Bartholomew Way Clinic

We now offer Custom-made Orthotic Sandals from Birkenstock

We are very pleased to be able to offer custom-made Birkenstock sandals made to a foam cast or 3D laser scan of your feet.

The footbeds to the sandals are computer milled to your footshape to ensure the most comfortable sandals you have ever worn.

You can choose from unisex styles Arizona or Milano and ladies-only styles Gizeh or Granada.

Book an appointment for a scan and choose your style and colour and your bespoke sandals should be on your feet in five working days*.

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Get 25% off your first Consultation with a Podiatrist

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Corns and Callus Treatment

Corns and Callus

Corns and callus are one of the most common problems seen by podiatrists everyday. There can be varying degrees of callus from minimal callus under the ball of the foot, to an infected ulcer that develops as a result of thick callus that damages the skin.

Corns and callus are pathologically the same, what that means is the skin has thickened in response to pressure, callus is a diffuse thickening of the skin and a corn is a more focal thickening.

What Causes corns and callus?

Are caused by too much friction, pressure, or shearing, or all of them. The pressure that occurs stimulates the skin to thicken in order to protect itself, but if the stimulation remains the callus build up gets great and becomes very painful.

The pressure, friction or shearing can come about due to;

• tight footwear
• toe deformities such as hammer toes cause increased pressure usually due to rubbing on the shoes
• bony prominence
• reduction in fatty padding on the ball or heel of the foot (this occurs naturally as we get older)
• biomechanical deformity, which can cause pressure under different areas on the bottom of the foot- for more information have a look at my page on biomechanics!!!

KEY POINT- corns or callus are usually there as a symptom of an underlying condition, so it is better to try and understand and treat the cause rather than just the symptoms

Corns and Callus Treatment

Self-Treatments for corn and callus removal?

• a file or pumice stone to reduce in-between podiatry appointments, little and often (under advise from your podiatrist)
• a moisturiser with urea (urea helps in breaking down the hard skin)
• application of padding to offload areas of high pressure

What can a Podiatrist do for you in clinic?

• assessment to see what is causing the corn/ callus
• use of padding to offload pressure
• footwear advice for style and fitting
• use of orthotics to relieve pressure under the foot (long term treatment)
• As I have previously written it is important to see a podiatrist if you have corns and callus AND also diabetes or poor circulation.

Any questions about any of the information above then don’t hesitate to drop me a line on 01403 276272.

Verruca or Wart? What is this on my foot?

A verruca is a wart that is usually found on the sole of the foot, but may also appear around or between the toes. In the early stages of a verruca, it is small and dark with a puncture mark or demarcated area in the skin, where you can see that the lines in the skin curve around the verruca. In time it may become rough and bumpy with a cauliflower like appearance and may develop little black spots in the middle, which are little blood vessels being drawn up through the skin, close to the surface.

A verruca may have a large centre with lots of little clusters of small warts around.

A verruca is caused by the human papilloma virus (HPV), it is a very contagious virus and can only be caught by direct contact. HPV thrives in warm, moist environments such as swimming pools, changing room floors and bathrooms.
Although it may appear harmless to begin with, if it is not treated it can cause sharp burning pain if it is in a weight bearing area, such as the ball or heel of the foot.

If you would like a chat about your problem or book an appointment please don’t hesitate to get in touch and call on 01403 276272, or contact us through the contact form HERE

Verruca Treatments

So how is a Verruca treated?
There are no right answers when treating a verruca, there are lots of home treatments and lots of treatments that podiatrists like to use, but no single treatment stands out as the best.
Examples of verruca treatments can include;

• Salicylic acid (most research behind proves good results)
• Silver nitrate
• Clinical Cryotherapy
• Duck tape (in conjunction with other treatments to macerate the tissues, essentially making them go soggy)
• Marigold therapy
• Home freezing treatments

What if I have tried all of these elsewhere and they haven’t worked for me?

Once all other conservative measures have been tried and the verruca is still present after two or more years then it is worthwhile trying electrosurgery.
Electrosurgery is carried out under local anaesthetic by a podiatrist specially trained in electrosurgical techniques using a special surgical unit. An electric current is sent down a small probe which is responsible for the evaporation of the cell contents and destruction of the virus-containing tissue on the foot. For more information on this subject follow the link for Verruca Surgery.

It is important to point out that 65-80% of verruca cases in children and young adults will resolve on their own. Leaving the verruca well alone and allowing it to get better by itself is an option that may be considered by one of our podiatrists. Treatment will be indicated if;

• The verruca is painful
• It is overlying a weight bearing area, such as ball of foot or heel
• It has been there for 2 or more years
• You simply don’t like the look of it
• You are concerned about it getting worse

What are the benefits of seeing a podiatrist at Bartholomew Way Clinic about my verrucae?

1. Diagnosis: Examination is worthwhile for peace of mind. Are you sure it’s definitely a verruca? It is therefore important to rule out more sinister skin conditions.
2. Experience: All four of the podiatrists have treated a large number of verrucae over the years in an effective and pain free manner.  We know what works and what doesn’t. We know what treatments work with different types of verrucae. We definitely know what one looks like.
3. Results: We have great results in reducing the size and pain of verrucae. We often recommend a course of three intensive treatments of cryosurgery to reduce the verruca in size.  Alternatively we may simply offer advice and support for you to self-treat the verruca more effectively at home, with reviews and monitoring appointments. Return appointments to reduce the verruca periodically are often worthwhile. As mentioned in ‘treating a verruca post’ if conservative care fails then electrosurgery may be indicated.

For information on what a verruca is, please refer to Verruca or Wart? What is on my foot ?

If you would like a chat about your problem or book an appointment please don’t hesitate to get in touch and call on 01403 276272, or contact us through the contact form HERE

Over Pronation: What is it?

What is over-pronation?

Depending on what you read around 60-70% of the population suffer from excessive or over pronation, but what determines what is ‘over or excessive’ when referring to pronation, there is no real criteria that says what is considered normal or more importantly abnormal. It is also important to point out that everyone pronates in their normal walking pattern, but its when we pronate to much that there is an issue, which can lead to a pathology with the foot or lower limb.
There is however a variety of theories of foot function:

• Sub-talar joint neutral theory
• Three rockers theory
• Sub-talar joint axis theory
• Tissue stress theory
• Kinetic chain theory

These theories should be applied by your podiatrist when looking at how the foot functions and if there is any pain present, and thus how to combat the pain.

It is possible for the foot to appear normal when sitting down with a clear arch present under the foot, however when you stand the arch becomes reduced, when walking the foot appears to roll inwards, this is what we call ‘over pronation’.

• Many people who ‘over pronate’ never have any issues throughout their lifetime, however some people have problems when they are much older and some people can have injuries at anytime in their life.
• Some examples of painful foot conditions that are present as a result of over pronation are; heel pain, plantar fasciitis, heel spurs, achilles tendonitis/ tendonosis, posterior tibial tendon dysfunction, in addition other parts of the body can also be affected such as knees, hips, lower back, and even the neck.
• There are many other causes of flat feet, these include obesity, pregnancy and or repetitive stress going through the feet, which can cause structures to get damaged.
• Over-pronated feet can also cause a complete loss in arch and become a flat foot.

Over Pronation Treatment and Prevention

• ‘Over pronation’ can be treated conservatively with orthoses/ insoles that depending on your level of ‘over-pronation’ need to be specific to you.
• Footwear should also been taken into consideration with the correct amount of support and cushioning.
• If there is pain with the foot position then the foot position needs to be addressed as well as the pain, therefore the symptoms need to be treated as well as the cause, usually being the foot position.

This is only touching the surface on what over pronation is; If you have any questions about any of the information above then please don’t hesitate to get in touch!!!

Sesamoiditis Treatment

Sesamoiditis
Is a common pain that affects the forefoot usually located just behind the big toe on the ball of the foot. Sesamoiditis generally means an irritation of the sesamoid bones, which are two tiny bones within the tendons that run to the big toe. Every time you push off when walking or running the sesamoids are involved and eventually they can become irritated, even fractured, because the bones are located within tendons, and thus the tendons can become inflamed as well.

The picture below shows where the sesamoids are located and where you would experience pain:

Cause

• The pain usually begins with a mild ache and increases gradually as the aggravating activity is continued, which may progress to an intense throbbing pain. In a lot of cases there is little or no bruising present.
• One of the largest reasons for sesamoiditis is increased activity suddenly, so it might be you have decided its time to get fit and have jumped straight into it, or you have increased the intensity or slightly changed your workout to run or exercise on different surfaces under foot.
• If you have a reduced fatty padding on the balls of your feet, so there is limited shock absorption there
• If you have in-appropriate footwear, in the same way if you have reduced fatty padding, if you dont have a cushioned trainer then that will also contribute to sesamoiditis.
• Finally if you have a high arched foot then a lot of pressure will travel through the ball of your foot.

Sesamoiditis Treatment

• Minor cases of sesamoiditis warrant a strict period of rest, along with the use of a modified orthoses to reduce pressure away from the affected area, a change in footwear may also be warranted.
• Trainers may also be adapted to offload the pressures away from the foot also.
• The big toe may also be strapped up to prevent any force going through it and also prevent the tendons from working which may be inflamed.
• Of course reduce or stop activity.
• Icing the area and using topical anti-inflammatories will also take down any swelling if there is some present
• While the injury is healing women should wear flat shoes to prevent increased pressure going through the foot.
• If the foot has a high arch then this may be needed to be addressed with orthotics
• If none of the above helps the pain then it will be useful to get x-rays done of the affected area to rule out any other bone involvement in the area.

If  you have any questions about any of the information above then please don’t hesitate to get in touch!!!

Freibergs Infraction Treatment

Freibergs Infraction/ Osteochondritis

• Freiberg’s Infraction is an avascular necrosis usually of the 2nd metatarsal head, this means that there isn’t enough blood supply to the growth plate and is usually caused by repetitive microtrauma, which is why this disorder is common in young athletes between the ages of 15-25 (although this age range varies depending on what you read).
• You are also more at risk if your second toe is longer than your big toe, and it is very painful when the toes are bent back when walking.

So if you have pain and swelling in your second toe, you play a lot of sport and your’ re between the ages above, then keep reading!!!

The above picture shows where pain and swelling will be if you have Freibergs Infraction

Pathology

• May be either unilateral or bilateral (meaning it might be on just one side or both)
• Its ischemia and bone necrosis within the head of a metatarsal (usually the 2nd) leading to a collapse of the articular surfaces and underlying area of subchondral bone, quite simply, due to the repetitive trauma the growth plate and blood supply are damaged which leads to a painful deformed second toe.

Differential Diagnosis

• synovitis
• stress fracture
• osteosarcoma
• mortons neuroma

Freibergs Infraction Treatment

• Treatment tends to depend on the level of bone damage, which can be seen as a result of X-rays that should be obtained.
• Initial management for a mild-moderate freibergs includes proper footwear, with orthotics to offload the affected joint/ joints.
• Activity must be limited to 4-6 weeks
• If symptoms don’t reduce or the damage is significant on first X-ray then cast immobilization must be considered within 3-4 weeks.

Surgery (rare)

• Only used when failure of conservative treatment isn’t successful
• The removal of metatarsal heads may be indicated, once again rare circumstances.

If you have any questions about the information above or you have pain in the second toe or anywhere else in the foot then please don’t hesitate to get in touch!!! 

Retrocalcaneal Bursitis

Retrocalcalneal Bursitis

Retrocalcaneal is a very fancy name, which when broken down means swelling between the heel bone and the achilles tendon.
A bursa is a sack of fluid that sits between a tendon and a bone to help the tendon move smoothly over the bone, with repeated trauma or overuse of the ankle the bursa can become inflamed and cause pain that can radiate up the leg and under the foot.
The condition is usually linked to achilles tendonitis

Signs and Symptoms

• Pain in the heel, especially with walking, running, or when the area is touched
• Tenderness and swelling which might make it difficult to wear certain shoes on the feet.Pain may get worse when rising on the toes (standing on tiptoes)
• Red, warm skin over the back of the heel
• When pressing fingers in both sides of the heel a spongy resistance may be felt.
• Pain may be worse when the ankle is bent upwards, or pain may be worse when you rise on your toes.

At Bartholomew Way Clinic in Horsham we have access to diagnostic ultrasound, as you can see from the image below this is a clear picture of a retrocalcaneal bursitis;

Treatment

As can be seen from the image above the bursa has a thin white line surrounding it. This line shows that the bursa is calcified and hardened and has therefore been there for months even years.

1. Treatment depends on how long the pain has been there and thus how long the bursa has been there.

2. Treatment also depends on whether there is associated tendonitis or tendonosis
1. NB: Tendonitis is acute inflammatory problem and tendonosis is chronic and has been long standing and no longer has an inflammatory process, this is why the treatment differs
3. Treatment also depends where the achilles tendon is damaged, if it is where it inserts into the back of the heel of mid way up the tendon up the leg then this also changes the treatment
4. Treatment also depends on whether there is a partial tear within the achilles tendon, as this will need to be repaired before treatment starts for the retrocalcaneal bursitis.

It is important to point out that everyone is different and they will have a combination of the above pathologies and you all need to be treated differently.

If you have any issues or questions regarding any of the information above. Do you get pain around the back of the heel or in the achilles tendon then please don’t hesitate to come in or contact me on 01403 276272

Convenient opening hours…Need an early chiropody appointment ?

We are open late evening to 7pm on Mondays and 6pm on Wednesdays and Thursdays.

However we are excited to announce that early chiropody appointment bookings are now available with Jon Collins on Thursday mornings from 8am.

Physiotherapy appointments with David Fraser are available everyday from 8.30am.

We also open one Saturday a month (usually the first Saturday) but do call us to confirm.

Book an appointment now by calling us on (01403) 276272 or contacting us on our contact form here.

Click Here to Contact us

A great testimonial from a happy patient

We always aim to care for our patients, the way we would like to be looked after ourselves…

We do achieve this most of the time too!  Thank you for your feedback Mrs B (and for your permission to use it.)

“Thanks very much for the great job of refurbishing my orthotics.
Excellent customer service and really pleased with the results. Will
definitely be using your service in future.

Kind regards.

Mrs B”

If we can help you… Please call us on 01403 276272 or contact us here