Chondromalacia - What is it?

You may have heard of Chondromalacia and know that it commonly refers to a condition of the knee. 
Why would the Footcare Clinic be interested in a knee problem?
Actually, any problem which causes you to walk differently is of paramount importance to your podiatrist because it will be affecting your feet and the problems you may have. Conversely, the way you walk and the angle at which you position your foot during walking may be the cause of chondromalacia in the first place.

The joints in our bodies are cushioned with articular cartilage. As each joint moves, the cartilage helps to cushion the bones and allows them to glide smoothly over one another.

Sometimes, the cartilage inside a joint softens and breaks down. This condition is called chondromalacia. and  as the joint moves, the ends of the bones can rub together, causing pain. Sometimes the cartilage can wear away completely, exposing the bone underneath and then the surface can grind painfully against the other bone(s) in the joint. The cells in the area respond by producing fluid in the joint, called joint effusion, i.e. swelling.


In the knee, chondromalacia-patella can be caused by an acute injury such as sudden impact, or from overuse usually due to the position of the patella itself, known as mal-tracking, where the patella moves sideways as a result of a muscle imbalance.
It is common in young athletes who depend on knee activity, especially runners, skiers, cyclists and other athletes. Anyone who spends a lot of time kneeling is also at risk, for example, floor layers.

If you are suffering with knee pain, get it checked out and remember to mention it when you visit your podiatrist. They may be able to help with a biomechanical assessment and orthotics.

Hammer Toes

What is a Hammer Toe

Hammer toes may occur in any toe except the big toe, most commonly the 2nd, 3rd and 4th. The toe is permanently bent at the middle joint  and may be flexible or rigid, The rigid toe is

often the most disabling as it is not capable of relieving pressure of its own accord and it often causes a 'back pressure'  onto the metatarsal area of the foot, in the metatarsals.  
There is often discomfort on the top of the toe due to rubbing against the shoe, resulting in corns and calluses both here and over the heads of the metatarsals.

What Causes It?

A Hammer Toe results from a muscle imbalance which causes the ligaments and tendons to become unnaturally tight causing the toe's joints to curl downwards.

People who have high arched feet may develop a hammer toe because the toes begin to slide upwards on the metatarsal heads, just behind the toes. This change in the structures on the sole of the foot causes the ligaments and tendons on the top of the foot to lengthen and weaken.

Also, those with flat feet will also tend to develop hammer toes because as the weight is transferred across the middle of the feet during walking, the smaller toes are trying to gain purchase on the ground, curling in an attempt to grip.

Arthritis can lead to many different forefoot deformities, including hammer toes. This is due to changes within the joint caused by inflammation and destruction. Shoes that are too narrow, too short or too shallow will contribute to the problem whilst Hallux Valgus, or bunions, may overcrowd the 2nd toe, pushing it upwards.

What happens next...

When these damaged toes are forced into shoes, the shoe rubs on the bony prominences. This added friction commonly produces a corn, or callus overlying the prominent part of the toe, which is over the hammered joint, or on the end of the toe.  Constant pressure will also cause the toe to become red and swollen in that area and is very painful. This may result in bursitis.

Treatment and Prevention

It is really important that footwear has enough depth for the toes, to prevent friction and rubbing. Having the callus and corns removed by a podiatrist is recommended, especially if the person lives with diabetes. In this case, the corn may not be painful, but may be causing a breakdown of skin underneath the corn, leading to infection.

Conservative treatments include gel toe shields and gel toe caps to eliminate friction between the shoe and the toe, while providing comfort and lubrication.

A word of warning, please do not use medicated corn pads as these often make the surrounding skin very moist and can cause an infection.

If the a hammer toe is causing a lot of problems and is a cause for concern due to infection, surgery may be appropriate.