Podiatry is a healthcare profession that specialises in the management of disease and disorder of the lower limb and foot. The foot is a highly complex structure which can develop problems affecting the overall health and quality of life of a person by promoting and maintaining mobility. Podiatrists are educated in diagnosis and in planning and implementing interventions for all age groups. Podiatrists work alongside other health professionals including doctors, nurses, physiotherapists, occupational therapists. They are the only medical specialist educated, trained, licensed and certified for exclusive treatment of the foot and ankle and play a critical role in the care, treatment and management of the diabetic, elderly and circulation circulation-impaired patient. The diagnosis, intervention and treatment by podiatrists may save patients from amputation, restore mobility or prevent other serious, more costly problems, by early detection and appropriate treatment.
The Podiatry Foot and Ankle service is provided on an in-patient and out-patient service either by self referral or with a referral from a GP or Consultant.
The Podiatry and Ankle Clinic at the Bon Secours Hospital Dublin provides a comprehensive specialist service that includes the management and treatment of number of conditions outlined below.
In addition the podiatrist also treats conditions including ingrown toe nails, cracked heels, thickened toe nails and fungal nails.
Niall has worked in private practice for the past 11 years and has held many private consultant positions in both the public and private sectors . Niall started the podiatry dept In Connolly Hospital in Blanchardstown in 2008 and stayed until 2011 when he left Connolly to join the Bon Secours in Dublin. He also works in the National Rehabilitation Hospital. He is particularly interested in the Diabetic and Rheumatoid foot and has an interest in minor skin and nail surgery.
Arranging Appointments The Department cares for inpatients and outpatients.
The Podiatry Foot and Ankle Clinic at the Bon Secours Hospital Dublin sees patients on the following days and times:
Wednesday 8.30am – 4pm
Friday 1pm – 4pm
The initial consultation fee is €65.
The Achilles tendon is the largest and strongest tendon in the body. It connects the 2 large calf muscles (the gastrocnemius and soleus) to the back of the heel bone (calcaneus). The tendon gives us the ability to rise up onto our toes and is very important in facilitating walking and running.
Achilles pain is usually a result of tendonitis caused by tight or fatigued calf muscles which transfer too much of the burden of walking or running to the Achilles tendon. If the tendon is placed under too much stress then it will tighten and become over worked. The tendon becomes inflamed and over time can produce a covering of scar tissue which is less flexible than the tendon. If an inflamed Achilles continues to be stressed, it can tear or rupture.
Not stretching the calves properly, excessive hill running or speed work, both of which stress the Achilles more than other types of running, can bring on Achilles tendonitis.
Running in shoes that are too stiff can overload the Achilles, while shoes that are too flexible allow the Achilles tendon to twist and in some cases can contribute to Achilles pain. People who over-pronate (their feet roll too far inward on impact) are most susceptible to Achilles tendinitis.
The pain can be a dull or sharp pain anywhere along the back of the tendon, but usually close to the heel. Often there is limited ankle flexibility with redness or heat over the painful area. A nodule of scar tissue can often be felt in the tendon. Sometimes you can hear a cracking sound (scar tissue rubbing against tendon) when the ankle moves.
To help prevent Achilles tendonitis stretching the calf muscles is important. Wearing the right shoes and orthotics to address any biomechanical abnormality is important to help normalise the strain on the tendon. Rest until the Achilles is pain free then ease back into any running or walking program. Avoid hill work, speed work and sand. Remember to incorporate rest into your future training schedule.
Ankle pain is normally caused from an accident; when walking on uneven surfaces; playing sports; or someone standing on the foot.
The causes of ankle pain also include: weakness in the muscles, poor proprioception, certain types of activity, footwear (e.g. high heel shoes), feet structure (e.g. hypermobile ankle and extreme varus foot type).
Treatment of ankle pain includes; rest, ice, anti-inflammatory, activity modification, proprioception training, strengthening, sports massage, orthotics, footwear, surgery.
Arch pain (usually Plantar Fasciitis) is a pain that is usually felt first thing in the morning; or after rising up from a prolonged resting position. The pain tends to increases during the course of the day.
The causes of arch pain include: weight, a foot injury, overuse, abnormal biomechanics of the foot (e.g. flat feet or abnormal pronation), footwear, certain activities, inappropriate training, and medical conditions (eg. rheumatoid arthritis).
Treatment of arch pain include: weight reduction, rest, ice, activity modification, anti-inflammatory products, sports massage, stretching, strengthening, acupuncture, strapping, steroid injection, ultrasound, orthotics, extracorporeal shockwave therapy, iontopheosis, and changing shoes.
A Biomechanical Assessment is required for all lower limb and foot problems and to treat and alleviate the following:
Assessment for foot and lower limb pain includes a non weight bearing assessment of joint range of movement, muscle testing. After the assessment, a treatment plan is developed and often includes the use of orthotics or a shoe recommendation.
If orthotics are prescribed, a digital lab is used for their production ensuring that they are made perfectly for a patients feet and the foot shape is captured perfectly resulting in improved orthotic function and comfort.
Frequently, back pain is caused by misalignments within the feet and between the feet and ground. Because Podiatrists are the health professional specialised in lower limb biomechanics we are able to help by assessing and treating these misalignments. There are a variety of orthotic treatment options to address these misalignments.
This includes a complete Biomechanical assessment. In most cases this will include a non weight bearing assessment of joint range of movement, muscle testing, a static assessment of posture, walking gait analysis to allow in-depth study of any abnormalities found.
Pronation is a word that is thrown around often by shoe retailers; it is actually a medical word which describes a tri-planner motion involving adduction, plantar-flexion, and internal rotation. Pronation is a normal part of gait, but when it occurs at the wrong time, or the range of movement is abnormal, or occurs too fast then this can lead to a chain reaction that travels from the foot to the lower back. Pain and injury can be the result if left untreated.
Through the biomechanical assessment, the podiatrist can identify if the pronation is normal or abnormal leading to the development of symptoms.
Pronation produces an internal rotation of the lower limb; this in turn increases the curvature in the lower back, placing stress on the lower back joints and muscles.
Physical therapists can often offer pain relief by “freeing up” the muscles in the lower back, and this is worthwhile for pain relief. However if your lower back pain is caused by poor foot alignment (abnormal Pronation) then your back pain is likely to return, and you will return to see that therapist on an ongoing basis. If you have abnormal pronation Podiatry treatment is a great long term option for addressing the cause.
Even though bunions are a common foot condition, they are probably the one with the most misconceptions. Many people suffer unnecessarily with the pain of bunions for years before seeking treatment out of fear about the “surgery”. The good news is that most bunion pain can be resolved without surgery!
Bunions (hallux valgus) are often described as a bump on the side of the big toe. But a bunion is more than that. The visible bump actually reflects changes in the bony framework of the front part of the foot. With a bunion, the big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment, producing the bunion's "bump." Bunions are a progressive disorder. They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which continues to become increasingly prominent. Usually the symptoms of bunions appear at later stages, although some people never have symptoms.
What Causes a Bunion?
Bunions are most often caused by an faulty foot mechanics. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion. Although wearing shoes that crowd the toes won't actually cause bunions in the first place, it sometimes makes the deformity get progressively worse. That means you may experience symptoms sooner.
Just because you have a bunion does not mean you have to have pain. There are some people with very severe bunions and no pain and people with mild bunions and a lot of pain. Symptoms for a bunion may include;
Other conditions which may appear with bunions include;
Bunions are readily apparent; you can see the prominence at the base of the big toe or side of the foot. However, to fully evaluate your condition, the Podiatrist may take x-rays to determine the degree of the deformity and assess the changes that have occurred.
Because bunions are progressive, they don't go away, and will usually get worse over time. But not all cases are alike, some bunions progress more rapidly than others. There is no clear-cut way to predict how fast a bunion will get worse. The severity of the bunion and the symptoms you have will help determine what treatment is recommended for you.
Sometimes observation of the bunion is all that's needed. A periodic office evaluation and x-ray examination can determine if your bunion deformity is advancing, thereby reducing your chance of irreversible damage to the joint. In many other cases however some type of treatment is needed.
Early treatments are aimed at limiting the progression of the deformity and easing the pain of bunion or an associated joint. Conservative treatments such as orthotics can achieve this but they won't reverse the deformity itself. These options include:
Orthotics are custom made and designed to optimise foot function. An orthotic can help prevent a bunion getting worse and reduce pain enabling you enjoy life without foot pain, and dysfunction. Orthotics can not re-straighten bunions, only surgery can to this.
When the pain of a bunion interferes with daily activities, and conservative treatment has been completed it's time to discuss surgical options. Because bunions are caused by faulty foot mechanics, surgery can improve the look of your feet by removing the “pump” but if the underlying mechanics are not address then the bunion is likely to return.
Corns and callus are one of the most common problems seen by Podiatrists. They occur as a result of pressure on the skin. Your body respond to the pressure by building more skin, for protection. However if the pressure on the skin continues then the skin thickens further and becomes painful.
A callus generally refers to a more diffuse thickening of the skin (common on the ball of the foot) whereas a corn is a deeper more focal formation of hard skin (more common on the toes). A corn can form under a callused area.
Pain from calluses is generally a mild discomfort, while a corn can give severe pain while weight bearing. If pain persists while non weight bearing, the corn may be infected. You should seek the advice of a Podiatrist as soon as possible.
Corns and calluses are caused by one thing – TOO MUCH PRESSURE. To treat corns and callus the Podiatrist will de-bride the hard skin, which is painless, and gives immediate relief. BUT, until the cause (pressure) is addressed the corn or callus is likely to return!
Too much pressure can be caused by:
Podiatric treatment of corns and calluses include:
Plantar Fasciitis, often referred to as a "heel spur" is a common foot problem. It starts as a dull intermittent pain in the heel which may progress to a sharp persistent pain. It is usually worse in the morning with the first few steps, or after sitting for a period of time and then standing up
The pain normally goes away when you start walking but recurs after a period of rest. If left untreated Plantar Fasciitis develops to severe pain that can stop you from weight bearing on your heel. The plantar fascia is a broad band of fibrous tissue which runs along the bottom surface of the foot. It is attached to the heel bone (calcaneous) and fans forward toward the toes.
Plantar Fasciitis is caused by inflammation of the tissues connected to the heel bone, due to excessive pulling and stretching of the fibrous bands that support the arch of the foot. Continuation of this irritation can lead to heel pain, arch pain or a bony growth on the bottom of the heel bone called a "heel spur".
Not all heel pain is plantarfasciitis, heel pain syndrome is caused by repetitive pressure placed on the heel of the foot when walking, which causes soreness of the heel. "It is" usually refers to the inflammation of a certain part of the body, therefore Bursitis refers to the constant irritation of the natural cushion that supports the heel of the foot (the bursa). Bursitis is often associated with Plantar Fasciitis, which affects the arch and heel of the foot.
Bursitis and Plantar Fasciitis can occur when a person increases their levels of physical activity or when the heel's fat pad becomes thinner, providing less protection to the foot.
Other causes can include:
Orthotics are the best treatment for this type of condition as they address the underlying biomechanical cause, and take strain off the injured structure so that it can heal. Orthotics are not Arch supports. Orthotics address biomechanical function of the foot, while arch supports simply “pack” the arch. Arch supports may offer short term pain relief for heel pain but will lead to weakening of the foot structures in the long term.
Appropriate footwear is a key consideration in preventing heel pain; Foot Mechanics Podiatrists are experts in shoe recommendation.
Other common components of a treatment plan for Plantar Fasciitis and Bursitis include:
Pain on the front of the knee can be due to bursitis, arthritis, or softening of the patella cartilage known as chondromalacia patella. Pain on the sides of the knee is commonly related to injuries to the collateral ligaments, arthritis, or tears to the meniscuses.
Pain in the back of the knee can be caused by arthritis or cysts, known as Baker’s cysts. Baker’s cysts are an accumulation of joint fluid (synovial fluid) that forms behind the knee.
General knee pain can be due to bursitis, arthritis, tears in the ligaments, or menisci, osteoarthritis of the joint, or infection. Instability, or giving way, is also another common knee problem. Instability is usually associated with damage or problems with the meniscuses, collateral ligaments, or patella tracking.
Tendonitis is inflammation, irritation, and swelling of a tendon, which is the fibrous structure that joins muscle to bone. Tendonitis pain in the knee is located in the front of the knee or the lateral side of the knee. The pain often gets worse when going up and down stairs or inclines. Tendonitis knee pain is common in runners, skiers, and cyclists.
A biomechanical examination will help determine if your knee pain is caused by, or irritated by an alignment problem. Often an alignment problem in the knee starts from poor foot posture. As the foot moves on the ground it sets up a chain reaction of movements throughout the body including the knee. Too much movement or the wrong movement at the wrong time can lead to the development of knee pain.
The treatment of nail and skin foot problem service includes the removal of hard skin of corns and callus which brings instant relief to patients and the care of ingrown toenails. The full range of services includes care of the following;
Orthotics improve the overall foot function enabling the body’s own support mechanisms to function efficiently leading to stronger healthier feet and in most cases the relief of symptoms including associated leg and foot pain. They do not however directly support arches.
Customised Orthotics are prefabricated and held in stock at the clinics and are matched to your foot size and your footwear. The orthotic is then customised to achieve the therapeutic effect the Podiatrist has identified as necessary.
Prescription Custom Foot Orthotics are custom made using digital cad/cam technology. A digital lab is used to manufacture all prescription custom foot orthotics. The lab uses cad/cam technology to produce an orthotic that is the perfect shape, maximising comfort and functionality.
Many factors are considered prior to prescribing orthotics including;
Arch supports pack the area under the arch which can feel comfortable in the short term. However long term use of “arch supports” will weaken the arch of the foot and can lead to other biomechanical problems in the feet, ankles, knees, hips or lower back. The foot is an engineering marvel and requires more expertise than basic arch supports to address biomechanical problems.
Orthotics do not directly support the arch but rather improve the overall foot function enabling the body’s own support mechanisms to function efficiently. This leads to stronger healthier feet and in most cases relief of symptoms.
Podiatric Acupuncture is a system which can influence three areas of health care:
Acupuncture has been used to treat many podiatric medical problems, but is particularly useful for pain. It can help with joint pains and neurological conditions relating to the lower limb. It has also been used to treat problems such as plantar fasciitis, Morton's neuroma and leg cramps. While acupuncture is often associated with pain control, in the hands of a well-trained podiatrist it has much broader applications. Acupuncture can be effective as the only treatment used, or as the support or adjunct to other podiatry treatment in many medical and surgical disorders.
HOW MANY TREATMENTS ARE NEEDED?
The number of treatments varies from person to person for complex or long-standing conditions, one or two treatments a week for several weeks may be recommended. For acute problems, usually fewer visits are required, and for health maintenance, four sessions a year may be all that is necessary. Most people need between 3 to 8 treatments, and some people need to return for regular "top up" treatments every few months.
Shin pain is a very common lower leg complaint that usually manifests itself as shin splints. Shin splints are characterised by pain in the front or side of the lower leg. It is especially common among people involved in athletic pursuits such as running and walking, although non athletic activities such as standing all day at work can also lead to shin splints.
Causes of Shin Pain
