Normally the body can rid itself of the Uric Acid through the Urine. However, in people with gout the Uric Acid builds up and forms grit-like crystals that collect in the joints. These crystals irritate the joint which causes the toe to become red, swollen and very painful.
The build up of Uric Acid can be caused by a number of factors:-

• It can be inherited. However it doesn’t mean that all the members of a family will have an attack.
• Drinking too much alcohol can cause a build up of Uric Acid.
• A lack of vitamin C.
• People with certain medical conditions have an increased chance of developing Gout. Including high blood pressure, obesity, kidney damage, and vascular disease.

Gout usually occurs in attacks. An attack normally develops over a few hours sometimes causing what looks like a boil near the joint. It can become extremely painful even a light touch can be painful. The attack typically affects the big toe joint however Gout can attack the Knee, Elbow or Ankle Joints.

A small number of Gout episodes causes no lasting damage,  however if the Joint is repeatedly attacked then it may cause long term Arthritis. In a few circumstances the Uric Acid Crystals may cause kidney stones or kidney damage.

Your doctor may take some fluid out of the swollen joint and examine it to confirm the gout diagnosis. The GP may also take some blood samples to measure the amount of urate in the blood.
Generally the treatment is to reduce the inflammation, this includes raising the Joint above heart level, and wrapping  with an ice pack (avoid direct contact with the skin) for 20 minute periods. Your GP can also prescribe a short course of anti-inflammatory pain killers which will quickly ease most gout attacks.

There a few other treatments that your GP can prescribe including Allopurinol which works over a period of time to reduce the amount of Urate in your body. However preventive treatment is the best method to fight gout. Lifestyle changes including:-

• Losing weight if you are overweight.
• Eat a sensible diet, try to avoid a high protein intake and rich food including liver, kidneys and seafood.
• Reduce the amount of alcohol you drink.
• Reduce the amount of sugary drinks you have.
• Drink plenty of water, try to avoid dehydration.
• Have your blood pressure checked regularly.

At Walk Right Podiatry we can help Gout sufferers by offering advice on Footwear, Orthotics and more to keep you comfortable, as well as working alongside you GP to get you on the best management plan to prevent further painful episodes.

If you would like any advice on gout or any other problems contact Walk Right Podiatry on 01706 655110 or visit www.walk-right.co.uk to book your appointment.

Fungal Nail Infection are common and around 3 in 100 people will have one at some point in their lives. The infection often only affects one nail but can affect all the nails of the feet.

The nails become thick, discoloured and usually a yellow colour. If the infection is left untreated the nails can become soft and crumbly, it is not usually painful though the thickening of the nails can place more pressure on the nail beds which can be uncomfortable.

Fungal Nail Infections can develop in a number of ways.

• If the nail has been damaged it is more likely to become infected.
• A fungal skin infection such as athlete’s foot can spread to the toenails causing a nail infection.
• You are at risk of catching a fungal nail infection if your immune system is low or you have poor circulation.
• It can also develop for no apparent reason because the fungi are common and can occur unexpectedly.

Treatments include Anti-fungal Nail Lacquer that has to be painted on the nails according to the directions of the treatment. However this treatment has to be continued until the infection has gone, this is usually around 6-12 months. Oral medication can be taken if the nail infection has affected all of the nails,  is painful or is impacting on a person lifestyle.

If you would like any advice or treatment for Fungal Nail Infection, call our clinic on 01706 655110 or visit www.walk-right.co.uk to book an appointment for any of your foot needs.

Here at Walk Right Podiatry through kind donations from patients we have managed to raise £113 over the last few weeks, we will continue to collect any donations on behalf of Adams family, and thank you so much for your kind support. We have another £20,000 to raise but many events are coming up that you can read about on Adams website.

Rebecca & Adam

If you would like to donate to Adams SDR Fund you can do so by visiting:

www.adamkuterebasdrfund.co.uk

Inflammation in the joints is usually produced to destroy things such as bacteria but with Rheumatoid Arthritis the inflammation attacks the tissue around the joint. This can cause damage to cartilage and sometimes bone. The amount of damage caused varies from person to person but once the joint has been damaged it is very difficult for it to heal back to its original state, causing lasting destruction within the joint.

Sufferers of Rheumatoid Arthritis often report periods of ‘flare ups’ these are usually unpredictable, trying to suppress the inflammation in the early stages is an important way to treat the disease. There are several different types of medication that can be taken to treat the pain and inflammation in the joint. Including DMARDS (disease modifying anti-rheumatic drugs),NSAID’s (non-steriodal anti inflammatory drugs) or a course of steroids to calm the inflammation.

Rheumatoid Arthritis can affect the joints in the feet, usually the joints in the toes. They can be very painful and become disfigured due to the inflammation, this can cause problems getting shoes to fit or even walking. Podiatrists form an integral part of the management team of a person with Rheumatoid Arthritis, enabling mobility and preventing wounds and ulceration.

For example, Insoles and Orthotics can be prescribed to cushion the shoe and accommodate any foot deformities.This is a simple technique that can make a big difference in a person’s day to day life. Podiatrists can also help with things that can become a struggle including toe nail cutting, corns and callus treatment, and advice on shoes and other footwear.

People who suffer with Rheumatoid Arthritis need to take care of their own joints through regular exercise. This however is a balancing act, not enough exercise and your joints will stiffen, too much and you will be doing harm to the joints. There are particular signs you should look out for: if the joint becomes warm or swollen then it is time to stop. Swimming is my top tip for people suffering with Rheumatoid Arthritis, it is the exercise that puts the least strain on your joints but utilises the muscles well.

The Arthritis Care Helpline 0808 800 4050 can offer you help and support with any issues regarding your Arthritis that you may have, or call us at WalkRight Podiatry on 01706 655 110 or visit www.walk-right.co.uk to book an appointment and discuss any issues that you may have.

Ingrowing toe nails can be caused by a number of things including:

• Ill fitting footwear
• Hereditary Problem
• Trauma due to Injury
• Bad nail cutting technique over time

An ingrowing toe nail is caused when the nail cuts into to the skin at the side of the nail known as the sulci. This is then aggravated when the nail continues to grow into the sulci causing a wound that cannot heal. Without the wound healing it is a portal for infection, this infection continues to get worse until the nail is dealt with and the wound can heal.

Podiatrists can treat Ingrowing Toenails in a number of ways by either conservatively managing the problem by removing any ‘spikes’ and with routine nail care management including packing underneath the nail, to alleviate the pressure on the sulci.

The more long term and often more successful treatment is Toenail Surgery. This involves removing part of, or the entire nail. A partial nail avulsion (PNA) involves removing a small slither of nail on the side that is the problem. A total nail avulsion (TNA) is removal od the whole nail. This tends to be a rarer procedure and is only carried out when either both sides of the nail are particularly bad or the nail is already deformed in some way.

Nail surgery involves a local Anasthetic into the toe that numbs it completely. Then the slither of the nail is removed or the whole nail, depending on what was agreed by the patient and podiatrist. An acid called phenol is then applied and neutralised, in most cases this prevents that part of the nail ever growing back. It is then dressed and managed by the podiatrist and patient over the next few weeks. The surgery usually only takes up to an hour in total and is a minor operation that can be done in clinic.

We regularly carry out this procedure at Walk Right Podiatry and our patients report a pain free experience and instant relief.  If you are having problems with ingrowing toe nails or any other issues with your feet call WalkRight Podiatry on 01706 655110 or visit www.walk-right.co.uk to arrange an appointment.

There have always been discussions within the Podiatry field as to whether Insoles and Orthotics are a help or a hinder to children’s developing feet, at Walk Right Podiatry we like to know if the child is in any pain or discomfort, or appears to be tripping or falling frequently, an important part of the assessment is listening to the parents observations.  If you are unsure book an appointment with us, never be tempted to buy ‘off the shelf’ Insoles for your child without knowing if they are functionally correct for them.

At 6 months old a baby’s feet consist mostly of cartilage, at 2 years the boney structures are starting to develop and at 8 years the bones are formed fully but it will take up to a further 10 years for the bones to fuse and form together.

Below are a few tips for tiny feet…..

• Don’t force your child into walking; they will start when there ready, usually between 10 and 18 months.
• Encourage your child to walk barefoot indoors. This will help the foot develop and strengthen.
• When your child is on their feet and starting to teeter around visit a reputable shoe shop that will measure the length of the feet and width and supply you with a well fitted shoe.
• Inspect your child’s feet regularly. The best time for this is bath time. Check for any cuts or abnormalities or any changes in temperature or colour.

Correct footwear for your child….

• Ideal shoes should be soft and flexible but also give stability and protection to the feet.
• They should have a fully adjustable fastening.
• Visit a shop that offers half sizes and different varieties. Less that a third of children’s feet are the average size the shops use.
• Feet grow on average 2 full sizes in a year for the first 4-5 years of life. So regular checks by experience staff at the shoe shop are essential.

Good fitting shoes are essential to your foot health, and the tips given above are not just for your children’s feet. Good fitting shoes and regular checks of your feet should be built into your routine health checks. If you would like us to check your childs foot health please contact us then we can provide you with the help and information that you may need.

Call WalkRight Podiatry on 01706 655110 or visit our website www.walk-right.co.uk to book an appointment.

This qualification enables us to massage and mobilise the soft tissues in the foot, around the ankle, and in the lower limb. This brings relief for people who suffer from pain and discomfort in these areas caused by Biomechanical dysfunction, Plantar Fasciitis and Metatarsalgia amongst others. It is also an effective treatment for injuries such as Chronic Ankle Sprains.

Soft tissue mobilisation aids healing and reduces pain in a number of ways;

• It straightens out any cross fibres in the muscle. This is what people generally refer to as a ‘knot’ making the muscle more efficient in what it has to do.
• It increases blood flow to the area, which helps with the healing process.
• It reduces the toughness of scar tissue again by straightening the fibres.

Soft Tissue Mobilisation can also be an effective tool alongside Gait Analysis and corrective Insole/Orthotic use. It compliments what we try to achieve with the use of Orthotics extremely well. Soft Tissue Mobilisation allows us to use massage techniques to increase tension in ligaments that my have been stretched to their limit over years of ‘flat foot’ walking for example.

For example, by massaging the Tibialis Posterior Ligament which runs down the inside of your leg and curls under the medial malleoli (inside ‘ankle bone’) the arch area profile of the foot is strengthened. It is rare that the site of pain is the actual cause of the pain and so muscles, ligaments and structures higher up the limb must always be assessed. A phrase taught was ‘he who treats the site of pain is lost’- this is indeed very true.

At Walk Right Podiatry our Biomechanics Service includes a course of Soft Tissue Massage (usually 5-6 sessions), a pair of Simple Insoles/Bespoke Orthotics, foot measuring, footwear advice, static stretching advice and prescribed exercises using a device such as a wobble cushion.

Podiatry is evolving all the time and Rebecca and I keep ourselves up to date with the latest techniques and Courses to provide our patients with the best cutting edge treatment available.  To book an appointment with us at WalkRight call 01706 655 110 or visit www.walk-right.co.uk

Adam was born 13 weeks premature weighing just 2lbs 8ozs, he suffered 2 lung haemorrhages and a brain haemorrhage within the first 4 days of his life. He was given a 10% chance of survival, he was in hospital for 12 weeks before he was well enough to come home.

Due to the brain haemorrhage Adam was left with Tetraplegic Cerebral Palsy, it affects both his legs and his right arm. Adam cannot stand unaided and when not in his wheelchair he crawls to get around. He can walk very short distances, across the room, inside with the help of a walking frame. His muscles are very tight so he is unable to get his legs straight so it is difficult for him to sit if not in a chair.

The operation we are sending for is called Selective Dorsal Rhizotomy and the following benefits are expected after the surgery:

His spacticity will be permanently reduced.

His sitting and standing postures will improve.

His transitions between postures will be faster and easier.

His balance and level of comfort will both improve.

His walking will improve – he will be able to walk independantly using a walker in all environments and may have potential to walk using crutches if his right arm improves.

We are looking to raise in the region of £60,000, this will cover the cost of the surgeries as well as the post-op care he will recieve over there including any equipment needed. Any extra money raised will cover the intensive physio he will recieve in America and once back in the UK.

So far we have raised an amazing £20,000 but we still have such a long way to go, if you feel that you could help in any way either by attending any events or giving a donation it would be greatly appreciated.

Please Visit http://www.adamkuterebasdrfund.co.uk

Many thanks from Walk Right Podiatry

Mr Stuttard kindly asked if I would like to shadow him during some of his surgical procedures, so on Thursday I took him up on his offer. I was asked to report to the Reception at Highfield Hospital not far from Walk Right Podiatry, our clinic on Drake Street. Upon arrival I was taken through the hospital, to the changing room where I was asked to wear the obligatory scrubs and clogs and wait for Mr Stuttard.

He explained to me that he had three Patients booked into the morning surgery session. The first operation being a Bunionectomy. A Bunion is a Bony deformity at the joint of the base of the big toe, it is also known as ‘Hallux Valgus Deformity’. The deformity can be caused by a number of issues including poorly fitting footwear (high heeled shoes/winkle pickers for men), they can also be hereditary, or can occur as a result of arthritic changes in the joint. This can lead to pain and discomfort and can make finding accommodating footwear almost impossible.

Through a set of swing doors the patient was already lying down prepared for surgery and being sedated by the Anaesthetist. Mr Stuttard just had time to re-assure the patient one more time. He then administered Anaesthetic and Adrenaline, via the procedure known as an ‘Ankle Block’. He performed this with ease and explained he had gained much experience and that he had been a qualified Podiatric Surgeon since 1987.

We then proceeded into Theatre where his team were preparing the equipment he was going to use. Upon incision and exposure of the bony deformity he described to me how the cartilage damage present and the bony cysts were causing the patient the pain and discomfort.

Forty-five minutes later the Bunion had been removed and Mr Stuttard was closing the wound. Recovery time for a Bunionectomy is around 6 weeks and can be a massive improvement for a patients quality of life, decreasing pain and improving mobility. You may be surprised to know that with this and many Foot Surgery procedures only day surgery is required and no overnight stay necessary.

Podiatry practitioners that utilise all the resources and referrals available to them have better outcomes and happier patients. Here at Walk Right Podiatry we work alongside Mr Stuttard and can refer you directly to him if you have a surgical need.

I am looking forward to retuning to Highfield Hospital and visiting Mr Stuttard and his team for a second round of surgery, we are proud at Walk Right to have such links to an excellent Podiatric Surgery team.
Please visit www.nhs.uk for more information on Bunions and the treatment available.

Diabetes arises when the amount of glucose in the body is too high. This happens because the pancreas fails to produce enough insulin (or none at all) to help glucose enter the body’s cells.

Over 30% of people with Diabetes over 40 suffer with foot problems. Common problems include nerve damage which can affect the perception of feeling heat, cold or pain, this is known as ‘Diabetic Neuropathy’.

Another problem that can arise is ‘Peripheral Vascular Disease’, this can reduce the flow of blood to the feet causing a reduction in the body’s ability to heal wounds, leading to long standing Ulcers and eventual possible surgery. It is estimated that 60% of all amputations in the United States are linked to Diabetes.

Therefore it is vitally important that all Diabetics have at least an annual Diabetic assessment on the feet, however regular Podiatry appointments are also advised to maintain healthy feet and spot any potential issues before they arise.

There are a number of tests that Podiatrists perform to assess the ‘health’ of the feet. Two of these include:

• Doppler Test – This machine uses Ultrasound waves to test the quality of blood flow to the feet. The strength and phases of the foot pulses can be heard and a diminished blood flow can be an indication of Peripheral Vascular Disease.

• 10g monofilament test – This tool is a light filament that is pressed onto several parts of the feet, the patient is asked to close their eyes and inform the podiatrist if they can feel the filament on different sites on the feet. This test is performed as a loss of sensation can be an indication of ‘Peripheral Neuropathy’, and therefore the feet may be are more prone or at risk of ulceration.

However, there is much that people with Diabetes can do to help maintain the health of their own feet.

Get to know your feet!! …… The easiest and most effective way to keep your feet healthy is by checking your feet each night for any swellings, cuts, bruises or irregularities that may have occurred during the day. That way the problem can be seen by a professional in the early stages and dealt with quickly and appropriately.

Use a good moisturiser every night all over your feet, but not in between your toes,  I personally recommend E45 cream. This keeps your feet supple and skin well hydrated, it can also help reduced hard skin build up. Dry skin can lead to cracks on the feet which are then a perfect portal for infection to enter the body.

Make a point of drying in between your toes. It can become very macerated (wet) in between your toes and they are then susceptible to split, leading to possible ‘ Athletes foot’. Bacteria loves to live in dark, warm and wet conditions, so keep them dry and this will benefit your foot health greatly.

Clean socks are always a must, and you can’t go wrong with proper fitting shoes and slippers with plenty of room for your toes but I’m sure we’ll discuss shoes in the near future.

Never self-treat corns, calluses, or Verrucae, always see the Podiatrist. Some Corn Plasters and Verrucae treatments contain acids that are not suitable for Diabetic feet.

To continue reading about Diabetes and your feet please visit www.diabetes.org.uk or www.feetforlife.org which are extremely informative web sites.

Hopefully you have enjoyed reading our Blog this week.