Gait Analysis
Our podiatrists perform comprehensive lower extremity biomechanical examinations and are highly trained at identifying abnormal variants that will contribute to injury or foot pain.
The information gained from the examination will allow our podiatrists to tailor a management plan based on each individual’s biomechanical requirements. A treatment plan will often include one or more of the following: correct footwear prescription, stretching and strengthening programs, taping and splinting, insoles or prescription orthotic therapy. The exact treatment plan will vary depending on the individual’s biomechanical structure and their short and long-term activity goals.
Orthotics
Foot orthotics are devices worn in shoes to improve foot function whilst reducing load on the structures of the lower limb. Abnormal foot movements increase forces on bone and soft tissues that lead to pain and injuries including Foot, Heel, Knee and Hip Pain.
Our customized foot orthotics are manufactured onsite in our Orthotic Laboratory to the highest standards using both flexible plastic and softer EVA (foam) materials. Each orthotic is made to a customized prescription meeting the needs of the individual patient, the manufacture of the orthotics is then overseen by the podiatrist who prescribes the orthotic.
Functional foot orthotics can be manufactured from a variety of materials ranging from plastic to soft foam. The appropriate material is selected after considering the foot symptoms, the activity of use, the footwear to be used, and other information gained during a biomechanical assessment.
Fungal Nail Laser
Unsightly nail fungal infections affect up to 10% of the population. At Tim Pain Podiatry we now offer effective laser nail therapy for this condition which has previously been difficult to manage.
Laser Treatment is:
- Safe – The laser energy passes through the toenail without causing damage to the nail or adjacent skin.
- Effective – Laser is much more effective than topical liquids.
- Cost Effective – Laser only requires 1-2 treatments, rather than the daily use of medications or liquids for 6-12 months making it very cost effective.
- Convenient – Unlike topical treatments nail polish can be used immediately after the use of laser.
Children’s Feet
Children’s feet are different to that of adults. Whilst a child’s foot is growing and developing their bones are softer and contain growth plates, also their soft tissues have more elasticity allowing much more joint movement than an adult’s foot. Thus, they are susceptible to abnormal pressure and loads from daily activities. Early detection and management is the key to preventing ongoing problems with children’s feet.
Some of the more common issues that children have include: flat feet, In-toeing or out-toeing, heel pain, toe walking, growing pains, bunions and joint problems
Radial Shockwave Therapy
Radial Extracorporeal Shockwave Therapy (RSWT) is a non-invasive solution for chronic musculoskeletal pain. We use shockwave therapy successfully on Achilles tendonitis, plantar fasciitis, and other musculoskeletal disorders of the foot and lower limb.
During treatment, series of acoustic waves are generated to stimulate a strong response in your body to heal an injured area. This results in improved circulation, a reduction in inflammation and reduction in calcium deposits. It also has an analgesic effect to the injured site which apart from feeling better helps to restore normal function.
Dry Needling
Dry Needling is used an effective way to help many foot and lower leg problems. It is particularly useful for resolving pain from musculoskeletal and neurological conditions relating to the lower limb.
Dry Needling stimulates a sensory response from within the muscle fibres causing a release of the constriction and allowing normal muscle function. Minimal discomfort is experienced with Dry Needling because the needles used in this procedure are finer and solid, unlike other needles used to inject substances into the body.
Dry Needling is commonly used to treat: Heel pain, neuromas, plantarfasciitis, Achilles tendon pain, shin splints and nerve pain.
Sport Podiatry
Our podiatry team have a focus on sports injuries. The foot is a complex structure and the demands of sporting and daily activities can cause many problems to occur within the foot and lower limb.
Through a comprehensive biomechanical and gait assessment our podiatrists can not only diagnose the problem but develop an individual treatment plan targeting the specific factors contributing to each person’s injury.We understand the importance of physical activity and strive to have our patients back to full activity and performing better than ever fully recovered.
Some of the more common sports injuries that we deal with our: heel pain, shin splints, knee pain, Achilles tendinopathy, forefoot pain, flat feet.
CAM Walker / Moon Boot
Early immobilization is essential if a broken bone is going to heal in the optimal timeframe without complication. We carry a range of Controlled Ankle Motion Boots, also known as Moon Boots, in stock so there is no unnecessary delay in waiting for a boot to be delivered when an injury occurs.
These boots are designed to protect the injured site, increase comfort and reduce swelling for people recovering from fractures to the foot, ankle and lower leg.
If you have a suspected fracture notify our reception staff to ensure that an appointment is arranged as soon as possible.
Stress Fractures
Bone Stress Injuries
Bones are very important and have many functions, including movement, structural support, protecting organs, storing minerals and creating blood cells.
Our bones remodel all the time (new bone forms and damaged bone is resorbed), this happens when bone comes under stress through walking, running and other activities which cause impact stress on bone. Microdamage is normal when these activities are undertaken and normal levels of remodelling occurs if your body is tolerating these exercise loads well.
Bone stress injuries (BSI) occur when there is an imbalance between bone being formed and resorbed due to exercise loading. This can result in stress reactions or stress fractures. Other factors that play a role in BSI inadequate recovery and sleep, nutrition, low energy availability OR Relative Energy Deficiency Syndrome (RED-S), training errors and underlying medical conditions. Females are also at greater risk of BSI and depending on sports played, this may also place you at greater risk of developing a bone stress injury in a certain area. BSIs are classified in to high and low risk categories due to where the bone comes under tension or compression on its bending axis and blood supply available to aid in healing the effected bone.
High Risk Bone Stress Injuries
- Femoral neck
- Anterior cortex of tibia
- Medial Malleolus
- Talus (lateral process)
- Navicular
- 5th Metatarsal (proximal diaphysis)
- 2nd Metatarsal (base)
- Big Toe (sesamoids)
Low Risk Bone Stress Injures
- Posteromedial tibia (shin)
- Fibula/lateral malleolus
- Femoral shaft
- Pelvis
- Calcaneus
- Diaphysis of 2nd to 4th metatarsals
- Big Toe (sesamoids)
If accelerated bone remodelling occurs (where resorption is greater than bone formation) normal adaptation does not take place and the risk of BSI increases. Stress reactions are graded 1, 2 or 3, before stress fracture (grade 4) and finally complete fracture. If there is a high clinical suspicion of a BSI then an MRI may be undertaken to confirm and grade the injury. Depending on the grade of bone stress injury and presenting clinical history, will determine the timeframe for a return to activity.
Management of Bone Stress Injuries
Depending on the clinical signs and symptoms and potential MRI findings will determine the management and treatment plan for BSI. If you have suffered a Grade 4 injury at a high risk site such as the Navicular this may involve complete non WB activity (CAM walker boot and crutches), where as a Grade 1 Injury at a low risk site may involve relative rest from aggravating activities such as running and other weightbearing sports and activities for 4-6weeks.
Management also needs to address why a BSI has occurred. This may involve addressing biomechanics, training patterns and footwear to help modify bone loading. As well as addressing factors that influence the bones ability to resist load such as overall bone health status, energy availability (RED-S), sleep, nutrition and other psychological and emotional stressors in everyday life. This may involve referral to a GP, dietician or sports psychologist.
After sufficient time has been given to heal the effected bone and other contributing factors to the BSI have occurred have been addressed then a gradual bone loading program can be introduced to help load and strengthen the bones to help reduce the risk of BSI reoccurrence.
References
Epidemiology of bone stress injuries in Australian high-performance athletes: A retrospective cohort study
Ruddick, Gemma K. et al.
Journal of Science and Medicine in Sport, Volume 22, Issue 10, 1114 – 1118
Nattiv, A., Kennedy, G., Barrack, M. T., Abdelkerim, A., Goolsby, M. A., Arends, J. C., & Seeger, L. L. (2013). Correlation of MRI grading of bone stress injuries with clinical risk factors and return to play: a 5-year prospective study in collegiate track and field athletes. The American journal of sports medicine, 41(8), 1930-1941.
Correct Training - Exercise, Load and Capacity
Walking and running are excellent, cost-effective ways of getting outdoors and keeping fit and healthy. We are all aware of the physical and mental health benefits these can bring but often we are time poor and finding that extra time in our busy lives can be hard.
For those who are at the start of their walking and running journey or those who are looking to take it to the next level during this time, a sudden spike in either activity may increase your risk of injury. The best and simplest way to reduce this risk is by gradually increasing the amount you walk or run on a week to week basis so that your bodies capacity can adapt to your new walking and running loads.
Training Load and Capacity
Load refers to your volume (how much), frequency (how often), intensity (how hard) and type as well as stress, anxiety and what else you do in your day to day life (work, inconsequential walking, habits, hobbies etc).
Whereas capacity refers to the different tissues in your body responsible for performing the movement and their ability to handle your day to day loads (Strength, control, biomechanics, previous injury history etc).
Background
Lower limb injuries (plantar fasciitis, posterior tibial tendinopathy, Achilles tendinopathy and others) are common runners and walkers who are starting out. According to Klutinberg et al (2015) up to 85% of novice runners experience a running injury that results in time lost from running.
Footwear and biomechanics are easy to attribute to the cause of injury (and definitely can contribute!), but often it is doing too much too soon and exceeding the capacity of the tissue that brings on the injury. This can be frustrating as it often strikes when you feel as though you are making progress with your exercise related goals.
Not being able to exercise can impact on your physical and mental health during an already tough and uncertain time. In order to reduce the risk of injury a gradual increase in exercise is often considered the best place to start.
Getting Started
For those new to running or looking to walk more, your previous activity levels can play a role in determining your capacity to tolerate these activities and this can vary from person to person. Have a go at a few short runs/walks (or a combination of both) for 2or 3 times during the first week and give yourself 24-48hours rest to recover.
Gradually increasing your volume by ~10% per week is a good place to start. This gradual increase in load will help build capacity of joints, muscles and tendons used in walking and running and reduce injury risk. If you are running you don’t need to go 100% on every run, take the foot off the pedal – this will reduce soreness and have you ready and raring to go for your next run.
As you build your load and capacity the best way to reduce injury risk is to increase one variable at a time. During this phase focus on volume (the amount you walk/run) at a comfortable pace and increase frequency, intensity and type of training later.
For those on their way
For those who have been running for a while, for example a couple of times per week (15km +) but are looking to increase their running volume or spend their time in social isolation training for their first race, a gradual increase is still the best. The 10% Rule, a 10% increase in volume or frequency or intensity per week is a good starting point for most people.
Increasing your load whilst following the 80/20 rule where 80% of the total weekly volume is done at an ‘easy pace’ and 20% is done at a high intensity (Seiler, 2010) . This is important because as you increasing volume it is important not to increase too many variables (speed, distance, hills, training surface) at once.
Remember you still need to recover from your runs and listening to your body is important as your body get used to the increase in exercise. If you are looking to incorporate more intensity (speed) into your running then try to keep it under 20% of your total mileage!
Other considerations
Other factors also play a role in your walking and running and potential risk of injury, including age, BMI, biomechanics, life stressors, sleep, recovery, diet/nutrition and footwear. Keep these in mind as you gradually build your load as they can play an important role in determining your current capacity.
No matter whether you are a walker or runner, where you are on your fitness journey and your previous experience it is important to know that if you increase your load to quickly your risk of injury increases too. A gradual increase ~10% is a good place to start and try not to adjust too many variables at once. Remember other psychosocial factors can increase your load and test your capacity.
References
Dallinga J, Van Rijn R, Stubbe J, et al Injury incidence and risk factors: a cohort study of 706 8-km or 16-km recreational runners BMJ Open Sport & Exercise Medicine 2019;5
Goon, T. (2016, April 11). Balancing training loads and tissue capacity [Blog post].
Kluitenberg, B., van Middelkoop, M., Diercks, R. et al. What are the Differences in Injury Proportions Between Different Populations of Runners? A Systematic Review and Meta-Analysis. Sports Med 45, 1143–1161 (2015).
Linton, Linda et al.
Running with injury: A study of UK novice and recreational runners and factors associated with running related injury Journal of Science and Medicine in Sport, Volume 21, Issue 12, 1221 - 1225
Seiler S. What is best practice for training intensity and duration distribution in endurance athletes?. Int J Sports Physiol Perform. 2010;5(3):276–291.