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Category: running and exercise
Plantar Fasciitis REVIEWED
Plantar Fasciitis REVIEWED

Feet play an important role in posture and gait. Foot pathologies are common amongst the adult population, in particular plantar heel pain. Foot pathologies contribute to a negative impact on quality of life. Plantar heel pain (or Plantar Fasciitis) is a common musculoskeletal foot injury and the most common condition presenting to our Townsville Podiatry clinic. Below is a summary of a recent review of the research on plantar heel pain. Learn more about Plantar Fasciitis or Heel Pain here. Review of research on Plantar Fasciitis or Heel Pain Plantar heel pain is most common between 40 and 60 years and may affect both athletic and non-athletic populations, but the incidence is higher among runners (affecting 17.4% of running population). The pathology is characterized by pain in the medial (inside) heel that is exacerbated by weight-bearing activity, as well as after periods of rest. Plantar Heel Pain is often chronic with typical symptoms lasting more than a year. Despite the name “Plantar Fasciitis” – the condition is considered a degenerative pathology rather than a primary inflammatory condition. Therefore, the more correct terms which should be used from now on are fasciosis or fasiopathy or plantar heel pain. Authors found that while Body Mass Index (BMI) was not associated with plantar fasciitis in the athletic population, there was evidence to support such an association in the non-athletic population. Muscle function and muscle size differences between those with and without plantar fasciitis was reviewed in seven studies - and the strength of muscle groups including hallux plantar flexion, lesser toe plantar flexion, ankle dorsiflexion, ankle inversion, and ankle eversion was lower in patients with plantar fasciitis. Studies found that patients with plantar fasciitis were more likely to have increased plantar fascia thickness, hypoechogenicity, and plantar calcaneal spurs. Patients with plantar fasciitis had 2.16 mm thicker plantar fascia than controls and tended to have absolute plantar fascia thickness values exceeding 4.0 mm. Review of Treatments for Plantar Heel Pain Corticosteroid Injections: Corticosteroid injections have been used for the treatment of plantar fasciitis as it can reduce inflammation, fibroblast proliferation and ground substance proteins, which have been thought to play roles in pathogenesis of plantar fasciitis. The review of the literature concluded that compared to placebo, corticosteroid injection was more effective in relieving pain at one month but not over longer intervals. Among 21 trials that reported adverse events, two ruptures of plantar fascia, three injection site infections, and 27 minor adverse events such as post-injection pain were reported. ESWT Extra-Corpeal Shockwave Therapy: The proposed mechanisms for the effect of ESWT include increasing nerve supply, blood supply and collagen synthesis in degenerative tissues. Shockwave reportedly have benefits in pain reduction at 12 weeks, unlike corticosteroid injections. ESWT showed greater reduction in VAS pain scores and success rate of improving heel pain by 60% over placebo when taking first steps and during daily activities. The most recent of studies compared ESWT with other therapies and found greater success rate, greater reduction in VAS pain scores, decreased return to work time, greater overall reduction in plantar fascia thickness up to 6 months post-treatment and less complications in those treated with ESWT compared to other interventions. The 39 studies concluded that while there may be common side effects such as pain during treatment and transient erythema (redness), complications during the first year of follow-up are highly unlikely and concluded that Shockwave Therapy is safe for treating plantar fasciitis. Low-Level Laser Therapy (LLLT): LLLT is a form of photobiomodulation therapy that involves the use of wavelengths ranging from 620 nm to the infrared (820–904 nm) over the surface of patient’s skin. The proposed mechanisms include anti-inflammatory effect as well as stimulation of cell proliferation, microcirculation, vascular neoformation, and collagen production [85]. Fewer studies have been conducted on the efficacy of LLLT in the treatment of Plantar Fasciitis, however the systematic reviews that have been done found that LLLT significantly improved pain and function and decreased plantar fascia thickness compared to other therapies, such as exercise.  In Summary Regarding treatment efficacy for management of plantar fasciitis, outcomes using corticosteroid, PRP, and ESWT may have the largest number of studies and most reviews concluded longer-term outcomes favoured non-corticosteroid interventions. Similar to tendinopathy, plantar fasciitis has been characterized by degeneration of collagen even though inflammation may play an important role in the early disease process. However, this does not mean that inflammation and degeneration represent a continuum of disease but reflect two distinct or often coexisting processes. Therefore, corticosteroids may offer benefits in short term particularly within 1 month following treatment. By Hayley Paterson | Biomechanical Podiatrist A Systematic Review of Systematic Reviews on the Epidemiology, Evaluation, and Treatment of Plantar FasciitisHye Chang Rhim 1,† , Jangwon Kwon 2,†, Jewel Park 3, Joanne Borg-Stein 4,5 and Adam S. Tenforde 4,5,*

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All About Running Footwear
All About Running Footwear

Chris Weber - Biomechanical Podiatrist & Runner - shares her insights into Running Footwear Correct Fitting  A comfortable and correct fit is the most important consideration for all shoes. Incorrect fit can be the sole cause of pain or injury. Consider the length, width and depth of the shoe.

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Is your child complaining of knee pain or foot problems?
Is your child complaining of knee pain or foot problems?

As parents, we all want the best for our children. Nothing is more concerning than our children in pain. Children’s feet differ from those of adults, as they are still growing. As a parent, it’s easy to think your child is experiencing growing pains and overlook this, however, it could also be an overuse injury. If your child is suffering from any lower leg symptoms, exhibits an awkward gait or walk, has flat feet, uneven shoe wear, poor posture and stability or complaining of pain then you should schedule a consultation with one of our Podiatrists. Overuse injuries can affect the muscles, ligaments, tendons, bones and growth plates. In children these structures are vulnerable as they are still growing. Want to learn more about overuse injuries? Contact us today.  Common Overuse Injuries in Children The three most common overuse injuries causing foot, knee and leg pain in Children are: Severs Disease (affecting the heel bone) Osgood-Schlatter’s Disease (affecting the knee) Iselin's Disease (affecting 5th metatarsal)  What Is Severs Disease? Severs disease (now more correctly termed Calcaneal Apophysitis) is not an actual disease but the irritation of the growth plate in the heel bone in children. The growth plate is a layer of cartilage near the end of a bone where the bone grows in length. It is weaker and more at risk for injury than the rest of the bone. Severs Disease often occurs during a growth spurt, when the bones, muscles, and tendons grow at different rates. Not all children will get heel pain, however, those that do will eventually grow out of the condition when the growth slows down. Our Podiatrists will offer the best treatment solutions aimed at reducing pain, improving stability, strength and flexibility – keeping your child on the sporting field. What is Osgood-Schlatters Disease? Osgood-Schlatter disease (again not an actual disease) is the irritation of the growth plate at the top of the shinbone. OSD typically causes pain and swelling below the kneecap. The pain usually gets worse with running, jumping, going up stairs, and walking up hills. It is one of the most common musculoskeletal problems seen in adolescents. It is most common in 10-15-year-olds but can be also seen outside of these ages, especially if a child has an early or late growth spurt. It is usually associated with high levels of physical activity, especially high-impact sports such as basketball or football. Want to learn more about common injuries leading to knee pain and foot pain in children?   Common signs of an Overuse Injury in children It is important to be aware of the more common signs of an overuse injury. These include: Pain – Especially pain that cannot be associated to an injury, such as from a fall or a contact in a sport. This pain often increases with activity. Painful limp or protective walk Decreased interest in activity or sport Treatments for Lower limb Overuse Injuries in Children and Adolescents Activity modification may be necessary (reduced intensity or reduced training days) Adequate water and food intake and sleep Improve footwear Address lower limb biomechanics if contributing factor – if your child has poor foot posture, tight muscles or joint hypermobility they may be more prone to getting overuse injuries. Want to learn more about our varied treatment options for children’s foot pain and lower leg pain? When Should I Bring My Child to see a Podiatrist? Podiatrists play an important role in addressing concerns with children’s feet and lower limbs, their walking and running patterns and gross motor development. Children’s feet and legs are more malleable to change when they are younger, often making treatments more effective at a younger age. If required, early Podiatry treatment can improve children’s strength and coordination and reduce the likelihood of foot and lower limb problems occurring in adulthood. Many children’s foot and leg issues can be simply addressed when caught early on. With the right treatment, this ensures that your child is moving well, and that they are healthy and happy in the long term.   [feature-block] Does your child suffer from knee pain or feet problems? Book an appointment with Foundation Podiatry today, so they can get back to everything they enjoy – pain free! Book Now [/feature-block]

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Running Related Injuries
Running Related Injuries

Image A is an injured runner displaying contralateral pelvic drop – that is, the hip/pelvis on the non-weight bearing limb drops lower than the weight bearing limb during the stance phase which results in an inward position of the knee and subsequent increase in foot pronation (rolling inwards).  This position has been linked to developing pain at the front (patellofemoral pain) and at the side (ITB friction syndrome) of the knee, shin splints and achilles tendon pain.  Image B is a healthy runner who is not displaying contralateral pelvic drop.

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'Start low & go slow’ – How to begin an exercise regime from scratch
'Start low & go slow’ – How to begin an exercise regime from scratch

The New Year is a great time to focus on becoming fit and healthy. Nobody will dispute that exercise (movement) is good for us. Due to our more sedentary occupations and lifestyles – even the act of getting up off the ground, climbing a ladder or cleaning out a bottom drawer may be a monstrous task. So think of the benefit of exercise (movement) as improving our ability to do daily tasks and sprucing overall health and well-being – not just minimising those tuck-shop arms and muffin tops! "As a Biomechanical Podiatrist I treat many patients who - due to yucky foot and lower limb pain - have become very inactive for a very long time. Once we have worked together to manage or resolve their pain, they have more energy, a positive head-space and are now ready to embark on some regular exercise". So here’s some advice I will often give to my patients: Have a goal in mind Do you want to enter the Townsville 5km, walk around the block without getting winded, or finish a 100-rep circuit without vomiting??? Have a goal that is clear, realistic and concise. Start Low & Go Slow If you have not exercised for quite some time, do not expect to race up Castle Hill on your very first go, even if you used to do it in a breeze. When people commit to starting an exercise program they are often so pumped and excited that they do ‘too much too soon’. If walking is your exercise, start with a short walk (20 mins) and increase the time by 10-15% each week. Rest days are good! To begin with I would recommend having a rest day every 2nd day. This is particularly so if coming back from injury. Rest days allow your body to recover and repair. After 2 weeks of exercise you may reduce your rest day to 2 on, 1 off. After 2 more weeks of exercise you may only need 1 rest day per week.  Alternate your training Mix it up - keep your body guessing! Where possible you may consider aqua aerobics, yoga or tai chi, weight training etc. Alternating your training styles means you are using different muscle groups, different energy systems, different loading patterns. This greatly reduces your risk of over-use injury, achieves greater results and keeps things interesting! When commencing an exercise program (whether that be following an injury, or starting from scratch for the first time) being SENSIBLE is the key. In Townsville we are very fortunate to have an abundance of gyms, amazing yoga teachers, water aerobics classes galore, great environment for outdoor sessions, zumba classes and the list goes on. Find something you enjoy and give it a go this New Year! Remember…..  Active FEET > Active BODY > Active LIFE   By Hayley Paterson | Biomechanical Podiatrist Townsville

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FOOT PAIN hindering your New Year's Fitness Resolution?
FOOT PAIN hindering your New Year's Fitness Resolution?

Most people try to kick off the New Year with a healthy, positive goal in mind. Whether that be regularly walking Castle Hill or training for a half marathon, it’s important to have a plan in place. Unfortunately for many people embarking on a new exercise regime… PAIN often follows! Foot pain, shin pain and knee pain are common culprits that can quickly put a stop to your training. 3 things to consider when embarking on a new exercise regime: FOOTWEAR is a biggy! What type of training are you doing? Running, CrossFit, netball, hiking?? A particular shoe may be required for a particular activity. In many instances, footwear can be the cause of an injury, or may help to resolve an injury. Have a read of our ‘How to choose the correct training footwear‘ article. Be careful of TOO MUCH TOO SOON! Most people are super excited when starting a new exercise regime. Take it easy and slowly build up the intensity, duration and frequency. Rest days are allowed! Any niggly injuries should be addressed before you start! Are you having heel pain or forefoot pain after training? Knee pain doing squats or shin pain when sprinting? The sooner you address these issues the sooner they will resolve, and the more likely you will be to reach your fitness summit. At Foundation Podiatry Townsville our Podiatrists Hayley, Chris & Emma are leaders in their field of Biomechanical Podiatry. Visit us for a detailed Posture, Movement and Gait Assessment to identify the cause of your problem, instead of just treating the symptoms. Remember…..  Active FEET > Active BODY > Active LIFE By Hayley Paterson | Biomechanical Podiatrist Townsville

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