I Just Want to be Fit For Summer

I Just Want to be Fit For Summer

I Just Want to be Fit For Summer

Walk run and skip and dont stop for foot pain

Don't let foot pain stop you from reaching your goals!

The warm weather had started last September, we had a series of warm spring days and this is when Sarah appeared in my office. “I just want to get fit for summer” I am so sick of not getting there and I just need some answers. Sarah went on to explain that this was not her first attempt at getting fit, frustratingly she had tried the year before and throughout winter to get there. But despite eating the right thing her training or more accurately her foot pain always got in the way!

New Shoes might be the answer?

Sarah had been to a reputable sports footwear retailer and had grabbed a pair of runners that the store had recommended. While initially comfortable and her looking seriously cool in them ;-). After her attempts each night to walk or run she still found herself in pain. If not that night, over the following days she developed pain in her arch on the inside of her foot. It went from being a dull ache to at times being a sharp pain. It also felt like it ran up the inside of her leg a little. (ahhhh ok so that’s a bit different) If she stopped running or walking for a few weeks / days it got better but once she started again it was back!

A visit to the doctor

Kühlpack auf Fuß mit SchwellungFrustrated with this she saw her GP who suggested she try putting some ice on the area. Again, she went home determined to get better but with little result, YUP the ice made it immediately feel better, but straight after on the next walk it came back.

Ok let’s try the physio!

Still not deterred she headed to a local Physio. He said it was a heel pain may be fasciitis or a heel spur? He did a short massage, used a machine that created a type of heat and showed her some stretching. Ok so this was a bit better she thought, for several days and even a session of walking it felt bearable but ………. on trying to increase her activity again, there it was like that old uncle you can’t stand but see every now and then at family function, you don’t want to see them but bam!!! There they are!!

A solution!

Finally, after speaking to a friend, who had a similar problem, she came across our clinic. “My friend drove across the city to see you and you got her better.” She said. “You must be worth it because my friend had been everywhere and now raves about you” (feeling pretty chuffed right now)

Its NOT a heel spur!

That’s right nope and it wasn’t fasciitis! Yep these are super common MISdiagnoses for this type of pain!  If you don’t see this multiple times a day, and you are also trying to work on shoulder pain and fix dodgy knees its easy to get it mixed up!

Tibialis Posterior pain is NASTY

On watching Sarah’s walk on our Video Walk run analysis equipment it became pretty clear that her walk or “gait” and “biomechanics” in podiatry speak was lousy! We found that Sarah’s feet were rolling in too much and that put very simply her arches needed more support, to give her muscles a chance to work properly.

While the physios stretches and exercises were great, the lowering of her arch needed assistance for her to be able to do all the work they required. NO amount of super special exercises are going to get this muscle strong enough. Not if you actually want to get active!

So, what’s the plan?

I chatted to Sarah and developed a treatment plan that meant we could get her back to training and finally fit for summer! So what did we do?

  • We made a custom-made pair of orthoses for her after taking a 3D laser scan and a detail series of Biomechanical measurements – fancy talk for checking each joint in your foots movement – all the muscles strength and how all the joints and muscles work together! SOFT SOFT SOFT but more below.
  • Arranged a series of Deep connective tissue massages. While the orthoses will fix why the problem was occurring the soft tissue therapy will address the muscle, we need to help the muscle along it way to being healthy again and ready for activity.
  • Stretches which is pretty standard BUT really importantly strengthening exercise were also prescribed if you don’t get the muscle STRONG we are running in circles.
  • We addressed Sarah’s shoes. While her shoes were fantastic, and truthfully loads of patients aren’t as good as Sarahs. If you don’t get this right with patient’s treatment falters! The right shoe for the patients foot type helps, not only supporting the foot, but also working with the orthoses. The aim is to get Sarah back to exercise as soon as possible to reach her health goals.

SOFT pliable inserts – NOT rock-hard harbour bridges!

That’s right SOFT devices we never make hard rigid devices! All our custom-made orthoses are made and designed exclusively by our clinic, in our onsite orthotic laboratory it takes about 3 weeks for the process of computer aided design by our me, they are then milled out using CNC milling and finished by hand. We have a super dedicated team and these are flicked off to a lab somewhere overseas like other clinics often do. Our devices are produced by our awesome lab technician right at the practice!

While waiting for these we began the treatment plan and her DCTM, strength and stretching.

So, what happened?

In four weeks at her review Sarah reported her discomfort had dropped dramatically. She no longer had pain after every walk and had found that she was able to increase to running. We reviewed her stretching and asked Sarah to increase her Km’s of running per week. She was stoked! 8 weeks later on her final review Sarah was ecstatic “I can run” she said. “I haven’t been able to run pain free in years”!

So, where to from here?

woman runner running at tropical parkYou don’t have to put up with Foot pain! There are answers other than waiting for it to go away and pills! At A Step Ahead we see dozens of people like you with foot and lower limb pain all day and we love it! We love getting people better so they can kick their health goals whether its running 5 km or 50 km’s or if it’s professional sport or simply ridding yourself from foot pain so you can play in the park with the kids!

Why not call our friendly team and ask if we can help? Chances are we can! You can also check out more of our website for information on other common conditions we see regularly!

Call us on 9673 2987 or 4732 2007. We are located in St Marys and Penrith in Sydney and unlike Macquarie street you can park right out front and it doesn’t cost 65 dollars an hour its free! We are privilege to have patients travel from all over Sydney and NSW to see us: From the North shore and as far away as Port Macquarie and Wollongong.

We would really love to help you get on the track so please give us a call.

Dr Brenden Brown
Podiatrist

Shen glasses

BB and Shendi Yes they have 3d glasses on at home. Because they can 😉

Heel pain – A patient’s experience

Heel pain – A patient’s experience

How Fiona beat Heel pain!

woman kicking water at beach

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.

A diagnosis

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.

Shock wave is a new and highly effective treatment.

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!

A choice

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.

A recovery

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?

Try our Dedicated Heel Pain Doctor site. HEEL PAIN DOCTOR.COM.AU

Or call our helpful team who are used to speaking to literally thousands of patients with heel pain! Our number is 02 9673 2987. We would love to help!

Heel Pain doctor Heelpaindoctor.com.au

Heel Pain doctor a dedicated site to the reduction of complex heel pain!

Book an Appointment Today

Growing Pains- More than just pain from growing – A case study

Growing Pains- More than just pain from growing – A case study

Growing Pains- More than just pain from growing - A case study - 1

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.

Growing Pains- More than just pain from growing - A case study - 2

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.

Pain free!

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

Does your child need to see a Podiatrist?

Does your child need to see a Podiatrist?

5 quick signs you need to see a Podiatrist (Foot Doctor)

When to see a Podiatrist

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

BB with one of his patients, kids foot pain

BB with one of his Patients!

What your Podiatrist WON’T tell you about heel pain.

What your Podiatrist WON’T tell you about heel pain.

Things your Podiatrist doesn't want you to know about Fasciitis

Heel Pain can stop you from getting back to exercise!

Pain on first step out of bed, pain in the ball of your heel, gets better after time on your feet only to get painful at the end of a day! Pain often doesn’t have a reason or incident. The horrible thing is this pain is often described to me months or even years after it first appeared and frequently after seeing a number of health care practitioners GP’s, Physios and including Podiatrists!

Many treatments Podiatrist’s and Physios prescribe DON’T WORK and sadly deep down they know this but in an effort to work with you, their patient, they persist not knowing what else to try. Sadly as a patient this doesn’t assist you, and leads only to frustration.

I see literally 8 to 10 people a day, with heel pain! I have been focusing on heel pain for over a decade, honing my skills to work through this complex problem. I see people from ALL over NSW and now have begun to see people travel to see me from interstate. I’d like to share with you some points I have learn't seeing literally thousands of patients.

So in an effort to help EVERYONE, I thought I would write a few of my Top Tips (maybe secretly frustrations). So you can get a better idea of why possibly you are NOT getting any better despite you seeking help.

Orthotics probably won’t work on their own.

This is probably the most common mistake in treatment I see on a day in day out. Orthotics are commonly used by Podiatrists and I use them also ALL the time! However they are not the only answer. I definitely see them having a role to play. We will prescribe so to provide a support or a “balance” to a foot, but you need more! The tissue is damaged and it’s VITAL that it is rehabilitated! Orthotics cant and won’t do this alone, you must rehabilitate the tissue,  using therapies such as deep connective tissue massage and shockwave and muscular stretching exercises!

Stretching won’t help 90% of people.

“I have been stretching for months and I am not getting any better” I see endless amounts of hard working people who have been given stretching exercises and sent on their way and told “Let me know how you go” by their well-meaning therapist.  I also see patients who present to me who have never had any treatment and I test their muscle tightness, only to find they have no tightness at all! Not all heel pain is from tight muscles and not all heel pain is Plantar fasciitis, so we need to break the mold and look elsewhere to help you, our patient.

Foot pain, footwear, heel pain

Great footwear is a key to treatment Yet lots of practitioner focus on this with their patients! Make sure you review your footwear!

You can’t wear any shoes you’d like and your love of Thongs/flip flop/ Jandals is harming you.

Sorry I am going to give you a hard time about shoes! Thongs, flip flops, yes even the special ones with arches etc  etc are all footwear that maybe adding to your pain. I know they make you feel good while you are wearing them. However over years of recommending more appropriate footwear and seeing significant changes in outcomes for the time it takes you to get better we keep you out of these. You can return when the foot is better and full recovered!

Hard rigid orthotics won’t only not fix it they may actually make things worse!  

I will start by acknowledging I am not a fan of rigid orthotics, I have never prescribed them and would not wear them myself. I know many many physios feel the same and are concerned about these actually irritating the structures of the base of your foot! I am sceptical at best around these rigid, hard, harbour bridge like devices in shoes.

Again I feel orthoses work however I believe the foot needs some of its natural motion and this is why our clinic has always used soft soft pliable orthotics that are custom made to your foot. These cup the heel and support the arch only where necessary and DON’T irritate the very area we are trying to fix! We make all our orthoses in our own onsite orthotic lab, we use the latest 3D technology and computer aided design, then milling them precisely to fit you foot, a mix of comfort and cushioning.

Heel pain - Is it your Orthotics causing you more pain?

You need more than a rub!

As I mentioned above most patients need soft tissue rehab HOWEVER I also see that without supporting the tissue around the foot and correcting some of the poor walking patterns that may have contributed to the problem slowly developing, patients often DO NOT get better! Have your walking pattern assessed and see improvements develop quickly

How to get better?

I think the key is to looking at treatment as NOT having one silver bullet that will fix everything. As you will see from my extended notes, just focusing on one element seems to be where people fall short. Looking at heel pain as if it is more than just the one condition, “Plantar fasciitis”, is also necessary to ensure that you get the right treatment. Heel pain can be and often is more than “Heel spurs” or “plantar fasciitis” and so to treat it you need to identify exactly what it is.

When you have established a good idea what’s going on, its time to look at treating all the contributors that made it sore in the first place. Structure, poor foot wear and then looking at treating the soft tissue.

Can you get better?

YES I hope you can see from this that there are very obviously MANY options available. As a practitioner one of the very nice parts of my day are seeing patients who have had this for months or years get better! Patients that don’t just get better they can now kick a ball with their kids, run with the kids in the park, keep up with the grand kids!

Can we help YOU?

Yes, if you would like our help back to a healthy happy lifestyle, we most definitely can and would LOVE to help! Unlike other podiatrists who focus on treating your Nan's toenails or dry hard skin on their feet, we focus on these more complex running and walking problems! We priorities patients just like you as we understand how important it is to get you back to pain free.  Please give our very friendly front desk team a call, not only are they helpful but after having helped literally hundreds of patients each year they are really good at leading you in the right direction back to pain free.

You can contact us on 96732987 or 47322007 we look forward to helping you.

Brenden Brown

Principal Podiatrist

A Step Ahead Foot + Ankle care

BB with one of his patients

BB to the right, with out the yellow skirt