Clinical Articles
Tarsal Tunnel Pain
I want to introduce you to the condition called tarsal tunnel syndrome as a cause of heel pain but with the distinctive quality that the pain burns. The second feature that gives the condition away is that feeling of fullness, a sort of exploding sensation when exercising worsening with standing walking or running. Sometimes this type of problem pain is called referred. This means that the source of pain and location may not match. The pain may be in front of the foot but is related to the structures in the hind part of the foot.
More About Heel Problems
The most common types of heel pain problems arise from general overuse or repetitive heel pad strain but heel pain is complex and if left can resist treatment. In this article, there are four key subjects that you need to know about. The first relates to children while the other conditions are adult related. There are conditions such as rheumatoid arthritis, gout and ankylosing spondylitis that may affect the heel as well as rarer conditions and of course fractures. If the pain does not subside with self-help remedies recommended after several weeks, then seek professional medical help from a podiatrist or medical practitioner.
Biomechanics and the foot orthosis
In the USA, from the sixties, the earlier designs were based around a popular subject called ‘biomechanics’. This was a pseudo term but became a significant part of the podiatric medicine degree course in the USA. Much of this pseudo-science involved measurements with protractors (tractographs) and in build error ‘eyesight’ assessment which led to assumptions with a predilection for the concept of wedging. The foot orthosis (F.O.), as it was called, tried to separate itself from the older insole and appliance. A google search today will still confuse the terms.
First Use of Corticosteroids by UK Podiatrists
There has been no previous podiatric publication regarding the use of local corticosteroids in the UK; indeed, in the USA podiatric literature studies have often been conducted empirically by retrospective analysis. It was decided to look at the range of foot pathology routinely treated with local corticosteroids to establish the clinical effectiveness of two preparations. Local glucocorticoid action is a common method used to treat inflammatory pain and one that is well recognized in clinical practice the world over.
Emergency in a Podiatry Setting
Alison’s detailed description provides an accurate timeline with considered actions and thoughts before, during, and after. It covers what we see as an anaphylactic emergency – that slow progressive change then wham-bam! In publishing this scenario, I dug out a case from 1999 that, at the time, I did nothing – maybe I was too embarrassed to admit my event, doubtless because, at the time, the drugs I had access to office were not the norm for podiatrists. We should all follow Alison’s approach to many such events which offer objective reflection.
Which Bones are Most at Risk from Fracture?
When my wife broke a bone in her foot back in October 2021, no one was more surprised than me. During my career, I have been interested in two facts. How people walk on their feet for so long without knowing they have broken a bone. Secondly, the methods we use to make such an assessment can fail, or the diagnosis can be missed. I wanted to introduces broken bones into the discussion about foot health as part of my ongoing pain series. Officially we all know breaks as fractures. Fractures, by dictionary definition (Little Oxford dictionary, 2002), are cracks or breaks which serves my purpose well. A quick check on Wiki and the definition has not changed but our views have.
The Changing Face of Consent
As podiatrists undertake more complex procedures the principles behind consent remain the same as surgery. As the profession of podiatry expands at all levels it is worth exploring the concept of consent in more detail. With the ruling of Montgomery applied to a recent podiatric high court case, the reality of isolated consent focusing on a judicial decision is no longer a fairy tale. This article sets out to reflect different views from within and outside the UK covering consent. Patients are encouraged to share decision-making with those who treat them and the manner in which consent is obtained continues to evolve.
The Football Stud and Soles
Historically, football boots were made of leather, initially without studs but subsequently also leather studs (shown). However, these were heavy, particularly when wet and were superseded by more lightweight versions which traditionally had two types of stud configuration, metal and moulded.
Falling Out with Employees
The narrative surrounds a case on a podiatry Facebook page where a new graduate was ‘let go’. Two crucial pieces of information came to the fore. First, the person had complaints against her, and secondly that an agreement was made not to set up a clinic under 10 miles from her employer’s practice. Lastly, should she, the employer do anything? As with all FB clinical posts, the evidence provided is thin, and more would be required to aid readers who could quickly become biased and empathic.
Are chemicals enough for hypergranulation?
As usual, Facebook (I won’t say which site) offers plenty of valuable discussion from members all around. The subject was hypergranulation and its management. Podiatric Surgeon Ian Reilly saw the trail of questions and answers and perhaps wondered why many respondents were unaware of Reilly and Burt’s 2021 article published in The Podiatrist.