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.

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.



Hammertoe is a condition that develops in the presence of pressure, where the bending of the toes at the joints (one or more at a single time) can lead to problems walking. Hammertoes usually start off as a minor problem, with slight discomfort noticed, and progress as time continues. In the earlier stages, the hammertoe is flexible, and can be treated through non-surgical methods. However, not treating a hammertoe in it’s earlier stages will result in it becoming more ridged and therefore, progressively less responsive to non-surgical treatments.

Because of the progressive nature of the hammertoe, it should be looked after immediately. Hammertoes do not get better on their own.


The most common cause of hammertoe is muscle/tendon imbalance. This toe-bending imbalance is a direct result from a structural change in the foot that may occur overtime in some people. A leading cause in this imbalance comes from inadequate fitting shoes, which forces a toe to bend in a cramped location, for an extended period of time. Occasionally, a hammertoe can steam from earlier drama to the toe. In some people, hammertoes are inherited.


Common symptoms include:

  • Pain or irritation of the affected toe when shoes are worn
  • Corns and calluses on the toes, between two toes or on the ball of the foot
  • Inflammation, redness
  • Bent shape of the toe
  • In severe cases, open sores may form on the top ridge of the toe


Although hammertoes are readily apparent, you should visit your family chiropodist to obtain a thorough history of your symptoms and for a foot examination. During your physical examination, the chiropodist will attempt to reproduce your symptoms by manipulating your foot and will study the shape and bending of your toes.

Hammertoes are progressive – they don’t simply go away, and will get worse overtime. Not all cases are alike – hammertoes can progress more rapidly in some cases then others. Your chiropodist will evaluate your hammertoe, and start you up on a treatment plan that is suited for you.

Non-Surgical Treatments

The most common of non surgical treatments are changes in shoewear and the implementation of orthotic devices that will help control the muscle/tendon imbalance. Splinting/strapping may be implemented to align the bent toe as well.

Consult your chiropodist today!

Achilles Tendinitis


Achilles tendinitis is caused by the overuse of the achilles tendon – which is found in the lower leg as a tissue that connects calf muscles to the heel bone.

This type of injury is found most common, but not limited to, in runners who suddenly increase the intensity or duration of their runs.

In the majority of cases, treatment is relatively simple, at-home care under the supervision of a qualified doctor, with a large focus placed on preventative measures, so that the injury doesn’t occur frequently. A more serious case of Achilles tendinitis can lead to to tendon tears – called ruptures – that may require surgical repair.


The initial pain associated with Achilles tendinitis usually takes the form of a mild ache in the back of the leg or slightly above the heel after running or another form of recreational activity such as basketball. Episodes of more severe pain are usually caused by continuous running or strain placed on the leg. Tenderness or stiffness are also common symptoms, which typically improve with mild, non-strenuous activity.

When should I consult someone?

If your pain is persistent and continuous around the achilles tendon, make sure to book an appointment to have it looked after. Immediate medical attention is required if the pain or impairment of the foot is severe, as it may hint at a torn tendon.

Location Point of Achilles Tendinitis On The Foot


Achilles tendinitis can be the result of repetitive or intense strain on the achilles tendon which, as perviously mentioned, is the tissue that connects the lower calf muscles to the heel bone. It is used continuously while walking, running, jumping or pushing up on your toes.

The structure of the tendon naturally deteriorates with age therefore making it more susceptible to injury.

Further Anatomical Overview of Achilles Tendonitis

Treatment Options

Tendinitis is usually well responsive to self care measures (such as restricting the intensity and duration of recreation activities) but if the pain is persistent, a foot doctor might be able to elevate some of the pain by creating custom orthotics which can relieve strain on the tendon, and provide a cushion that lessens the amount of force exerted on the tendon.

Preventative Options

The shoes you wear while exercising play a large role in minimizing the risk of recreation related injuries. Shoes should provide cushioning for your heels and should have a firm arch support.

Ingrown Toenail

The ingrown toenail is a very common condition that affects all ages but particularly may have devastating effects with diabetic population. There are several causes that may be associated with this condition such as poorly fitted footwear, improper trimming of toenails and involuted (curved) toe nail plates. Usually the 1st toenail is affected but it may appear on any toenail. Read more…