News from the Locker Room
Michael Kinchington & team work with a wide network of sport medicine professionals which they utilize to optimize results for patient outcomes. If you require a second opinion or confirmation of your condition Dr Michael Kinchington PhD is happy to meet with you to assess your condition and refer you to the appropriate health professionals.
Achilles tendinopathy is generally caused by overuse of the affected limb and is more common among athletes training under less than ideal conditions. The Achilles tendon does not have good blood supply or cell activity, so this injury can be slow to heal. The tendon receives nutrients from the tendon sheath or paratendon. When an injury occurs to the tendon, cells from surrounding structures migrate into the tendon to assist in repair. Some of these cells come from blood vessels that enter the tendon to provide direct blood flow to increase healing. With the blood vessels come nerve fibers.
Seeing the team at CFPM for treatment as soon as possible is important, because this injury can lead to chronic condition. We will advise you on the likely cause of your condition, analysis the causative factors and implement a treatment program based upon evidence based medicine. The CFPM works closely with a range of health professionals including sports physicians, physiotherapists, rheumatologists and radiologists who will assist as part of a multidiscipilnary approach when required.
The team at CFPM have an extensive knowledge of footwear.
Dr Michael Kinchington (PhD) is a leading expert on athletic footwear and football boots. He has been a keynote speaker at International Society of Biomechanics Footwear Symposium. This is the leading footwear scientific conference held annually in the world. He has developed the consumer self help guide Shoe Buddy TM and provides international consultancy to sporting organiisations and industry groups on athletic footwear, football boots and industrial shoes.
The Centre has a complete resource of current footwear styles and liaises closely for shoe fitting with Athletes Foot Sydney City store and Macquarie Shopping Centre
Groin pain is a complicated topic that requires a multi-faceted approach. Dr Michael Kinchington (PhD) has an interest in lower extremity biomechanics as a cause of groin pain and rehabilitation of groin injury by gait stabilisation. He has teamed with Dr John Garvey a world leader in Groin Injury. For further information contact the Groin Pain Clinic +61 2 9004 1060 www.groinpainclinic.com.au
HEEL PAIN IN CHILDREN
Growing pains are common in Children especially those who are very active. While the term growing pains is not scientifically accurate, the terminology is often used by families when seeking advice. Heel pain is common in children. They will complain of pain in one or both heels with running, sports or walking, usually at the back of the heel or under the heel. The cause of heel pain in children is a condition called calcaneal apophysitis, usually affecting 8 to 14-year olds.
The team at CFPM have an extensive knowledge of growth plate related conditions of which the heel is a common entity. There are a range of simple interventions which when implemented can relieve heel pain in children.
Pain and numbness at the ball of the foot can be many conditions. Morton's neuroma (also known as Morton's metatarsalgia, Morton's neuralgia, plantar neuroma and intermetatarsal neuroma) is one of the more common entities. The condition is a benign neuroma of an intermetatarsal plantar nerve, most commonly of the second and third intermetatarsal spaces (between 2nd-3rd and 3rd-4th metatarsal heads). This problem is characterised by pain and/or numbness, sometimes relieved by removing footwear.
Foot orthoses comprise a specially fitted insert or footbed to a shoe. Also commonly referred to as "Orthotics" these orthoses provide support for the foot by distributing pressure or realigning foot joints while standing, walking or running. A great body of information exists within the podiatry and pedorthotic community describing the sciences that might be used to aid people with foot problems as well as the impact "orthotics" can have on knee, hip, and spine conditions. As such they are often used by athletes to relieve symptoms of a variety of soft tissue inflammatory conditions, optimise foot-leg biomechanics and assist with injury prevention. They may also be used in conjunction with properly fitted orthopedic footwear in the prevention of foot ulcers in the at-risk diabetic foot.
PLASMA RICH PLATLET THERAPY-The Research
Platelet-rich plasma (PRP) is blood plasma that has been enriched with platelets. As a concentrated source of autologous platelets, PRP contains (and releases through degranulation) several different growth factors and other cytokines that stimulate healing of bone and soft tissue. PRP has been investigated and used as clinical tool for several types of medical treatments, including nerve injury, tendinitis, osteoarthritis, bone repair and regeneration. PRP has also received attention in the popular media as a result of its use in treating sports injuries in professional athletes.
PLANTAR FASCIITIS – HEEL PAIN
The plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes. Plantar fasciitis is a painful inflammatory process of the plantar fascia, the connective tissue on the bottom of the foot.
It is often an overuse condition, but can also be acute in cases where the fibres of the plantar fascia are torn. The condition is very common and last up to two years if not well managed. Longstanding cases of plantar fasciitis often demonstrate more degenerative changes than inflammatory changes, in which case they are termed plantar fasciosis. The suffix "osis" implies a pathology of chronic degeneration without inflammation.
Since tendons and ligaments do not contain blood vessels, they do not actually become inflamed. Instead, injury to the tendon is usually the result of an accumulation over time of microscopic tears at the cellular level.
The condition is commonly associated with long periods of weight bearing. Among non-athletic populations, it is associated with a high body mass index. The pain is usually felt on the underside of the heel and is often most intense with the first steps of the day.
The team at CFPM has extensive experience with the condition. We can offer you a treatment program of self-help through to multi-layered and faceted interventions including orthotics, Shock-Wave therapy and PRP injections.
Runners Knee (Patello-Femoral Syndrome)
Runner’s knee is an overuse injury common with running, jumping and court sports. The basic mechanism of the injury is the mal-tracking of the knee cap upon the knee joint. Of all of the conditions that predispose to lateral tracking of the patella, faulty biomechanics may be the most consistent as well as the most significant.
A common lower limb biomechanical imbalance is the relationship between the foot and the knee. Excessive foot pronation, with flattening of the arch or rolling in of the heel results in internal rotation of the leg, which changes the angular alignment of the knee relative to the leg and foot. Injury occurs in two broad circumstances -- either when the patella is forced with excessive pressure against the underlying femur or when it tracks excessively on one side or other of the groove. In either case, this would cause irritation and abrasion of the cartilage of the patella, resulting in inflammation and pain.
Shin Splints (Medial Tibial stress syndrome; Anterior shin pain
Shin splints (medial tibial stress syndrome) are an exercise-related pain. Shin splints occur along or just behind the inner (medial) edge of the shin (tibia). The pain usually involves a span measuring about 6 to 8 centimetres.
Studies show that medial tibial stress syndrome (MTSS) commonly affects running sports, aerobics & court sports. An over pronated foot predisposes to internal tibia rotation placing strain on the lower leg musculature which attaches to the bone.
Pathology: shin splints are an inflammation of the thin layer of tissue that covers the bone (periosteum), which can be seen on bone scan examinations. The muscles that attach to the shinbone are also involved. The constant wearing & movement of the bone & the muscle tendons create inflammation.
Recommendations: By preventing excess foot pronation using orthotics assists reduction of internal tibial rotation and reduces medial tractional forces upon anterior tibialis and posterior tibialis muscles. Motion control and stability athletic footwear also assist over pronation syndromes. Additional treatments include ice therapy (15 minutes, 3 times a day), rest from running, deep tissue massage.
Australia has one of the highest recorded prevalence of diabetes for a developed nation. Foot care for people with diabetes is important because diabetes affects the feet in two ways. Diabetes can reduce blood circulation and also damage the nerves to the feet.
How to prevent foot problems
A few simple steps can help prevent foot problems. A checklist of simple strategies to care for feet include:
Regular foot inspections and treatments by a qualified podiatrist will aid in an overall foot diabetic management program.
CFPM has a diabetic foot health strategy which is based upon scientifically proven methods promoted by the Australian Podiatry Council and Diabetes Australia. It is recommended that people with diabetes (especially insulin dependent diabetics) organise a regular appointment with one of the Podiatrists on our team to care for toe nails and hard skin. Furthermore a foot vascular-neurological assessment should be performed annually.
Ingrown Toe nails
Ingrown toe nails are a common, painful condition that occur when skin on one or both sides of a nail grows over the edges of the nail, or when the nail itself grows into the skin. This condition is usually very painful and can be associated with infection of the toe. Some ingrown toenails are chronic, with repeated episodes of pain and infection. Irritation, redness, an uncomfortable sensation of warmth, as well as swelling can result from an ingrown toenail.
Ingrown toenails develop for many reasons. In some cases the condition is congenital, such as toenails that simply are too large.
People whose toes curl, either congenitally or from diseases like arthritis, are prone to ingrown toenails. Often trauma, like stubbing a toe or having a toe stepped on, can cause a piece of the nail to be jammed into the skin. Repeated trauma, such as the pounding to which runners typically subject their feet, also can cause ingrown nails.
The most common cause is cutting your toenails incorrectly, causing them to re-grow into the skin. Tight hosiery or shoes with narrow toe boxes only make matters worse. If the skin is red, painful or swollen on the sides of the nail, an infection may be present. This occurs because the ingrown nail is often in a warm, moist and bacteria-rich environment. When the nail penetrates the skin, it provides a convenient entry for germs that can cause infection. Untreated, the nail can go under the skin, causing a more severe infection. In either case, the infection needs to be cured with sterile instruments and antibiotics.
Treatment and Prevention
Ingrown toenails should be treated as soon as they are recognised. In many cases, people with ingrown toenails can obtain relief with the following simple regimen:
Cutting toe nails properly goes a long way toward the prevention of ingrown toenails. Using a safety nail clipper, cut the nails straight across, so that the nail corner is visible. If you cut the nail too short, you are inviting the nail corner to grow into the skin. It is the natural tendency, when the edge of the nail starts to grow in, to cut down at an angle at the nail edge, to relieve the pain. This does relieve the pain temporarily, but it also can start a downward spiral, training the nail to become more and more ingrown.
Our Podiatry team have experts within the clinic who can perform a minor in-office surgical procedure to cure in-grown toenail problems. This procedure generally takes about 60 minutes, is pain free with local anaesthesia with wound resolution within 4 weeks. Contact our rooms to make an initial appointment to discuss your nail condition and options that are available.
Warts are one of several soft tissue conditions of the foot that can be quite painful. They are caused by a virus, which generally invades the skin through small or invisible cuts and abrasions. Plantar warts tend to be hard and flat, with a rough surface and well-defined boundaries; warts are generally raised and fleshier when they appear on the top of the foot or on the toes.
The team at CFPM have a variety of management strategies to best treat verrucae (plantar warts). Options range from chemicals and acids to removal by liquid nitrogen.
Dry skin is the primary culprit behind cracked heels. While the dry skin itself is not dangerous, if untreated and bleeding and infection result, it could be a serious problem for diabetics and older patients. Dry, cracked heels often appear with increased age, poorly fitted shoes, diabetes, and dry indoor air.
RECOMMENDATIONS: Dry, cracked heels are best treated with therapeutic ointments and creams, avoiding lotions that may contain drying alcohol. Eulactol heel is especially formulated for dry, cracked heels and calluses. Apply Eulactol twice daily. For further management apply a generous slab of sorbolene cream to the heel area and use night sucks to assist absorbtion.