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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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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!
Copyright 2015. We take our copyright quite seriously. If you reproduce this without seeking our permission we will be very upset. So upset we will contact our solicitor and instruct them to deal with you. Big hairy scary with a steely glare enormous shoulders and a square jaw she will take you to task! We will instruct her to take all necessary measures to recompense us for your infringement on our intellectual property and copyright!
If you would like to reproduce this and are happy to acknowledge our company and share a link to our website then we will most likely be happy to allow you to reproduce this, but hey why not ask!
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“I have these really cushioned shoes” she says with pride!
“The guy in the shop says they will be the best thing they are just so comfortable”
“I bought the best ones they had”
“They worked for a while but now it has come back and it feels just as bad if not worse than it did before”
“I am so frustrated I have tried everything”
Asics Nimbus for Neutral or higher arched foot types – great supportive cushioning
This is generally how the conversation with many of our patients who first visit us tends to sound like. Why does it sound like you? Because we see “you” …or someone just like you every day. (often 6 – 10 times a day!)
Heel pain and foot pain can be frustrating. It can stop you from doing the things you love. Putting off the plans you have. Tried walking the city to surf with heel pain or for that matter the streets of Greece on that big overseas trip you had planned? Heel pain can be a game changer!
Many people do the very first thing that comes to mind BUY NEW SHOES! From GP’s to nurses to your next door neighbor, people will tell you that new shoes are the way to go and we won’t disagree BUT BE WARNED the choice of shoes is what’s important.
Most very cushioned shoes WILL NOT help you! Our experience of successfully treating thousands of heel pain patients says, a shoe that has a firm shell with a small amount of structured cushioning is what works best.
Footwear for heel pain needs to be more supportive. We have found that cupping the foot with a firm heel counter (The very back part of the shoe). Supporting the foot through the midfoot with a shank, meaning a firm part of the sole, so the shoe doesn’t bend in the middle. When you visit us with your heel pain it’s one of the very first things as practitioners we look at.
Our “got to shoe” of 2014 is the Asics Gel cardio zip 2
Avoid your trendy Nike footwear with large bulky cushioned air bags. Avoid footwear that are super flexible and bend in the middle. Light weight and footwear like “supasoft” and “gel cushioning”. Our experience says these at first these feel ok but quickly become more of a problem than a solution. Don’t even start us on minimalist shoes and barefoot running – a recipe for disaster.
Footwear is only part of a more detailed solution. When visiting A step ahead foot +ankle care we will develop a detailed treatment plan addressing everything from your footwear to soft tissue rehabilitation through to correcting your poor foot posture. Heel pain is a complex problem that won’t go away by itself (it will if you are happy to wait anywhere between 12 month and 5 years). Sadly unlike other conditions unless you are going to stop walking altogether you are going to have to deal with this problem before it will go away.
The podiatrists at A Step Ahead Foot and Ankle Care specialize in lower-limb mechanics and sports medicine. Their podiatrists have been featured on television and in magazines such as Men’s Health, Good Medicine, Prevention and many others. They see more than 15,000 patients every year with foot pain just like yours. The practice has been servicing Western Sydney for over 30 years.
They work closely with a number of General practitioners, Orthopaedic surgeons, Sports physicians and Sports physiotherapists to assist in the treatment of many of their difficult patients. They are also the podiatrists that other podiatrists refer to when they need someone to work with their complex patients.
You can contact A Step Ahead Foot + Ankle care on 96732987 or 47322007 to make an appointment.
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Fungal nails will soon become a thing of the past
Fungal or ugly looking nails
It is estimated that over 2 Million people in Australia suffer from Fungal toenails ! (that’s 10% of the Population). So if you think your nails have a fungus you may well be right!
Fungal nails can be unsightly and embarrassing. Often described as “rotten nails”, patients may describe their nails as varying in colour, from a yellow through to a brown discolouration. The nail may also look like it is thickened or even eaten away.
Sadly treatment to date has been limited with only expensive but often ineffective nail paints or prescription only heavy duty oral medication which while effective taken a long time to work and can have significant side effect for many people. There are a multitude of “home” remedies that are reported to work but most often lead to no success! If Vicks worked on toenails don’t you think the company behind Vicks would have cottoned onto this by now?????
Laser therapy is a new and highly effective treatment for this embarrassing and health effecting problem.
Why choose Laser
- Highly effective – Fast result
- Safe – No side effects!
- No Aesthetic required
- Comfortable with minimal discomfort
- Nail Polish can be applied immediately after you leave
- No need to take medication
Brenden after many years in Podiatry and feeling the frustration of literally tens of thousands of patients took the decision to look for a solution to chronic fungal toenails. “Each year I see literally hundreds of patients who have struggled with this horrible condition” Says Brenden. “Many of these patients have tried multiple creams lotions and medicament with no relief”. Frustrated by this, Brenden along with some Podiatry friends decided to look worldwide for a solution that would be safe simple and pain free for patients.
In search of an answer Brenden attend a conference in America and after some research found the Class 4 Diode laser now being introduced to A Step ahead foot and Ankle care. Finally he had found an answer which provided patients with simple and safe solution to a complicated problem.
We are now very pleased to be taking bookings for this treatment to fight nasty nail infections!
Call us at Penrith on 47322007 or St Marys on 96732987 if you too would like to the fungal toe nails gone!
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Q) Why did we start our own Orthotic Company in 2010?
A) Sometimes you just know things can be better!
I have been making orthoses for patients for a long time now nearly 20 years. I do it because time and time again I see these seemingly simple devices (they are actually not simple) make great changes to people’s lives. Put simply I have watched as orthoses made with love, passion and a good dash of knowledge and advanced technology, make people live better!
In the past I had all my devices made by third party companies – almost all Podiatrists do. They are made from a script which we fill out giving you a series of options. For many people it works it did for me for many years. However while it worked and worked well, I knew we could do better I knew I could help people MORE and get a better fit if I could have more control right from the start till right to the finish.
Our Lab technicians working on orthotics for patients each pair is hand finished. Some of our Lab technichians have been making orthotics for more than 15 years – that’s experience!
Better design – I wanted to design orthotics that patients LOVED to wear! So after extensive investigation and visiting 2 other countries, I came across what I consider to be the best orthotic design package available in the world to date. So we invested in a state of the art system with limitless design capabilities.
Perfect fit – It has to fit our patient’s feet PERFECTLY! Not only did the package come with a brilliant design package it came with a laser scanner that took a 3D scan the accuracy and likes of which I could not find elsewhere. It maps the foot accurately to within half a millimetre – Heck I have had a piece of dirty stuck to someone’s foot and these scanners have picked it up! We bought two world leading scanners – I have not found better
More flexibility-Our patients need us to work with them! With minimal restrictions! If a patient really needs a different cover or a particular fit for a particular shoe, I want to give it to them! I wanted to not be restricted to a series of boxes ticked on a prescription. We now deliver a true Bespoke – custom made orthotic.
Best quality– Our patients deserve the best! I want to provide all the best materials for my patients! The highest quality, too the best standards- no compromise! I wanted to be the person deciding on the quality – I am super fussy and I like expensive stuff! We now buy only what we consider will last the longest for our patients and what will deliver them the most comfort and performance!
No excesses – Our patients are paying good money, they deserve only the best. If a cover is wrong, if it isn’t comfortable, if it wears out, if it needs to be better – it is all up to us! It’s not someone else’s fault, a faceless guy at a lab. It all comes back to us! We guarantee what we make- we make the best and stand behind it! 12 months guarantee on the shell and top cover, if it’s not right we fix it and in that time you will never pay!
We started this company to make patients the happiest they can be!
A Step Ahead Foot and Ankle care are located in Sydney’s Western Suburbs. We would love to be able to help you with your foot or ankle pain.
A side note: We are glad to see other practices around us start to develop a love for making their own orthotics. We say that’s great if we can lead the way and others pick up on our technology and as an end result we get all get better results for our patients that’s an awesome thing! We have now been doing this for a long time if we can help you in any way please let us know – Happy to help others get it right!
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!