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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.
Links Sport & Biomechanics
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 your 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 Mellitus
Diabetes affects the whole body, but the eyes, heart, kidneys and feet are most at risk.
There are 2 primary aspects of management of the Diabetic foot: 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 among other things, correct 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 Children
Podopaediatrics is the evaluation and conservative management of congenital, developmental and traumatic conditions affecting the foot and lower limb of newborns to adolescents. Is My Child Walking Right?
At first they have jerky hip and knee motions. By 15 months your infant will be walking unaided with a flat foot and full foot strike. By 2 years they will be running with more flexibility at the knees and ankles with a period when both feet are off the ground, negotiating steps one at a time, jumping off a low step and kicking a ball forward. They will still appear flat footed. By 2½ years they can jump off a step with a 1 foot landing. By 3 years they will have a near normal adult gait – that of heel strike to toe–off pattern, will be able to mount steps with alternate feet, jump off a step with a 2 foot landing and put on their own shoes. They will also be able to do some special tricks of walking on their tip toes as well as on their heels. By 4 years they will be able to climb, walk downstairs with alternating feet, hop on 1 foot for about 5–8 consecutive hops, run on their toes and kick a ball in the air. By 5 years your youngster will be skipping with alternate feet and be able to place 1 foot directly in front of the toe of the opposite foot walking forward along a straight line and generally be more rhythmical and efficient with assistive upper limb movements. Running by this stage will be characterized by the body leaning forward, arms swinging in a straight line with the elbows bent. They will by now have learnt all the skills of adult gait. 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. Other Deviations 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. Another serious condition is talipes adductoequinovarus – club foot – which is rectified by serial casting and bracing. This method has significantly superior long term outcomes compared with that of surgical intervention. Other Disorders that your Podiatrist can Diagnose and Treat Various osteochondroses which affect the ossification centers of the bone such as: Osgood–Schlatter Disease – active children aged 10–15 years more prevalent in males than females, characterized by local pain, swelling and tenderness over tibial tubercle (knee). Sever’s Disease – usually 8 –15 years, characterized by pain on palpation of posterior plantar aspect of calcaneus (heel). Kohler’s Disease – most commonly in ages 3 –9, more prevalent in males than females, characterized by vague pain and tenderness localized over the navicular (midfoot) and is usually unilateral. Freiberg’s Disease – can affect any metatarsal head, but 2nd is most common (70%) pain experienced usually on the dorsum, usually ages 11–17, more prevalent in females than males. Diaz or Mouchet’s Disease – osteochondrosis of the talus; rare; probably associated with acute trauma in which there is compression of dome of talus; bone often remodels to a normal shape. Buschke’s Disease – osteochondrosis of the cuneiforms. Very rare. Osteochondroses of Os Navicular – has been described as affecting this joint; needs to be differentiated from other pathology of os navicularis/accessory navicular. Iselins Disease’ – osteochondrosis of the 5th metatarsal base at attachment of peroneus brevis; need to differentiate from a stress fracture, os vesaleanum or fracture; pain increases on tension on peroneus brevis Treves’ or Ilfeld’s Disease – osteochondrosis of the sesamoids. Tenderness and pain on palpation; significant pain on dorsiflexion. Thiemann’s Disease – osteochondrosis of the phalanges. Many of these conditions can be rectified or greatly benefited by wearing conservative in–shoe mechanical corrective devices (orthotics) to realign the foot and leg in the best functioning position. Did you know that up to 15–30% of Children Experience Growing Pains? Growing pains generally peak around the ages of 4–5 but can occur up to age 12. It usually occurs in the popliteal fossa – behind the knee and can be relieved by gentle massage. True Growing Pains only occur at night and are benign and self limiting – meaning that treatment is not usually required. However, studies show that in 90% of cases, treatment with foot orthoses relieves the majority of growing pains. 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.  Club Foot - Congenital Tallipes Equinovarus (CTEV)
The Ponseti Method has >95% success rate — the most successful method of correcting club feet in the world. 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 manipulative treatment. 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. Once the casting phase is completed, maintenance of the corrected position is the responsibility of the parents. 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. After two months of manipulation and casting the foot appears slightly overcorrected — after a few weeks in splints however, the foot looks normal. Children are adept at learning new ways of getting around in the brace — they can sit, crawl and walk in the brace. None of the milestones in their development are adversely affected. In rare cases some children require a surgical procedure at around 3 years which may involve re–locating a tendon in the foot to make it pull more laterally. After 4 years the brace can be discarded altogether and your child’s feet will be corrected without the need for major surgery. There’s no scare tissue, no reason to expect pain, arthritis or stiffness. Instead your child can look forward to normal, pain free and completely functional feet. Does surgery "cure" clubfoot? No. If ’successful’ it improves the appearance of the foot but diminishes foot and leg muscle strength causing pain and stiffness in the second or third decade of life if not earlier. A 50 year follow up study of the Ponseti Method compared with surgery shows a quality of life equivalent to normal compared with that of a Parkinson’s sufferer for the post surgical clubfoot.
X-ray of Bilateral Clubfoot Bilateral Clubfoot Series of casts of newborn Abduction Brace General Treatment
This is a medical grade pedicure – be prepared to feel like you are walking on air. Beginning with a relaxing tea tree 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
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. Soft Tissue Surgery
Onychocryptosis – ingrown nails The three most common methods for resolving a painful ingrown toenail are:
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:
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Did you know your feet will take you on a journey of approximately 128,000km during your lifetime?
Podiatry Professionals has established defined protocols and tools for clinicians and 
Normal development is characterized by the following milestones:
