Gout and Your Feet


Image Credits: WebMD

“Three things in life – your health, your mission, and the people you love. That’s it.”  Naval Ravikant

There are many root causes for joint pain. Arthritis is an autoimmune response that causes inflammation and stiffness in the joint. Under the subset of arthritis, is gout. Gout is a painful condition that causes pain, stiffness and also has an associated swelling of the joints during an attack. The onset pain is attributed to a build-up of uric acid in the bloodstream. In time, the uric acid crystals crystallize, and the body reacts to their presents via an autoimmune response, in order to remove them from the the joint. One of the regions that are most affected by gout are the feet, particularly the big toe.

Gout must be carefully treated in order to prevent flare ups, because it does have a re-current nature. If not carefully monitored, tissue damage can result. Gout prevalence varies globally, with between 0.1% and 10% of the total population being impacted by the condition. There are a few factors which influence the onset of gout. These are:

Diet: Rich, and highly sweetened foods have the propensity to increase the risk of gout. Meats, seafood and sweet drinks create the ultimate pathway for the synthesis of uric acid via metabolism, and can increase the risk of gout. Carefully managing the diet, and ensuring that the weight is properly managed is key.

Pre-existing condition: The body is one interconnected unit. If you suffer from conditions that affect your cardiovascular systems (eg high blood pressure or diabetes), you will have the propensity to induce the onset of gout if the condition is not managed. Treatment of these conditions can also create the environment within the body that can facilitate gout. Check your family history for any traces of these conditions, in order to ensure that you are not at hereditary risk.

Gender: Men are more prone to develop gout than women due to their higher levels of uric acid. With age however, there can be an eventual match in the levels and the playing field can be levelled.

How is gout treated?

Your foot and ankle specialist will be able to facilitate the treatment of gout. The condition will initially be diagnosed via diagnostic tests such as a joint fluid test. Additionally, the condition can be determined via blood test to determine the uric acid content in the body. Additionally, deeper assessments are determined via ultrasounds or CT scans, in order to ensure that there are no other underlying root causes.

Via a series of prescribed medications, appropriate management of your gout will result. Since the entire process of gout management is the management of internal chemistry, the following processes are facilitated by gout treatment:

  1. Treatment of a current flare up

  2. Prevention of a future attack via controlling the internal management.

In the treatment of gout, the medication most prescribed include nonsteroidal anti-inflammatory drugs (NSAIDS), colchicine, or corticosteroids. Your doctor will determine what is best for your condition. Additionally, injections of treatments are administered.  Expect about two weeks for a full recovery.

As with all conditions, prevention is better than cure, so take good care in ensuring that your diet is rich in foods that enable your body to function well, and prevent the onset of gout. A diet rich in fluids, particularly water will facilitate the function of your kidneys, and flush uric acid from your system.


  1. Gout Slideshow: https://www.webmd.com/arthritis/ss/slideshow-gout

  2. Everything you need to know about gout: https://www.medicalnewstoday.com/articles/144827.php

  3. Gout-symptoms and causes: https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897


Ankylosing Spondylitis and the Feet


Image Credit: Arthritis Support Board

“Cheerfulness is the best promoter of health and is as friendly to the mind as to the body.”- Joseph Addison

What is Ankylosing Spondylitis?

The human body, is a system of interconnected systems. There are many root cause conditions which have the ability to develop downstream complications in the body and affect the feet as they progress. Ankylosing Spondylitis (AS) is one such ailment. As an inflammatory condition that first begins in the spinal cord, calcium deposits in the ligament-bone condition can cause a fusion of the spinal cord. There are treatments that can control this condition and slow its propagation to the rest of the body.

In the peripheral regions of the body, there can be complications due to AS. The feet can be affected by more than one condition as a result of AS. The entire skeleton is one interconnected unit, and the spine is connected to the pelvis, and the bones and joints connect all the way to the feet. Since the flow is linear. If there’s a problem in the spine, the propagation to the feet is more than likely imminent.

The body, as a system adjusts its alignment if certain areas become painful. The gait pattern will shift if the muscle and joint connections are shifting. Foot complications developing as a result of this shift are as follows:

Plantar Fasciitis:


Image Credit: Upstep.com

This condition develops as a result of the inflammation of the plantar fascia fusion to the heel bone. The plantar fascia is one of the tissues in the feet and provides the cushioning under the heel. With the aggravation of this joint due to shifts in the gait and weight distribution, patients often experience painful sensations under the heels at differing points during the day.

Your orthopaedic surgeon will facilitate your treatment. Usually physiotherapy is prescribed, along with treatments that aid to cradle the area (via orthotics) in a means to protect the inflammed segments of the feet. Where necessary, your foot and ankle specialist will inject the area with cortisone (steroid) injections. Carefully wrapping the feet can also provide the appropriate therapies needed.

Insertional Achilles Tendinitis

In some instances, the point at which the Achilles tendon attaches to the heel bone can also become inflamed. This condition is known as Achilles Tendinitis. Painful sensations are experienced at the back of the heels, along with a swollen heel region and painful walking. If not monitored, a Haglund’s bump or bony protrusion is noticed.

Treatments include raising the heels to relieve pressure during healing. Additionally, orthotic use to cradle the area are key to ensuring that mobility is facilitated.

Toe Ailments

Due to posture changes, the gait will change. As the muscles also shift to accommodate the change, then the propensity for muscle spasms and cramping to occur in the toes is a possibility. With AS, if the spine shifts to create a forward curve, the toes will adjust (clawing motion), in order to provide the support to keep the body stable. The knees also adjust themselves to flex, and facilitate the skeletal stability. With the shifts, the knee joints can be affected as well as the toes. Orthotics will enable appropriate support.

Additionally, if there are additional treatments needed, your foot and ankle surgeon will determine what these are.


  1. What is AS: https://www.versusarthritis.org/about-arthritis/conditions/ankylosing-spondylitis/

  2. NASS Article: https://nass.co.uk/about-as/what-is-as/your-feet/


Morton's Neuroma

Morton's Neuroma.jpg

“Health is a large word. It embraces not the body only, but the mind and spirit as well; …and not today’s pain or pleasure alone, but the whole being and outlook of a man.” - James H. West

Morton’s neuroma, develops when there is a non-cancerous growth between the third and fourth toes. The nerve tissue expands and becomes swollen, as outlined in the image above, and the resultant sensation is a painful sensation, often experienced by patients as “feeling as if there’s a marble” in the sole of the feet. Consult with your orthopaedic specialist if you experience any prolonged pain in the feet. With the appropriate diagnostic tools, your specialist will be able to diagnose your condition.

Women are more prone to Morton’s neuroma, and the primary root cause is tied to the wearing of high heeled shoes. Take caution with your shoe design. Wearing high heels induces the conditions that develop the condition - the ability to induce stress to the nerves since the feet are not in positions that they are comfortable in, but remain elevated and stretched for prolonged periods of time. The nerves respond by thickening, causing neuroma. Additionally, some sporting activities which stress the feet, are also capable of inducing the condition.

What happens in your consultation?

During your consultation, your orthopaedic surgeon will usually ask detailed questions about the symptoms that you are experiencing. Your medical history and lifestyle will be assessed. A thorough medical examination will follow, with an X-ray, Ultrasound scan or MRI used to get a closer look at the internals of the feet. What these tools will do, is eliminate other possibilities such as stress fractures and other orthopaedic conditions, and facilitate a clear view of the internals of the feet.


Morton's Surgery.jpg

Image Credit: YouTube

After your consultation, your orthopaedic surgeon will determine the path that you will take to recovery. For acute conditions, treatments such as corticosteroid injections, and alcohol sclerosing injections are used. These treatments are done in series, and eventually facilitate the healing of the area. If the instance of severe Morton’s neuroma, your orthopaedic surgeon will recommend a surgical option. Minimally invasive treatments are used to remove the painful growth. The adverse effect of surgery is numbness, so attempt the acute treatments for up to 6 months, before deciding with your surgeon’s help, that surgery is the path for you.

Recommended with your treatment are the following lifestyle changes:

  1. Footwear changes

  2. Pain treatment - painkillers or injection

As with all conditions, early treatments will ensure that drastic medical action will not have to be taken. Along with your treatments, there are series of physical therapy exercises that you can do, to ensure that you are improving the flexibility of the area. Additionally, insoles and orthotic devices can be applied to the area, in order to protect the area and facilitate healing.

Reference Articles:

  1. Morton’s Neuroma: https://www.mayoclinic.org/diseases-conditions/mortons-neuroma/symptoms-causes/syc-20351935

  2. Medical News Today: https://www.medicalnewstoday.com/articles/179773.php



Sesamoid Bones.jpg

Image Credit: The Foot Group

“Our greatest happiness does not depend on the condition of life in which chance has placed us, but is always the result of a good conscience, good health, occupation, and freedom in all just pursuits.”- Thomas Jefferson

What is sesamoiditis?

In the human body, there is a special family of bones called sesamoids, that are unique in their connection to the rest of our skeleton. Sesamoid bones, are connected to muscles via a tendon connection. The two areas of the body where sesamoid bones are found are in the knees, and in the feet. The majority of the bones in the body, are connected via joints.

In the feet, are two small sesamoid bones, which are in the soft padded area, close to your big toe. These bones can become inflamed, once aggravated. When this takes place, the condition that develops is known as sesamoiditis. Based on the location of the injury, statistically athletes and dancers are prone to develop this condition.

This is due to the fact that athleticism requires use of the feet, causing vigorous vertical stress during jumping. With the excessive activity, the area of the feet are overworked, and the sesamoids ultimately become aggravated.

Diagnosis of sesamoiditis

Consult with your foot and ankle specialist if you feel that you may have sesamoiditis. Any prolonged pain in the feet, should be examined by your orthopaedic specialist, just to ensure that you are treated for the right condition. The examination will be very thorough, and your orthopaedic surgeon will look for the signs of tenderness in the region around the sesamoid bones as an indicator of the condition.

Many foot and ankle ailments have similar symptoms, so ensure that the right diagnosis is determined. Via X-rays and other scanning mechanisms, you will be able to determine the root cause of your pain, and then ultimately treat it.

Treatment of sesamoiditis

As an inflammation of the sesamoid bones, what you’ll need to heal is to simply reverse the conditions that induced the condition. Your doctor will prescribe for you rest. In terms of treatments, you can take pain-killers and anti-inflammatories (Aspirin or Ibuprofen work well ) to ensure that the inflammation is reduced.

The sesamoids are very critical to the function of your feet, and they provide pulley mechanisms that permit your tendons to smoothly glide over as you are walking. Take good care, if you feel pain in the area. If you’re an athlete, if you aggravate the area, you ultimately lead to a fracture, so ensure that you attend to the pain early. Additionally ice treatments help to soothe the area and reduce inflammation. When wearing shoes, ensure that they are comfortable, and have the appropriate cushioning.

Sesamoiditis, is easily treatable so ensure that you facilitate your healing. Dancers and baseball players are particularly prone, so if you find yourself in this category, wear protective insoles to ensure that you protect your soles.

Reference Articles:

  1. Sesamoiditis: https://orthoinfo.aaos.org/en/diseases--conditions/sesamoiditis

  2. Sesamoiditis on Healthline: https://www.healthline.com/health/sesamoiditis




Image Credits: Medicinenet

“Keep your vitality. A life without health is like a river without water.”- Maxime Lagacé

The types of shoes that you wear can either help your feet or affect them adversely. The hammertoe is the result of wearing incorrectly sized shoes for the feet. If the shoes are too narrow, over time, there will be stresses induced on the second, third or fourth toes. Over time, the toes will have a bend at the middle joint. The angular shape created by the toe, creates a shape much like a hammer.

Hammertoes are actually painful, and over time the muscles, tendons and ligaments will be distorted as the toes are bent out of shape. In the beginning, the hammertoes are actually flexible, but with the conditions sustained, the toes eventually remain in their position. At this point, surgical intervention will be required in order to restore them to their original state. Symptoms include:

  1. Pain in the toes. As the soft tissue distorts, movement will induce pain.

  2. Corns and callouses due to the fact that the toes are rubbing against the shoes due to the projections.

  3. Open sores on the toes

Some root causes of hammertoes are:

Shoes: Tight shoes or high heels are constricting to the toes.

Gender: Women are more prone to hammertoes due to the fact that they are more prone to tight shoes or high heels.

Injuries: During regular activities such as walking, a toe can be stubbed. Additionally, during sporting activities the feet are prone to impacts which can induce hammertoes.

A visit to your orthopaedic surgeon will determine the severity of your hammertoe condition, and determine the next phase of your treatment. Your orthopaedic surgeon will prescribe either minimally invasive surgery, or other simpler treatments.

Hammer toe Treatments Include:

  1. Toe exercises to flex the joint. Stretch the toes to ensure that the joint is being exposed to both stretches and contractions.

  2. Changing your shoes from those that are tight and constricted to those that are roomier.

  3. Shoe inserts to facilitate the re-alignment of the toes.

If these methods don’t work, then minimally invasive surgical procedures can be utilized in order to treat the area. Surgical treatments including methods such as arthroplasty, arthrodesis, tendon transfer, will help to realign the muscles and tendons, and realign any bones that may be in the incorrect position.

In the case of human induced hammer toes, prevention is always better than cure. Take good care of your feet, ensure that you have the correctly fitting shoes, and you’ll be well on your way to having feet that you can be proud of. Since women are the most affected, it is best to seek comfort rather than cosmetic appearances. On occasion, you can wear heels if you have special events, but for the every day, you can wear flatter shoes or wedges if you’re seeking height. Your health...is your wealth.

Reference Article:

  1. Medical News Today: https://www.medicalnewstoday.com/articles/315600.php

  2. Hammertoe: https://www.foothealthfacts.org/conditions/hammertoe


Arthritis of the Great Toe


Image Credit: Orthosport Victoria

“Your health is what you make of it. Everything you do and think either adds to the vitality, energy and spirit you possess or takes away from it.” - Ann Wigmore

There are certain aspects of our body that often go un-noticed until they start to ache. The big toe, is one such pain point in the body. Over time, as we mature there are conditions that can affect the foot and cause pain at individual pain points. Arthritis has the ability to attack the MTP, or metatarsophalangeal joint. At a critical juncture in the body that must bend every time you walk, it is very important to ensure that appropriate treatment is taken, if one is feeling symptoms that are representative of arthritis. Your orthopaedic surgeon will be the best person to diagnose the condition, so seek their consultation if you feel pain in the region.

Arthritis in the toes, is induced by usage of the area. Common in older persons, the result is as a result of a wearing away of the joint. The following are symptoms usually experienced by persons who suffer from arthritis:

  1. Pain in the area, particularly around the toe joint where the flexor motion takes place

  2. Swelling of the toe joint, due to aggravation of the joint causing an immune reaction.

  3. Stiffness of the area, experienced after long periods of inactivity such as early in the morning.

Your orthopaedic surgeon will recommend initial treatment of your arthritis such as protective shoes and inserts such as orthotics. In terms of pain management, ice treatments, and pain killers are often prescribed. Patients are often prescribed pain killers that are available either over the counter or via prescription. Additionally, injected corticosteroids are effective in reducing swelling of the joint.

Surgical Intervention for Arthritis in the Great Toe

When the aforementioned treatment methods aren’t effective, one effective means via which arthritis can be treated is via minimally invasive surgical procedures. As the MTP joint becomes more painful to the patient, there are moments where deeper intervention will have to be investigated. Your orthopaedic surgeon will do a detailed assessment of the area, utilizing analytical tools such as X-rays, in order to identify the severity of your condition. Many times during analysis, the following may be found:

A bone spur, caused during the wearing away of the MTP joint. The bone spur impacts the ability of the toe to bend, and the result is known as Hallux Rigidus, or stiff big toe. Prevalent in the age group 30-60 years, toe stresses are the main root cause.

Minimally Invasive Surgical Treatment for Arthritis

There are three main surgical treatments for arthritis. These are arthroplasty, arthrodesis and cheilectomy. Your orthopaedic surgeon will determine which method is best for your adverse arthritic condition. Arthroplasty as a treatment, is a joint replacement treatment, which ensures a restoration of the area via the use of implants that the body will heal itself around. Arthrodesis, involves fusing the bones via a series of pins, screws and plates. The toe cannot bend under this condition, but the pain reduction compared to the prior condition is noticeable. Finally with a cheilectomy, the joint is restored via procedures such as removal of the bone spurs, to facilitate the motion of the joint.

As a critical impactor to our ability to walk, it is critical to ensure that any pain sensations in the feet are appropriately assessed by your orthopaedic surgeon.

Reference Articles:

  1. Stiff Big Toe: https://orthoinfo.aaos.org/en/diseases--conditions/stiff-big-toe-hallux-rigidus

  2. What’s Aching Your Big Toe: http://blog.arthritis.org/living-with-arthritis/big-toe-foot-pain-relief/


Post-Op Treatment for Bunions


“If we are creating ourselves all the time, then it is never too late to begin creating the bodies we want instead of the ones we mistakenly assume we are stuck with.” - Deepak Chopra

Bunions are caused by a misalignment of the bones in the feet, which cause a protrusion on the metatarsophalangeal joint.  Surgical methods can be used to remove this protrusion . The surgery is planned in detail by your surgeon, and once the procedure is completed, as a patient, you will either be taken to a recovery room for observation then be allowed to return to your home with key hole techniques.

Your orthopaedic surgeon will make a series of assessments depending on what type of anaesthetic was used in the surgery. The following parameters will also be monitored by your surgeon, just to ensure that everything is well:

  1. Foot Blood Circulation

  2. Pressure tests to ensure that the feet are feeling sensations

  3. Blood Pressure

  4. Pulse

  5. Breathing Rate

All being well, you will then be allowed to return to your home. Your orthopaedic surgeon will give you detailed instructions with respect to caring for your foot (or feet if you happen to have bunions on both feet). When you are discharged from the hospital, you are usually given special surgical shoes in order to protect your feet as you are mobile. Additionally, you may be given a walker or a cane, to support the body, and facilitate weight distribution that doesn’t stress the healing leg.

The most critical post operational activity, is rest, rest and more rest! Orthopaedic surgeons advise that you keep your affected foot elevated. What this will facilitate is the healing process. Raising your feet facilitates circulation, and helps to reduce that post operational pain, and swelling that is associated with healing post surgery. Additional treatments include icing the feet -  compression is good for healing, especially if there is swelling associated with the post surgery experience.

As you can see from the image above, there is a dressing that is applied to the feet, post surgery. It is important to ensure that the feet stay clean and dry. Recommendations for maintenance include covering the foot with a plastic bag, and protecting the healing area from excessive moisture during activities such as showers.

Take a pain reliever for soreness as recommended by your healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding. Be sure to take only recommended medicines. Your healthcare provider may also prescribe antibiotics to help prevent infection following your surgery.

Your orthopaedic surgeon will monitor your progress across the healing weeks. The initial healing will take place across the first six weeks, and full healing can be expected across four months. You will be given a checklist of adverse symptoms to look out for. Do not hesitate to call your orthopaedic surgeon if you notice anything out of the ordinary. Monitor yourself and your vital signs and ensure that you are in the normal to healthy ranges for all the critical parameters such as your blood pressure, as well as ensuring that you are feeling sensation in your legs are healing.

As part of your healing, you will be advised to take exercises either at home, or with a physical therapist, in order to ensure that appropriate mobility is restored to the region. Happy healing!


  1. Bunion Surgery: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/bunion-surgery

  2. Bunion Removal: https://www.healthline.com/health/bunion-removal


Bunion Treatment


Image Credit: MyHealthAlberta

“The three big ones in life are wealth, health, and happiness. We pursue them in that order but their importance is in the reverse.”- Naval Ravikant

Bunions, are protrusions of the big toe, caused by misalignment of the bones in the foot. Eventually a lump forms on the metatarsophalangeal joint. If the condition persists, it can become painful, and restrict activities such as shoe purchase. Minimally invasive surgical procedures will be the best solution to you condition if you are diagnosed with a bunion.

After an initial analysis, your orthopaedic surgeon will be able to tell if you have any of the following classifications of bunions:

Mild bunion: Treatment involves the bone minimization to eliminate the protrusions, and realignment of the muscles and other soft tissue in the joint.

Moderate bunion: Treatment involves bone incision and realignment of the toe and soft tissue repositioning.

Severe bunion: Treatment involves protrusion removal, bone incision and realignment, and soft tissue repositioning.

Arthritic bunion or big toe joint: Joint fusion facilitated in order to allow the bones to heal. Occasional reconstruction of the joint.

With appropriate surgical procedures, the ability to walk will be restored after the appropriate healing time, as well as reduction of other symptoms that are associated with bunions such as pain or swelling of the joint. From a cosmetic perspective, there will be an improvement in the appearance of the foot. An example of the appearance, 6 weeks post surgery is shown below.


We use taping to hold the position usually from 6 to 12 weeks. The main aim being restoration of plantar flexion.

The bunion surgery varies in terms of the final treatment. In some instances only a slight numbing of the foot will be necessary. In other instance, anaethesia will be needed in order for the appropriate changes to be done by your surgeon. The treatment usually takes approximately 6 weeks for normal usage of the feet.

Treatment Preparation:

All surgical procedures have detailed plans. Your orthopaedic surgeon will highlight to you the risks and the associated benefits of your procedure. You will then proceed to prepare yourself by ensuring that you are not on any medications that will interfere with the surgery, particularly since you are on anaesthetic for the procedure. A detailed checklist will be provided by your surgeon.

Surgery Day:

With the appropriate plans in place, you are now ready for your surgery. You will be advised on your dietary requirements in the hours preceding the surgery. Following the plan accordingly, and you’ll be well on your way to a speedy recovery.There is an an average surgery time of approximately one hour per bunion, After a short stay in recovery you will be able to return to your home to heal.

Consult with your doctor if you suspect that you have a bunion. With an appropriate plan, you will be able to have your condition treated, and your health restored.


  1. Bunionectomy: https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=zu2039

  2. Bunion Surgery: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/bunion-surgery


Child Acquired Flat Foot


“Health is a large word. It embraces not the body only, but the mind and spirit as well; …and not today’s pain or pleasure alone, but the whole being and outlook of a man.” James H. West

Flat feet is a condition indicated by the absence of the arch of the feet. Also known as pes planus, overpronation or pes valgus, the condition is easily identified by the fact that the soles of the feet are touching the floor when they are inspected. In children, the condition is often overcome by physical activity or other alternatives that will be discussed below. When it comes to children, you may consult an orthopaedic surgeon, who specialises in paediatric care. Usually, there are three main types of child acquired flat foot diagnoses:

  1. Flexible flatfoot: According to studies, all children have this condition, which affects both feet. The good news is that there is no treatment needed for this type of flatfoot condition.

  2. Flexible flatfoot coupled with a short Achilles tendon. Unlike flexible flatfoot, the second type is prone to cause both pain and disability.

  3. Rigid flatfoot is a rare condition in children, that usually surfaces if there’s a bone condition known as tarsal coalition present. The resultant outcome is pain and disability.

While the majority of babies are born with flatfoot, most children tend to outgrow the condition. While 80-90% of children have flatfoot, only approximately 20% of adults have flatfoot. With rigid flat foot, there is a concern since no arch is seen during an examination. The arch is an indicator of flexibility, and care must then be taken if none is visible. Pain in the foot, is normally concentrated to specific areas.

How is Child Acquired Flat Foot Diagnosed?

An orthopedic surgeon, via a series of tests, will be able to determine the type of flat foot that your child would have. Via a series of imaging tests, the feet and ankles are assessed. These tests include X-rays, EOS imaging (3D visual), CT scans and MRI images. With the appropriate internal imagery available, if there are pain points on the child’s feet, the root causes of the condition can then be identified with a deeper probe.

How is Child Acquired Flat Foot Treated?

If the condition is painless, normally treatment isn’t administered. If there’s is pain however, there will be a series of treatments that your orthopaedic surgeon will administer. Studies have shown that children develop their arches by the age of 5, so allow time if there is no evidence of pain. As an initial treatment, stretches are often effective in facilitating the improvement of the flexibility of the ankle and the legs. One of the most popular stretches is for the heel cord. The following is the procedure for the heel cord stretch:

  1. Stand in front of a wall, and lean forward with one leg in front and the other behind the leg. Both heels should be on the floor for this exercise.

  2. The back leg should be straightened, with the heel against the floor.

  3. The front leg should be bent, and allowed to hold this position for up to 30 seconds. Ensure that the toes of the back leg are aligned towards the heel of the front foot.

The suggestions for this procedure are a minimum of three times on each leg. If necessary, feel free to do more than the prescribed exercises. With additional treatments such as orthotics and additional foot support, the appropriate natural enhancing treatments can be facilitated by the supports. With your orthopaedic surgeons assistance, the right path for your child can be determined.

Additionally, there are surgical treatments that can facilitate the restoration of flat feet in children. The image below, is the after image of the initial image in this blog article. The child was treated with minimally invasive technology, a day case surgery. The patient presented with severe bilateral flat foot, and had an inability to run or stand for long periods of time. After surgery, the condition was corrected.


Adult Flat Foot Deformity


“Life is like a tree and its root is consciousness. Therefore, once we tend the root, the tree as a whole will be healthy.”- Deepak Chopra

Adult Flat Foot Deformity, as a by product of existing health conditions, is induced by various underlying root causes. Normally as children grow and develop, there is a detectable flat foot condition, which usually goes away with designed treatment, or as the child grows. Adults can have their feet and ankles be compromised by varying internal conditions such as diabetes, which causes loss of feeling in the legs, and ultimately degradation of the joints. While several root causes can result in the final outcome, let us identify what the main contributors are to adult flat foot deformity.

What causes adult flat foot deformity?

 Adult flat foot deformity is a condition that is prevalent predominantly in women. . Pregnancy, due to the additional weight that is induced by a growing child, can affect the mother’s feet and ankles. Additionally, if childhood flat foot was noted in the medical history, the adult will have  a higher possibility of developing adult flat foot deformity due orientation of the tarsal bones.. Posterior tibial tendon (PTT) insufficiency is a cause of acquired flat foot deformity as the tendon is instrumental in the maintenance of the arch of the foot.


The PTT is critical to adult flat foot deformity. The root causes of weakening of the tendon include tendonitis, to tearing induced by either trauma to the leg caused by athletics. A mid-foot injury known as a Lisfranc injury, can also cause the foot to flatten. According to scientific studies, the calcaneonavicular ligament, is the one most affected in the pre-curser to adult flat foot deformity, resulting in what the field calls plantar sag or forefoot abduction.The final result is a flattening of the arch, as the foot is displaced from the talus bone. Your orthopaedic surgeon will be the one to diagnose if you have adult flat foot condition. Other root causes of adult flat foot deformity include:

  1. Interosseous Ligament weakening

  2. Deltoid Ligament weakening - root cause of medial ankle instability

  3. Achilles Tendon tightness

  4. Diabetes induced Charcot foot also induce adult flat foot deformity. Neuropathy, induced by diabetes, is the root cause of Charcot foot.

Symptoms of Adult Flat Foot Deformity

Varying according to the root cause of the condition, the following are the possibilities of symptoms:

  1. Pain along the back of the calf

  2. Swelling of the ankle region

  3. Pain during motion such as walking or standing

  4. Increasing ankle pain as the ankle weakens  

Any adult can develop adult flat foot deformity. With the various root causes highlighted above, with the help of your orthopaedic surgeon, you will be able to find an appropriate path for treatment.


  1. Cleveland Clinic: https://my.clevelandclinic.org/health/diseases/15961-adult-acquired-flatfoot

  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4094099/


Pan Talar Fusion with Anterior Plate


The secret of health for both mind and body is not to mourn for the past, not to worry about the future, or not to anticipate troubles, but to live in the present moment wisely and earnestly. - Buddha

Pan Talar Fusion with Anterior Plate, also known as Pan Talar Arthrodesis, is a procedure used to facilitate the healing of the ankle joint. Very often due to neuropathy induced by conditions such as diabetes, patients end up losing sensation in their feet. As a result, complications such as Charcot foot can develop, which involves a degradation of the ankle joint. Additionally, arthritis induced by either athleticism or aged induced degeneration of the ankle, can cause weakening of the critical joint that facilitates our body weight distribution.

The Pan Talar Fusion with Anterior Plate entails fusion of the following segments of the body:  the tibiotalar, subtalar, talonavicular, and calcaneocuboid joints. The process is a salvage procedure, and facilitates the restoration of the joint by bracing the region for natural healing. There are some instances where if the process is not applied, the alternative would be to amputate the leg. In order to restore function and mobility, your orthopedic surgeon will describe the best course of action to take, in order to ensure that the optimum treatment path is followed. Not everyone requires this treatment, so ensure that an appropriate assessment followed by a diagnosis is carried out. Severe deformities and degradation of the joint are usually the roots that facilitate this treatment. A general list of possible treatments include:

Charcot Arthropathy

Post-traumatic Arthritis,

End-stage posterior tibial tendon dysfunction,


Failed total ankle replacement,

Rheumatoid arthritis,

Paralytic foot (Polio induced)


In an assessment, the orthopedic surgeon will look at mobility, alignment, and general stability of the region. 

Economic studies have been done on the procedure, and have proven to be effective. Even though prevention is significantly better than cure, it has been found that the limb salvage procedure that is involved is approximately US $10,000 less than the amputation costs. Patients are also significantly more comfortable keeping their limbs intact.

How does the procedure work?

The Pan Talar fusion procedure is a stabilizing force in the affected foot. Before the process is facilitated, the orthopaedic surgeon will carry out a detailed analysis of the region. Via tests such as X-rays of the region, the extent of damage can be assessed, and an appropriate treatment plan can be developed, that facilitates the healing process. Additional assessment via processes such as Computed Tomography (CT) studies, magnetic resonance imaging (MRI) and nuclear imaging can assist with the deeper details of the integrity of the joint. Once the assessment is carried out, the surgery plan can then be created.

The Pan Talar Fusion surgery is a complicated procedure, requiring a series of incisions in order to facilitate the appropriate scaffolding of the region. The process requires the following activities to be facilitated:

Including one-and two-incision approaches with open reduction, and internal fixation retrograde intramedullary nailing and the use of external fixation.

During the process, the surgeon will take the steps to maintain the integrity of the ankle joint while fusing together the plate, and the relevant screw inserts that will ensure that the region is restored. Via series of cuts, the insertions of the appropriate segments of the internal scaffold will be facilitated. The central bone that the procedure will focus on is the talus.

With an appropriate plan, the procedure will be successful, and as a patient you will be well on your way to recovery and mobility restoration.


Reference Article:


Diabetic Ulcers

Diabetic Ulcer 2.jpg

Image Credit: Woundsource

Your health is what you make of it. Everything you do and think either adds to the vitality, energy and spirit you possess or takes away from it. Ann Wigmore

Diabetes is a condition that must be monitored carefully. While by itself it can have adverse effects on the body, there are additional peripheral conditions that are induced by the diabetic condition. Diabetes, coupled with poor circulation can lead to conditions such as diabetic foot ulcers. The extremities of the bodies are particularly prone to sores due to the fact that with conditions such as peripheral artery disease, patients often cannot feel sensations in their feet.

A diabetic foot ulcer is a wound that develops due to wearing away of the skin on the feet. Approximately 15 percent of the diabetic population is prone to this condition. Located predominantly on the soles of the feet, there are downstream conditions that result from ulcers. If they are not treated properly, eventually the leg may have to be amputated. Fortunately there are processes that a foot and ankle surgeon can administer to salvage the foot and prevent it from any further degradation. According to industry statistics, up to 24 percent of patients who develop foot ulcers require amputation. At 25% as the upper range, this is a significant number of the population. In this instance, prevention is better than cure.

Root Causes of Diabetic Ulcers

The following persons are prone to diabetic ulcers:

1)       Diabetics who are treated with insulin

2)       Diabetics with auxiliary conditions such as kidney, eye and vascular conditions

3)       Diabetics who aggravate their conditions by smoking and using alcohol

Diabetes ultimately develops neuropathy, which is a reduction in sensation in the feet due to nerve damage. Additional conditions such as Charcot Foot, and foot ulcers can develop due to this fact. Since individuals can’t feel pain in the feet, the two possibilities for trauma in the feet include joint degradation internally, and externally  the development of ulcers.  It is highly recommended that you consult with your orthopaedic surgeon for testing for neuropathy. It will save you from future potential ulcers.

Ulcers are detected by inspection of the feet. Initially, there will be a swelling of the area, and there will ultimately be a puss build up in the area, which eventually drains. Your orthopaedic surgeon will take measures to minimize the infection, facilitate healing and ensure that healing is accelerated.

How are Ulcers Treated?

As with all conditions, prevention is better than cure. In the instance that the ulcer does develop there are series of steps that are taken to ensure that appropriate healing is facilitated. The processes are as follows:

Off-loading: This process is the simple process of ensuring that weight is removed from the foot with the ulcer. Since the individual does not have the ability to feel, weight will aggravate the ulcer. Rest, will facilitate healing and improve circulation.

Debridement: This process involves the removal of the dead tissue that is surrounding the ulcer. Leaving the live skin around the area will ensure that healing is facilitated.

Medical Treatment: With the wound exposed, the appropriate medical treatment will then be accounted for. This will facilitate healing in a sanitary environment.

Internal Health Management: The state of the internal health is reflective of the exterior health of an individual. Managing critical body parameters such as pH, glucose levels will ensure appropriate healing.

Your orthopaedic surgeon will determine the best course of action for your treatment. Consult with them for minimally invasive treatments if necessary.

Reference Article: https://www.apma.org/Patients/FootHealth.cfm?ItemNumber=981

Treating Paediatric Flat Foot with Arthroeresis Plugs

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Image Credit: Podiatry Today

“Think positively and exercise daily, eat healthy, work hard, stay strong, build faith, worry less, read more, and be happy.” Anonymous

Paediatric flatfoot is common in children, and normally heals on its own as children grow, develop and become more active in their early childhood. Flatfoot is defined by the absence of the arch at the base of the leg. Babies are normally born with padded feet, so the arch tends to be absent. Otherwise however, with a flexor motion strengthened and via physical activity the arch will become more prevalent with time. By the time children are at the age of eight, the condition will have alleviated. If you notice any unusual appearances in your child’s feet, do consult with your podiatrist or your paediatric orthopaedic surgeon. Via a series of diagnostics algorithms outlined below, the root cause of the problem will be identified, and the appropriate treatment plan can be developed. Treatment is either via exterior intervention, or via minimally invasive procedures such as Subtalar Arthroereisis.

Symptoms of Paediatric Flatfoot

Paediatric Flatfoot is a common condition in children. While not a contributor to deformities in children, it affects appropriate weight management in children. With sagging of the medial arch and the heel valgus as its main identifiers, in many patients they may develop complications later in life that will affect their mobility. With minimal symptoms in the majority of the population, some children do experience pain in their feet, and ultimately find themselves limiting their physical activity due to the pain they experience after the sporting event. Symptoms of paediatric flatfoot include:

  1. Pain in the bottom of the leg, which spreads to the ankle regions.

  2. Lateral motion in the heels. The heels will vere outwards.

Consultation with your paediatric orthopaedic surgeon, will facilitate an appropriate diagnosis of the condition. Usually, a series of decisions are made by your specialist. The following diagram represents that outcome:


Image reference: Article #3

With the various action steps that are taken by your specialists, there are a series of possibilities that determine the path that will be taken by your foot and ankle surgical specialist. After detailed analysis and observations, the ideal path for your child’s progression will be determined.

Treatment of Paediatric Flatfoot

The minor cases of paediatric flatfoot that requires treatment,often utilize the processes of either orthotic devices, that custom made to fit the feet or surgical procedures such as Subtalar Arthroeresis plugs. The process of arthroeresis is based on the concept of Greek root meaning “ to press a thing against”. This process is a means via which the ankle joint can be propped by an implement, much as identified in the image above. The arthroeresis procedure aims to achieve the following:

  1. Control the motion at the subtalar joint

  2. Facilitate range of motion (3-5) degree allowance

  3. Preserve the joint

Orthopaedic surgeons have been utilizing surgical treatments for paediatric flat foot for many years. It has proven to be successful in children. If you’re a concerned parent, then talk through the above decision matrix with your orthopaedic surgeon to determine what path of action is best for you.


  1. Pediatric Flatfoot: https://www.ncbi.nlm.nih.gov/pubmed/23263679

  2. Flatfoot in Children: https://my.clevelandclinic.org/health/diseases/14483-flatfoot-in-children/management-and-treatment

  3. Pediatric Flexible Flatfeet: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684468/

Foot and Ankle Treatments (Braces)

Orthotix - Foot Braces Image.jpg

Image Credits: Orthotix

“Take care of yourself, be healthy, and always believe you can be successful in anything you truly want.” Alessandra Ambrosio

Ankle injuries affect many persons, particularly those who are actively engaged such as athletes of all levels. If you’re feeling aches in your ankles, you may be wondering what procedures and steps to take in order to alleviate that often sudden pain that comes with treating your symptoms.

If you’re not seasoned in understanding your body’s signals, the best action to take is to consult your foot and ankle specialist. Via a series of assessments and via tools such as X-rays and MRI scans, a proper diagnosis can be made. Early detection can save your life. At the most basic levels however, there are action steps that you can take to treat yourself.

In the preliminary stages of foot care, inserts and orthotics are utilized by foot care specialists in order to facilitate the appropriate treatment plan.

What are Inserts and Orthotics?

Inserts are familiar to many persons on a surface level. Many advertisements about products such as Dr Scholl’s foot inserts are presented to public on a regular basis. Additionally, when you walk into your pharmacy, you’ll often see ankle braces, gels, blister caps, foot creams and other similar devices readily available on display for you to purchase. Accessible without a prescription, inserts are the first steps that you can take in order to treat yourself if you feel that initial pain, and can’t access your foot care specialist. They are generic products and may or may not always be the best for you in terms of the root cause of the condition. Use with caution.

Orthotics on the other hand, are the custom made prescription accessible treatment options. Designed to be worn inside the shoes, they facilitate either regular motion or assist in re-aligning your body. The treatment options for orthotics are widespread, and often used in order to prevent downstream surgical procedures. With a wide range of options and different material baselines depending on the healing properties needed, your orthopaedic surgeon will design a unit(s) that will ease the symptoms you have and facilitate healing.

As minimally invasive treatments, as a patient, you will have access to a host of treatment possibilities. Take your time, and investigate the root causes. Prevention is better than cure. Since your feet support your body, and provide mobility it will be beneficial to you to ensure that they are well taken care of.

What are Leg Braces?

Leg Braces are often prescribed by your orthopaedic surgeon in order to facilitate the healing of a myriad of root causes. These include metatarsal stress fractures, foot drop, ankle sprains and achilles tendonitis. If you require a surgical treatment, special medical walking shoes, that support the feet yet facilitate mobility can be accessed. With the advent of material science, the materials that can be used to create leg braces include rigid plastic, carbon fibres, leather, cushioned material that supports the feet as inserts, and other synthetic cloths that can be used to provide a tie of some sort, and enable the braces to be attached and strapped to the feet.

Leg braces can either be ordered custom made from the manufacturer or ordered off the shelf from organizations such as Amazon.com. Detailed research indicates that Amazon, is well stocked in this particular medical innovation.

Depending on the level of support needed, carefully treat your feet or consult with your orthopaedic surgeon in order to determine whether orthotics or leg braces will be needed in your recovery.

Reference Articles:

  1. WebMD: https://www.webmd.com/pain-management/what-are-shoe-orthotics#1

  2. Leb Braces: https://www.heel2toe.net/any-foot-any-need/innovative-bracing/leg-braces/

Severe Flat Feet and Children

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Image Credit: theconversation.com

“Your health is what you make of it. Everything you do and think either adds to the vitality, energy and spirit you possess or takes away from it.” - Ann Wigmore

While the majority of us take our feet for granted because they operate normally, there are a small select few who suffer from the childhood ailment known as severe flat feet. The human foot, looks simple from the surface, but with a combination of 33 joints, 26 bones and 100 plus muscles tendons, and ligaments holding it together, one can’t help but marvel at this natural creation. All the different aspects of the feet work together to provide the appropriate strength, as well as the relevant resistance that keeps the joint flexible during physical activity.

While adult flat feet onset is induced by various causes, there are many babies who are born with the condition known as flat feet. Over time either via intervention or via natural changes during growth and development, the condition can be treated. The beauty about young bones is that they are soft and relatively malleable, so if necessary the appropriate foot dimensions can be restored. Babies are often born with a soft pad on their feet, and over time the arch develops. Additional alignment conditions that are witnessed by orthopaedic surgeons in children and young babies is the fact that feet can also turn out due to malalignment induced by the flat feet.

If you’re a parent, and your child has flat feet, do not worry. With time and treatment, the condition is treatable. In this article an overview of general non-surgical treatments that you can use in the early stages of detection can be outlined. Naturally methods work wonders, but if necessary, consult your orthopaedic surgeon for a detailed consultation on minimally invasive surgeries or brace based techniques that can help your children have their alignment restored. Depending on the root cause, the treatment can be found and applied.

Your orthopaedic surgeon will utilize diagnostic tools such as MRI scans and X-ray to conduct a detailed analysis of the internals of your child’s feet, and based on the findings, the path forward can be determined. As a start, here are some of the common symptoms that have been associated with flat feet in children:

  1. Pain is usually a first symptom. Due to the fact that the joint is under severe compressive pressure, the ligaments start to strain and the root cause is experienced as a pain in the feet by the patient.

  2. The feet will malalign and tilt outwards due to fact that the joint is weakening.

  3. Pain during physical activities. As a sensitive area, your child may not be as eager as some of the other children to participate in sports that involve excessive running. They would prefer the quietude to the aftermath of having swollen ankles once they link the activity to their pain.

As a parent, it will be important for you to observe your children’s reaction to sporting activity. Physical activity will be important to their growth and development, and withdrawal is a sign of an internal problem.

Feet Exercises as Natural Treatments

In the early stages of flat feet, natural remedies are recommended. There are a variety of non-surgical methods that exist in the field of orthopaedics. Explore the options with your consultant and see if they can help with the restoration of the health of your child’s feet. Include in your regimen as much physical therapy and shoe modifications as possible. A suitable assessment will determine the methods that will work best for your child’s condition. Along with a physical therapist exercises such as heel cord stretching, golf ball rolls, and a host of other exercises designed to restore the arch are also helpful. Additionally, if you have your child involved in an activity such as dance or gymnastics which causes a repeated exercising of the feet via pointing and flexing, over time the feet will restore themselves, and the arches will naturally develop.

Reference Articles:

Paediatric Flat foot: https://www.foothealthfacts.org/conditions/pediatric-flatfoot

Flat Feet: https://www.medicalnewstoday.com/articles/168608.php

Tibialis Posterior Failure (Acquired Flat Foot)

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Image Credit: Wikipedia.com

Happiness is the highest form of wealth. - Dalai Lama

The human feet and ankles are amazing biological engineering marvels. Supporting our body’s weight and enabling motion at the same time, the care of this very critical aspect of our function and operation is critical to longevity and comfort. In the ankle regions, occasionally, there can be degeneration of the ligaments that bind the critical joints together. One very critical condition is the tibialis posterior failure, also known as acquired flat foot. If you’re feeling unusual pain in your feet, consult with your orthopaedic surgeon, in order to have an appropriate analysis and diagnosis. With diagnostic tools such as MRI and X-rays, the internals of your ankles can be properly assessed, to identify any abnormalities.

The tibialis posterior failure, is the condition induced by the weakening, and ultimate disruption of the operations of the posterior tibial tendon. The tendon is critical in the process of facilitating joint integrity, and also the relevant strain needed for flexibility, motion and weight distribution and management. The auxiliary ligaments and joints that complement the posterior tibial tendon also weaken as a result of it’s failure. The ultimate result, is the generation of the condition known as flat foot. With excessive compressive forces due to the body’s weight, and no resultant opposing forces to sustain the joint, the feet ultimately flatten under gravity. If not diagnosed early, there can be  adverse health challenges later in life. Acquired flat feet is a deformity which causes malalignment of the skeleton, and must be addressed by a foot and ankle specialist.

Diagnosis Summary:

  1. As a very common condition, statistics have shown that the most susceptible category of patients are women over the age of forty. If you are in this age group, it would be advised for you to ensure that you are taking great care of your feet, and have regular assessments by your orthopaedic surgeon.

  2. The medial hindfoot is afflicted with pain and swelling.

  3. The feet change in shape and possibly get broader, due to more weight on them due to increased compressive forces.

  4. The feet flatten as a result of the degeneration of the posterior tibial tendon.

  5. Valgus heel formation, diagnosed by lateral heel rotation, a flattened longitudinal arch and an abducted forefoot.

Your foot and ankle specialist will usually look for these symptoms and then prescribe an appropriate treatment path for the improvement of your condition. With the appropriate treatment, recovery and restoration of the joint is possible. Aside from usually medical treatment with painkillers, minimally invasive surgical treatment is available. The procedures usually facilitated by your orthopaedic specialist include:

  1. Hindfoot Osteotomy

  2. Arthrodesis of the Hindfoot

Hindfoot Osteotomy is preferable if the patient is in the early stages of tibialis posterior failure, while the latter - arthrodesis, is preferable if the patient is in an advanced stage of the condition. Medical science has classified tibialis posterior failure into four main stages. Stage one is the early onset with the patient feeling pain along the tendon. The joint is still intact, and the feet appear as normal, with the pain sensations being experienced by the patient. Stage two has early onset deformity, with slight foot collapse and arch reduction. Ligament failure also begins at this phase. Stage three is complete deformation, while stage four is a spread of the deformity from the ankle to rest of the foot.

As a serious condition that can adversely affect the feet, it is imperative that appropriate treatment be sought via a specialist. As with all health related condition, the earlier the detection is made, the higher the odds of a full recovery. With both non-surgical and surgical options available, the patient can feel confident in their ability to live a long, healthy and mobile lifestyle.

Reference Articles:

  1. Tibialis Posterior Failure: https://www.hss.edu/conditions_posterior-tibial-tendon-insufficiency-overview.asp

  2. Tibialis Posterior Dysfunction: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC534847/

Salvage Surgery in The Diabetic Foot

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Image Credit: Baylor College of Medicine

“The best six doctors anywhere and no one can deny it are sunshine, water, rest, air, exercise and diet.”~Wayne Fields

What is Salvage Surgery?

Limb-salvage surgery, as the name implies, is a procedure that is used to save two primary functions of the desired limb. These functions are:

  1. The use of the limb, in order to facilitate the maximum function post surgery. Since the patients use their limbs for mobility, as best as possible, the surgeons aim to sustain the function of the limb. Where necessary, auxiliaries to the limbs can be incorporated.

  2. Appearance of the limb: When it comes to certain surgical procedures, cosmetics do play an important role in the objective of the surgery. As best as possible, patients want to feel as if they still possess their original limb.

Limb-salvage surgery, is conducted by your local orthopaedic surgeon. Feel free to consult with them, for an idea of whether this option may be right for your condition. If you are diabetic, you are a prime candidate for limb salvage surgery, provided you suffered from some downstream condition that would have affected your circulation. For the diabetics, appropriate health care is critical to ensuring that longevity is sustained. With negligence, many possibilities exist for limb loss, so this subset must be extremely careful.

Factors that impact amputation

With diabetes, there does exist the possibility of limb loss. One recommendation that has been made by orthopaedic surgeons is a daily foot inspection. Due to the fact that diabetes feeds into peripheral artery disease, and there is a resultant reduction in circulation, the diabetic patient may lose sight of the fact that they have lost nerve sensation to the feet. With a reduced ability to feel pain, ulcers often develop and can become infected. With blood flow already reduced to the area, wounds on a diabetic may not heal. In order to minimize infection spread to the rest of the limb, it will be critical for the leg, or a portion of it to be amputated. Diabetics often have amputated:

  1. Toes

  2. Feet

  3. Lower Legs

Fortunately, with the advent of systems such as diabetes management, the odds of amputations are reduced. Appropriate diet, and self care are the keys to prevention. Here are three foot care tips that you can utilize if you are a diabetic:

  1. Have yourself or your spouse, conduct a daily foot inspection. With use of the feet, it is possible for small wounds or blisters to develop. If caught early they can be treated.

  2. Conduct a foot massage, in order to ensure that you are feeling sensation in your legs. Gently rub the feet, and also use light objects such as feathers to ensure that you are feeling light pressure sensations.

  3. Daily foot exercises will help you to ensure that your feet are in great shape. By wiggling your toes, and exercising the ankles, you’ll ensure that the function of the limb is at its peak.

If you’re diabetic, establish a solid relationship with your orthopaedic surgeon. Consult them if you experience any abnormal sensations. Early detection, can save your limbs! Your health is your wealth!

Reference Articles:

Journal Article: http://care.diabetesjournals.org/content/38/10/e156

Diabetes and Amputation: https://www.healthline.com/health/diabetes/diabetes-amputation#other-foot-problems

Sports Shoes

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Image Credits: Pexels.com

“Your body holds deep wisdom. Trust in it. Learn from it. Nourish it. Watch your life transform and be healthy.” ~Bella Bleue

Your health is your wealth, and your feet are your primary mobility machines. For most persons, an active lifestyle is one that is part of our daily and weekly routines. The natural tendency when getting ready for the gym, the great outdoors, and even our own backyards is for us to put on our sports attire, and then put on the associated sports shoes. Since your feet carry the weight of your body, it is important to ensure that they are well protected as you carry out your sporting activity. Statistically, the majority of ankle related injuries are due to physical activity, so let’s get you organized with respect to how best you can protect your precious feet.

It is very important to choose the right pair of sporting shoes. Depending on your sport, the type of shoe that you invest in will vary. Bear in mind that with the differences in the design of sports shoes, you can induce injury if you wear the wrong shoes. For instance, you wouldn’t want to play basketball in football boots. One requires more stiffness since you’ll be using your feet to impact a ball, while the other will require more cushion, because your vertical motion and consistent jumping require you ensure that the feet are adequately protected from the impact of the ground during a jump. Based on how the ankle joints are designed, excessive pressure will wear away the cartilage, and cause conditions such as arthritis. With our focus on prevention rather than cure, let’s jump into the criteria.

Types of Sports Shoes

While by no means exhaustive, the following are the main categories of sports shoes:

  1. Running Shoes: With jogging increasingly on the rise, it is important for persons to ensure that they purchase the right shoes. Your sporting goods store will facilitate the appropriate fitting, if requested. Don’t guess in this instance, the staff are trained to assist you.

  2. Football Boots: Football is a sport that relies on the lower body significantly. Football boots are designed to be tough, but utilized on a soft surface such as grass. If worn on a hard surface, the odds of stressing the feet are higher as the impacts will shock the feet during the match. Careful fitting is necessary, as foot conditions such as corns and calluses, as well as ingrown toenails can develop if the boots are too tight.

  3. Tennis and Squash Shoes: These shoes require much more cushion, since the athlete will be running and jumping a lot. The ankles need support, based on the motions that a tennis player undergoes.

  4. Trainers: Owned by the majority of persons, for physical activity the best options will be the ones that offer cushions for the feet. With activities such as jumping jacks, or rock climbing, the feet must be protected.

Now that the categories have been outlined, let us look at the five main criteria to look for when choosing shoes for your sport. When you have a foot problem, you usually consult with your foot and ankle specialist. Likewise, when you’re choosing your shoes, the assistants in all sporting goods stores, are trained in gait analysis and will facilitate sizing and shoe choice. You need to arm yourself with information in order to make the right decisions.

  1. Ensure that you understand your feet. Your orthopaedic surgeon can give you an assessment, and allow you to understand the various dimensions of your feet. If you have special conditions such as flat feet, you’ll be able to add features to your shoes that will customize them for your personal design. A “wet-test” which involves you tracing your feet, will determine what size shoes are best fitted for you. Simply wet your feet, after you’ve been active for a few hours, and place them on a brown paper large enough for your feet. Go ahead and stamp your feet. Based on the outline you can determine factors such as:

*Foot Curvature

*Your Arches

*Critical Ratios (length to width)

2) Ensure that the shoes fit on the spot

Unlike leather shoes, which your feet will have a chance to warm to and adapt to, sports shoes are designed to work on the feet right away. If you take the time to ensure that they are adapted to the feet, then it might be too late, and shoes may need to be replaced.

3) Ensure adequate space for movement of your feet

Bearing in mind that you’ll be wearing socks with your running shoes, you need to ensure that there is adequate space (⅜-½ inches) between the front of your big toe, and the end of your shoe. Ensure that toes can wiggle with and without socks.

4) Invest in Quality

An investment in your health will always be worth more than the price that you pay for the shoes. Choose quality over price, and you’ll reap the benefits in comfort. Additionally, the higher the quality, is the longer that the shoes will likely last.

5) Replace at the appropriate point in time

Just like the tires on your car, your shoes will eventually begin to wear at the sole. Since factors such as absorption of shock will be critical to your ankle health, it will be important to ensure that the shoes are providing the adequate protection. Orthopaedic surgeons have recommended replacing after 350-400 miles. Unless you have a device that can measure the miles, just check the soles, and once you see signs of wear and tear, you’ll know when it’s time to replace the shoes.

For further details on your shoe purchases, ensure that you speak to your orthopaedic surgeon. A consultation will ensure that you get off on the right footing! No pun intended!

Reference Articles

WebMD: https://www.webmd.com/fitness-exercise/features/how-choose-athletic-shoes

Choosing Sports Shoes: https://www.nhs.uk/live-well/healthy-body/choosing-sports-shoes-and-trainers/

Women's Shoes

Image Credit: Pixabay (free to use and share commercially)

Image Credit: Pixabay (free to use and share commercially)

“I believe that the greatest gift you can give your family and the world is a healthy you.”- Joyce Meyer

When it comes to shoe shopping, the key is to find the right one. With the myriad of shoes that are available on the market, it can be tempting to purchase shoes because of how they look, because that’s what’s trending, or simply because those models were readily available. The right shoe is critical to ensuring the health of your feet. Many current foot and ankle ailments take place over very long intervals of time. With appropriate care, prevention will be better than cure in the long run.

What is the right shoe?

The right shoe provides the feet with a mixture of cushion, support and comfort. The anatomy of the foot is such that it supports the body on a hinge joint. The appropriate alignment of the feet is critical to so much, inclusive of the health of the spine. The right fit of the shoe should be such that it fits snugly, and there is at least 1-1.5 cm of space at the end of shoe. A few key characteristics of shoes that should be factored in include:

a)    A stiff back for appropriate heel support

b)    Flexibility to facilitate the motion of your feet

c)    Appropriate arch support - The arch of the foot is part of its engineering design that facilitates its ability to support the body appropriately. Shoes will not all be perfectly designed, so with the appropriate inserts, shoes can be customized to facilitate that additional comfort.

d)    Heel height - Heel height is very important for the support of the feet and the body. The body was designed for an optimum height. The higher an individual is off the ground, the higher will be the center of gravity of that individual. Any object with a high center of gravity will have the tendency to fall, compared to an object with a lower center of gravity. Women are aware of the fact that with higher heels, they do feel the instability that comes with being elevated. It will be important for an individual to ensure that they match their heel height with their personal height.


A consultation during the shoe purchase will help to facilitate that there is a match. With heels, the injury risk is significantly higher. Aside from the fact that one can fall, the possibility of a high ankle sprain due to twisting of the ankle is highly probably. Before you wear heels, ensure that you are aware of the terrain. If you’ll be walking on flat surfaces, you’ll be fine. Road surfaces that are rough or grainy such as asphalt, are not conducive to heels. Neither are grassy terrains. For the latter, heel stoppers, will prevent high heels from sinking too deep into the grass, and causing a potential injury.


e) Check your running shoes. Even though, they are designed to be comfortable, periodically check your running shoes, and change them once they are at a point where they are worn. Designed to absorb the shocks that are attributed to running, a worn running shoe will lose its ability to absorb shock. Check your shoes and ensure that you have the appropriate support for your arch as well as your sole.


As shoe designs vary, the key is to ensure that the critical key criteria are met for the purchase. Take some time to have your feet assessed by your foot and ankle surgeon, to determine the current health of your feet. Your orthopaedic surgeon will be able to guide you with respect the best shoes for your feet. As much as you want to purchase those cute shoes, the key will be to determine if they’ll enhance the health of your feet and body. For a special occasion, it will be occasion to purchase those out of the box shoes, but for every day care, it will be critical for you to ensure that the right fitting shoe is purchased.


When shoe shopping, carry a trace of your feet, and also allow yourself to shop for shoes in the afternoon when your feet have gotten a chance to expand, and also had a chance adjust to the weight of your body. When you first wake up, your feet will have been relieved of your weight. Giving them a chance to warm up will enable the appropriate choice to be made.


When it comes to women’s shoes, the options available are significantly greater than men’s shoes. Choice can lead to confusion, so it is important before hand to know what choices to be taken, in order to make the right decisions and enhance your health.


Article References:

1)    https://www.health.harvard.edu/staying-healthy/10-tips-for-finding-the-right-shoes

2)    https://www.uhs.umich.edu/shoes

Ring External Fixatuer

Image Credits: National Library of Medicine (USA)

Image Credits: National Library of Medicine (USA)



For various foot and ankle related injuries, minimally invasive procedures are ideal for treatment. For more severe conditions, orthopaedic surgeons utilise an external fixation device to facilitate the appropriate realignment of the bones. When it comes to conditions such as Charcot foot or fractures of the tibia and/or fibula, brace realignment will be necessary in order to facilitate a relatively flawless healing and restoration of the foot.


The semi-permanent brace that is used in restoring severe foot injuries, is the Ring External Fixateur also known as the Ilizarov Apparatus. Much like orthodontics (braces for one’s teeth), the Ring External Fixateur

is a wire frame that applies appropriate vertical and lateral pressures to the healing system. The frame is designed to keep the fractured bones in the optimal position for fusion and restoration.


Orthopaedic surgery has a wide range of advanced technologies for healing fractured bones. Consult with your foot and ankle surgeon to determine the best treatment plan for your current condition.

Treatment Plans


Generally used to lengthen or to reshape the bones in the leg, the root causes for which the ring external fixateur is the solution do vary. First pioneered by the orthopaedic surgeon Gavriil Abramovich Ilizarov, based in the Soviet Union, the procedure has found widespread application in the field of foot and ankle surgery.

Consultation with your orthopaedic surgeon will usually identify the following conditions as appropriate for treatment with the ring external fixateur:

  1. Angular Deformity

  2. Leg-Length Differences

  3. Non-Unions

The main mechanism of attachment of the ring external fixateur is highlighted in the image below:

Image credit: A.D.A.M. Inc

Image credit: A.D.A.M. Inc

Image credit: Wikipedia.org

Image credit: Wikipedia.org

Mechanism of Action


The apparatus comprises of the external circular fixator, constructed of stainless steel or titanium, held in place by a series of pins to the bone and in turn the rings are aligned vertically and held together via series of rods. Together, they form a column that surrounds and supports the leg while it heals. The central rings and pins immobolise the fracture site.


The frame is also attached to the healthy bone above and below the injury site. This acts as a by-pass (of the fracture site) and allowing movement through the leg and partial weight bearing through the appartus.


Article References: 

  1. https://medlineplus.gov/ency/imagepages/18021.htm

  2. https://en.wikipedia.org/wiki/Ilizarov_apparatus