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.

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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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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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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Hallux rigidus is a big toe joint that does not move. Invariably this is due to osteoarthritis in the joint that has progressed to the stage that the joint hardly moves. Hallux rigidus makes not only the joint painful, but as the joint is not moving properly, other joints get forced to move at a time when they should not be moving. These compensation in other joints can also be painful. The big toe joint is so important for forward motion as this is the joint that the body pivots forward over the foot when the foot is in the ground. The treatment for hallux rigidus is to somehow restore that motion, which in a joint with osteoarthritis is not really possible. The only options are to add some sort of rocker to the shoe, so the foot can pivot forward over the rocker and not need to use the joint. The other option for hallux rigidus is surgical, in which the joint is either fused or replaced with a spacer so there is still some movement.

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Questions keep being asked in all sorts of forums about the MBT Shoes (MBT Shoes, do they Work?; Do MBT shoes Work). MBT stands for Masai Barefoot Technology and the shoes are designed to mimic the gait of the Masai tribe from Africa, who have a very upright posture and do not develop any postural or low back problems. The shoe is designed to help people with these problem A number of studies have shown the biomechanical effects of the shoes, but very limited studies have shown the effects on outcomes. The shoes certainly do help some people with these problems and do not help others, and the evidence provide little guidance. When MBT shoes first came on the market they claimed to cure everything including cellulite. It was this cellulite claims that got them labels as ‘snake oil’. That claim has now been removed from the website. From what I have observed a key principle in using MBT shoes is the correct use of them and there are videos to aid that.

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Golf is a popular sport or activity for participation and for competition. It attracts millions of dollars in sponsorship and prize money (and a few controversies!). There are a lot of golf forums on the web for discussion of golfing and related issues. Foot orthotics for golf do raise some issues when they are indicated. On the one hand you need a fairly supportive foot orthotic to control the foot over the long distances that get walking during a game of golf (and unless you are a pro, you have to carry or pull the extra weight of the golf clubs). On the other hand, the rearfoot area of an orthotic for a golfer needs to be reasonably flexible to allow for the side to side motion that happen in stance during a golf swing. Just what needs to be done to help the golf biomechanics is always going to be one of compromises between these two competing considerations.

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Peroneal tendonitis is not a common problem that occurs on the lateral side of the ankle, usually starting with an ache above and/or below the lateral malleolus. It seems to occur in those with low supination resistance. This mean that the peroneal muscles are having to work much harder to resist that force that is easy to supinated. Combine that with some sports activity, then there is a high risk for peroneal tendonitis. This means that the treatment for peroneal tendonitis is to use some sort of lateral foot wedging to reduce the force that the peroneal muscle need to contract. There is a paranoia among some clinicians about the lateral wedging pronating the foot more and creating more problems, but those that use this do not see this problem. Peroneal tendon problems can be difficult to manage.

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Sinus tarsi syndrome can be a tricky problem. It usually presents with pain on the outside of the ankle joint. Sinus tarsi syndrome can be due to two quite distinct causes. It can follow a lateral ankle sprain in which the structures in the sinus tarsi are damaged as part of the ankle sprain.  This usually presents as a chronic problem following the ankle sprain. The other cause of an sinus tarsi syndrome is a chronic pronated subtalar joint in which the joint functions at its end range of motion. If the forces driving the joint into its pronated position are great enough, sinus tarsi syndrome can result. Treatment of the post-ankle sprain sinus tarsi syndrome is best managed with physical therapy and mobilisation. The chronic sinus tarsi syndrome from a pronated foot is best managed with a foot orthotics. In either case, if they are resistant to treatment, they can be helped with a sinus tarsi injection.

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Chilblains are a common skin condition in the colder climates that occur on the toes. Chilblains, however, are NOT caused by the cold and they are NOT caused by poor circulation. The cause of a chilblain is a too rapid warming of the foot or toe after it has got cold and the circulation not responding quick enough to that warming. It is not the cold that is a probem in chilblains, it is the rewarming that the problem. It’s not the quantity of circulation that is the problem, it how the circulation responds. The best way to prevent chilblains is not get cold in the first place and if you do, make sure any warming of the foot happens very slowly.

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Severs disease is a relatively common problem in youngsters aged 10-15 years. The pain is felt at the back and sides of the heel. This is where there is a thin cartilage growth plate that allows the heel bone to grow. This growth plate merges with bone by age 15, so it’s no longer a problem after that. Severs Disease tends to be much more common in those who are more active, particularly on the harder sports fields. The Achilles tendon also attaches to the back of this growth area, so that increases the pull on it.  It has been suggested that severs disease be thought of as a stress fracture and should be treated like a stress fracture (but there is no evidence if it is or not actually a stress fracture). The best initial treatment of severs disease is a reduction in sports activity to tolerable levels and the use of a cushioned heel raise. Sometime foot orthotics are used to correct foot alignment and calf muscle stretches are also considered important. Ice is often helpful when the severs disease is painful.

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