Bartholomew Way Clinic » Conditions Treated

Health Checks for the Diabetic Foot Horsham & Henfield

JonCollins — Mon, 06 Feb 2012 09:56:23 +0000

Health Checks for the Diabetic Foot Horsham & Henfield

What is Diabetes?Diabetes is a condition where the pancreas has either stopped making insulin, doesn’t make enough insulin or makes the wrong type which doesn’t work. You can either have Type I or type II diabetes, although they are both slightly different in the disease process, what is important is that they both have the same effects on the body and most importantly to myself as a podiatrist THE FEET!!!

It is therefore impossible to mention podiatry without mentioning diabetes. Diabetes can effect the feet in a wide number of ways, Diabetic foot health checks include;

Neuropathy- which means loss of sensation which usually starts off in the feet, but can also effect the hands- so you are therefore unable to recognize or prevent injury to the feet.
Poor circulation- cramps in the calf, change in colour of the feet/ legs, the temperature of the feet maybe either extremely cold or extremely hot
Decreased resistance to infection- which can be problematic if the foot is injured in anayway.

And what do you have to do??

Check your feet morning and night, looking for anything out of the ordinary which may include heat, redness, swelling, pus, around a cut, or even a cut that doesn’t have these signs. If you notice any of these signs then put a dry dressing on the wound and come into clinic as soon as possible.
moisturise the feet x2 daily. taking good care of the skin will go a long way to keeping it in tact and preventing any infection going into the feet
Make sure your shoes fit well
Don’t walk around the house or outside barefoot
Have regular exercise
Eat the right foods and keep your blood sugar under control your HbA1C needs to be 6.5% ideally.
Have your feet checked by a podiatrist at least once a year.

100 people a week lose a limb in the UK through diabetes (Diabetes UK 2009). This figure is ever rising and with simple podiatric monitoring and care we hopefully can prevent this figure including patients all over the country, the world, and in those of you with diabetes who can come in and see me at either Bartholomew Way Clinic in Horsham or Paddocks Healthcare in Henfield!!

If your reading this now and you think well I have diabetes but I don’t have any of these problems, well that’s fantastic, but it is worth seeing a podiatrist at least once a year to get a full check over of your lower limb health, incluing your nerves, your blood supply, your skin integrity and range of motion of your joints.

Key points if you think you have diabetes but are unsure?

Eating more than usual
Drinking more than usual
Feeling tired more than usual
Feeling pins and needles in the hands and feet
horrible smell when you pass water

Plantar Fasciitis Treatment

JonCollins — Fri, 03 Feb 2012 12:57:33 +0000

Plantar Fasciitis Treatment

What is plantar fasciitis?
Plnatar fasciitis is a common condition that causes pain on the bottom of your foot, although the pain is usually localised to either the ball of the foot or the middle of the heel, the pain can be anywhere underneath. As can be seen by the picture where pain can be felt anywhere along the red line!!

Signs and Symptoms of Plantar Fasciitis!!

The diagnosis of plantar fasciitis is usually made by clinical examination, along side certain key signs and symptoms that are associated with planter fasciitis.So do you think you have plantar fasciitis? Below is a list of positive clinical examinations along side the most common reported signs and symptoms;

Pain on the undersurface of the foot (usually on the middle of the heel bone, or on the ball off the foot in the middle)
Pain first thing in the morning and pain after periods of sitting for a long time
less stiffness and pain after walking around for a while

What causes plantar fasciitis?
It is caused by straining the plantar fascia that supports the arch, repeated strain can cause tiny tears in the plantar fascia that can lead to pain and swelling. It is important to get planter fasciitis resolved very quickly, obviously because of the pain, but also because if it is left for long periods of time then it can become chronic in nature and be harder to fix than if it merely happened a few days ago. But never fear there are things we can do if it has been there for a long time!!!

Below is a list of the most common causes of plantar fasciitis!!

your feet have a tendancy to roll in and look like your arch drops, this is known as excessive pronation
you have high arches
you have a flat foot
you have a job that means your on your feet for long periods of time
you are carrying a few extra pounds
you wear shoes that have minimal support in terms of a thin sole or slip on shoes, or they are worn out
you have tight muscles in the calf (back of the leg)

How is it treated?
If your reading this and you think well I’ve tried a few of these online treatments and nothing is working, it is important to remember that different treatments work well for different people, and no one single treatment works well in isolation. Plantar fasciitis needs to be treated in various different ways to really repair the plantar fascia in as short amount of time as possible.
Here is a few tips to try to repair the plantar fascia…….

Try and take a break from activity for a while, give your feet a rest
To reduce the pain and swelling try topical ibuprofen, or icing the under surface of the foot
Calf’s need to be stretched, in order to feel the benefit of the stretch, it needs to be held for at least 30 seconds (ideally 45 seconds). This needs to be done twice a day
When you wake up in the morning spend 30 seconds massaging along the length of the heel
Ideally get a new pair of shoes
It is also important to see what is going on with the structure of your foot, and see if this will cause you to have plantar fasciitis in the future or other conditions associated with the feet, some patients get an alleviation in symptoms with the stretching and tips above, however it may come back due your foot structure not being in the ideal place… If you are concerned about this then please don’t hesitate to give me a call and come in.
we offer many more methods for plantar fasciitis treatment…… just call in and have a chat!!!

Hopefully this helps, if you have any questions about any of the information or similarly any other problems associated with your feet then dont hesitate to get in touch!!!!

Chiropody

JonCollins — Fri, 03 Feb 2012 09:41:01 +0000

Chiropody is a very misleading title. A chiropodist is someone who deals with anything to do with feet, and well a podiatrist is….. someone who deals with feet as well.

There is no real difference between a chiropodist and a podiatrist,,,, however over time with Podiatry becoming a more familiar term used, Chiropody is what we do very very well, these include

nail care
fungal nails
thickened nails
corns
callus (hard skin)
fungal skin infections
dry cracked heels

In some patients this is needed, if you cannot bend down, if you cant see, if you have other medical conditions that mean the feet have to be checked regularly, such as diabetes and rheumatoid arthritis.

HOWEVER some of you may merely want to treat yourself to getting your hard skin removed and your nails done, this is absolutely fine.

Here is a picture of a patient I saw who really needed chiropody care. Don’t let it get to this stage………

This is what it can look like just after 30 minutes and a little care and attention……

So whatever the reason why not give me a ring, drop me an email or come on in!!!

Nail Surgery- Ingrown toenail treatment

JonCollins — Tue, 31 Jan 2012 12:23:02 +0000

So what is nail surgery / ingrowing toenail treatment?

This page will hopefully tell you the need to know the facts!

We have lost the big words and the terminology that isn’t important.

What I do want to talk about is:

Are you suitable for treatment?
What does it entail?
What are the benefits and what are the negatives?
…and much more

But first of all lets forget about that word ‘SURGERY’!! Surgery to me means…. ‘put to sleep, very painful, dangerous, invasive’… all of which the procedure for ingrowing toe nails is not.

So what does the procedure entail?
The procedure involves the removal of the side of the nail that is causing you pain and digging into the side of the skin. Some of you maybe thinking that its happening on both sides of the nail and sometimes both sides will have to be removed.
Finally some of you maybe thinking that my nail is so curved I can’t even see the edges and it looks very pinched like the one below:

So lets start at the beginning. If you have an ingrowing toe nail and you need to see a chiropodist/ podiatrist, once again some of you maybe thinking my toe looks a little infected. It looks red, pus is coming out, its swollen, its hot to touch and of course its very painful. These are all the cardinals signs of infections, we can write to your GP to get them to prescribe some antibiotics to take away the infection quickly. Some of you wont have an infection and will have an ingrowing nail, this is when we merely discuss in detail what the procedure entails, if you are eligible and then lets just book you in.

So who is eligible for the procedure?

There are some patients who are what we called contra-indicated for the procedure, what this means is there is a small number of people that depend on their medical history cannot have the procedure, however these people are few and far between and can be screened at the initial consult.

So what do we do?

The procedure entail local anaesthetic being put either side of the big toe to make the toe go numb so you wont be able to feel anything.
The toe is then washed and an antiseptic is applied all over the area to prevent any further infections
The actual procedure differs depending on what is done, however it usually involved removing part or all of the nail
Once the offending nail is removed a chemical called phenol is applied, this is what stops the nail from growing back
The nail is then dressed with a huge dressing to prevent any further trauma or infection getting in.
We then get you back within a day to redress and make sure your all ok!!

If you have any further questions regarding nail surgery/ procedure or anything else then please don’t hesitate to get in touch:

Call us on (01403) 276272 or contact us here.

Heel Pain

JonCollins — Mon, 23 Jan 2012 12:24:08 +0000

When presented with heel pain in a clinic it means various different things to myself as a podiatrist however to you as the patient it just means pain and thats why you are reading this or coming in to see me. When anyone types ‘heel pain’ into a search engine the main search results points to a condition called planter fasciitis. Planter faschiits is a very common condition for all age groups and I’m sure we all have known someone who has had it in the past.

However it is not always planter fasciitis and may be any number of other conditions, for example;

Heel spur
posterior tibial tendon dysfunction/ pathology
Achilles tendon pathology
Tarsal tunnel syndrome
Heel pad atrophy (reduction in fatty padding on heel)
Reiters Syndrome
Gout
Heel fracture
Of course planter fasciitis
the list is almost endless
All of these should you have one I would explain in detail, the point I am trying to raise is that the foot is so very very complex and can have damage to so many different areas that surround the foot and in particular the heel.

Heel Spur

JonCollins — Mon, 23 Jan 2012 12:20:54 +0000

Interesting patient today with a possible heel spur!!

So what is a heel spur?- A heel spur is small extension of bone that extends beyond the normal dimensions of the heel bone (calcaneus). The most commonest place for a heel spur is on the bottom of the foot in the middle of the heel, usually as a result of ongoing planter fasciitis but can also present on the inside part of the heel and also insertion in to the achilles tendon, as a result of pathology associated with the achilles tendon, so if the tendon has been damaged and isn’t as long as it should be then it can constantly pull on the heel bone and cause a heel spur.

Sometimes these heel spurs can be big enough to palpate however usually an X-ray is needed to make sure the diagnosis is the correct one.

So today saw a patient with a suspected heel spur in the middle pat of the heel bone that had most probably come about due to the patients history of having planter fasciitis for sevral years.

I have sent the patient off for an X-ray today and modified his orthotics (shoe inserts) by removing the middle part of insole to stop the insole pressing on the suspected heel spur….. this was greeted with immediate relief.

Lets see in a few weeks what the results are of the X-ray and I will keep you posted…………To Be Continued………

Any questions about heel spurs or you think you may have then feel free to ask for more advice.

Regards

Jon

Gait Analysis

JonCollins — Tue, 17 Jan 2012 15:59:43 +0000

So what is Gait Analysis??
Gait is simply the way in which we move our whole body from one point to another. More often than not we may also run, skip, hop, waddle, jump and any way you imagine.
Gait analysis is a method used to assess the way we walk or run and to highlight/ if any biomechanical abnormalities. Having the ability to move efficiently and having a “good” “normal” “neutral” “fluid” gait is important in avoiding injuries. It is crucial to have joints capable of providing good quality, and good direction of movement, in addition to having muscles capable of producing sufficient force is vital to generate an efficient gait cycle. If a joint is stiff whether due to trauma, tight muscles, osteo arthritis, rheumatoid arthritis, psoriatic arthritis or any other condition that effects the joints then the body must find ways of compensating for problem, leading to the biomechanical deformities, and therefore paving the way to show purpose for a biomechanical assessment by one of the Podiatrists within our team.

Electrosurgery for removal of verrucae and corns

JonCollins — Tue, 17 Jan 2012 15:34:24 +0000

Over the last 10 years a form of electrosurgery called electrodesiccation has been used in podiatry to treat long standing corns and verrucae with good results.

Quite simply: Electrodesiccation is completely painless this is achieved by an injection of local anaesthetic which is given before treatment begins. An electrocautery unit looks like this:

Our electro surgery unit

The probe is held against the corn or the verrucae. The energy from the radiowaves causes evaporation of the cell contents, which then forms a hard plaque that is then removed with a scalpel, this technique enables the corn to be removed a lot deeper than usual. More often than not the corn and more so with the verrucae can be removed permanently.

The Procedure

On the day of your operation you should eat and drink as normal. You will be awake for this procedure, which involves the administration of local anaesthetic injection adjacent to the nerves supplying the area to be treated. The radiolase is then used to remove the infected tissue. Antiseptic dressings are applied and a pressure-relieving pad applied (if the area is weight bearing). You should ALWAYS arrange for transport as you will not be allowed to drive on the day of this procedure.

The appointment time required for this treatment is one hour to one and a half hours. It is advisable to rest the foot for the remainder of the day of operation and the following day as much as possible, however most patients are able to return to work after 24 hours. A follow up appointment 1-2 days later is required for the wound to be redressed. The wound must be kept covered and remain dry for 1 week.

There is some post-operative discomfort, which is usually relieved with ibuprofen. The wound is usually dry with a scab formation within 2 weeks. Healing takes place over the next few weeks depending on how much rest you are able to take and provided the wound remains free from infection. The wound normally forms a scab 10-14 days post-op depending on the size of the wound. You may have to return to your podiatrist in four to six weeks to have any remaining scab reduced.

The majority of verrucae cases are completely eradicated in one treatment (94%) with the remaining (6%) lesions requiring a second treatment.

If you require any more questions on electrosurgery/ electrodesiccation then please don’t hesitate to get in touch and have a chat with one of the team, Jon, Mo, Gary or Charles on 01403 276 272, or ask a question here.

Nail Problems

admin — Tue, 06 Sep 2011 19:58:45 +0000

As podiatrists we encounter a lot of problem nails , that many of our patients can be quite embarrassed about.

Call us to help you with your toenail problem. (01403) 276272

A common misconception is that there may be a fungal infection present, however many discoloured nails do not have a fungal cause. (which can also mean a long wait to see if an anti fungal treatment has worked)

We can’t promise any miracle cures, but in a very realistic way we may be able to markedly improve the appearance of your ‘ugly’ nail or nails.

A deformed nail may be the result of trauma (stubbing, dropping something on or otherwise injuring the nail) .

We often come across these nails and quite a few have shown a greatly improved regrowth , after a cautious chiropody care.

Many people, without realising it, are putting a significant pressure on the nail, from footwear and activities. We hope that with the right approach it may be possible to rehabilitate your nail(s)

Treatment regimes can include :-

Thinning and reshaping the nail .
Removal of as much infected/affected nail as possible (painless).
Discussion of appropriate therapies (anti-fungal lacquers and/or oral medications where appropriate).
Discussion of realistic expectations and underlying factors that may affect the nail growth.

Things may not be as bad or as hopeless as you think.

We guarantee that the treatments we provide involve as little pain and embarrasment to you as possible (and for all you court shoe wearers out there we promise not to nag you too much!)

Call reception on 01403 276272 to book an appointment or request a call back for one of the podiatrists.

Treat that Verruca?

admin — Thu, 28 Jul 2011 09:10:08 +0000

Painful verruca on a heel

Verrucae (the plural of verruca) produce skin lumps that can sometimes be uncomfortable , usually we find that they don’t cause much pain and they have a life span, with time they may go on their own .

Anyone can contract them, at any age, but we often seen cases where there has been no cross-infection within the family home (even after a long time) .

They appear to need a scratch or graze of the skin in order for the virus to gain entry to the skin . They live in the part of the skin that is not in contact with the blood supply – so the body might not recognise the infection.

The skin is an excellent barrier against infection so with normal foot hygiene and cleanliness around the home and you usually are safe from cross-infection.

To treat or not to treat? – That is the question…

They can look horrible and they can cause pain . Our primary goal of any treatment is to reduce pain and improve the aesthetic appearance.

Treatment of verrucae is never 100 % successful – some patients problems resolve very quickly, others can be seemingly resistant to any treatment.

Treatment options can include :

Leaving it alone.
Guided self-management using over the counter medicaments and abrasion with occasional returns to the podiatrist for reduction of hard skin to improve effectiveness.
Clinical application of suitable acids and cryotherapy (freezing with liquid nitrogen , carbon dioxide or nitrous oxide)
Insoles and shoe advice to reduce pressure and pain of verrucae on the weightbearing surfaces of the foot.
Minor surgeries under local anaesthetic.

Call us on (01403) 276272 to book an appointment….

We should be always be cautious about treatment, children are often affected and as a parent it can be worthwhile discussing your child’s case as to what action you should take . The treatment could be worse than the condition !

If you are pregnant , or have a medical condition; diabetes or other conditions that affect your immune response, we need to approach treatment with care.

Call us on (01403) 276272 to book an appointment for assessment and treatment where necessary.