https://www.tweedpodiatry.com/blog daily 0.75 2023-09-22 https://www.tweedpodiatry.com/blog/foot-care-in-the-extreme monthly 0.5 2022-07-25 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1618562174274-YYX6RHMNXFMPU31W12JI/Start+Line.jpg Blog/Media - Foot Care in the Extreme! And we’re off! The start of day 1 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1618562267918-33RHLPKRIV9IJ98M9KFU/More+Plasters%21.jpg Blog/Media - Foot Care in the Extreme! Pre-taping some hot spots https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1618562697981-VE3DLM8GFWXH0BH7PHOE/15+miles+into+the+long+stage.jpg Blog/Media - Foot Care in the Extreme! Around 15 miles into the long stage (55 miles) https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1618571238727-XQ96A72UKMW10SP4FS66/Bivouac+life.jpg Blog/Media - Foot Care in the Extreme! Bivouac life https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1618562665729-FPICX03IO3AK27I5UAYH/Heat+reaction+angle+2.jpg Blog/Media - Foot Care in the Extreme! An extreme heat reaction https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1618571357317-9K9XK4FRNLW2B4ZNZR3Q/Mummified.jpg Blog/Media - Foot Care in the Extreme! Mummified! https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1618571393603-P1SELG4784HAPXS83IM2/Running+on+the+ridge.jpg Blog/Media - Foot Care in the Extreme! Ridge running on day 3 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1618562599086-2U8KJZ46TU7LHXDXCIJU/Holly+and+Clive+at+the+Finish+Line.jpg Blog/Media - Foot Care in the Extreme! Me and my dad – finishers! What a week! https://www.tweedpodiatry.com/blog/ultrasound monthly 0.5 2021-04-16 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1599312406774-SBRRRWU68NQJWS18X3SX/image-asset.png Blog/Media - Medical Ultrasound – The Future Is Here! https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1599312408063-0BCGRLEC9E732SEHI56V/image-asset.jpeg Blog/Media - Medical Ultrasound – The Future Is Here! https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1599312409603-LTJTGEQ00SBF51OU4ZQI/image-asset.jpeg Blog/Media - Medical Ultrasound – The Future Is Here! https://www.tweedpodiatry.com/blog/thenewnormal monthly 0.5 2020-09-05 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1599312415245-X8BXMDAKUKOTHMJRBH6D/image-asset.jpeg Blog/Media - The New Normal - How We’ve Adapted to COVID-19 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1599312416497-OHINSROLGNU6TE1K98QM/image-asset.jpeg Blog/Media - The New Normal - How We’ve Adapted to COVID-19 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1599312418519-RK1K3WNGYQF6EI5IEB41/image-asset.jpeg Blog/Media - The New Normal - How We’ve Adapted to COVID-19 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1599312419952-JUFZ0WF6X3R1CI9ZIBH2/image-asset.jpeg Blog/Media - The New Normal - How We’ve Adapted to COVID-19 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1599312421028-FI4XEMXGFQGHSI5K434N/image-asset.jpeg Blog/Media - The New Normal - How We’ve Adapted to COVID-19 https://www.tweedpodiatry.com/blog/onlineconsultations monthly 0.5 2020-09-05 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1599312424765-ZKSN956YDGQJYS4MCMU0/image-asset.png Blog/Media - Online Video Consultations - FAQs https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1599312425980-9VV04T8I5HWU5VYF386B/image-asset.png Blog/Media - Online Video Consultations - FAQs https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1599312427832-7QEOOT1E55AE05B44T0H/image-asset.png Blog/Media - Online Video Consultations - FAQs https://www.tweedpodiatry.com/blog/ingrown-toenails-part-2 monthly 0.5 2020-09-05 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1599312433868-OSUNBYBUBLJFGT1APQP6/image-asset.jpeg Blog/Media - Ingrown Toenails - Part 2 Four years post-procedure. Still good. https://www.tweedpodiatry.com/blog/ingrown-toenails-part-1 monthly 0.5 2020-09-05 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1599312436509-JEOD9NCTJOVJKIL66MZ9/image-asset.jpeg Blog/Media - Ingrown Toenails - Part 1 A very common picture of a very unhappy toenail. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1599312438102-XHTTR18ETJOEYD6S5RYG/image-asset.png Blog/Media - Ingrown Toenails - Part 1 Yep, couldn't find a better picture so made my own on MS Paint. https://www.tweedpodiatry.com/blog/category/Ingrown+Toenails monthly 0.5 https://www.tweedpodiatry.com/services daily 0.75 2026-01-21 https://www.tweedpodiatry.com/services/swift-verruca-treatment monthly 0.5 2025-07-23 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/e86ab845-803c-46b7-a26c-1485bf536fe4/Swift_Machine-.jpg Services - Swift® Microwave Therapy For Verruca - What is Swift®? Developed in the UK, Swift® microwave therapy is an award-winning technology that uses a highly accurate, precise applicator to focus microwave energy at the verruca. This damages the verruca whilst protecting healthy skin. This means no risk of burns, blisters or scarring. The goal of Swift® is to trigger an immune response where your body fights off the virus and rebuilds normal skin. Numerous studies have shown a cascade of immune responses in human skin following Swift® microwave therapy that are not seen in other treatments. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/f32e7dc0-612a-4a69-a3cf-7f8844029f3d/JFAR+Verruca+pre+and+post.jpg Services - Swift® Microwave Therapy For Verruca - What will treatment look like? The treatment is called “Swift®” for a reason, lasting only lasting 5 to 10 seconds! There can be some pain or discomfort during these seconds. However, it rare to have any pain at all once the treatment has finished. Better yet, unlike other treatments, there is no need for injections, dressings or other special care to be taken; simply have your treatment and go about your day as you please! Work published in the Journal of Foot and Ankle Research (JFAR) suggests a success rate of over 83% after just 3 treatments. These success rates are much higher than for other commonly used methods like cryotherapy (45.6%) and salicylic acid (13.6%). Based on this research, we usually recommend 3 treatments, 4 weeks apart and a review appointment 12 weeks after this. Like the researchers in this paper, we also offer further treatments to boost success rates even higher in those patients who haven’t had a total resolution of their verruca after 3 treatments. https://www.tweedpodiatry.com/services/msk-and-sports-podiatry monthly 0.5 2025-04-06 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615207404330-RIPOIKAE44YFVM3EE6LM/running%2Bpic%2B6.jpg Services - MSK and Sports Podiatry - Whatever your activity, we’re here to help. Musculoskeletal (MSK) and Sports Podiatry are branches of Medicine concerned with systems involved in movement of the lower limb, both when they are functioning well and when dysfunction occurs. All aspects of Podiatry care are covered in our practice but this represents our team's primary area of expertise. No matter your activity, from light walking to ultra-marathons, from rugby to tennis, from golf to skiing, whether you are just looking to maintain/improve your mobility or you’re competing at an elite level of sport, our team have the skills, knowledge, equipment and experience to help you through the obstacles that foot, ankle and lower limb problems can put in your way. With the most advanced set-up of any Podiatry clinic in the Scottish Borders, you are in good hands. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615207424936-6GY7YFETJE55C5QNKCCC/gym%2Bpic.jpg Services - MSK and Sports Podiatry - A diverse and fascinating area of our practice. There as so many fascinating aspects that make up MSK and Sports Podiatry in our practice including gait analysis, custom-made foot orthoses (bespoke insoles), diagnostic ultrasound, injection therapies, shockwave therapy and exercise programs for building strength, endurance and balance. Not to mention various referral networks we have built to explore bloodwork and other health issues. Each with an important role to play in reducing pain and restoring function. Each treatment plan different to the next depending on your needs. During your treatment journey, we place a strong emphasis on encouraging the body to rebuild, to become stronger and more capable of taking on the demands of daily activity and sport. Our rehab. plans focus on the fundamentals of supporting you whilst progressively increasing the load you are exposed to in order for the body to adapt. The principles here are straightforward and important for all individuals to get better yet every person has their own unique path. This is why we work closely with you to figure out the details and find a programme that works for you and your goals. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615207437915-JYB2U232EB223EKGKM4I/me%2Bin%2Bclinic%2Bwith%2Bdiagnostic%2Bultrasound%2Bmachine.jpg Services - MSK and Sports Podiatry - Getting you back on your feet. Diagnostics are front-and-centre in our practice and we are proud of our reputation for getting to the root of the problem. The foundation of this is a expert dedicated team with detailed knowledge of anatomy and foot function, augmented by being the Scottish Borders’ only Podiatry clinic to offer fully-certified, in-house diagnostic ultrasound and indeed, the first private Podiatry clinic in Scotland to do so. This allows on-the-spot imaging - we can literally look inside your foot and ankle, with both you and your Podiatrist watching in real-time. To say this has transformed the way we practice would be an understatement! Our ultra-slow-motion video gait analysis is another facet we love. It allows us to spot the subtle movements in your walking or running style that provide clues to the nature of your pain and may help guide treatment. Our Podiatry team are also experienced in gait retraining where we can guide you through new movement patterns to reduce load on painful structures and potentially improve performance later down the line. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615207488095-QSYFHI3JB7VPKZ1FDBR3/Walkng%2Bup%2Bsteps.jpg Services - MSK and Sports Podiatry - Here for you, every step. Supporting you through your rehab. can look different for everyone. Some people will simply require pointers on their exercises plus advice on appropriate footwear. Some may require taping techniques that offer a short-term "leg up" so you can move on. Many people will also benefit from orthotic therapy: These specialist shoe inserts can supplied as an off-the-shelf device right through to fully bespoke, custom made devices and allow us to modify the load on injured structures in your feet and lower limbs and improve function. Our team have extensive experience in this realm and have time and time again seen game-changing results from orthotic therapy. And where a problem remains stubborn to heal or needs to heal faster to get you ready in time for a big event, we are excited to have introduced, from Summer 2022, a treatment-accelerator like no other: Extracorporeal Shockwave Therapy (ESWT) - click to read more! As a team of Podiatrist with personal experience and passion for sporting activity, we can relate to how frustrating it is when pain or injury put you on the side lines. We take immense pleasure in spotting the issues that are holding you back and helping you on your journey back to the activity you love. https://www.tweedpodiatry.com/services/shockwave-therapy monthly 0.5 2024-11-13 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/c322ae7e-8453-4081-b60e-52c417bd74a2/ESWT+Image+1.jpg Services - Extracorporeal Shockwave Therapy (ESWT) - Persistent problems…a powerful solution. Extracorporeal Shockwave Therapy (ESWT), often simply referred to as Shockwave therapy helps to solve a core issue behind A LOT of the musculoskeletal conditions people come to us with: body tissues that have become damaged or degenerated i.e. have failed to heal successfully. Chronically degenerated tissues have undergone cellular changes that make them more resistant to treatments that would otherwise work well in acute cases. The challenge is therefore to help the body, in whatever way possible, to boot-start healing again. In the case of our Shockwave machine, an applicator is applied to the skin (with a layer of gel in between) and a ballistic is rapidly fired back and forth through a cylinder which creates an audible high-energy wave (the shockwave part) that is transmitted into the body toward the tissue we are seeking to treat. Over the course of treatment the energy transmitted is steadily increased and, as it raises, so too do the potential healing benefits. This is done gradually as the sensation can be a little uncomfortable to start and this gives the body some time to adjust. Interestingly, many people actually report an instant relief of their pain after treatment, thought to be due to a “hyperstimulation” effect on the tissues. The whole process takes only a few minutes and is usually repeated once a week for around 3 - 6 sessions depending on the condition. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/c278b4f8-a319-480d-9466-9ff327212c24/Storz+Medical+Radial+ESWT+%286%29.jpg Services - Extracorporeal Shockwave Therapy (ESWT) - Turning DEgeneration into REgeneration! Shockwave therapy produces a number of interesting phenomenon in human tissues important to healing. These have been demonstrated in many high-quality peer-reviewed studies and include: A stimulatory effect on the micro-circulation and vasodilation, improving blood flow and supply of nutrients to injured tissues. Increased cell permeability (making cells more efficient at moving useful compounds in and moving waste products out). Release of substance-P, an important neurotransmitter involved in pain reduction. Stimulation of cells involved in rebuilding healthy tissue structure including fibroblasts and osteoblasts. Increased production of collagen, an essential building block in many human tissues such as tendons, joints and ligaments. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/c7425666-16df-4042-956c-572333823162/ESWT+Image+2.jpg Services - Extracorporeal Shockwave Therapy (ESWT) - Backed by evidence. Shockwave isn’t the first technology to make bold claims about it’s ability to boost blood flow, improve healing and reduce pain. There’s no shortage of snake oil out there! So why believe this actually works? One word: Evidence. Shockwave is VERY well studied (with around 300 new scientific publications released annually) in a wide range of applications, with success rates as high as 90% in some conditions. Most notably, for the interests of our practice, it has been shown repeatedly to be effective in the treatment of tendon problems such as achilles tendinopathy and plantar fasciitis (fasciopathy) as well as ligament damage and even bone injuries like medial tibial stress syndrome. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/d2df51fb-337f-4cc0-8c90-b9d8ac2e7a3e/2022-11-01+20_44_28-Extracorporeal+Shockwave+Therapy+%28ESWT%29+_+Foot+%26+Ankle+Specialists+in+Kelso%2C+Twe.png Services - Extracorporeal Shockwave Therapy (ESWT) - Supported by NICE. Our ethos at Tweed Podiatry is to always seek the best quality evidence in support of how we practice. This is why Shockwave has been introduced and our team trained as certified shockwave professionals. But it’s important to state that we DO NOT use it in isolation: the best quality research available places Shockwave as an adjunct therapy that is best used alongside other practices to accelerate results. This includes patient-specific exercise programmes, orthotic therapy, taping and other modalities our MSK and Sports Podiatry team will often employ. The evidence in support of shockwave has also led to it being recommended by the National Institute for Health and Care Excellence (NICE) who carefully and critically review the available science on various conditions and treatments, and supply qualified health care professionals, such as ourselves, with clinical guidance on how best to help our patients. This gives immense confidence both to our team, and we hope to you too, that Shockwave therapy is the real deal. https://www.tweedpodiatry.com/services/diagnostic-ultrasound monthly 0.5 2023-12-24 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615207590754-CT82TXB0VMK7HQ0RYS4E/me%2Bin%2Bclinic%2Bwith%2Bdiagnostic%2Bultrasound%2Bmachine.jpg Services - Diagnostic Ultrasound - The Scottish Borders’ First and Only One of our core beliefs at Tweed Podiatry is that you must understand what you're facing if you're going to take it on. Accurate and timely diagnosis can change everything and we believe in putting this front-and-centre when patients come to see us with foot, ankle and lower limb problems. In this spirit, probably our proudest achievement is to have become the first, and hitherto only, private Podiatry clinic in Scotland offering fully-accredited in-house Diagnostic Ultrasound. This extended scope of practice allows us to better respond to the needs of our patients without lengthy NHS referral times and as a far more accessible, cost-effective option than other private clinics. It allows on-the-spot look inside your body that both the Podiatrist and you can see in real-time. To say this has transformed the way we practice would be an understatement! https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615207610321-C9QR6L0NMIKUKLDHUD6I/Ultrasoubd%2Bguided%2Bcorticosteroid%2Binjection.jpg Services - Diagnostic Ultrasound - Fast, Dynamic, Safe and Accurate Ultrasound has a number of key advantages over other imaging modalities; it is entirely safe (does not involve radiation), it can be used then and there alongside the rest of your consultation and it is dynamic meaning we can move your foot whilst scanning to assess tissues such as tendons and ligaments in both their relaxed and stretched positions. It is also versatile in terms of what we can look at; joints, ligaments, tendons, muscles, fascia, even blood vessels and nerves can be assessed with our high-resolution ultrasound machine. All combining to give incredibly useful information about the nature of your injury and helping to steer treatment in the right direction. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615207631298-JUIDRJC51L39UIC7P5KZ/diagnostic%2Bultrasound%2Bmachine.jpg Services - Diagnostic Ultrasound - A Clear Diagnosis = A Clear Plan Existing patients can request our diagnostic ultrasound service at any time provided they have been assessed by one of our Podiatrists for suitability. We are also seeing an ever-growing number of referrals from other healthcare providers, both locally and from farther afield, who see the benefits of their patients receiving cost-effective and rapid-access to medical imaging, carried out by a team with high levels of clinical experience in lower limb care. If you are interested in how diagnostic ultrasound may help you get the answers you need to your foot, ankle or lower limb problem, get in touch today or ask your healthcare provider for a referral. https://www.tweedpodiatry.com/services/ultrasound-guided-injections monthly 0.5 2025-08-26 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615209589341-W73YBTDFIJIR67RKRHLL/corticosteroid%2Binjection%2Bbits.jpg Services - Ultrasound-Guided Injections - A powerful aid in rehabilitation. Many people come to us struggling with persistent pain, inflammation or an injury that just seems to get stuck. Injection therapies, in the right hands, alongside a comprehensive treatment plan, can work wonders for many of these problems. Injections however are not without their risks and some are simply not safe without knowing exactly where to inject…that is why we are proud to be the first Podiatry clinic in the Scottish Borders to offer injection therapies, including, local anaesthetic, steroids and Ostenil®, in the safest and most reliably form possible - with ultrasound-guidance. We believe in a light touch when it comes to injection therapies and don’t seek to over-treat. Meaning we will always take the time to think carefully about the use of injections in your individual case, discuss the intended benefits and potential downsides with you and only inject when we (and more importantly, you) have a very high degree of confidence we will be successful. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615209611097-GF70V9X0LOZ2H2P75AXI/Steroid%2Bkit.jpg Services - Ultrasound-Guided Injections - Knowing when and what to inject. There are a few reasons we may consider an injection in clinic: The first, as already hinted at, is for situations where we are satisfied you are doing everything else right in your treatment plan (e.g. a good exercise programme / orthoses / footwear and so on) but your symptoms keep persisting. This may be due to persisting inflammation, swelling or restriction in movement. Some very common examples of this include Plantar fasciopathy, Morton’s neuroma and Midfoot Arthritis to name but a few. The decision to inject local anaesthetic, steroid, Ostenil® or any combination of those will depend on lots of factors but they would often be used for these reasons: Local anaesthetic: For pain relief either as a stand-alone therapy or in combination with other drugs like steroid OR as a “diagnostic block” where the aim is to numb the suspected source of your pain and back-up what we believe to be your diagnosis. Nerve entrapments and some hard to pin-point joint pains are good examples for this. Steroid: Also used for pain relief but on a longer-lasting level by significantly reducing inflammation and swelling. As we use diagnostic ultrasound in our practice, confirmation of this swelling can be given so we know the steroid has an effective target to work on. Steroids are powerful and it is very important the injection is accurate which is why we, in our practice, generally opt for ultrasound-guidance when using this treatment option. Ostenil®: This is kind of like WD-40 for humans! The active ingredient is Sodium Hyaluronate which acts as a lubricant similar to the synovial fluid found in joints and tendon sheaths (those being the main targets we use it on). It has an exceptional safety profile with very few side-effects, has been shown in numerous studies to have a protective effect on cartilage, and is also great for longer-term relief and improving mobility. In our practice, Ostenil® can be delivered as a single injection or as part of a treatment package, typically involving 3 injections, 1 week apart. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/b5aef295-bac3-4ef5-a87f-2760da834338/IMG_20220406_163230.jpg Services - Ultrasound-Guided Injections - Knowing where to inject. An injection carried out by a member of our team has a distinct advantage over other Podiatry practices in the Scottish Borders - we are the first to offer an in-house, fully certified diagnostic ultrasound imaging service. This makes a tremendous difference when it comes to planning injections as we can first ensure we are making exactly the right diagnosis and know how severe the condition is. Assessing the location and severity of tissue damage with clinical examination and the naked eye can only get you so far and ultrasound allows us a far superior level of precision so we can a) know precisely IF an injection is appropriate and b) know precisely WHERE that injection should go. The where part is also huge. Whilst we are very experienced in performing landmark-guided injections (sometimes called blind injections) we are utterly convinced, from our own practice and from the mountain of clinical research on the topic, the most injections should really be performed under ultrasound-guidance. Fundamentally, ultrasound-guidance means we can see where the needle is being injected in real-time. The result is much greater safety, accuracy and the ability to perform highly specialised procedures, such as High-Volume Image-Guided Injection (HVIGI) and Midfoot Arthritis injections, that are just not possible for most practices to carry out with the safety and precision you should expect. https://www.tweedpodiatry.com/services/custom-foot-orthoses monthly 0.5 2025-10-25 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615209884227-KZMPWX7IP4C5UWCKLDGA/A%2Brow%2Bof%2Bcustom%2Bfoot%2Borthoses.jpg Services - Custom Made Foot Orthoses - The pinnacle of orthotic technology. As an advanced Podiatry practice, we strive to offer the widest array of orthotic options for our patients. These devices are a mainstay of Podiatry practice that can help an enormous array of problems in the feet, ankles and lower limbs by offloading painful and injured tissues whilst we work with you to get back to the activity you love. From a huge selection of off-the-shelf devices, to our in-house Sidas custom orthoses service to the most cutting-edge devices available anywhere thanks to our expert lab partners. If you require foot orthoses, you’re in good hands. In our strive to innovate, 3D technology exists in two key stages of your custom foot orthoses journey with us. The first is in the precise capturing of the dimensions of your foot which we achieve using 3D scanning technology. No more messy plaster of Paris or foam boxes sitting in the post office, just a very clever device fitted to an iPad and we’re good to go! A detailed prescription is then filled out digitally and sent with the scan straight to the lab ready to be designed to our exact specifications and 3D printed to create a durable and beautifully finished device to help you on your road for recovering from foot and ankle pain. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615209898774-NLTJZJP1YVNLKXQ4UGAX/3D%2Bprinted%2Bcustom%2Bfoot%2Borthoses.jpg Services - Custom Made Foot Orthoses - Good for your feet and the environment! We now choose 3D-printing as standard for all our lab-made devices for 2 big reasons: By printing a device from scratch, we are not tethered to the limitations of traditional manufacturing techniques. New design features allow us to incorporate stiffening or flex zones across the shell of a device so the resistance changes at different points. As Podiatrist with in-depth knowledge of foot mechanics, we get very excited about this as it allows us to alter the loading of joints, tendons, ligaments and muscles with a level of precision that was out of our reach before now. 3D-printing has also completely changed the environmental impact of foot orthoses for the better. Something we all must take very seriously. Traditional manufacturing techniques involve milling large blocks of plastic down the required shape and discarding of the remaining material - usually in excess of 80% waste! By building a device from scratch using only the material needed, there is minimal excess/waste material - now less than 4% and improving all the time. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615209915640-97QV15CG1M00AVZNZCSY/plantar%2Bfasciopathy%2Bcustom%2Bfoot%2Borthoses.jpg Services - Custom Made Foot Orthoses - Getting you back on your feet. Foot orthoses of all shapes and sizes represent an important tool in the rehabilitation. tool box. The primary goal of orthotic therapy is to change where load is distributed through the tissues in your foot, ankle and lower limb. By reducing the load on an injured structure we are aiming to give it the opportunity to heal more effectively. Custom foot orthoses represent our best and most evidence-informed way of achieving just this. From tendon pain to arthritis, to ligament strains and bony injuries, custom foot orthoses can completely change the game in rehabilitation. As always this only works well in the long term if we also gradually expose the body to stress/load again in a thoughtful manner that gives it something to respond and adapt to. The goal is not for your orthoses to be a life-long crutch. Rather they are a helping hand which, for many conditions, will not be needed forever. That said, in more advanced foot and ankle conditions that are not easily reversible, there is definitely a place for ongoing support. This is where the incredible durability of 3D-printed custom foot orthoses become our treatment of choice. https://www.tweedpodiatry.com/services/axit monthly 0.5 2023-12-19 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1675799585084-UX5JFDTO2MFAYIN2MOAD/unsplash-image-87n4IpQl6c4.jpg Services - AxIT Strength & Power Assessment - How we move = how we live. Movement is at the very core of how we spend a significant proportion of our lives and how well we move is, in some real sense, a reflection of how well we live. Two fundamentals that dictate how well we move, whether we’re young or old, are strength and power. Lacking strength and power can have different consequences for different people. The busy mum and weekend runner concerned about preventing a knee injury, the pro footballer returning to sport after an ankle sprain, the older adult at increased risk of falls. At no point in our lives does the strength and power our musculoskeletal system stop being important. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/726ec136-dfd6-4f26-861b-837af8c04626/20230122_153503.jpg Services - AxIT Strength & Power Assessment - Understanding our bodies better But how do you actually know if you’re strong enough? if you’re powerful enough for the task ahead of you? For the longest time the kind of data required to answer those questions properly meant access to equipment and technology only available to high-end research institutions and elite sportspeople…but no longer! Right here at Tweed Podiatry, we are proud beyond measure to introduce, for the VERY FIRST TIME ANYWHERE IN THE UK: The AxIT system. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/c729f58c-8027-493b-8708-7ba3663eb66b/image+%281%29.png Services - AxIT Strength & Power Assessment - Getting you back on your feet. The AxIT system is a unique set of devices that allows us to take all the guess-work out of strength and power assessment and provide deep insights into the quantity and quality of how your muscles work. It allows us to set baseline data, track your performance over time and know exactly how and when to change direction in your rehab or training plan and in a way that is genuinely unique to each and every person. It doesn’t matter whether you’re recovering from an injury or looking to prevent one, whether you’re trying to hit a new personal best in your sport or you simply want to remain active and able to carry out tasks of daily living. Our team are now equipped with the technology to assess you, me and everyone like an elite athlete and help you achieve your goals like never before! https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/7af8f126-7c29-4e68-a578-f05ee82cf5f6/Untitled+design.jpg Services - AxIT Strength & Power Assessment - What does an AxIT assessment look like? Supporting your rehab or training looks different for everyone - as it should! Our AxIT assessment begins with a discussion around why you are seeing us in the first place. If you currently have a lower limb injury, we require you to attend an initial musculoskeletal consultation with us before we can determine what level of AxIT assessment is appropriate for you; some of the data the system can gather may be offered at your initial consultation. If you are a non-injured individual, it is fine to book directly into an AxIT assessment which begins with a “super session” - this is a highly in-depth analysis of the strength and power you possess throughout your lower limbs. The clinician working with you will then analyse the data gathered and arrange a “training plan session” to go over your results and lay out a road map for your success! This will involve various exercises to work on the deficits/imbalances identified and we will take care to factor in your level of exercise experience, your injury history and the kind of equipment you have access to. The beauty of the AxIT system however is not only the detailed information gathered at your initial session but the ability to accurately track progress over time; once your training/rehab programme is underway, we provide periodic re-assessments of those key strength and power metrics pulled from your initial results to provide further insights on how you have improved or where more work needs to be done. The whole process completely removes guess work and time wasted on ineffective training/rehab, allowing you to get straight to the point and reach your goals with confidence. And, to top it all, we offer all this in two fantastic packages. The first is our silver package designed to bring the best of the AxIT system to those needing a programme that is focussed toward lower limb injury-recovery and those returning to activity after a long break. The second is our gold package, led by our very own Holly Lackenby who, as well as being a specialist sports/msk Podiatrist, is a level 2 strength & conditioning coach with British Weightlifting. Here she brings her knowledge and expertise to design truly bespoke programmes for active people who want to take their rehab or training to the next level, not only for lower body but also upper body assessment, giving the option of a truly holistic review of your body’s strength and power. https://www.tweedpodiatry.com/services/nail-surgery monthly 0.5 2023-11-28 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615207771900-RFT4HMNN1HIYHR3BX0NK/Ingrown_nail_002.jpg Services - Nail Surgery - Nail pain? We can help. With a combined experience of over a thousand procedures under our belts, if you have a nail problem requiring surgery, you're in good hands. Anyone who has suffered an ingrown toenail can tell you what an extreme pain it can be. When conservative care is only fixing the problem for a short period or when you are experiencing recurring infections, nail surgery represents a safe and effective cure. And after quick anaesthetic, it can be performed painlessly by our caring, expert team in no time at all. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615207788419-PDQV3Z9CR7MEPBTZDS3S/5372322_orig.jpg Services - Nail Surgery - Expert care and permanent cure. Ingrown toenails are both exceptionally common and exceptionally painful at times. Sometimes we will offer conservative care by way of gently cutting away and filing down the offending nail edge, especially in minor cases and where it has not been a repeat offender and deserves the benefit of the doubt. However, if the issue keeps recurring, is leading to infections or has produced large amounts of swelling, it is likely this will not resolve without surgery. Whilst this can sound distressing to many, it is actually a very straightforward procedure and has one very important upside - it's a cure! https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615207800772-NO0I4UFPG7SM6J743CV9/Toe%2Bbandage.jpg Services - Nail Surgery - Straightforward and effective solutions. Our first job is to ensure you are medically fit for nail surgery - the vast majority of people are with the occasional need for extra care during the post-operative healing phase if you have a condition which may affect this (such as diabetes or circulation issues). Once this is done and you have been through the consent process, we can begin. The procedure begins with a local anaesthetic at each side of the affected toe to ensure it is numb and therefore pain-free during the surgical process. A small tourniquet is then applied over the toe so there is little to no bleeding. The next step will then depend on which type of surgery we have agreed is best for you. This may simply mean removing a portion of overgrown skin overlapping the nail or, more often than not, will involve removal of either part or all of the offending nail with specialist tools (baring in mind you won't feel it!). The nail bed is then treated with an agent called phenol which destroys the portion of the nail bed we are concerned with, ensuring the problem nail does not grow back. The tourniquet is then removed and a dressing is applied to be kept on until we see you a few days later to check up on things. At this point we supply you with your own pack of dressings and guide you through the process of redressing the toe at home. Healing varies from person to person depending on factors like your age, overall health, any unforeseen trauma or infection to the toe after the procedure but is usually between 4-6 weeks. Other than your dressings, you are not particularly limited in your daily activity and can walk out of the clinic immediately after the procedure. https://www.tweedpodiatry.com/services/achilles-hvigi-therapy monthly 0.5 2025-08-16 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615210854659-S2E1WFIJK3VMSRSXYY6R/rsz_fkcbzejvabp93nsoyh8q.jpg Services - Achilles Tendon High-Volume Image-Guided Injection (HVIGI) - A painful problem…a powerful solution! Achilles Tendinopathy (which used to get called tendinitis) is an overload injury where the tendon is not healing/adapting fast enough to keep up with the stresses placed upon on it. This leads to changes in the tendon’s structure and a reduction in it’s ability to handle the stresses placed on it. As we always preach, the fundamentals of getting an achilles tendon better are a) reduce the loads/stresses on it that are making it irritable/painful and then b) apply the principle gradually exposing the tendon to load again through a methodical exercise programme. But what happens when it doesn’t work out? Where do you go when you just can’t get going with your exercise programme because the pain is holding you back? Our Podiatry team share your frustration. We have seen this situation time and time again. But we are also super excited to share something with you that we believe to be a genuine game-changer in treating this problem. For the first time, in any clinic in the Scottish Borders, we bring you: High volume image guided injection (HVIGI) therapy. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/eb209dbd-d585-476f-add0-783d42a8a83d/IMG_20220406_164725.jpg Services - Achilles Tendon High-Volume Image-Guided Injection (HVIGI) - The cycle of pain in Achilles Tendinopathy. To understand why HVIGI therapy might be for you it helps to first understand a little bit of what’s going on behind the scenes with your tendon and therefore how one of the major obstacles in achilles tendinopathy can be overcome by adopting this pioneering technique. Beneath the achilles tendon lies a area of fat tissue that we call “Kager’s fat pad” which is rich with blood vessels and nerves. As achilles tendinopathy progresses, it is very common for new nerves and blood vessels from this fat pad to spread and grow into the achilles tendon in a process called “neovascularisation”. And here we hit the problem! As we get increasing ingrowth of these very sensitive neovessels we are faced with the conundrum of trying to load/exercise a tendon that is just downright sore and stuck in a very difficult cycle. Put simply, HVIVI therapy aims to break this painful cycle. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/b5aef295-bac3-4ef5-a87f-2760da834338/IMG_20220406_163230.jpg Services - Achilles Tendon High-Volume Image-Guided Injection (HVIGI) - Breaking the cycle. Once the problem of neovascularisation has been determined (using our in-house diagnostic ultrasound system) and we know you are medically fit to proceed, we can offer HVIGI therapy. The procedure involves a single injection between achilles tendon and the Kager’s fat pad that lies deep to it. The “image guided” part of HVIGI therapy is the use of ultrasound. This is done throughout the procedure so the needle inside can be seen as we inject - this is essential to ensure a safe, accurate and painless as possible injection. On the point of pain (a natural concern to have) we have not found patients to struggle at all! This is partly due to the order we prefer to follow: firstly we introduce local anaesthetic which rapidly numbs the area for the remaining steps, secondly we inject a high-volume (hence the name!) of sterile saline water and a tiny dose of steroid to finish. Pain relief and localised anti-inflammatory effects from the anaesthetic and steroid are helpful. But crucial to all this is the high volume of fluid which strips the tendon and fat pad away from each other, separating the painful nerves and blood vessels that otherwise prove so challenging to conquer. This combination and technique has been well studied and is similar to that employed by some of the UK’s other leading Podiatric, Orthopaedic & Sports Medicine centres. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615207488095-QSYFHI3JB7VPKZ1FDBR3/Walkng%2Bup%2Bsteps.jpg Services - Achilles Tendon High-Volume Image-Guided Injection (HVIGI) - Getting you back on your feet. Aftercare with HVIG therapy is simple but important. You must not drive on the day of the procedure and are asked to avoid any strenuous activity for 2 weeks post-procedure. This means avoiding any running, hopping, jumping, basically anything where the tendon would be asked to work hard and fast. Your exercise programme prescribed by your Podiatrist will also be put on hold for this short period. But then…the magic happens! Patients often report enormous pain relief before the 2 week period is complete however the goal now is to crack on with our rehab. programme (which may include in not only a much less painful condition but in a much more sustainable and achievable way. Our Podiatry team will continue to work closely with you and monitor your progress to with the aim of achieving a full and complete recovery. Combined with our expertise in providing existing treatments for achilles tendinopathy like our in-house and lab-made custom foot orthoses, and our gait retaining services, we believe HVIGI therapy is the missing piece of the puzzle for many suffering with a painful achilles tendon. We are proud to continue bringing new and pioneering treatments and services to the Scottish Borders and delighted to be the first clinic here to offer this service to our patients. As always, we are here to help and if you have any further questions about this or other services we offer, please don’t hesitate to get in touch with the details below. https://www.tweedpodiatry.com/services/routine-podiatry-care monthly 0.5 2025-08-03 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615209500760-SJU4IUW500SWBM4E9KN1/cristian-newman-111295.jpg Services - Routine Foot Care - Put your feet in our capable hands. “Routine Foot Care” involves the assessment, diagnosis and treatment of the many skin and nail problems which we can all experience from time to time in our lives. For some people this can mean a short spell of treatment to fix a painful corn or thickened toenail. For others it may mean a helping hand with the regular maintenance of our feet so we can stay more healthy and mobile. And for some it is the opportunity to have an assessment of our feet because of health problems like diabetes or circulation issues. Whatever the case, our friendly, expert team are here to offer the care you need. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615209520190-KC25M06UYD12VY33S5EK/Me%2Bdoing%2Ba%2BDoppler.jpg Services - Routine Foot Care - Medical experts in foot health. Your feet are often a window into your overall health. As the last part of the body to receive blood and nutrients it is no wonder this is often where the first signs of health issues will emerge. This is why every initial consultation with our team begins with gathering information about your medical history, medication, allergies and family history. Depending on your age and health status, we will then carry out any necessary tests. Usually, especially for those of the age of 50, this will involve a short neurovascular assessment. A neurovascular assessment in our practice can involve the use of several tools depending on your needs. The most commonly used is a Doppler ultrasound - this compact device allows us to listen to the flow of blood in your feet and assess the health of your arteries. It can also allow us to pick up heart irregularities which we can assess further in-house using a mobile ECG device. For patients with potential nerve problems or conditions related to this like diabetes, we can also assess the protective sensation in your feet with tools like a monofilament and non-contact thermometry. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615209539989-1ZNM4ASOANSQ7N12RO5O/Callus%2Bdebridement.jpg Services - Routine Foot Care - Taking the time to do things properly. Going through your medical history and any necessary health assessment of your feet typically takes less than 10 minutes. Then it’s on to the matter at hand - your feet! Our team have the skills, the tools and the knowledge to get to the bottom of all manner of skin and nail problems and provide ourselves in offering meticulous treatment. Many people’s first experience of seeing a Podiatrist or Foot Health Practitioner can be an anxious one, especially when sharp instruments are involved - we want to put you at ease from the moment you walk in the door. Both our initial and follow-up consultation times are much longer (and, for the time given, much better value for money) than other clinics nearby because we don’t believe in a quick conveyor belt approach. Instead we are proud to take the time in ensuring your experience is as enjoyable as possible. For more detailed information on some of the specific conditions we treat like corns and callus, ingrown toenails and athletes foot, head over to the conditions page of our website. https://www.tweedpodiatry.com/services/richie-brace-therapy monthly 0.5 2024-10-20 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615209694763-1IBS9G67JBVSWIV9X9LY/Richie%2BBrace.jpg Services - Richie Brace Therapy - A game-changer of a treatment option. There’s a Chinese proverb that says “The best time to plant a tree was 20 years ago. The second best time is now”. Often we meet patients with foot and ankle conditions that have reached quite advanced stages and many of the usual treatment options like taping and even custom foot orthoses (bespoke insoles) are no longer sufficient. But we are always optimistic and when the Richie Brace became a treatment option in the UK we were thrilled to start using it in practice - to say it has been a game-changer for some patients would be an understatement. We have used Richie Brace therapy with great success for patients with late-stage posterior tibial tendon dysfunction, severe arthritis, chronic lateral ankle instability and drop foot. Many of these patients were told elsewhere that surgery was the only option left to them - but the Richie Brace can offer hope! https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615209714128-0DNEWJ4SFGO2LTUHZA65/casting.jpg Services - Richie Brace Therapy - Getting our hands dirty! Whilst 3D scanning has become our main technique in our clinic for capturing the shape of your feet for most custom devices, the method used for the Richie Brace is still good old fashioned Plaster of Paris! (PoP) From a prone (lying face down) position we apply several layers of PoP to capture the shape of both the foot and the ankle - this is important because the device has pivots that need to match up precisely with the articulation of your ankle joint. This way the device is able to offer enormous stability but also allow a normal upward and downward motion of the ankle whilst walking, making it much more versatile than a fixed-brace. Once the cast and key marks from your foot are capture, the cast is very carefully packaged up and sent on it’s merry way to Firefly Orthoses (our lab partner for this particular device). Upon arrival of the finished brace, our team will give you a call and look forward to seeing you for your fitting appointment! https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615209729417-GN3CI3GYHK6TXI3EX2L3/Richie%2BBrace%2Bbeing%2Bworn.jpg Services - Richie Brace Therapy - Restoring mobility and confidence. At your fitting appointment, we check the brace for a precise fit against all points of your foot and make any last-minute minor adjustments that may be required (rarely necessary) and check the brace in your shoes for fit. Due to the thin but high durable materials the brace is made of it is a lot less bulky than many other devices and patient’s are often pleasantly surprise how well it fits in shoes - that said, it is important to understand the best results will be found in walking shoes, boot and trainers. After a short adjustment period, daily activity (even including sport) in the brace should not only feel comfortable but significantly easier and less painful than without it. We have seen some truly remarkable results from Richie Brace therapy and would not be without it in our toolbox. A favourite fond memory of a patient’s experience of their first Richie Brace comes to mind that Firefly Orthoses share here. https://www.tweedpodiatry.com/services/sidas-custom-foot-orthoses monthly 0.5 2023-12-24 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615209788873-VL6ZC9K7F1CUJQZXDX4J/sidas%2Bcustom%2Bfoot%2Borthoses%2Bmachine.jpg Services - Sidas Custom Foot Orthoses - The First and Only for the Scottish Borders As an advance Podiatry practice, we are always looking for innovative ways to help our patients progress on their journey to healthier, happier feet as quickly as possible. Custom foot orthoses are specialised insoles that have been designed specifically with you and your feet in mind. Alongside our off-the-shelf range of devices and our 3D-printed custom devices from our lab partners, we are extremely proud to be the Scottish Border’s first and only practice to offer custom foot orthoses made in-house. Our friends at Sidas Medical have made this possible with their premium station which our practice took ownership of in winter 2019. By creating fully-bespoke foot orthoses in-house, we have complete control over ever part of the process and can give our patients the opportunity to walk (and hopefully skip!) out of the clinic with their new devices on the very same day as their consultation. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615209805654-GB9UCQN6CT6OLMAWQVLN/sidas%2Bfitting.jpg Services - Sidas Custom Foot Orthoses - Moulded to your feet, ready on the day. The obvious advantage as already mentioned is the speed of delivery of our Sidas orthoses; whilst our lab partners remain vital to us for many of the devices we need to help our patients, the lead time is typically 2-3 weeks. When we can achieve the desired outcome with our Sidas devices, this lead time vanishes almost entirely; 95% of patients will leave with their new orthoses in-hand (or rather in-shoe) the very same day. And on the 5% of occasions where extra time is needed to perform more complex device modifications, we will have this done by the next day. We also love that the whole process can be carried out right before your eyes and patients regularly report how satisfying this is. We begin by vacuum-moulding the exact shape of your feet with the Sidas silicon pillows. Meanwhile, our carefully selected base materials that will make up your device are gently vacuum-heated until pliable. The soft devices are then placed in between you and the mould of your feet to take shape. After cooling and firming, our Podiatrists will carry out any additional tweaks to the devices depending on what we are trying to achieve for your feet and voila! Foot orthoses made uniquely to your feet, ready to take home. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615209824209-U2Y7XBA0GMCRDC6ST5OP/Holly%2Bdoing%2Ba%2Bsidas%2Bfit.jpg Services - Sidas Custom Foot Orthoses - Getting you back on your feet. Foot orthoses of all shapes and sizes represent an important tool in the rehab. tool box. The primary goal of orthotic therapy is to change where load is distributed through the tissues in your foot, ankle and lower limb. By reducing the load on an injured structure we are aiming to give it the opportunity to heal more effectively. As always this only works well in the long term if we also gradually expose the body to stress/load again in a thoughtful manner that gives it something to respond and adapt to. The goal is not for your orthoses to be a life-long crutch. Rather they are a helping hand which, for many conditions, will not be needed forever. The beauty of our Sidas orthoses is that, not only are they tailored to your own feet for maximal effect, they are supremely easy to modify; as your rehab. progresses it is simple for our team to modify your devices using heat moulding, grinding and various other tools in our workshop to make sure they are always best suited for whatever stage of recovery you are in. This is why they are our device of choice for many patients when we are considering orthoses as a short- to medium-term tool on your road to recovery. https://www.tweedpodiatry.com/services/gait-analysis-and-retraining monthly 0.5 2024-03-30 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1633248786424-9SIKTVNFXV5VALN2WDPY/Rehab+Room.jpg Services - Gait Analysis and Retraining - A different point of view. Gait analysis is a service that always fascinates our patients. The ability to see yourself moving in ultra-slow motion from multiple angles can be genuinely insightful to both to you and to us! Lower limb pain and injury often have mechanical components. Gait analysis performed in our clinic allows a detailed examination of your dynamic movement during walking and/or running which often leads to valuable information about the nature of your problem and how we can address these factors with greater precision and effectiveness. Autumn 2021 saw an enormous upgrade to our practice which now boasts a dedicated injury, performance and rehabilitation space. Here we can provide a one-to-one detailed assessment your balance, strength and, very excitingly, the way you move whilst running or walking; A specialised treadmill, slow-motion camera system and innovative analysis software allows us to identify important features in your gait that can steer the course of treatment, whether it be orthotic prescription, strength and balance work or gait retraining programmes. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615209982316-9UHIXZL4D8M9F1XDXHVJ/running%2Bpic%2B1.jpg Services - Gait Analysis and Retraining - Movement is medicine. The way we move is, as you might expect, a very important part of why we might develop pain. Alongside training load (both the volume and rate at which we apply load to our bodies during exercise) it can be useful to think about whether the way we move is exerting unhelpful stress. The evidence these days is now very clear that completely resting an injury (in most cases) is a bad idea. Instead we need to look at ways of modifying our activity so the movements and loads that aggravate an injury are reduced whilst we work on rebuilding the strength and capacity to load the body properly again. Taping and foot orthoses can help, so can changing to other non-running activity like cycling. But for many runners, stopping running is the last thing they have any intention of doing! This is where we believe there might be another way: Gait retraining. Our Sports Podiatrists, Holly and Robert, both have a keen interest in gait retraining and have pushed to develop in this area of practice where most other Podiatry clinics have yet to innovate in. Holly has direct experience both as a running coach and a very accomplished ultrarunner in her own right. Robert has lectured on the topic of gait retraining at several conferences and as part of university masters programmes. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615209996577-DENY0G6ZGT87FTKCEJB2/running%2Bpic%2B3.jpg Services - Gait Analysis and Retraining - A valuable tool in the toolbox. The concept of gait retraining is to use various cues that will alter the way you move. This may be to change your stride length, your cadence, the width between your steps and so on. For example, if you are a forefoot striker with an achilles tendon problem, it might be beneficial to lower your cadence and lengthen your stride to reduce the load on the tendon. The cues/instructions we give are usually very simple. If you have shin pain in the form of medial tibial stress syndrome (MTSS) it might help to work on increase you step to shift the load elsewhere. Gait retraining falls into the same part of the toolbox as foot orthoses, footwear changes and taping; they are all rehabilitation tools we can consider when trying to offload a painful tissue whilst we then build strength and capacity back into those tissues. Often those changes will only be needed in the short term (like many interventions) but in some runners we have found them to have longer-term benefits. Although injury fixing and, hopefully, prevention is what we’re generally aiming for, another fascinating area is gait retraining to improve running performance. Our Sports Podiatrist and Running Coach, Holly, has a particular interest in this area and can work with you on strategies that may not only get you over the finishing line pain-free but also faster! https://www.tweedpodiatry.com/conditions daily 0.75 2024-03-30 https://www.tweedpodiatry.com/conditions/plantar-fasciopathy monthly 0.5 2022-07-30 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1658825752132-CVMTX0VIVNBNLCZP4JUX/Storz+Medical+Radial+ESWT+%286%29.jpg Conditions - Plantar Fasciopathy - The Highlights The plantar fascia is a thick tendon-like band of connective tissue running from the heel to the toes. Plantar fasciopathy is an extremely common overload injury to this structure. It’s more commonly known as “plantar fasciitis” but we try to avoid this term because “itis” means inflammation and we now know that isn’t what matters. Pain at the heel and/or into the arch (especially when first standing from rest) are the most common symptoms. Although common, many people struggle with this condition for a long time - it doesn’t have to be that way! In our clinic, we can diagnose this problem easily with physical examination and occasionally with the added use of diagnostic ultrasound. Evidence-based treatment includes taping, foot orthoses (specialist insoles), footwear advice and progressive loading exercises. And when the condition is more chronic (more than a couple months), extracorporeal shock wave therapy (ESWT) can be a game-changer. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615134066265-MMQN5JDCTRB7OIPYE3H9/iStock-1073416780.jpg Conditions - Plantar Fasciopathy - What is it and what are the symptoms? Plantar Fasciopathy is an overload injury to the plantar fascia - a thick band of tissue that joins your heel to the base of your toes and acts as one of the key load-bearing structures of your arch. It is one of the most common conditions we treat in our practice. Plantar fasciopathy symptoms usually involve pain (which can vary from mild to severe) at the plantar surface (sole) of your heel and/or pain into the arch of your foot. The pain is often worse when first standing up from a rested state (getting out of bed in the morning for example) which tends to ease after moving around only to worsen again at the end of the day. The pain can be a dull ache or a sharp stabbing pain and may also feel burning. If you have nerve-type pain like zapping and tingling you might have a nerve entrapment in the area (which we can help diagnose) rather than true plantar fasciopathy. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615210756556-YR9V36C1XP09OSSZNF0J/Plantar%2BFascia%2BImage.jpeg.jpg Conditions - Plantar Fasciopathy - Why does it happen? Plantar fasciopathy is an overload injury - in essence, the amount of mechanical load or stress the plantar fascia can take on a daily basis has been exceeded too many times for it to keep up with healing and adapting. Symptoms often follows a clear "spike" in load - a sudden increase in walking or running mileage, a change in profession (those on their feet a are particularly at risk), a change in shoes and weight-gain are all risks. We also know that factors like poor sleep and emotional and psychological stresses can all play an important role. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615210789950-NQ6J09J50CFBKH3HOL59/Plantar%2Bfascia%2Bcustom%2Borthoses.jpg Conditions - Plantar Fasciopathy - What are the treatment options? Once the diagnosis of plantar fasciopathy is confirmed (usually through physical examination but this may also include the use of diagnostic ultrasound), we can make a treatment plan. This will be tailored to you based on some of the factors above that may need addressed. Key amongst these is offloading the injured tissue to give it the opportunity to heal - taping and foot orthoses (specialised insoles) are both incredibly helpful for this (as a side, we do not recommend patients buy cheap flimsy over-the-counter insoles that promise to help heel pain as these devices are next to useless). Between this and correct footwear (very important) we can then look at a rehabilitation programme designed to give the plantar fascia the necessary stimulus to repair and also to strengthen the muscles that aid it's function. In most cases, we find these steps will be enough to eventually resolve the problem. Where pain persists or needs to be tackled quickly for a big event coming up, we will recommend extracorporeal shock wave therapy (ESWT). This advanced technology is clinically proven to accelerate healing and reduce pain, and has been approved for use in plantar fasciopathy by the National Institute for Health and Care Excellence (NICE). https://www.tweedpodiatry.com/conditions/achilles-tendinopathy monthly 0.5 2023-12-10 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615210854659-S2E1WFIJK3VMSRSXYY6R/rsz_fkcbzejvabp93nsoyh8q.jpg Conditions - Achilles Tendinopathy - The Highlights Achilles tendinopathy is an overload injury to the achilles tendon experience by both active and non-active people. It results in pain, stiffness and swelling within the tendon. In our clinic, we can diagnose the type of achilles problem you have (yes, there are several possibilities!) with a thorough clinical examination and, when a definitive diagnosis and highly detailed understanding is required, we can provide on-the-spot diagnostic ultrasound to take a look inside! Treatment is fundamentally about rebuilding strength and load-tolerance into the tendon through progressively challenging exercises. All other treatment methods are in service of this goal. This includes footwear changes and foot orthoses (specialist insoles). In addition, as a practice specialising in this condition, we can also offer advanced treatment options including Storz Medical Extracorporeal Shockwave Therapy (ESWT) and High-Volume Image-Guided Injection therapy (HVIGI). Both of which make us unique amongst Podiatry clinics in the Scottish Borders. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615210877384-7OIFDM0L0QDGILZ8NHRW/2021-02-05%2B18_51_38-Complete%2BAnatomy.png Conditions - Achilles Tendinopathy - What is it and what are the symptoms? Achilles Tendinopathy is an overload injury where the tendon is not healing/adapting fast enough to keep up with the stresses placed upon on it. The result is a cascade of cellular processes leading to degeneration of the tendon with lowered function and, of course, pain. Side note: Tendinopathy is the more accurate term for this condition and not “tendinitis” as you might have heard it called…now you know! Symptoms of tendinopathy can vary depending on severity of injury and the length of time you have had it. Common features include pain in the tendon when first moving from a rested position or beginning activity like a run. A lot of people will report the pain eases once they get going. Due to the cellular processes taking place in and around the tendon there can often be swelling and/or a feeling of thickening in the tendon. The pain is usually a dull ache but when aggravated it can feel quite sharp or even burning. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615210899803-OO3F9JNS22SYRK10YD9F/mountaineering-455338_1920.jpg Conditions - Achilles Tendinopathy - Why does it happen? As mentioned, Achilles tendinopathy is a classic overload injury - in essence, the amount of mechanical load or stress the achilles tendon can take on a daily basis has been exceeded too many times for it to keep up with heeling and adapting. This often follows a clear "spike" in load - a sudden increase in walking or running mileage, a change in profession (those on their feet a lot for work are particularly prone to this condition), a change in shoes, weight-gain as well as emotional and psychological stresses can all play an important role. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1659180194407-HT7ERIENYGTN9Y7NC8FG/unsplash-image-nA0UDNDbxys.jpg Conditions - Achilles Tendinopathy - Treatment Options: The Fundamentals As with all conditions, getting the diagnosis right is paramount and different parts of the achilles tendon require different treatment approaches. First and foremost our team will help you figure out which part is the issue and this may include diagnostic ultrasound imaging to get a better picture of the tendon's overall structural health and help to rule out other conditions such as a bursitis or a systemic inflammatory condition. Load management (altering how much demand is placed on the injured tissue and how much it can handle) is fundamental to achilles tendon rehab. A lot of the people we see with this problem have had treatment elsewhere which has failed or only given short term relief because it has not properly addressed this fundamental pillar of how tendons recover. Without stimulation, the tendon has nothing to adapt to and simply will not improve. Our team will guide you through a personalised programme that allows your achilles and it's associated muscles to strengthen and become more resilient to load. This will tend to involve a series of evolutions to your programme as we progressively increase the challenge for the tendon and get you back to normal function. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1649260694458-ZXUHOKHD4Y7XGL6OY9VP/IMG_20220406_163230.jpg Conditions - Achilles Tendinopathy - Treatment Options: Advanced Techniques All other treatment options centre making tendon loading more achievable. For many patients, foot orthoses (specialised insoles) can be very helpful to address biomechanical factors in your feet and lower limbs and offload the tendon, especially in the short- to medium-term (they are not usually needed in the long-term if the tendon becomes strong enough). Taping has low evidence in achilles tendinopathy research but some patients do find it helpful/reassuring in the short term. In our running clients, we also offer gait retraining programmes to change your running mechanics to put less demand on the tendon whilst allowing you to keep active. In degenerative tendons with low levels of inflammation, when healing is proving stubborn or not moving fast enough (often an important factor in our sporting patients training for a big event) then we will often recommend Extracorporeal Shockwave Therapy (ESWT). This advanced technology is clinically proven to accelerate healing and reduce pain, and has been approved by the National Institute for Health and Care Excellence (NICE). Read more about ESWT here. In more inflammatory midportion tendon issues (a few cm above it’s insertion on the heel bone) which is most common, we can offer an advance procedure called high-volume image-guided injection therapy (HVIGI). This is especially helpful when “neovascularisation” is present. This is an excessive growth of blood vessels and nerve fibres into the tendon causing pain (something we can determine with our ultrasound technology right from your first appointment). We are exceptionally proud to be the first and only clinic in the Scottish Borders to offer this powerful treatment option which you can read more about here. https://www.tweedpodiatry.com/conditions/hallux-limitus monthly 0.5 2021-03-08 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615210969123-2YHAWSBB155FV79L5DMX/rsz_dd4cn7nbop16inwklmnu.jpg Conditions - Hallux Limitus - The Highlights Hallux Limitus is restricted motion in the big toe joint caused by arthritic changes making the joint thicker with bony prominences over it's top margins, often involving pain. In our clinic, we can diagnose this problem easily with physical examination and occasionally with the added use of diagnostic ultrasound. Treatment involves protecting the joint from painful end-range motion using appropriate footwear, taping and foot orthoses (specialist insoles). Other treatments to improve the condition can include joint mobilisation techniques and steroid injections. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615210993005-ADNKDBXLE0NSJWJNLT0S/Nicola%2BBending%2BBig%2BToe.jpg Conditions - Hallux Limitus - What is it and what are the symptoms? Osteoarthritis (OA) of the 1st metatarsal-phalangeal joint (MTP joint), i.e. the big toe joint, is an exceptionally common problem we see in clinic. It's thought to be about as common as hip arthritis and despite not being talked about nearly as much, it can be highly painful and debilitating. Hallux limitus is the term used to described reduce range of motion in the joint, usually secondary to arthritis. There is often a thickening (what we call osteophytes) at the dorsal (top) margins of the joint which may be seen and felt when pressing across it - this pressing along with both upward and downward bending of the joint can provoke symptoms. As can any weightbearing activity where the toe bends. Like a lot of arthritic pains, it will often be worse in the morning, ease with a little movement and get worse as the day goes on. Stiffness in the MTP joint is also a common feature with reduced upward bending motion available. This is partly to do with thickening of the joint capsule but more to do with a "bony block" where the thickened margins on the top of the joint line hit against one another. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211011006-5GMZPZ46XNOBQJ5YO5LU/big%2Btoe%2Boa%2Bxray.jpg Conditions - Hallux Limitus - Why does it happen? A number of factors can lead to MTP joint OA; Trauma to the joint either recently or in the past can increase the risk of developing OA and is often reported when we see it in younger individuals. Other joint conditions like rheumatoid arthritis and gout may damage the joint and lead to secondary OA. Another important consideration is your gait and biomechanics (which our team can look into). There are also genetic factors that seem to put some people at increased risk and family history may give this away. A lot of the time though we simply see this as normal age-related joint changes and that's important to understand because not all joint changes should be a cause for concern. However, pain is not normal and we should certainly be able to help if your joint hurts or is otherwise affecting your ability to enjoy normal daily tasks. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211028230-4DBCFE8FH5Y06R5B71CJ/147419390_757417975206140_8007808954232116808_n.jpg Conditions - Hallux Limitus - What are the treatment options? This will depend a lot on what stage the joint OA is at. This is decided based on your symptoms, clinical presentation and, as we often employ in our practice, diagnostic ultrasound imaging to visualise the joint and surrounding soft tissues in more detail. The bending motion of the toe is what applies stress to the joint and can impact on the changes we see. If the problem is in an early stage, the goal is to improve mobility in the joint and encourage regeneration. This can be achieved through mobilisation techniques which we teach patients how to perform at home and foot orthoses (specialist insoles) to change the mechanics of how the joint behaves. It may also involve techniques to help protect the joint like taping and advice on appropriate footwear (stiff soled or rocker shoes are super helpful whilst very flexible shoes usefully make things worse). If the condition is a bit more advanced (which is probably 90%+ of the time when people see us) the goal is still to preserve joint health but to focus more heavily on protecting the joint from what will now likely be quite painful bending motions. The shoe advice becomes more important than ever and can be augmented further with a specialist carbon plate insert that essentially stops almost all bending motion at the MTP joint when walking in shoes. We are also a big fan of corticosteroid injections which, in our practice, we perform following a small local anaesthetic first to ensure it is as close to painless as we can achieve. We find very few patients will fail conservative treatment if done properly but if it happens, we also have some excellent ties with both NHS and Private Practice orthopaedic surgeons who can offer a number of options from cheilectomies (shaving off the overgrown bone to improve motion), joint fusions and even joint replacements. All of which we can help explain before you go down that route of enquiry. https://www.tweedpodiatry.com/conditions/adult-acquired-flat-foot-deformity monthly 0.5 2022-07-05 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211084000-0Y4RY14JG69G15U5LG30/My%2Bflat%2Bfoot.jpg Conditions - Adult Acquired Flat Foot Deformity - The Highlights Adult Acquired Flat Foot Deformity (AAFFD) is a progressive flattening of the medial (inside) arch of the foot, very often with pain and loss of normal function. Our team have extensive knowledge and skills in diagnosing which tissues are affected from physical examination and our in-house diagnostic ultrasound service where needed. Treatment involved stabilising the foot to prevent further deterioration. This can include footwear advice, foot orthoses (specialist insoles) and custom Richie Brace therapy. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211106833-40LOERXI8T3DP6MU61L2/2021-02-05%2B18_11_59-Complete%2BAnatomy.png Conditions - Adult Acquired Flat Foot Deformity - What is it and what are the symptoms? Adult Acquired Flat Foot Deformity (AAFFD) is a progressive flattening of the medial (inside) arch of the foot, very often with pain and loss of normal function in a number of areas around the foot and ankle. A progressively flattening foot is of course the main sign of this problem but the location of associated pain can vary significantly from person to person as many tissues around the ankle and hindfoot can play a part (our Podiatrists can guide you through which parts are a problem). Common features may include a sense of losing mobility - the foot may feel stiff and less "propulsive" than it once did and may ache until you get moving. You may also find this is having a knock-on effect for how the rest of the body is moving. Both the inside (medial) and outside (lateral) parts of the ankle may be painful as well as the heel and over the top of the midfoot. Again, this can be pinpointed with accuracy in clinic. People also tend to find less supportive shoes become harder to wear without discomfort. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211137972-A9C94LLE298QMKNFJNJ9/Flat%2Bfoot.jpg Conditions - Adult Acquired Flat Foot Deformity - Why does it happen? As mentioned already, there are a number of tissues in our feet and ankles responsible for controlling how our arch behaves during weightbearing activities. Damage to any one of them (whether slowly over time or due to trauma) may increase the risk of developing a flat foot deformity. The most common of all is damage and elongation the tibialis posterior tendon with the knock-on effect of damage to the spring ligament. And if one tissue suffers, others have to compensate which, if not address may simply progress to more tissues failing to cope properly. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211154220-W8KINV8WEVL69SC6LQJJ/147441284_441442930524106_2839442358698798779_n.jpg Conditions - Adult Acquired Flat Foot Deformity - What are the treatment options? During the initial stage of developing AAFFD, the foot will tend to still have some flexibility and with that gives a lot more conservative treatment options which is why we always stress the importance of seeing someone who knows what they're doing (we like to think that's us!) without delay. If left unmanaged, AAFFD can lead to a very stiff and arthritic foot which, whilst not without hope, also cannot be truly reversed and gives us fewer conservative options. Either way, treatment can and should almost certainly include the use of well-designed foot orthoses (specialized insoles) to halt the progression of the condition and reduce pain, fully-bespoke Richie Brace therapy if standard foot orthoses aren't enough, footwear advice (flexible shoes are best avoided), exercises to strengthen the muscles that support the arch and management for any knock-on effects needing dealt with such as ultrasound-guided steroid injections for painful joint and tendon problems. This is a problem we have a special interest in and feel we as an advance podiatry practice we can offer you a great opportunity for success in managing this problem and returning to the activity you love. https://www.tweedpodiatry.com/conditions/peroneal-tendinopathy monthly 0.5 2024-01-31 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211240782-G8ZMWIKZI0PM2NGXGGZ7/Ankle%2Bpain%2Bimage.jpg Conditions - Peroneal Tendinopathy - The Highlights Peroneal tendinopathy is typically an overload injury to one or more of the peroneal tendons that around and behind the outside of the ankle. In our clinic, we can diagnose this problem easily with physical examination and occasionally with the added use of diagnostic ultrasound. Treatment is fundamentally about rebuilding strength and load-tolerance in the tendon through progressively more difficult exercises. All other treatment methods are to support this including taping, foot orthoses (specialist insoles), Extracorporeal Shockwave Therapy and even ultrasound-guided injection therapies. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211261203-IFAP907QXJGT0WFYGI29/2021-02-05%2B18_32_50-Complete%2BAnatomy.png Conditions - Peroneal Tendinopathy - What is it and what are the symptoms? In essence, Peroneal Tendinopathy is the progressive decrease in health of either the Peroneus Brevis or Peroneus Longus tendons which lie in the posterior-lateral compartment of your leg before passing into the foot behind your lateral malleolus (the bony prominence on the outside of your ankle). It is a condition we see a lot in runners both road and trail-based as well as hikers but it can affect people of all levels of ability. Peroneal tendinopathy can occur anywhere along the course of either tendon but common sore spots for both tendons are behind your lateral malleolus (the bony prominence on the outside of your ankle). There may also be pain at the attachment on to the base of the 5th metatarsal bone if the peroneus brevis tendon is involved and occasionally under the cuboid bone where the peroneus longus travel under the foot. It results in pain, difficultly walking (lifting the heel off the ground in particular) and may lead to a feeling of instability at the ankle. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1613834640616-4YE9PI1AU3Q85CMA9ZT9/Dress%2BShoes.jpg Conditions - Peroneal Tendinopathy - Why does it happen? Like other tendinopathies, the ultimate driver of peroneal tendinopathy is an ability for the tendon to keep up with the demands placed upon it, being unable to adapt and heal sufficiently. The locations where the tendon becomes damaged tend to be at it's points of maximum friction or at their enthesis (insertion points onto bone), suggesting this might be an important factor. The mechanical function of some people's feet and lower limbs can also place high loads on these tendon which we will seek to address in treatment. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211283079-8OW59G40VCCQJDGO8SLG/Laterally%2Bposted%2Bcustom%2Bfoot%2Borthoses.jpg Conditions - Peroneal Tendinopathy - What are the treatment options? Diagnosis, as we preach in our discussion of all foot and ankle conditions, is key to getting to the right treatment. Fortunately, experienced Podiatrists (we like to think that's us!) can usually assess and diagnose this problem easily from simple clinical tests. On occasion we may also advise our in-house diagnostic ultrasound service allowing us to take a look inside at the overall tendon health and the adjacent structures they relate to. Footwear (ideally with good upper support like walking boots) is very important in this condition as it tends to be with most tendons that cross the ankle. In runners, we will also tend to take an interest here in which shoes are involved as these can make a big difference. The next steps of rehabilitation involve finding ways of reducing the load on the tendons so they have the opportunity to properly heal. This can include the use of taping in the short term. It can also include foot orthoses (specialist insoles) designed to influence foot mechanics in a positive way - on this point, almost all mass-marketed insoles that can be bought online or over the counter are designed in a way that does the exact opposite of what we need for peroneal tendinopathy; as such we strongly recommend people don't go down this route and instead see a Podiatrist who understands how to design a device that actually works for this issue. Our range of bespoke custom foot orthoses can be especially helpful in dealing with more advanced peroneal tendon issues, especially if there are also ankle instability issues. As part of our mission to bring advanced Podiatry practices to the Scottish Borders we also offer options for more complex or longstanding versions of this condition including fully-bespoke Richie Brace therapy and ultrasound-guided injection therapies which can be a game-changer when other options haven't hit the spot. https://www.tweedpodiatry.com/conditions/ingrown-toenails monthly 0.5 2022-07-05 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211378707-ANWGCRGURCMO689ALLDI/5372322_orig.jpg Conditions - Ingrown Toenails - The Highlights Ingrown toenails involve a portion of nail piercing the surrounding skin, leading to swelling, inflammation and potentially infection. Especially curved nails and certain medical conditions can increase the risk of this and are important to have dealt with by a professional if you have underlying health problems. Our Podiatry team specialise in managing this problem which can involve conservative care (careful and precise trimming of the nail for pain relief) or surgical intervention (removing the offending piece of nail under local anaesthetic) - the latter being something we have done over a thousand times with excellent results. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211402794-S6IPAQRAUM5AD5ZD29M6/Ingrown_nail_002.jpg Conditions - Ingrown Toenails - What is it and what are the symptoms? Ingrown toenails (known in medicine as Onychocryptosis) are an extremely common (and often very painful) problem for people of all ages and levels of activity. It occurs when a portion of the nail plate digs in or punctures the surrounding skin. Left untreated, ingrown toenails will often become even more painful and can become infected. Pain is, as you would guess, the almost universal feature of an ingrown toenail. The damage inflicted to the adjacent skin can also lead swelling, redness and, very often, localised infections. As swelling around the offending piece of nail increases, the nail is enveloped even further and therefore digs in more, leading to a viscous cycle and potentially severe versions of the symptoms described. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1613834640616-4YE9PI1AU3Q85CMA9ZT9/Dress%2BShoes.jpg Conditions - Ingrown Toenails - Why does it happen? Two of the most common factors when combined that increase the likelihood of an ingrown toenail are involution (curvature of the nail plate edges) and poor self-care of your nails in terms of how they are cut (or ripped, bitten…we’ve seen it all!). Although it’s important to underscore the risk factors behind ingrown toenails can be diverse and can include factors related to genetics, hormonal changes, medications and other systemic health problems. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211432545-Q6A2F7U2174GV11D7QDK/image-asset.jpeg Conditions - Ingrown Toenails - What are the treatment options? In the first instance, it is important to see an experienced Podiatrist or Foot Health Practitioner who understands the condition. Our team have seen several thousand ingrown toenails and can confidently clear out the offending piece of nail to give instant relief. In mild cases, especially if it is the first such episode, we will usually then give it the benefit of the doubt and simply advise on appropriate nail care at home or provide you with ongoing routine nail care should you wish. In cases where the nail problem is more chronic or severe, we advocate nail surgery as the treatment of choice. This is very routine for our team, with a combined experience of over a thousand (you read that correctly - over a thousand!) nail surgery procedures under our belts. A small local anaesthetic is administered to the toe in question and the offending nail plate is painlessly removed, either entirely or a thin strip depending on what is appropriate for your case. The part of the nail bed (the matrix) involved in making that piece of the nail is then treated with a potent chemical called phenol to ensure it does not regrow (in our experience, this is successful in virtually all cases). You are then provided with dressings and follow-up appointments as required, hopefully very happy in the knowledge the problem has been solved for good! https://www.tweedpodiatry.com/conditions/posterior-tibial-tendon-dysfunction monthly 0.5 2021-03-09 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211514520-HTVQDY5IGCT7RMZJRSGK/2021-02-05%2B18_11_59-Complete%2BAnatomy.png Conditions - Posterior Tibial Tendon Dysfunction - The Highlights Tibialis Posterior Dysfunction is an overload injury to the main dynamic arch-stabilising tendon of the foot, often resulting in pain below the inner part of the ankle and arch. In our clinic, we can diagnose this problem easily with physical examination and occasionally with the added use of diagnostic ultrasound. As a progressive condition, it is essential we treat this as soon as we can. Foot orthoses (specialist insoles) are a mainstay for offloading the tendon as are appropriate shoes and boots. There is also a focus rebuilding strength and load-tolerance in the tendon through progressively more difficult exercises. In ongoing or more severe cases we can also look at more advanced treatment options like Richie Brace therapy and ultrasound-guided injection therapies. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211534100-W9LS462F1SWHRSBCAJIB/My%2Bflat%2Bfoot.jpg Conditions - Posterior Tibial Tendon Dysfunction - What is it and what are the symptoms? Tibialis Posterior Dysfunction (TPD) or Posterior Tibial Tendon Dysfunction (PTTD) is one of the most common tendon problems we see in our practice and therefore one we have a huge amount of experience treating. It is the progressive decrease in tendon health, usually behind your medial malleolus (the bony prominence on the inside of your ankle) and/or at the attachment on to the navicular bone. It results in pain, difficultly walking (lifting the heel off the ground in particular) and, if left unmanaged, the development of an acquired flat foot deformity. Pain is typically in the locations already mentioned and if the tendon sheath is inflamed then pain may run along it's full course. Symptoms of tendinopathy can vary depending on severity of injury and the length of time you have had it. Common features include pain in the tendon when first moving from a rested position or beginning activity like a run. A lot of people will report the pain eases once they get going. There may also be swelling around the inside of the ankle. The pain is usually a dull ache but when aggravated it can feel quite sharp. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211551386-4E23L5EYFRO8VHUNDU68/tibialis%2Bposterior%2Btaping%2Btechnique.jpg Conditions - Posterior Tibial Tendon Dysfunction - Why does it happen? Like other tendinopathies, the ultimate driver of TPD is an ability for the tendon to keep up with the demands placed upon it, being unable to adapt and heal sufficiently. The locations where the tendon becomes damaged tend to be at it's points of maximum friction as is passes behind the medial malleolus, suggesting this might be an important factor. The mechanical function of some people's feet and lower limbs can also place high loads on this tendon which we will seek to address in treatment. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211569556-5UWQTFF13R3XTUOJNNWR/A%2Brow%2Bof%2Bcustom%2Bfoot%2Borthoses.jpg Conditions - Posterior Tibial Tendon Dysfunction - What are the treatment options? We ascribe to the idea of TPD being a medical emergency of sorts; the evidence is very clear - if left untreated, this condition will almost certainly worsen and lead to permanent deformity and disability. For that reason we advise anyone worried about having this problem to see someone who knows what they're doing (we like to think that's us!) without delay. Our director and clinical lead, Robert McCririck, has a special interest in this condition having suffered from it himself! Foot orthoses (specialist insoles) are very important in almost all cases for at least the short- to medium-term and often over a longer period. There is perhaps no better example of a condition where this is more true. Our team are exceptionally skilled at assessing and prescribing foot orthoses for this problem and can offer both off-the-shelf and more bespoke custom-made options to suit your needs. Exercise therapy to strengthen the tibialis posterior tendon and associated tissues also plays an important role. As part of our mission to bring the most advanced Podiatry practices to the Scottish Borders we also offer options for more complex or longstanding versions of this condition including fully-bespoke Richie Brace therapy and ultrasound-guided injection therapies. https://www.tweedpodiatry.com/conditions/midfoot-arthritis monthly 0.5 2021-03-09 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211614993-OC1V7XJFET9QW4URKYNU/midfoot%2Barthritis%2Bpain.jpg Conditions - Midfoot Arthritis - The Highlights Midfoot arthritis is a common source of midfoot pain caused primarily by over-compression of the tops of the joint line in the midfoot leading to osteoarthritic changes. In our clinic, we can diagnose this problem easily with physical examination and occasionally with the added use of diagnostic ultrasound. Treatment involves decreasing the stresses over the top of the joints with appropriate footwear, foot orthoses (specialist insoles) and taping. Exercises to strength foot muscles are also important and if symptoms persist, ultrasound-guided steroid injections can help. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211636948-IFNCHENUJD6A69LH51O7/foot%2Bbones.jpg Conditions - Midfoot Arthritis - What is it and what are the symptoms? Midfoot Osteoarthritis or, to give a technical mouthful, "dorsal midfoot inter-osseous compression syndrome" (DMICS) is an extremely common problem encountered in our practice which, in our opinion, seems poorly understood, underdiagnosed and not treated well by many. As the name partly suggests, it is related to compression of the joints over the top of the middle section of your foot (usually the joints called the "tarsometatarsal joints") which we see both in older patients and in younger active individuals. Walking (especially during propulsion), going uphill, running and jumping can all be painful over the top of the midfoot, sometimes in a very specific location but, as this can affect multiple joints at once, it may be more vague and difficult to pinpoint. Symptoms may come on suddenly but more often it is a gradually onset over weeks or months, usually getting worse as we are on our feet during the day. In runners, we will often see this following a sharp increase in mileage, intensity or both. Flat, flexible shoes or going barefoot in the house is often worse than firm, supportive shoes and shoes with a small heel may also feel better. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211661369-ESK14SBA38XJJK0YGFL2/image-asset.jpeg Conditions - Midfoot Arthritis - Why does it happen? From a mechanical point of view, this problem occurs when the dorsal (top) of the midfoot joint margins compress against one another with too much force too often for the joint and it's related tissue to handle which can lead to pain quite acutely. If the problem persists, further joint changes can occur that would be consider osteoarthritis. These high and repetitive forces on the joints can be related to the particular function of your feet, ankles and lower limbs and may be exacerbated by poor footwear and large increases in activity (a bike spike in walking or running). https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211682589-EZ9YSQEYI9U8W02MIQTI/A%2Brow%2Bof%2Bcustom%2Bfoot%2Borthoses.jpg Conditions - Midfoot Arthritis - What are the treatment options? Coming back to the point about shoes, it's important to find shoes that don't bend a lot in the midfoot - whatever the style, when you pick up the shoe it should be difficult to bend in the middle. Stiff-soled shoes like walking boots are great or shoes with a rocker-sole which also reduces bending in the midfoot. Once we have assessed your overall biomechanics, we will often advocate the use of foot orthoses (specialist insoles) to address the challenges your feet may be having in properly coping with these high midfoot forces on their own. Robust construction here is important and we would not recommend people waste time or money on soft / flexible devices. Taping can be used in conjunction of foot orthoses or as a stand-alone treatment to decrease the load and give the tissue the opportunity to heal. In particularly painful or advanced cases, corticosteroid injections can work wonders for this condition. The vast majority of healthcare practices in the Scottish Borders are unable to offer reliable injections for these joints due to their very challenging anatomy and requirement to be done under imaging-guidance. We however can! We are proud to offer in-house diagnostic imaging which gives us the ability to perform these injections under imaging and see exactly where we're going, leading to safer and more effective treatment for this all-too-common condition. https://www.tweedpodiatry.com/conditions/mortons-neuroma monthly 0.5 2021-03-09 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211768572-BZXACBY2MOA2S35T5K64/mortons%2Bneuroma.jpg Conditions - Morton’s Neuroma - The Highlights Plantar Digital Neuritis (PDN) or "Morton's Neuroma" is an enlargement of the plantar digital nerve and/or bursal tissue surrounding the nerve as it passes between the metatarsal bones. It results in pain between the toes (and sometimes into the toes) and in the ball of the foot. Our Podiatrists can diagnose this condition through physical examination and ultrasound. Treatments include footwear advice, pads and insoles, and corticosteroid injections. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211785631-KAF5F4FVP7ZQI8DT2XSI/M%2BNeuroma.jpg Conditions - Morton’s Neuroma - What is it and what are the symptoms? Plantar Digital Neuritis (PDN) or "Morton's Neuroma" as it's more commonly referred to, is an enlargement of the plantar digital nerve and/or bursal tissue surround the nerve as it passes between the metatarsal bones. In medicine, because of the combination of these tissues involved, the more modern approach is to think of it as an enlargement of the "neuroma-bursal complex". But the phrase "Morton's Neuroma" remains what most healthcare providers, patients and search engines are used to. Because of the nerve-component of the problem, symptoms will often include classic "neuralgic" type pain such as tingling, burning, zapping, numbness or stabbing. The pain will usually come on very suddenly during a walk and is often bad enough to stop someone in their tracks and may lead them to take their shoes off and massage the area. The most common locations for symptoms are between the 3rd - 4th toes. The 2nd - 3rd being the next most common. Symptoms will also often radiate up into the toes which is a strong sign this is the issue. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1613834640616-4YE9PI1AU3Q85CMA9ZT9/Dress%2BShoes.jpg Conditions - Morton’s Neuroma - Why does it happen? This remains a point of some debate; narrowness between the metatarsal bones, excessively tight calves (leading to increased time on the ball of the foot), tight footwear, mechanical issues as the metatarsal-phalangeal joints (toe joints) and pre-existing forefoot deformities like bunions have all been cited as factors that may increase someone's risk of PDN / Morton's Neuroma. Underlying conditions like rheumatoid arthritis (which can cause swelling of bursas like the ones between the toes) could also be a risk factor. In reality it is probably a combination of different factors and may vary from person to person. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211804415-06SADOSZXBZBIY13YFUY/Ultrasoubd%252Bguided%252Bcorticosteroid%252Binjection.jpg Conditions - Morton’s Neuroma - What are the treatment options? From years of seeing forefoot pain, we can tell you the first thing to do is see an experienced Podiatrist (we like to think that's us!) because PDN/Morton's Neuroma is OVERdiagnosed - sometimes in clinic we feel as if everyone with forefoot pain is being labelled as having this when in reality there are many causes of forefoot pain, each with a different treatment protocol - far too often we see patient's misdiagnosed with this and treated inappropriately - see the experts as soon as you can. If we find you do indeed have PDN / Morton's Neuroma (which clinical tests and, if needed, diagnostic ultrasound can help us uncover). We first need to look at the mechanics of how your feet are behaving for clues of overload on these tissue as well as ensuring you are using appropriate shoes - in fact shoes might be the single most important thing to get right. After that we can look at exercise to optimise your biomechanics as it relates to this problem and potentially pads or foot orthoses (specialist insoles) to modify the loads on your forefoot. One of the challenges a lot of patients have found with this elsewhere is the bulk of the devices in their shoes - we have found our in-house custom orthotic system (the only one of it's kind in the Scottish Borders) to have worked really well here as we can design especially low-profile devices that are much better suited to most footwear. We have also found Corticosteroid injections are especially helpful in settling down this condition, both in terms of reducing pain and reducing the size of the offending nerve. In our practice, these can also be done under ultrasound-guidance which increases accuracy and effectiveness. https://www.tweedpodiatry.com/conditions/medial-tibial-stress-syndrome monthly 0.5 2021-03-08 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211855348-MD6NR843B2AL27H9IZYR/375x321_shin_splints_tibial_stress_syndrome_ref_guide.jpg Conditions - Medial Tibial Stress Syndrome - The Highlights MTSS is an overload injury to the middle to lower third of the front-inner part of the tibia (shin bone) that is commonly experience during running and easing with rest. Our team can diagnose this problem through physical examination and will add other factors into the equation including your gait/running pattern and your medical history. Treatment firstly needs to address any underlying problems with your bone health. If these are taken care of, we can look at methods of offloading the area through gait retaining, taping and foot orthoses (specialist insoles). https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211872181-GQ45HWNYVZDOP6JQ2OJL/Shin%2BPain.jpg Conditions - Medial Tibial Stress Syndrome - What is it and what are the symptoms? Medial tibial stress syndrome (MTSS) is a coming overload injury that we primarily see in our sporting patients - runners most of all. It is the more accurate term for what some people mean when they say "shin splints" - a term we avoid in clinic as it's too vague and can mean pain in different places around the shin so isn't helpful. The pain with MTSS is experienced around the middle to lower third of the anterior-medial aspect of the tibia (the front-inner part of your shin essentially). The pain usually comes on with running (or very brisk walking) and, over weeks and months, if symptoms worsen it will tend to come on faster and faster one activity begins. It is often painful enough that a runner will stop activity - at which point the symptoms will generally subside very soon afterwards. Another condition that many (including us) believe is on the same spectrum as MTSS is a tibial stress fracture - the onset and nature of the symptoms can be quite similar but may linger for longer and the site of pain is usually easier to pinpoint - It is VERY important you see the experts (we like to think that's us!) to have this problem investigate thoroughly as it is a challenging condition to treat. More important still - if you are experiencing an extraordinary amount of pain in the front of the shin brought on by exercise or a blow to the shin (such as a bad tackle in football that continues when you are at rest, there is the possibility we are dealing with a condition called compartment syndrome - this is a medical emergency and you should seek medical attention immediately, even if only to have this ruled out. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211898573-4DHI1B1KZXC1U37Q6PI3/image-asset.jpeg Conditions - Medial Tibial Stress Syndrome - Why does it happen? Honestly? No one is 100% sure. One popular theory is mechanical "bending forces" applied to the bone during high impact activity like running lead to stress and pain in the periosteum (the outer lining of the bone). Other ideas include stress from pulling on the bone from adjacent muscles and another is the potential role of connective tissue called fascia. What we DO KNOW is that in running and other sports this injury almost always involves the oldest training error in the book - too much too soon. Looking over the history of the problem there is typically an increase in running mileage or intensity leading up to the problem. As discussed next, there is also the possibility that changes in your bone health status will have put you at increased risk. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211916973-C0XK32MSSN3465SWDUHE/Treadmill.jpg Conditions - Medial Tibial Stress Syndrome - What are the treatment options? Because of the potential for this to be a challenging condition to treat and the risk of it developing into a more serious injury (a stress fracture) our Podiatrists will focus first and foremost on the history of the problem and also discuss your overall health and lifestyle which will include questions about your eating habits, stress, sleep, hormonal status, menstrual cycle (for woman obviously) and family history of bone problems like osteoporosis - the reason being that we need to get a picture of your general bone health. If any flags are raised over this, there may be a need to refer you to other colleagues either for additional investigations or treatments. Rest assured we will guide you through this. Bone health aside, our team may look to address mechanical issues through various strategies like gait retraining, foot orthoses (specialist insoles), taping techniques, strength training and a deep dive into your overall training plan which may include a "return to run" programme or incorporating lower impact activity in like cycling. All with the aim of finding the optimal amount of "stress" that does not cause further injury but instead provides the stimulation to adapt and heal. https://www.tweedpodiatry.com/conditions/corns-and-callus monthly 0.5 2021-03-08 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615211987719-8VE74VQWOB5VI6R0GKZW/corns%2Band%2Bcallus.jpg Conditions - Corns and Callus - The Highlights Corns and callus are two different types of excessive hard skin formation in response to excessive mechanical stress (friction) on the skin cells. Diagnosis is key - our team can quickly and easily identify these problems and explain the factors relevant to you for why they are happening. Our team are experts in treating these conditions through painless scalpel debridement and advising on how to reduce the friction on the skin through good footwear, foot orthoses (specialist insoles) and improving the skin's health through the right urea-based creams. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212006017-NG887AD6W8UBXGR9WA7I/Foot%2BCallus.jpg Conditions - Corns and Callus - What is it and what are the symptoms? Corns and callus are what we call "hyper-keratotic lesions" which simply means a mass of over-accumulated hard keratin material that our skin is largely composed of. They represent the most common skin complaints people see us for by a country mile and although often very painful, they are very easily treated and in most cases, with the right strategies, can either be massively delayed from recurring or cured altogether. Callus represents a layer / sheet of hardened skin which may be over a small area or very wide-spread (such as across the ball of the foot or the heel borders). It may sometimes also form cracks which, at their worst, can split and be very painful. Corns are made of the same material (keratin) but they form a circular / conical shape and can be especially painful as they grow. People often mistakenly think of corns as having a "root". In reality they are better thought of as "growing inward" - as more compacted hard skin form they become deeper and, in the extreme, may lead to ulceration and infection in the underlying skin (as such if you have health problems like diabetes, rheumatoid arthritis or circulation issues, DO NOT avoid getting treatment for corns and callus as these can quickly escalate). Like with callus, corns tend to form at pressure points but may occasionally exist elsewhere due to skin trauma like stepping on a thorn or nail in the past. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1613834640616-4YE9PI1AU3Q85CMA9ZT9/Dress%2BShoes.jpg Conditions - Corns and Callus - Why does it happen? Corns and callus (both made of the same hardened keratin but in different forms) are, in simplistic terms, the skins reaction to too much mechanical stress, shearing stress in particular (pressure + friction). When this happens there is an increase in low-grade inflammatory activity which changes the way cells in the skin called corneocytes develop. And because these cells don't develop normally they essentially develop a "sticky" quality and clump together into what we would see visually as corns and callus. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212031074-SGIX24L2VJLSBIJ6K6AN/Callus%2Bdebridement.jpg Conditions - Corns and Callus - What are the treatment options? Getting the correct diagnosis here is super important - pretty much on a weekly basis we see patients with fungal infections which look like dry skin and mislead them to apply moisturisers which make the problems worse not better! Same problem with mistreating verruca that are actually corns and so on. Many of these conditions, although common, can have subtle features and are often misdiagnosed by patients or even other healthcare providers - see the experts! Once the diagnosis is sorted we can move on to what we do about it: Improving the skins "coefficient of friction" i.e. reducing the shear stress causing the corns or callus and improving moisture levels is very important for normal skin cell development and improvement of these problems. We highly recommend a cream/emollient which contains urea - the reasons being are that urea attracts water molecules to it and also encourages the skin to "help itself" by improving its own moisture-retention abilities and it's ability to defend against multiple forms of bacteria and fungus. 10%-20% urea is suitable as a daily moisturiser for most people but speak to the experts (we like to think that's us!) fist to see what is appropriate for you. Gentle debridement of hard skin with an emery board / foot file can be helpful for maintenance alongside a good cream but for many people this will not be enough. This is where we come in. As Podiatrists, we have extensive experience in what's called sharp debridement - the use of scalpels to skilfully remove corns and callus and get the skin in a much better position to be maintained. We often hear our patients compliment us on how thorough and yet gentle we are during this process which is something we take immense pride in. We can also offer expert advice and treatment on other strategies to decrease the recurrence of corns and callus - this includes the use of specialist padding and/or the creation of bespoke silicon devices for toes, it can also include footwear tips and foot orthoses (specialist insoles) which we can make in-house or via our lab partners to fit specifically to your feet and effectively offload pressure from problem areas in the long-term. https://www.tweedpodiatry.com/conditions/plantar-plate-injury monthly 0.5 2021-03-08 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212090803-V65COGIHJPWJTTEQKZLC/Foot%2Bstep.jpg Conditions - Plantar Plate Injury - The Highlights Plantar plate injuries involve damage to the small ligaments connecting your toes to the ball of the foot, often causing pain and the sensation of walking on a pebble. Our team can diagnose this problem through physical examination and ultrasound. Treatments include footwear advice, taping, foot orthoses (specialist insoles) and exercises to strengthen toe muscles. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212113411-GHA621F0OC4UDBCE47YQ/Plantar%2BPlate%2BSchematic.jpg Conditions - Plantar Plate Injury - What is it and what are the symptoms? Plantar plates are small ligaments on the sole of your foot that connect the ball of your foot to the base of your toes. They play an important role in stabilizing the toes and preventing excessive bending (in turn protecting the joints) as we propel forward. Damage to these ligaments is very common in our clinical experience but extremely under-diagnosed by many other healthcare professionals. Plantar plate injuries will often result in pain on the ball of the foot when weightbearing which feels like walking on a pebble. There may also be swelling over the painful site, sometimes including the whole joint above it (capsulitis). Symptoms tend to progress slowly over time but it is possible (especially in sports people) to have sudden traumatic injury to this structure. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212134076-ZM15G9V9WN0ZJLMEZPOF/Nicola%252BBending%252BBig%252BToe.jpg Conditions - Plantar Plate Injury - Why does it happen? Plantar Plate Injuries are usually overload injuries - in essence, the amount of mechanical load or stress the ligament can take on a daily basis has been exceeded too many times for it to keep up with healing and adapting. This sometimes follows a clear "spike" in load - a sudden increase in walking or running mileage, a change in profession (those on their feet a lot for work are particularly prone to this condition), a change in shoes and weight-gain can all play an important role. Sometimes however the onset has been more gradual. We also know that certain other factors may increase the loads on the plantar plate ligament and increase the likelihood of injuries. These include mechanical factors like limited ankle range of motion and big toe issues like Hallux Limitus (stiff big toes) and Hallux Abductovalgus. Inappropriate footwear is also a really important factor; bendy/flexible shoes are bad news for this problem as are high heels. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212159609-JR7ZGO279C03AIVQZ7YK/Double%2Bplantar%2Bplate%2Btape%2Band%2Bpad.jpg Conditions - Plantar Plate Injury - What are the treatment options? Prior to carrying out any treatment plan, our Podiatrists carry out a medical history taking and physical examination of your feet, ankles and lower limbs as necessary. We may also recommend further examination such as gait analysis or diagnostic ultrasound imaging - both of which are available in-house. We are the first and only Podiatry clinic in the Scottish Borders (NHS or Private) to offer diagnostic ultrasound and for this condition it is particularly useful for determining this is the injured structure versus some common neighbouring problems like capsulitis, osteoarthritis, fat pad contusion and Morton's neuroma. Right diagnosis = faster, better treatment. Plantar plate treatment depends on it's severity; it is a ligament we can see rupture which can only be fixed surgically. However, most patients in pain will visit us well before this point and lower grade damage or even partial tears can be treated very well in our clinic. Reducing the painful upward bend motion of the toe is key to reduce stress on the ligament; we achieve this through footwear advice (stiff-soled shoes are essential), taping techniques, padding and foot orthoses (specialised insoles) which we can design to manipulate the mechanics around the toe. We will also recommend exercises to strengthen the muscles which support the toe and in the very common case of neighbouring tissues also being injured, we will seek to address these too, for example corticosteroid injections for toe joint or nerve complaints. https://www.tweedpodiatry.com/conditions/sinus-tarsi-syndrome monthly 0.5 2021-03-08 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212208169-EO78TGGJYKVGTIB7JJGO/Sinus-Tarsi-syndrome-01.jpg Conditions - Sinus Tarsi Syndrome - The Highlights Sinus Tarsi Syndrome involves excess repetitive compression or a sudden strain to the open in the front-outer space of the rearfoot in a joint called the subtalar joint. In our clinic, we can diagnose this problem easily with physical examination and occasionally with the added use of diagnostic ultrasound. Treatment involves decompressing the joint with supportive footwear, foot orthoses (specialist insoles), taping and reducing excessive pain with steroid injections. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212244293-Q5PL44KAEBW25F7GK06G/Sinus%2BTarsi%2Bpain%2Blocation.jpg Conditions - Sinus Tarsi Syndrome - What is it and what are the symptoms? The Sinus Tarsi is effective a large gap on the anterior-lateral (front-outside) part of your subtalar joint - the gap between your talus and calcaneus (heel bone). Sinus Tarsi Syndrome, put simply, is pain in this gap. It is common in adult patients off all ages and activity levels although we tend to see it at two ends of the spectrum - young athletic individuals and older patient who have a combination of other progressive foot issues like Adult Acquired Flat Foot Deformity (AAFFD). As mentioned, the location of the pain is typically the anterior-lateral (front-outside) part of your subtalar joint - feel for the dip around this location in front of the outer part of your ankle bone - rotating your foot around may help you feel this gap opening and closing. The pain tends to be specific to this location for Sinus Tarsi syndrome BUT as we'll talk more about, it isn't always a condition in isolation so be aware pains elsewhere may still be relevant. It may be a dull aching pain for much of the day (or may be fine for low-grade activity) but during higher activity (running, big walks, jumping etc.) can feel like quite a sharp/stabbing pain. It will tend to worsen as the day goes on but ease reliably with rest. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212271209-9PUG69IOSX0MITENE35K/Adult_Flatfoot.JPG Conditions - Sinus Tarsi Syndrome - Why does it happen? This gap we're calling the Sinus Tarsi is heavily populated with nerves and blood vessels which lends itself to being a sensitive spot of our foot's anatomy. Combine this with high compression forces as your foot pronates (rolls inward) and we have the ability to set off symptoms (as a side note - the amount of visual movement we see as your foot pronates is not the issue as many people still think - it's about the internal forces on the joint - we can't see this with the naked eye by tests in clinic can help us take a reasonable guess). In our more athletic patients we can see this condition in isolation but in older individuals it's far more likely it's co-existing with other issues to do with how the rearfoot copes with the loads placed on it. We have links to some of these conditions we've spoken about already including: tibialis posterior tendon dysfunction, plantar fasciopathy and AAFFD. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212286417-Z8HR4MM7KMIZPPBWGREG/3D%2Bprinted%2Bcustom%2Bfoot%2Borthoses.jpg Conditions - Sinus Tarsi Syndrome - What are the treatment options? After assessing your foot, ankle and lower limb biomechanics, our Podiatrists are likely to have a good idea of what predisposing factors are placing painful amounts of load on your sinus tarsi and how to address this. Footwear is important here and sturdy walking shoes or, better yet, boots are a great place to start. Foot orthoses (specialist insoles) selected carefully by our team can be extremely helpful in "decompressing" the sinus tarsi and will often give long-term relief, potentially combined with taping in the short term for an added boost in effectiveness. This will virtually always be given alongside an exercise programme to encourage the muscles that protect the joint to work at their fullest potential. We will also often advocate the use of corticosteroid injections for this issue if symptoms are especially painful or not improving enough with other measures. These are very straightforward procedure performed in clinic in a matter of minutes which can massively facilitate long-term improvement when used in conjunction with the other treatments mentioned. If there are particularly high levels of swelling and pain that don't signicantly reduce with rest, we will tend to offer diagnostic ultrasound to visualise the sinus tarsi, the rest of the subtalar joint and adjacent structures because this is a joint we often see large joint effusions and synovitis (swelling and inflammation) which could indicate an inflammatory joint disorder. If this is suspected, we will liaise with your GP to arrange appropriate further tests. https://www.tweedpodiatry.com/conditions/diabetes monthly 0.5 2021-03-09 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212352522-L1CBCTBJK014GQ60KHHU/Finger%2Bprick.png Conditions - Diabetes and the Foot - The Highlights Diabetes is a metabolic disorder characterised by chronically elevated blood sugar levels (hyperglycaemia) resulting in a complex series of problems in multiple body systems (as this rather long article would suggest!) including peripheral nerves and blood vessels - hence it's seriousness for foot health. Type 2 Diabetes (which accounts for around 90% of cases in the UK) is a preventable condition primarily due to diet and lifestyle factors although some individuals (due to genetic factors) may be at greater risk of developing it. As Podiatrists, we play a pivotal role in helping people with diabetes to monitor and manage their foot health through regular diabetic foot assessments. In our clinic, we pride ourselves in taking these assessments to a much higher standard and routinely have patients tell us it is the most comprehensive look at their foot health they have ever had. Beyond our high standards of assessment, we help people with diabetes with treatment of the complications that can arise including skin and nail problems or more serious issues like foot ulcers and advise on strategies that ensure your feet are in good hands. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212376947-RHVFT7S9Q2TD0LI0VNG7/DM%2BSymptoms.jpg Conditions - Diabetes and the Foot - What is it and what are the symptoms? Diabetes Mellitus (often just shortened to Diabetes) is a chronic metabolic disorder that involves excessively high blood sugar levels (hyperglycaemia). The condition can be broadly divided into: Type 1 diabetes - where the body's own immune systems destroys the cells that produce insulin (the key hormone that tells cells to absorb sugar from the blood). Type 2 diabetes - where, through damage, the cells that produce insulin aren't functioning properly and the body's cells won't respond properly to insulin (insulin resistance) Gestational diabetes - where pregnant women experience heightened levels of blood sugar and cannot produce enough insulin to remove it. In the UK, about 90% of people with diabetes have type 2. In each form of diabetes, if poorly controlled, can affect many systems throughout the body but is particularly important for foot health as it can affect the small blood vessels and nerves, leading to poor circulation in the feet (peripheral vascular disease) and loss of sensation (diabetic neuropathy). Diabetic Neuropathy does not generally occur in the early stages of diabetes but can develop in time if blood sugar control is not achieved; symptoms are wide and varied by may include sensory changes such as numbness and tingling or indeed increased sensitivity and discomfort. Skin issues like dryness can also occur due to the nerves' role in controlling skin moisture. Blood vessel changes can involve calcification (hardening) of arteries which disrupts normal blood flow; patients may experience difficult healing and coping with infections. In more severe cases, it is possible to develop tissue breakdown known as diabetic foot ulcers - these CANNOT go without medical care as the consequences can be limb- or even life-threatening. Patients with diabetes who have ANY concern over their foot health should consult their Podiatrist, GP or other appropriately qualified health professional as soon as possible. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212407039-EIDHC1T97QZ7ELJUQUTM/unsplash-image-6SMF42-JTAc.jpg Conditions - Diabetes and the Foot - Why does it happen? The full roadmap of all that goes on in Diabetes is incredibly intricate and complex but here is a basic outline: Type 1 diabetes is an autoimmune condition where the body's immune cells essentially misinterpreted the beta cells in our pancreas (the ones that make insulin) as foreign entities and attack them, rendering our ability to make our own insulin destroyed. This usually begins in teenagers and younger adults. Genetic factors are thought to be involved but we still don't know a lot about exactly why this happens in the first place. In Type 2 diabetes, too much sugar or foods that breakdown into sugar (fructose sugar probably being the worst) cause our beta cells to work overtime and start to break down, leading to decreased insulin production. Insulin is a signalling hormone that tells the cells throughout our body to "open the gates" to sugar in our blood, taking it on board and using it for energy. Bombarded with too much insulin, cells stop listening to these signals and become "insulin resistant". So the double whammy effect is a low level of insulin and cells that wont listen to it in the first place so these cells soon have too little energy to allow them to work properly. Blood sugars continue to rise further and the cycle gets worse. Moreover, the volume of sugar in the blood causes direct damage to blood vessels. These fundamental issues in our body's metabolism go a long way to explaining why diabetes is so globally damaging to our bodies. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212427392-PPLRICYS4Q7WN9IYNBF2/Me%2Bdoing%2Ba%2BDoppler.jpg Conditions - Diabetes and the Foot - What are the treatment options? Gestational diabetes usually resolves on it's own after childbirth. Type 1 diabetes has no known cure although a lot can be done to improve the severity of the condition. Type 2 diabetes is somewhere in between - if dealt with early in the process, before more significant damage is done, it is possible to get one's blood sugar levels back into healthy range consistently and to the point that you may be classed as being in remission. The label however, especially here in the UK, is not often removed once its on. Diet and lifestyle factors are key at every stage of the diabetes journey (and we would always encourage you ask for support around this if unsure). Beyond lifestyle and diet factors, some patients may also require medication. In the case of people with type 1 diabetes, this is a given as they require insulin injections to function effectively. Most people with type 2 diabetes (unless very severe) will not require insulin but may be on other medications that make their cells more sensitive to the insulin they have or encourage the body to secrete some of their glucose through their urine. As Podiatrists, we play a pivotal role in helping people with diabetes to monitor and manage their foot health through regular diabetic foot assessments which every person with diabetes should have at least once a year. We pride ourselves in offering a level of assessment well above the standard approach taken; diabetic foot checks will often include the practitioner checking pulses with their fingers - we feel this is isn't sufficient as pulses are not always palpable and it is completely unknown if the pulse is actually a healthy one. All patients receiving a diabetic foot assessment with us are given a Doppler ultrasound examination - this is a simple handheld device that uses ultrasound waves to listen to the flow of blood in the arteries - it provides much more useful information about the overall health of the artery and can help us determine if further investigation is needed, either by us or a referral to another department. We also have the ability to carry out more in-depth circulation tests including the ankle-brachial pressure index - which is even more sensitive to potential issues. We also take our neurological assessment further; as well as the Semmes-Monofilament tests (the little plastic rod your feet are poked with to check you have feeling) we can look at precise temperature levels at different points in your feet (because discrepancies here can be an early indicator of nerve damage) and use a digital skin moisture detector to know if you're skin is excessively dry or moist (this is in part also down to your autonomic nerves and whether they are working effectively). https://www.tweedpodiatry.com/conditions/sesamoiditis monthly 0.5 2021-03-08 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212491094-89NAMDSQ4OEN8MTNVEBM/2021-01-26%2B20_10_15-Sesamoiditis%2Bimage.jpg%2B_-%2BPhotos.png Conditions - Sesamoiditis - The Highlights Sesamoiditis involves irritation (and pain) around the small sesamoid bones and the tendon they sit in under the 1st toe / ball of foot area. Diagnosis is made through physical examination and sometimes diagnostic ultrasound. Treatment involves offloading the area with foot orthoses (specialist insoles), footwear advice and occasionally the use corticosteroid injection therapy. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212520985-AMNKJP0FRH95JP17UKJL/2021-02-05%2B18_35_17-Complete%2BAnatomy.png Conditions - Sesamoiditis - What is it and what are the symptoms? Sesamoid bones exist in the body to act like a pulley that give tendons a mechanical advantage for moving joints. The patella (knee cap) is the largest and best known sesamoid bone in the human body but in this case we are discussing the 2 much smaller sesamoid bones we have under the ball of each of our big toes. Pub quiz question you can debate - often the foot is said to have 26 bones each; it's actually 28 if you count the sesamoids and, in our opinion, they should definitely count! In sesamoiditis, irritation occurs around these bones and the tendon (flexor hallucis brevis) which they sit in, often resulting in an acute pain which we commonly see in dancers, runners and those doing sports with cutting actions like football or tennis. There is generally a focus of pain under the ball/pad of the big toe (the sesamoids sit under your 1st metatarsal head). Occasionally in acute injury there may be swelling at the site too. Pain can be dull or sharp and is usually brought on by direct pressure to the area and bending of the big toe which will worsen with increased activity and reliably ease with rest. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212538254-GW418TJXKAEG4U0X1G8V/unsplash-image-TPC-Tx8dcNE.jpg Conditions - Sesamoiditis - Why does it happen? Increases stress on the sesamoid and flexor hallucis brevis tendon will predispose you to this issues. Foot function and structure may be important: high arches may increase forefoot pressures and as can a stiff 1st ray (the bones making up the front portion of the medial/inner arch of your foot) which your Podiatrist can assess. Footwear like high heels and shoes with very little forefoot cushioning may also be an issue. There may even be risk factors to do with the development of your sesamoid bones which vary a lot from person to person; this can influence their size, position or even occasionally a total absence of one of them during childhood development. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212553259-H2OJAET9YL6BINUFEVGM/A%2Brow%2Bof%2Bcustom%2Bfoot%2Borthoses.jpg Conditions - Sesamoiditis - What are the treatment options? Imaging can be useful in the first instance to ensure we are dealing with a sesamoiditis. We employ diagnostic ultrasound in-house to aid this and also assess factors mentioned above like the size, position and normal development of these bones. In cases where we are suspicious of more serious issues like a sesamoid fracture we will refer you for other imaging, most likely X-rays. Treatment then becomes about significantly offloading the forces underneath the sesamoids. In our experience, especially in people with high arches, this is a condition that is challenging to improve without the use of foot orthoses (specialist insoles) that we can design in clinic to achieve adequate offloading. Custom foot orthoses which we can make in-house or through our lab partner are particularly good at achieving this. We will also counsel on appropriate footwear to use in conjunction with these - the main takeaway here being shoes that do not have a large heel, do no bend very much in the forefoot and ideally have reasonable forefoot cushioning. In cases of sesamoiditis that are particularly painful or not improving with other treatments, we can offer corticosteroid injection therapy - this is a very straightforward injection which we perform after first administering a local anaesthetic so there is minimal pain involved. https://www.tweedpodiatry.com/conditions/patellofemoral-pain monthly 0.5 2021-03-09 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212630399-XMSM9GRB5AOE1AQSCG6M/pfp%2Bimage.jpg Conditions - Patellofemoral Pain - The Highlights Patellofemoral Pain (PFP) is pain at, around and behind the knee cap, usually brought on during activity, using stairs or long periods of sitting. It is sometimes called patellofemoral pain syndrome or anterior knee pain. Our team can provide expert assistance in diagnosing this condition and ruling out other problems (such as patella tendinopathy) as well as analyse your biomechanics to look for potential areas to be addressed. Treatment at different stages may include taping, foot orthoses (specialist insoles), gait retraining and progressive loading exercises. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212644248-LGXGHMGHUAS4SZ535Z9S/Knee%2BPain%2BGuy.jpg Conditions - Patellofemoral Pain - What is it and what are the symptoms? PFP describes pain at, around and behind the patella (knee cap). Exactly "what" it is remains up for debate in the research - the exact tissues responsible for pain are not clear but what we do have is sound evidence of what seems to help people reliably get better. Alongside the location of pain around the patella, the progression of pain (it usually starts subtly and builds over time) and the things that bring on the pain can be a useful clue you have PFP - squats, lunges, jumping, running, climbing stairs and prolonged periods of sitting can all be provocative. There may also be associate swelling (usually mild) and crepitus (a creaking sensation around the patella). https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212663346-0ZZITSF08FBO8CE8QBV4/unsplash-image-RtUK6jT5y_A.jpg Conditions - Patellofemoral Pain - Why does it happen? PFP, as we've already mentioned, is not fully understood but is at least understood to have an overloading component - in essence, the amount of mechanical load or stress the structures around the anterior knee can take on a daily basis has been exceeded too many times for it to keep up with healing and adapting. This often follows a clear "spike" in load - a sudden increase in walking or running mileage, a change in profession (those on their feet a lot for work are particularly prone to this condition), a change in shoes, weight-gain as well as emotional and psychological stresses can all play an important role. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212677979-M6XVUNJCGJWEPVEIPR8F/unsplash-image-hOuJYX2K5DA.jpg Conditions - Patellofemoral Pain - What are the treatment options? Prior to carrying out any treatment plan, our Podiatrists carry out a medical history taking and physical examination of your feet, ankles and lower limbs as necessary. We may also recommend further examination such as gait analysis which is available in-house. Diagnostic imaging is rarely required unless symptoms are not improving. PFP is considered a diagnosis of exclusion meaning our Podiatrists will diagnose it by first ruling out other knee pain conditions like actual knee joint pain, patella tendinopathy and iliotibial band syndrome. Once diagnosis is confirmed, we can look at different ways to offload the injured tissues and tailor a progressive exercise programme to your requirements. Strengthening of both knee, and hip related muscles is a very well established part of treatment and, if done correctly, gives the injured tissues the right amount of exposure to stress in order to adapt and heal. We may also look at gait retraining to change your movement patterns for a period of time so you can work around the problem which gradually being exposed to increased load. To aid in your rehab programme, we may also look to employ other techniques: both taping and foot orthoses (specialised insoles) have been demonstrated to relieve symptoms very well in the short term for most patients and foot orthoses may continue to be useful in a subset of patients over a longer period. https://www.tweedpodiatry.com/conditions/lateral-ankle-instability monthly 0.5 2021-03-08 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212734133-X0DQC47G69KYYXJ2QOI1/lateral%2Bankle%2Bsprain.jpg Conditions - Lateral Ankle Instability - The Highlights Lateral ankle instability involves a repeat history of going over on the outside of the ankle or feeling as if this is regularly going to happen. Our team can assess all the mechanical factors causing the problem in your case and look a the structures involved, both physically and with the use of diagnostic ultrasound. Treatment involves building strength and balance back into the foot, ankle and lower limb and looking at ways to support them through taping and foot orthoses (specialist insoles). https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212762241-W07R2DY1UX9QM4838BHA/unsplash-image-_r19nfvS3wY.jpg Conditions - Lateral Ankle Instability - What is it and what are the symptoms? Lateral ankle instability is characterised by persistent and recurring problems "going over" on the ankle or having the feeling this is going to happen. It usually follows a history of a painful ankle sprain but other factors can be at play which we'll get to. Hikers, trail runners, football players and rugby players often visit our practice for this problem. In fact, ankle sprains are widely thought to be the most common sporting injury full stop. But that's not to say it can't happen to people of any level of activity or age. Patients with lateral ankle instability, as we've already mentioned and name gives away, have a repeat history of either "going over" the ankle (an inward and downward turn of the foot) or have a persistent feeling of instability, especially on uneven ground. Depending on the cause and the tissues affected, patients may often report having poorer balance on the affected side as well as pain around the lateral (outer) part of the ankle. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212779739-JVOU4VRXALPIDEOPI9Q0/Runner%2Bankle%2Bpain.jpg Conditions - Lateral Ankle Instability - Why does it happen? Most lateral ankle instability can be thought of as "mechanical" - following from an ankle inversion injury or "sprain" involving a high-force, high-speed inward turning of the foot on the ankle, resulting in varying degrees of damage to the structures that support the ankle. The number one predictor of an ankle inversion injury is drum roll a previous ankle inversion injury. Because the stabilising structures like ligaments will tend to heal in an elongated shape and provide less robustness going forward. Part of the challenge of lateral ankle instability is that when we talk about the ankle complex, we can really be talking about three joints; the talocrural joint (the one we'd all recognise as the ankle joint), the subtalar joint (which sits below it) and the tibiofibular syndesmosis (which sits above it)...couple this with all the ligaments, fascia, tendons and nerves related to them and it starts to get complicated very quickly doesn't it!? This is why we always recommend seeing a Podiatrist with an excellent knowledge of anatomy (we like to think that's us!) to help you get to the bottom of things. It's also important to recognise the idea of a "functional" lateral ankle instability; this is relates to predisposing factors such medical conditions involved in proprioception (balance) like Parkinson's or Diabetic Neuropathy, or conditions that affect ligament laxity like Ehlers-Danlos Syndrome. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212797895-0HVZXD7L0LXO2TMY5T0J/sidas%2Bfitting.jpg Conditions - Lateral Ankle Instability - What are the treatment options? The first step is to rule out more serious injuries like fractures which would likely require orthopaedic involvement. There are well-validated clinical tests our team can carry out which can give us a very good indication of whether it is appropriate to send you for an X-ray to rule out fractures. If these tests don't suggest this, we will often still recommend our in-house diagnostic ultrasound service; this can still be useful in evaluating bone injuries but has the other advantage of being able to assess the ankle's soft tissue structures (to check for ligament damage for example) which can be helpful to guide the next steps of your rehab or decide if surgical referral is appropriate. We have a lot of experience in helping people to rehabilitate from ankle injuries and the programme put in place will be highly individualised to your abilities, activity goals and of course the degree of injury. In all case though there are likely to be elements of strength training, proprioceptive (balance) training and a progressive move towards more dynamic activities (hurdle jumping and cutting drills for example). There are also lots of options in terms of taping techniques and foot orthoses (specialist insoles) or braces to go alongside appropriate footwear advice which can all provide both support and symptom relief. In most cases these are only needed in the short- to medium-term but some people with underlying medical conditions as described above may need these as a more permanent tool to aid mobility. https://www.tweedpodiatry.com/conditions/fungal-toenails monthly 0.5 2021-03-08 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212849153-XAJZV6W4C5C7IFE17B8Y/FungusToe.jpg Conditions - Fungal Toenails - The Highlights Fungal toenails are exceptionally common and are actually usually an infection of the nail bed rather than the nail itself resulting in discolouration, thickening and breakdown. The diagnosis is usually made clinically or occasionally requires lab tests to confirm. Treatment depends on the severity of infection and may include nail debridement (by our Podiatrists), topical anti-fungal treatment or referral for oral antifungal medication. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212868359-P31O1EGBALRB8EIMNJDG/Fungal%2BToenail.jpg Conditions - Fungal Toenails - What is it and what are the symptoms? Fungal toenail infections (also called onychomycosis or tinea unguium) are a very common nail problem we see almost daily in clinic. It is exactly as it sounds - the nail (and the underlying nail bed) have been infected with a fungal infection that feeds of the keratin they are made of, leading to an unsightly damaged nail and potential secondary complications like skin infection or other painful nail changes like thickening. There are a number of different appearances fungal nail infections can take depending on the type of fungus involved. Changes in colour (white/yellow/brown are all common) and quality (thickening/breaking down) and separation from the underlying nail bed are all common features. Fungal nail infections on of themselves should not be painful but the resultant changes to the nail like thickening make cause increase pressure on the nail bed which can hurt. It may also spread to the surround skin (or have come from there in the first place) so checking for signs of Athletes Foot is also a good idea. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212885360-WA9QU825SS7FLH3HM6JA/unsplash-image-FDPDDlT3V7U.jpg Conditions - Fungal Toenails - Why does it happen? Fungal spores are all over our environments and that's not exactly the problem - the problem is when they grab the opportunity to grow out of control. A split in the skin or a crack in a nail for example can be all it takes for them to take advantage and, combined with a warm moist environment you have the perfect growing medium. This can happen to anyone and we always stress this to patients because many are unduly ashamed about fungal toenails - trust us, we see it all the time and there’s nothing to be embarrassed about so don’t let that put you off seeing us! https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615212901057-BG2S5V5ZNOFD8LNSJT9V/unsplash-image-t7sosxqMEFA.jpg Conditions - Fungal Toenails - What are the treatment options? First things first - see a Podiatrist and get the right diagnosis! Fungal infections are often missed and at the same time, they may be falsely diagnosed when simple nail trauma is to blame. Some infections are obvious and can we can plan treatment accordingly. Others are more subtle and may require nail and skin samples to be tested before we can make a definitive diagnosis. If fungal infection is confirmed, the treatment then becomes about the extent of the infection. Fungus that’s isolated to the distal (far) edge of the nail and over the surface are generally well managed with topical liquid antifungal drugs. For some more deeply infected nails we may offer a treatment called the Lacuna Method which involves painlessly drilling small holes into the nail to create an entry point for antifungal drug. In nails with complete infection, which is unfortunately quite common, we can either offer nail surgery where we painlessly remove the offending nail under local anaesthetic or refer to your GP for oral antifungal medication. https://www.tweedpodiatry.com/conditions/athletes-foot monthly 0.5 2021-03-07 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1614259073799-XS9Y79FL9X6P4JDWW8TN/Athlete%27s+Foot.jpg Conditions - Athlete’s Foot - The Highlights Athlete's Foot (Tinea Pedis) is a super common fungal skin infection caused by an over-population of the fungal spores that usually live in low concentrations on our skin. Diagnosis is key! We've seen literally hundreds of people mistake this problem for dry skin and treat in the exact opposite way they should - see the professionals! Treatment is fast and effective in most cases: topical antifungal agents plus treatment to socks and shoes (which should be changed regularly) should help. When this is not so, oral antifungal medication can also help. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615141523549-2DOYIQ4IBB1HH7PWNFU6/Athlete%2527s%2BFoot%2B-%2BThe%2BReturm.jpg Conditions - Athlete’s Foot - What is it and what are the symptoms? Athlete's Foot is the common term usually used to describe Tinea Pedis - an extremely common fungal infection of the foot. It is a type of fungus called a dermatophyte, of which about 95% of skin fungal infections are. These dermatophytes colonise the skin and use it as their fuel source. So common are these infections, it is unusual for us to go a full day in clinic without seeing one. Tinea Pedis can, in principle, appear anywhere on the foot but is generally on the sole of the foot or between the toes. These areas are usually have more moisture (which fungus loves) and are rich in keratin (which they feed off). The results are often broken/irregular/flaking areas of skin which can be slightly red and occasionally itchy. Although the infection usually starts in one spot, if left unmanaged, it can spread across much of the feet. Sometimes it can be difficult to distinguish fungal infections from simple dry skin which is why diagnosis from a Podiatrist can be so important as we'll get to. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615141684124-P1KZ8T8O0A4L2EWMEPH6/ID+maceration.jpg Conditions - Athlete’s Foot - Why does it happen? Fungal spores are all over our environments and that's not exactly the problem - the problem is when they grab the opportunity to grow out of control. A split in the skin between the toes for example can be all it takes for them to take advantage and, combined with a warm moist environment you have the perfect growing medium. This can happen to anyone and we always stress this to patients because many are unduly ashamed about athlete’s foot - trust us, we see it all the time and there’s nothing to be embarrassed about so don’t let that put you off seeing us! https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615141601176-F4O5LRPLWOVSEWBYUVI9/unsplash-image-FDPDDlT3V7U.jpg Conditions - Athlete’s Foot - What are the treatment options? Treatment of foot fungal infections boils down to two things: a) getting an appropriate anti-fungal drug to the source of the infection and b) creating an environment that fungal infections struggle to grow in. Let's deal with these back-to-front. Creating the right environment means keeping the feet dry; change your socks daily (or more if particularly prone to sweating), try not to wear the same pair of shoes two days in a row and ensure they dry out properly between uses. There are also antifungal sprays that you can fire into all your footwear, socks and indeed on your feet to cover all the places the fungus might be hiding. It is also important therefore to stop the use of moisturising creams on your feet as these will only help the fungus the grow (we see a huge number of patients who mistake their fungal infection for dry skin and end up feeding the infection - sometimes for years. So make sure you get the right diagnosis from an expert). For anti-fungal drugs (we're talking topical agents you apply directly to the skin), the first thing to know is many products you can buy over the counter are indeed proven to be effective against fungus BUT some are better than others (depending on the type of infection) and the method of application matters. Fortunately, getting the desired application on the skin is a lot easier than dealing with a fungal toenail (see our page on that here). Our Podiatry team can recommend appropriate antifungal agents (many of which are available at our clinic) or, in severe cases that also involve nail infection, we may advise oral medication which can be arranged via your GP practice. https://www.tweedpodiatry.com/conditions/bunions-and-hallux-valgus monthly 0.5 2022-08-30 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1612024247799-J6GKXVPZN9B6EKMJXUMK/bunion_1280.jpg Conditions - Bunions and Hallux Valgus - The Highlights Hallux Abducto-Valgus (HAV) or Hallux Valgus is a largely hereditary deformity leading to an outward positioning of the 1st metatarsal and an inward positioning of the big toe. A bunion (which is a separate issue) is the protrusion/bump on the side of the toe that commonly exists alongside HAV. These conditions may or may not be painful and may involve secondary arthritis and deformities to other toes. These secondary problems are more often the reason people seek our help. No conservative treatments can permanently reposition the toe (only surgery can) but many treatments can make it more comfortable including footwear advice, mobilisation techniques and, if arthritis is also present, the use of foot orthoses (specialist insoles) and steroid injections. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615109013392-F1550JTU1IMJNOOLDSW7/RA+foot.jfif Conditions - Bunions and Hallux Valgus - What is it and what are the symptoms? The terms "bunion" and "hallux abducto-valgus" (HAV) are often used interchangeably, even by healthcare professionals, but they are in fact two different but connected things: Hallux valgus describes the positional deformity of the 1st metatarsal bone relative to the bones on either end of it; the medial cuneiform behind and the proximal phalanx in front (1st bone in your big toe) whereby the metatarsal drifts outward from the others and the toe drifts inward toward the others. A "bunion" describes the outward "bump" made of bone and sometimes bursa that develops on the medial side of the big toe joint because of this deformity. For bunions, the pain is located specifically over the medial bump, usually brought on my pressure from narrow shoes (and relieved of course when they come of). There may be associated redness and swelling which worsens throughout the day. For HAV, any pain involved is likely due to the uneven forces applied to the big toe joint leading to secondary arthritis. This pain will tend to be more over the top of the toe joint and hurts when the toe is bent upward or downward. It is important to note that symptoms don't always match the severity of the deformity; some with mild changes have extraordinary pain whilst some, even with severe HAV and bunion deformities, report no pain. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615142574460-ASA37MTS0L4EKDXPBI97/Family+tree.jpg Conditions - Bunions and Hallux Valgus - Why does it happen? Research now tells us that HAV and the bunions that may co-exist with it are highly hereditary - you can blame the family tree and your parents or grandparents for passing on their genes and not so much those bad shoes! Some footwear and biomechanical factors around how your feet function could in theory speed the progression of HAV and bunions but does not appear to cause them in the first place. Sorry folks - it's just luck of the draw! https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615142670979-R0A6UXQEE7YLXJ7ROW7M/Bunion%2BOp.jpg Conditions - Bunions and Hallux Valgus - What are the treatment options? Conservative treatment of bunions and HAV centres around symptom relief - there is no good evidence that conservative (non-surgical) treatments like splints, braces and insoles can correct a bunion. Yes these things might help with pain relief but they won’t “correct” anything. Regarding bunions, reducing pressure over the area is important and footwear is key to this. Finding well-fitting shoes is a frequent complaint of many patients and we can offer our experience in finding solutions. We can also provide offloading pads and devices to assist with this further. In the rather common situation where osteoarthritis is in fact the cause of pain and not the bunion itself (which is why it's important to see an expert to find out), there are perhaps better conservative options we can give you such as foot orthoses (specialist insoles) and corticosteroid injections. The other common issues to address include pathology affecting the other toes (most often the 2nd). As the 1st toe isn't "behaving itself" there tends to be knock-on effects on the lesser toes. Indeed, people with often visit our clinic specifically about this and have no concern over the HAV / bunion whatsoever. In many cases, this is a good example of a problem where we will happily refer you to one of our orthopaedic colleagues, either in the NHS of Private Practice, to seek a surgical opinion. HAV and bunion surgery have excellent success rates with many options available depending on your needs. https://www.tweedpodiatry.com/conditions/rheumatoid-arthritis monthly 0.5 2021-03-08 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615213224851-KHWSW368CLAMA22E86YG/rheumatoid%2Barthritis%2Bin%2Bfeet.jpg Conditions - Rheumatoid Arthritis - The Highlights Rheumatoid Arthritis (RA) is an auto-immune condition causing chronic inflammation throughout the body but most well known for affecting the small joints of the feet and hands. Our advanced practice offers in-house diagnostic ultrasound which can support you in getting to a diagnosis (and therefore treatment) of RA much sooner. In both newly diagnosed and long-standing cases of RA, we can help you manage symptoms through various treatments including footwear advice, foot orthoses (specialist insoles), management of skin problems due to foot deformity and steroid injections during joint flare-ups. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615213236416-072GKXJIHDWWX8PYGJOQ/Inflamed%2Bjoint.jpg Conditions - Rheumatoid Arthritis - What is it and what are the symptoms? RA is a long-term (chronic) autoimmune condition that causes inflammation in multiple connective tissues throughout the body - the most common being joints and of these, the most common being hands, wrists and feet although joint, in principle, can be affected. Because RA can affect multiple systems in the body, there is a long list of potential symptoms and these will also be influence by how long you have had the condition, the medications you are on for it and it's severity which is influenced in part by what subtype of the condition you have - the two broad categories being "sero-negative" and "sero-positive" - the latter usually being the more challenging to manage. Joint pain, swelling and stiffness (especially in the mornings) are common and, as mentioned, tend to affect the smaller joints of the hands and feet first. The metatarsal phalangeal joints and inter-phalangeal joint (the toe joints) are most commonly affected in the foot and pain across the ball of the foot is a common as a result. These symptoms are also usually symmetrical (both hands / both feet will often be problematic at similar times). Soft tissues like tendons and bursa (fluid filled sacs located around the body) can also be inflamed and painful. In time, without good drug-management, these symptoms may worsen leading larger, misaligned joints, nodules in the skin and thickening of tendons. RA is also a condition that goes through "flares" - you can have periods of feeling quite well for months on end and then quite suddenly experience a severe spike in symptoms, not always with an obvious trigger. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615213258318-1UR6LQSXL7N8F8T2W7CF/RA%2Bjoint%2Bdiagram.jpg Conditions - Rheumatoid Arthritis - Why does it happen? People with certain genes (HLA-DR1 and HLA-DR4) are more susceptible developing RA A family history also greatly increases your odds of developing this condition. Environmental factors are also known to play a role - smoking is a well-documented trigger for rheumatoid arthritis and certain infections may also initiate RA. There is a long and complex cascade of cellular processes that trigger and develop the disease processes of RA but the extremely shortened version is this: certain proteins in connective tissues like collagen and swapped around, these are misunderstood by immune cells as being foreign. These immune cells then essentially "sound the alarm" to other immune cells in the body which flood the joint with inflammatory substances can force the synovial membrane which lines the joint to swell and thicken as well as releasing it's own substances which join in to degrade cartilage, neighbouring soft tissues and eventually bone. Similar such viscous cycles can occur in other body systems like blood vessels (causing vasculitis), skin (forming rheumatoid nodules), muscle (causing protein breakdown) and even the brain (causing rheumatic fever). https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615213276411-WUEMJQ1RNLU95VBM05XL/CSI%2Bplus%2BSIDAS%2Bplus%2BSCALPEL.jpg Conditions - Rheumatoid Arthritis - What are the treatment options? We are incredibly fortunate in the UK that patients with RA will usually have good access to their local rheumatology department including rheumatology consultants, nurses and potentially physiotherapy and podiatry input. We are also incredibly fortunate to have all manner of advances in medication to treat RA and keep the condition under good control and this is usually started early the disease process. As such, in Podiatry clinics we now see fewer and fewer patients with the more advances foot complications associated with RA like significant joint deformities and nodules. As the Scottish Borders' only Podiatry clinic to offer in-house diagnostic ultrasound, we see a big part of our role here as helping to monitor patients with known RA and, on occasion, we are also the first to pick up this condition and can help lead to a faster referral to rheumatology and ultimately faster therapy. Ultrasound is very helpful here as it is able to detect synovitis (increased blood flow within joints) as well as increased blood flow in soft tissues which can be a useful early indicators (much earlier than X-rays) for inflammatory conditions like RA. We have also seen plenty examples of patients diagnosed with a mechanical joint or tendon problem elsewhere only for our ultrasound investigations to discover they instead were experiencing an inflammatory condition. When foot complications do occur, we can play an important role in improving foot function and comfort; we can provide routine management of corn and calluses that may develop at high-pressure area. Footwear advice is often important and custom-made foot orthoses (specialist insoles) can be very helpful in offloading high-pressure areas as well. During acute "flares" in symptoms, we can also offer corticosteroid injections which are a highly effective treatment for RA and are considered a good strategy to halt an inflammatory flare before it inflicts joint/tendon/bursa damage that cannot be undone. Combined with our clinic's ability to recognise joint flares on ultrasound, our success rates with these injections are very high. https://www.tweedpodiatry.com/conditions/gout monthly 0.5 2024-03-30 https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615213524694-7JRPDZLTDE4MCEGBVYYW/gout.png Conditions - Gout - The Highlights Gout is an incredibly painful inflammatory joint condition (most commonly affecting the big toe joint) where the body launches an inflammatory response to an excess accumulation of substances called uric acid crystals, either because of dietary intake of their precursors (purines) or an inability to sufficiently filter and excrete uric acid from the body. Diagnosis can be made by a combination of medical history, physical examination, diagnostic ultrasound (available in our practice), blood tests and examination of joint fluid under a microscope. Treatment is primarily about medication to manage inflammation and then lower uric acid levels for long-term management. Our practice can also help by protecting the joint through footwear advice, foot orthoses (specialist insoles) and targeted management of joint inflammation with corticosteroid injection therapy. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615213547467-LYJCP5NHE6M42VUJTAHT/osteoarthritis%2Bbig%2Btoe.jpg Conditions - Gout - What is it and what are the symptoms? Gout is an exceptionally painful inflammatory mono-arthritic (single joint) disease caused by the body's response to high levels of a substance called uric acid. If left untreated, it can lead to frequent joint flares and associate high levels of damage to the affected joint. As the big toe is the most commonly affected joint in the body, we see the results of this disease regularly and can play an important part in managing it. An acute gout attack comes on suddenly and can last for around a week. It usually only affects one joint at a time (it may also affect soft tissues like tendons). The single most common site for a gout attack is the 1st metatarsal phalangeal joint (the big toe joint). The symptoms of gout are a red, swollen joint and pain...a lot of pain! So much so that people often struggle to sleep and even light pressure can be unbearable (if it's "just a little sore" - you probably don't have gout). The knock-on effect of multiple gout attacks is fairly significant joint damage and the formation of "tophi" which are large whitish masses that can protrude from the joint often leading to a permanently enlarged, stiff joint and secondary osteoarthritis which may itself need addressing. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615213568644-TWSVX9GJAO6YMG34W2O9/unsplash-image-hK9hIPgF3QU.jpg Conditions - Gout - Why does it happen? Compounds called purines are the start of the story - they exist in our own body tissues and also in many of the things we consume - especially for diets high in meat, seafood, alcohol or fructose-containing sweets and drinks (I know, all the good stuff). Purines are broken into uric acid which is filtered through our kidneys and excreted in our urine...however...if we take in too many purines (leading to too much uric acid) and/or if we have a problem processing them because of kidney problems, as well as other risk factors like being male, certain blood pressure drugs like diuretics and genetic factors, we will end up with high concentrations of uric acid in our blood (hyperuricaemia). This uric acid has to go somewhere and that somewhere included being deposited as crystals in our joints' synovial linings. Sudden changes in our uric acid levels (possibly from a meal rich in purines) or trauma (such as stubbing a toe) may dislodge some of these crystals...and here's where the problems really begin. The crystals occur naturally in dead or dying cells and in the presence of infection which is exactly what immune cells called macrophages think they are dealing with when they encounter these crystals during gout. They respond by signalling to other immune cells to flood the joint and begin releasing huge quantities of inflammatory substances. And before you know it, the gout attack has begun! https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1615213588765-6JM0B4WML2RH2E8HUE42/unsplash-image-nhG5gix93es.jpg Conditions - Gout - What are the treatment options? Diagnosis, as always, comes first. Your past medical and lifestyle factors combined with the clinical presentation will usually make it straightforward to lead to gout. On top of this, blood tests are usually done by your GP to check the uric acid levels in your blood. The one issue with this is that blood uric acid levels tend to peak a few weeks before there is enough joint crystal deposit to launch an attack. So by the time you show symptoms, your blood levels may have dropped back into normal range. The gold standard test for gout involves arthrocentesis - fluid is remove from the joint with a needle and examined under a microscope to look for the presence of these crystals. Another useful tool in the diagnosis of gout is diagnostic ultrasound - both during and outside of an attack, gout has unique features detectable with this imaging technology - we are proud to be the only Podiatry clinic in the Scottish Borders able to offer this service in-house. Once gout is diagnosed, medication is begun. Anti-inflammatories (most often Naproxen or Colchicine) are used during an acute attack to relieve symptoms and then medication to help manage hyperuricaemia in the long-term is used - Allopurinol being the most common here. It is very important any medication you take to treat gout is done so under the guidance of your GP: some over-the-counter anti-inflammatories like aspirin should be avoided because although the decrease inflammation they also decrease the kidneys' ability to remove uric acid from the blood. Outside of oral medication, our clinic can offer localised, targeted therapy in the form of corticosteroid injections directly to the problem joint. This can be very helpful in settling symptoms and lowering the inflammation which may otherwise lead to permanent joint damage. 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At Tweed Podiatry, we specialise in the assessment, diagnosis and treatment of virtually all foot and ankle problems including joint, ligament and tendon pain, sports injuries and skin and nail conditions. We are the Borders’ first and only Royal College of Podiatry accredited practice and offer the region’s widest and most advanced range of podiatry services including diagnostic ultrasound, shockwave therapy, nail surgery, gait analysis, custom foot orthoses (insoles), image-guided injection therapies and so much more. https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1613934504459-PD20JMJU4WLSYBLLQLKQ/big%2Btoe%2Boa%2Bxray.jpg Home https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1612030773216-2N5X8UN1PDVTE9JMEGN8/sidas%2Bcustom%2Bfoot%2Borthoses%2Bmachine.jpg Home https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1613934941431-15W5CNL07EQ457TP5B5Z/Clinic%2BPic%2B2.jpg Home https://images.squarespace-cdn.com/content/v1/5f538bdcabe403086f164dae/1613937786602-1CQHHSVITG4WI5MO42I2/me+in+clinic+with+diagnostic+ultrasound+machine.jpg Home - How can we help? Our expert team care passionately about providing a professional and friendly service to every person we meet and will work closely with you to understand the nature of your problem and the strategies we can implement to get you moving forward towards your goals. https://www.tweedpodiatry.com/jobs daily 0.75 2026-01-31 https://www.tweedpodiatry.com/store daily 0.75 57477-12-23