wont do soft tissue then find a physio who will!
Surgery. Yes if this condition progresses to an unresolvable tear there is a need for us to refer you to an orthopaedic surgeon for surgery. SURGERY is A LAST resort! On most occasions surgery can be avoided with early quality intervention. As a note we worry about the amount of these we see that have unnecessarily sent to a surgeon. Many times way too early and before conservative care I has been trailed correctly these patients (you) are sent to surgery!
Heel pain
Is this you? (What it can look like)
• Pain on the first few step in the morning or pain on rising after sitting (Or Both)
• Pain Located in the heel area, under the heel where the slightly fatty area is, or pain in the Achilles running up the back of the lower leg.
• Pain may initially subside in first stages after first few steps
• Pain worsened by long period on your feet may become painful after walking or activity for reasonable periods of time.
Correct Diagnosis
The first thing your friends will tell you is “It’s a Heel spur”. Sadly life is not that simple and where once medicos lumped this into one general diagnosis (Sadly some still do). We recognise that this set of symptoms may be one of many conditions. Plantar fasciitis, fatty pad syndrome, Achilles tendonitis, and even Abductor Hallucis tendonitis can contribute to this pain. Find a practitioner who knows the difference! Again not all practitioners see these things a lot.
At times simple clinical signs are enough, but diagnosis maybe needed via radiology such as diagnostic ultrasound. Xray will show you a spur (Yes I know) but the bony spur is NOT the problem.
Treatment
Strong supportive footwear is a key here yet again ! Shoes should be solid on the base not bend or twist. Cushioning this condition with fancy air bubbles WILL NOT fix this!
Orthotics (Custom made) – Well-made and designed orthotics will assist poor foot posture and correct alignment. They cannot come out of a packet and fix this; they need to be designed to help address this.
Soft tissue therapy – Deep connective tissue massage, will be useful in all the above conditions. Again be wary of people simply telling you that orthotics will get rid of this. They go hand in hand but are not the only answer.
Shockwave – As a clinic we have been using shockwave for about 3 and a half years. As we are “early adopters” of new therapies, this is not as common to other practitioners but the use of this therapy is very handy and growing in popularity. We find this takes half the time that Deep connective tissue does to relieve this in combination with the other therapies.
Stretching – there are some very specific stretches that can be used for this group on conditions and for a large group of individuals this will help. Don’t be discouraged if these don’t work. Look above there are more options and solutions.
Tibialis Posterior dysfunction.
(Super flat feet / Fallen arches)
Is this you? (What it can look like)
• Pain in and around the arch. May be worse after walking or standing
• Discovering you have a “Fallen arch”
• Noticing one arch is lower than the other.
• Pain fatigue during or after walking. Pain on standing on toes ,climbing ladders.
Correct Diagnosis
This should be fairly easy to diagnose. The lowering of one arch, as opposed to the other, in combination with pain located in the arch. Should lead to an easy diagnosis. Diagnostic Ultrasound maybe used and your Podiatrist (us) can refer you off for this.
Treatment
Strong supportive footwear is a key here yet again and now again ! Shoes should be solid on the base not bend or twist. Cushioning this condition with fancy air bubbles WILL NOT fix this! (Can you see a pattern)
Orthotics (Custom made) – Well-made and designed orthotics will assist poor foot posture and correct alignment. They cannot come out of a packet and fix this; they need to be designed to help address this. IN particular without orthoses this condition WILL NOT get better! Get them and GET THEM QUICKLY!
Soft tissue therapy – Deep connective tissue massage, will be useful in all the above conditions. Again be wary of people simply telling you that orthotics will get rid of this. They go hand in hand but are not the only answer.
Braces – In the initial stages having braces specifically designed to support the arch will support and make steady the arch. It works well at first but is really a short term solution. Look towards orthoses and soft tissue.
Surgery. Yes if this condition progresses to a tear there is a need for us to refer you to an orthopaedic surgeon for surgery. On most occasions surgery can be avoided with early quality intervention.
Bunions
Is this you? (What it can look like)
• Your big toe starts to point out towards the smaller toes and is no longer straight
• Pain may develop around the big toe joint. Making it difficult to walk or stand
• Many people can have a bunion and not have any pain.
• The toe may begin to twist as well
Correct Diagnosis
On most occasion a qualified health practitioner should be able to diagnose this simply by looking at the clinical signs, however you may require a xray if you are considering surgical intervention.
Treatment
Strong supportive footwear. (Wow we just wont stop talking about this supportive footwear will we!!!) Shoes should be solid on the base not bend or twist. Cushioning this condition with fancy air bubbles WILL NOT fix this! (Can you see a pattern)
Orthotics (Custom made) – Well-made and designed orthotics will assist poor foot posture and correct alignment. This problem is often a result of a variance in the structure of your feet Yet again these cannot come out of a packet and fix this; they need to be designed to help address this.
Soft tissue therapy – Deep connective tissue massage, will be useful in all the above conditions. There is a problem with the balance of two muscle in your feet. This can also lead to another condition that may damage other muscles and soft tissue structure, the plantar plate rupture or dysfunction. Again be wary of people simply telling you that orthotics will get rid of this. They go hand in hand but are not the only answer.
Braces – Often called night splints there is some research that suggests these can be really helpful. I (Brenden) am a little dubious! This relies on you being super diligent on putting the splint on night after night. I always argue that on a Friday night after a busy week and a catch up with the girls after work it’s not likely you’ll want to pop this on before heading to bed. This is where the success of these will fall down BUT if you are super diligent, give them a try.
Surgery. Yes if this condition progresses there is often a need or want for us to refer you to an orthopaedic surgeon for surgery. This surgery over years has increased in its success. See a orthopod who does this all the time. Why ? Because ensuring that the person does this and other foot surgeries often increases the chance of success. If they are also doing shoulders knees hips wrists etc etc they simply cant be as use to doing this surgery as someone who does this every day.
The HARD sell !
At A Step Ahead foot + Ankle care we see several patients a day with this condition. We have patients that travel literally hundreds of kilometers to seek our help –which is really lovely! Our clinics are set up quite specifically to treat patients with muscle injuries and mechanical problems with their feet. We have invested hundreds of thousands of dollars into equipment and the latest technology to help us, help you- beat your pain.
Our principal Podiatrist Brenden Brown is recognized as one of Australia’s leading experts in Podiatry (No really). A past President of the Australasian Podiatry council he is regularly asked for his opinion in the media, appearing regularly on television shows like the Today Show and Magazines like Men’s Health.
It would be a pleasure to help you beat your foot pain.
We are located in Penrith and St Marys in Sydney’s Western suburbs. You can contact us on 47322007 or 96732987 we hope you will……. See that wasn’t so bad was it!
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Dr Brenden’s White paper report on the “6 Reasons You Won’t Beat Heal Pain” outlines what’s stopping you from beating this and tips on how to stop it in its tracks!