Pain on the top of the foot (which is probably dorsal midfoot interosseous compression syndrome) is becoming seen more often due to the trend to barefoot and minimalist running. The constant load on the forefoot is causing a forefoot dorsiflexion moment that is greater than what the tissues can tolerate and the pain on the top of the foot develops as the dorsal jamming of the midfoot joints. The treatment of this pain on the top of the foot is to increase the plantarflexion moments which is done by using a running form that heel strikes, using a heel raise, using a foot orthotic that has design features to plantarflex the forefoot and using calf stretching.

Poor circulation is something that complicates many podiatry problems. When intermittent claudication sets in, its time for a vascular surgery consult. There is a recent post on Podiatry Arena (Intermittent claudication testing and differential diagnosis) with a question about the differential diagnosis of intermittent claudication. Musculoskleteal causes is probably the most common, but there are some others such as a compartment syndrome or a nerve entrapment. The treatment options these days are much better for those with peripheral vasucalr disease. The Foot Health Forum has a number of threads from people with poor circulation and it is always helpful to peruse them to see what people with the condition actually think about their problems.

I can’t believe that so many people are that gullible that they fall for the foot detox scam and I can’t believe that so many keep a straight face when they try and sell it. But it is selling well!

A foot detox is a bowl of water with some pads through which pass a small ion charge. You put the feet in the water and this is supposed to help rid the body of toxins. The evidence that it is doing this is the change in colour of the water as the foot detox takes place. It has been well demonstrated in a number of you tube videos that this foot detox is a scam. The water will even change colour if the feet are not even immersed in it.

The foot detox is really resting on the body detox movement and all of its dubious claims made for it.

Don’t fall for the foot detox scam.

One thing that I have come to the realisation with recently is that plantar fasciitis is due to too much load on the plantar fascia (kind of simple when you think about it!). So to treat plantar fasciitis you need to reduce that load. You reduce that load with weight loss, strapping, stretching and foot orthotics. Pretty much none of the other treatments for plantar fasciitis reduce the load. That does not mean that they are not helpful, as they will help the tissues heal, but I have to ask just how effective they are for plantar fasciitis if the load in the plantar fascia is not reduced.

That also raises the issue of foot orthotics for plantar fasciitis. The design features used on the foot orthoses have to reduce the load in the plantar fasciitis. Not all foot orthotics have design features that do that. Pretty much every single failed foot orthotic for plantar fasciitis that I have seen recently did not reduce the load. Adding design features to those orthotics help in most cases. Understanding these principle have really lead to what I believe is a massive increase in the success rate of using foot orthotics for plantar fasciitis.

In the last year or so I have add little use for any treatments for plantar fasciitis other than stretching and foot orthotics (with the right design features).

My latest blog post on plantar fasciitis is over at Running Research Junkie and on Its a Foot Captain!

Have just done a stint of paid forum posting. This is being paid to post on forum! It was kinda cool. It does not pay much and most of this get outsources to countries like India and Pakistan. Paid forum posting is usually used by owners of new forums and as I run a couple of forums, I thought I would have a go at helping out on some forums that are new. I have been there done that! Running a forum is not easy and have a think about the time you have visited a forums. Which forums do you revisit? Surely it’s the ones that are active and busy, so there is nothing worse for a forum admin to have an inactive forum. This is where paid forum posting comes in. New forum owners contract a number of paid forum posting firms to populate their forum with the initial content to get it going. Usually those who do the posting do not hang around and are not good long term members, but they do provide that initial content to get the forum going.

There is a lot of misunderstanding about growing pains in children. The terms growing pains is unfortunately used as a term to dismiss anything like leg pains in children. The term growing pains should really be reserved for pain in the leg of children; that only occurs at night (usually wakes them from sleep); is in the back of the knee or upper calf muscle; and is self-limiting. If the pain is in bone or a joint or occurs during the day, then it is something else. Some of the other causes of growing pains in children are potentially very serious, so all need to be investigated to see if it’s a true growing pain or one of those rarer serious problems. The cause of growing pains in children is not really known, but it does appear to be related to biochemical issues associated with fatigue. The treatment of growing pains in children is really just reassurance of the child, some gentle massage to get them back to sleep.

This is the wife’s clinic: Croydon Total Foot Care is a well-established podiatry clinic in the eastern suburbs of Melbourne Australia. She has been at it for over 15 years now.

They have a full range of podiatry services for patient.
Please phone 9722 9422 for an appointment to see a Podiatrist in Croydon.

I have been known to occasionally work there, but I very busy with my own ventures and looking after the girls!

I not much of an expert in onychomycosis, but have been following the debate and discussions on onychomycosis laser therapy. The laser for onychomycosis is new and expensive. Several devices have now been approved by the FDA as safe. In promotion of this method, it is interesting how that approval is being linked to the efficacy of the method when it does not. There have been no independent clinical trials on the method to compare it to placebo or the current topical or oral medication used, yet some extraordinary claims are made for how effective it is. All the research at the moment is some unpublished small clinical outcome studies done by the companies – this is the basis of the claims! My interest in not really if onychomycosis laser is effective or not, its watching how this technology develops and the claims made for. The pattern is similar to what has happened in the past with other new high tech treatments. They all eventually found their place, but none lived up to the hype and touting of how good they were. Surely alarm bells should start ringing when You Tube videos on onychomycosis laser start appearing to tout the method. The insurance companies are not covering the cost as they consider it still experimental.

Sinus tarsi syndrome is something of a paradox. It can be caused by an excessively inverted foot and sinus tarsi syndrome can also be caused by an excessively everted foot.

Sinus tarsi syndrome caused by an excessively inverted foot is the ankle sprain. During an ankle sprain the structures in the sinus tarsi can get stretched. They often get missed as the initial diagnosis of an ankle sprain due to the pain and swelling. It is only later that sinus tarsi syndrome gets diagnosed as a chronic problem following the ankle sprain. The pain is usually felt on the outside of the ankle joint. Sinus tarsi syndrome following ankle trauma usually responds really well to physical therapy and home exercise programs. Sometime a steroid injection into the sinus tarsi is helpful.

The other cause of sinus tarsi syndrome is an excessively pronated foot. This foot forces the subtalar joint to the end range of pronation or eversion and compresses the lateral side of the sinus tarsi. This produces pain on the outside of the ankle joint. This type of sinus tarsi syndrome responds really well to foot orthoses designed to keep the subtalar joint from pronating to its end range of motion.

Just got back from taking the girls to their ballet class (usually the wife does that) and ended up making the usual small talk with the other mums (not dads their unfortunately). Needless to say sometime I admit what I do for a job and the topic got to feet. This time it was actually interesting. What the mother related to me was clearly a case of tarsal coalition without me even looking at their kid (they were busy dancing). I obviously did not say much, but the really need to get to see someone who knows what they are doing. They had been mucked around by many different health professionals.

A tarsal coalition is a fusion of bone between two bones in the rearfoot (tarsus). The most common ones are a talocalcaneal coalition and a calcaneonavicular coalition. I usually like to send them for surgical consult as this is going to be there forever and if it can be removed, why not remove it? If that is not an option then some sort of foot orthoses can be used to limit motion which usually helps the symptoms.

I had to make a number of subtle suggestion as to what might be going on in this child foot and what they might need to do to get the right advice. Obviously without the benefit of an x-ray and a full examination, I was only speculating. I made this really clear to her.