As the sportsman’s injury, plantar fasciitis makes sports headlines in the USA, UK podiatrist, Martine Abrahams sheds some light on this common, often debilitating condition

Image Albert Pujols, player for Los Angeles Angels of Anaheim, the latest elite athlete left sitting on the bench, thanks to plantar fasciitis

High profile athletes might create headlines, but this painful condition can affect us all.

The plantar tendon and its function:

The plantar tendon runs the length of the bottom of your foot, spanning the area from the base of the toes to the front of your heel. The two ends of the tendon attach at the base of the toes and at the front of the heel bone by means of fascia, a strong fibrous membrane. The plantar tendon keeps the arch of the foot from flattening completely when the foot bears weight, providing cushioning and shock absorption during walking, running or standing. This tendon also allows you to point your toes.

What is Plantar Fasciitits?

When the plantar fascia tissue is stressed, small tears can occur, which in turn, causes extreme pain during movement or even weight bearing – or any movement that creates a pull on the tendon.

Stressors can be varied in nature and include: regular exercise/sport, heel striking during striding, tight calves, inflexible Achilles tendon and wearing high heels.

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Other common causes of plantar fasciitis include:

  • Wearing inflexible or worn out shoes
  • Very low or high arches
  • Being overweight
  • Spending long hours on your feet
  • Tight calf muscles or tight/stiff ankle muscles
  • Walking barefoot in soft sand for long distances
  • Those with natural flat feet (hyper-pronation) seem to suffer this condition more than others

Symptoms of Plantar Fasciitis:

Pain can be extreme and is often felt on the underside of the heel and more intense at the start of the day:  “You almost want to pee in your bed rather than go to the bathroom,” Pujols told USA TODAY Sports. “It’s really painful in the morning.”

Treatment:

This condition can be difficult to treat and, perhaps most annoying for those who enjoy exercise, is that the main solution is rest, combined with physiotherapy, anti-inflammatory medications, corticosteroid injections and/or night splints to stretch the injured fascia.

As a short-term pain relief measure, you can roll the bottom of the foot back and forth over a tennis ball or cold bottle of water, to gently stretch out the tendon and disperse the fluid that pools there.

Stretching exercises can also help:

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Orthotics can be worn to help support the foot arch:

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Ultimately, prevention is probably better than cure where plantar fasciitis is concerned.  Wear good shoes with adequate arch support; stretch the area well before and after exercise and regular foot massages will all help.

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Watch out pregnant women – it’s not only your bump that gets bigger – often feet do too! Laser expert podiatrist Martine Abrahams talks feet and pregnancy

Image  Watch out pregnant women – it’s not only your bump that gets bigger – often feet do too!

As if the hot summer months weren’t enough to bear, try adding a 7lb bump and swollen feet into the bargain – not much fun!

Why do feet get bigger?

The obvious reason is fluid retention.  Gravity pulls fluid down to the lower extremities resulting in ballooning ankles and.

A lesser-known cause of enlarging feet during pregnancy is due to the secretion of hormone ‘relaxin’  during the 2nd trimester of pregnancy.  This aptly named hormone helps to keep pelvic joints loose and ligaments soft, offering the baby a smoother journey down the birth canal.

Sadly, it’s not just the abdominal ligaments that loosen – those in the feet can too, resulting in toes spreading and feet seeming to get bigger.

Are the changes permanent?

Thankfully any fluid build up will subside after the baby is born, however for those of you who have suffered negative effects of softening ligaments, this could well be permanent.

Some women claim their feet have grown up to one size post pregnancy!

What can you do?

I advise if you can, to wear larger shoes that sit comfortably for the duration of your pregnancy. Try not to invest in anything too expensive, as you may need to revert to your old shoes around one month after the birth.  Wearing tight shoes can cause or aggravate bunions or other painful foot issues such as ingrowing toenails, corns and calluses.

Image     The good news is that your pregnancy will only last 9months (if you’re lucky!) The bad news is that your feet could grow with each pregnancy, so maybe hold off that Blahnik treat until after your family is complete!

Festival goers BEWARE – fungal spores lurk in dark, damp conditions, waiting to take hold in those vulnerable nail beds!

Glastonbury Festival 2013 is upon us and I hope all you intrepid campers have fun in the sun…Image

…but, JUST in case the British summer does what it does best, please remember to take good care of your feet Image

Clearly foot care will not be your number one priority, but maybe it should move up the list – at least a little!  

Why? Fungal spores love dark, damp and dirty conditions and the fields of the Glastonbury Festival provide the perfect breeding ground – especially when the heavens open!

During the summer months I see an increasing number of holidaymakers who made the brave decision to camp in the UK, only to come home with fungal nail infections and Athlete’s Foot.  

Fungal spores enter via any small break in the skin integrity and soon take hold.  Once established, the infections can be difficult to eradicate.

 Here are some practical tips to help avoid nail fungal infections during the long weekend:

Trim your nail short before you go

Dry feet thoroughly after bathing – try to keep your towel clean and dry (!)

Wear 100% cotton or wool socks – helps absorb the sweat and moisture 

Wear shoes that have wide space for your toes to ‘breathe’

In wet and moist areas, avoid walking in barefoot

If possible, wear shower shoes, sandals or flip flops when going to public areas

Before going to bed, try to thoroughly dry your feet

NEVER share shoes and sandals with others

Avoid injury to nails, nail beds, and nail plates 

If you do suspect a fungal nail infection has taken hold, then book in to see your local podiatrist.  Over-the-counter solutions are not particularly effective and you may well need a more sophisticated treatment such as state-of-the-art Lunula Laser. 

Symptoms of nail fungus:

  • Thickened nails
  • Crumbly or brittle nails
  • Nail distorted in shape or separated
  • Nail with no lustre or shine
  • White, yellow or brown coloured nail

How does it work? Unlike conventional solutions, the Lunula Low Level Laser is the first treatment to tackle the root cause of nail fungus – not just the symptoms.  Known as the ‘COLD’ laser – this new device does not rely on heat to treat, instead utilises two light wavelengths, 635nm and 405nm, to tackle differing cell membranes. 

Have a fabulous time – if nothing else, keep your feet happy by avoiding walking barefoot around the venue, and let’s hope you will all be basking in sunshine. (I’ll save my sunscreen lecture for next year!)

UK’s leading laser Podiatrist Martine Abrahams talks GOUT – “the disease of kings”

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The topic for my blog this month is gout – an unpleasant and often debilitating disease, which can put you out of action for several weeks.  There have been a number of high profile sufferers throughout history – Henry VIII, Pavarotti, Jim Belushi and more recently, Jared Leto, who contracted gout symptoms after piling on 60lbs for a film role.

The incidence of gout has increased over the past few decades and now an estimated 1-2% of the Western population are affected by it at some time during their lives.  The main reasons for this trend seem to be the Western lifestyle/diet and longer life expectancy.

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Gout is a type of arthritis, in which crystals of uric acid produced by the body, can form inside joints.

The most common symptom is sudden and severe pain in the joint, along with swelling and redness. The joint of the big toe is usually affected, but it can develop in any joint.

Symptoms can develop rapidly to their worst point in 6-24 hours and usually last for 3-10 days (this is sometimes known as a gout attack). After this time, the joint will start to feel normal again and any pain or discomfort should eventually disappear completely.

Most people with gout will have further attacks in the future.

The crystals may cause two problems:

  • Some may spill over into the soft lining of the joint (synovium), which causes the pain and inflammation associated with gout
  • Some pack together to form hard, slowly expanding lumps of crystals (“tophi”) which can cause progressive damage to the joint and nearby bone; this eventually leads to irreversible joint damage which causes pain and stiffness when the joint is being used

Factors that increase your risk of gout include:

  • age and gender
  • being overweight or obese
  • high blood pressure or diabetes
  • close relatives with gout (gout often runs in families)
  • long-term kidney problems that reduce the elimination of uric acid
  • a diet rich in purines; such as frequently eating sardines and liver
  • drinking too much beer or spirits – these types of alcoholic drinks contain relatively high levels of purines

There are two main goals in treating gout, relieving the symptoms with painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs) and preventing future attacks with Allopurinol which can help lower levels if uric acid.  Lifestyle changes can also help – reducing weight and alcohol intake.

Some good news for us women – men are more likely to suffer gout, as oestrogen reduces a woman’s levels of uric acid by increasing excretion of uric acid via the kidneys.  Sadly however, we catch up with men after menopause!

Gout can be very painful and distressing, but if you do suffer from acute episodes don’t despair, as attacks are usually short lived and lifestyle changes combined with anti-inflammatories can help a great deal.

   HIGH HEELS CAN LEAVE A LASTING IMPRINT

Image   HIGH HEELS CAN LEAVE A LASTING IMPRINT ON YOUR FEET acknowledges famous shoe fanatic, actress Sarah Jessica Parker

We all have our favourite heels that come out for special occasions, but, for those of us who wear them all the time, take note: high heels can damage your feet and cause a whole load of problems as the years move on.

Not just foot pain, problems range from the more common concerns such as bunions, corns and calluses to more complex issues like misshapen hammertoes or excruciating pain in the ball of the foot, which seems to get worse every time the shoes are worn.

Will women stop wearing their vertiginous favourites? Not likely, judging by a survey conducted by the American Podiatric Medical Association, which showed some 42% of women admitted they’d wear a shoe they liked even if it gave them discomfort; 73% admitted already having a shoe-related foot issue.

Shoes that constrict the natural foot shape are bound to cause pain and, at the same time, excess weight is placed on these parts of the foot.  So crushing the foot along with extra weight can cause extreme discomfort.

Image Bunions – described as an enlargement of bone or tissue around the joint at the head of the big toe. Footwear is not the only cause of a bunion. Genetics do play a significant role, and people who have bunions in the family are also much more likely to have bunion than people who do not. Injuries to the foot can also be a factor in developing a bunion. However, there is no doubt that high heels aggravate this condition, and in many cases cause the misshapen toes.  Introducing lower heels into your wardrobe can stop the problem getting worse, but surgery to correct the bunion is often required.

Image Corns and Calluses – build up of layers of dead skin, usually on the toes, soles or sides of the foot (the body’s way of building natural protection against trauma) as a result of ill fitting shoes.  Before treating your own feet with home remedies, please consult a Podiatrist as you could cause damage by if you remove too much hard skin yourself.

Image   Tips to protect your feet and still enjoy your heels:

1.  Get a proper fit – avoid styles that leave too much room at the toes, allowing the foot to move forward, putting increased pressure on the toes

2. Cushion! Invest in gels pads to protect the ball of the foot.  We lose fat on the ball of our feet as we age so replacing this with a cushion can help

3.  Thicker heels give improved balance and distribute weight through the foot instead of isolated pressure points

4. A gradual drop from heel to toe can be easier to wear than those with a straight drop

5. Open toed high heels can avoid excess pressure on toes and corns

6. Take a rest from heels as much as you can, to allow toes to spread in a more natural fashion and to stop the calf muscles tightening

The Queen of Heels has just admitted to the damage her Blahniks have wrecked on her feet and it also looks as if Victoria Beckham has had her notorious bunions repaired. Ultimately, enjoy your footwear, but do take notice of what your feet are telling you – if they hurt they’re sending you a message!

Sarah Jessica Parker: “I went to a foot doctor and he said, ‘Your foot does things it shouldn’t be able to do. That bone there…You’ve created that bone. It doesn’t belong there.'”

http://uk.eonline.com/news/396572/sarah-jessica-parker-high-heels-ruined-my-feet

Prepare your feet properly for the marathon season warns leading London Podiatrist, Martine Abrahams

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Prepare your feet properly for the marathon season.  Things are finally hotting up – well, at least in the world of extreme running, if not the weather!

Take things slowly and prepare your feet gradually for the abuse that lies ahead.   They are going to take a pounding over the next few weeks and if you don’t prepare carefully, you could do some damage – most problems are reversible, but the symptoms could stop you competing.

  • Not many of us like it hear it BUT stretching before starting any exercise is vital to keep injuries at a minimum.
  • Choose the right type of footwear for the specific terrain – there are so many styles and brands of running shoes, all promising different things, it can be very confusing, try contacting your podiatrist for advise.
  • Ask a trainer to suggest the best way to build up your routine so all leg muscle groups are engaged slowly and completely warmed up before the long distances are tackled.
  • Here are some common injuries to look out for – and ideally prevent

Shin splints: Shin splints, which are painful and appear at the front and inside of the leg, are often caused by running on hard surfaces, over striding, muscle imbalance, or overuse. Shin splints can also be related to the shape and structure of your feet. Treatment includes rest, stretching, changing your running technique, and rebalancing foot mechanics with special show inserts. Physiotherapy can also be helpful. If you begin to feel this type of pain, slow down, take shorter strides, and see a podiatrist at your first opportunity.

Stress fractures: A stress fracture is a tiny or incomplete crack in a bone that is often caused by overuse. Stress fractures occur most frequently in the foot and ankle, so your podiatric physician is well trained to diagnose and treat this problem. Signs of a stress fracture are pain that increases with activity and decreases with rest, pain that increases over time or pain that persists even at rest. Often a stress fracture will result in swelling and a spot that feels tender to the touch.    Prompt diagnosis and treatment of a stress fracture can often prevent further injury. A podiatrist can determine your best treatment with x-ray and a physical examination. Many stress fractures can be treated with rest, ice and over-the-counter pain relievers. For most people, an appropriate period of rest will be sufficient for the bone to heal, but like all fractures, the bone can take up to 8 to 10 weeks to heal completely. In other cases, your podiatrist may need to immobilise the affected bone with a cast, cast boot, fracture shoe, or a splint. Surgical intervention may be suggested if other, more conservative treatments are not effective.

Blisters and nail problems: Runners often have blisters and nail problems but with a little maintenance and care, they can be avoided or minimised, so that they don’t limit your ability to keep up your training routine. Blisters are caused by skin friction. Don’t pop them. Apply moleskin or an adhesive bandage over a blister, and leave it on until it falls off naturally in the bath or shower. Keep your feet dry and always wear socks as a cushion between your feet and shoes. If a blister breaks spontaneously, wash the area, apply an antiseptic, and cover with a sterile bandage. Nails can become bruised or broken. Keep nails short to limit damage and if trauma occurs remove any loose pieces of nail by cutting with nail scissors and filing smooth with an emery board.

Ingrown nails are nails whose corners or sides dig painfully into the skin, often causing infection. They are frequently caused by improper nail trimming but also by shoe pressure, injury, or poor foot structure. Runners are particularly susceptible to nail problems, and long-distance runners often lose some of their toenails entirely while they are training. If an ingrown portion of the nail is painful or infected, your podiatrist can remove the affected portion to allow for healing. It is possible to permanently remove the offending portion of the nail to prevent occurrence. Soaking in warm salt water can relieve the discomfort of ingrowing toenails and prevent infection.

‘Locker room’ nail fungus – typically, fungal spores thrive in dark, damp, warm environments, and running shoes are perfect breeding grounds.  Look out for signs of Athlete’s Foot, itching under the arch or between the toes; little red spots over the sole of the foot; flaky skin particularly under the arch or around the heels; and moist, white macerated skin between the toes. Treat with over the counter topical anti-fungal cream. Athlete’s Foot can lead to nail fungal infections and vice versa…

Symptoms to look out for:

  • Thickened nails
  • Crumbly or brittle nails
  • Nail distorted in shape or separated
  • Nail with no lustre or shine
  • White, yellow or brown coloured nail

Conventional treatments include topical creams, and oral anti-fungal tablets, however a new laser treatment ‘Lunula Laser’ or ‘cold’ laser is revolutionising nail fungus treatments. Contact my office for more information http://www.thelondonnaillaserclinic.co.uk

Marathon running can give you a real sense of achievement and an increased feeling of wellbeing – just remember to take care of the most vital component to a successful fun run – your feet!

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Chiropodist vs Podiatrist?

Image   Chiropodist vs Podiatrist?

I find clients are still a little confused about the perceived difference between the two terms, when in fact they are the same discipline.   Chiropody underwent a name change in 1993 and is now known as Podiatry.

The reason for this?  A Podiatrist is internationally recognised as a foot specialist, so it makes sense for all practitioners to be under the same name umbrella.

In my opinion it was a positive change, as the science of Podiatry is continually evolving.  Podiatrists diagnose, treat, and prevent diseases of the foot – but are also specialists of lower limb disorders.

The training of Podiatrists is constantly evolving, and is now an accepted medical based discipline.  An intense 4 year degree course, followed by post graduation continuing education enables Podiatrists to treat a vast array of foot and lower limb conditions.

Some Podiatrists choose to specialise in the area they find most rewarding whilst others practice general podiatry.  Some specialist areas:

Biomechanics – joint alignment

Orthotics – custom made insoles/shoes

Podopaediatrics – lower limb disorders in children

Surgery – an increasing amount of foot surgery is performed by specialist Podiatrists

Sports injuries – Podiatrists often work alongside physiotherapists

Personally, I am passionate about technological advances that have impacted on podiatry.  Laser science is the most dramatic, offering massive benefits to those suffering from nail infections of all kinds. The ‘cold’ Lunula Laser is revolutionising nail fungus treatment and, by using variable light energy, the procedure is both pain free and effective – a very exciting development!

No longer an enclave of the elderly, men and women of all ages consult Podiatrists for a variety of conditions.  As with most medical problems, prevention is better than cure so make sure you look after yourself – and your feet!