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Wednesday, October 23, 2013

Is one leg longer than the other?

Most people are slightly asymmetrical. In fact it is estimated that 90% of people have a leg length discrepancy (LLD). Studies haves shown that the right leg is usually longer than the left. The difference is often negligible and does not need to be treated. The body generally adjusts using several compensatory mechanisms to keep the pelvis level. Some of these compensations take place in the spine, pelvis, hips, knees and even the feet.
If the LLD is too much for your body type and activities, then you may have symptoms in the form of back, hip, knee or foot pain. Depending on the severity of your symptoms one can choose a) not to treat the problem, b) conservative treatment or c) surgical treatment.
Conservative treatment usually involves using ‘lifts’ in your shoes, either in your shoe, or on your shoe, or both. The amount to adjust must be carefully considered because the body has compensated over time. If someone has 2 centimetre difference and symptoms, then the adjustment should not be for the full 2 centimetres otherwise new problems may arise. A graduated approach should be taken and your foot specialist should consider the impact of your other treatments such as physiotherapy and chiropractic.
As a foot specialist I see patients suffering from heel or arch pain which is much worse on one foot. After initial assessment I often see a small leg length discrepancy for which the patient is compensating by pronating the foot on the side with the long leg (which shortens the long leg and levels the pelvis). This pronation is creating the downstream problem of plantar fasciitis. A mild heel lift sometimes reduces the pronation and eases the plantar fascia ligament. It is usually wise to provide leg stretching exercises in conjunction with any ‘lift’ or other orthotic therapy.

Thursday, October 17, 2013

Skin conditions on your foot

Seeing skin conditions or skin irritation on the toes, toenails or foot is a daily event for those practicing podiatric medicine.

The most common irritations are caused by pressure, immune reactions, fungus, viruses, bacteria or parasites. It is important to see a foot specialist if you have a skin problem so that we can determine what the irritation is caused by and therefore decide on the appropriate medication/treatment.

In our experience, most cases are caused by pressure and the skins reaction to pressure. The next most common cause is our own immune system. After that, fungal and viral infections seem to be the culprit.

The foot needs a balance of dryness and moisture. Too much moisture makes a good environment for infections and too dry could lead to cracking and fissuring.

Tip: if you have difficulty drying between your toes after a shower or a swim, spray a little isopropyl alcohol (IPA 50% or IPA 70%) on the tops of your toes – it runs down between the toes and keeps them dry.

Thursday, October 10, 2013

Things you should know before having an ingrown toenail procedure

If you have ingrown toenails and this has been causing pain, swelling and infection for some time, then you may have decided to have a partial or full nail removal. The most common procedure we perform is the PNA w/matricectomy (or partial nail avulsion with phenol or laser matricectomy). While this procedure is relatively minor there are some things you and your foot specialist should know;
If you are pregnant in your 1st trimester, have ischaemia (very poor arterial blood flow in your lower limbs), have been diagnosed with RSD/CPRS (a chronic pain syndrome), or have allergies to local anaesthetics, then you should consider postponing the procedure and trying alternative treatment. In addition, if you have an infection at the site of injection, are under the age of 5, or have porphyria (a disorder which affects heme and the distribution of oxygen in the tissue), then you should also consider conservative (non-operative) treatment.
Your foot specialist should also tailor your procedure and recovery based on other considerations.
Your healing may be affected if you have diabetes, take steroids, have anaemia, leukaemia, autoimmune disorders, connective tissue disorders, kidney disease, liver disease or thalassaemia. The use of a toe tourniquet during the procedure may cause problems if you have Sickle cell anaemia, Raynaud’s or other connective tissue conditions. Healing could also be impaired if you are taking blood pressure medication such as ACE inhibitors, ARBs or have severe calcification of the blood vessels.
While there is little risk in using modern local anaesthetics for this procedure, your specialist should also be aware if you are taking beta blockers, anti convulsants, diuretics, MAOIs, procarbazine or benzodiazepines, or if you have kidney and liver disease. Also if you are under extreme anxiety, let your specialist know.
Conditions like MS and Parkinsons need to be taken into consideration also. Allergies to betadine, iodine, shell fish, chlorhexidine, latex, silver and bandages should also be discussed.
To assess the risk of infective endocarditis (or inflammation, of the inner tissue of the heart) your specialist should ask about your history of heart valve damage, prosthetic heart valves, and any history of rheumatic fever.
To assess the risk of post-op bleeding your specialist should also ask you about anticoagulant and antiplatelet medications, or haemophilia. Adjustments in your medication may be needed prior to the procedure. Also if you are having chemotherapy, treatment for AIDS/HIV or on medication for severe acne or psoriasis, your specialist should know. Other drug or tobacco use should also be candidly discussed.
All of this information should be collected in a medical history and consent for special procedure process. This will significantly increase your chances of a successful procedure. Evidence shows that following standard post-op regimes, this procedure is safe and effective in more than 95% of cases and results in resolution of your ingrown toenail problem.

Wednesday, October 9, 2013

Why do orthotics cost so much?

Why do Prescription Custom Foot Orthotics (PCFO’s) seem to cost so much ?
Chiropodists are often asked this question. Here are some things you should know about PCFOs; In Ontario, the business of selling PCFOs (which are medical devices) is NOT regulated. So anyone can sell them. Chiropodists ARE however regulated by the College of Chiropodists and the province under the Chiropody Act. As such, we are held to strict standards for prescribing and dispensing orthotics. Most insurance companies will only honour your claim if the PCFOs are prescribed and dispensed by regulated health professionals like your family doctor or chiropodist.
The PCFO device itself is only a piece of high tech plastic – so why does it cost so much? These medical devices are designed to treat medical conditions, eliminate, mitigate and/or prevent symptoms from various pathologies and/or biomechanical abnormalities. The education and clinical experience required to assess/diagnose these pathologies or biomechanical abnormalities in a patient requires years of training and experience. In addition, the correct casting of your feet, the writing of a prescription which identifies the type of device and specific accommodations also requires expertise – as does the manufacture of these devices. The total cost should reflect a blend of product and medical service and expertise.
Got any questions – feel free to give us a call at 905-916-3668 or go to