PODIATRY

Podiatry – from Gk Podo – Foot; Iatros – Specialist/Healer. There are over 300 foot and leg conditions or syndromes that podiatrists diagnose and treat. A few of these are heel spurs, plantar fasciitis, shin splints, ingrown nails, warts, flat feet, bunions, club foot etc

Did you know your feet will take you on a journey of around 128,000km during your lifetime?

That’s about 3 times around the earth. If you’re active in sports, you can add your training schedule.

Extra kilometers and biomechanical stresses caused by increased physical exertion make wear and tear on joints virtually inevitable.

Podiatry is the only medical modality that examines the body in motion so podiatrists are uniquely qualified to care for people who are active in sports.

Around 50% of people have flat feet. The percentage of people of Asian ethnicity tends to be even higher. This is disadvantageous because the mechanics of this type of foot does not allow for adequate suspension. The body compensates by transferring the shock to ankles, legs, knees, hips or lower back.

Foot orthoses are recommended for people who have sustained injury associated with abnormal lower extremity mechanics. Many lower extremity injuries are the result of excessive pronation. These increased motions lead to abnormal patellofemoral joint alignment and result in knee pain and such pathologies as iliotibial band syndrome, meniscal pain etc.

There are a plethora of other conditions that strike athletes and sports people such as stress fractures, bursitis, thrombophlebitis, tenosynovitis, synovial plicae, tendon rupture, plantar fasciitis, nerve entrapment, metatarsalgia, sprains etc.

Orthotics support specific phases in the gait cycle – abnormal motion is controlled while normal motion is unrestricted. They support a flexible flat foot, reduce heel jarring which contributes to plantar fasciitis, heel spur and severs disease, and they reduce upper body compensatory problems – eg. shin splints, knee, hip and back pain.

Application of orthotic therapy is the most effective way of improving function.

Orthotics can truly transform your life – athletes, kids, adults. Just about everyone can benefit from wearing orthotics.

Diabetes affects the whole body, but the eyes, heart, kidneys and feet are most at risk.

Body Clinic uses internationally defined standards such as screening frequency, goals, physical examinations and treatment protocols and Footcare Advice to Patients founded on evidence–based clinical guidelines and present strategies in management and prevention as recommended by the International Consensus on the Diabetic Foot which is endorsed by the International Diabetes Federation.

This decreases variability in practice, reduces complications and improves quality of life.

There are 2 primary aspects of management of the Diabetic foot:
1. Prevention
2. Management

Prevention focuses on patient education in foot care and footwear, off–loading the deformed or insensate foot and re–perfusion if the arteries are affected by build up of atherosclerotic plaque. A series of non–invasive investigations are performed to establish a baseline and basis upon which risk of acquiring diabetic foot disease is assessed and subsequent to that a treatment plan can be devised to provide preventive treatment and therapies.

Management of acute wounds requires accurate diagnosis and choice of treatment plan, investigation for infection, application of the moist wound healing technique and prevention of recurrence.

Control of infection, pressure and perfusion are key in interrupting the pathways that lead to gangrene, necrosis, amputation, morbidity and mortality.

This is a highly skilled sub–specialty of podiatry and the company’s goal is to establish an acute diabetic foot clinic in association with a multi–disciplinary tertiary facility in Jakarta.

Studies show that where debridement and off–loading (podiatry services) and re–vascularization (by Vascular Physician) are included in a multi–disciplinary approach, there is a 73% long–term lower extremity salvage rate.

More About Diabetes

Podopaediatrics is the evaluation and conservative management of congenital, developmental and traumatic conditions affecting the foot and lower limb of newborns to adolescents.

My child has flat feet – What should I do about it?

Young children tend to have a fat pad in the arch giving the appearance of a flat foot.

It is usually not indicated to interfere earlier than about 6 or 7 years of age once their foot resembles that of an adult unless the youngster exhibits significant orthopedic or congenital deformities.

Expert diagnosis will alleviate your fears. If necessary proper care and treatment of the feet by your podiatrist beginning in childhood will prevent many of the mechanical and orthopedic problems seen in adults.

Deviation from Normal

Certain neurological conditions result in spastic gait for instance and orthopedic conditions such as congenital deformities, osteochondroses, fractures, torsional and positional deformities.

Manifestation of X and O legs is common in Indonesia as is flat feet.

In addition, many children walk with an excessively in–toe or out–toe gait. Although they may not be in pain, they are damaging their feet. If indicated, orthotics can be fabricated with a gait plate to help correct in–toeing or out toeing.

Other Disorders our Podiatrists Diagnose and Treat

What are Growing Pains?

Growth Spurts

Warning: If something is unusual or your child complains of pain, they avoid weight bearing activities such as sports, or they constantly trip or fall, don’t delay in seeking professional diagnosis – it could be a potentially serious problem – bone tumour, hip dysplasia, infection, juvenile chronic arthritis etc. If serious, early treatment benefits outcomes.

The best method of correcting congenital talipes equinovarus (CTEV or club foot) is the Ponseti Method of serial casting and subsequent bracing which has >95% success rate.

An otherwise normal foot turns into a clubfoot during the 2nd trimester of pregnancy. There are theories, but no known reason why this happens and it should not be viewed in any way as being the fault of the parents.

Treatment of clubfoot normally starts when the child is just a few days old, but it is possible to apply this method through childhood.

The foot is gently and gradually manipulated into a more correct alignment over a period of 6–8 weeks and held in position with a new plaster cast applied approximately every 7 days. A series of 6–8 casts may be applied over 2–3 months. The connective tissue, cartilage, and bone respond to the mechanical stimuli created by the gradual manipulation.

As the foot is moved into the correct position, the ligaments, joint capsules, and tendons are stretched and the foot becomes more flexible. The displaced bones are thus gradually brought into the correct alignment with their joint surfaces progressively remodeled yet maintaining congruency.

Sometimes a tenotomy is performed under local anesthetic at the end of the series of plaster casts so that the equines deformity can be corrected. This is a simple procedure which involves severing the Achilles Tendon usually under local anesthetic. The child’s feet are cast again this time in a 25° dorsiflexed position (toes pointing upwards) for about 3 weeks allowing the tendon to rejoin.

In order to prevent a relapse, the child has to wear a pair of shoes attached to a metal bar in an abducted position (out–toe overcorrection). This brace has to be worn initially for 23 hours per day for 3 months. The time is then reduced to between 12–14 hours per day mainly during sleeping.

Ponseti Method Outcomes

In Memoriam of Beloved Orthopaedic Surgeon

Brace Information for Parents

General Treatment is a medical grade pedicure – be prepared to feel like you are walking on air.

Beginning with a relaxing tea tree oil footbath, a general treatment comprises cutting of nails, debridement of callous and fissures, enucleation of corns, treatment of warts, blisters, ingrown toenails, fungal nail infections etc. It finishes with a short invigorating foot massage.

International infection control procedures are closely observed including employing single use sharps and sterilization of all instruments.

Mobilization is primarily employed in a hypomobile (inflexible) foot. It is similar to chiropractic for the feet. The joints are manipulated to break down adhesions and increase range of motion.

Onychocryptosis – ingrown nails

The three most common methods for resolving a painful ingrown toenail are:

1. removing a sliver of nail especially if ingrown at the apex

2. nail bracing (wire spring to re–train the involuted nail) and

3. partial nail avulsion (PNA) – using a local anaesthetic, the PNA is performed without sutures and takes about 20 minutes. In most cases the patient can resume normal activity within 1–2 days unless the sulcus has been infected in which case it will take longer.

Verrucae Pedis – plantar warts

There are 3 methods commonly used to manage warts which usually occur on pressure areas on the plantar surface of the feet:

1. repeated debridement and application of silver nitrate which acts on the protein in the skin to kill the active wart tissue

2. cryotherapy which freezes and kills the wart tissue

3. surgery to enucleate the wart under local anaesthetic. This takes about 20 minutes and in most cases the patient can resume normal activity within 4–5 days.