Chronic Ankle Stability

What Is Chronic Ankle Instability?

Chronic ankle instability is a condition characterized by a recurring “giving way” of the outer (lateral) side of the ankle. This condition often develops after repeated ankle sprains. Usually the “giving way” occurs while walking or doing other activities, but it can also happen when you’re just standing. Many athletes, as well as others, suffer from chronic ankle instability.

People with chronic ankle instability often complain of:

  • A repeated turning of the ankle, especially on uneven surfaces or when participating in sports
  • Persistent (chronic) discomfort and swelling
  • Pain or tenderness
  • The ankle feeling wobbly or unstable

Chronic ankle instability usually develops following an ankle sprain that has not adequately healed or was not rehabilitated completely. When you sprain your ankle, the connective tissues (ligaments) are stretched or torn. The ability to balance is often affected. Proper rehabilitation is needed to strengthen the muscles around the ankle and “retrain” the tissues within the ankle that affect balance. Failure to do so may result in repeated ankle sprains. Repeated ankle sprains often cause – and perpetuate – chronic ankle instability. Each subsequent sprain leads to further weakening (or stretching) of the ligaments, resulting in greater instability and the likelihood of developing additional problems in the ankle.

In evaluating and diagnosing your condition, the chiropodist will ask you about any previous ankle injuries and instability. This will be followed by an examination of your ankle to check for tender areas, signs of swelling, and instability of your ankle.

Non-Surgical Treatment
Treatment for chronic ankle instability is based on the results of the examination and tests, as well as on the patient’s level of activity. Non-surgical treatment may include:

  • Physical therapy. Physical therapy involves various treatments and exercises to strengthen the ankle, improve balance and range of motion, and retrain your muscles. As you progress through rehabilitation, you may also receive training that relates specifically to your activities or sport.
  • Some patients wear an ankle brace to gain support for the ankle and keep the ankle from turning. Bracing also helps prevent additional ankle sprains.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed to reduce pain and inflammation.

Flexible Flatfoot

What Is Flatfoot?

Flatfoot is often a complex disorder, with diverse symptoms and varying degrees of deformity and disability. There are several types of flatfoot, all of which have one characteristic in common: partial or total collapse (loss) of the arch.

Other characteristics shared by most types of flatfoot include:

  • “Toe drift,” in which the toes and front part of the foot point outward
  • The heel tilts toward the outside and the ankle appears to turn in
  • A tight Achilles tendon, which causes the heel to lift off the ground earlier when walking and may make the problem worse
  • Bunions and hammertoes may develop as a result of a flatfoot.

Flexible Flatfoot

Flexible flatfoot is one of the most common types of flatfoot. It typically begins in childhood or adolescence and continues into adulthood. It usually occurs in both feet and progresses in severity throughout the adult years. As the deformity worsens, the soft tissues (tendons and ligaments) of the arch may stretch or tear and can become inflamed.
The term “flexible” means that while the foot is flat when standing (weight-bearing), the arch returns when not standing.


Symptoms, which may occur in some persons with flexible flatfoot, include:

  • Pain in the heel, arch, ankle, or along the outside of the foot
  • “Rolled-in” ankle (over-pronation)
  • Pain along the shin bone (shin splint)
  • General aching or fatigue in the foot or leg
  • Low back, hip or knee pain.

In diagnosing flatfoot, the chiropodist examines the foot and observes how it looks when you stand and sit. The chiropodist, after extensive examination, will be able to detail a treatment option that is best for you.

Non-surgical Treatment
If you experience symptoms with flexible flatfoot, the chiropodist may recommend non-surgical treatment options, including:

  • Activity modifications. Cut down on activities that bring you pain and avoid prolonged walking and standing to give your arches a rest.
  • Weight loss. If you are overweight, try to lose weight. Putting too much weight on your arches may aggravate your symptoms.
  • Orthotic devices. Your chiropodist can provide you with custom orthotic devices for your shoes to give more support to the arches.
  • In some cases, it may be necessary to use a walking cast or to completely avoid weight-bearing.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce pain and inflammation.
  • Physical therapy. Ultrasound therapy or other physical therapy modalities may be used to provide temporary relief.
  • Shoe modifications. Wearing shoes that support the arches is important for anyone who has flatfoot.



While most bones in the body are connected to each other by joints, few bones are not connected to any other bone; but rather, are connected exclusively by tendons or are embedded in muscle. These types of bones are classified as sesamoids. The kneecap is the largest sesamoid in the human body. Two very small sesamoids are found in the underside of forefoot, near the big toe – one on the outer side of the foot and the other close to the middle of the foot.

Sesamoids act as pulleys by providing a smooth surface over which the tendons slide, thus increasing the ability of the tendons to transmit muscle forces. The sesamoids in the forefoot also assist with weightbearing and help elevate the bones of the big toe. However, very much like other bones, sesamoids can fracture as well. This can cause the surrounding tendons to become irritated or inflamed – resulting in sesamoiditis. Sesamoiditis is a form of tendinitis and is common amount dancers, runners, and sports players.


  • Pain is focused under the great toe on the ball of the foot. With sesamoiditis, pain may develop gradually; with a fracture, pain will be immediate.
  • Swelling and bruising may or may not be present.
  • You may experience difficulty and pain in bending and straightening the great toe.


During examination your Chiropodist will examine the foot and the sesamoids. They can then determine what treatment option is best for you.


Treatment is generally non-operative and your Chiropodist can usually help. Only in extreme cases, would it result in a referral to a surgeon for further measures.

  • Stop the activity causing the pain.
  • Take aspirin or ibuprofen to relieve the pain.
  • Rest and ice the sole of your feet. Do not apply ice directly to the skin, but use an ice pack or wrap the ice in a towel.
  • Wear soft-soled, low-heeled shoes. Stiff-soled shoes like clogs may also be comfortable.
  • Use a felt cushioning pad to relieve stress.
  • Your chiropodist might recommend a certain type of custom orthotic to displace force on bones
  • Return to activity gradually, and continue to wear a cushioning pad of dense foam rubber under the sesamoids to support them. Avoid activities that put your weight on the balls of the feet.
  • Tape the great toe so that it remains bent slightly downward (plantar flexion)..
  • If symptoms persist, you may need to wear a removable short leg fracture brace for 4 to 6 weeks.

Fracture of the Sesamoid

  • You will need to wear a stiff-soled shoe or a short, leg-fracture brace.
  • You may have to wear a J-shaped pad around the area of the sesamoid to relieve pressure as the fracture heals.
  • It may take several months for the discomfort to subside.
  • Cushioning pads or other orthotic devices are often helpful as the fracture heals.



Fungal Infections

What is Toenail Fungus?
            Onychomycosis, commonly referred to as toenail fungus, is an infection underneath the surface of the nail, caused by fungus. You may notice the nail becoming darker in colour and emitting an odour – it is best to start treatment right away to minimize the spread of the fungus to health toenails. If left untreated, long-term effects can impair your ability to walk or run and make it increasingly painful to wear shoes. This type of fungal infection can also be accompanied by a secondary bacterial or yeast infection, in or about the nail plate.


Your feet are especially vulnerable in or around damp areas where you are likely to walk around barefoot, such as swimming pools, locker rooms, or showers. Injury to the nail can increases your susceptibility to all types of infection, including fungal infections. Those who suffer from chronic diseases such as diabetes, circulatory problems or immune-deficiency conditions are especially more prone to fungal infections, and extra protection and preventative measures should be taken accordingly to prevent such infections as they can result in increased severity of the infection, where the risk wouldn’t typically be present in healthy patients. Other contributing factors may include a history of athlete’s foot, or excessive perspiration of the foot, which can be brought on by a number of causes.

Symptoms and Treatment Options

Toenail fungus is often ignored because the infection can be present for months or years at a time without causing significant pain. The disease is characterized by a progressive change in the structure and colour of the toenail, which can lead to an un-aesthetic look about the infected nail.

A daily routine of cleaning over many months may temporarily suppress a mild infection. While the markings that appear on the surface can be filed off, that doesn’t solve the root of the problem, so it is suggested that you follow up with an over the counter liquid antifungal agent. While this might solve the problem temporarily, there is no guarantee that the fungal infection won’t arise again, so keeping a close eye on the nail is important to prevent any further spread of the infection. You should visit a podiatrist when you notice any discolouration, thickening or deformity in your nails. The earlier you seek the help of a professional, the greater your chance of getting your nails healthy again.


Treatments vary depending upon the nature and severity of the infection. Your podiatrist can detect a fungal infection early, and can prescribe you the best treatment option for your case.


Proper hygiene and regular inspection of the feet and toes are the first and best lines of defence against fungal infections. Clean and dry feet resist disease.

  • Wash your feet with soap and water, remembering to dry thoroughly.
  • Wear shower shoes when possible in public areas.
  • Change shoes, socks, or hosiery more than once daily.
  • Clip toenails straight across so that the nail does not extend beyond the tip of the toe.
  • Wear shoes that fit well and are made of materials that breathe.
  • Avoid wearing excessively tight hosiery to decrease moisture.
  • Wear socks made of synthetic fiber that “wicks” moisture away from your feet faster than cotton or wool socks do.
  • Disinfect instruments used to cut nails.
  • Disinfect home pedicure tools.
  • Don’t apply polish to nails suspected of infection (those that are discoloured, for example).


Cavus Foot (High Arch Foot)

What is Cavus Foot?
Cavus foot is a condition in which the foot has a very high arch. This high arch causes an excessive amount of weight to be placed on the ball and heel of the foot when walking or standing, leading to a significant amount of discomfort, pain, and damage to the health of the foot as time progresses.

Causes of Cavus Foot
Cavus foot is often caused by a neurologic disorder or other medical condition such as cerebral palsy, muscular dystrophy, polio or stroke. In other cases, more often of the time, the condition is related an inherited structural abnormality.

An accurate diagnosis for the cause of the issue is important in determining the future course it will take. If the high arch is to a nerologic disorder or other medical conditions, it is very likely that the condition will progressively get worse. However, in cases of inheritance, the disorder usually doesn’t change in appearance.

The arch of the foot will appear higher even when standing. In addition, one or more of the following symptoms might be present, such as:
– Hammertoes or claw toes
– Calluses on the balls, sides or heals of the feet
– Pain when walking or standing
– An unstable foot due to the heel tilting inwards, leading to increased ankle sprains
Some people with this condition may also experience foot drop, weakness of the muscles in or around the area of the arch as a result to the dragging of the foot when taking a step.

Diagnosis and Treatment Options
Diagnosis would include a review of the patient’s family history and any and all medical conditions that the patient has. An accurate diagnosis is important because it will help determine the treatment option that’s right for the specific case. Treatment options will vary, but include:
– Orthotic devices that fit into the shoe provide stability and cushioning
– Shoe modifications such as a high-topped shoe to support the ankle
– Bracing to keep the foot and ankle stable.

Visit your local podiatrist for the more details, and to set up a treatment option that is right for you.

Charcot Foot

What is Charcot Foot?
Charcot foot is a condition caused by weakening of the bones in the foot that can occur in people who have significant nerve damage (neuropathy). The bones are weakened enough to actually fracture, and with the continuation of walking and movement, the foot eventually alters its shape. As the disorder progresses, the joints collapse and foot takes on an abnormal shape.
This is a very serious condition that can lead to severe deformity, disability and even amputation. Because of its seriousness, it is important that patients who have neuropathic conditions – such as diabetes – take preventative measures and seek immediate attention if signs or symptoms start to appear.

Charcot foot develops as a result of neuropathy, which decreases the sensation of the foot and the ability to feel temperature, pain, or trauma. Because of the diminished sensation, the patient may continue to walk – making the injury worse. As such, people with neuropathic conditions (especially those with long standing diagnosis) are at risk for developing Charcot foot. Likewise, neuropathic patients with a tight Achilles tendon have been shown to have an increased tendency to develop Charcot foot.

Symptoms and Treatment Options
Symptoms of the disease include warmth to the touch of the affected area, redness accompanied with swelling, and/or pain and soreness of the foot area.

There are several non-surgical treatment options for those suffering from Charcot foot, consisting of:
– Immobilization either via a cast or brace, with the assistance of a wheelchair or crutches, to prevent damage of the weakened bone structure so that it can begin to repair itself.
– Custom shoes and braces with special inserts can be used to help the healed bones take on daily                 activities – as well as prevent a reoccurrence of the condition
– Activity modification to prevent a repeat of trauma to both the feet. A patient with Charcot in one               foot is more likely to develop it in the other, so measure must be taken to protect both feet.

Preventive Care
The patient can play a vital role in preventing Charcot foot and its complications by following these measures:

  • Keeping blood sugar levels under control can help reduce the progression of nerve damage in the feet.
  • Get regular check-ups from a foot specialist
  • Check both feet every day—and see a foot specialist immediately if you notice signs of Charcot foot.
  • Be careful to avoid injury, such as bumping the foot or overdoing an exercise program.

Rheumatoid Arthritis of the Foot and Ankle

Rheumatoid Arthritis of the Foot and Ankle

Rheumatoid arthritis (RA) is a systemic disease that attacks multiple joints throughout the body. About 90 percent of people with rheumatoid arthritis eventually develop symptoms related to the foot or ankle. Usually symptoms appear in the toes and forefeet first, then in the hindfeet or the back of the feet, and finally in the ankles. Other inflammatory types of arthritis that affect the foot and ankle include gout, ankylosing spondylitis, psoriatic arthritis and Reiter’s syndrome.

The exact cause is unknown but there are several theories. Some people may be more likely to develop the condition because of their genes. However, it usually takes a chemical or environmental trigger to activate the disease. In RA, the body’s immune system turns against itself. Instead of protecting the joints, the body produces substances that attack and inflame the joints.

What are the symptoms of rheumatoid arthritis?

The most common symptoms of RA in the foot are pain, swelling and stiffness. Symptoms usually appear in several joints on both feet. You may feel pain in the joint or in the sole or ball of your foot. The way you walk may be affected. You may develop corns or bunions, and your toes can begin to curl and stiffen in positions called claw toe or hammer toe.

If your hindfoot (back of the foot) and ankle are affected, the bones may shift position. This can cause the long arch on the bottom of your foot to collapse (flat foot), resulting in pain and difficulty walking.

Because RA affects your entire system, you may also feel feverish, tire easily and lose your appetite. You may develop lumps near your joints, particularly around the elbow.

How is rheumatoid arthritis diagnosed?

Sometimes arthritis symptoms in the foot are the first indication that you have RA. Your doctor will ask you about your medical history, occupation and recreational activities, as well as any other persistent or previous conditions in your feet and legs. The appearance of symptoms in the same joint on both feet or in several joints is an indication that RA might be involved.

If you’ve already been diagnosed with RA, you should be aware that the disease will probably spread to your feet and ankles. Watch for early signs such as swelling and foot pain.

What is the treatment?

Many people with RA can control their pain and the disease with medication and exercise. Some medications, such as aspirin or ibuprofen, help control pain. Others, including methotrexate, prednisone, sulfasalazine and gold compounds, help slow the spread of the disease itself. Your chiropodist can suggest special shoes. If your toes have begun to stiffen or curl, you should wear a shoe with an extra-deep toe box. You may also need to use a soft arch support with a rigid heel. In more severe cases, you may need to use a molded ankle-foot orthotic device, canes, or crutches.

Exercise is very important in the treatment of RA. Your chiropodist can provide recommendations specific to you, upon analysis of your feet.


What is a Bunion?

A bunion (also referred to as hallux valgus or hallux abducto valgus) is often described as a bump on the side of the big toe. However, the visible bump on the toe is reflective of changes to the bone framework of the front part of the foot. The big toe leans into the second toe, rather ten pointing straight ahead. This throws the bones out of alignment, producing a bunion, noted as a bump.

Bunions are a progressive disorder. They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which becomes increasingly prominent. Symptoms usually appear at later stages, although some people never have symptoms.


Although bunions themselves are not inherited, a certain foot type which is inherited can make a certain person more prone to developing bunions. With the progressive nature of bunions, people can develop any of the symptoms listed below as the condition gets worse. While wearing shoes that crowd the toes together won’t create bunions, it can make the deformity of the toes progressively worse, allowing for symptoms to appear sooner.


Symptoms, which occur at the site of the bunion, may include:

  • Pain or soreness
  • Inflammation and redness
  • A burning sensation
  • Possible numbness

Symptoms occur most often when wearing shoes that crowd the toes, such as shoes with a tight toe box or high heels. This may explain why women are more likely to have symptoms than men. In addition, spending long periods of time on your feet can worsen the symptoms of bunions.

Non-Surgical Treatment

Sometimes observation of the bunion is all that’s needed. To reduce the chance of damage to the joint, periodic evaluation by the chiropodist is recommended.

In many other cases, however, some type of treatment is needed. Early treatments are aimed at easing the pain of bunions, but they won’t reverse the deformity itself. These include:

  • Changes in shoewear. Wearing the right kind of shoes is very important. Choose shoes that have a wide toe box and forgo those with pointed toes or high heels which may aggravate the condition.
  • Padding. Pads placed over the area of the bunion can help minimize pain.
  • Activity modifications. Avoid activity that causes bunion pain, including standing for long periods of time.
  • Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
  • Icing. Applying an ice pack several times a day helps reduce inflammation and pain.
  • Injection therapy. Although rarely used in bunion treatment, injections of corticosteroids may be useful in treating the inflamed bursa (fluid-filled sac located around a joint) sometimes seen with bunions.
  • Orthotic devices. In some cases, custom orthotic devices may be recommended and provided by the chiropodist.

Athlete’s Foot

Athlete’s foot is classified as a skin infection caused by fungus. Fungus commonly attacks the feet because it thrives in dark, warm, and wet environments, such as shoes, and socks. These fungal infections are most common in warm weather, when feet tend to perspire a lot more.

Fungus thrives in damp areas, such as swimming pools, shower areas, and locker rooms. Athletes commonly have sweaty feet and use the facilities where fungus is found, thus commonly termed “athlete’s foot”

Athlete’s foot usually produces itchy, dry, scaling skin. It is commonly seen on the soles of the feet and in between the toes. In advanced cases, inflammation, cracks, and blisters may form; an infection caused by bacteria can also occur. The fungus can spread rapidly through other areas of foot, including the toenails. Here, good foot hygiene can prevent the spread of fungus. Visiting the chiropodist can provide you with the proper information required for treatment and care options available to you.

Plantar Wart (Verruca Plantaris)

What are Plantar Warts?

A wart is known as a small growth on the skin that develops when the skin is infected by a virus. Warts can develop anywhere on the foot through contact with an infected area (typically, during a visit to a public pool, or through public showers).

What types of Plantar Warts Are There?

There are two dominant types of plantar warts:

–        Solitary Wart: a single wart that often increases in size and eventually multiples forming additional, smaller warts around the infected surface

–        Mosaic Wart: a cluster of small warts that are growing closely together in one specific area. Mosaic warts are typically more difficult to treat then solitary warts

Causes and Symptoms

Plantar warts are caused by direct contact with the human papilloma virus (HPV), which is the same virus that causes warts on other areas of the body. These strains of HPV are harmless, but can cause severe pain and are aesthetically unappealing to most people.

Plantar warts have similar characterisitcs of other warts; they are typically associated with the thickening of the skin. However, plantar warts are usually associated with pain, either through direct pressure as a result of walking or standing, or through addition of pressure, such as by pressing or squeezing along the sides of the warts. In addition, the key distinctive feature of plantar warts is tiny black dots that are actually dried blood contained in the capillaries. They are found on the surface of the wart and usually can be seen by the naked eye.

Characteristically, plantar warts grow very deep into the skin. Usually this growth occurs slowly, with the wart starting off small and becoming larger over a period of time. Typically warts could go away after several years, but most often, because they grow very deep into the skin, will grow uncontrollably until treated appropriately.

Diagnosis and Treatment

To diagnose a plantar wart, the chiropodist will examine the patient’s foot and look for signs and symptoms of a wart. The goal of treatment is to remove the wart completely, through any one of the following methods:

–        Topical treatments

–        Cryotherapy (freezing)

–        Acid treatments

–        Or a small surgery to remove the wart

Although there are many folk remedies for warts, patients should be aware that these remain unproven and may be dangerous. Patients should never try to remove warts themselves. This can do more harm than good.