Westbury Podiatry Clinic

25/05/2021

Nail surgery performed 5th June 2020, delighted to see the Hallux/big toe looking so good, you can hardly tell it’s been done! ...... and more importantly Mr C is extremely please.

13/01/2021

13/01/2021

08/10/2020

A interesting article:

Plantar Heel Pain: An Urgency To Treat
October 08, 2020
By Doug Richie Jr. DPM FACFAS FAAPSM

In my previous blog, I discussed the myth promoted by many authors of authoritative articles discussing plantar heel pain with a promise that “conservative treatment is successful 90 percent of the time.”1 These conservative measures usually include rest, stretching, physical therapy, shoe inserts, nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroid injections.2-5 Most of these authorities do not provide a timeline or criteria for determining “successful” treatment for relief of plantar heel pain.

Whether it is home-based or implemented by a clinician, conservative treatment of plantar heel pain does not have a 90 percent success rate within a 12-week time frame.6 Hansen and coworkers further verified this in a study that followed 174 patients 10 years after their plantar fasciitis diagnosis.7 Despite receiving an average of 3.8 different treatments, 45 percent of the patients were still symptomatic after 10 years. This study showed that when patients wait more than eight months to seek professional treatment for plantar heel pain, there is a significant impact on their prognosis for successful conservative treatment.7 The patients who eventually did become pain-free with conservative treatment had their symptoms for an average of 256 days before seeking treatment while those who remained symptomatic for 10 years had their symptoms for an average of 365 days before obtaining professional care.

Therefore, one reason for failure of conservative treatment of plantar heel pain is the fact that most patients do not seek immediate treatment. One can verify this when looking at studies on the prevalence of plantar heel pain and then comparing these prevalence rates to studies showing the actual number of visits to medical professionals made by patients with this condition.

Plantar heel pain is one of the most common conditions of the foot and ankle, affecting 10 percent of all people during their lifetime.8 The actual prevalence of plantar heel pain in the general population is reportedly between four and nine percent.9-12 However, this condition is likely far more prevalent as studies indicate that the majority of people with plantar heel pain do not seek medical treatment. In short, the prevalence of heel pain in the general population is not mirrored by the frequency of visits to health-care professionals for treatment of this condition.

For example, out of 855 million patient visits to doctors in the United States, only 0.12 percent were associated with a diagnosis of plantar fasciitis.13

A study in southwestern Australia mirrors these findings, documenting that only 1.9 percent of visits to primary care doctors were for treatment of plantar fasciitis.14 Therefore, only one out of 10 patients with plantar heel pain appear to seek professional treatment as evidenced by these studies.8,13,14 On the other hand, a study done in the United Kingdom, where most patients have access to a government sponsored health-care system, 62 percent of patients with plantar heel pain consulted a health care professional for treatment.12

In the United States, a study of 75,000 people revealed that the prevalence of plantar fasciitis with current pain was 0.85 percent.13 This prevalence, however, required a diagnosis from a health-care professional so the overall incidence of plantar fasciitis was probably much higher within this patient population. What is interesting to note from this study is that while 40 percent of patients first sought medical treatment for their plantar fasciitis within the past year, 50 percent did so at least three years previously and still had pain. This study indicated that many patients, once diagnosed with plantar fasciitis, will go on to suffer chronic symptoms for several years.

Recognizing The Potential Psychological Impact Of Chronic Heel Pain
In terms of the false promise that plantar heel pain will resolve within 10 months with conservative treatment, consider the emotional toll this takes on the patient when this promise fails. What is the effect of consistent morning pain, which the patient has to endure week after week while waiting for these conservative measures to be effective? Several quality studies show that the chronic nature of plantar heel pain leads to significant disability and psychological stress.12,15,16 Irving and colleagues showed that chronic plantar heel pain has a profound negative impact on foot-specific and general health-related quality of life measures.17 The overall impact of plantar heel pain affects both leisure and work activities.18 These studies show a progressive downward spiral in in a patient’s motivation to maintain overall body health and fitness when suffering from chronic heel pain.

The psychological effects of delayed response to treatment are reflected in a recent study of patients treated for plantar heel pain with a mean 16 months duration.19 The participants indicated that chronic heel pain led to disruptions in the physical, mental and social aspects of their lives. Furthermore, the patients express doubt and frustration with their treatment and prognosis for a cure. Yet they all received traditional, clinician-implemented conservative interventions including foot orthoses and physical therapy. Most importantly, the participants in the study expressed a strong desire to have their symptoms resolve rapidly.19

We know that if a patient suffers plantar heel pain for more than nine months, the risk of having symptoms for another five years is 50 percent.7 Hence, there is a need to encourage patients to seek treatment early and a need to improve treatment outcomes that can resolve symptoms more effectively and rapidly.17

An Elusive Etiology
The challenge of treating plantar heel pain centers upon the fact that there is no universal agreement about the etiology of the condition.20 Thus, any patient presenting to a health-care professional with plantar heel pain will emerge from the initial visit with a myriad of possible explanations for causation and with a variety of treatment recommendations. The most popular treatments focus on relieving mechanical load on the insertion of the plantar fascia to the calcaneus.4,20,21 These interventions include stretching, taping, insoles, custom foot orthoses, heel pads, heel lifts and plantar fascia night splints.21 Other treatments focus on reducing inflammation or pain. These treatments include corticosteroid injections, oral NSAIDS, ice and physical therapy modalities.18 Regardless of medical specialty, there is a growing consensus that no single treatment or therapeutic approach will give rapid, predictable and positive results for the treatment of plantar heel pain.12,18-21

Part of this dilemma for clinicians is the fact that patients with plantar heel pain may have one or more different pathologies causing their disability.22 Imaging and histologic studies show that plantar heel pain can result from:

degeneration of the plantar fascia;22
thickening of the plantar fascia;23
calcaneal spur;24 and
periosteal edema of the calcaneus and bone marrow edema of the calcaneus.25
Few accepted treatments can actually target a specific pathology causing plantar heel pain. This is because advanced diagnostic testing is required in order to properly ascertain a precise diagnosis and this testing is not routinely justified in the clinical setting, based on cost and third party payors not authorizing such studies on a routine basis.

What About Entrapment Of The Inferior Calcaneal Nerve?
In my opinion, many patients suffering from chronic plantar fasciopathy eventually develop entrapment of the inferior calcaneal nerve, which will then propagate plantar heel pain for many years. I wrote previously about the anatomy of the inferior calcaneal nerve and the multiple areas for potential entrapment.26 A consistent finding among patients with chronic plantar heel pain is thickening of the plantar fascia by greater than four mm.28,23 This thickening will impinge upon the tight corridor under the heel, which provides passage of the inferior calcaneal nerve. This corridor’s plantar border is the insertion of the plantar fascia and superior border is the body of the calcaneus. A few millimeters of thickening of the plantar fascia will impinge upon the inferior calcaneal nerve. When this happens, one must focus on decreasing the thickening of the plantar fascia or perform surgery to decompress the inferior calcaneal nerve.28,29

Another approach to relieving plantar heel pain, particularly with entrapment of the inferior calcaneal nerve, is performing radiofrequency nerve ablation. This overlooked procedure demonstrates impressive results in multiple prospective and retrospective clinical trials with virtually no adverse effects.30-34 This procedure is not common among foot and ankle specialists because the equipment and training are not readily available in the United States.

Final Notes
Whether the condition is plantar fasciopathy or entrapment of the inferior calcaneal nerve, the pathomechanics of chronic plantar heel pain is still not well understood.20,35 This may explain why the prognosis for treatment of plantar heel pain is guarded and somewhat unpredictable.6 As a result, medical practitioners continue to seek new treatments for plantar heel pain. At the same time, the evidence supports the fact that when plantar heel pain is left untreated, the greater the risk is for the patient to continue suffering symptoms for an extended period of time.

08/10/2020

In my previous blog, I discussed the myth promoted by many authors of authoritative articles discussing plantar heel pain with a promise that “conservative treatment is successful 90 percent of the time.”1 These conservative measures usually include rest, stretching, physical therapy, shoe inser...

07/05/2020

Condition in Focus:

Sjögren’s Syndrome

Sjögren’s syndrome is a connective tissue disorder that affects mainly the salivary and tear glands. It is relatively rare and may occur as a primary form (in the absence of any other disease), or in a secondary form associated with other rheumatic diseases such as RA or lupus.
The condition is more prevalent in women (90% of cases are female). It can occur at any age, but it usually is diagnosed after age 40 and can affect people of all races and ethnic backgrounds. It’s rare in children, but it can occur.
Its main effects are to cause dryness of the mucous membranes, especially
the eyes and mouth. The skin can be affected also, and anhydrosis is the most common manifestation in the foot. The disease can affect other glands too, such as those in the stomach, pancreas, and intestines, and can cause dryness in other places that need moisture, such as the nose, throat, airways, and skin.
Sjögren’s syndrome can be called a rheumatic disease as the condition can cause inflammation of the joints, muscles, skin and other body tissues. Sjögren’s syndrome can be associated with vasculitis, and the toes can be involved.
Treatment of Sjögren’s Syndrome
Treatment is different for each person, depending on what parts of the body are affected. But in all cases, the treatment aim is to relieve symptoms, especially dryness. For example, artificial tears can be used to help with dry eyes and saliva stimulants and mouth lubricants to help with a dry mouth.
If there is extra-glandular involvement, treatment may include NSAIDs for joint or muscle pain, saliva- and mucus-stimulating drugs for nose and throat dryness, and corticosteroids or drugs that suppress the immune system for lung, kidney, blood vessel, or nervous system problems.
Hydroxychloroquine, methotrexate, and cyclophosphamide are examples of such immunosuppressants.
Often the skin is affected and patients can benefit from education about the importance of an emollient regime, including footbaths and creams.

07/05/2020

The Foot in Diabetes:
The major impacts on the foot in diabetes are the consequence of neuropathic and circulatory changes which may, in many instances, be complicated by additional problems such as deformity and trauma sometimes resulting in infection and potentially serious health impacts. Thus the clinical abnormalities affecting the lower limb are diverse, ranging from permanent abnormalities
to reversible (albeit acutely crippling) ones. The following list provides an overview of the main complications facing the feet in diabetes.

Symptoms:
Neuropathic: Paraesthesia, Pain, Oedema, Painful
Wasted Thigh, Foot drop.

Ischaemia: Claudication, Rest Pain

Structural Damage:
Neuropathic: Ulcer, Charcot Joints, Abscess,
Osteomyelitis, Digital, Gangrene, Sepsis

Ischaemia: Ulcer, Sepsis, Gangrene.

The neuropathic impacts of diabetes lead primarily to sensory deficit and autonomic dysfunction whilst the vascular disease leads to atherosclerosis of the leg vessels (usually bilaterally) leaving the leg and foot below the knee at heightened risk of tissue breakdown, infection and necrosis. Infection is rarely a single, sole factor in the diabetic foot, however, it does serve to complicate the issues of ischaemia and / or neuropathy and is thus responsible for considerable tissue death in the diabetic foot.
For simple categorisation, the foot in diabetes is divided into two entities: the neuropathic foot (whereby the neuropathy predominates yet the circulation to the foot remains good) and the neuroischaemic foot (where there is neuropathy but also significantly compromised circulation). The purely iscahemic foot without neurological involvement is a rarity in diabetes, but regardless the management is the same as it would be for the neuroischaemic foot.
The neuropathic foot presents as a warm, numb and dry (usually painless) foot in which the pulses are clearly palpable. Three major complications are known to arise from the neuropathic foot: the neuropathic ulcer located on weight bearing surfaces of the foot, neuroarthropathy (Charcot foot) and, rarely, neuropathic oedema.
The neuroischaemic foot presents as a cool and pulseless foot which is characterised by pallor, pain, ulceration on the margins of the foot (non-weight bearing areas) which develops necrosis and gangrene.

07/05/2020

07/05/2020

24/03/2020

In the light of the PM’s statement yesterday evening. It is with regret that I will have to close the surgery for Podiatry treatment.

If you have “critical” medical care needs regarding your feet, please do contact me on my mobile 07977449338 and I may be able to sort out some treatment for you.

This unfortunate decision has been made, not only to protect myself and my family but also to safeguard the health of all my clients, especially the venerable and weak.

Your co-operation and understanding in this matter is much appreciated.

Please stay safe and follow the sensible government guideline:
https://www.gov.uk/coronavirus

Find out about the government response to coronavirus (COVID-19) and what you need to do.

15/03/2020

Corvid-19 update:

Opening will almost certainly be affected over the coming days and weeks. I will try to keep every one updated as soon as possible.

At present I’m open as normal, the surgery is taking all necessary precautions!

The advice is:

Not to come, if you or someone you have been in contact with has had a temperature or cough. Over 70’s must only come if absolutely necessary.

Thank you

Charles Barnsley

24/06/2019

Gout
Did You Know...?
Gout occurs in about 1% of men and 0.3 - 0.6% of women, and the incidence increases with age, being rare in adults under 30 years of age. The underlying pathology of gout is crystal deposition into the joint space as a result of elevated levels of uric acid in the blood stream (hyperuricaemia). Primary gout due to an inborn error of metabolism accounts for about 90% of cases of the disease, and approximately 10% of cases are due to secondary gout. The enzyme defect responsible for hyperuricaemia is unknown.
Uric acid is a by-product of the breakdown of purines, a component of many foods we eat. Certain foods that are high in purines can increase uric acid levels and bring on an acute attack of gout. These foods include red meats, shellfish, beer, red wine and salt. Some medications, such as diuretics that are often used to control high blood pressure or reduce swelling, also may cause an acute attack of gout. Stress, infection or trauma are other possible causes. Therefore it is good practice to advise the patient to avoid any of the above where possible.

11/07/2018

11/07/2018

19/03/2018

NAIL CUTTING HINT: When cutting a nail, follow the natural curve of the nail itself. Avoid over-cutting away the nail sides. If nail problems arise see a chiropodist /podiatrist for expert help and treatment