Baxters nerve entrapment is a problem that occurs at the heel and can often be misdiagnosed as plantar fasciitis. Complicating this is that he inflammation associated with plantar fasciitis can actually cause the Baxters neuritis! Differentiating between the two is important so that the treatment can be better directed. Plantar fasciitis is more painful in the morning compared to the Baxters neuropathy. The pain of a Baxters nerve entrapment tends to radiate more than the pain from plantar fasciitis. A unique feature of Baxters is that that those with it tend to have a problem abducting the little toe, however so do a lot of people so it is not that accurate.

The high arched or pes cavus foot provides challenges in clinical practice. The first thing that needs to be established is the cause of the pes cavus. Neurological causes need to be ruled out initially as this condition can be first sign of several different problems. The treatment of pes cavus will depend on the cause of any symptoms. The pain in pes cavus can be from pressure on the metatarsal heads, so accommodative type foot orthotics are often needed. If the pain is in the arch or heel, then more supportive foot orthotics are indicated. If the pain is further up the lower limb, functional foot orthotics may be needed to change the function of the foot. If the pain is on top of the foot, then footwear advice is often needed. If all else fails then pes cavus surgery is indicated.

Unfortunately there is no secret best running shoe! They are all good. Every runner is different. Every runner has a different foot type and structure. Every runner has a different running style. Every runner has different needs. Every running shoe make and model has different design features all designed to achieve different things and meet different characteristics. The secret (if there is one) is to match the characteristics and needs of the runner to the correct running shoes. Theoretically of you get the match wrong, there is a potential for increased injury risk and decreased performance. If you get the match right, then there is possible a decreased injury risk and a potential for increased performance. The challenge in running shoe prescribing is to get the match between the two right. It is not an easy task and best left to the speciality running shoes stores.

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The Australian Podiatry Council (APodC) is the peak body for the podiatry profession in Australia. There are only six members, which are the State Podiatry Assocaition (NSW, Vic, Tas, SA, WA, Qld).  APodC are headquartered in Melbourne, Victoria. The staff at the APodC office carry out national activities and goals whereas the state associations are responsible for state activities. See also ANZPAC.

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The Ponsetti method for clubfoot is becoming the most popular method for treating clubfoot. It is a manipulative technique that does not need surgery. Gradual corrections are achieved through gentle manipulation and then plaster casts are applied to maintain that correction. This is repeated regularly for several months in the infant to achieve full correction of the deformity. A lot of research now supports the Ponsetti method for clubfoot.

I just noticed several questions being asked in some online forums about pitted keratolysis (see: pitted keratolysis). Pitted keratolysis is a condition that affects the soles of the feet. It mostly happens in those who sweat more especially if they wear closed in footwear. It is caused by corynebacteria infection that develops in the moist environment. It affects either the forefoot or the heel or both and appears as white with areas of punched-out pits or small cavities. They look a lot worse when the foot is wet. The primary treatment for pitted keratolysis is to deal with the hyperhidrosis or sweaty foot first. Occasionally a topical antibiotic, either topical or oral is needed if control of the hyperhidrosis is not successful in the treatment of pitted keratolysis.

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The Weil Osteotomy is a common surgical procedure for problems in the forefoot such as plantar corns and calluses, plantarflexed metatarsals and problems commonly lumped under the term ‘metatarsalgia’. While the Weil Osteotomy is commonly used, it is also controversial and opinions are clearly divided on its usefulness. There have been a couple of online polls about this. Podiatry Online TV has some video clips on the Weil Osteotomy.

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When we are first developing before birth, the foot is just a lump of cartilage. Inside that cartilage the individual bone develop separate from each other and the joints between them develop, so at birth we should have all the bones well on their way to being developed and the joint form. Sometimes a joint or joints between bones does not form and are joined by a bridge or cartilage. This is called a tarsal coalition. There are several types of tarsal coalitions, depending on which bones are involved. Two common one are the talocalcaneal coalition and the calcaneonavicular coalition. Initially these tend not to cause any problems as the cartilage is very flexible, but at the child gets older, they can become symptomatic as the bone becomes more developed. Foot orthotics can be used to restrict movement of the bones to help the symptoms. In most cases of tarsal coaltions a surgical removal of the bridge of bone connecting the bones across the joint can be helpful.

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A pedorthist is a health professional that specializes in the use of footwear and supportive devices to treat conditions which affect the feet and lower limbs. Pedorthists work in a number of different setting with a wide range of people. A number of organisations offer pedorthics certification (CPed). To be qualified in pedorthics there must be the study of anatomy, physiology, and biomechanics, as well as all the conditions that can affect the foot, especially the footwear and orthotic management of them.

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Forefoot varus is a position of the forefoot that is inverted when the subtalar joint is in its defined neutral position and the midtarsal joint is maximally pronated. To get this foot flat on the ground the rearfoot has to pronate. This can lead to a number of problems.

Forefoot supinatus is also an inverted position of the forefoot when the subtalar joint is in its neutral position and the midtarsal joint is maximally pronated. However, it is a very different beast to forefoot varus. Forefoot varus is an osseous deformity, but forefoot supinatus is a soft tissue contracture. When the rearfoot pronates, for whatever reason, the forefoot can not go through the ground, so it is in a relatively inverted position compared to the rearfoot position. As the soft tissues adapt to this position, a forefoot supinatus develops.

So, forefoot varus is the cause of  excessive foot pronation and forefoot supinatus is the result of rearefoot pronation. Forefoot varus is not very common and forefoot supinatus is very common.  The management of them is very different and potentially can cause problems if it is done wrong.

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Podiatrists are always in demand and good staff are always hard to find. There are many places to advertise for podiatry jobs and discuss podiatry employment. The growing demand for podiatry due to the aging of the population possibly means that there will always be a shortage of podiatrists.

Smelly feet are an embarrassing problem. The actually odour of smelly feet is due to the action of bacteria on sweat, so the two logical ways to treat this problems are to get rid of the sweat and get rid of the bacteria. There are a number of strategies to get rid of sweat, such as going barefoot as much as possible, using socks, insoles and powders that can absorb the sweat. There are a number of medications that can be used to help try up the sweat and work on the bacteria that break down the fatty acids. There is no magic secret sauce for smelly feet or foot odour, it’s just a lot of ongoing hard work to keep the sweat and bacteria under control.

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There has been a lot of controversy around the Vibram five fingers shoes lately given the barefoot or minimalist running trend. Part of the controversy surround the hype and exaggerated claims about how barefoot running can reduce the injuries when it’s becoming increasingly clear that this is not the case (see:  Vibram FiveFingers Cause Metatarsal Stress Fractures?; Why are barefoot runners getting so many injuries?; Vibram Five Fingers).
Vibram Five Fingers are a novelty item and should be treated as such. Those contemplating Vibram Five Fingers are well advised to follow the advice of the barefoot running advocates and transition slowly and carefully over a long period of time. Just don’t fall for all the hype and exaggerated claims about the alleged benefits.

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Medial tibial stress syndrome is a common overuse injury in the legs of athletes. There are many theories and ideas as to what it exactly is. Equally, there are many theories and ideas as to exactly what causes or increases the risk for medial tibial stress syndrome.  One idea that is gaining increased popularity is that it is due to higher bending moments in the tibia. These can be reduced with the use of medial wedging under the foot. See this discussion on medial tibial stress syndrome.

A key diagnostic feature of navicular stress fractures is tenderness at the so-called “n spot”. This is an spot on the proximal dorsal portion of the navicular bone. When the thumb is pressed into this area, the tenderness is felt. This is an important physical finding of a navicular stress fracture. This should be confirmed with an x-ray (or MRI). Tenderness at the n-spot is also used to monitor progress. Many of these navicular stress fractures are placed in a weight bearing cast or walking splint until that tenderness subsides.

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