July 16, 2013

Top 10 Myths About Feet – A Podiatrists View


I thought in this post we would explore some common myths and fallacies which we podiatrists often encounter day to day.

Here’s our “Top 10 Myths About Feet”.

10. ‘Growing pains’ in children is normal.

The term ‘growing pains’ is a misnomer, which has developed over many years describe aching legs and feet in children as they approach teenage years. There are many causes for painful legs and feet in children, and some of them do have a relationship to growth. However the term ‘growing pains’ diminishes the significance of these to a trivial matter. Sometimes, these symptoms are a sign of something far more serious, and should never be discounted if they persist for more than a few days. Your podiatrists can advise you on a specific diagnosis of what might be the cause of leg and foot pains in your son or daughter.

9. An ingrown toenail can be cured by ‘cutting a V’ in the end of the nail.

This is a classic old wives tail, which unfortunately doesn’t hold true. Despite the fact that nail growth occurs from the base of the nail and moves out to the end of the toe, there continues to be a misconception that by cutting a ‘v’ shaped defect at the end of the nail- the sides of the nail will grow up and out of the nail groove and fix the pain of an ingrown toenail. If only it was that easy. Unfortunately, what you see is an illusion – as the nail slowly grows out the ‘v’ slowly disappears as the end of the nail is worn away, until it looks like the edges have come out and closed the gap.

8. Heel spurs are the cause of my heel pain.

Heel pain is one of the most common things podiatrists see every day. More often than not, patients will present to us with this type of pain, along with an x-ray ordered by their GP which clearly demonstrates a small outgrowth of bone under the heel – known as a heel spur. Therefore both patients, and often GPs, suspect that this outgrowth of bone is the cause of the pain. Unfortunately, this is usually not true. Most heel pain relates to inflammation of the band of tissue running through the arch of the foot, called the plantar fascia, at its point of attachment to the heel. Anatomical studies of heel spurs have suggested for many years that the location of these spurs is more intimate with the small muscles under the plantar fascia, and not connected to the plantar fascia itself. There are other causes of heel pain such as nerve entrapments and stress fractures which can also be the cause of heel pain.

7. Podiatrists hate high heels because they are always bad for feet.

Often true, but not always. In fact, for some people with certain biomechanics, wearing a heeled shoe is much better for them than a dead flat shoe. Although many women need to wear fashionable heels for work, it doesn’t mean that this is every podiatrists’ nightmare. Just keep things in perspective and use moderation. If your job requires you to be seated behind a computer 8 hours a day, then your shoe choice is not so much of a big deal. However, if you need to stand all day in a retail store serving customers, then wearing killer stiletto’s with pointed toes every day of the week is probably going to take its toll and cause pain or longer term issues.

6. Bunions are lumps that grow on the side of the foot.

Many people who have bunions (hallux valgus) are under the mistaken impression that a lump has ‘grown’ on the side of the big toe joint, and it can simply be ‘cut off’. Unfortunately, bunions are a complex deformity of the 1st MTP joint, which requires careful assessment. At issue is that the joint itself has become subluxed towards the inside of the foot, and is not functioning correctly anymore. Whilst it appears like something has ‘grown’ on the side of the foot, in reality it is the misalignment of the joint which causes the protrusion, rather than ‘extra’ bone growth.

5. If I have to wear orthotics, then I’m stuck with ‘grandma shoes’

Wrong. Advances in orthotic manufacturing have allowed us to design lighter and smaller devices which can be used in dress shoes far more easily than in the past. Our own Orthema orthotics design and milling system allows us control over many parameters, allowing us to mill orthotics down to 1mm thickness. Our senior podiatrist Elouise Carmichael has a particular special interest in orthotic design and manufacture for fashion footwear.

4. Orthotics are hard and uncomfortable to wear

Not true at all! At The Podiatry Practice, our goal is to ALWAYS ensure that orthotics are comfortable and blend into the shoe so that you are usually barely  aware they are there. In the past, podiatrists were reliant on hard plastic devices, but modern advances have allowed us to use softer and more flexible materials that greatly improve overall comfort, whilst still maintaining adequate correction or control over the problem we are trying to fix.

3. If I have diabetes, my circulation to the foot will be affected and it might need to be ‘chopped off’.

Amputation is a serious risk and concern for patients with diabetes. However, the pathway to amputation is usually when someone with diabetes is admitted to hospital with severe infection or severe impairment of blood flow. In this day and age, we now know that contact with a podiatrist can dramatically reduce the risk of hospitalisation and amputation. We can assess your circulation and arrange for a vascular surgeon to intervene before things get too bad. We can usually fix chronic neuropathic wounds which might lead to infection over time. More often that not, it is actually nerve damage (neuropathy) that is the concern, and blood flow to the foot is actually amazingly good. An annual review with your podiatrist is essential if you have diabetes.

2. Barefoot running is the best and most natural way to run.

OMG. The current craze for barefoot and minimalist running shoes has its fair share of evangelists and devotees. Whilst most podiatrists groan at the thought, they also quietly chuckle at all the new patients booking in with the plethora of stress fractures, tendon injuries and other problems that this fad has created. Like the old saying that one shoe will not suit every foot, there will be a small proportion of runners who can ‘get away’ with running this way. Just as many end up with injuries and problems. Let’s not talk even start about all the foreign bodies, bits of glass and puncture wounds that running in urban environments might put you at risk of.

1. Podiatrists just treat corns and calluses.

Ugh! The greatest myth of all. Maybe that was the case 50 years ago, when chiropodists were the mainstay of foot care in Australia. But for the past 20-30 years, university trained podiatrists have been caring for all types of medical and surgical conditions affecting the lower extremity. In almost all states of Australia, appropriately trained podiatrists can prescribe and administer scheduled medicines such as antibiotics, analgesics and corticosteroids. We refer people for x-rays, ultrasound scans and MRI scans to diagnose foot pathology. Some podiatrists undertake specialist training to perform reconstructive foot and ankle surgery in hospitals with general anaesthesia provided by anaesthetists. Podiatrists can choose to work solely in paediatric practices or sports injury clinics, or work in hospitals managing the devastating complications of diabetes. Podiatrists are experts in everything to do with the foot and ankle – from a humble little corn, to serious diabetic foot complication that might require an amputation. We are like dentists – health professional experts in a specific area of anatomy.

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