Fiona is a 43 year old lady with two teenage daughters and a busy household. In the past six months she has returned to exercise by joining a gym, which she is …. or was really enjoying.
Lately she has been waking up in the morning, placing her heels on the ground, only to get what she describes as "excruciating pain". She feels the same pain if she sits for long periods and tries to stand: the pain, while not as bad as those first few step in the morning, can make her hobble. This is now a BIG problem as she was really enjoying her return to fitness and wants to see what she can do to rid herself of the pain.
Is it really a heel spur that causes the pain?
A visit to the GP
She visited her GP who spoke to her about a heel spur, he took x-rays and indeed there was a heel spur in the picture. He explained to her that generally very few surgeons will operate on heel spurs and there is little she can do but wait out the pain which on average would go away after about 18 months! He did give her some general stretches and said he could try an injection if she really wanted, but it was painful!
Fiona also went to the chemist to try to buy some heel pads to take pressure of the heel. She tried these for about a month. While they worked for a short while, the pain quickly returned. She also tried some very cushioned shoes, again while this was comfortable at first within a short period of time this very expensive pair of sneakers gave little relief.
On attending an appointment at A step Ahead Foot and Ankle care Fiona was just about to give up. A friend referred her after they had suffered a similar pain and our podiatry team had made her pain free.
Our Podiatrist, after a thorough assessment, diagnosed Fiona with plantar fasciitis. Plantar fasciitis is a soft tissue condition of the underside of the foot starting at the heel, where much of the pain is located, however the pain can radiate out towards the toes where the fascia again ends. The pain can begin quiet subtly at first and can last on and off for many patients for many years.
Shock wave is a new and highly effective treatment.
We discussed a treatment plan with Fiona to rid her of her heel pain, this included looking at some new more appropriate runners, a series of stretches, and soft tissue treatment options. Our Podiatrist provided Fiona with options which included:
Deep connective tissue massage – This is a firm to hard massage which is in this condition under taken on the base of the foot around the heel and into your calf muscle as this is almost always also tight. These session can range from as short as one a week for 3 weeks but up to 12 – 18 weeks long, dependent on how long your pain has been present.
Shockwave Therapy (Extracorporeal Shockwave Therapy (ESWT)) – Shockwave is a relatively new treatment which we have found very successful. The basic principles behind shockwave therapy are the high pressured acoustic shockwaves that travel through the skin to stimulate pain relief and tissue repair. We have found this treatment very successful and sees patients recover quicker. Most patients like Fiona recover within 6 to 9 weeks. This treatment is often recommended by sport physicians and orthopaedic surgeons. (Be warned - How long has your Practitioner been using this?)
Orthotic therapy – Orthoses are designed to hold your feet in a “corrected position”. Feet that are in poorly positioned or have poor foot posture have to over work which in turn causes muscles to over work and is most often the reason why people develop foot pain. While there are varying devices that do this there is no replacing custom made orthoses. These devices are made to match your foot exactly. - HARD RIGID orthotics can cause you MORE PAIN!! Soft pliable devices are the way to go!
In this instance Fiona opted for the quicker Shockwave therapy and orthotic therapy. Her podiatrist helped her select the correct foot wear to purchase from a footwear retailer. We then also provided her with an Isometric Strength exercises - NO NOT STRETCHES! that's right NOT stretching! Our team worked with Fiona to build up her strength readying the surrounding muscles for its work ahead at the same time as repairing the damaged tissue. On each occasion of shockwave reviewed these and provided supportive sports tapping to further support her foot.
Fiona attended for shockwave over a period of five weeks and made good progress over that time with her pain dropping slowly over the first two weeks and then quickly once combined with her orthoses and more appropriate footwear.
At week five it was decided to push her appointments out to fortnightly and then when this was found successful out again another month. In total Fiona attended a total of seven times before her pain was relieved completely.
We introduced Fiona slowly back to attending the gym, with strict instruction on stretching and appropriate footwear for her foot type. Fiona made a full recovery and with a month had returned to three gym sessions a week and a walk with friends for exercise on weekends.
Interested in more information? How about the common myths around heel pain?
Growing Pains- More than just pain from growing – A case study
Sam is 10-years-old. He’s a great kid who loves being active, but there’s a problem and it’s getting worse. Sam plays football in winter and, in summer, he’s a cricket fanatic. Apart from these regular sports he’s running about at school and is, yes your average Aussie kid!
Sam’s mum and dad brought him into A Step Ahead Foot + Ankle Care because, despite being a very happy and active kid, Sam is waking up a couple of nights a week with pain in his lower legs. When he wakes he wants his mum to rub his legs because they ache and are sore. Sam’s mum Beth has used heat packs and paracetamol which does take the pain away after a while but, as Beth says, “They aren’t fixing the cause”.
A key factor is that fact Sam’s parents recognised that the pain sometimes came on in the night after Sam had quite active days, like sports days or family activities with lots of walking.
Visiting the GP, Physio and Dr Google
Sam’s parents took their son to a GP who sent them to see a Physiotherapist. While the physio was nice and showed Sam some stretching and did a couple of massages, these again helped at the time but didn’t stop the problem from coming back. After chatting to the GP their opinion was that this was “Just growing pains”—something Sam would have to get used to, and that he would simply “Grow out of it”. Frustrated with a fantastic but upset little boy, Sam’s parents felt they needed another opinion.
Sam’s mum Beth jumped onto Dr Google and found herself even more confused. Some parents were recommending vitamin supplements, others recommended oils and others suggested all kinds of home remedies. She then found herself on Facebook asking other parents for help. This is where a friend of Beth’s recommended our practitioners at A Step Ahead Foot and Ankle Care.
Finally some answers
When our practitioners assessed Sam it became pretty clear there was more than just some kind of phantom pain going on. We undertook a detailed walk and run assessment, along with some measurements and testing on Sam’s muscles. Nothing was invasive and everything we do is done in a fun, friendly and non-confronting environment. After a short while we established that Sam’s feet were rolling in a lot and his arches where a little flat. In essence Sam had pretty poor foot posture. What this meant is that the muscles in Sam’s lower legs were over working to try and give his poor foot posture support.
This meant that a big day on his feet, like a family outing, a busy day at school or doing sports caused his muscles to work even harder. This led to them getting sore, not necessarily at the time of the injury, mostly at night several hours after the muscles had rested.
Helping fight “growing pains”
To help Sam we gave him a custom-made pair of orthotic insoles. These are made from a soft material so are very comfortable to wear but provided support for the rolling of his ankle. We took a 3D scan of Sam’s foot and video recorded his walking patterns using our specialised assessment software. The orthotics are then designed using our computer-aided design software. Next step is to make the orthotics, which is done in our on-site Orthotic laboratory by our technicians and overseen by our podiatrist.
After fitting his new orthotics into a new pair of runners that we recommended, Sam headed on his way feeling comfortable to return in a couple of weeks. We prescribed some stretching to work with his orthoses and suggested that we may need to follow this up with a specialised massage to relax his muscles as his orthoses took over and began doing their job.
A couple of weeks later a very relieved set of parents and Sam returned to our clinic. In a little over two weeks the orthoses had started to do their thing. Sam had only had pain in his legs once since starting to wear his orthoses and this was after a very big day, his school athletics carnival! After only a couple of weeks we expected this to decrease so we asked them to return in another month at which time they reported Sam to be pain free!! Sam’s parents also reported that he was much more comfortable at sport as well. They were overjoyed; they had their happy, healthy little boy back!
Growing pains ARE TREATABLE in most cases. While many well-meaning health practitioners may say you have to wait and outgrow growing pains, there are alternatives. Our practitioners have had the pleasure of helping many kids with this same problem. It’s what we love to do! Helping kids become pain free, happy, healthy and active is a privilege. If you would like to help your little one to become pain free, please give our helpful reception team a call on +61 9673 2987 or 4732 2007. You can also see find us on our Facebook page https://www.facebook.com/podiatristsydney
5 quick signs you need to see a Podiatrist (Foot Doctor)
Kids feet are different to Adults feet! Its the building blocks to making sure our kids enjoy activity
Have you been through this?
Grandma's are great at spotting it. Your friends aren't bad. The Shoe shop lady is often a superstar at it! But lets face it you've got a lot on and the occasional "Mum" or "Dad I am" ........ shhhhhhhh I have stuff to do! "Just a second but Mum ..... my feet are sore! Whaaaaaaaaaaaaat!
So you drag the kids down to the plaza and seek out the closest and “best” footwear retailer you know. (Same woman you remember saying vaguely about it last year.) But on the way or while you are there, some funny things happen! You mention it to your “grandma” and she asks about your little ones “Flat feet” and asks have you had them checked! "Remember I mentioned it to you?" Hmm then you head to the shoe shop and the lady who is fitting the shoes asks the same thing. “Have you thought about seeing a Podiatrist” - WOW that's twice now - Houston we have a problem!
Kids and flat feet, growing pains, tripping falling and all that normal stuff!
It’s not the only time someone may say it but it happens and we hear about it when Parents bring their youngsters into us confused with quotes like “I am not really sure if I should even be here?” So after seeing literally 1000’s and 1000’s of kids over my 20 years of practice I thought maybe a quick check list may help parent on what are the reason you bring your kids to see me !
Here is my quick 6 checklist – these are the reasons I WOULD bring my child to see a Podiatrist!
1. Flat feet. I thought I’d throw this on the mix pretty early as it’s often a reason people are told they need to see a Pod. It can be confusing and often it seems like there is conflicting advice. Here is my rule – If your little one is ONLY flat footed and does NOT have any of the following, you may well be perfectly ok the way they are now! However if they have Flat feet and ANY of the following YOU NEED TO SEE OUR PODIATRISTS !
2. Tripping or falling. You may notice it or it may take someone to mention it to you. With little reason and sometimes without notice your little one trips! Sometimes it seems justified other times it seems like they tripped over a blade of grass! Somethings happening here and yes we may need to take a look.
3. Pain at night or Growing Pains. If your little one wakes at night with pain in their legs, ankles or feet its more than likely time to see one of our team. Now it can be confusing at times you will take them to see a GP and sadly very sadly they will say “Its growing pains” Grrrr 9/10 you can attribute this pain can be treated and you don’t have to wait for them to “grow out of it” If your little one has “Growing Pains” or anything else like that sounds or smells like this – Visit` our team!
4. Kids that don’t like walking or avoid activity. Some kids seem like they are always whinging, you are out shopping or with the family and out on a long walk or other family activity and your child wants to “Sit down” or “stop”. Often we simply think our kids are being Lazy. However for a good proportion of these kids it’s got to do with their poor foot posture making walking harder and yes they are actually in pain! Sometimes kids don’t even realise they are uncomfortable (Its ok, we realise it sounds strange) they just know they want to stop! We have fixed kids foot posture and seen a change that means these kids go from not wanting to walk to almost running!
5. Unusual wear on old footwear. Have you noticed that your kids shoes seem to lean to one side after a couple of months or even weeks? Have you noticed they wear out the toes and have simply blamed it on loads of Handball? This again is in our top 5 reasons for needing to see one of our team!
6. Sore feet or pain at any times. (Ok so this is a sneaky Reason 6!) It seems simple but if your child has sore feet it means they need to see a Podiatrist. NO you don’t need a referral (Permission slip) from your GP simply call and we will help. YES It’s what we do, we LOVE seeing kids because delightfully they often respond really well and very quickly to our treatment – and who doesn’t like a big smile!
So if your kids have ANY of the above Grandma and the shoe shop lady are actually on the money! If not then guess what you can fairly confidentially not worry!
As we have said above, we LOVE seeing kids. We are very lucky in that we see literally hundreds every year! If you have any of these problems or any other foot or ankle complaints please let us know! We are located in 2 spots in Western Sydney both conveniently located minutes from the M4 and with parking right out the front. Please call our helpful team on 96732987 and our team will answer any questions and help with making times to see our Podiatrists.
Dr Brenden Brown (BB) Podiatrist For the team at A Step Ahead Foot + Ankle care
If you’ve ever even CONTEMPLATED getting orthotics – read this first!
Let me start by answering a question that goes through almost all of my patients minds at some point – nope, orthotics are definitely NOT all the same and when the right orthotic is properly designed for my patients foot using the right materials and design skills that come from years of experience (and very honestly, learning from previous mistakes that others are still making today), yes they ABSOLUTELY do alleviate foot, ankle and low-er limb pain.
In fact, orthotics couldn’t be more different – and in many ways, they should be! Let me explain while answering a few concerns I often hear:
Are my orthotics going to be like my pair from my previous podiatrist?
I know someone that has had orthotics before but they didn’t help him?
What do orthotics actually do?
Let me start in answering these with the first and most important point:
The way your orthotics look and how effective they are are dependent entirely on the skills and preferences of your podiatrist! Yes – your specific podiatrist alone dictates how they are made and using the resources, materials and skills they have available at any point in time. If your podiatrist wants to heat-mold a pre-made, soft, thin orthotic and add a colourful harder piece and call that a custom-made orthotic, then that’s what you get. If you get plaster-cast and the cast gets sent to Canada for a firm, plastic-like device to come back, then that’s the orthotic you get.
What does this mean? Simply and unfortunately put, you may receive a lower quality product (often associated with a cheaper price) that claims to do the same thing, but often fails to produce the same results (pain relief!) and tends to have a shorter shelf-life. Think of it as buying make-up (clearly, this is written from a female perspective). You’re after a lipstick. Sure, you can buy an $8 lipstick from pretty much anywhere, but we know it will never compare to buying a Mac lipstick, that you’ll love and keep using until the very very end.
So how do I know if my orthotics will be good? Don’t be afraid to ask! They should be more than happy to talk you through the process – I LOVE talking through our orthotic design and manufacture – from the extensive testing of the range of motion of your foot and ankle joints to muscle strength, foot posture index, video gait analysis and 3D laser scanning your foot! But that’s only the part you see – it all then collides when our principal podiatrist and founder, Brenden Brown, designs every single one of our patients orthotics (yes, over all of our clinics!) himself, using his 20 years of experience and the widest range of materials I’ve ever seen as a podiatrist. BUT THEN, our CAD/CAM milling machine actually mills out the base of your orthotic, all in our VERY OWN (and very exciting!) orthotic lab, and hand finished by our orthotic technicians! It’s safe to say that it’s a little more technical than sticking two bits of material together and naming it an orthotic, and FAR more effective.
Finally, think about what your orthotics do! Orthotics have a FUNCTIONAL purpose to alter the alignment of your foot, changing different pressures and strains over your muscles, bones, joints and exactly where you’re having your pain. They address the CAUSE of your lower limb problems to provide you with long-term relief, and when designed and created right, they do this VERY well.
Happy orthotic hunting!
Dr Nina Lansdowne
Podiatrist and Superstar Blog writer
Dr Nina , BB and a good looker who happens to be our patient!
“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!
Contact us at 9673 2987 with questions we want to truly understand what’s happening at present with your foot and leg pain if you are ready we will set up your initial appointment.
Learn more about your condition - Check out over 40 Educational videos our team has prepared on our Facebook page. From heel pain, and what’s the best shoes, to ball of foot pain; it’s all there.
Speak to A Foot Doctor - Reserve your free 10 minute review with one of our qualified Sports Podiatrists to review where you are up to and discuss what are your next best treatment options. (Availability limited due to demand)
Try our Heel Pain Treatment advisor. Answer 7 simple questions to get a quick, reliable report on what treatment options you should be considering!