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Monday 09:00 - 18:00 Wednesday 09:00 - 18:00 Friday 09:00 - 18:00

Lawrence Atrash, Podiatrist, Sports Injury Clinic, Fourways, Johannesburg (2025)

31/07/2025

Foot temperature monitoring has emerged as a promising method to predict the onset of diabetic foot ulcers (DFUs) before visible signs appear. The principle is based on detecting subtle changes in temperature that reflect localised inflammation, which often precedes tissue breakdown.

Research from the Netherlands and the USA shows that daily foot temperature checks using handheld thermometers or wearable sensors can significantly reduce ulcer incidence in high-risk diabetic patients. These tools can identify “hot spots” which signal the need for offloading or clinical intervention.

In South Africa, thermographic tools are not widely used in podiatric practice due to equipment cost and availability. However, awareness of these developments is important. Podiatrists can implement manual temperature checks as a cost-effective alternative and educate high-risk patients on home monitoring routines.

Adoption of foot temperature monitoring, even in basic forms, can greatly enhance early detection and prevention of ulcers, especially in patients with a history of previous ulceration or peripheral neuropathy.

While advanced thermographic devices may be out of reach for many South African practices, integrating basic foot temperature checks could become a powerful tool in diabetic ulcer prevention.

Source: Lavery, L.A., et al. (2007). Thermometry in the prevention of diabetic foot ulcers. Diabetes Care. https://f.mtr.cool/ephqstzlfx

31/07/2025

It’s itchy, it’s flaky, and it spreads like wildfire. Athlete’s foot isn’t just annoying, if ignored it can cause bigger problems.

Athlete’s foot isn’t only for athletes. It’s a contagious fungal infection that thrives in warm, damp places like gym showers, tight shoes, or sweaty socks. And while it might start as a small itch between the toes, it can quickly turn into cracked skin, blisters, and even bacterial infections.

What makes it tricky? It spreads easily, not just from person to person, but from foot to hand, or into the toenails. That’s why scratching can make things worse.

The first signs are usually peeling skin, itching, and redness. Some cases burn or sting, especially when the skin is broken. Left untreated, athlete’s foot can lead to thickened nails, fungal nail infections, or painful fissures that invite bacteria in.

The good news? Treatment is simple, if caught early. Over-the-counter antifungal creams or powders usually clear it up within a week or two. But consistency matters: keep using the treatment for a few days after symptoms disappear.

Prevention is just as important. Dry your feet well, change socks daily, and wear sandals in communal areas like pools or changing rooms. And never share shoes or towels, fungus loves a free ride.

Athlete’s foot might seem minor, but it can grow into a bigger problem fast. Treat it early, keep your feet dry, and don’t ignore the itch. Healthy feet don’t take risks with fungus.

31/07/2025

Chronic foot pain not only limits physical activity but also significantly impacts a person’s mental health and quality of life. Patients with ongoing pain often report increased levels of depression, anxiety, and social withdrawal. These psychosocial effects are often underdiagnosed in clinical settings focused solely on biomechanical or dermatological conditions.

Recent studies underscore the need for a holistic approach to foot care, integrating psychological support into the management of chronic foot pain. Tools like the Foot Health Status Questionnaire (FHSQ) can help assess the broader impact on daily functioning and emotional well-being.

In South Africa, where public health resources are stretched, these psychosocial aspects are often overlooked. Podiatrists, however, are well-placed to identify red flags during consultations and refer patients to counsellors or psychologists when needed. Recognising the link between chronic pain and mental health enables more effective, patient-centred care.

Collaborative care models, especially in multidisciplinary settings, can ensure that the emotional burden of chronic foot conditions is addressed alongside physical symptoms.

Chronic foot pain affects more than mobility—it impacts mental well-being. South African podiatrists can enhance care by acknowledging and addressing the emotional dimensions of persistent foot conditions.

Source: Psychological Factors Associated with Pain and Function in Adults with Chronic Foot Conditions – Journal of Foot and Ankle Research. https://f.mtr.cool/fvbmgqdtdf

31/07/2025

Flat feet, high arches, or something in between...knowing your foot type is the first step to preventing pain and choosing the right shoes.

Look down. Your foot shape holds more clues about your health than you might think. Whether you have flat feet, normal arches, or high arches, the structure of your foot affects how you walk, what shoes you should wear, and even how your knees and hips function.

Flat feet (low arches) tend to roll inwards, a movement called overpronation. This can lead to arch pain, heel discomfort, and tired legs. People with flat feet often do best in shoes with good arch support and firm midsoles.

High arches are the opposite. The foot doesn’t absorb shock as well, which can cause pain in the ball of the foot or heel. These feet often need shoes with extra cushioning and stability to protect the joints.

Most people fall into the middle, neutral arches but even they benefit from regular checks, especially if they spend a lot of time on their feet, play sports, or experience unexplained foot pain.

Not sure where you fall? Try the “wet foot test.” Step onto a piece of cardboard with a damp foot and observe the imprint. A full footprint suggests a low arch, while a narrow or disconnected one hints at a high arch.

Your foot type is more than a label, it’s a guide. Understanding it helps you make smarter choices in footwear, prevent injuries, and support your body from the ground up.

31/07/2025

Hallux valgus, commonly referred to as a bunion, is a progressive deformity that affects the alignment of the big toe. In cases where conservative treatments fail, surgery becomes necessary. Recent innovations include minimally invasive techniques that reduce soft tissue trauma and improve recovery times.

Procedures such as the minimally invasive Chevron or scarf osteotomy have gained popularity in the UK and Australia. These approaches offer reduced scarring, shorter hospital stays, and quicker return to function when compared to traditional open procedures.

In South Africa, such procedures may not yet be widely available due to training limitations or equipment costs. However, podiatrists can play a crucial role in pre-operative evaluation and post-operative care, ensuring that patients are referred appropriately and rehabilitated correctly.

Keeping abreast of international surgical advancements allows South African podiatrists to advocate for improved services and guide patients in understanding their options, even when surgical care is referred externally.

While surgical scope remains outside podiatry in South Africa, podiatrists are central to managing bunion cases pre- and post-operatively. Awareness of modern surgical techniques supports better patient education and outcomes.

Source: Minimally Invasive Surgery for Hallux Valgus: A Review – Journal of Foot and Ankle Surgery. https://f.mtr.cool/zmsoygdiwf

31/07/2025

Foot pain without a clear cause? These are the tools podiatrists use to find out what’s going on under the surface.

Sometimes, foot problems go deeper than what you can see. That’s where diagnostic tools come in, helping your podiatrist uncover what’s really causing your pain, weakness, or instability.

1. The first step is often a biomechanical assessment. You’ll be asked to walk, stand, or perform specific movements while your gait, posture, and foot alignment are observed. This helps identify pressure points or abnormalities in how you move.

2. X-rays are used to check for bone problems such as fractures, arthritis, or misalignments like bunions. They’re quick, painless, and commonly used in diagnosing chronic foot pain or sudden injuries.

3. Ultrasound scans can show soft tissue damage such as torn ligaments, tendonitis, or bursitis. While podiatrists in South Africa may not currently perform these scans themselves, they often work closely with radiology centres for access.

4. Vascular assessments check blood flow using a Doppler device, essential in patients with diabetes or poor circulation. It’s non-invasive and gives crucial insight into how well blood reaches the feet.

5. Lastly, monofilament tests and tuning forks help detect nerve issues. These are often part of a diabetic foot screening to identify early signs of neuropathy.

Podiatrists don’t guess, they test. These tools help uncover what’s happening beneath the skin so you can get the right treatment, faster and more accurately.

12/07/2025

Pediatric flatfoot is a common condition where the medial longitudinal arch is reduced or absent. Flexible flatfoot is often asymptomatic and resolves with age, but in some cases, it can cause pain or affect mobility, necessitating podiatric intervention.

Assessment tools such as the Foot Posture Index (FPI) and gait observation are used internationally to determine the need for treatment. A 2018 study recommended the use of objective measurement tools to ensure consistent and accurate diagnoses in paediatric populations.

In the South African context, access to such tools may be limited, but clinical assessment remains invaluable. Education for parents is also essential, especially in rural or under-resourced areas, to distinguish between normal developmental variation and symptoms requiring treatment.

Interventions may include foot strengthening exercises, orthotic devices, or footwear modifications. These can often be implemented at a low cost, making them suitable for public sector clinics or school-based screening initiatives.

Early and accurate assessment of pediatric flatfoot can prevent complications and unnecessary interventions. South African podiatrists can lead in developing community-focused screening and education efforts.

Source: Pediatric Flexible Flatfoot: Clinical Aspects and Algorithmic Approach – PMC. https://f.mtr.cool/pfsnhqxhjo

12/07/2025

Busy workdays and long hours on your feet can quietly take a toll. Here’s how to care for your feet without slowing down your schedule.

By the time most people notice foot pain, it’s already interfering with work, exercise, or daily life. But adult foot care doesn’t have to be reactive, it can be preventative, even in the middle of a packed schedule.

Whether you're sitting at a desk all day, standing in retail, or running between meetings, your feet absorb the pressure. Swelling, heel pain, tight calves, and sore arches aren’t just ‘part of getting older’, they’re signs that your feet are asking for support.

Start with footwear. Office shoes often prioritise style over support. Choose shoes with a firm sole, cushioned heel, and enough space for your toes to spread. Rotate your footwear during the week and avoid wearing worn-out shoes that no longer offer structure.

Add small habits to your routine. Roll a tennis ball under your foot while sitting, stretch your calves against a wall, or prop your feet up at lunch to reduce swelling. These micro-breaks ease tension and boost circulation.

If your work is on your feet, padded insoles and compression socks can make a massive difference. And if pain persists, don’t wait. A podiatrist can pinpoint the cause and help you prevent long-term issues.

Foot care isn’t a luxury, it’s a survival skill in the working world. With the right habits and support, your feet can carry you through the busiest weeks without burning out. Make foot health part of your daily routine, your whole body will feel the difference.

07/07/2025

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

07/07/2025

Don’t ignore pain in the heel! It’s a red flag, not just discomfort.

07/07/2025

What you stand on at home affects your feet more than you think. Here’s how to make sure your flooring supports, not stresses, your soles.

Most people think about shoes when it comes to foot health. But the surface underfoot matters just as much, especially at home, where you spend hours standing, walking, or moving barefoot.

Hard floors like tiles, laminate, and concrete may look sleek, but they offer zero shock absorption. Over time, this can lead to heel pain, sore arches, or even stress injuries, particularly for people with flat feet or high arches.

Wooden flooring has a slight give, which makes it more foot-friendly. Vinyl flooring is another soft-surface option, offering better cushioning while still being durable and easy to clean that is especially useful in kitchens, where standing for long periods is common.

If you already have hard floors, add rugs or anti-fatigue mats in high-use areas like the kitchen or bathroom. They help distribute pressure and reduce the strain on your feet, knees, and lower back.

For those with existing foot conditions, go further: invest in supportive house shoes or orthotic slippers. Walking barefoot on tiles all day isn’t just uncomfortable, it can worsen foot conditions.

Your home flooring plays a silent but powerful role in your foot health. Small changes, like soft mats or supportive slippers, can protect your feet where it matters most: right under your own roof.

27/06/2025

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

Lawrence Atrash, Podiatrist

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Monday	09:00 - 18:00
Wednesday	09:00 - 18:00
Friday	09:00 - 18:00