Bunions are arguably the foot and lower limb positional abnormality that is most often seen as a presenting complaint to podiatry clinics.  Medically, bunions are referred to as a hallux abducto valgus deformity and are often characterised by a deviation of the big toe towards the other toes of the foot and the prominence of a lump at the metatarsophalangeal joint which eventually hardens over time. The condition is seen in both men and women, however women do make up a large majority of symptomatic bunion cases that require intervention. The condition itself often leads to restricted and/or painful range of motion of the big toe joint which is essential in the proper functioning of the feet during the gait cycle. By altering the halluces ability to flex upwards during the propulsion phase of gait, bunions can ultimately alter the method of propulsion and thus, the gait cycle itself. Bunions by themselves can be either symptomatic or asymptomatic but will generally also affect a person’s ability to find properly fitting footwear as well as affecting the cosmetic appearance of their feet.
There are many factors identified as causative in bunions, some within a person’s control others out of it. Research supports the idea that no single factor can be pinpointed as being a primary cause of bunions forming, but rather, a combination of factors may result in bunions forming. The following factors have been shown to contribute to the formation of bunions:

• Genetic inheritance
• A persons predisposition to developing bunions can be controlled by their genetic makeup.
• Tight or narrow footwear
• Wearing excessively tight or narrow footwear exposes toes to compressive forces which over time results in permanent deviation of the hallux toe joint to a position that results in the formation of a bunion.
• Foot injury or trauma
• Arthritis (osteoarthritis, rheumatoid arthritis or psoriatic arthritis).
• Ongoing abnormal biomechanics
• Excessive pronation of the feet alongside tight muscular structures (such as the gastro-soleus and intrinsic foot muscles) can contribute to overloading of the medial aspect of the hallux toe joint and consequential deviation of the toe joint.
• Lifestyle factors
• Occupations that require extended periods of weight bearing can cause excessive pressure through the feet which can cause unstable foot joint positions that gradually adopt to a more permanent bunion position.

Bunions come in different shapes and sizes, as well as different severity of symptoms. The mildest forms usually involve a small lump which may be red, with mild deviation of the hallux joint. The severest bunions involve complete subluxation of the hallux joint with possible overriding or underriding of the 2nd digits. The severity of the deformity will direct the necessary course of action to be taken.
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There are a number of treatments options available to assist in settling down existing bunion pain as well as preventing further complications. Some of these possible treatments involve:

• Avoiding tight fitting or ill-fitting shoes. Focus on wearing shoes that have adequate space in the toe box and do not compress the toes themselves.
• Applying ice for 10 minutes every day on the inflamed joints to ease discomfort.
• Wearing a bunion brace or splint.
• Correcting altered biomechanics with orthotics.
• Wearing a bunion cushion.
• Using anti-inflammatories to reduce pain associated with bunion pressure.
• Surgical advice on correction of bunion abnormality as a more permanent solution.

Podiatrists are able to assess your bunions through a biomechanical assessment and tailor make a treatment protocol to your requirements. Proper diagnosis and treatment approach is vital to help reduce current symptoms and prevent symptoms from getting worse. If you or anyone you know has concerns about bunions, contact us at Health Associates for an assessment.

​Dr Anel Kapur delivers an outstanding clinical podiatric care to all clients. He has earnt himself an exceptional reputation among his clients for his attention to detail, gentle approach and depth of knowledge.
Dr Anel Kapur is available for appointments Monday and Saturday.
Bookings are available online or contact reception on 9542 3330 ​

Name:  Alessandra Gotch
Occupation: Environmental/town planner
What does health mean to you? 
Being physically and mentally healthy, so that I can try and set a good example for my kids. Also so that when I'm older I'm still fit and healthy and can keep up with the kids!. I also mental health I think is just as important as being physically fit. As Guru Alana Bowles would say  - "be kind to yourself". 
How do you keep healthy? 
By eating well and aiming for 90% home cooked meals.  I suppose you could say that it is clean eating - although if my Nonna was here with us today she would laugh and say isn't that just cooking? Trying to be active wherever possible with the kids. I also think being healthy isn't just about keeping physically fit - mental health or total well being health is just as important. We love camping and regularly book weekends away - it is so relaxing and great to spend time away together as a family. 
How you stay motivated? 
By setting goals to look forward to such as booking regular holidays with our family. I think the key to staying motivated also is again learning from Alana that it's ok to take care of yourself and your family when times are tough as your goals will still be there. I have had to adjust my fitness goals over the past few months, but small changes I have made to diet and lifestyle can make a difference and contribute to my overall well being and health.  
Why do you like coming to Health Associates?
The team are so friendly and in general AMAZING. I have seen Chris for injuries and also injury prevention, Alana for overall health and fitness goals and Carlie for remedial massage to help with injuries or generally to relax and help mentally unwind.  I really believe the team at HA care about your overall well being and health and whatever your goal is will try their very best to achieve that.   I also love that they are not just a traditional clinic. The side programs they run such as the Couch to 5kms (which I am participating in) is an awesome program that encourages people of all fitness levels to think about their health while having fun! 
Advice for others wanting to improve their health?
Go see the HA team. They really care about your well being and offer a complete service. You can tell that they really care and will listen to whatever problems you are having or goals you want to achieve and offer realistic advice and support. ​

Did you know that Health Associates bulk bills for chiropractic and podiatry services under the chronic disease management plan?

What is the Chronic Disease Management Plan? (formally Enhanced Primary Care)
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People with a chronic medical condition may be able to get Medicare benefits to cover allied health services that help manage their condition.

A chronic medical condition is one that has been, or is likely to be, present for at least 6 months. Anyone with a chronic or terminal medical condition can have a GP Management Plan in place.

A referral under the CDM plan can entitle you to up to 5 visits in a 12 month period. 

Health Associates CDM Policy
From the 1st of May Health Associates new CDM policy will be effective for all new or renewed referrals.

At Health Associates we believe that high quality allied healthcare should be accessible for all facets of the community.

We provide bulk billed CDM plans when referred by your GP for pensioners and health care card holders. To be eligible for bulk billed services the patient must present with a current pensioner or health care card. 

Seniors and concessions receive a 10% discount off services in the clinic. When visiting under a CDM this discount will be applied to the full amount then reduced by the medicare rebate. A gap payment will be payable.

All other referrals will be required to pay the full gap payment.

Chronic Disease Management Fee Schedule

Chiropractic
Initial Consultations - 45min 
Full Fee $125 - $52.95 Gap payment $72.05
Sen/conc $112.50 - 52.95 Gap payment $59.55

Follow up consultations - 20min
Full Fee - $82 - $52.95 Gap payment $29.05
Sen/conc - $73.80 - $52.95 Gap payment $20.85

Podiatry
Initial Consultation - 45min
Full Fee $110 - $52.95 = Gap payment $57.05
Sen/conc $ 99 - $52.95 = Gap payment $46.05

Follow up consultation - 20min
Full Fee - $75 - $52.95 = Gap payment $22.05
Sen/conc - $67.50 - $52.95 = Gap payment $14.55

If you would like to make an appointment or learn more about our services please contact us on (02) 9542 3330.

Dr Melanie Xabregas is an experienced and passionate chiropractor with a special interest in helping children experience optimal performance and longevity in dance and gymnastics. She brings a gentle, caring and friendly approach to her examination and treatment.

Available for consultations Tuesday & Friday between 2pm - 6pm ​

As a podiatrist, I see patients who present with a range of biomechanical problems and concerns however by far the most commonly occurring complaint people have is heel pain. Whenever there is any pain in the body, it is your bodies way of informing you that something potentially malicious is occurring that may require treatment of attention. Heel pain may be caused by a number of factors and as such can be treated in any number of way. This weeks blog will aim to bring some light to this common problem and how it can be corrected.
What are some causes of heel pain?
The heel is collectively a complicated structure which consists of:

• A bone called the calcaneus.
• A layer of soft fatty material that acts like an anchor and shock absorber.
• A series of ligaments connecting the heel to the ankle.
• A number of tendons of muscles both found inside and outside the foot that insert into different parts of the heel enabling different movements and functions.

Often times, heel pain is a result of excessive strain placed upon these soft tissues in the foot. During every day activities such as walking and running, the heel structure collectively experiences a large quantity of forces throughout its components. This can lead to tearing, straining of soft tissues or bruising and fracture of bones. The list outlined detailed below is a non exhaustive outline of commonly observed factors that may be contributing to your heel pain.

1. Plantar Fasciitis
   1. Put simply, is an inflammation of the plantar fascia (a band of fibrous tissue that supports the arch and connects the heel to the toes). By far the most common cause of heel pain, it is commonly caused by excessively flat or high arched feet, overly active lifestyles and poor choices in footwear.
2. Flat feet (pronated) or feet that roll out (supinate) excessively
   1. It is normal for feet to roll in and out a certain amount during activities of everyday living.  Both motions are essential in the proper functioning of the foot structure. Excessive motions (either rolling in or out) however, does put certain soft tissues in the feet under stress. The intrinsic (found inside) muscles of the feet have to work extra hard to cope with feet that are already in the extreme positional alignment that they eventually become injured and sore. The clearest example of this is the effect that flatter or high arch feet have on the plantar fascia. Feet that exhibit these two extremes (more commonly in flat feet), lead to long term stress across the fascia and particularly at the heel section which can lead to heel pain and may precipitate plantar fasciitis (mentioned above).
3. Bursitis
   1. The heel has a number of fluid filled sacs called ‘bursae’ which can become inflamed as a result of compressive pressure during weight bearing activities or injury. Much like plantar fasciitis, it is this inflammation that is the primary cause of discomfort.
4. Neuroma or cysts
   1. Since we are dealing with soft tissue structures in the foot, they require both blood supply and nerve supply. Following injury or by chance, cysts may form either in the bone or within the soft tissue that may ilicit pain on weight bearing. Neuromas form when the healing process results in an excessive collection of nerve fibres forming a bundle which may lead to radiating pain when the lump is pressed.
5. Bone bruises or fractures
   1. Often seen in response to traumatic injury or long term overuse of the heel structures, bruising and fracture of bone will often result in the decreased integrity of the bone surface and result in heel pain that does not alleviate over time and may actually get worse the longer you spend time on your feet.
6. Muscular, tendon or ligament fatigue
   1. Certain foot types and lifestyle factors over the course of a lifetime will put overly large amount of stress on the foot structures. Normally this may not be a problem, however over the long term, they may suffer from fatigue and result in dull, aching pain developing in the region of the heel.
7. Tight calf muscles
   1. It might seem trivial, but tight calf muscles can lead to discomfort in the heel. The calf muscles insert into the back of the heel through the Achilles tendon. When the calf muscle complex is overly tight, the strong Achilles tendon will continue to pull on the bone attachment point. This can in turn lead to inflammation and pain at the site where the bone and tendon meet (insertion point). Similarly to this, calf muscle tightness can lead to inflammation and stress of the middle section of the Achilles tendon (mid-portion) which can also lead to residual heel pain.

It is not all doom and gloom however. There are a number of things that factored in to help reduce symptoms of current heel pain or reduce your chances of developing it initially. Some of these include:

• Apply ice to sore areas of the heel daily for about 10 minutes. Using a frozen bottle of water as a roller is an effective way at not only icing the affected area, but also to stretch out constricted structures.
• Stretch your calves. This can be done simply using a towel or a belt and involves pulling the ball of the foot up towards you. Hold for 30 seconds, and repeat 3 times. Perform this daily. DON’T forget to stretch before and after exercise.
• Avoid inappropriate footwear. Always try to wear foot supportive shoes and avoid walking around barefoot on hard surfaces. Shoes with supportive heel counters work well to cushion the pressure going through the heel and reducing heel pain.
• Seek professional help and guidance. Heel pain is relatively easy to treat once the causing factors are identified. If you have lingering pain, seek the help of a podiatrist who can not only give you a definitive diagnosis but also structure a personalised treatment plan .

If you of anyone you love is suffering from heel pain,  we are here to help. Call us at Health Associates and let us help rid you of your heel pain and get you back on your feet happy and healthy.

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Congratulations to the all our Health Associates Couch 2 5km participants. For 6 weeks our dedicated runners completed a comprehensive running program designed to not only help people run 5km but to help them run it strong. The program included 4 sessions from strength/hills, pilates, track and endurance. Participants were encouraged to attend at least 3 times per week.

At the beginning of the program our runners were put through a time trial to get a benchmark. Over the course of the 6 weeks we saw people improve their time by over 3 min. At the start of the program we had a few walkers and by the end everyone ran the whole way!!

Participants ranged from mums and dads, seniors and teenagers. A personal highlight would be two sisters Maddi and Ashley. One in primary school and the other in high school. The early mornings were very hard. Waking up at 5.30am to be at the track for a 6am start was very challenging but they did it and they were super stars. Maddi was so excited when she did a personal best in a school running event. She could see that her hard work was paying off. 

What makes the Health Associates C25K unique is that it is a not-for-profit program designed to engage community members into safe and effective exercise. Our coaches range from former-professional athletes, allied health professionals and busy, working parents who get the challenge faced by so many. It is comprehensive offering a complete suite of training options to support you to perform at your best and to run injury free.

If you would like to join the next program registrations are now open. Click the link to find our more and register before it sells out!