Podiatry’s Role in Cycling

Posted by | July 23, 2020 | Podiatry Issues

The foot is so crucial to a cyclist. It is how the power from the leg is moved to the pedal to make the cycle move! If there is something wrong with the alignment of the foot, then this is going to be inefficient. Also, because of that lower that is generated, then the loads on the foot, especially if the footwear is tight, can lead to a whole range of foot problems. There are many podiatrists who specialize in cycling because of that important role that the foot plays. A lot of knowledge of the sport, the cycle and the problems is needed to be able to do this well.

PodChatLive has an episode on Podiatry and cycling and talked with two real experts with deep knowledge of the topic:

COVID Toes (chilblains)

Posted by | July 22, 2020 | Podiatry Issues

There have been lots of reports of chilblains in those with COVID-19, resulting in the use of the term COVID toes.

The actual reason for this is not totally clear as it could be:

  • it is part of the pathophysiology of the coronavirus infection. Chilblains are a problem with the way the small blood vessels react to cold, so the inflammatory process of the infection could affect the way the blood vessels react, causing the chilblain
  • the higher incidence of the chilblains may not be directly related to the COVID-19, but are due to lifestyle changes that happened during the lockdown and it was those lifestyle changes that predisposed to the chilblains.

It could be either one of these reasons or even both of them. The whole issue of chilblains and COVID toes was address in this episode of PodChatLive:

The supination resistance test is clinical test used in the biomechanical assessment of the foot that helps determine how much force is needed to supinate the foot. The results of the test are thought to indicate how hard the muscles need to work to supinate the foot and how much force is needed from a foot orthoses if the foot is overpronating.

For more on this, see this video from PodChatLive on the supination resistance test:

The test is increasingly and widely used in clinical practice.

A plantar plate tear (or dysfunction) is a common cause of pain in the ball of the foot (metatarsalgia). The pain is typically under the metatarsal head and just distal to the head and sometimes on the top of the metatarsophalangeal joint. The plantar plate is a thickened area of the bottom part of the joint capsule (ligament) of those metatarsophalangeal joints.

The diagnosis is generally made by the location and the description of the symptoms as well as by a range of clinical tests. Confirmation is often done with the use of a diagnostic ultrasound.

The non-surgical treatment for plantar plate tears is to prevent the toe from dorsiflexing. This can be best done by strapping that holds the toe in a plantarflexed position. A stiffer sole shoe or rocker sole shoe can also be very helpful for this as well or as an adjunct to the tape. This is generally all that is needed, but to can take a while to work and patience is needed. If that is not successful then a plantar plate repair can be done surgically.

How to cure chilblains

Posted by | July 19, 2020 | Podiatry Issues

Chilblains are a cold injury that typically affects the toes. They are unheard of in the warmer climates. The are caused by an abnormal response of the small blood vessels to the change in temperature which cause the inflammation. This inflammation initially causes a red itchy and painful patch on the toes. After repeated episodes, this becomes chronic and takes on a dark bluish, almost black type of appearance.

The best way to “cure” chilblains is not to get them in the first place. You can prevent chilblains by preventing them from becoming cold. This is obviously not always that practical, but what is practical is the use of socks that are warm and footwear that is insulating. If the foot does get cold, then it is extremely important that it is warmed up slowly. Do not come in from the cold and put the foot in front of a heat source. It is the too rapid warming of the skin before the circulation responds that is considered to trigger the inflammatory response.

If you do get a chilblain, then follow the advice above about preventing the next one and then deal with the current one by using creams to help stimulate the circulation and protect it with padding or wound dressings while it heals up. Preventing another one from occurring is the key to the ongoing management.

It is also important to eat and be healthy, perhaps taking beetroot juice, and other foods that are thought to help the circulation. In the worst cases, there are drugs that could be trialed to help with the circulation to prevent them.

Arch Supporting Flip Flops

Posted by | July 19, 2020 | Podiatry Issues

Flip flops are not the best thing that you can wear on your feet. They offer no support, which can be important if you need it. They also force the muscles to work in an unnatural way in the toe to help maintain the footwear on. Nothing wrong with that if you feet are healthy and if you have no problems.

There are a group of flip flops, like the Archies, that have an arch support built into them. The amount of arch support that they have is usually modest and probably equal to the amount of arch support you get from the arch supports that you can buy at retail.

Are they any good as alternatives to foot orthotics? If you have a minor problem and your arch shape is average, then they might help. This is something you need to discus with a podiatrist.

Where the arch supporting flip flops really come into their own are a recovery footwear for athlete after a hard training session. They are comfortable and they help facilitate the recovery of the tired muscles.

Severs disease, or more appropriately called Calcaneal apophysitis as its not a “disease” is a common problem of the heel in growing children. The pain is typically at the back and sides of the heel bone. It is more common in active children.

The key to managing Severs disease is to manage the load or activity levels of the child. The levels need to be reduced to a level that the pain is tolerable or manageable. How long Severs disease lasts will depend on how much the loads are reduced. This can be challenging as all kids want to be active and while there organized sports activity can be reduced, it is the unplanned activity, perhaps undertaken during the lunch break at school that parents can have little control over. A lot of education of the child and negotiation with the child will be needed to help with this. Given time, this will lead to a reduction in the symptoms and buy time for the pain to improve and the heel pain to get better.

In addition to load management, ICE can be applied after sport if it is particularly painful. Soft shock absorbing heel pads or inserts are also often helpful

Severs disease is a self-limiting condition as the growth plate that it occurs at merges with the rest of the heel bone about the early teenage years, so it is no longer a problem. The key to its management is the loads, the lifestyle and expectations to keep it under control until such a time that it is outgrown and is no longer a problem.