Christelle Ingratta Podiatrist

07/04/2025

It comes suddenly. One minute you’re fine, the next...searing pain in your big toe. Gout isn’t just painful, it’s disabling. And it loves to strike when you least expect it.

Gout is often described as a burning, stabbing pain, and for good reason. It tends to target the base of the big toe, swelling it up, turning it red, and making even the weight of a bedsheet unbearable.

The cause? A build-up of uric acid crystals in the joint. These needle-like crystals trigger a powerful inflammatory response. Although anyone can get gout, it’s more common in men over 40, those with high blood pressure, or people who consume too much red meat, alcohol, or sugary drinks.

South Africans with a rich, meat-heavy diet or who struggle with hydration may be at higher risk, especially in hot climates where fluid loss can concentrate uric acid in the bloodstream.

Gout attacks are intense but usually short-lived. However, repeated episodes can lead to joint damage, deformities, and chronic arthritis. That’s why managing lifestyle, diet, and hydration is key.

Medication can help reduce pain and control uric acid levels. But prevention is the real goal, staying hydrated, limiting certain foods, and seeing a podiatrist if attacks become frequent or interfere with daily activities.

Gout may come and go, but its effects can linger. If your big toe is throbbing and swollen out of the blue, don’t wait. Proper diagnosis and management can help keep this painful condition under control.

07/04/2025

Onychomycosis, a fungal infection affecting the toenails, is particularly common in elderly individuals due to age-related changes in nail physiology, slower nail growth, and a weakened immune response. The infection often presents as thickened, discoloured, or brittle nails and can lead to pain or secondary bacterial infections if left untreated.

Globally, studies show high prevalence rates of onychomycosis in older populations, often coexisting with conditions like diabetes or peripheral vascular disease. These comorbidities can complicate treatment and require an integrated approach. Antifungal treatments may include topical or oral medications, with varying efficacy depending on the severity and patient adherence.

In South Africa, podiatrists working with older adults need to be vigilant in identifying early signs of fungal nail infections, especially in retirement communities or among patients with reduced mobility. Education on foot hygiene, proper nail care, and regular screenings can significantly reduce the risk and improve patient outcomes.

Access to effective treatments and awareness campaigns targeting elderly care facilities could improve early intervention rates. Incorporating podiatry into geriatric health services can make a meaningful difference in managing chronic foot conditions like onychomycosis.

Given South Africa’s ageing population, proactive podiatric care and awareness of onychomycosis are critical to maintaining foot health and preventing complications in elderly patients.

Source: Epidemiology and Treatment of Onychomycosis in Older Adults – PubMed. https://f.mtr.cool/qeouopcfee

07/04/2025

Achilles tendinopathy is a common overuse injury, often affecting runners, athletes, and middle-aged adults. It involves pain, swelling, and reduced function in the Achilles tendon, typically caused by repetitive strain. Eccentric loading exercises are widely recognized as a gold-standard treatment.

Numerous international studies have shown the effectiveness of these exercises in reducing pain and restoring function. The Alfredson protocol, in particular, provides a structured framework for rehabilitation using heel drop exercises performed twice daily over a 12-week period.

In South Africa, where access to physiotherapy may vary depending on geographic location, podiatrists can play an essential role in prescribing and demonstrating these exercises. Collaboration with physiotherapists ensures that patients receive consistent messaging and optimal care.

Education on load management, footwear assessment, and potential referral for imaging (where necessary) can help manage more severe or chronic cases. Although diagnostic ultrasound is not within the current podiatric scope of practice in South Africa, multidisciplinary partnerships can bridge this gap.

A structured rehabilitation programme using eccentric exercises offers an effective, low-cost treatment for Achilles tendinopathy. Podiatrists in South Africa should consider integrating this into standard care while advocating for broader access to allied therapies.

Source: Eccentric Exercises for the Management of Achilles Tendinopathy – NCBI. https://f.mtr.cool/ldiujvmftv

06/16/2025

06/16/2025

Your feet weren’t designed to hurt. A podiatrist can help you walk pain-free.

06/16/2025

First time seeing a podiatrist? Knowing what to expect can calm nerves and help you get the most out of your visit.

There’s no need to feel anxious. A visit to the podiatrist is more straightforward (and more helpful) than most people imagine. Whether you’re struggling with pain, injury, or simply need a check-up, the process is built around your comfort and mobility.

Start by jotting down any foot-related issues you’ve noticed: pain, swelling, numbness, or changes in skin and nail appearance. Bring a list of medications and medical history, especially if you have diabetes, arthritis, or circulatory issues.

Wear shoes you use often, including trainers or work shoes, and bring any orthotics if you use them. These provide valuable clues about your walking pattern and foot mechanics.

During the visit, your podiatrist will examine your feet, ask questions, possibly perform gait analysis, and may check your footwear. If needed, they might suggest further scans or refer you to a specialist, but in most cases, treatment or advice can begin straight away.

Don’t worry about grooming. Your podiatrist isn’t there to judge unpainted nails or calluses. In fact, leave the feet natural, it helps us see what’s really going on.

Think of it as a tune-up for your feet. With the right prep, your first podiatrist visit can set you on the path to pain relief, better mobility, and long-term foot health.

06/16/2025

Diabetic foot ulcers (DFUs) are a serious complication of diabetes, often leading to infections and amputations if not properly managed. Advancements in wound care have introduced new therapies aimed at enhancing healing and reducing complications.

One such advancement is the use of platelet-rich plasma (PRP) therapy, which involves applying a concentration of a patient's own platelets to the wound to promote healing. Studies have shown that PRP can accelerate wound closure and reduce infection rates in DFUs.

In South Africa, the adoption of advanced wound care therapies like PRP may be limited due to cost and resource constraints. However, incorporating evidence-based practices, such as regular debridement, appropriate dressings, and offloading techniques, can still significantly improve outcomes for patients with DFUs.

Education and training for healthcare providers on the latest wound care protocols are essential to ensure effective management of DFUs across various healthcare settings.

While advanced therapies offer promising results in DFU management, implementing standardized, evidence-based wound care practices remains crucial in the South African context to reduce complications and improve patient outcomes.

Source: New Evidence-Based Therapies for Complex Diabetic Foot Wounds – NCBI. https://www.ncbi.nlm.nih.gov/books/NBK581559/

05/24/2025

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Marathon finisher medals are earned not just with lungs and legs, but with well-cared-for feet. Running places enormous stress on your feet—up to three times your body weight with each stride! Proper foot care can be the difference between crossing the finish line triumphantly or limping to the medical tent.

Start with shoes specifically designed for your running style and foot type. Replace them every 300-500 miles, even if they still look good externally. The supportive cushioning breaks down long before visible wear appears.

Blisters derail running plans faster than anything. Prevent them with moisture-wicking socks (cotton is your enemy!), properly fitted shoes, and strategic application of lubricants or specialized tape on hot spots. At first sign of a hot spot, address it immediately—never "push through" developing blisters.

Post-run recovery deserves as much attention as the run itself. Elevate your feet after long runs, use ice baths for inflammation, and consider compression socks to improve circulation. Regular foot strengthening exercises like towel scrunches and marble pickups build resilience in often-neglected small muscles.

Listen to your feet—they'll tell you when something's wrong long before serious injury develops. The strongest runners know that respecting these warning signs isn't weakness—it's wisdom.

04/30/2025

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INFOGRAPHIC: Muscle activity during running 🏃‍♀️

Peak loads on the calf, hamstrings and hip flexors will increase significantly with faster running and sprinting.

03/03/2025

Ok, so what footwear category causes injury?
It is football boots, specifically in children. According to a very recent systematic review published in Paediactrics by Nieto-Gil et al (https://lnkd.in/gttpejVa
) ankle dorsiflexion limitation is the most frequent intrinsic factor related to Calcaneal Apophysitis, also called Sever's Disease. The second biggest risk factor was maximum plantar pressures as a consequence of the condition described in this systematic review.
The way both of these are addressed is with footwear with a meaningful midsole and a gradient from heel to toe reducing (i.e., a "drop"). The vast majority of children's football boots are made with no midsole and no drop ensuring a heel down position in these boots, Given most children are wearing footwear with an at least 8mm drop for the 8 hour school day, this sudden reduction to negative is problematic.
ASICS is the only brand that consistently offers football product for kids across its entire range with a 10mm heel gradient and some foam under the heel.
A 10mm drop has also been shown to change kinematics at the hip knee and ankle and change iEMG signal in the hamstrings. How come all children's football boots are not made this way?

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10/30/2024

Our new sign is up! Let us help you at The Therapy Team on 8th!

10/30/2024

Thank you to the Biokinetics association of South Africa, for the privilege to be part of your conference. Thank you for enriching my mind!