Podiatry Blog

Poor circulation due to peripheral vascular disease is a common problem in podiatry clinical practice and complicates a lot of conditions such as the diabetic foot and infections. Minor surgical procedures are more difficult to heal due to the problem and minor wounds can be more serious in the presence of poor circulation. The biggest issue with peripheral vascular disease is that it does not get the public health attention as other conditions, such as diabetes that put the foot at risk for damage.

Top of foot pain often presents as a diagnostic challenge, but most recently the Dorsal Interossoeus Compression Syndrome has been described as a entity and all of a sudden, it has become quite a common problem. Top of foot pain due to this occurs when there is greater dorsiflexion of the forefoot of the rearfoot and this results in some dorsal jamming of the midfoot joints producing the symptoms. Often in the past this may have been dismissed as “arthritis”. The treatment for top of foot pain caused by this is the use of foot orthotics to plantarflex the forefoot on the rearfoot, so that the dorsal jamming does not occur. Low dye strapping has also been suggested to be very effective at also doing this provided that the tape actually plantarflexes the forefoot on the rearfoot. Barefoot running is also a common cause of this and ‘top of foot pain’ is widely discussed on barefoot running websites. The common recommendation on these websites is to change running form in such a way to lesson that dorsal jamming in the midfoot.

There is no best running shoe. There never will be a best running shoe. All runners have different styles and foot types and different characteristics. The secret to proper running shoes prescribing is matching up those characteristics to the different design features of the running shoes. It really is a very complex task to get the match up right. There is a potential from increased risk from injury if the match is wrong. There is also a potential for a decreased risk of injury and increased performance if the match is wrong. To further complicate things is that the running shoe companies are constantly changing things, so it can be a difficult task to keep on top of the running shoes changes that are constantly happen. From a podiatry perspective it is very helpful to develop a relationship with a local specialty running shoes store to help out.

Growing pains in children can be distressing for the parent and child, but there are no long lasting consequences. Classical growing pains in children occur in in the upper part of the calf muscles or back of the knee. Typically it causes night-time foot pain. They do not occur in the knee joint and they do not occur in the bone. They usually wake the child from sleep. The child can normally be got back to sleep with reassurance and gentle rubbing of the area. The reason growing pains in children is important is that the pain on very rare occasions can be due to something very serious, so they do need to be carefully evaluated. Sometimes stretching before bed time can be helpful. If they are keeping the child from sleeping, then anti-inflammatory drugs can help some. The cause of growing pains in children is not known, but is likely to be biochemical and maybe related to muscular fatigue. Despite it being very common not a lot is clearly known about growing pains in children.

The Pinpoint laser for toenail fungus reviews on the web are mixed. On the one hand, there are the positive reviews  from those who make money by owning or selling the laser. On the other had other are objecting to the high price for treatment and the lack of research comparing this method of treating the toenail onychomycosis with the more traditional methods. The FDA has approved the PinTointe machine as safe for use, Approval does not mean that it is better than other clinical methods of treating onychomycosis. All pinpoint laser for toenail fungus reviews needed to be interpreted in the context of this lack of scientific research that is published for peer review.

Forefoot varus has been getting more attention of late. It is claimed by many that forefoot varus is common when, in fact it is rare. Many confuse the osseous and non-reducible forefoot varus with the soft tissue and reducible forefoot supinatus. The distinction between forefoot varus and forefoot supinatus is extremely important as the management of them is very different. Forefoot varus is a cause of excessive foot pronation, whereas forefoot supinatus is a result of excessive foot pronation. Getting the distinction wrong can be potentially injurious between the two. Even in research projects in which the inclusion criteria of ‘forefoot varus’ is highly unlikely to actually all be forefoot varus and many will be forefoot supinatus, bringing into doubt the outcomes of the research. Researchers new to be really clear if they have an inclusion criteria of forefoot varus that the actually understand the difference between forefoot varus and forefoot supinatus.

Chi running, like the barefoot running movement is something that Podiatrists need to be familiar with. Patients will come in with injuries from one or more of the many different running technique and to be able to adequately treat patients who participant in running and use some of the many alternative techniques. Chi running is a running style that uses more of  forward leaning and uses more of a midfoot strike than the traditional heel or rearfoot strike used by most runners. Like the barefoot running, there are many claims made for Chi running that are not supported by any research. That does not means that there is necessarily anything wrong with Chi running, it just means that the evidence does not support it. There are many Chi running websites, book and other resources available, but many do seem to trying to sell something.

Two recent studies have shown just how important podiatrists are to managing the complications of the diabetic foot and in reducing the burden of lower limb amputation.

The first on one JAPMA showed:

Early identification of individuals at increased risk for lower-extremity ulceration and subsequent referral for advanced multidiscipline podiatric medical specialty care may decrease rates of ulceration and proximal amputation and improve survival in patients with diabetes mellitus who are at high risk for ulceration and limb loss.

The second one in Health Services Review showed:

Individuals with an LEC had high mortality. Visiting both a podiatrist and an LEC specialist in the year before LEC diagnosis was protective of undergoing lower extremity amputation, suggesting a benefit from multidisciplinary care.

This is good news to have even more evidence on podiatrists role in the management of the diabetic foot. Many of the complications of diabetes put the foot at increased risk for damage to create the so-called diabetic foot, which can range from a simple need for basic nail care to foot ulcer management to Charcot’s foot to the need for an amputation. Podiatrists play a key role in the multidisciplinary management of the diabetic foot. Diabetic foot complications represent a significant burden to society and to the individual.