Pain at the back of the leg near your heel.

The Achilles tendon is the largest tendon in the body and connects all of the calf muscles to your heel bone (calcaneus). Although the Achilles tendon can withstand huge stresses from running and jumping, too much strain on the structures may result in overuse and degeneration.

There are two types of Achilles tendinopathy

• Mid portion Achilles Tendinopathy

In mid-portion Achilles tendinopathy, fibres in the lower one third of the tendon have begun to degenerate, swell, and thicken. This is the most common cause of Achilles tendon pain in young, active people.

• Insertional Achilles Tendinopathy

Insertional Achilles tendinitis occurs where the tendon attaches (inserts) to the back of the heel bone. This may be the result of degeneration or an inflammatory arthritic condition.

In both mid-portion and insertional Achilles tendinopathy, damaged tendon fibres may calcify. Bone spurs may form at the bony attachment point with insertional Achilles tendinopathy.

Causes of Achilles tendinopathy

Achilles tendinopathy may not be caused by a specific injury. It often results from repetitive stress to the tendon when we to do too much, too soon.

Other factors can make it more likely to develop tendinopathy, including:

• Overuse of the Achilles tendon. This can be a problem for people who run regularly, for dancers and for people who are involved in sports that require jumping.
• Wearing inappropriate footwear.
• Poor training or exercising techniques - for example, a poor running technique.
• Increasing the intensity of your training and how often you train.
• Training or exercising on hard or sloped surfaces.
• Having a high-arched foot.
• Having poor flexibility - having tight or underdeveloped calf or hamstring muscles.

Symptoms of Achilles Tendinopathy

• Pain and stiffness in the Achilles tendon when rising from bed in the morning
• Pain along the tendon or back of the heel that worsens with activity
• Severe pain the day after exercising
• Thickening of the tendon
• Swelling that is present all the time and gets worse throughout the day with activity

If you have experienced a sudden "pop" in the back of your calf or heel, you may have ruptured your Achilles tendon. See your doctor or health professional immediately!

Management of Achilles tendinopathy may include some of the following:

Rest

• Time off from sporting activities may be necessary if you have Achilles tendinopathy.
• Immediately stop any high-impact activities or sports (such as running).
• As pain improves, restart exercise as pain allows.
• Complete rest, if it is prolonged, can actually be worse for the injury.

Achilles tendon rehabilitation exercises

Your medical professional will be able to provide an exercise programme suitable for your symptoms.

Specific exercises to help strengthen the Achilles tendon can be extremely helpful and must be done every day. These exercises are shown help with pain and stiffness.

Other treatments such as ultrasound and massage may help relieve symptoms and encourage healing of the Achilles tendon.

Foot orthoses and footwear advice will change the loading and function of your foot which alter the forces sustained by the tendon to reduce tissue stress.

Formthotics™ can help relieve symptoms of Achilles tendinopathy

Formthotics support the structures of the foot to encourage optimal function and even pressure distribution.

Formthotics can provide the ideal base to support, distribute and alter loading forces in people with achilles pain. A variety of Formthotics options allow your medical professional to select Formthotics best for your feet, biomechanics and activity. Your Formthotics are then able to be customised specifically for your needs.

An ankle sprain is a very common, acute, painful injury and usually occurs on the outside part of the ankle.

An ankle sprain is a sudden injury to the tough bands of tissue (ligaments) that connect the bones of the leg to the foot. An ankle sprain usually happens when you accidentally twist or turn your ankle in an awkward way, which can stretch or tear the ankle ligaments.

The most common ankle sprain occurs on the lateral or outside part of the ankle. This is an extremely common injury which affects many people during a wide variety of activities. Ankle sprains can occur with a slip, trip or fall during day to day activities or as a result of landing badly during intensive sporting activity.

Some people are predisposed to ankle sprains. In people with a high arch, where often the posture of the heels is slightly turned toward the inside, these injuries are more common.

Symptoms of an ankle sprain

• Swelling
• Tenderness
• Bruising
• Pain
• Inability to put weight on the affected ankle
• Skin discoloration
• Stiffness

Management of ankle sprains may include some of the following

Treatment in the first 48 to 72 hours consists of resting the ankle, icing 20 minutes every two to three hours, compressing with an elastic bandage, and elevating the limb.

• Use elastic bandages (such as Theraband) to wrap the ankle.
• Wearing a brace to support your ankle.
• Use crutches, if needed.
• Elevate the foot. This will help reduce swelling.
• Take anti-inflammatory medication (if you are able) to manage swelling and pain.

Reduce weight-bearing on the ankle until the pain subsides. For mild sprains, this may take a week to 10 days, while more severe sprains may take several weeks to heal.

Prevention of future ankle sprains

• Wear an elastic bandage or brace, if necessary
• Wear foot orthoses to improve stability and feedback
• Ongoing strengthening exercises
• Avoid high heels
• Warm up before exercising
• Wear good fitting, sturdy, quality, fit for purpose footwear
• Pay attention to surfaces you’re walking on
• Slow or stop activities when fatigued

Formthotics can help relieve the symptoms, and prevent recurrence of ankle sprains.

Foot orthoses have been shown to have a positive effect for patients with chronic ankle instability or for any patient who has suffered a significant acute ankle sprain.

Foot orthoses can significantly improve balance and proprioception in the lower extremity, and can be a valuable adjunct to a functional rehabilitation program after an ankle sprain.

Formthotics can provide the ideal base to support and distribute loading in people with high arches. The multiple density options allow your podiatrist to select Formthotics best for your feet, footwear and activity. Your Formthotics are then able to be customised by your podiatrist specifically for the needs of your feet.

Pain in the arch area is generally the result of overuse or over compensation of a muscle caused by poor foot alignment and function.

Arch pain, also known as plantar pain, refers to pain in the arch at the bottom of the foot. This pain can present as a result of various causes, usually following activities that involve significant stress to the arch of the foot.

The arches of the feet play an important role to absorb and return the force between the body and the ground, supporting bodily movement when people are on their feet. However, when the arches are put under excessive stress due to intense movements or extended periods of time standing on their feet, injury and pain to the area can present.

The structure of the foot is very complex and, for this reason, an individual that is experiencing arch pain should be referred to a podiatrist who will make the relevant investigations as to the cause of the condition.

This usually begins with a physical examination of the foot and a consultation about the medical history and recent events that may have caused the pain. There is often a lump or bruise in the arch of the foot that is evidence of damage to the connective tissue.

Causes of arch pain

Injury to the arch of the foot can occur due to direct force trauma can result in pain and inflammation. This may include:

• Ligament sprains

• Muscle strains

• Biomechanical misalignment

• Fractures due to mechanical stress

• Muscle overuse

• Inflammatory arthritis

Pain in the arch area is generally the result of overuse or over compensation of a muscle caused by poor foot alignment and function. There are three main diagnoses for arch pain:

Plantar fasciopathy (or commonly known as Plantar Fasciitis) – The plantar fascia is a soft tissue structure that runs from the heel, under the arch, to the bones of the toes. Plantar fascia pain can occur in the heel and/or arch, it is generally painful first thing in the morning and again in the evening.

Flexor Halluces Longus or Brevis Tendonitis – The Flexor Halluces Longus and Brevis muscles cause the big toe to bend downward. Overuse of these structures can occur when these muscles are having to work hard at stabilising the foot.

Posterior Tibialis Tendonitis or dysfunction – The posterior tibial tendon supports the arch during weight-bearing activity. Weakness or dysfunction in the muscle can lead to arch pain, and in severe cases the onset of flat foot in adults.

Management of arch pain may include some of the following:

• Seek professional assistance - from your medical professional

• Activity modification - reduce activities that cause your pain.

• Physical therapy - an exercise programme and other physical therapy modalities may be used to provide temporary relief.

• Weight loss - if you are overweight this may aggravate your symptoms.

• Orthotics - your medical professional can provide you with Formthotics for your shoes to improve your function and provide support to the foot structures.

• Footwear - wear shoes that support the function of the foot and are appropriate for your activity.

Formthotics can help relieve the symptoms of arch pain

Formthotics support the structures of the foot to encourage optimal function and even pressure distribution. In doing this they reduce fatigue, increase shock absorption and reduce pain.

Formthotics dual density products add a cushioning layer on top of the supportive structure of Formthotics. The Formax™ dual density foam provides increased shock absorption and even pressure distribution while maintaining a good level of support to optimise foot function and general comfort.

Formthotics can provide the ideal base to support and distribute loading in people with arch pain. The various Formthotics options allow your podiatrist to select Formthotics best for your feet, footwear and activity. Your Formthotics are then able to be customised by your podiatrist or medical professional specifically for the needs of your feet.

Arthritis is a common condition that causes inflammation of the joints. The inflammation causes pain, swelling and stiffness. Arthritis can occur in any joint of the body.

There are many different types of arthritis. Two common forms of arthritis are osteoarthritis and rheumatoid arthritis.

Osteoarthritis

Osteoarthritis can be considered as the result of general wear and tear. It can occur from traumatic injuries, overuse and age. The pain of osteoarthritis results from a loss of cartilage, which usually provides cushioning for the bones in the joints.

With the loss of cartilage, the bones can rub together in the joints, causing inflammation and pain, swelling and stiffness. Osteoarthritis commonly occurs in the feet and may impact only one joint or many joints of the foot.

Treatment for osteoarthritis may include; orthotics, special footwear, anti-inflammatory medication, physical therapy, cortisone injections, arthroscopic and joint replacement surgeries, and chronic pain rehabilitation programs.

Rheumatoid Arthritis

Rheumatoid arthritis occurs when the immune system mistakes healthy cartilage as diseased, and attacks the cartilage of the joints. Over time, the immune system erodes the cartilage. The subsequent loss of cartilage causes inflammation, pain, joint stiffness and swelling. In advanced stages, the joints become deformed. Rheumatoid arthritis most commonly occurs in the hands and feet.

Treatment and management for rheumatoid arthritis of the feet may include; anti-inflammatory medication, chemotherapies, physical therapy, chronic pain rehabilitation programs, specialist footwear and orthotic management.

Autoimmune disorders:

Other forms of arthritis can occur due to autoimmune disorders, when the body's immune cells destroy the cartilage. Systemic Lupus Erythematous, Reiter's Disease, Ankylosing Spondylitis, and Psoriasis, along with Rheumatoid Arthritis are all examples of autoimmune disorders that can cause arthritis.

Formthotics can help feet at risk due to arthritis

Formthotics™, in particular ShockStop Formthotics™, are designed to absorb shock, deflect impact and reduce plantar pressures while supporting the structure of your feet.

The cushioning and support provided by ShockStop Formthotics reduce plantar pressures and sheer forces while affording support to damaged and painful joints. ShockStop Formthotics are heat mouldable and fully customisable which means that your podiatrist or medical professional is able to ensure the best solution for your feet.

ShockStop material is a totally unique and revolutionary hybrid EVA polymer foam. The top layer deflects impact significantly more than other standard foam materials, while the base maintains support and stability.

Back pain, most commonly of the lower spine, affects 4 out of 5 people at some stage of their life.

Back pain can start suddenly after reaching or twisting or come on slowly over a few days or weeks.

Short term (acute) back pain is often caused by simple muscle strains or spasms. It usually lasts less than 3 months, and then normal function returns.

Long term (chronic) back pain tends to develop over time and last more than 3 months. This is less likely to be linked to tissue damage or injury and may be as a result of a more long-term spine condition.

Causes of back pain

There are many causes of lower back pain. These include structural misalignment, hereditary disorders, disc degeneration in the spine, nerve damage, muscle imbalance and dysfunction of the lower back/pelvic region caused by poor timing or function of the feet and legs when walking. Very often it is a combination of a number of these factors and that’s why if only one area is treated the condition improves but does not completely resolve.

IMPORTANT NOTE:

See a doctor immediately if you have any weakness in your lower legs, develop any bowel or bladder problems (such as incontinence) or numbness over your buttocks and anal region.

Abnormal foot function and back pain

If your foot works in an excessively rolled in position, especially as it lifts off the ground, it causes the leg to remain in an internally rotated position, resulting in a forward tilt of the pelvis which in turn increases the curvature of the spine and places strain on the muscles and ligaments of the lower back.

Poor foot function due to leg length difference

Most people have a slight difference in the length of each leg but if this becomes marked through dysfunction of the pelvis or injury and sometimes surgery, (for example hip surgery), it will force the foot to compensate. Usually this causes one foot to function rolled-in and the other to function in a rolled-out position. This places strain on the foot, leg and pelvis and may result in a pelvic tilt and twisting of the spine, placing strain on the associated muscle and ligaments.

Management of back pain

The first step to managing back pain is to get a good diagnosis and management plan. Seek help from your doctor, physiotherapist or other suitably qualified medical professional.

They will:

• Assess your back and pinpoint where any problem areas may be.

• Identify any function or restriction that may be adding to your pain.

• Provide you with exercises and advice to reduce pain and prevent further episodes.

In cases where the way your foot and leg works is impacting lower back pain, a podiatrist can work with the health professional team to assess mechanics and function from the ground up and offer solutions.

The podiatrist will ascertain what dysfunction is occurring in your feet, how this may be interacting with the muscles in your back, pelvis and legs and will see what areas in your lifestyle may be placing you at risk of continuing the injury; Eg: sport, posture and even footwear.

What we do every day is important to help keep backs strong and flexible

Three tips for healthy backs:

1. Keep active – undertake regular exercise such as walking, or swimming.

2. Maintain good posture – sit and stand up straight. Review how you sit, relax and stand.

3. Take extra care with lifting – bend your knees, keep your head up, back straight, ensure your core muscles are engaged when lifting and be sensible about what you lift.

For recurring back pain, the following may help:

• Exercise regularly - people who do regular exercise have less back pain than those who are inactive.

• Lose weight - the more overweight someone is, the more strain this put on all their joints, muscles and back.

• Avoid activities that cause sudden movements and muscle strain.

• Review your footwear - flat shoes with good arch support and cushioning can help.

• Manage stress and anxiety -anxiety and stress can all increase muscle tension and back pain.

Formthotics can help relieve the symptoms of lower back pain

Where foot function or a leg length discrepancy is impacting your back, orthotics can be used to assist and significantly improve the foot and leg function, which in turn can improve back pain.

Formthotics support the structures of the foot to encourage optimal function and even pressure distribution. In doing this they reduce fatigue, increase shock absorption and reduce pain.

The multiple options available allow your podiatrist or medical professional to select Formthotics best for your feet, footwear and activity. Your Formthotics are then able to be customised by your clinician specifically for your needs.

Formthotics dual density products add a cushioning layer on top of the supportive structure of Formthotics. The Formax™ dual density foam provides increased shock absorption and even pressure distribution while maintaining a good level of support to optimise foot function and general comfort.

Bunions (hallux abducto valgus)

Bunions are a symptom of faulty foot mechanics caused by an inherited foot type and function

Bunions are a symptom of faulty foot mechanics caused by the foot we inherit and exacerbated by inappropriate footwear use. As the big toe bends towards the others this lump becomes larger and the bunion can become painful - arthritis and stiffness can eventually develop.

Bunions can follow foot injuries and trauma and people with flat or pronated feet appear to have a higher incidence of bunions.

Some activities, such as ballet dancing, put added pressure on the joint and may increase the chance of bunions developing.

As the big toe begins to deviate the bunion can become painful - there may be redness, some swelling, or pain at or near the joint.

With any pain the most important starting place is obtaining a confirmed diagnosis from an experienced health professional. Any pain of sudden and severe onset must be investigated urgently by your podiatrist or medical professional.

Management of Hallux Valgus (bunions)

Footwear - Wearing the right kind of shoes is very important. Choose shoes that have a wide toe box and forgo those with pointed toes or high heels which may aggravate the condition.

Padding - Pads placed over the area of the bunion can help redistribute pressure from the bunion area and reduce pain.

Activity modifications - Avoid activity that causes bunion pain, including standing for long periods of time.

Medication - Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.

Icing - Applying an ice pack several times a day helps reduce inflammation and pain.

Orthotic devices - customised orthotic devices are used to improve foot function and relieve pressure on the bunion joint with walking and activity.

Bunion surgery

If nonsurgical treatments fail to relieve bunion pain and when the pain of a bunion interferes with daily activities, it’s time to discuss surgical options with a foot orthopaedic surgeon.

A variety of surgical procedures is available to treat bunions. The procedures are designed to remove the “bump” of bone, correct the changes in the bony structure of the foot, and correct soft tissue changes that may also have occurred. The goal of surgery is the reduction of pain and deformity.

Formthotics can help relieve the symptoms of bunions

Formthotics support the structures of the foot to encourage improved foot function and relieve pressure on the bunion joint with walking and activity.

Children’s feet are very soft and pliable. Abnormal pressures from shoes and surfaces can lead to complications later in life if ignored.

At birth, the bones in your baby’s feet are not yet fully formed and are mostly still cartilage. As the feet grow, the cartilage starts changing into bone and the foot strengthens and lengthens. Baby feet are not miniature adult feet; they are shorter and wider in shape and taper toward the heel. Most babies are born with flat feet; this is because the arch has not yet formed and that foot is protected by a layer of baby fat. Your baby’s feet will grow quickly. In fact, they will reach almost 1/2 their adult foot size during your baby’s first year but will continue to develop well into their teens.

Baby feet look so cute and cuddly but it is also important to remember that they are also very soft and flexible and therefore vulnerable to damage. Too much pressure can affect the shape of your baby’s foot and the layer of baby fat means that your child will feel no pain while this is happening.

Most children start to take their first steps around 10 – 18 months. While your child is learning to walk and are safely indoors, let your child walk barefoot as much as possible. Walking barefoot is completely natural and allows the muscles and ligaments in your child’s foot to grow straight and strong.

Once your child is ready to walk outdoors or on rough surfaces such as grass, concrete and asphalt, it’s time to consider buying your child’s first shoes. The main purpose of shoes at this stage is to protect your child’s feet. The shoes should be lightweight, flexible and made of natural or ‘breathable’ materials. The shoes must be comfortable straight away. If they need to be ‘broken in’ they are not the right shoes for your child.

Poorly fitted shoes restrict your child’s feet and can cause foot problems and deformities, so make sure the shoes are the proper length, width, depth and shape for your child’s feet. Take time to find a good footwear store with competent shoe fitters as they can help you select the right shoes for your child. As growth spurts can occur at any time, expect your child to outgrow their shoes well before the shoes are worn out. Toddlers often require new shoes every 2 – 3 months, young children (24 – 36 months of age) every 3 – 4 months and children over 3 years, every 4 – 6 months.

Once your child has mastered the art of walking, then the fun really begins. Young children have boundless energy and are soon running, jumping and skipping everywhere. They love playing sports and are eager to participate. As a parent, it is hard not to worry about your children getting injured playing sport as sports injuries are quite common. It is important to monitor your child’s sporting activities particularly if the sports involve a great deal of running and turning or are full contact sports.

There are also a number of things you can do to try and prevent foot and lower limb sports injuries:

• Consider buying your child sports-specific footwear to help protect the feet.

• Make sure your child uses the proper protective gear for a particular sport.

• Encourage your child to do warm-up exercises, such as stretching and light jogging before sports. This can help reduce the risk of muscle strain and soft tissue injury.

• Encourage your child to do cooling down exercises after sport. This helps to loosen muscles that have tightened during sport.

Many adult foot problems have their roots in childhood problems that were either ignored or undiagnosed. Don’t assume that your child will know if they have a problem with their feet. Remember that your child’s foot is soft and flexible and can be twisted and squeezed without your child even being aware of it.

So use the following indications to help you identify whether your child has a potential foot problem:

• Your child’s feet don’t look normal to you or appear to have a deformity

• Your child’s shoes show uneven wear patterns or seem to wear out too quickly

• Your child complains of tired feet and legs or wakes up with night time cramps

• Your child seems to walk irregularly? He or she walks on their toes, toe in or toe out, seem to have one leg longer than the other or have knocked knees.

• Your child often trips or stumbles.

There is a Formthotics™ Youth range available specifically designed for young children through to young adults. They support your child’s foot in its natural foot posture to make them more comfortable. Formthotics Youth products give your child’s feet gentle ‘forgiving’ support and to enhance the natural development of your child’s musculoskeletal system.

Make an appointment with your local podiatrist who can help determine the care needed for your child's feet, and whether or not orthotics will help.

Corns and calluses are two of the most common foot complaints

Corns and calluses are caused by abnormal pressure or friction from poor fitting footwear or abnormal foot function.

When there is excessive tissue stress exerted on skin, the body’s natural protection mechanism is to build up hard layers of skin to protect the underlying tissues. The skin continues to thicken and harden as the pressure continues and eventually the area will become painful.

A corn or callus is a symptom of an underlying cause that needs to be assessed by a podiatrist

Calluses

Calluses are a diffused thickening of the skin over bony prominences or around the boarder of the heels. They are often painless but may also throb or burn. Especially in the summer, when the skin is dry from not wearing shoes, it is common for calluses to crack (fissure) especially around the heels and under the ball of the foot. Fissures can lead to infection and are often extremely painful.

Corns

There are two main types of corns:

Hard corns (digital corns) which are concentrated areas of dry and hardened skin. They are often found over the joints of the toes as a result of pressure from poorly fitting footwear.

Soft corns which are white and rubbery and generally develop between the toes.

Infection and ulceration of corns may occur and is a serious complication for people with diabetes, insensitive feet or with poor circulation.

Causes of corns and calluses

• Poorly fitting footwear that is too tight across the toe box or too hard underfoot.

• Toe deformities, such as hammertoes, retracted toes or bunions

• Bony prominences and diminished fibrofatty padding on the feet

• Biomechanical or gait abnormalities

Prevention of corns and calluses

Corns and callus are easy to prevent - just take away the cause. That cause is excessive pressure. Correct fitting of footwear around the toes, the use of pads to relieve pressure, surgical management of a bony prominence and regular podiatric care are the best options for prevention of corns and calluses.

Treatment of corns and calluses

• Never try to cut out a corn yourself, and don’t use corn paint or plasters as these chemicals can be dangerous (especially for diabetics or those with poor circulation)

• There are other things you can do to help relieve pain:

  • Use a pumice stone or a foot file to rub away the thickened skin, do this carefully and gently (but not if you’re a diabetic) after you have soaked your foot in warm water to soften the skin.

  • Wear shoes with a wide toe box and a low heel.

  • Purchase cushioned insoles for your shoes.

Make an appointment to see a podiatrist

Podiatry management of corns and callus includes a proper assessment to determine the cause of the corn or callus and an implementation of a management plan.

A management plan is likely to take into account several options:

• Regular maintenance to keep the corn and callus reduced.

• Padding to prevent pressure causing the corn or callus to form.

• Footwear advice.

• Foot orthotics to relieve areas of pressure under the foot

• Surgical correction of a bony prominence that is causing areas of high pressure.

Formthotics can help relieve the symptoms of corns and callus

Formthotics relieve the pain for corns and callus by dissipating the forces on the feet during activity.

Formthotics™ are an ideal base to relieve areas of pressure under the foot and dissipate weight-bearing forces over a larger surface area. Formthotics also assist in providing optimal foot alignment to improve foot function during activity.

A variety of Formthotics options enable your podiatrist to select Formthotics best for your feet, footwear and activity. Your Formthotics are then able to be customised by your podiatrist specifically for the needs of your feet.

Diabetes is the result of the body not making enough insulin to keep blood glucose (sugar) levels within the normal range. If the glucose in a person’s blood is too high, over time it can lead to damage of multiple body systems, including the feet.

There are three main types of diabetes:

1. Type 1 diabetes: is a chronic condition where the pancreas produces little or no insulin, a hormone needed to allow sugar (glucose) to enter cells to make energy for the body.

2. Type 2 diabetes: (adult-onset or noninsulin-dependent diabetes) is a chronic condition that affects the way your body metabolises sugar (glucose), an important source of fuel for the body.

3. Gestational diabetes: is a condition where women, without previously diagnosed diabetes, show high blood glucose (blood sugar) levels during pregnancy. Gestational diabetes is caused by faulty insulin responses.

The effect of diabetes on the feet

Some people with diabetes develop complications due to their diabetes. Two of the common foot related complications of diabetes are:

• Damage to nerves (neuropathy)

• Damage to blood vessels (vascular disease)

Diabetic Neuropathy

People with diabetes sometimes develop nerve damage to their feet which may result in either whole or part of their feet becoming numb and insensitive to pain or injury.

If you have diabetic neuropathy in your feet you are:

More likely to get an injury AND less likely to know to get help for the injury early on.

Diabetic Vascular Disease

Diabetes can cause the lining of blood vessels to become thickened meaning that less blood is able to travel through the blood vessels.

If the blood vessels to your feet are partially or completely blocked the skin and soft tissue of your feet will struggle to maintain a healthy condition.

If you have diabetic vascular disease in your feet you are:

Less able to fight off infection AND less likely for tissues to heal quickly once damaged.

In serious cases there is an increased risk of developing gangrene, especially in the toes, if the blood supply to the feet is dramatically reduced or non-existent.

When nerve damage and poor blood supply both exist, feet are especially at risk.

In this situation, there is an increased risk of foot injury (because you cannot feel pain), AND injury is more likely to be slow to heal, become infected, ulcerated and possibly gangrene could develop (because the blood supply is so poor or non-existent).

Every diabetic needs to take good care of their feet

Even if you currently have no nerve or blood vessel damage you need to take good care of your feet.

Foot Care TIPS:

Wash and carefully dry your feet, including between your toes, every day.

Moisturise your feet every day, but not between toes.

Wear well-fitting and sensible shoes that are suitable for your activity. Avoid seams and materials that could cause injury. Your podiatrist can give you advice on choosing suitable shoes.

Look at your feet, both top and bottom, every day to make sure they look healthy. Report any changes immediately to your podiatrist or doctor.

Have regular foot checks by your doctor, foot specialist or diabetes nurse educator. These checks should pick up any developing numbness or signs of poor circulation.

If you have nerve or blood vessel damage to your feet you also need to:

• Carefully examine your feet every day. Look for redness, hard skin, splits, swelling, bruising, rubbing or blisters. Get help if you can’t see your feet. Get advice immediately from your doctor or podiatrist if you notice anything.

• If the feeling in your feet is reduced, it is a good idea to get someone who is properly trained (i.e. a podiatrist) to cut your toenails for you.

• Gently wash and thoroughly dry your feet every day. Get help if you can’t reach your feet.

• Make an appointment with a podiatrist. Take any shoes you commonly wear to this appointment for the podiatrist to assess.

• Before wearing any new shoes ask your podiatrist to check that they are safe for your feet.

• Always check inside your shoes before putting them on to make sure there are no rough edges or objects inside them.

• Don’t go barefoot anywhere, even inside, at home.

• Wear well fitting, seam free socks. Seams can cause pressure areas on your feet that can result in blisters or ulcers. Diabetic specific socks are readily available.

• Ask your podiatrist to assess and fit Formthotics Medical Original ShockStop orthotic into your shoe.

Formthotics can help feet at risk due to diabetes

Formthotics™, in particular Shockstop Formthotics™, are designed to absorb shock, deflect impact and reduce plantar pressures while supporting the structure of your feet.

The cushioning and support provided by Shockstop Formthotics reduce plantar pressures and sheer forces, reducing the risk of tissue break down and ulceration in diabetics. Shockstop Formthotics are heat mouldable and fully customisable which means that your podiatrist or health care professional is able to ensure the best solution for your feet.

ShockStop material is a totally unique and revolutionary hybrid EVA polymer foam. The top layer deflects impact significantly more than other standard foam materials, while the base maintains support and stability.

Download the ShockStop Product Information Brochure - this contains detailed information about the ShockStop foam, explains why it is different, including lab test results. An essential read to gain a greater understanding of when to prescribe and how to use Original ShockStop for the best results with your patient.

Flat feet (pes planus) is a complex structural disorder resulting in the lowering of the foot’s arch on weight-bearing.

Flat feet are sometimes called ‘fallen arches’ or ‘excessive pronation’ of the feet. A person with flat feet needs a biomechanical and functional assessment to determine whether they are at risk of long-term complications. People with flat feet may have foot, ankle, knee or lower back pain.

With any pain the most important starting place is obtaining a confirmed diagnosis from an experienced health professional. Any pain of sudden and severe onset must be investigated urgently by your podiatrist, doctor, or suitably qualified health professional.

Flat feet due to injury, disease, or normal aging is often not preventable. In some cases, flat feet are caused by a physical abnormality in the structure of the bones of the feet. Diseases such as diabetes and rheumatoid arthritis can lead to flat feet. An injury, such as a bone fracture, dislocation, sprain or tear in any of the tendons and ligaments in the foot and leg may also cause flat feet.

Symptoms of flat feet

The main symptom of flat feet is the absence of an arch when standing. Other symptoms may include:

• Foot pain

• Pain or weakness in the lower legs

• Pain or swelling on the inside of the ankle

• Uneven foot wear

Management of flat feet

The focus when treating flat feet is managing symptoms so that you are able to function without pain or disability. Sudden development of a flat foot requires immediate medical attention.

Management of flat feet may include some of the following:

• Seek professional assistance - from your podiatrist, medical professional

• Activity modification - reduce activities that cause your pain.

• Physical therapy - an exercise programme and other physical therapy modalities may be used to provide temporary relief.

• Weight loss - if you are overweight this may aggravate your symptoms.

• Orthotics - your podiatrist can provide you with Formthotics for your shoes to improve your function and provide support to the foot structures.

• Footwear - wear shoes that support the function of the foot and are appropriate for your activity.

• Immobilisation - occasionally, it may be necessary to use a walking cast or to completely avoid weight-bearing.

• Medication - anti-inflammatory medication (NSAIDs), such as ibuprofen may help reduce pain and inflammation.

Formthotics™ can help relieve symptoms of flat feet.

Formthotics support the structures of the foot to encourage optimal function and even pressure distribution. In doing this they reduce fatigue, increase shock absorption and reduce pain.

Formthotics dual density products add a cushioning layer on top of the supportive structure of Formthotics. The Formax™ dual density foam provides increased shock absorption and even pressure distribution while maintaining a good level of support to optimise foot function and general comfort.

The Formthotics low profile models offer the clinician options to comfortably support flat feet.

If pain persists we recommend a visit to a podiatrist or medical professional.

Pain underneath your heel, especially when you first step out of bed in the morning.

Plantar fasciopathy(often known at Plantar Fasciitis) affects 10% of the general population and limits personal activities in many individuals.

Plantar fasciopathy is the main cause of heel pain and occurs when the plantar fascia, a band of fibrous tissue which supports the length of the arch, becomes injured at its attachment to the heel bone.

When there is increased stress on the arch, microscopic tears can occur within the plantar fascia, usually at its attachment to the heel. This results in inflammation and pain with standing and walking, and sometimes at rest.

Symptoms of heel pain

Heel pain is often worst in the morning immediately after rising from bed, or after sitting for long periods.

Pain is present on the bottom of the heel; however, this pain may extend under the arch of the foot. The pain is often described as a stone bruise, but a history of injury is usually absent and onset has occurred over time.

Pain can be worse when barefoot.

An increase in activity, especially regular walking or running, may trigger heel pain particularly if the footwear is not supportive.

Risk factors for plantar fasciopathy include:

• Excessive running.

• Standing on hard surfaces for prolonged periods of time.

• High arches of the feet.

• Leg length inequality.

• Excessive pronation (flat feet) makes them more susceptible to plantar heel pain.

• Obesity is seen in 70% of individuals who present with plantar fasciitis.

• Achilles tendon tightness.

• Inappropriate footwear has also been identified as a significant risk factor.

 Management of plantar fasciopathy

Seek professional assistance - from an experienced podiatrist, sports doctor or physiotherapist.

They will be able to assess if a biomechanical problem such as flat feet/high arch that may be contributing to the symptoms.

Treatment and management for plantar fasciopathy may include:

• Modification of activity.

• Change to appropriate footwear specific for the activity or occupation.

• The use of customised insoles or orthotics.

• The application of foot taping to stabilise and rest structures.

• Rehabilitation foot exercises.

Formthotics can help relieve the symptoms of heel pain

Your podiatrist or medical professional can confirm the diagnosis of your heel pain and provide a management plan which may include Formthotics™, functional taping, footwear advice, strengthening exercises, stretches, or other interventions.

Formthotics™ encourage optimal foot function, this means that the structures that run underneath your foot will be supported, offloaded and relieved. Heel pain responds well to treatment especially when dealt with early, and a full recovery is likely.

Pain in your hips or lower back during and after activity.

Hip pain

Hip pain can make it difficult to walk, go up and down stairs and slopes, squat, or even sleep on the side that hurts.

Often people describe themselves as having hip pain where in fact their pain is located around the sides of the pelvis or spine. Pain in the actual hip joint itself is usually felt in the region of the groin.

The hip is the largest ball-and-socket joint in the body. The thigh bone (femur) fits tightly into a cup-shaped socket (acetabulum) in the pelvis.

The hip joint is held together by muscles in the buttocks, groin, and spine; tendons; ligaments and a joint capsule. The largest nerve in the body (sciatic nerve) passes through the pelvis into the leg. With all these structures surrounding the hip it is understandable that there may be some confusion about the cause of pain.

As with any pain the most important starting place is obtaining a confirmed diagnosis from an experienced health professional. Any pain of sudden and severe onset must be investigated urgently by your podiatrist, doctor, or suitably qualified health professional.

Once the cause of your hip pain has been ascertained then a management plan can be implemented.

Formthotics can help relieve the symptoms of hip pain and reduce falls risk

If your hip pain is related to how you function during activity, a leg length discrepancy or biomechanical imbalance then foot orthoses, in conjunction with an exercise programme may form part of your management plan.

In cases where postural instability and an increased risk of falling and sustaining a hip fracture are evident it may be that full contact foot orthoses, in conjunction with suitable footwear and other safety measures may be implemented.

Knee pain is a common complaint that affects people of all ages.

Knee pain may be the result of an injury, such as a ruptured ligament or torn cartilage. Medical conditions - including arthritis, gout and infections - can also cause knee pain.

With any pain the most important starting place is obtaining a confirmed diagnosis from an experienced health professional. Any pain of sudden and severe onset must be investigated urgently by your podiatrist, doctor, physiotherapist or suitably qualified health professional.

Anatomy of the knee

The knee is the largest joint in the body and is made up of the upper leg bone (femur) and the lower leg bones (tibia and fibula), which are connected together by ligaments, tendons, and muscles.

The upper and lower bones of the knee are separated by two discs (menisci) and the surface of the bones inside the knee joint is covered by articular cartilage, which absorbs shock and provides a smooth surface for joint movement.

Types of knee pain or injury

Meniscus tear

A torn meniscus is a common knee injury that occurs due to forceful twisting or rotation of the knee, while it is fully weight bearing.

Each knee has two menisci which are C-shaped pieces of cartilage that act like a cushion between the bones in the knee. A torn meniscus causes pain, swelling, and stiffness.

Conservative treatment is sometimes enough to relieve the pain of a torn meniscus and give the injury time to heal on its own. In other cases, however, a torn meniscus requires surgical repair.

Knee Bursitis - housemaids knee

Knee bursitis is inflammation of a bursa located near your knee joint. A bursa is a small fluid-filled sac that reduces friction and provides cushioning between bones and the tendons and muscles near the joints.

Any of the eleven bursae found around the knee can become inflamed, but knee bursitis most often occurs over the kneecap or on the inner side of the knee below the joint. Knee bursitis causes pain and can limit mobility.

Osgood-Schlatter disease

Osgood-Schlatter disease is a common cause of knee pain in growing adolescents. It is an inflammation of the area just below the knee where the tendon from the kneecap (patellar tendon) attaches to the shinbone (tibia).

Osgood-Schlatter disease generally occurs during periods of fast growth, when bones, muscles, tendons, and other structures are developing rapidly. Physical activity puts additional stress on bones and muscles, therefore children who participate in running and jumping sports are at an increased risk for this condition.

Runner’s Knee – patellofemoral pain syndrome

Patellofemoral pain syndrome (PFPS) is the most common cause of knee pain and is caused by imbalances in the forces controlling the way the knee cap (patella) moves during knee flexion (tensing) and extension (straightening).

Risk factors include overuse, trauma, muscle dysfunction, tight lateral muscles and ITB (iliotibial band), a mobile patellar, and poor thigh muscle (quadriceps) flexibility. Symptoms include pain behind or around the knee cap which increases with running and activities that involve a lot of knee flexion.

Jumper's Knee – patellar tendinopathy

Patellar tendinopathy is an injury to the tendon connecting your kneecap (patella) to your shinbone. The patellar tendon works with the muscles at the front of your thigh to straighten your knee so you can kick, run and jump.

Patellar tendinopathy is also known as jumper's knee and is common in athletes who participate in jumping sports— such as basketball, netball and volleyball.

Treatment of patellar tendinopathy starts with physical therapy to stretch and strengthen the muscles around the knee.

Ligament injuries – There are four main ligaments in the knee that can become injured. During injury, a knee ligament may be stretched (sprained), or torn (ruptured). During a rupture either part of the ligament fibres are torn or the complete ligament has torn through its complete thickness.

Knee ligament injuries can cause pain, swelling, tenderness, bruising and reduced movement of your knee and the knee joint may feel unstable.

Treatment of a knee ligament injury can depend on which ligament is injured and to what degree as well as the level of activity or sport you participate in.

Knee osteoarthritis

Osteoarthritis is the most common form of arthritis in the knee. It is a degenerative, “wear-and-tear" type of arthritis that occurs most often in people 50 years of age and older, but sometimes may occur in younger people, too.

In osteoarthritis, the cartilage in the knee joint gradually wears away. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. This can result in bone rubbing on bone, and produce painful bone spurs.

Formthotics can help relieve the symptoms of knee pain

Formthotics™ can change the distribution and angle of force through the foot and ankle, which can result in a change in the distribution of force through the knee. They can also change the alignment of the foot and ankle, which can result in a change of alignment at the knee.

Formthotics support the structures of the foot to encourage optimal function and even pressure distribution. In doing this they reduce fatigue, increase shock absorption and reduce pain.

The variety of Formthotics options allow your medical professional to select Formthotics best for your feet, footwear and activity. Your Formthotics are then able to be customised specifically for your needs.

Pronation

Your foot rolls inwards.

Pronation is a naturally occurring and normal motion in the foot which involves your foot rolling inwards, this can become an issue when this movement is excessive. Excessive supination is less common, this is when your foot sits on its outer edge.

Pronation of the foot occurs with every step we take to enable us to adapt to uneven terrain and dissipate shock sufficiently. When the foot over pronates there is an issue as it places excessive stresses on soft tissue of the foot leg and ankle. Excessive pronation can lead to complaints such as shin splints, plantar fasciitis, posterior tibial tendon dysfunction, knee pain, hip pain and even lower back pain. Good supportive shoes will help as well as Formthotics™. Formthotics™ are designed to reduce pronation; they do this through their unique heat moulding process and arch contour design.

Supination & High Arches

Your foot rolls outwards with supination.

Supination is the opposite of pronation; it is where the foot rolls outwards so that the lateral edge of the foot is mostly in contact with the ground, the foot may also have an extremely high arch. Those who excessively supinate may find their outer ankle and leg become painful as well as their arch; Shoes may wear out quite quickly towards the outer edge and morph into a “banana” like shape. A neutral shoe will help with this foot type. Formthotics™ could also be beneficial; however they will require modifying by a medical professional such as a podiatrist.

The pes cavus foot type is one in which the sole of the foot is markedly hollow when bearing weight, and the arch is rounded and high.

Pes cavus is often called; high instep, high arch, talipes cavus, cavoid foot, or supinated foot type.

A person with high arches (pes cavus) needs a biomechanical and functional assessment to determine whether they are at risk of long-term complications. As with any pain the most important starting place is obtaining a confirmed diagnosis from an experienced health professional. Any pain of sudden and severe onset must be investigated urgently by your podiatrist, doctor, or suitably qualified health professional.

Due to the high arch, an excessive amount of weight is placed on the ball and heel of the foot when walking or standing. A cavus foot can cause a variety of symptoms, including pain and instability. High arches can develop at any age, and can occur in one or both feet.

Symptoms of Pes Cavus

The arch of a cavus foot will appear high even when standing. In addition, one or more of the following symptoms may be present:

• Hammertoes (bent toes) or claw toes (toes clenched like a fist)
• Calluses (hard skin) on the ball, side, or heel of the foot
• Pain in the ball of the foot, arches, heels and outside leg when standing or walking
• Susceptibility to ankle sprains and ankle instability
• Increased risk of trips and falls

The excess loading on the base of the big toe can predispose people to develop sesamoiditis; forces lead to repetitive stress on the tendons at the outside of the foot and leg, causing tendon and muscle overuse; forces are increased on the inside of the ankle causing pain.

The foot is also more susceptible to: ankle sprains; fractures on the outside of the foot (Jones fractures); and pain directly under the big toe (sesamoiditis).

An unstable foot due to the heel tilting inward can lead to ankle sprains

Some people with cavus foot may also experience foot drop, a weakness of the muscles in the foot and ankle that results in dragging the foot when taking a step. Foot drop is usually a sign of an underlying neurologic condition.

Management of Pes Cavus may include some of the following:  

• Orthotic devices - foot orthotics or insoles help support and protect the foot and relieve pressure areas. Customised orthotic devices provide optimal support, stability and cushioning to the foot.
• Shoe modifications - high-topped shoes support the ankle, and shoes with heels a little wider on the bottom, and heel flares add stability.
• Bracing - a brace to help keep the foot and ankle stable, and for managing foot drop can be useful.
• Hard painful skin - if corns and callus are present, they can be treated by a registered Podiatrist.
• Surgery - in very severe cases, especially if pain is present and the height of the arch is progressively increasing in height, surgery may be considered.

Formthotics™ can help relieve symptoms of pes cavus.

Formthotics can provide the ideal base to cushion, support and unload pressure areas in people with high arches. The multiple density options allow your podiatrist to select Formthotics best for your feet, footwear and activity. Your Formthotics are then able to be customised by your clinician specifically for the needs of your feet.

As cushioning is essential in managing the high arched foot, Formthotics dual density products add a cushioning layer on top of a supportive base. The Formax™ dual density foam provides increased shock absorption and even pressure distribution while maintaining a good level of support to optimise foot function and general comfort. Soft single density Formthotics are also available and are often the base of choice for high arch feet.

Pes Cavus, high arched feet need to be well managed and we recommend you visit a podiatrist or medical professional.

Shin Splints (medial tibial stress syndrome)

Shin splints are one of the most common problems in the lower leg in people who exercise or play sports

Shin splints is the name given to exercise-induced pain in the front of the lower leg, between the knee and the ankle. Shin splints are also known as medial tibial stress syndrome (MTSS).

Shin splints is a general term to describe a number of different, potential pathologies.

With any pain the most important starting place is obtaining a confirmed diagnosis from an experienced health professional. Any pain of sudden and severe onset must be investigated urgently by your podiatrist or medical professional.

The most common presentation of shin splints is over the inner (medial) part of the shin.

Symptoms over the front (anterior) or outer (lateral) part of your shin may not be due to shin splints and may be due to a compartment syndrome in the leg.

Shin Splints (MTSS) is caused by overuse and often occurs in runners.

Risk factors for Shin Splints include:

• A sudden increase in training frequency or intensity.

• Hard running surfaces.

• Running up an incline

• Previous leg injury.

• Poorly fitted or inadequate running shoes.

• Various problems with the biomechanics of the the lower leg and foot.

Management of Shin Splints

• Rest - this means avoiding any activity, such as running, that may have led to the shin splints.

• Ice - applying ice to the shin and raising your leg may help to relieve pain from shin splints.

• Elevation of the leg aims to limit and reduce any swelling. Keep the foot up on a chair to at least hip level.

• Painkillers or anti-inflammatory medication may be useful to relieve pain and may also limit inflammation and swelling.

With rest and treatment, you can fully recover from shin splints. However, they may return if the original cause is not well managed.

A specialist such as a sports physiotherapist or a podiatrist is able to assess your biomechanics and function which may highlight factors that have contributed to the development of shin splints.

They will also be able to help you modify your exercise programme and may suggest the insertion of an insole inside your shoes.

Prevention of shin splints

• The use of shock-absorbent insoles inside shoes while you are exercising may be helpful.

• Orthotics to manage abnormal foot function may also be helpful.

• Running and functional re-training can alter the forces transmitted to the shins.

• Regular replacement of running shoes is important.

• Graduated running programmes that build in rest days may also help.

Formthotics can help relieve the symptoms and prevent reoccurrence of shin splints

Formthotics support the structures of the foot to encourage optimal function and even pressure distribution. In doing this they reduce fatigue, increase shock absorption and reduce pain.

Formthotics dual density products add a cushioning layer on top of the supportive structure of Formthotics. The Formax™ dual density foam provides increased shock absorption and even pressure distribution while maintaining a good level of support to optimise foot function and general comfort.

Formthotics can provide the ideal base to support and distribute loading in people with arch pain. A number of Formthotics Medical options allow your podiatrist to select Formthotics best for your feet, footwear and activity. Your Formthotics are then able to be customised by your podiatrist specifically for your needs.