Month: January 2016

Kohlers Disease

Posted on by Staff

Kohlers disease is a growth problem with the navicular bone in the foot that is most common around the age of 5 years.

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Köhler’s disease is a rare bone disorder that primarily affects children, typically between the ages of 3 and 7, and more commonly in boys. It involves the avascular necrosis (loss of blood supply leading to bone death) of the navicular bone in the foot. The navicular is a small bone in the midfoot that plays a key role in maintaining the arch and allowing smooth foot movement. In Köhler’s disease, this bone temporarily loses its blood supply, which can cause it to become flattened, fragmented, or sclerotic (hardened), leading to pain and discomfort, especially when weight is placed on the foot.

The exact cause of Köhler’s disease isn’t fully understood, but it’s believed to be linked to mechanical stress placed on the developing navicular bone during a period of rapid growth when the bone is still forming. Because the navicular bone is the last of the foot bones to ossify (harden into bone), it’s more vulnerable to pressure and trauma. As children grow and their bones solidify, the temporary loss of blood flow seems to resolve on its own in most cases. There is no strong genetic or systemic disease association, which sets it apart from other conditions involving bone necrosis.

Clinically, children with Köhler’s disease often present with a limp, localized swelling, and pain over the top of the foot or along the arch. The child may avoid putting weight on the affected foot and may walk on the outer edge to reduce discomfort. Diagnosis is typically confirmed with X-rays, which reveal characteristic changes in the navicular bone—such as flattening, increased density (sclerosis), or fragmentation. It’s important to differentiate Köhler’s disease from other causes of limping in children, like juvenile arthritis, infections, or other bone disorders, which may require very different management strategies.

Treatment for Köhler’s disease is usually conservative and focuses on symptom relief. This may include limiting physical activity, using supportive footwear or arch supports, and in more painful cases, applying a short leg cast for a few weeks to reduce pressure on the bone. The good news is that the prognosis is excellent: the condition is self-limiting and typically resolves on its own within 6 to 24 months. After the healing period, the navicular bone returns to a more normal shape and function, and long-term complications are very rare.

Most Useful Resources:
Kohlers Disease (Podiatry Arena)
Kohlers Disease (PodiaPaedia)
Kohlers Disease (Podiatry TV)
My Advice for Kohlers Disease (Running Injury Advice)
Pain on child arch ? (Podiatry Experts)
Kohlers Disease (Foot Health Forum)
Kohlers Disease (Dr the Foot Without the Dr)
Kohler’s Disease in Kids (Podiatry Ninja)

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Laser Therapy for Onychomycosis

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Laser therapy uses the high intensity light to try and destroy the fungal elements in toenail onychomycosis.

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Laser therapy for onychomycosis—a fungal infection of the nail—is an increasingly popular treatment option, especially for individuals who either can’t tolerate antifungal medications or have not responded well to them. Onychomycosis typically causes thickened, discolored, and brittle nails, and it can be persistent and difficult to treat due to the hard-to-penetrate structure of the nail plate. Laser treatment works by emitting focused light energy that penetrates the nail and heats the underlying fungal pathogens, effectively damaging or killing them without harming the surrounding tissue.

There are different types of lasers used for this therapy, with the Nd:YAG 1064 nm laser being the most common. Some systems use pulsed lasers, while others use continuous light; both aim to raise the temperature of the fungal cells to a point where their structure breaks down. Treatments are typically painless or only mildly uncomfortable, and sessions last about 20–30 minutes depending on how many nails are involved. Most patients require multiple sessions, spaced a few weeks apart, to see noticeable improvement. The biggest advantage of laser therapy is that it’s non-invasive and drug-free, with minimal side effects compared to oral antifungals, which can cause liver toxicity or interact with other medications.

However, laser therapy is not a guaranteed cure, and results can vary widely depending on the severity of the infection, the type of fungus, and how strictly post-treatment care is followed. Clinical studies show moderate to good success rates, especially when combined with good hygiene and preventive practices like keeping feet dry and trimming nails regularly. It’s also worth noting that while the nail may appear healthy after treatment, regrowth can take several months, and reinfection is possible if proper precautions aren’t taken. Overall, laser therapy offers a promising alternative or adjunct to traditional treatments, but it’s best viewed as part of a broader treatment plan, not a one-time fix.

Most Useful Resources:
Laser treatment for nail fungus (Podiatry Arena)
Laser Therapy for Onychomycosis (PodiaPaedia)
Laser Therapy (Podiatry TV)
Laser treatment for toenail fungus (Podiatry Update)
New Laser for fungal nails (Foot Health Friday)
My Advice for Nail Laser Treatment (Running Injury Advice)
What is everyone opinion of laser treatment for nail fungus? (Podiatry Experts)
Laser Onychomycosis (Foot Health Forum)

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Golf

Posted on by Staff

The feet are crucial in golf. They are used to walk around on all day and a the platform or foundation that the golf swing starts from.

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Golf is a sport that’s all about precision, patience, and strategy. Unlike many fast-paced games, golf unfolds slowly and thoughtfully, giving players time to plan each shot. It’s typically played on expansive courses with 18 holes, each offering unique challenges like sand traps, water hazards, and varying terrain. The core goal? Get the ball into the hole in as few strokes as possible. What makes it interesting is that the course itself becomes an opponent—changing weather, tricky greens, and unpredictable bounces can all shift the tide of a game.

One of golf’s most iconic features is its equipment. Clubs are categorized mainly into drivers, irons, wedges, and putters, each designed for specific shot types and distances. Golf balls also matter—a lot. The number of dimples, the compression, and the material can all influence flight and spin. Add to that the importance of golf attire (hello, collared shirts and spikeless shoes), and it’s clear the sport balances tradition with a touch of flair. Unlike team sports, golf is mostly a solo mental game, which makes consistency and self-control major assets.

From a cultural standpoint, golf has deep roots, especially in places like Scotland, where the modern game was born. Over time, it’s grown into a global phenomenon, with major tournaments like The Masters, the U.S. Open, and The Open Championship drawing huge crowds and media attention. Big-name players like Tiger Woods, Rory McIlroy, and Scottie Scheffler have brought fresh energy and broader appeal to the sport. It’s also a favorite among business professionals—not just for the game itself but for the networking and conversations that often happen during a round.

Finally, golf isn’t just for the pros. It’s widely accessible through public courses, driving ranges, and even mini-golf setups. People of all ages and skill levels can enjoy it, and it offers both physical and mental benefits—walking the course provides light exercise, while planning shots and reading greens sharpens focus. Plus, there’s something therapeutic about spending a few hours in open, green spaces. Whether you’re chasing a birdie or just trying not to triple-bogey, golf invites you to slow down and enjoy the challenge.

Most Useful Resources:
Golf Threads (Podiatry Arena)
Golf and foot orthotics (PodiaPaedia)
Golf (Podiatry TV)
Golfshot (Podiatry Apps)
Foot Orthotics for Golf (Podiatry Update)

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Haglunds Deformity

Posted on by Staff

Haglunds deformity is an anatomic variation in which the back of the heel bone is larger than normal. Generally there is nothing wrong with that except that pressure from the shoes can be painful.

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Haglund’s deformity, sometimes nicknamed the “pump bump,” is a bony enlargement that develops on the back of the heel, right where the Achilles tendon attaches to the heel bone (calcaneus). It gets its nickname because it often affects people who wear stiff, high-backed shoes—like pumps or certain dress shoes—that constantly rub against the heel. That repetitive pressure and friction can irritate the area, causing inflammation, swelling, and sometimes blistering or redness over the bony bump. It’s not just limited to fashionable footwear, though—any tight or poorly fitting shoe can contribute.

So what causes Haglund’s deformity in the first place? It’s often a combination of factors. Some people are just anatomically more prone to it—like those with a high arch, a tight Achilles tendon, or a naturally prominent heel bone. These structural factors put more pressure on the back of the heel when walking or running, especially if combined with the wrong type of footwear. Over time, that repeated stress can lead to bone growth and soft tissue irritation, particularly in the bursa—a fluid-filled sac that cushions the tendon. When this bursa gets inflamed, it’s called retrocalcaneal bursitis, and it makes the whole area painful and swollen.

Symptoms typically include a noticeable bump on the back of the heel, pain where the Achilles tendon attaches, and swelling or redness around the area—especially after wearing shoes that aggravate it. The pain often worsens with activity, particularly walking uphill or climbing stairs, and can make certain shoes impossible to wear comfortably. If the tendon gets involved due to chronic friction or inflammation, it can lead to Achilles tendinopathy, which adds even more discomfort and stiffness.

Treatment usually starts conservatively: switching to softer, open-backed shoes, applying ice to reduce inflammation, using heel pads or orthotics to relieve pressure, and stretching the Achilles tendon to loosen it. Anti-inflammatory meds (like ibuprofen) can help, too. If conservative methods don’t bring relief, especially if there’s significant pain or tendon involvement, a doctor might recommend physical therapy, cortisone injections (though cautiously around the tendon), or in more persistent cases, surgery to remove the excess bone and inflamed tissue. The key to managing Haglund’s deformity is early recognition and adjusting footwear and activity to prevent long-term complications.

Most Useful Resources:
Haglunds Deformity (Foot Health Forum)
The Haglunds deformity or ‘Pump Bump’ (Foot Health Friday)
Haglunds in an elite marathon runner (Podiatry Arena)
The Pump Bump (Podiatry Ninja)
Haglunds Deformity (Best Running Shoe)

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Kinetic Wedge

Posted on by Staff

The kinetic wedge is an extension that can be used on the front part of the foot orthotic to assist in the clinical management of of functional hallux limitus.

The Kinetic Wedge is a specialized modification used in foot orthotics, primarily designed to improve the function of the first metatarsophalangeal joint (1st MPJ), which is the big toe joint. It was originally introduced by Dr. Howard Dananberg as a solution for functional hallux limitus—a condition where the big toe has full range of motion when non-weight bearing, but becomes restricted during walking. The wedge works by allowing more unrestricted motion of the first ray (the first metatarsal and associated structures), which helps promote efficient propulsion during gait. This modification typically involves removing material under the first metatarsal head while maintaining support under the lesser metatarsals.

Biomechanically, the Kinetic Wedge helps “free up” the big toe during the push-off phase of walking. Normally, the first ray needs to plantarflex (drop down) to allow proper dorsiflexion (upward movement) of the big toe. When this doesn’t happen due to joint restriction or poor foot mechanics, it can lead to a range of issues like compensatory gait patterns, metatarsalgia, or even plantar fasciitis. The Kinetic Wedge alleviates this by creating a small cutout or depression under the first metatarsal head in the orthotic, which reduces resistance to first ray plantarflexion. This allows the big toe to dorsiflex more freely, facilitating a more efficient and less painful gait.

Clinically, the Kinetic Wedge is often used for patients with functional hallux limitus, forefoot pain, early-stage hallux rigidus, or abnormal propulsion mechanics. It’s not a one-size-fits-all solution, though—it requires proper biomechanical assessment to determine if the patient would benefit from improved 1st ray mobility. When used correctly, patients often report reduced forefoot pressure, improved comfort during walking, and better overall gait mechanics. However, in patients with structural hallux limitus or severe arthritic changes, this modification may be less effective, and alternatives such as rocker soles or more rigid orthotics might be more appropriate.

Most Useful Resources:
Kinetic Wedge (Foot Health Forum)
What is the Kinetic Wedge? (Foot Health Friday)
Kinetic Wedge (Podiapaedia)
Kinetic Wedges: Question (Podiatry Arena)
Kinetic Wedge Threads (Podiatry Arena)
What is a Kinetic Wedge Orthotic? (Podiatry FAQ)
K is for Kinetic Wedge (Podiatry ABC)

 

Jones Fracture

Posted on by Staff

A Jones fracture is a particular type fracture that occurs at the diaphysis of the fifth metatarsal of the foot that was fist described by the British orthopedic surgeon, Dr Robert Jones.

 

A Jones fracture is a specific type of break that occurs at the base of the fifth metatarsal, the long bone on the outside of the foot that connects to the little toe. It’s named after Sir Robert Jones, who first described the injury in 1902—after experiencing it himself while dancing. What sets this fracture apart from other fifth metatarsal injuries is its location: the fracture occurs in a spot that receives less blood flow, which makes healing more difficult and slower compared to other foot fractures.

This injury typically results from acute trauma or repetitive stress. It’s common in athletes, particularly those involved in sports like basketball, soccer, or football, where sudden twisting motions or jumping and landing awkwardly put pressure on the outside of the foot. A person might feel a sharp pain and sometimes even hear a “pop” at the time of injury. Swelling, bruising, and difficulty bearing weight are all classic symptoms. The limited blood supply in this part of the foot means it doesn’t always heal well on its own, which sets it apart from more straightforward avulsion fractures.

Treatment for a Jones fracture depends heavily on the severity of the break and the patient’s activity level. For minor or non-displaced fractures, doctors often recommend non-surgical treatments like rest, immobilization in a boot or cast, and non-weight-bearing protocols for several weeks. However, due to the high risk of delayed healing or nonunion, surgical intervention is sometimes the preferred route—especially for athletes or those with displaced fractures. Surgery typically involves inserting a screw along the shaft of the bone to stabilize the fracture and promote faster healing.

Recovery from a Jones fracture can be frustratingly slow. Even with surgery, it can take anywhere from 6 to 10 weeks—or longer—for the bone to heal properly. Return to full activity, especially for athletes, might take several months. Physical therapy is often part of the recovery process, focusing on restoring strength, mobility, and balance. Because of the recurrence risk, proper footwear, gradual return to activity, and regular monitoring are key to preventing future complications.

Most Useful Resources:
Jones Fracture (Foot Health Forum)
Jones Fracture Average healing times (Foot Health Forum)
The Jones Fracture (Foot Health Friday)
Jones Fracture (Podiapaedia)
Jones Fracture (Podiatry TV)
Jones fracture (Podiatry Update)

Jacks Test

Posted on by Staff

Jacks Test is a test of how hard it is to dorsiflex the hallux when weightbearing, so is a test of the integrity of the windlass mechanism. It is known at the Hubscher maneuver in the USA

Jack’s test is a clinical examination used to assess the function of the medial longitudinal arch of the foot, particularly in evaluating for flexible flatfoot (pes planus). It is also known as the “Hubscher maneuver.” The test is typically performed while the patient is standing. The examiner dorsiflexes the big toe (hallux) while observing changes in the arch of the foot. A positive result is indicated by the formation of an arch when the big toe is dorsiflexed, suggesting that the flatfoot is flexible and not rigid.

This test is based on the windlass mechanism of the foot. Dorsiflexion of the big toe tightens the plantar fascia, pulling the heel and the ball of the foot closer together and raising the arch. In a patient with a functional (flexible) flatfoot, this mechanism remains intact, and the arch reappears when the toe is lifted. However, in cases of rigid flatfoot, the arch remains flat despite dorsiflexion of the toe, indicating a more serious structural problem that may require orthopedic intervention.

Jack’s test is a simple yet valuable tool for distinguishing between flexible and rigid flatfoot, helping clinicians guide treatment strategies. Flexible flatfoot is often managed conservatively with physical therapy, orthotics, or footwear modification, while rigid flatfoot may necessitate more invasive interventions. Jack’s test can also be useful in pediatric assessments, as flatfoot is common in children and often resolves with age. By providing insight into foot mechanics, the test aids in early detection and proper management of arch-related foot disorders.

Most Useful Resources:
Jacks Test (Podiapaedia)
Jacks Test and failure of STJ supination with ext tibia rotation (Podiatry Arena)
Is Jacks test valid? (Podiatry Arena)
The Hubscher maneuver or Jacks test? (Podiatry Ninja)
Jacks Test (Bunion Surgery)

Homeopathy

Posted on by Staff

Homeopathy is an alternative medicine practice that has been shown not to work. Any affects of homeopathy are no better than a placebo.

Homeopathy is a system of alternative medicine developed in the late 18th century by Samuel Hahnemann, based on the idea of “like cures like”—that a substance causing symptoms in a healthy person can, in extremely diluted form, treat similar symptoms in a sick person. Remedies are made through a process of serial dilution and succussion (vigorous shaking), often to the point where no molecules of the original substance remain. Supporters argue that the water retains a “memory” of the substance and that this somehow triggers the body’s natural healing processes.

However, from a scientific standpoint, homeopathy lacks credible evidence for efficacy beyond the placebo effect. Numerous large-scale, high-quality studies and systematic reviews have consistently found that homeopathic treatments are no more effective than placebos. The dilutions used are often so extreme—sometimes beyond Avogadro’s number—that they contain no active ingredient, which challenges basic principles of chemistry and pharmacology. The placebo effect, patient expectations, and the therapeutic context (such as the long consultations homeopaths often provide) are often responsible for perceived improvements.

That said, many people report personal benefits from homeopathy, and in some cultures or communities, it holds significant traditional or holistic value. These experiences are real to them, and in some cases, homeopathy might indirectly support health by encouraging lifestyle changes, reducing stress, or simply by making patients feel cared for. But it’s essential to distinguish between perceived efficacy and actual biological mechanisms of action, especially when treating serious conditions where delays in effective care could have consequences.

While homeopathy may offer comfort or symptom relief for some individuals through placebo or supportive interaction, there’s no robust scientific evidence supporting it as an effective treatment. If someone finds it helpful for mild, self-limiting conditions, that’s their choice—but it shouldn’t replace proven medical treatments, especially for serious or life-threatening illnesses. A balanced, informed approach is key: understanding its limits while respecting people’s autonomy and experiences.

Most Useful Resources:
Homeopathy (Podiapaedia)
Homeopathy (Podiatry Arena)
Damning report on homeopathy (Podiatry Arena)
The Myth of Homeopathy (CP)
Homeopathy for Foot Problems (Foot Health Friday)
Homeopathy (Podiatry Ninja)

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Hoka Running Shoes

Posted on by Staff

The Hoka  running shoes created the maximalist running shoe category. They are the antithesis of the barefoot running and minimalist shoe trend.

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Hoka was founded in 2009 in Annecy, France, by former Salomon engineers Nicolas Mermoud and Jean‑Luc Diard, aiming to enhance downhill running with ultra‑cushioned midsoles. Instead of minimalist designs popular at the time, Hoka introduced “maximalist” shoes featuring oversized CMA midsoles and rocker geometries. This bold approach created a cushioned, buoyant ride that gained quick traction with ultramarathoners before becoming popular across all runner types.

In terms of technology, Hoka’s signature features include thick CMEVA or supercritical EVA midsoles, Meta‑Rocker geometry, and strategic low heel-to‑toe drops (~5–8 mm). These combine to provide a smooth, energy-efficient ride that enhances natural forward momentum. Models like the Clifton 10 and Mach 6 exemplify this—lightweight yet plush, ideal for long-distance comfort with responsive feel .

Hoka’s range now spans daily trainers, max-cushion recovery shoes, lightweight racers, trail rugged models, and even stability workhorses like the Arahi 7, which features J‑Frame technology and has earned endorsement from podiatrists and healthcare professionals for all-day comfort and overpronation control. On the trail side, the brand’s rugged offerings—like the Tecton X2 with carbon plates—bring stability and traction to off-road terrain.

Today, Deckers Brands, which acquired Hoka in 2013, reports it as a key growth driver—reaching ~$1 billion in annual revenue by 2022. While the “max‑cushion” aesthetic sparked the “gorpcore” fashion trend, Hoka remains deeply rooted in performance‑driven innovation through advanced foam, rocker technologies, and expanding use in everyday and medical footwear

Most Useful Resources:
Hoka Running Shoes (Foot Health Forum)
Super padded running shoes (Foot Health Friday)
Hoka One One (The Best Running Shoe)
Hoka One One (iPodiatry)
Hoka One One (Podiatry TV)
Hoka One One (Podiapaedia)
Hoka Ones (Podiatry Arena)

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