Jade Young Podiatrist

31/05/2023

We welcome Farhaanah Khan as the new Podiatrist taking over at Health-worx medical Centre Boksburg.

Please contact her on 011 306 1300 or via whatsapp message 079 172 5737 for an appointment.

16/05/2023

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08/10/2022

Happy International Podiatry Day to all Podiatrists from all over the world. Be proud of this unique and vital profession. Lets work together for a better future for this profession. Together we achieve more 🥰🦶

Happy International Podiatry Day to all Podiatrists from all over the world. Be proud of this unique and vital profession. Lets work together for a better future for this profession. Be part of FIP. Join us to harmonize Podiatry in Europe and beyond. Together we achieve more 🥰🦶

03/10/2022

FOOT IN MOTION

FOOT IN MOTION

Our activities of daily living inherently involve interacting with the physical environment: the complexity of our bipedal walking is commonly done in an apparent remarkable easiness. We definitely want to keep feet in the best possible shape, as if they hurt your mobility and enjoyment of life are affected.
Movements allow children to connect concepts to action and learn through trial and error; as people age, their joints can lose fluid and tissue and this can cause pain and stiffness: motion is like lotion for joints and for independence to care for their selves.

Many foot pathologies are of biomechanical, infective or inherited nature. The Podiatrist is the foot specialist who can diagnose, prevent and rehabilitate complications of the feet, relief pain and keep people of all ages mobile and active.

In an average lifetime we walk 1000,00 miles: it is what our bodies are designed to do, but there are some sensible precautions we can take to ensure that our feet continue to give good service.
Healthy feet, at any age, enable to continue being active as we want, with less pain as possible.
Damaging feet due to inherited conditions, badly fitting shoes and illness can cause serious arm to our bodies and daily life, preventing from completing our daily tasks.

References:

Gait adaptability
Weerdesteyn V, Hollands KL, Hollands MA. Copyright © 2018 Elsevier B.V PubMed (nih.gov)
Gait Posture 2013 Mar;37(3):445-51. doi: 0.1016/j.gaitpost.2012.09.007. Epub 2012 Oct 26. Foot type biomechanics part 1: structure and function of the asymptomatic foot. Howard J Hillstrom 1, Jinsup Song, Andrew P Kraszewski, Jocelyn F Hafer, Rajshree Mootanah, Alyssa B Dufour, Betty Shingpui Chow, Jonathan T Deland 3rd

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28/09/2022

PES PLANOVALGUS (Flat Foot)

PES PLANOVALGUS (Flat Foot)

Pes planovalgus (i.e., flatfoot) is a common condition among young children and also is encountered in adults. In children, congenital pes planus typically resolves with age as the foot musculature strengthens. Flexible pes planus is defined as a normal arch during non-weight-bearing activity or tiptoeing, with a flattening arch on standing. In rigid pes planus, the arch remains stiff and collapsed with or without weight bearing. Patients with rigid pes planus should be referred for subspecialist treatment. Patients with flexible pes planus, in the absence of signs of rheumatologic, neuromuscular, genetic, or collagen conditions, should be treated conservatively. Asymptomatic children should be monitored and maintenance of a healthy weight should be encouraged. Surgical intervention for refractory symptomatic pediatric pes planus may be considered but there is little evidence to support it. Several etiologies of acquired pes planus in adults have been identified as posterior tibial tendon dysfunction. Clinical and x-ray evaluation can assist in staging the condition and guiding treatment decisions.

A Podiatrist can reduce the symptoms through conservative treatments; advise appropriate shoes and exercises, he can prescribe custom made orthotics and rest or advise surgery when recommended. The correct foot position will help avoiding the risk of further problems, especially in severe cases and for further deformity especially in children.
The flat foot may impact on quality of life: pain and stiffness may cause disability and limitation at any age. There are many conservative and simple ways to reduce pain and limitation. The Podiatrist will evalute your condition and advice or treat if needed.

References:

1. Foot and Ankle Conditions: Pes Planus
Charlie Michaudet 1, Katherine M Edenfield, Guy W Nicolette, Peter J Carek
Foot and Ankle Conditions: Pes Planus - PubMed (nih.gov), 2018 Feb

2. Flat Foot in a Random Population and its Impact on Quality of Life and Functionality
Salvador Pita-Fernandez 1, Cristina Gonzalez-Martin 2, Francisco Alonso-Tajes 2, Teresa Seoane-Pillado 1, Sonia Pertega-Diaz 1, Sergio Perez-Garcia 2, Rocio Seijo-Bestilleiro 1, Vanesa Balboa-Barreiro 1
Flat Foot in a Random Population and its Impact on Quality of Life and Functionality - PubMed (nih.gov)

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25/09/2022

Skin foot infections 👣👣

Skin foot infections

An infected foot is often painful and can make it difficult to walk. Infections can be both fungal and bacterial infections. An infection can occur after an injury, having bacteria entering the wound, such as a cut or a skin crack, and cause an infection. Certain medical conditions, such as diabetes mellitus and ingrown toenails, can also increase your risk for foot infections. An untreated infection can lead to cellulitis, which is a potentially serious skin infection that can spread to your lymph nodes and bloodstream. One must look for discoloration and consistent oozing, which are signs that the infection needs immediate attention.

Fungal foot infections like Tinea pedis and onychomycosis are commonly found in 34% of the European population, mostly in Northern European regions. Studies showed that this high occurrence is due to longer winters, where occlusive footwear is worn for longer periods of the year, which promotes fungal growth
Turner R & Testa M. Measuring the impact of onychomycosis on patient quality of life. Qual Life Res 2000;9(1):39–53. PMID: 10981205
[5] Lubeck DP, Patrick DL, McNulty P et al. Quality of life of persons with onychomycosis. Qual Life Res 1993;2(5):341–348. PMID: 8136799
[6] Burzykowski G, Molenberghs D, Abeck E et al. High prevalence of foot diseases in Europe: results of the Achilles project. Mycoses 2003;46(11–12):496–505. doi: 10.1046/j.0933-7407.2003.00933.x
[7] Faergemann J & Baran R. Epidemiology, clinical presentation and diagnosis of onychomycosis. Br J Dermatol 2003;149(Suppl 65):1–4. PMID: 14510968 Havlickova B, Czaika VA & Friedrich M. Epidemiological trends in skin mycoses worldwide. Mycoses 2008;51(Suppl 4):2–15. doi: 10.1111/j.1439-0507.2008.01606.x

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25/09/2022

OVERUSE INJURIES 🦶👣

OVERUSE INJURIES

Overuse injuries due to lifestyle problems, unpaired walking or sporting activities commonly lead to ankle and foot abnormalities. The tendons, bones and muscles are specifically prone to degeneration. The various disorders may be classified by a grading system that includes peritendinous inflammation, degenerative tendon disease, and ruptures. Bone marrow edema is another typical manifestation of overuse. An anatomic distribution is an urgent need to provide immediate positive effects on walking.
Overuse injuries provide a challenge to the diagnostic acumen and rehabilitative and preventive skills of the medical community. The challenge is intensified when the primary lesion is located in the foot, whose levers, arches, and pulleys are responsible for absorbing shock, as well as converting a mobile adapter into a rigid lever for propulsion.

Podiatrists permit people and sportspeople benefit from accurate diagnosis, technique correction where necessary, manual therapies to joint and soft tissue, appropriate strengthening programme. They perform gait control using shoe-insoles and sensor technologies such as ankle joint support for falls prevention, shock absorption, preserving dynamic balance via foot and may contribute to prevent overuse injuries. Expertise rehabilitation and clinical competencies are important as well.
Reduction of predisposing factors is of utmost importance in the successful management of overuse injuries.

Most overuse injuries are avoidable: the risk of traumatic injuries and, in particular, of sustaining a fracture, contusion, or concussion is higher during sports. They are also more likely to occur as you get older — especially if you don't recognize the impact aging can have on your body and modify your routine accordingly. If you suspect that you have an overuse injury, consult your doctor. He or she will likely ask you to take a break from the activity that caused the injury, but you may be able to perform alternative training as long as it does not stress the involved body part. Don't allow an overuse injury to prevent you from being physically active. By working with your doctor, listening to your body and pacing yourself, you can avoid this common setback and safely increase your activity level..

References:
1. Shoe-Insole Technology for Injury Prevention in Walking
Hanatsu Nagano 1, Rezaul K Begg 2,
Shoe-Insole Technology for Injury Prevention in Walking - PubMed (nih.gov).

2. The rehabilitation of overuse foot injuries in athletes and dancers
The rehabilitation of overuse foot injuries in athletes and dancers - PubMed (nih.gov) , Clin Podiatr Med Surg 1989 Jul;6(3):639-55.

3. Overuse syndromes of the foot
F Kainberger 1, P Peloschek, C Weidekamm, M Uffmann, [Overuse syndromes of the foot] - PubMed (nih.gov), Radiologe. 2007 Mar;47(3):210-5.

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19/09/2022

Overriding digit/ digitus superductus deformity

Overriding digit/ digitus superductus deformity
is characterized by hyperextension of the corresponding metatarsophalangeal joint and lateral or medial deviation of the toe that comes to lay over the other.

Digitus superductus deformity usually occurs in combination with complex forefoot deformity like splayfoot and hallux valgus or digitus quintus varus deformity.

The raised toe shows pressure sores and corns (med. Clavus) and the plantar plate (med. Plantar aponeurosis) is under permanent tension which can lead to a destabilization of the metatarsophalangeal joint with subsequent joint dislocation (med. luxation).

The aim of the treatment is to reduce the pressure points and restore a nearly normal rolling motion.
Conservative:
• Wear soft shoes with a high toe box
• Use cushioning tubes and toe spreaders to reduce friction on the shoe and socks
• Use bandages, supports like orthosis and tape (podiatrist) in case of flexible deformity even in newborn
• See a Podiatrist to remove excessive callus and receive advice for pressure relief
• Wear a soft-bedded shoe insole to distribute weight and reduce pain under the forefoot (med. metatarsalgia).

Surgical:
• Correction of the toe position can be achieved by surgery
• If the joint is not dislocated, the toe position can be corrected by a minimally invasive procedure
• Correction of the cause (the big toe malposition) is necessary and from various surgical options the best tailored method can be chosen. For better stability the plantar aponeurosis is sutured

References

L T Bogy et al pubmed.ncbi.nlm.nih.gov/1401732/, Correction of overlapping second toe deformity: long-term results including a 7-year follow-up, J Foot Surg. Jul-Aug 1992;31(4):319-23.

W Gary Smith et al nlm.nih.gov/19030460/, Prospective study of a noninvasive treatment for two common congenital toe abnormalities (curly/varus/underlapping toes and overlapping toes), Paediatr Child Health. 2007 Nov;12(9):755-9. doi: 10.1093/pch/12.9.755.

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17/09/2022

PLANTAR FASCIITIS🦶🦶

PLANTAR FASCIITIS

Plantar fasciitis is a common and a disabling musculoskeletal disorder primarily affecting the fascial enthesis; it is thought to have a mechanical origin. It is predominantly a clinical diagnosis. Symptoms are stabbing, inferior heel non radiating pain in the morning; the pain becomes worse at the end of the day and can be triggered and aggravated by prolonged standing, walking, running and obesity

In particular, pes planus foot types and lower-limb biomechanics that result in a lowered medial longitudinal arch are thought to create excessive tensile strain within the fascia, producing microscopic tears: inflammation is rarely observed in chronic plantar fasciitis. Evidence indicates a link between arch function and heel pain. With proper treatment, 80% of patients with plantar fasciitis improve within 12 months.

A Podiatric complete differential diagnosis of plantar heel pain is important; a comprehensive history and physical examination guide accurate diagnosis. Many nonsurgical treatment modalities are used in managing the disorder, including rest, drugs, custom and off-the-shelf orthoses, injections, physical and shock wave therapy as nonsurgical management of plantar fasciitis is successful in approximately 90% of patients.
A Podiatrist can arrange investigations, perform gait analysis and be helpful for this condition; he can advise strapping technique and appropriate shoes, custom made orthotics. Ha can help with an accurate diagnosis, reduce the pain and relief pain to a better quality of life.

References:
Plantar fasciitis: evaluation and treatment. Steven K Neufeld 1, Rebecca Cerrato - PubMed (nih.gov), 2008 Jun
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15/09/2022

Hallux valgus👣👣

Hallux valgus

The common term for hallux valgus is bunion. It is characterized by a mostly painful medial deviation of the metatarsal head 1 and the simultaneous deviation of the ossa phalageale 1 laterally towards the other toes. As a result, deformities and displacements of the other toes may occur.
The causes have not yet been definitively determined. However, they may be a dysbalance of the extrinsic and intrinsic foot muscles, a biomechanical disorder such as hyperpronation, or heredity.

The development of hallux valgus is promoted by the following factors:
- Wearing shoes that are pointed at the front.
- Wearing shoes with a raised heel area (heels) due to overloading and pushing apart the metatarso-phalangeal joints
- insufficient training of the foot muscles
More rarely, hallux valgus develops as a result of trauma or rheumatoid arthritis.

Degree: Hallux valgus angle (HVA) / Intermetatarsal angle (IMA)
- Normal: less than 15 degrees / 9 degrees
- Mild: 15 to 30 degrees / 9 to 13 degrees
- Moderate: 30 to 40 degrees / 13 to 20degrees
- Severe: over 40 degrees / over 20 degrees

Root et al. divided HV deformity into four stages, as outlined below:
- Stage 1: Lateral displacement of the hallux at the MTP joint
- Stage 2: Progression of the hallux abduction (hallux pressing against the second toe)
- Stage 3: Increased intermetatarsal angle, possible associated second hammertoe deformity
- Stage 4: Partial/Complete hallux dislocation at the MTP joint

The conservative treatment consists in reducing the symptoms.
- Shoe modification: Low-heeled, wide shoes.
- Orthoses: Improves alignment and support.
- Analgesics: Acetaminophen and NSAIDs.
- Ice: Icing the inflamed deformity to reduce inflammation.
- Medial bunion pads: Prevents irritation of HV deformity.
- Stretching: Helps maintain joint mobility in the affected joint.

Surgical methods can be used when conservative treatments are not sufficient:
Osteotomy - A cut in the first metatarsal bone puts it into a less adducted position and the method varies in position and shape depending on the surgical strategy.
Arthroplasty - The mobility of the first MTP joint is maintained while relieving the pain. The joint is removed (total joint arthroplasty) or replaced with an implant (hemiarthroplasty).
Arthrodesis - Fusing the metatarsocuneiform or MTP joint into the correct position. This is only performed when the joint is severely degenerated and regaining functionality is unlikely.
Soft tissue procedures - primarily involves soft tissue (McBride procedure). In this, the fibular sesamoid is excised, causing Interphalangeal joint flexion, MTP joint hyperextension and medial deviation of the hallux.

Differential Diagnosis to Hallux valgus deformity
• Osteoarthrosis
• Freiberg’s disease
• Hallux rigidus
• Morton's neuroma
• Turf toe
• Gout
• Septic joint

References:

Fleischner, Dr. Gerhard, Der schmerzende Fuß, Monographie, Ein Kompendium der medizinischen Fußpflege Band II, Verlag Neuer Merkur München, ISBN 3-921280-745, 1991

Hircin, Emrah, Andrees, Moritz, Fink, Bijan, Wedig Dr. med., Martin P.
flexikon-mobile.doccheck.com/de/Hallux%20valgus, Hallux valgus, 07.07.2022, 21:51

Hetherington Dr., Vince, Poster Hallux abducto valgus

Kuhn 1, James, Alvi 2, Farhan, Hallux valgus, In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan., 2022 May 1., Affiliations expand
PMID: 31971732 Bookshelf ID: NBK553092, Free Books & Documents
pubmed.ncbi.nlm.nih.gov/31971732/

Wülker, N, Mittag, F., The treatment of hallux valgus. Dtsch Arztebl Int. 2012 Dec;109(49):857-67; quiz 868. [PMC free article] [PubMed

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12/09/2022

Plantar digital Neuroma: General Surg/Conser

Morton’s neuralgia

Plantar digital Neuroma: General Surg/Conser

Morton’s neuralgia

Morton's neuralgia is a painful nerve disease of the foot due to chronic compression, which is caused by swelling and nodular thickening of the interdigital nerves (neuroma) mainly in the area of the metatarsal heads III and IV, more rarely between II and III.
Additional compression can also be generated by an inflammatory altered and enlarged bursa, which is also located between the heads of the metatarsals and can form a conglomerate with the nerve node.

Other foot deformities such as splayfoot and hallux valgus, which can also be caused by wearing unsuitable shoes that are too tight, are particularly conducive to the development of Morton's neuroma.

Symptoms are severe pain in the area of the metatarsus heads up to the toes especially after longer walking distances due to the rolling of the foot and can be detected by the compression of the Metatarsal heads, the “squeeze test”, which is very painful in Morton´s neuralgia.
At the same time, there is usually numbness of the toes in the shoe, requiring patients to remove their shoes and massage their feet. These intermittent paraesthesia and pain in the forefoot are caused by sclerosing thickening of the nerves digitales plantares communes.

Conservative treatment may consist of padding and spreading the anterior transverse arch, also with orthosis, to widen the spaces between and straighten the toes and thereby relieve the neuroma. Also, temporary pain management with local anaesthesia or infiltration of a local anaesthetic may be performed.
Surgical removal of the neuroma may be necessary.


References:
Fleischner, Dr. Gerhard, Der schmerzende Fuß, Monographie, Ein Kompendium der medizinischen Fußpflege Band II, Verlag Neuer Merkur München, ISBN 3-921280-745, 1991 (The aching foot, monograph, A Compendium of Medical Foot Care Volume II)

Grünewald, Klaus, et al GmbH, ISBN 978-3-95409-027-3, 3. Auflage 2015 und ISBN 3-929360-52-7, 1. Auflage 2001 (Theory of medical foot care, Volume 2, Picture Orthosis)

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10/09/2022

Vascular conditions in diabetic Patients

Vascular conditions in diabetic Patients

Diabetic patients have a higher incidence of lower extremity peripheral vascular disease (PAD) than non-diabetic patients. Patient complaints may include pain with walking relieved by a short rest period (intermittent claudication), rest pain at night, and a slow healing or nonhealing wound. Clinical examination should record the patient's presenting symptoms. The initial physical examination should include palpation of pulses. Unfortunately, many more common tests such as capillary filling time, dependent rubor, and skin temperature are unreliable predictors. The presence of neuropathy with loss of pain awareness can also cloud the patient's assessment. Predictors include claudication, absent pulses, and a low Ankle-Brachial index. PAD is the number one cause of amputation in people with diabetes.

A vascular specialist should evaluate patients suspected of PAD for further testing and evaluation. Annual visits to a podiatrist for a foot examination are recommended for all diabetic patients.

Reference:

Hinchliffe RJ, Forsythe RO, Apelqvist J, Boyko EJ, Fitridge R, Hong JP, Katsanos K, Mills JL, Nikol S, Reekers J, Venermo M, Zierler RE, Schaper NC; International Working Group on the Diabetic Foot (IWGDF). Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update). Diabetes Metab Res Rev. 2020 Mar;36 Suppl 1:e3276. doi: 10.1002/dmrr.3276. Epub 2020 Jan 20. PMID: 31958217. Boyko EJ. How to use clinical signs and symptoms to estimate the probability of limb ischemia in patients with a diabetic foot ulcer. Diabetes Metab Res Rev. 2020 Mar;36 Suppl 1:e3241. doi: 10.1002/dmrr.3241. Epub 2019 Dec 16. PMID: 31845475.

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