Podiatrists treat the diseases and conditions of the foot. They are trained in the whole range of appropriate methods of treatment for systemic and local conditions. Treatment is limited to the foot itself, but the function of the entire lower limb is considered when planning the approach to the patient’s individual problems.
The treatment rationale adopted at Sevenoaks Podiatry is to cure or improve the condition rather than to palliate or encourage repetitive treatments. We offer treadmill gait analysis to aid diagnosis, as well as more conservative services where these are more appropriate.
Our areas of interest are sports podiatry, diabetes, arthritis and children’s feet.
We treat corns, callouses, verrucas, ingrowing toenails, bunions, heel and forefoot pain. We can supply a range of inshoe devices from insoles to prescription orthoses.
The hip joint is a bony and ligamentous structure that allows extensive range of motion without sacrificing stability. The majority of injuries to the hip are chronic over-use problems rather than acute injuries.
The injuries and conditions affecting the hip can include stress fractures, tendonitis/bursitis, sprains and capsulitis.
The number of stress fractures seen in clinic has increased over the last 20 years because of the increased amount of individuals who regularly participate in sport. A stress fracture is a partial or complete break in the structure of the bone due to repeated loading such as running and jumping activities.
Pain is the main symptom and is mostly located in the groin. Some pain may occur in the abdominal muscles.
Tendonitis and Bursitis
Within the hip it is very difficult to differentiate between the two. Trochanteric bursitis is inflammation on the lateral aspect of the hip. It occurs between the tensor fascia lata and the greater trochanter of the hip. Symptoms include pain along the lateral aspect of the upper thigh. Repeated hip flexion and extension may cause pain because the tensor fascia lata glides over the inflamed bursa.
All ranges of hip motion are affected; the most problematic movements are flexion and abduction of the hip. The main symptoms are pain and stiffness.
Shin splints, or medial tibial stress syndrome as it is more accurately referred to, is believed to be the most common injury among athletes whose sports involve extensive amounts of running. The injury is troubling because it interferes with training programmes.
It causes pain along the shinbone in the lower third of the leg. Swelling may arise around the injured shin.
Running on uneven surfaces and downhill racing can contribute to shin splints. It is essentially an inflammatory reaction involving deep tissues of the lower leg and may involve tendon and muscle. The inflammatory reaction occurs at the point where the deep tissues insert into the inside (medial) aspect of the lower third of the leg bone (tibia).
Causes of shin splints include over-training, over-pronation of the feet (flat feet), tight calf muscle, road running, excessive hip rotation and poor running technique.
The treatment includes a reduction in training, gentle stretching, biomechanical assessment/gait analysis and avoiding downhill running.
The knee is a joint that has three compartments; inner, outer and knee cap. Injuries to the knee are common occurrences across many different sports and probably account for the majority of all sporting injuries. The knee is subjected to extreme loading and also to repetitive loading.
Knee joint injuries
These include anterior cruciate ligament injury, medial ligament sprain, lateral ligament sprain, posterior cruciate ligament injury, patella dislocation, medial cartilage meniscus injury, lateral meniscus tear, patella tendonitis, Osgood-Schlatter’s disease, patellofemoral pain syndrome, chondromalacia patella, Housemaid’s knee (Prepatellar Bursitis), Clergyman’s knee (Infrapatellar Bursitis) and fat pad impingement.
Ankle pain can often be due to an ankle sprain, namely an inversion sprain. This is where the lateral ligament complex, which comprises of three ligaments, the ATFL (Anterior Talo-Fibular Ligament which goes from the talus to the fibula), the CFL (Calcaneo-Fibular Ligament which goes from the calcaneus to the fibula) and the PTFL (Posterior Talo-Fibular Ligament which goes from the talus to the fibula) which all support the joint capsule is over-stretched. The lateral ligament complex limits inversion (rolling outwards) of the ankle. The treatment for this condition, albeit minor or moderate, is Rest, Ice, Compression, Elevation.
Other causes of ankle pain can include peroneal tendon injuries, tarsal tunnel syndrome (nerve compression), Achilles tendon injuries, fractures, Posterior Tibial Tendon Dysfunction (PTTD) where there can be marked flattening of the medial arch of the foot, and poor biomechanics.
Plantar Fasciitis is a painful inflammatory process of the plantar fascia. Longstanding cases of plantar fasciitis often demonstrate more degenerative changes than inflammatory changes. The plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the five toes. It has been reported that plantar fasciitis occurs in 10% of the population over a lifetime.
It is commonly associated with long periods of weight bearing. Among the non-athletic populations it can be associated with a high body mass index. The pain is usually felt on the underside of the heel and is often most intense with the first steps of the day.
Treatment options for plantar fasciitis include massage and stretching, but the most effective way of curing plantar fasciitis is orthoses management (i.e. insoles).
Otherwise known as Achilles tendon bursitis it is a common foot problem in athletes, particularly runners. It can be mistaken for Achilles tendonitis.
Patients with this condition experience pain during activities such as running uphill, going up and down stairs, jumping or hopping.
Factors which can predispose patients to developing a retrocalcaneal bursitis include poor flexibility, inappropriate training, poor footwear, joint stiffness, muscle weakness and poor foot biomechanics.
Morton’s Neuroma, aka Morton’s Neuralgia and Morton’s Metatarsalgia, is a benign neuroma of an intermetatarsal plantar nerve, most commonly of the third and fourth intermetatarsal spaces.
Symptoms include pain on weight bearing, frequently after only a short time. The pain is felt as a shooting pain affecting the adjacent halves of the two toes. Burning, numbness and paresthesia (pins and needles) may also be experienced. The pain is due to pressure on the enlarged section of nerve where it passes between the metatarsal heads and is squeezed between them.
The main cause of Morton’s Neuroma is “ill fitting” footwear, usually slip-on shoes. Orthoses and corticosteroid injections are widely used to treat this condition. If surgical intervention is required (neurectomy) it involves removing the affected piece of nerve tissue.
Also known as avascular necrosis, Freiburg’s Infarction is a condition where progressive degeneration of the head of the metatarsal bone (usually the second toe) results in foot pain.
The condition is more common in females, with the main treatment being to remove stress from the area usually by way of orthoses and a reduction in physical activity.
This problem means toe joint stiffness and decreased movement due to degenerative arthritis at the lower joint of the big toe. It can be caused by a single instance or repeated instances i.e. from a kick or blow. It can also be present due to poor foot posture i.e. over-pronation.
Treatment can include orthotic management or a surgical procedure depending on the severity of the injury.
Hallux Rigidus means no range of motion at the base of the big toe joint. Causes can include osteoarthritis, trauma, splitting osteochondritis of the 1st metatarsal head or gout.
Conservative treatment includes cortisone injections (which are considered a short term treatment) and footwear that provides a “rocker sole” for pain free walking. Surgical intervention may be considered.
Hallux Valgus, often referred to as a “bunion” is a deformity of the big toe joint. The toe deviates towards the outside aspect of the foot. Bunions are usually hereditary; they are very common in people with a flexible foot type and more common in women than men.
Sesamoiditis is inflammation and pain of the sesamoid bones which are located just behind the big toes. They act as a fulcrum (pulley) for the tendons which bend the big toe downwards.
Sometimes the sesamoid bones can fracture and be difficult to pick up on an x-ray. If this is the case a bone scan would be a better alternative.
The result of the arch supports you fitted for me two months ago has gone beyond anything I could have hoped for: I am walking without discomfort, and as a bonus have noticed an improvement in my knees and lower back.