On a daily basis patients turn up at our offices with heel pain and a referral from their physician with a diagnosis of heel spurs.
The difficulty with this is that the patient then associates the continued presence of the bone spur with future suffering. In actual fact the pain is from inflammation and the spur, the thicken fascia, soft tissue swelling and bone inflammation are all symptoms of a chronic overuse injury. Our task to effectively resolve the immediate pain and prevent long term reoccurrence, is to identify the structural and functional origin of the condition. Sometimes it’s fairly easy other times prolonged, requiring multi faceted approaches. There is no one fix for all and many professed “cures” actually prolong and exacerbate the condition.
This senario used to be a more common place occurrence in our clinics and emergency rooms across the country, thankfully of late, less so.
Imagine you're suffering from the discomfort of a corn or a callous, browsing the isles of your local pharmacy you notice a product marketed as a "cure" for your corns. So, If it's sold on the shelves in the drug store its gotta be safe to use; Right? Wrong!
Usually, somewhere further down on the box, in the unreadably small print, there is advice and qualifiers for the application of this medicated pad or liquid. Needless to say much goes unread and unheeded. Normally these fall off, or wash off and with it some skin. This can bring some relief or little effect at all. However, if left on for longer than intended, or applied to skin with poor sensation and/or poor blood supply the results can be catastrophic and in a blink of an eye.
This gentleman had applied corn pads to painful calluses under both big toes, seven days prior to his visit with us. Both came off after two days, one however had caused the tissue to ulcerate and subsequently he developed cellulitis (infection) in his forefoot thus requiring aggressive management. He noticed intense pain, oozing yellow discharge and swelling.
Fortunately when he called we happened to have a cancellation and a motivated receptionist (thanks Mel).
He is in his 80s; diabetic, only one Covid-19 shot and thus very reluctant to visit the busy emergency department. To boot, his first available doctors appointment wasn’t until late July.
Its easy to see from one foot to the other how dramatically different the effects can be from the same medication on the same individual but different localized circulatory and sensory status.
Such lesions can be limb or life threatening if not managed properly and can take a considerable time to resolve completely.
These are difficult times so please check-in with those at risk and ask if they are worried about any health issues, even those that may seem minor or inconsequential.
To schedule an appointment at an office location near you with one of our dedicated specialists. We do not require a referral, however pertinent information from your primary care specialist may help in our diagnosis. Bring any pertinent images (X-rays) or test results with you and if appropriate samples of your footwear. Given the nature of our specialty it is likely we will want to observe you standing or walking during the initial exam. Call The Podiatry Associates in Mississauga, at (905)568-3800. We are also located in Brantford, ON, at (519) 751-2900 and Whitby, Ontario, at (905) 433-0200
Birthdays in the midst of pandemics dont really seam that much fun and its easy to get in a funk and try to let them pass quitely.
NOT HAPPENIN IN BRANTFORD!!!
This what I arrived to this morning. What a wonderful start to the day, and what a wounderful treat it is to work surrounded by kindness and caring. Thank you so much Mel and Nicole for the suprise and for lifting my spirits. Lots of delicious treats to try and get to if Melanie hasnt been too cruel with our schedule today.
The tibialis posterior, is a muscle found in the lower leg wrapping around the inside of the ankle and inserts into the medial aspect or the inside of the foot. It is one of three playing vital roles in postural stability, shock absorption and the structural integrity of the foot. Weakness in this muscle and its reduced ability to carry out its role, is referred to as “Post Tib Disfunction”.
On occasion “Tib Post” may be congenitally absent, injured, ruptured, torn or plain old ‘overused’. The difficulty is that like a drowning victim, without help the situation predictable gets worse and ends in failure. Thus the urgent need for early detection and identification to determine the source and extent of the injury. Without knowing the cause and extent we cannot advise an appropriate treatment plan.
Arriving in our offices the patients’ typically pinpoint the insertion of the tibialis posterior tendon as the focus of pain, and the exact path of the tendon on the medial ankle or the generalized medial ankle and inside of the foot. Sometimes however they will be without pain and simply identify they have very flat feet or notice it has flattened over time.
Over the last 10 years we have seen a dramatic increase in juvenile and teenage cases of Post tib disfunction, often times in generally; healthy, average weight, well nourished, and active individuals. I mention the weight factor to illustrate that while yes obesity most certainly will be an additional complicating factor, it is not an identifiable cause for many in this group.
Physical examination, history taking and video gait analysis form the mainstay of identifying the condition. The following image is of one of the simple tests we perform on potential cases where we ask the patient to stand on one foot while stabilized and rise up slowly onto the ball of the foot, for some this will be impossible or very challenging.
Treatment is often multifaceted with footwear advice and functional orthotic intervention being the essential components. Fortunately our clinical partners at Integrity Orthotics have come to our aid developing a custom orthotic devices capable of delivering the significant functional support these individuals require and doing so in a manner that is appropriate to the stage of development and severity of the disorder.
Many new clients suffering from this condition have sought treatment previously, arriving with collections of orthotics often times causing severe arch pain to be tolerable, or too soft rendering them completely ineffective.
To summarize, this condition is progressive and debilitating, reducing quality of life and affecting mental and physical well-being. The earlier a diagnosis is made, the more destruction and adaptation can be prevented.
Schedule an appointment at an office location near you with one of our dedicated specialists. We do not require a referral however pertinent information from your primary care specialist may help in our diagnosis. Bring any pertinent images (X-rays) or test results with you and if appropriate samples of your footwear. Given the nature of our specialty it is likely we will want to observe you standing or walking during the initial exam. Call The Podiatry Associates in Mississauga, at (905)568-3800. We are also located in Brantford, ON, at (519) 751-2900 and Whitby, Ontario, at (905) 433-0200
The last 2 weeks have been a bit stressful!
In our Brantford and now Mississauga offices as our workhorse; The Pedigait video-gait analysis system that we purchased almost 10 years ago developed a serious problem preventing us from gathering new video images.
It’s at times like this that we suddenly realize how crucial a component it has become in helping us deliver the services we do.It also illustrates how little I understand about computer systems and how they function, thank goodness for you strange folks that choose to specialize in this field.
Looking back on my years of teaching as a clinical instructor in our professional programme at Toronto General Hospital, I can’t help but wonder how much better a job I could have done for the students then.
The Pedigaits primary role is helping us identify and diagnose the root cause of biomechanical disfunction. Subsequently; we can use it to evaluate both improvement in function and deterioration over time. In deciding surgical intervention and/or orthotic modification we often run a more recent Pedigait video analysis, then contrast and compare to previous captures, to assist the decision making process.
Better still it provides an amazing platform for us to demonstrate to our patients the actual source of their complaint in a crisp clear video, in slow motion, and from every angle. We believe an important part of our job is to inform and educate, without that our patients can never truly make an informed decision regarding which treatment course they would like us to deliver or to seek referral.
The average human eye can see 40-60 frames per second, decreasing with age. Fighter pilots and gamers can be trained to see up to 220 per minute. But processing these images requires a much slower rate in the high teens to 20 for most. Thus watching human motion at real time, even with many years of experience and training is limited in its insight and detail.
So while dealing with our short term crisis may cause some interruption in service, I apologize in advance to Dr Milioto but we will continue to pester you to leave your clinic for a few hours and return to your design lab and craft a new version of your superb system.
This website includes materials that are protected by copyright, or other proprietary rights. Transmission or reproduction of protected items beyond that allowed by fair use, as defined in the copyright laws, requires the written permission of the copyright owners.