Month: January 2016

Metatarsalgia

Posted on by Staff

Metatarsalgia is a ‘waste bucket’ term that means pain in the forefoot or metatarsal region. It could be any number of things such as sesamoiditis, plantar plate dysfunction or a mortons neuroma

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Metatarsalgia is a general term that refers to pain and inflammation in the ball of the foot, specifically around the metatarsal heads—the bones just behind the toes. This condition often feels like a sharp, aching, or burning pain in the forefoot, especially during activities like walking, running, or even just standing for long periods. Many people describe it as feeling like there’s a pebble in their shoe or that they’re walking on a bruise. It typically develops over time due to repetitive stress rather than a single traumatic event.

There are a variety of causes and contributing factors for metatarsalgia. Improper footwear—like high heels or shoes with a narrow toe box—can concentrate pressure on the metatarsals. High-impact sports, foot deformities (like bunions or hammertoes), tight calf muscles, or having a high arch (pes cavus) can all shift weight abnormally to the forefoot. Additionally, carrying extra weight or experiencing age-related fat pad thinning under the metatarsals can make someone more prone to this condition. Sometimes, metatarsalgia occurs in tandem with other problems like Morton’s neuroma or stress fractures, complicating the diagnosis.

Treatment is usually conservative and focuses on offloading pressure and reducing inflammation. This includes wearing shoes with a wide toe box and cushioned soles, using metatarsal pads or custom orthotics to redistribute weight, and modifying activities to avoid prolonged standing or high-impact movements. Ice, NSAIDs (non-steroidal anti-inflammatory drugs), and stretching exercises—especially for the Achilles tendon and calf—can also help. In rare, persistent cases, surgical intervention may be considered to correct anatomical issues or relieve nerve compression. Early management is key to preventing chronic pain and long-term changes in gait.

Most Useful Resources:
Metatarsalgia (Podiatry Arena)
Metatarsalgia (PodiaPaedia)
Metatarsalgia (Foot Health Forum)
M is for Metatarsalgia (Podiatry ABC)
Metatarsalgia (Best Running Shoes)

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Multiple Sclerosis

Posted on by Staff

Multiple sclerosis (MS) is a chronic, often unpredictable disease that affects the central nervous system (CNS)—which includes the brain, spinal cord, and optic nerves. It’s classified as an autoimmune disorder, meaning the body’s immune system mistakenly attacks its own tissues. In the case of MS, the immune system targets the myelin sheath, a protective layer that surrounds nerve fibers. This damage disrupts the normal flow of electrical signals in the CNS, leading to a wide variety of neurological symptoms. Depending on where the damage occurs, symptoms can include numbness, vision problems, muscle weakness, balance issues, fatigue, or even cognitive changes.

The course of MS can vary dramatically from person to person. There are a few main types: relapsing-remitting MS (RRMS) is the most common and involves clear flare-ups (relapses) followed by periods of recovery (remission). Others may experience secondary progressive MS (SPMS), where the disease gradually worsens over time, or primary progressive MS (PPMS), which is progressive from the start without distinct relapses. The exact cause of MS isn’t fully understood, but it’s thought to involve a mix of genetic predisposition and environmental triggers—like certain viruses (e.g., Epstein-Barr), low vitamin D levels, and possibly smoking. MS is more common in women and often starts between the ages of 20 and 40.

Treatment focuses on managing symptoms, modifying the disease course, and improving quality of life. Disease-modifying therapies (DMTs) are the cornerstone for many patients—they help reduce the frequency and severity of relapses and slow progression. These drugs include injectable medications, oral pills, and infusion-based therapies. Alongside that, physical therapy, lifestyle changes (like staying active and managing stress), and medications for specific symptoms (like spasticity or fatigue) all play a role. While there’s currently no cure, ongoing research in immunology, stem cells, and remyelination techniques is offering a lot of hope for better treatments—and maybe even a cure—in the future.

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Most Useful Resources:
Multiple Sclerosis (Podiatry Arena)
Multiple Sclerosis (PodiaPaedia)
Multiple Sclerosis (Foot Health Forum)
Multiple Sclerosis Diagnosis & Management (Podiatry Apps)

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Maximalist Running Shoes

Posted on by Staff

Maximalist running shoes are the antithesis of the fad there was with minimalist running shoes. Maximalist running shoes have lots of padding and other design features added.

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Maximalist running shoes are a distinct category of footwear designed with extra-thick cushioning to provide a plush, protective ride. Unlike minimalist shoes that aim to simulate barefoot running with minimal material between the foot and ground, maximalist shoes go the opposite direction—offering an abundance of foam underfoot. This design is especially popular among long-distance runners, ultramarathoners, and those recovering from injury, thanks to the enhanced shock absorption and reduced impact forces on joints.

One of the key benefits of maximalist shoes is the reduction in perceived fatigue, particularly on hard surfaces and extended runs. The generous midsole often uses lightweight, responsive materials like EVA or newer superfoams, which cushion each step while still returning energy. While some worry this added foam could make the shoe unstable, many models use a wide base or rocker geometry to counteract that, helping maintain a smooth gait and stable transition from heel to toe.

However, maximalist shoes aren’t a perfect fit for everyone. Some runners find that too much cushioning dulls ground feel and responsiveness, making it harder to react quickly or engage the foot’s natural mechanics. For speed workouts or races, many still prefer lighter, lower-profile shoes that feel more agile. Also, runners with certain gait patterns might not benefit from the extra stack height, as it could lead to inefficient stride mechanics or even discomfort over time.

Still, maximalist shoes have carved out a solid niche in the running world. Brands like Hoka One One, Altra, and New Balance have pioneered many innovations in this space, leading to shoes that feel almost cloud-like yet durable enough for hundreds of miles. Whether you’re aiming for ultra distances, recovering from a stress-related injury, or simply craving a softer ride, these shoes offer a compelling, comfort-driven alternative—especially for those who prioritize cushioning over minimalism.

Most Useful Resources:
The maximalist Brooks Transcend Running Shoe (Podiatry Arena)
Maximalist Running Shoes (PodiaPaedia)
Maximalist Running Shoes (Foot Health Forum)
‘Maximalist’ Running …. the new black? (Friday Fitness)
The next maximalist running shoe trend (Foot Health Friday)

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Minimalist Running Shoes

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Minimalist Running Shoes are shoe that have minimal or no design features. They are almost close to running barefoot.

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Minimalist running shoes are designed to mimic the natural biomechanics of barefoot running while offering a layer of protection against the elements. These shoes typically feature a low heel-to-toe drop (often zero), minimal cushioning, and a flexible sole that allows the foot to move freely. The idea is to promote a more natural running gait by encouraging forefoot or midfoot striking, which can potentially reduce the impact forces associated with heel striking in traditional running shoes.

One of the biggest appeals of minimalist shoes is how they help strengthen the muscles of the feet and lower legs. Traditional running shoes, with their thick cushioning and stability features, tend to do a lot of the work for your feet. By stripping away that support, minimalist shoes force your body to adapt, using intrinsic muscles that may have weakened over time. Runners often report improved balance, proprioception, and a more connected feel to the ground beneath them. That said, this transition isn’t instant—adapting to minimalist footwear requires a gradual, mindful approach to avoid injury.

Another important point to consider is injury risk. While some runners find that minimalist shoes help alleviate chronic issues like plantar fasciitis or knee pain, others might experience new problems like calf strains or metatarsal stress fractures if they dive in too quickly. It’s not that minimalist shoes are inherently risky, but they do demand a shift in running mechanics that your body needs time to accommodate. A good strategy is to alternate between traditional and minimalist footwear, slowly increasing your mileage in the latter over several weeks or even months.

From a practical standpoint, minimalist shoes tend to be lighter and more breathable, making them popular for warm weather runs or travel. They’re also more versatile—many models double as casual footwear thanks to their sleek, low-profile design. However, they might not be the best choice for every runner or every surface. For example, technical trails with sharp rocks or cold climates may call for more substantial protection. So, while minimalist running shoes offer a compelling, back-to-basics approach, it’s essential to weigh their benefits against your individual needs, running style, and terrain.

Most Useful Resources:
Transitioning to Minimalist Running Shoes (Podiatry Arena)
Minimalist Running Shoes (PodiaPaedia)
Minimalist Running Shoes (Foot Health Forum)
Minimalist Running (Podiatry TV)
Critique of ‘are you ready for minimalism’ preparation tests (Running Research)
Minimalist Running Shoes (Podiatry Books)
Minimalist Running Shoes (Shop)

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Medial Tibial Stress Syndrome

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Medial Tibial Stress Syndrome is one of the more common overuse injuries of the leg. It was typically and previously referred to as shin splints.

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Medial Tibial Stress Syndrome (MTSS), commonly referred to as “shin splints,” is a condition characterized by pain along the inner edge of the tibia (shinbone). It typically develops as a result of repetitive stress on the tibia and the connective tissues that attach muscles to the bone. MTSS is especially common among runners, dancers, and military personnel—anyone who suddenly increases the intensity or duration of physical activity. It’s considered an overuse injury, meaning it usually stems from excessive or improper loading of the lower leg over time rather than a single traumatic event.

The pain associated with MTSS is usually diffuse and located on the medial (inner) portion of the lower leg, typically spanning a length of 5 to 15 cm. This contrasts with other conditions like stress fractures, which often produce more localized pain. The discomfort usually starts as a dull ache during or after exercise, and if activity continues without proper treatment, the pain can become more intense and persistent, even at rest. MTSS is thought to result from a combination of tibial bone stress and inflammation of the periosteum (the tissue surrounding the bone), as well as dysfunction in surrounding musculature such as the soleus or tibialis posterior.

Risk factors for developing MTSS include biomechanical issues like flat feet (overpronation), tight calf muscles, or improper footwear, as well as poor training habits like rapid increases in workout intensity, volume, or frequency. Hard running surfaces and inadequate recovery between sessions can also contribute. Diagnosis is usually clinical, based on patient history and physical examination, although imaging (like MRI or bone scans) might be used in unclear or severe cases to rule out more serious issues such as tibial stress fractures or compartment syndrome.

Treatment and prevention of MTSS focus primarily on conservative measures. Relative rest from high-impact activities is essential in the early stages. Ice therapy, anti-inflammatory medications, and stretching or strengthening exercises for the lower leg muscles can help alleviate symptoms. Long-term prevention often requires addressing the root cause—correcting foot biomechanics with orthotics, improving running technique, and gradually progressing training loads. Cross-training with low-impact activities like swimming or cycling is also helpful. If addressed early and properly, most cases of MTSS resolve without long-term complications.

Most Useful Resources:
Medial Tibial Stress Syndrome (Podiatry Arena)
Medial Tibial Stress Syndrome (PodiaPaedia)
Medial Tibial Stress Syndrome (Foot Health Forum)
Medial Tibial Stress Syndrome (Clinical Boot Camp)
Medial Tibial Stress Syndrome (Podiatry Update)
Cheap orthotic for shin splints? (Podiatry Experts)
Medial Tibial Stress Syndrome (Podiatry TV)
Shoe Wedging or Gait Retraining for Medial Tibial Stress Syndrome? (Running Research)
Medial Tibial Stress Syndrome (Best Running Shoes)
Medial Tibial Stress Syndrome (Podiatry Books)

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Metatarsus Adductus

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Metatarsus Adductus is a problem in children (and occasionally adults) in which the forefoot is excessively adducted on the rearfoot

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Metatarsus Adductus (MTA) is a common congenital foot deformity where the forefoot is adducted, or curved inward, relative to the hindfoot. It usually presents at birth or within the first few months of life. The condition affects the metatarsal bones, which are the long bones in the foot leading to the toes, causing them to angle medially. While the heel remains in a normal position, the forefoot appears curved like a “C-shape” when viewed from the bottom. It’s considered one of the most frequent foot abnormalities in infants, with a higher prevalence in first-born children and those with a family history of foot deformities.

The cause of Metatarsus Adductus isn’t entirely clear, but it’s believed to result from intrauterine positioning—essentially, the baby’s foot being pressed into an abnormal shape due to space constraints in the womb. This explains why it’s often bilateral and more noticeable in full-term infants. There are two main types: flexible, where the foot can be manually straightened, and rigid, where the deformity is more fixed and less responsive to gentle manipulation. A flexible MTA usually resolves on its own, while rigid forms may need intervention.

Diagnosis of MTA is typically clinical and based on physical examination. The “V-finger test” is a quick, informal method where the examiner uses their index and middle fingers to assess the curvature of the forefoot. X-rays are rarely needed unless the diagnosis is unclear or the deformity is rigid and persistent. It’s crucial to distinguish MTA from more serious conditions like clubfoot (talipes equinovarus), which involves multiple planes of foot deformity and generally requires more aggressive treatment.

Management of Metatarsus Adductus depends on the severity and flexibility of the deformity. Most mild and moderate flexible cases resolve spontaneously by 6 to 12 months of age without any treatment. For persistent or more severe cases, especially rigid ones, options include stretching exercises, serial casting, or orthotic bracing. Surgery is rarely needed and typically reserved for older children with significant residual deformity that impairs function. Early identification and monitoring are key to ensuring that the condition does not interfere with the child’s walking or foot development.

Most Useful Resources:
Metatarsus Adductus (Podiatry Arena)
Metatarsus Adductus (PodiaPaedia)
Metatarsus Adductus (Foot Health Forum)
Metatarsus Adductus (Podiatry ABC)

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The MBT Shoes

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The Masai Barefoot Technology (MBT) shoes are a toning shoe that is claimed to have a number of health benefits

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Masai Barefoot Technology (MBT) shoes are a unique footwear innovation designed to mimic the natural instability of walking on soft, uneven terrain. Developed in the 1990s by Swiss engineer Karl Müller, MBT shoes aim to engage muscles more actively, improve posture, and reduce joint stress. Let’s delve into the specifics of these distinctive shoes.

Design and Technology

At the heart of MBT shoes is a multi-layered, curved sole featuring the patented Masai Sensor and Pivot Axis. This design creates a rolling motion from heel to toe, simulating the experience of walking on soft ground. The intentional instability challenges the body to maintain balance, thereby activating various muscle groups, including those in the feet, legs, and core. This mechanism not only promotes a more natural gait but also encourages better posture and muscle engagement.

Health Benefits

MBT shoes are renowned for their potential health benefits. By promoting a mid-foot strike and enhancing muscle activation, they can alleviate pressure on joints, making them beneficial for individuals with conditions like plantar fasciitis or arthritis. The enhanced muscle engagement may also aid in strengthening the lower body and improving overall stability. Additionally, the unique sole design can contribute to better spinal alignment, potentially reducing back pain.

Considerations and Usage

While MBT shoes offer numerous advantages, they may not be suitable for everyone. Individuals with certain foot conditions, such as flat feet or valgus deformities, might find the instability challenging. It’s advisable to consult with a healthcare professional before incorporating MBT shoes into your routine. For new users, it’s recommended to gradually increase wear time to allow the body to adapt to the unique mechanics of the shoes.

Availability and Varieties

MBT offers a diverse range of footwear options, including casual shoes, athletic trainers, dress shoes, and sandals, catering to various lifestyles and preferences. Each style incorporates the signature curved sole technology, ensuring that users can experience the benefits across different settings. For those in Australia, MBT shoes are available through local retailers and online platforms, providing accessible options for those interested in exploring this innovative footwear solution.

In summary, MBT shoes present a distinctive approach to footwear, emphasizing natural movement and muscle engagement. While they offer potential health benefits, it’s essential to consider individual needs and consult professionals when necessary.

Most Useful Resources:
masai barefoot technology (Podiatry Arena)
Clubfoot (PodiaPaedia)
mbt shoes (Foot Health Forum)
MBT Shoes (Podiatry TV)
MBT Shoes (Podiatry Books UK)
MBT (Toning Shoe Market)
Are MBT Shoes Helpful? (Podiatry Update)
Does anyone know if the MBT shoes help heel spurs? (Podiatry Experts)
Do MBT Shoes Work? (Clinical Boot Camp)

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Clubfoot

Posted on by Staff

Clubfoot is a congenital condition in which the foot at birth is in a plantarflexed, inverted and adducted position

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Clubfoot, medically known as congenital talipes equinovarus (CTEV), is a birth defect in which one or both feet are twisted out of their normal position. The condition affects about 1 in every 1,000 live births, making it one of the most common congenital deformities. In a clubfoot, the foot typically points downward and inward, and the soles may face each other. This abnormal positioning is due to a combination of bone, tendon, and muscle abnormalities present at birth, though the exact cause is often unknown. It can occur as an isolated condition or be associated with neuromuscular disorders like spina bifida.

There are two main categories: idiopathic clubfoot, which occurs in otherwise healthy babies with no known underlying condition, and non-idiopathic clubfoot, which is associated with other syndromes or neurological disorders. The deformity isn’t painful for infants but, if left untreated, can lead to significant mobility issues and lifelong disability. Children may walk on the sides or tops of their feet, resulting in skin breakdown, pain, and difficulty with shoes. Fortunately, early diagnosis—often via prenatal ultrasound or at birth—allows for prompt intervention.

The gold standard treatment is the Ponseti method, a non-surgical approach that involves a series of gentle manipulations and casting to gradually move the foot into the correct position. This process usually starts shortly after birth and continues over several weeks. After achieving the desired alignment, a minor procedure called a tenotomy is often performed to release the tight Achilles tendon. Once corrected, the child must wear a brace (foot abduction orthosis) for several years during sleep to maintain the correction and prevent relapse. Compliance with bracing is critical for long-term success.

In more severe or resistant cases, or when initial treatment is delayed or fails, surgical intervention may be necessary. Surgery can involve lengthening tendons, repositioning bones, or even joint fusion in complex cases. However, surgery is typically considered a last resort due to potential complications like stiffness and reduced foot flexibility. With proper and timely treatment, most children with clubfoot go on to lead active, pain-free lives, participating fully in physical activities and sports. The key is early recognition, consistent follow-up, and a treatment plan tailored to the individual child’s needs.

Most Useful Resources:
Clubfoot (Podiatry Arena)
Clubfoot (PodiaPaedia)
Clubfoot in the Newborn (Foot Health Friday)
Clubfoot (Foot Health Forum)
Clubfoot (DPM Podiatry)
Clubfoot (~ talipes equinovarus) (ePodiatry)

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Magnetic Insoles

Posted on by Staff

Magnetic Insoles are pseudoscience nonsense. They are insole with magnets that have made up claims about the health benefits of walking around on magnets.

Magnetic insoles are shoe inserts embedded with small magnets, typically made from materials like neodymium or ferrite. They’re marketed with the idea that the magnets can interact with the body’s natural magnetic fields or stimulate specific pressure points in the feet. Most designs place these magnets at strategic locations, like the arch, heel, or ball of the foot, aligning with reflexology zones or acupuncture principles. While the science behind “bio-magnetism” remains controversial, these insoles continue to be popular in alternative wellness circles.

Supporters of magnetic insoles claim they offer a range of benefits, such as pain relief, improved circulation, and increased energy. The magnets are said to produce low-level magnetic fields that may help reduce inflammation or stimulate nerve endings. This is particularly appealing to people with conditions like plantar fasciitis, arthritis, or chronic foot pain. Some even suggest that consistent use can ease discomfort in areas beyond the feet—like the lower back or knees—by altering posture or gait mechanics.

From a scientific standpoint, however, the evidence is mixed at best. Several controlled studies have shown little to no difference between magnetic insoles and placebo (non-magnetic) versions in terms of pain reduction or functionality. Critics argue that any perceived benefits are likely due to the placebo effect or the general comfort of the insole rather than the magnets themselves. Still, because the risks are minimal, many users continue using them based on personal experience, even in the absence of strong scientific validation.

If you’re considering magnetic insoles, it’s worth taking a few factors into account. First, they shouldn’t replace medical treatments for serious foot issues. Also, not all magnetic insoles are made equal—some are cheaply constructed and uncomfortable. Look for well-reviewed products that fit your foot shape properly and provide adequate cushioning. If they help with your discomfort, great—but it’s best to approach them as a complementary tool, not a cure-all.

< Most Useful Resources:
Magnetic insoles ineffective for nonspecific foot pain in the workplace (Podiatry Arena)
Magnetic Insoles (PodiaPaedia)
Magnetic Insoles = Snake Oil (Foot Health Friday)
Magnetic Insoles (Foot Health Forum)
Do magnetic insoles work? (Dr The Foot Without the Doctor)
M is for Magnetic Insoles (Podiatry ABC)

LisFranc Injury

Posted on by Staff

The LisFranc injury or fracture occurs when there is a displacement of the metatarsals on the tarsal bone. Many different joint and bones are involved.

Lisfranc fractures are injuries that occur in the midfoot region, specifically involving the tarsometatarsal (TMT) joints, where the metatarsal bones meet the bones of the midfoot (cuneiforms and cuboid). The term “Lisfranc” originates from Jacques Lisfranc de St. Martin, a French surgeon who first described this injury in the 19th century. These fractures can range from subtle ligament sprains to severe dislocations with multiple fractures, and they are often misdiagnosed due to their sometimes vague presentation.

The mechanism of injury typically involves either a direct or indirect force. Indirect injuries are more common and usually result from a twisting motion of the foot, often when it’s plantarflexed (pointed downward) and an axial load is applied — like falling while wearing stirrups or stepping awkwardly off a curb. Direct trauma, such as a heavy object falling on the foot, can also cause a Lisfranc fracture-dislocation. Athletes, especially in sports like football and soccer, are at increased risk due to the high-impact and pivoting motions involved.

Diagnosis can be tricky and often missed if not carefully considered. Clinically, patients may present with midfoot pain, swelling, inability to bear weight, and bruising on the sole of the foot (plantar ecchymosis), which is a key indicator. Radiological evaluation typically starts with weight-bearing X-rays, but CT scans and MRIs are often required to fully assess the extent of the injury, especially in cases with subtle dislocations or purely ligamentous injuries. Missing the diagnosis can lead to chronic instability, deformity, and post-traumatic arthritis.

Treatment depends on the severity of the injury. Mild, nondisplaced injuries may be managed conservatively with immobilization and non-weight-bearing for 6–8 weeks. However, most Lisfranc fractures, particularly those involving displacement or instability, require surgical intervention. This may involve internal fixation with screws or plates, or in some cases, primary arthrodesis (fusion) of the affected joints. Postoperative rehabilitation is critical and often includes a lengthy period of non-weight-bearing followed by progressive physiotherapy to restore function and strength. Early and accurate management is key to achieving good long-term outcomes.

Most Useful Resources:
Outcome of surgically treated Lisfranc injury (Podiatry Arena)
LisFranc Fracture (PodiaPaedia)
LisFranc Fracture (Podiatry TV)
A fracture of the LisFranc Joint (Foot Health Friday)
LisFranc (Foot Health Forum)