Chikungunya (What - on EARTH??)

A patient called her podiatrist for an appointment this week as she had been suffering with chikungunya and she needed some therapy on her joints.

Naturally some research was required (as this was something not encountered previously!)  and we thought you may like to share our findings. Interestingly, Chikungunya is caused by a mosquito type bite and is most common in hotter lands than the UK;  although there have been reported outbreaks as close as Northern Europe.  Not surprisingly, Chikungunya is on the increase.

 Countries with reported local transmission of chikungunya virus (as of July 2014)

Chikungunya  is a virus and is transmitted by aggressive biting mosquitoes, which attack during the day. Once infected , the person has a high fever and severely debilitating painful joints, very often in their hands and feet. Our lady suffered severe vomiting and was hospitalised for a number of days. She was weakened and the painful joints made it difficult for her to walk. The mosquito responsible in her case, was very large and she witnessed the bite.

Outbreaks have previously been reported in Africa, Asia, Indian and Pacific Oceans. Although the virus has been reported since the 1950's, the incidence has been mainly in developing countries and sadly little interest was shown. An outbreak in the French colony of La Reunion in the Indian Ocean during 2005 motivated France to invest in research.  The first transmission of the virus in the Caribbean, was reported in 2013. So be aware if you are travelling to this popular destination.

Chondromalacia - Diagnosis and Treatment

Chondromalacia patella is a painful condition of the knee caused by a breakdown of the cartilage behind the knee cap, usually caused by overuse or direct trauma.
If you think you may be suffering from chondromalacia patella, the first line of treatment is to rest, apply compression and ice to the area to reduce inflammation.

It is important to visit a professional to have the cause identified. A biomechanical assessment will identify any problems with your walking and the alignment of joints. For example a foot which is not aligned with the knee may be causing the lower leg to rotate, putting a twist on the knee. Any problems can be corrected and strengthening exercises can be prescribed.


Patella taping can be used to instantly reduce pain by preventing the kneecap from constantly rubbing.  A patella knee support can support the patella and relieve pain. In some cases manipulation techniques can ease the discomfort.

A full knee exercise regime should be undertaken.. Exercises aimed at increasing the strength of the muscle on the inside of the knee and stretching the muscle on the outside of the knee is most often needed, although your podiatrist or physiotherapist will advise accordingly.  

The main message is, don't suffer in silence.  Visit your podiatrist and request a biomechanical assessment. Help is out there!

Chondromalacia - What are the symptoms?

Chondromalacia patella is a breakdown of the cartilage in the knee, usually due to trauma or mal-tracking of the patella over the knee joint.

The most common symptom of chondromalacia patella,  is a dull, aching pain in the front of your knee, behind your kneecap/patella. It can flare up after you have been sitting in one position for a long time. For example, your knee may be painful and stiff after a long trip in a car or aeroplane and it is often worse first thing in the morning; it may therefore be confused with an arthritic problem.  The pain can get worse when you go up or down stairs.

Chondromalacia can sometimes make your knee joint "lock" which means you suddenly have trouble moving it past a certain point.  Sometimes the joint may buckle or not support you effectively, which tends to occur when you bend your knee repeatedly, especially when you go up or down stairs. Occasionally the knee may be swollen and hot. 




Chondromalacia can cause a grinding sensation when you move your knee. This is not always a true test of diagnosis, as there are many other conditions which cause the knee to creak.

If you are struggling with chondromalacia, please visit a professional for advice.

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.

Chilblains - now what do I do?

It's all very well understanding what causes chilblains and how to prevent them, but what do you do when you actually have a chilblain?

They will have started as red itchy patches caused by an abnormal reaction to a change in temperature, then they will have turned a dark blue which has become increasingly painful. Now you face the prospect of them drying out and an ulcer forming from infection.

Corns and calluses in the area will make the chilblain worse and so removal of these will help. Padding of the area to  deflect the pressure will ease the pain and these are  issues your podiatrist can assist with.

A cracked area that has become ulcerated certainly requires professional intervention. Your podiatrist will be able to help with this and any other foot problems you may encounter. If you suffer with a medical condition such as diabetes, you must visit your G.P.

Footcare Clinic, Macclesfield.

Posterior Tibial Dysfunction

People who suffer with Posterior Tibial Dysfunction often complain about a pain on the inside of the ankle, swelling in the area and often, they are unable to stand on their toes. This is more common in women over 40 years old, but it does happen to men too.

The posterior tibial tendon starts in the calf, passes down behind the inside of the ankle and attaches to bones in the middle of the foot. It provides support as you push off on your toes when walking. If this tendon becomes inflamed, or damaged, there is pain on the inner ankle and a gradual loss of the inner arch on the bottom of your foot, leading to flatfoot. This condition is also called 'Adult Acquired Flat Foot'. It is not hereditary but may be caused by an inherent abnormality of the tendon. Inflammation of the tendon may be caused  by excessive force on the foot, such as running uphill, or in sports where there is a rapid change of direction, for example football, hockey or tennis.

Those who are living with diabetes or inflammatory diseases such as rheumatoid arthritis are more likely to develop this condition, as is anyone with previous trauma to the foot. Obesity and pregnancy often put more pressure on the tendon and lead to inflammation.

An easy diagnostic exercise is to stand facing a wall. Support yourself against the wall and lift the unaffected foot out of

the way, whilst rising onto tiptoes of the other.  From behind, a companion will be able to see if the heel of the affected foot turns inward. If there is no inward rotation, then dysfunction of the posterior tibial tendon is indicated and a trip to your podiatrist is recommended.

Treatment of the disorder will involve orthotics, ranging from small shoe inserts to fixed ankle supports. Sometimes a walking boot is recommended.

Without treatment, the flatfoot that develops from posterior tibial tendon dysfunction eventually becomes rigid.  Pain increases and spreads to the outer side of the ankle and consequently, the way you walk may be affected causing pain in the hips knees and back.

If you think you may have this disorder, rest is recommended, especially reducing the amount of exercise which causes the pain. Utilise low impact exercise instead, such as swimming. Always warm up with stretches before exercising and using ice on the area can reduce inflammation. For specific advice on orthoses, a biomechanical assessment is recommended.

Please don't ignore this problem, it will get worse and your podiatrist can help you.

Charcot Foot

We are all aware that diabetes is a very serious condition. If you are in any doubt about the effects it can have, then look no further than Charcot foot.  

Diabetes, along with other conditions, can cause neuropathy which is a loss of the ability to feel temperature, pain and trauma. People with neuropathy, especially those who have had it for a long time, are at risk of developing Charcot foot. It is named after Jean-Martin Charcot, a French neurologist who in 1868 first associated neuropathy with bone and joint destruction in the foot.

The problem is due to the inability to ‘feel’ the ground as you walk, a lack of 'proprioception'. A good example of this is when walking on uneven ground. As the foot hits the ground, proprioceptors in the foot and leg recognise the position of the ground and adjustments are made in order to keep walking forward. When sensation in the feet is lost, the connection is not made between the feet and the brain; the feet do not adjust properly, causing excessive strain on the joints and bones. Over time these joints and bones begin to break down. The bones are weakened enough to fracture and with continued walking, the joints collapse and the foot takes on an abnormal shape.

The damage to the joints results in a foot that no longer functions properly. There are pressure points on the foot which may ulcerate and become infected which may in turn lead to osteomyelitis.

Nobody wants this to happen, so it is very important to understand the process and be able to recognise the symptoms.

The first stage is very destructive and the foot displays signs of inflammation; redness, swelling and increased heat. Under the surface the bones may be fractured, even though there is probably still no pain. Next, the body attempts to heal the fractured bones to restore normal joint function, but they are already damaged and with continued pressure from walking, they are deformed.

If Charcot's is treated early, the damage can be limited. Usually, a total contact cast is applied to the affected foot to evenly distribute the weight, although non-weightbearing is best. This prevents further damage and helps the bones to heal properly. If damage has occurred, then specialist footwear will help to minimise pressures on the foot and prevent ulcerations. Severely deformed feet may require surgery to remove bony prominences and to fuse weakened joints in order to prevent further damage.

SO VERY IMPORTANTLY:

• With diabetes, keep blood sugar levels under control to help reduce the progression of nerve damage in the feet.
• Check both feet every day. Charcot usually occurs in one foot, so if there is a difference between your feet, such as one is warmer and more swollen than the other, then contact your podiatrist or GP IMMEDIATELY
• Be careful to avoid injury, such as bumping the foot or overdoing an exercise program.
• Visit a podiatrist regularly.

Haglunds Deformity

What is Haglund's Deformity?

Haglund’s deformity is a bony enlargement or lump on the back of the heel bone (calcaneus), where the Achilles tendon attaches to the foot area. When that bony enlargement rubs against the heel counter of a shoe, the soft tissue near the Achilles tendon becomes inflamed, often leading to bursitis .

People suffering with Haglund's deformity complain of a rubbing pain which makes them limp when they put their foot to the floor, in shoes. They have a noticeable bump on the back of the heel, which is swollen and inflamed. It is relieved when walking barefoot.

The calcaneum, or the heel bone, is shaped differently on different people and those with a prominent bump are more likely to develop Haglund's deformity.

As with many foot disorders, Haglund’s deformity may be due to inherited foot structures. These  include

A prominent heel bump squeezing the tissues between the shoe counter and the heel.

A high-arched foot

A tight Achilles tendon

A tendency to walk on the outside of the heel.

Treatment of Haglund’s deformity is generally conservative, aimed at reducing the inflammation of the bursa. While these approaches can resolve the pain and inflammation, they will not shrink the bony protrusion. Your podiatrist will be able to advise on the best treatment options for you, but for immediate relief, ice may reduce the swelling of the inflamed area. Wearing shoes with modified heel counters or open-backed shoes will take pressure off the bump, as will walking barefoot.

Longer term, placing pads or cushions inside the heels of shoes can help take pressure off the back of the heel and orthotics may help to stabilise and control the motion of the foot. Some people find that wearing padded socks can also help take pressure off the back of the heel.

Whereas the bony protrusion will not change with conservative treatment, the thickened soft tissues may shrink back to normal size in time, once the pressure is removed.

Anyone who has suffered from Haglund's deformity will want to prevent it happening again. Logical steps to take include:

Wearing appropriate shoes - avoid shoes with a rigid heel back

Performing stretching exercises to prevent the Achilles tendon from tightening

Avoiding running on hard surfaces and running uphill  

Using orthotic devices as prescribed by your podiatrist

As ever, please don't suffer in silence. Call in to see us and ask for our help.

Cellulitis

Any area of the skin that is  red, warm, swollen and painful may be cellulitis.  

Cellulitis often begins as a small area of tenderness, which is swollen and red and spreads to adjacent areas.

The involved skin may also feel warm. There may be red lines under the skin before the generalised redness appears.  As this red area begins to enlarge, the affected person may begin to feel unwell developing a fever and nausea as the infection enters the blood stream or the lymphatic system. 

There are other conditions which look similar to cellulitis.  Poor leg circulation can lead to a red scaly skin, but this is not infectious.

The lower leg is the most common site of the infection, particularly over the front and in the foot.

Cellulitis  occurs when bacteria enters the skin through a crack or break. Sometimes the break in the skin is obvious, such as a scratch or an insect bite. Other times it can be due to a tiny crack in the skin caused by a fungal infection such as  athletes foot, or a cracked heel. Eczema or psoriasis  cause skin damage, as does radiation therapy. Any of these may lead to cellulitis. 
People who are living with diabetes or have a weakened immune system, such as those who have had chemotherapy,  are particularly susceptible to developing cellulitis, as are those who have conditions affecting the circulation in the legs. These include pregnancy and surgery.

As cellulitis is an infection of the  deeper layers of the skin, it is not contagious.  The top layer of the skin provides a cover over the infection.

If you suspect cellulitis, you should visit your GP as soon as possible as antibiotics are usually prescribed. This is dependent on many factors  including general health, the condition of any wound, the site of the problem, the bacteria involved and the extent of the inflammation.

If there is an underlying problem, such as athletes foot, ulceration or overall dryness of the skin, these must be treated to reduce the chance of re-infection. A visit to your podiatrist is recommended.

Cellulitis is not always preventable, but sensible precautions are always advised:

* Trim your toenails carefully.
* Moisturize your skin regularly to avoid peeling and cracking.
* Attend to any infections, such as athlete’s foot.
* Check your feet and legs regularly to detect any early signs of infection.

Restless Legs

"I'm not sleeping well"

"Once my legs start to jump, I know I won't get any peace"

Have you ever felt this way?

Strangely, people tend to mention this whilst in the podiatrist's chair as a topic of conversation, rather than visit their GP. They feel it is something they should tolerate and not "worth bothering" their doctor with. Some even feel they will be laughed at.

It is called 'Restless Leg Syndrome'  and was first described by Ekbom in 1944 as occurring mainly at rest and included 'sensory symptoms'. Legs jump and twitch and are sometimes painful. Sensations similar to electric shocks have been reported, as have crawly and fizzing sensations. All symptoms are worse at night and are improved with exercise. Some people find that staying still for any length of time is difficult and they avoid trips to the theatre, cinema or even travelling by car or plane.

It commonly disrupts sleep causing tiredness through the day and may even lead to depression. Many adults report that their symptoms began in childhood and studies have proved that nearly 2% of children have significant symptoms which are often dismissed as 'growing pains'.  

A strong genetic link has been identified by Daniel Picchietti, a professor of paediatrics in the University of Illinois College of Medicine; who reported that more than 70% of children with the condition have at least one parent with symptoms.

Sometimes it can be secondary to another condition, such as iron deficient anaemia, magnesium deficiency or pregnancy.

Some people have found the condition improves by walking and stretching; taking warm baths; yoga and relaxation; reducing alcohol and caffeine intake. Eating foods rich in magnesium has helped in many instances.  

Ignoring the symptoms may cause stress and an inability to cope. Lack of sleep can cause irritability  and lead to inevitable problems at work.

But there is no need to suffer in silence as your G.P. can help.

For more advice about podiatric issues, click here.