Chronic in-growing toe nails that are frequently painful, inflamed and infected, require a permanent solution. We offer a very effective procedure for this problem called a Partial Nail Avulsion (PNA) and Phenol application. The offending nail fragment is removed while under a local nerve block anaesthetic and tourniquet. A controlled, timed chemical burn destroys the cells (matix) that were forming that part of the nail. The majority of the nail is left intact, resulting in only mild appearance changes. Two follow up dressings are required over the following week. Pain is usually only mild and effectively relieved by Panadol. It is a possibility that the nail may re-grow, but we have a success rate of at least 80%.
Ankle, knee, hip and back pain
June 25, 2017
Pronation is a complex tri-planar movement (the arch drops, the heel tilts medially and the leg internally rotates) and it effects our entire posture. We take thousands of steps every day. Abnormal, compensatory pronation can result in symptoms throughout the whole body (even headaches). Through biomechanical assessment gait abnormalities can be detected. In simple terms, functional orthoses aim to customise the ground to your foot shape, improving foot function and minimising abnormal compensatory movement with each step. By improving posture and reducing the amount of repetitive strain occurring with each step, symptoms usually decrease.
This is the most common biomechanical problem presenting to podiatrists. The Plantar Fascia is a ligament that extends over the full length of the plantar surface of the foot. (see diagram). This ligament is best likened to a piece of rope rather than an elastic band. Poor biomechanical function can result in inflammation and pain anywhere along its length, most commonly in the arch and insertion site at the heel.
Self treatment may include rest, stretches, massage and anti inflammatories.
For short term relief I find the application of a rigid supportive strapping to be extremely reliable. This strapping does need to be kept dry and removed immediately if the area gets itchy as this may indicate sensitivity to the tape or a fungal skin problem.
Long term treatment focuses on functional orthotic devices and footwear advice.
Other treatments may include shock wave therapy or dry needling. Your GP may inject cortisone around the heel insertion site.
We have worked closely with the same orthotic laboratory for over 15 years to provide custom made orthoses. By using 3D scanner technology we can assure you of a fully customised device if required. Otherwise we can choose a specific pre-fabricated device from our range that best suits your foot. It has been shown that for the majority of people these devices will work just as effectively as customised devices in relieving symptoms. The choice between these options is dependent on what is observed during biomechanical assessment, severity of symptoms and such practicalities as your private health insurance policy cover.
A standard podiatry consultation will involve the cutting and filing of toe nails and removal of excessive thick skin and corns. Chronic toe irritation, due to the involuted shape of some nails, can be relieved by removing slivers from the edges of the nail. Minor foot deformities may result in areas of increased pressure and the formation of painful thick skin deposits and corns. The skin and corns are removed during the consultation, but these areas of pressure may be offloaded through the fabrication of deflective padding or devices, which will keep the patient much more comfortable between consultations.
Podiatrists are not foot massagers. We have no education or qualification in foot massage. However, at the end of your consultation an emollient cream is applied to moisturise the skin, and a short foot massage is given in the application of this cream. If this part of the consultation is particularly important to you, please mention this to the podiatrist.
Half of all hospital admissions for diabetics are due to foot problems. Long term Diabetes results in degeneration of peripheral nerve endings and blood vessels. Your feet are the furthest point from both your brain and your heart and are therefore the most vulnerable body part to these changes. These changes occur gradually, and your level of risk for developing foot problems needs to be monitored. It is therefore important that all diabetics have at least an annual assessment of their foot risk status by a podiatrist. This assessment will include a basic neurological and vascular assessment of your feet and a close examination of your feet for any areas of deformity that may result in wound formation. Appropriate lifestyle and footwear advice will be given depending on your level of assessed risk. Prevention of complications is the goal of these regular assessment s and advice.
This is definitely a team effort between Podiatrists, GPs and community nurses. There is also a high risk foot clinic at Gosford Hospital which is a significant resource we regularly use. Degenerative changes in peripheral sensation and circulation due to diabetes and other causes may result in wounds with delayed, or an absence of, healing. Debridement of the area by podiatrists and appropriate dressing application, is supported by antibiotics from the GP and ongoing dressings by community nurses. The high risk foot clinic will provide care for severe problems.