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

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

Blog, Heel Pain, Shockwave

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

Sometimes practitioners get it wrong: Heel pain a treatment gone wrong

Sometimes practitioners get it wrong: Heel pain a treatment gone wrong

Blog, Growing pains, Heel Pain, Kids Feet, Sports Care

How come my child’s heel pain isn’t getting better ….

Sometimes practitioners get it wrong: Heel pain a treatment gone wrong - 1

Soccer, rugby league and Netball all culprits for creating heel pain in kids if mixed with poor foot posture and growth spurts

“He had heel pain last year and now it’s back. They have NO idea what it is. They did an x-ray and it’s not Severs. The physio massaged his calves and it helped for a few weeks but it’s not better. It’s almost been 6 months. We had to halve how much sport he does now and he hates it. As soon as he starts running or playing a game, it comes on. He describes a tight feeling when he walks too”

Very honestly, these were the exact words that came from a frustrated and concerned mum, paired with an equally frustrated 13 year old boy, just before lunchtime today. This family traveled across the city to see us, which is not uncommon but it must be frustrating.

The tragedy in these words is that they’re NOT uncommon. At least a few times a week I hear grumblings from frustrated parents – and they most definitely have a right to be frustrated! – because they’ve seen various practitioners without a real diagnosis and just when something has been suspected, imaging has gone and ruled it out and we’re back at square one. Or are we?

The matter of the fact is: People make mistakes. Practitioners make mistakes. Radiographers make mistakes. We’re human! It’s going to happen.

I feel like I could host a conference discussing the amount of times I’ve been handed an xray telling me that there is nothing wrong with my patient that currently sits in front of me in AGONIZING pain!

If it doesn’t sound right, you better believe that it’s not. Let me emphasis: pain does NOT happen for no reason, and no amount of negative radio-graphs is going to magically fix your very real pain.

Sometimes practitioners get it wrong: Heel pain a treatment gone wrong - 2

Kids stay happy and healthy and active – Kids should play sport PAIN FREE!

So then, WHY does this happen?

There can be a variety of reasons, and I’m going to give you the very real uncensored version that other practitioners may get annoyed at me for.

• Referrers can order the wrong TYPE of imagine study. If you’ve damaged a muscle, ligament, tendon or any soft tissue, your x-ray will show you are perfectly fine! Yep, go over there and sit your torn Achilles tendon down because you’re fine to go run that marathon. (Please DONT we are kidding)

• Radiographers are very HUMAN and can miss things. Some are likely to have seen more of a certain condition, or be more familiar with an area of the body, and so some may pick up or recognise things that others miss. And you can’t blame them – the body is composed of an extraordinary amount of bone and soft tissue and any expectation for every single person to be a scholarly expert on every single part is drastically unrealistic.

• Things CHANGE over time. Your imaging from a few months ago is a picture of what is happening in your foot a few months ago. Since that time, some tissues may have gotten better, some tissues may have gotten worse, and some ones may now be damaged that weren’t before!

Be assured:

  • There is NOTHING wrong with wanting a second opinion and getting a referral for another ultrasound or X-ray
  • There is NOTHING wrong with re-imaging if you feel that your injury has changed. And if you’re having pain but you’re being told there’s nothing wrong, you have EVERY right to be frustrated!
  • You SHOULD get a second opinion! or a third even if you are not getting the answers you need.
  • There is increasing evidence that we need to look past radiology reports and look at clinical symptoms 

So what do you do next?

Your child should not have to play sport in pain, we can happily tell you that we work with kids to get them back to happy healthy and active every day. Our team will work with your child to develop a detailed care plan, this of course after a thorough assessment of their run + walk patterns; including video analysis. we will examine foot wear and make recommendation and look at the damaged soft tissue and assess what is the best way to rehabilitate this back to health! They may require a soft pliable orthotic for inside their shoes to wear while playing (just like our patients that are international level athletes!)

One of the delightful things about treating kids is seeing them return smiling and back to playing the sport they love!

And for all those wondering.. Yes our little champion from this morning did have Severs 😉

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.

About our clinics

Sometimes practitioners get it wrong: Heel pain a treatment gone wrong - 3

Our team see dozens of kids from across Sydney every day

Our clinics are set up with kids in mind we have big toy boxes, 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!
Fungal nail with “false negative” results?

Fungal nail with “false negative” results?

Blog

So you think you have a fungal nail? A sequence of a toe nail suffering from fungus infection.

Does any of this sound familiar?

  • Yellow and discoloured?
  • It has a line running through it or often down the nail.
  • It’s maybe becoming crumbly and brittle?
  • It may be a little smelly

You think it’s a fungal infection and all the pictures you’ve seen of fungal on the net tell you it’s a fungal infection, but your Doctors testing keeps saying you’re wrong. But maybe you’re NOT!

I hear time and time again over many many years this very same story. So why does it happen? Over the many years these are my summations as to why we are getting what we refer to as “False Negative” results.Fungal maginifying glass

  • Mistake 1. You need to treat it like mould in your kitchen! So your Doctor trims your nail and pops the offending nasty bit in a little see-through plastic jar with a yellow lid. Seems like it all ok, however that same little yellow container later that day is often placed in the back of a Pathology collectors car and it sits there possibly in the sun as they run around collecting all sorts of nasties from other Dr’s clinics. Sadly like mould fungus is killed off by UV sunlight – So here we have mistake one!
  • Mistake 2. This has been going on for months and you have tried everything! You tried creams and paints of all descriptions! However while it may seem to go away a little it comes back time and time again. Now if you have used those paints and creams then this may have an effect on the result the test results small amounts may kill any fresh fungal spores and are most likely to kill surface fungus however not the entrenched fungus. So all that cream may not be killing the real fungal problem but is killing the chance of a positive test result.
  • Mistake 3. When you head to your GP they often don’t cut very much of the nail and so the amount of nail sent with fungus on the surface or ingrained in the nail is not significant and possibly they miss the area entirely!

fungal bugs ASAWith 20 years of experience I have seen literally thousands of fungal infections and with those thousands of frustrated patients who had tried all the marketed pharmacy ointments paints and creams. I am really happy to say that we have finally found an answer in Laser treatment of fungal nails.

Laser treatment of fungal nails is now a safe and highly effective treatment of fungal nails. As a practitioner I personally went over to research treatment options for this condition and was impressed with laser so brought this technology back to Australia. Since bringing this back almost 3 years ago now we have had excellent results and haven’t looked back. Part of this success though has outstripped others in the field as we have introduced in combination with laser a 4 point system that assist in killing the fungus in all the places it lives.

If fungal nails are a concern for you please contact our team A Step Ahead Foot and Ankle care and chat to the team about Laser and our system for making sure you are truly successful in removing all traces of fungus in your nails.

Please call us on 96732987 or 47322007 we would love to help get you back on the right track!

BB's looking super clever in Bright red Red Foo frames! No BB doesnt wear glasses!

BB's looking super clever in Bright red Red Foo frames! No BB doesnt wear glasses!

Brenden Brown

Principle Podiatrist
A Step Ahead Foot + Ankle care
Penrith, St Marys and soon to come to a suburb near you!

Warming up and Stretching for Netball – NetballSmart

Warming up and Stretching for Netball – NetballSmart

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Hi guys, back again to chat about rehab and even more importantly PREHAB, and we will stick to our netball theme in light of the Diamonds stunning World Cup Victory last weekend.

2015 World Netball Cup Allphones Arena Gold Medal Game Australia v NZ Caitlin Bassett celebrating the win with teammate Sharni Layton. Picture: David Callow

2015 World Netball Cup
Allphones Arena
Gold Medal Game

Preventing injuries is of massive importance as it link directly to enjoyment of sport, and optimum performance.  Lets face it, we all want to get around the court like Paige Hadley or shoot like Caitlin Basset right?  Sitting on the sidelines nursing an injury takes you away from the sport you love, and away from the eyes of coaches and selectors alike.

Warming up and Stretching for Netball - NetballSmart - 2

Quite often we see resources that don’t address the specific factors that will minimise the risk of injury to our netballers!  Our A Step Ahead NetballSmart blog aims to overcome this by giving you guys a simple to understand, point by point action plan for injury prevention.
Warming Up and Stretching
 
Preparing the body for participation in sports by warming up, will enhance the maximal performance and reduce the risk of injury!  Its a sentence i often find myself repeating over and over again to my young patients.  The Netball World Cup was a great example for us as a practice, with the public being able to see first hand the amount of time the best teams in the world spend on warming up before games.
Warming up improves blood flow to the heart, increases the muscle temperature and makes muscles more pliable.
Cold or less pliable or elastic muscle works harder to accommodate a given load and will be more resistant to sudden stretch.  Less pliable muscle tissue is also more susceptible to overuse injuries.
Below we have come up with a simple to understand table to break down the different stages of warming up.
Component
Purpose
Example for Netball
Aerobic Exercise
Increase Body Temperature
2-3 Light Jogging the width of the court
Stretching
Increase Elasticity of Tissue
Increase Joint Range of Motion
Dynamic Stretches for Leg Muscles
(see examples below)
Sport Specific Exercises
Prepare the body for the type of activity expected
Short Sprinting
Changes of Direction
Passing and Shooting drills
Right, so now we have established our table, what does it all mean?  Well, basically, the first column (component) is the breakdown of a typical warm up routine you can use before your saturday games.  Once we have established we need to break our warm down into three different parts, and you want to skip the detail, we can look across the table to the examples.
First we start with a jog across the width of the court 2-3 times.  We can then move into some dynamic stretches for the major legs muscles you will use for the game.
A good start is to warm up the Calf muscles, which are the big muscles at the back of the lower leg and then upwards  to the Hamstring muscles.  If you don’t know much about Dynamic stretching, see our short description below!
Dynamic stretching WARMING UP PRE EXERCISE
Dynamic stretches differ from the norm in that they stretch the body through movement. Instead of putting your body into a stretched position and keeping it there as the muscles relax gradually, you move quickly into and out of a position that stretches your muscles. 
 
Dynamic Calf stretches:
Get yourself into a classic push up position.  Then, hike your hips towards the ceiling or sky creating a V position with your body.  Keep your back as straight as possible.  
Place one foot over the back of the other ankle, and slowly but actively push your heel into the ground.  Then, push your ankle upwards going up onto your toes.  
Perform three sets of 10 repetitions per stretch for improved calf movement and flexibility.
Warming up and Stretching for Netball - NetballSmart - 3
Dynamic hamstring swings:
 
A two-part dynamic stretch for the hip flexors, hip extensors, hip adductors, and hip abductors
This involves gentle swings of the leg forwards and backwards gradually getting higher and higher each time. Around 10 to 15 swings on each leg should be enough. 
Warming up and Stretching for Netball - NetballSmart - 4
We then want to move into some sort of sport specific movement, something that you will be doing regularly on the court.
We had the absolute privilege of watching the Diamonds take on Jamaica during pool play of the World cup thanks to Asics Australia.  It was really interesting to watch the girls going through there physical and sport specific warm ups.  These are generally done as a team, so your coach will want to have some input here.
I hope this blog has been informative, without being over the top with mumbo jumbo you don’t need.  That’s always the aim, to try and get the important information out there as efficiently as possible!
My next blog will be up shortly regarding cooling down and some specific things you can do!  Stay tuned for more editions of the A Step Ahead NetballSmart blog!
Aneesh Kesha
Part of the A Step Ahead Foot and Ankle care team
Warming up and Stretching for Netball - NetballSmart - 5
When should I bring my child to see a Podiatrist?

When should I bring my child to see a Podiatrist?

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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.

When should I bring my child to see a Podiatrist? - 1

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.

When should I bring my child to see a Podiatrist? - 2

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!