Author: Staff

Haglunds Deformity

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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

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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

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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

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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

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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

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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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Growing Pains

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Most cases of growing pains in the child are benign and they come right, but on rare occasions the symptoms are the same as some pretty nasty things, so for this reason all cases of growing pains have to be taken seriously and properly investigated.

Growing pains are a common, benign condition in children, typically characterized by aching or throbbing sensations in the legs, most often felt in the thighs, calves, or behind the knees. These pains usually occur in children between the ages of 3 and 12 and often strike in the late afternoon or evening, sometimes waking the child from sleep. Despite the name, growing pains are not directly caused by growth spurts—bones grow gradually and don’t cause pain themselves. Instead, the discomfort may be linked to muscle fatigue or overuse from physical activity during the day.

The pain is typically bilateral, meaning it affects both legs, and is not associated with swelling, redness, or limping. That’s an important distinction because if the symptoms are persistent, occur in only one leg, or are accompanied by fever or swelling, it may point to something more serious like juvenile arthritis, infection, or injury, which requires medical evaluation. Growing pains often go away by morning, and children usually don’t have any pain during the day. The condition tends to come and go over time and may be more noticeable after particularly active days.

No single test can diagnose growing pains, so healthcare providers usually base the diagnosis on symptoms and physical exam findings, while ruling out more serious conditions. There’s no specific treatment, but symptoms can be relieved with gentle massage, stretching exercises, or warm baths. Some parents also find that applying a warm heating pad or giving a mild over-the-counter pain reliever like acetaminophen or ibuprofen (under a doctor’s guidance) helps. It’s also reassuring to explain to the child that the pain, while uncomfortable, is not dangerous or permanent.

Although growing pains are not harmful, they can be distressing—both for kids who experience them and for parents trying to comfort them. Open communication, reassurance, and a consistent bedtime routine can help ease the emotional and physical discomfort. It’s a good idea to keep a symptom diary if the pains are frequent, just in case patterns emerge or the doctor needs more context. And while growing pains are normal, anything unusual—like pain in one specific spot, persistent or worsening pain, or other symptoms like joint stiffness—should be evaluated to rule out other causes.

Most Useful Resources:
Growing Pains (Foot Health Forum)
Growing Pains (Podiatry TV)
Growing Pains (PodiaPaedia)
Growing Pains (Podiatry Arena)
Growing Pains in Children (Podiatry Arena)
Night-time foot pain in children (Foot Health Forum)
Growing Pains? (Podiatry Experts)
Growing Pains in Children (iPodiatry)
Take Growing Pains in Kids Seriously (Foot Health Friday)
Growing Pains (Foot Health Guide)
Growing Pains in the Leg: Throwing the kitchen sink at growing pains

Foot Posture Index

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Foot Posture Index is a composite measure of the posture of the foot based on 6 different observations of the alignment or posture of different segments of the foot.

The Foot Posture Index (FPI) is a widely used clinical tool for quantifying standing foot posture, helping to classify feet as pronated, neutral, or supinated. The most common version is the FPI-6, which involves observing and scoring six specific criteria. This assessment is quick, simple, and reliable, making it valuable for clinicians and researchers alike.

Here’s how to calculate the FPI-6:

1. Preparation and Patient Positioning
The patient should stand barefoot in a relaxed, neutral stance with both feet supporting their weight. Their arms should be naturally at their sides, and they should look straight ahead. It can be helpful to have them march in place for a few steps before settling into their stance. The assessment usually takes about two minutes, and the assessor needs to be able to move around the patient freely.

2. The Six Criteria and Scoring
Each of the six criteria is scored on a 5-point scale, ranging from -2 to +2. A score of 0 indicates a neutral position for that specific criterion. Positive values (+1, +2) are given for pronated features, with higher scores indicating more pronation. Negative values (-1, -2) are given for supinated features, with more negative scores indicating more supination. If an observation cannot be made (e.g., due to swelling), it should be skipped and noted.

The six criteria are:

  • Talar Head Palpation (Transverse Plane): This involves palpating the talar head. The score depends on whether the talar head is more palpable on the lateral (outer) or medial (inner) side of the foot.
  • Curves Above and Below the Lateral Malleolus (Frontal/Transverse Plane): Observe the curvature around the ankle bone (lateral malleolus) from behind. The score is based on whether the curve below the malleolus is straight, convex, or more or less concave compared to the curve above it.
  • Calcaneal Frontal Plane Position (Frontal Plane): Observe the heel bone (calcaneus) from behind. The score reflects whether the heel is inverted (varus), everted (valgus), or vertical, often estimated in degrees.
  • Prominence in the Region of the Talonavicular Joint (Transverse Plane): View the inside of the foot at an angle. The score depends on whether this area is concave, flat, or bulging.
  • Congruence of the Medial Longitudinal Arch (Sagittal Plane): Observe the inner arch of the foot from the inside. The score ranges from a high, acutely angled arch to a very low, flattened arch that might be making ground contact.
  • Abduction/Adduction of the Forefoot on the Rearfoot (Transverse Plane): View the foot from behind. The score is based on how many medial (inner) or lateral (outer) toes are visible, indicating whether the forefoot is abducted (splayed out) or adducted (turned in) relative to the rearfoot.

3. Total Score and Classification
After scoring each of the six items, sum the individual scores to get a total FPI-6 score. The total score can range from -12 (severely supinated) to +12 (severely pronated). The foot posture is then classified based on this total score:

  • Severely Supinated: ≤ -5
  • Mildly Supinated: -1 to -4
  • Neutral Posture: 0 to +5
  • Mildly Pronated: +6 to +9
  • Severely Pronated: ≥ +10

It’s important to note that a slightly pronated foot posture (mean raw score of +4) is considered the normal position at rest in a healthy adult population. The FPI is a practical tool that aids in deciding appropriate interventions, such as strengthening exercises, stretching, manual therapy, gait training, or selecting suitable orthotics.

Most Useful Resources:
Foot Posture Index (Podiatry TV)
The Foot Posture Index (Podiatry Update)
Foot Posture Index (Clinical Boot Camp)
Foot Posture Index (PodiaPaedia)
Foot Posture Index (Podiatry Arena)

Foot Health Practitioners

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Foot Health Practitioners are a group of unregulated practitioners in the UK who came into existence to get around the requirements of the Health Professions Council to be registered as a podiatrist.

 

Foot Health Practitioners (FHPs) in the UK form a distinct group within the wider foot care sector, often working alongside or independently from regulated professionals like podiatrists. While they are not subject to statutory regulation—meaning there is no legal requirement for registration with a government body—they typically complete specialized training through accredited colleges or private providers. These courses often range from a few months to a year and equip FHPs with essential skills in routine foot care, such as nail trimming, corn and callus removal, and basic diabetic foot monitoring.

Despite their unregulated status, many FHPs provide valuable services, especially in areas where access to NHS podiatry is limited or has long waiting lists. They often operate private practices, offer home visits, and serve communities that might otherwise struggle to get basic foot care. Their work is particularly appreciated among elderly clients or those with mobility challenges who benefit from regular maintenance of foot health to avoid complications. However, because they’re not regulated by the Health and Care Professions Council (HCPC), they are legally restricted from using the title “podiatrist” or performing advanced clinical procedures.

One of the key concerns surrounding unregulated practitioners like FHPs is the inconsistency in training standards and oversight. Unlike HCPC-registered podiatrists, who must adhere to strict educational requirements and professional codes of conduct, FHPs are not legally bound to the same levels of accountability. This can lead to confusion for patients who may not understand the difference in qualifications and scope of practice. While many FHPs are highly competent and ethical, the absence of formal regulation leaves the door open for potential variability in care quality.

That said, there are voluntary registers and associations—such as the Alliance of Private Sector Practitioners and the British Association of Foot Health Professionals—that aim to uphold professional standards within the field. These organizations offer guidelines, continuing education, and ethical frameworks to promote safe and effective practice. Still, without statutory regulation, the onus remains largely on the public to research and choose their foot care provider wisely. Clearer differentiation and perhaps future regulatory reform could help improve transparency and protect both patients and practitioners.

Most Useful Resources:
Foot Health Practitioners (Foot Health Forum)
Foot Health Practitioners (Foot Health Practitioners Info)

Foot Pain

Posted on by Staff

Foot pain is what Podiatrists do. There are plenty of good and bad resources on the web on foot pain.

Foot pain is a common complaint that can arise from a variety of causes—ranging from overuse and injury to underlying medical conditions. The human foot is a complex structure with 26 bones, 33 joints, and over 100 muscles, tendons, and ligaments, all of which must work together smoothly to support body weight and enable movement. When any part of this intricate system is stressed or damaged, pain can develop in different areas such as the heel, arch, toes, or ball of the foot. The nature and location of the pain often provide clues to its cause.

One of the most frequent culprits is plantar fasciitis, a condition involving inflammation of the thick band of tissue (plantar fascia) that connects the heel bone to the toes. This typically causes sharp pain in the heel, especially during the first steps in the morning or after prolonged periods of rest. Other common causes include bunions, flat feet, high arches, Achilles tendinitis, and stress fractures. Footwear plays a huge role too—shoes lacking proper arch support, cushioning, or fit can gradually lead to discomfort or exacerbate existing problems.

Systemic conditions like diabetes, arthritis, and gout can also manifest as foot pain. Diabetic neuropathy, for instance, leads to nerve damage that causes burning, tingling, or numbness, especially in the feet. Rheumatoid arthritis can cause swelling and deformity in foot joints, while gout results from a buildup of uric acid crystals, often striking suddenly with intense pain in the big toe. These types of foot pain usually require medical management beyond just physical therapy or orthotic support.

Treatment depends entirely on the cause. For overuse injuries or inflammation, rest, ice, compression, elevation (RICE), and non-steroidal anti-inflammatory drugs (NSAIDs) may offer relief. Proper footwear, custom orthotics, stretching exercises, and weight management can go a long way in preventing recurrence. Chronic or severe pain should always be assessed by a healthcare provider, as ignoring it can lead to long-term dysfunction or more serious conditions. If your foot pain lasts more than a few days or interferes with your daily activities, it’s best to get it checked sooner rather than later.

Most Useful Resources:
Foot Health Forum (Foot Health Forum)
Foot Pain Info (Foot Pain Info)
Foot Pain (ePodiatry)
Foot Health Friday (Foot Health Friday)
Dr the Foot Without the Dr (Dr the Foot Without the Dr)