What do you call a nurse with a sore foot? A nurse.

Who works harder than nurses? OK, no need to start a fight here, but do I have a point?! Walking around a LOT, standing for hours, hard concrete floors, lifting and manual handling. And not always in the best shoes... because they're usually the ugly shoes! One thing is for sure, at Pioneer Podiatry, we see a LOT of nurses.

Not surprisingly, there have been quite a few studies into the kind of injuries that nurses get. And guess what? Nurses have some of the highest rates of musculoskeletal injuries amongst all the medical and health professions. In some studies, up to 85% of nurses reported a musculoskeletal injury, with foot and ankle pain coming in close second behind lower back pain, and just in front of shoulder pain.

Another review of over 35 studies into lower limb injuries in nurses showed that foot and leg pain is a major cause of sick leave amongst nurses.

So how do we help nurses?

Firstly, footwear prescription is so important to get right. Just like writing the right script for the right antibiotic for the right bacterial infection is critical to getting a good clinical result, so is getting the right footwear script with the right design and technology elements to prevent or help to cure a musculoskeletal injury. Too much, or not enough, support or cushioning can make a small problem worse. Other things such as midsole density and heel pitch make a huge difference. And, perhaps the most important factor of all... style! If you need a more dressier footwear style, you don't want to have to be stuck with the ugly shoes. The honest truth is... you might buy them, but you're very unlikely to wear them.

We take all these factors into account when prescribing shoes; support, design function, and fashion. If you get one element wrong, it's not going to help. We are certified shoe nerds, and we pretty much know every shoes out there. If we can't direct you to where to get the shoe you need, we can source and fit it directly for you.

The second way we help nurses is by using one of the super skills of our profession... custom orthotics. An orthotic is something you put in a shoe to change the way the foot works, usually to reduce the tissue stress on an injured area, or to improve biomechanical function. A custom orthotic is an orthotic that is made from a 3 dimensional impression, mould, or optical scan of your foot. Custom orthotics are very effective at treating many injuries, and they are many nurses walking around Mackay with our orthotics in their shoes. It has enabled them to walk and work without the end of day pain they previously experienced. And that is good news, not just for those nurses, but also for the patients they treat! I mean, is it easier or harder to do your job with a sore foot? You know what I'm saying?

If you know a nurse with a sore foot, you should share this blog post. They will thank you for it!

Frequency and risk factors of musculoskeletal pain in nurses at a tertiary centre in Jeddah, Saudi Arabia: a cross sectional study
Suzan Mansour Attar
BMC Research Notes 2014, 7:61 doi:10.1186/1756-0500-7-61

Lower extremity musculoskeletal disorders in nurses: A narrative literature review.
Stolt M, Suhonen R, Virolainen P, Leino-Kilpi H.
Scand J Public Health. 2015 Sep 9. pii: 1403494815602989

Is the hippocratic oath still relevant today?

Ever since the dawn of medicine, we have been drawn towards a sense of presumed ideals and ethics necessary in the healing arts. When we seek the help of a doctor, most people are in a state of physical, mental, or emotional vulnerability, and we need to assume the best intentions of the person into whose hand we are putting our health, or perhaps even our life. For this reason, there is a long tradition of oaths used by physicians upon completing their training to explicitly outline these ideals, so no one is guessing what is expected of these venerable citizens.

And when I say long, I mean really long. The Hippocratic oath is perhaps the oldest, and most well known, and is attributed to the ancient Greek Physician Hippocrates of Kos from the 5th century BC. While it is a fascinating read, it is hardly something most modern physicians would honestly abide by, particularly considering the opening promise to "swear by Apollo the physician, by Aesculapius, Hygeia, and Panacea". However, even in these dark distant past times, there are thoroughly modern medical concepts such as to use treatments and procedures only "for the good of my patients according to my ability and my judgment and never do harm to anyone". There is even a promise to not undertake procedures that you are not experienced in, but to "leave this operation to be performed by specialists in this art".

Many medical oaths also make explicit the most powerful skill which a treating physician can possess. Surprisingly, this is not an elusive technical clinical skill, but rather the rare art of careful listening. It is the ability to truly probe into the root motivations and desires of our patients and to empathise with what they want to achieve. In teaching our new graduates, I tell them to look beyond to presenting complaint, and find out what this pain is preventing your patient from doing. Their real problem isn't heel pain or an ingrowing toenail, it's the fact that they can't play soccer with their teammates, or that they can't stand at work, and are afraid of losing their job. Or that they can't go walking each afternoon for exercise with their wife, they are gaining weight, and facing mounting criticism for this from their doctors. Once you find this deepest level of "why", you have to key to connecting your medical interventions in a relevant and engaging way.

In "A Modern Hippocratic Oath by Dr. Louis Lasagna" we have the wise assertion to "... remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems if I am to care adequately for the sick." Unless we truly understand the surrounding life context of our patients, we are never able to work alongside them in a partnership towards their goals.

And finally, though the modern oaths have removed the references to Apollo the Physician, there is still space to recognise these oaths as more than just a code of ethics for professional behaviour. Dr Lasagna states in his modern oath "...Above all, I must not play at God", indicating that there may be ethics and decisions above our pay grade as mere mortals. In recognising some of these self-evident truths, many ways choose to define this oath as a pledge to God himself. Whatever the personal persuasion may be in the end, to recognise the gravity and weight of such a responsibility as we have, and by articulating this and declaring it in front of those we seek to serve, is surely one of the most powerful ways to keep ourselves accountable to our highest ideals and ambitions.

Healing Heel Pain

Firstly, the longer you or your patient has had the symptoms, the longer it will take to heal.

heel pain to see podiatrist

Plantar heel pain is the culprit in most mechanical heel pain cases. It has a fairly predictable patient description- severe pain localised to the plantar heel, particularly when first weight bearing after a period of non-weight bearing (i.e. getting out of bed in the morning, after driving 30 minutes in the car etc). This pain will typically decrease after a number of minutes, and then returns gradually through the day, and worsens with more time spent on feet, or with higher intensity activities (e.g. running, exercise, jumping etc).

You are more likely to develop the condition if you're femaleoverweight or have a job that requires a lot of walking or standing on hard surfaces.

You're also at risk if you walk or run for exercise, especially if you have tight calf muscles that limit how far you can flex your ankles. People with very flat feet or very high arches also are more prone to plantar fasciitis.

When to see or refer to us:

  • Heel pain that continues when NOT walking or standing
  • Heel pain that lasts MORE than a few weeks, even trying rest, ice and other home treatments

Reach out -- we can help!

Lacing Techniques for Proper Shoe Fit

Certain lacing techniques for shoes can prevent injuries, alleviate pain and relieve foot problems. If you have specific foot problems, follow these lacing techniques to get a good fit with your shoe:

Narrow Feet

Use the eyelets farthest from the tongue of the shoes. This will bring up the side of the shoe.

Narrow Heel and Wide Forefoot

Use two laces. Thread through the top half of the eyelets and the other lace through the bottom half of the eyelets. The lace closest to the heel (top eyelets) should be tied more tightly than the other lace closest to the toes (bottom eyelets).

Wide Feet

Use the eyelets closest to the tongue of the shoe. This technique gives the foot more space.

Heel Problems

Use every eyelet, making sure that the area closest to the heel is tied tightly while less tension is used near the toes. When you have reached the next-to-last eyelet on each side, thread the lace through the top eyelet, making a small loop. Then, thread the opposite lace through each loop before tying it.

We are always here to help. whether be it in the correct shoe lacing techniques or in finding the correct footwear! Head over to our book online page to see our real time availabe schedules!

How to use others' perspective to help you see your vision and achieve your running goals

To achieve great things, we need to be surrounded by people who agree with our vision of the future. But not only do we need them to agree with our vision, we need them to share with us their own unique perspective of that vision, from their own unique position in their life, and in ours.

When talking about the literal use of the word perspective, as Podiatrists, we are experts in viewing human movement and considering its role in health and injury. So obviously, we literally view our patients from several perspectives to assess this. One of the most fun parts of our job is showing people how their own body moves, and showing them how problems with this movement can be a major part of what causes injury.

Just as a car with poor wheel alignment wears out tires, steering and suspension in a quarter of the kilometers, so too does a body with poor biomechanics wear out joints, ligaments, tendons and muscles at a rate that the body cannot endure.

The body is an amazing thing, and the foot itself is very remarkable. A quarter of the bones in the body are below the ankle, not to mention the hundred joints, ligaments, tendons and muscles that are there as well. The forces that act on the tissues in the foot are massive when you consider that your whole body weight is spread over these 5 small bones. And this movement is repeated 5 to 10 thousand times each day! It is easy to see why just a small amount of discrepancy in movement and tissue stress can add up and cause an injury, particularly when doing a very repetitive activity, like running.

Whether you're aiming at a 5k fun run, a 42k marathon, a 108k ultra marathon, our perspective at Pioneer Podiatry is that we are here to help you achieve that, without foot pain. We will find out what your vision is and share it, and give you our unique perspective.

How can Video Gait Analysis be beneficial to you?

Many professionals can benefit from gait analysis. A person's gait is a very powerful indicator of their health. Some people even say that walking speed is the 5th vital sign! That's a pretty powerful statement, but it's true - the speed and cadence of a person's gait can be very telling.

There are three basic stages to the human gait cycle, and it is impossible to view the details of this intricate motion with the naked eye.

With computerised video gait analysis, we are able to break each second of the gait cycle into tiny segments (frames), allowing detailed assessment of the patient’s foot position and overall posture.

Video gait analysis is particularly useful in helping to diagnose conditions associated with running or sport, as well as painful foot and leg conditions of an ‘overuse’ nature.

Using video technology to analyse how the feet responds to every step, our expert podiatrists at Pioneer Podiatry can assess how much your foot pronates - that’s the extent to which the foot naturally rolls inward when you run – and where your foot strikes the ground.

If you love Flip Flops, take time to read!

Flip Flops had been in fashion for quite some time. But did you know there are some bad effects in constantly wearing them? Especially when they do not provide the proper foot support? We have found the article below that best summarises its effects along with some great tips on choosing and wearing Flip Flops which can be beneficial for your foot health.

Remember - Your Feet carry you every day! 

Uncomfortably cold feet during winter?

Experienced Cracked Heels or Dry Skin, Blisters, Foot Pain and Tenderness or Small, Itchy, Painful Red Swelling on the Skin of the Feet or even Skin Breaks?

If your feet have the tendency to get cold during the cold winter weather, then the problem may lie in your shoes and even your socks. In addition to that, some medical conditions may be affecting your circulation and peripheral nerves, which may also lead to feelings of coldness. Whatever the reason may be, quality shoes, socks, and inserts that we can recommend can help tackle this common problem. And keep in mind, to enjoy your winter strolls, it is essential to protect your feet from excessive moisture and heat loss.

If you’ve suffered from cold feet winter after winter, you’ve probably tried tackling this problem by wearing thicker shoes and socks. However, you might actually be making problems even worse in this way. Instead, you’d be better off with good-fitting shoes consisting of two or three layers and accompanying winter socks.

WE can definitely help, head on over to our easy online booking system to book your appointment and speak to the feet experts!

What is Acquired Adult Flat Foot?... How to help your patients avoid catastrophic foot surgery.

Don't miss this flat foot condition in your patients... with tips on how to recognise it.

Flat feet don't usually hurt, especially in children. But if you notice a one-sided, worsening, painful flat foot in an adult, think.... Acquired Adult Flat Foot!!

How does it present?

  • Gradual onset (usually) of medial ankle pain, and sometimes lateral ankle pain (as the condition worsens)
  • Patient will be unable to do a single leg heel raise (see picture below) due to posterior tibial muscle and tendon dysfunction
  • Usual age- 45 to 65, women 4x more likely to get. Risk increased with diabetes, hypertension, and obesity.

Tests to diagnose?

  • Single leg heel raise (inability indicates post tib dysfunction)
  • Hubschers maneuver (indicates midfoot collapse and dysnfuction in the windlass mechanism)
  • Xray (to show joint position and disease) and MSK ultrasound (to assess the posterior tibial tendon integrity), although clinical assessment can identify the level of deformity

How to fix it?

This is not a condition to be complacent with! Depending on the stage of deformity, different degrees of immobilisation, orthotic support, and rehabilitation therapies will be needed. Physio's take note- these patients always will need custom orthotic therapy. Do NOT give heel raise exercises and cross your fingers and hope for the best! It will get worse, they will not be happy with you, and they will need a more corrective orthotic and possibly surgery.

At Pioneer Podiatry (here's the plug...) we specialise in treating this condition, including custom AFOs which are very effective in treating this condition. The good news is about 50% of all AAFF patients treated with custom AFOs are symptom free after 12 months, and can often go without the brace for most activities.

This article is really a very brief overview, so if you've got a hankering for the details of how to assess and treat this condition, have a squizz over at our Clinical Practice Guideline in our Referrers Portal. It's free, instant assess to clinical tests with video demonstrations, patient handouts for this condition, and treatment protocols to help you give the best treatment and advice to your beloved patients. Find it here.

Have a great day! Keep being awesome.

My VA's first encounter!

I have had it with ingrown! I first had one the first time I had my toenails cleaned, trimmed and pedicured at a local beauty shop. It looked good. It was pretty in Royal Blue! But all of that good feeling changed, when I felt a sharp yet dull but tingling pain on the right side of my big right toe! I could not explain what the pain was at that time.

It was tolerable for the first few hours but became a sharp and irritating pain after a few days. I then noticed a small lump or bump on the side skin and just thought maybe it was just due to the cutting and the skin is just adjusting to it. And as I learned more reading about this, yes, I was right. It was the skin and the way the nail was cut. Probably in my case, it was not cut all the way thru and/or was just cut very short on the side. But there was more to it, it could lead to a possible infection. Apparently, it was cut too short and the skin on the sides are starting to cover the corners of my nail thus the bump/lump.

It was difficult to wear closed shoes, it was painful and irritating at that. I had to bear the pain for a few days until it finally subsided to again a tolerable one. I had to wear open footwear like slippers or fit flops, it did help but was required an explanation to the clinic I worked at before.

Good thing it did not lead to an infection. I just had to let it dry and let it heal but I had to suffer the pain and consequences of the wrong cutting of nails.

I could have complained about the attendant at the beauty shop but part of it was my fault for not knowing how I wanted my nails to be cut.

So from now on, I know. I've learned it the hard and painful way. It did grow back like normal and I am now extra careful when I get them done by someone else.

This is a simple tip but really, cutting the nails straight across and not too short (especially on the sides) could save you from the pain and hassle I had to experience.
 

 

Above is one of my team's first hand experience of the famous yet annoying problem with Ingrown Toenails. Many of you might have had similar experience with what she had to deal with. We, at Pioneer Podiatry, make sure that you get the right treatment for this. We make sure you will perfectly understand how this happens and give you professional prevention tips. 

Learn more on our site! Or call us 07 4942 5016 and we are happy to help!