Blog Archives

Involuted Nails

6/25/2019

Lately in clinic, I have been hearing a lot of concerns regarding painful nails, sometimes accompanied by red, hot and swollen surrounding skin, OUCH! The type of nails that just don’t seem to know where to grow and patients are completely bewildered as to what they have done to deserve this?!

These types of nails are often referred to as involuted or if you’re experiencing the worst type, INGROWN.
Ingrown vs involuted is quite simple. Involuted refers to a nail shape that as it grows, changes shape encroaching on the surrounding skin causing pain. Involuted nails can have varying degrees of pain and curvature in the plates shape.

An ingrown nail is one that has surpassed this and is now cutting into the skin, commonly causing infection or the skin to hypertrophy (increase in size) and envelop the nail plate. These are incredibly painful and can stop you from doing what enjoy such as playing sport or performing the worm on the dance floor, pain free.

What causes this stubborn issue?!

Usually there are multiple factors contributing to your nails misbehaving in this way. Until you discuss what you and your feet have been up to with your Podiatrist, it may be hard to put your finger (or toe) on it.

It is all good and well addressing symptoms of pain much like any other problem in the body, however, until you 'nail' the cause, this can stick with you for many new shoes, netball games, trail runs or whatever it's stopping you from doing.

The main causes include (some more common than others)

Genetic predisposition
Trauma to the nail
Posture of the foot
Biomechanics of the foot in movement
Foot deformity e.g. bunions and clawed toes
Poor cutting technique or picking nails
Poor fitting shoes and or hosiery
Sweating
Brittle/weak nails (this can be due to things like diet or arterial insufficiency)
Fungal infection
Medications e.g. beta blockers; Isotretinoin

Who experiences these pesty nails?

Any one can have involuted or ingrown nails. Usually seen from the age of wearing footwear and consistent weightbearing, onwards e.g. walking and running around.
Anyone that is exposed to one, many or any of the above-mentioned causes is vulnerable to involuted or ingrown toenails!

How do we tame these naughty nails?

Let’s talk involuted…

Figure out why the shape is changing and address the cause e.g. correct the position of the toe as result of a bunion with the help of a prefabricated or custom-made orthotic device; or look at purchasing shoes with a more appropriately fitting toe box.
Correct the cutting technique. This may mean you will need to frequent a podiatrist so they can gradually correct your nail shape and direct the growth away from the site of pain.
Depending on the severity of the curvature of the nail, conservative cutting techniques that are pain free may be completely fine. However, if the nail is particularly curly and has been left for too long a portion of the nail may need to be removed under local anesthetic.

And of course, the nasty ingrown…

If the toe is infected, you will need visit your GP for possible prescription of antibiotics. In the meantime, keep the toe incredibly clean, cleansing it with warm salty water twice a day. You will need to keep this dressed in clean and new materials.
Do not try and cut any of the nail away, immediately visit your Podiatrist to have this addressed properly, cleanly and safely in order to save yourself any further complications! No pliers or scissors PLEASE...
Nail surgery to remove a part or the entire nail under local anesthetic is the most likely, effective treatment for this depending on the severity. This is something your podiatrist will discuss with you in detail. It’s a very quick procedure and depending on how tough your tummy is you can even watch! However, if you’re uncomfortable with the idea of blood or anything slightly invasive your Podiatrist will make sure you feel completely at ease and we can have you laying down talking about how much fun you’re going to have when you have your normal toe back!

Depending on whether this is your first one or you’ve had this recurring problem for years, the main message I want you to take away from this blog, is there is hope and your toe/s will be looking and feeling great again before you know it!

Image 1 - http://dubaipodiatry.com/ingrown-toenail-dubai-podiatry-centre/
Image 2 - https://www.palmettostatepodiatry.com/ways-to-prevent-smelly-feet/
Image 3 - http://www.yourpodiatrist.com.au/condition/ingrown-toenails/

Written by Anneliese Ball
Podiatrist at Health Associates
Working Monday and fortnightly Saturday

Anneliese Ball
Podiatrist
Anneliese is at Health Associates as a podiatrist working Monday and fortnightly Saturday.
She holds both a Bachelor of psychology and podiatry and has dedicated herself to studying full time for 7 years.
As a podiatrist she combines her proficient knowledge of human mechanics and ability to connect and engage with her patients to deliver outstanding clinical outcomes and an exceptional customer experience.
Anneliese loves health and fitness and enjoys encouraging her patients to maximise their health.

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Hamstring Strain

6/14/2019

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Hamstring strain is a common sporting injury due to the muscle being prone to tears and strains. They are common in sports that need a large amount of speed, power and agility such as rugby (54% of injuries), AFL, athletics (14%), basketball and football (10%). It hasn’t been un-noticed that 2019 appears to be the year of hamstring injuries with some big-name players in the NRL suffering tears to their hamstrings early in the season such as Tom trbojevic and Matt Moylan. To understand why this is happening to these professional athletes so early in the season we need to know what hamstring injuries are, the anatomy of the muscle, signs and symptoms of an injury, possible factors that make an athlete more at risk and ways to prevent hamstring strains from occurring. When an injury does occur, we must know what to do and how to manage it to return to play as soon as possible.

WHAT ARE HAMSTRING STRAINS/TEARS?
Acute hamstring injuries occur when there is a forceful contraction of the posterior thigh muscle/s or a sudden movement, this occurs when hamstrings decelerate hip flexion and knee extension. The person immediately feels discomfort and is aware of what has happened, there can be an audible pop. A Hamstring strain can occur in one or more of the three muscles in the group.

ANATOMY OF THE HAMSTRING

The hamstrings are composed of 3 muscles on the posterior thigh, bicep femoris (long and short head), Semimembranosus, Semitendinosus.
The top of these muscles attaches to the pelvis and run down along the posterior aspect of the femur and attach just below the knee joint on the tibia and fibula (shin bones).
The hamstrings are innervated by the sciatic nerve.
The hamstring performs two movements flexion of the knee joint and extension of the hip joint.

SIGNS AND SYMPTOMS
Hamstring strains are classified from grade 1-3 depending on severity.

Grade 1 (Mild)

Overstretching muscle fibres or tendon without tearing the muscle.
Minimal to no loss of muscular strength or flexibility.
Increased tightness of the muscle during stretching or through full range of motion.
Mild discomfort felt along the muscle on palpation.
There may be discomfort when sitting or walking uphill/stairs.
Depending on the severity there may be mild swelling and difficulty doing daily activities including walking.

Grade 2 (Moderate)

Partial tear in muscle fibres.
Strength and flexibility of the muscle decreased.
Pain is more immediate and greater than grade 1.
Pain on range of motion and contraction of the muscle.
Pain when pressing on the muscle.
Change in normal walking and sometimes sudden twinge of pain.
There may be bruising and swelling.

Grade 3 (Severe)

Major tear or complete rupture of the muscle. The muscle can be bunched together making a depression where the tear has occurred.
Total lack of muscle function.
Immediate intense pain in the back of the thigh usually sharp.
Difficulty walking or weight bearing.
Large bruise and swelling within a few days after injury.
Usually occurs at the origin of the muscle.
May need surgical repair to re-attach the muscle.

RISK
Hamstring injuries usually occur due to an imbalance between itself and the quadriceps muscle. The quadriceps are large and powerful group of muscle that extend (straighten) the leg at the knee joint. When there is a powerful contraction of the quadriceps muscle it may over stretch the hamstring and place a large load on the muscle.

Previous hamstring injury.
Increasing age of player.
Sudden change in movement (acceleration or deceleration).
Poor flexibility.
Weakness in the muscle.
Muscle fatigue.
Muscle imbalances, hamstring to quad ratio.
Poor or no warm up.
Body mechanics.
Psychological factor.
Poor technique during activity.

PREVENTION

Proper warm up before exercise including sport specific function movements as well as sport specific skill drills.
Include speed work within training program to allow the hamstring to sustain high acceleration forces.
Have a high level of endurance to prevent muscular fatigue.
Include stretching, functional and strength training within the program.
Having adequate pre-season preparation prior to competition to ensure readiness to play.
Gradual increase in training duration and intensity.
Wearing the right and comfortable protective gear and footwear.
Adequate recovery times between session to allow the body recover and prevent burning out/over-training.
Avoid activities that cause pain.

ACUTE MANAGEMENT

RICER protocol for the first 48-72 hours; rest, ice, compression, elevation and referral. The leg should be elevated when applying ice. The ice should be used for 20 minutes every 2 hours. This protocol will reduce the swelling and bruising of the muscle.
Another protocol for acute hamstring injuries is the No HARM protocol. This is no heat, no alcohol, no running or activity and no massage. This will also help to decrease bleeding and swelling in the tissue.

REHABILITATION

Rehab will vary based on the severity of the injury.
restore flexibility of the muscle.
Re-activation of muscle fibres.
Progressive eccentric loading on the muscle.
Restore endurance.
Strengthen the hamstring back to usual strength.
Strengthen other muscles of lower limb and trunk.

RETURN TO PLAY (depending on how well managed the injury is)

Grade 1 = 1-3 weeks.
Grade 2 = 4-8 weeks.
Grade 3 (may require surgery) = approximately 3 months.

Early return to play and/or poor rehabilitation of the injured muscles will increase the chance of re-injury. Full range of motion and strength is required along with the muscles ability to endure full speed training. The player must be able to perform sports related activities such as jumping, sudden change of direction and twisting.

Joshua Hallinan
Chiropractor
Working Tuesday and Thursday at Health Associates

References
Prior, M., Guerin, M., & Grimmer, K. (2009). An Evidence-Based Approach to Hamstring Strain Injury: A Systematic Review of the Literature. Sports Health, 1(2), 154–164.

Hamstring Strain Injuries: Recommendations for Diagnosis, Rehabilitation, and Injury Prevention Bryan C. Heiderscheit, Marc A. Sherry, Amy Silder, Elizabeth S. Chumanov, and Darryl G. Thelen Journal of Orthopaedic & Sports Physical Therapy 2010 40:2, 67-81

Hamstring strain injuries Opar, D.A., Williams, M.D. & Shield, A.J. Sports Med (2012) 42: 209.

Verrall GM, Slavotinek JP, Barnes PG, et al Clinical risk factors for hamstring muscle strain injury: a prospective study with correlation of injury by magnetic resonance imaging British Journal of Sports Medicine 2001;35:435-439.

Sherry, Marc A., Tyler S. Johnston, and Bryan C. Heiderscheit. "Rehabilitation of acute hamstring strain injuries." Clinics in sports medicine 34.2 (2015): 263-284.

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Blisters - How to Get Your Feet Across the Finish Line

6/4/2019

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It’s not just winter putting our feet back into enclosed shoes, we have some fierce events coming up!
With the Maximum Adventure Race Series June 1st, PAYCE Sutherland 2 Surf on the 21st of July followed closely by the Sutherland Half Marathon on the 27th of July we have many things to consider in regards to our feet carrying us the distance.

A big concern is those relentless BLISTERS.
Blisters are so painful and self limiting, yet so many people excuse them, some even expect them!
Blisters are absolutely unnecessary and you really, REALLY do not have to put up with these common pests!

Blisters are just another way of our body saying “Hey, I really hate what you’re doing to me here, so I am going to let you know somethings wrong and start fixing the problem behind the scene”. The “scene” being that fluid filled, puffy sack. This is a protective mechanism the skin provides so the injured skin underneath can begin to get some TLC (tender loving care); someone’s go to do it!

No other body part sustains the high coefficient of pressure and friction as much as feet do. Which is why it is so important to address internal and external factors creating blisters.

Causes can include:-

- Trauma; such as that from ill fitting footwear or the wrong socks (fit or material)
- Poor skin integrity; too much or not enough moisture in the skin
- Foot deformities or bony prominences; bunions, lumpy heel bones, clawed toes ect.
- Bacterial or fungal infections; highly irritable and weak skin is prone to blistering.

Prevention is going to be your most powerful tool against these merciless blisters.

1. Not only should your shoes fit well but your SOCKS should fit just as grand. From the toes all the way to the cuff of the sock should be neither tight or loose. We want to reduce the friction of any materials on our skin, so just as you’d get your shoes fitted correctly, fit your socks just as well! You can ask us about the fitting of both if you’re ever unsure of what to look for and if not more importantly, what to AVOID.

2. On the topic of SOCKS. Merino wool is going to be your best friend, especially on those long walks, runs or even big work days. Merino wool actually works to wick the moisture away from your feet keeping them in a more optimal environment for longer. Cotton actually holds moisture next to the skin increasing the risk of more nasty rubbing.

Now, how can The Podiatrist help!?

1. After locating those high pressure areas on your feet or toes that are vulnerable to blistering, they can be easily protected with various different materials and devices. Not only do they provide a cushioning effect, they work to offload the area and give those sensitive areas a rest. Custom made for you, Otoform devices can provide instant relief!

2. CALLUS is that hard, dry skin that builds up adding more unnecessary pressure onto the healthy skin underneath or next to. Callus is a common culprit for causing blisters. Removal of this callus is crucial and can be safely and effectively removed.

3. It’s all about keeping the integrity of our skin and its many layers as pristine as possible! Applying a moisturiser that contains UREA (a naturally occurring compound that exfoliates and moisturises skin) is great at providing a barrier for the skin, keeping it strong and resilient against shear forces. Frequency of application, required concentration of Urea and reliable brands are just a few hot tips we can provide you with.

4. Before those big events you may want to consider TAPING your feet and or toes into a more functionally desirable position. Clawed, hammer or mallet toes are common deformities that tend to rub on shoes causing nasty sores and blisters. It is actually possible to put these toes where they should sit and behave! Taping can be highly beneficial in avoiding irritable spots anywhere on foot.

5. Never ever, ever should you have to break in your SHOES! Getting that perfect fit should never be underestimated. Understanding where and how your feet should be sitting in your shoes is a common misunderstanding. And just when you think there is no better shoe for you, we can throw in a game changing lace-lock as well.

So you haven’t read this blog in time and your crippled with blisters....

1. COMPEED Blister packs can be found at pharmacies such as Priceline. These nifty skin savers provide a medical grade technology called “hydrocolloid”. Acting as a second skin they support the natural moisture balance, reducing pain and increasing the healing rate.

2. Blisters can get big and angry, fast! If they become unmanageable or show signs of infection it’s best to bring them in for clean and safe removal, followed by a suitable dressing and ongoing management if need be.

Now, that will get your feet across the finish line!

References
Picture 1 - https://www.runnersworldonline.com.au/blisters/
Picture 2 - https://www.youtube.com/watch?v=dgL4bWtNiWM

Anneliese Ball
Podiatrist
Anneliese joins Health Associates as a podiatrist working Monday and Saturdays.
She holds both a Bachelor of psychology and podiatry and has dedicated herself to studying full time for 7 years.
As a podiatrist she combines her proficient knowledge of human mechanics and ability to connect and engage with her patients to deliver outstanding clinical outcomes and an exceptional customer experience.
Anneliese loves health and fitness and enjoys encouraging her patients to maximise their health.

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