COMPLEMENTARY HEALTH - PODIATRY SYDNEY PODIATRIST

Podiatry is one of the core services provided by Holdsworth House Allied Health.

Podiatry involves the treatment of conditions below the knee including those affecting the lower leg, ankle and foot.

It may involve treatment of common skin conditions, nail conditions or biomechanical related conditions whereby the relationship between the leg and foot incorporating the ankle joint is important.

Originally the profession was known as 'chiropody' and focused on the maintenance of the toe nails and general skin condition, and has since broadened to include the study of gait patterns, role of footwear, treatment of sports injuries and initiation/maintenance of exercise programs. The 'modern day' podiatrist is a primary practitioner meaning no referral is required and has become an important part of the allied health team meaning the benefits are recognised by GP's, physiotherapists, chiropractors, osteopaths etc and the podiatrist is often able to work together with these people to help treat and resolve a range of conditions.

These include the debridement (removal) of callus which is an over production of skin on the foot in response to pressure, a focal area of pressure can result in a corn which can also be removed via mechanical debridement. Other skin conditions include plantar verrucae's which are warts on the bottom surface of the foot which can become painful with weight-bearing activity. These may be debrided and then treated via dry ice/acidic therapies. Fungal infections of the skin of the foot are also common due the environment within shoes where ventilation is poor and moisture can build up, these are also contagious through water droplets in public bathing areas such as showers and pools. Bacterial infections can also occur on the skin particularly when there is injury to the skin surface or when circulation is poor. An example of this is with ingrown toe nails whereby the nail pierces the superficial layers of the skin. The podiatrist is trained to recognize the difference between these things, treat where necessary and offer suggested therapies.

Nail conditions may include thickening of the nails due to either trauma, onychomycosis (fungal infection), neglect, or poor circulation. A podiatrist is able to maintain the nails and suggest other conjunctive therapies. Ingrown toe nails as previously mentioned are also commonly treated and the podiatrist may skillfully remove these with or without the administration of local anaesthetic depending on the site and degree of the problem. In this situation the podiatrist works closely with the GP and antibiotics may also be administered if infection is present.

Care of the diabetic foot has become an important facet of podiatry due to possible complications involving the sensory and vascular system of the foot and leg. With poor diabetes control the circulation and / or nerve supply to the feet may be compromised. Neurovascular tests along with assessment of the general foot condition are performed to determine whether the patient is at low, medium or high risk of foot complications. Neurovascular testing of the diabetic foot is recommended every 12 months minimum, and quite often ongoing treatment throughout the year is required to maintain the foot and prevent problems. Once again podiatrists work very closely with GP's/ Endocrinologists on this matter and may be included in the overall care plan for the patient - as designed by the GP

Various lower limb injuries related to activity and overuse syndromes may have a biomechanical cause. Podiatrists are able to identify such things through gait analysis and biomechanical assessment. For example an overly pronating ('rolling in') foot may be associated with such conditions as

1. heel spur syndrome/arch pain- 'plantar fasciitis'
2. Achilles tendonitis
3. Shin pain- often generically referred to as 'shin splints' eg. periostitis, tendonitis, stress fracture
4. anterior knee pain- patellofemoral joint pain
5. metatarsalgia- any conditions affecting the metatarsals
6. sinus tarsi syndrome
7. tibialis posterior dysfunction - most common cause of unilateral flat foot in adulthood
8. tarsal coalition- most common cause of unilateral flat foot in children
9. morton's neuroma- a perineural fibroma ie- scar tissue build up around an intermetatarsal nerve

An overly supinating ('rolling out') foot is less common and may be associated with conditions such as

1. repetitive lateral ankle joint sprains
2. peroneal tendonitis
3. lateral ligament sprains
4. Iliotibial band friction syndrome

Podiatrists are experts in prescribing/manufacturing foot orthoses which may be used to support and/or re-align the foot, or redistribute pressure away from prominent joints or painful areas. The biomechanical assessment provides the necessary information to be able to prescribe the appropriate orthoses for the condition. The orthoses are placed within the shoe and may be moved from shoe to shoe when required. Footwear styles required to accommodate the orthoses are generally closed and ideally quite deep and wide. Any sole within the shoe is removed and replaced with the orthoses.

By re-aligning joints and assisting in stability the supporting soft tissue eg muscles, ligaments and tendons may act more efficiently and be less subject to fatigue and strain. The joints may be less subject to wear and tear. By redistributing pressure, orthoses may reduce the build up of callus etc

Podiatrists have knowledge in footwear design and research and the common features in a shoe which are important. Poor non-supportive footwear can lead to some of the conditions discussed above. Generally a shoe needs to have a firm heel counter, quite stiff through the middle and be flexible only up at the toe joints, the shape of the shoe including the depth and width needs to be able to accommodate the foot shape/size, the fit of the shoe is very important!

Podiatrists may direct their patients to the appropriate shoes for their foot type and presenting symptoms as well as giving them examples of styles, brands and models.

At Holdsworth house the podiatry team of David Bugg and Joel Urban have a strong background in management of sports and activity related injury having worked closely with soccer, rugby and afl football teams. They have also gained extensive experience in general podiatry having worked with the elderly and high risk diabetics at their other clinics over the years.

David and Joel are committed to working in all aspects of podiatry and closely communicating with the Holdsworth GP's and allied health practitioners.

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