Taking care of your feet at work - trades & services

Any work that involves walking or standing for long periods of time is hard on the feet — with up to twice your body weight in force applied through your feet and legs with every step. Your feet are taking a lot of force over extended periods of time! Pain is common in the heel, balls of the feet, and arches.

Most foot injuries occur in workers involved in manufacturing, construction, transport and storage, and range from cuts, bruises and sprains from falling objects, and trips and falls, through to overuse injuries such as sprains and stress fractures.

Risk factors

Standing in one spot or walking for more than 4 hours at a time
Overuse injuries are prevalent for people who are on their feet for long periods of time. Proper foot care is paramount to relieving discomfort and preventing more serious injuries from occurring. When your feet are sore and tired you are at increased risk of tripping and falling injury. Supportive footwear and/or orthotics can reduce your risk of injury.

Walking on hard surfaces
Hard surfaces such as concrete lack flexibility and multiply ground force with every step. Workers employed regularly on hard surfaces can benefit from cushioned soles for shock absorption. Custom orthotics may also be useful for additional arch support.

Unsupportive footwear
Shoes that are unsupportive or lack appropriate protection for workplace conditions.

How to reduce your risk
Common overuse injuries among workers include repetitive strain injuries to the Achilles tendon, stress fractures through constant force applied to the feet, arch pain (as arches can be strained through long periods of standing and carrying weight), and heel pain.

These problems can be avoided by:

Wearing supportive shoes
Shoes that are properly fitted with comfortable inners, lower heels and good arch support
are recommended to reduce discomfort and prevent injury.

Changing position regularly
Keep your muscles mobile and to give pressure points a rest. Keeping joints flexible by moving around is just as important as sitting down and having a rest at regular intervals. Make sure you change positions frequently so that any one particular muscle group isn’t getting more strain than another.

Take care of your feet at home
Many foot problems can be prevented simply by cleaning your feet regularly, inspecting them for corns, calluses and cuts, and keeping your nails in good condition. Your feet are more susceptible to injury if you are on your feet all day, so looking after your feet will make your working life easier and pain free.

What can a podiatrist do for you?

Podiatrists are highly-skilled health professionals trained to help prevent, diagnose, treat, and rehabilitate medical and surgical conditions of the feet. Professional care can often benefit both employer and employee.

Podiatric treatment for trades & services workers can include:

Managing existing injuries
If you are suffering from foot pain, we can recommend treatments to provide your feet with more support throughout the day and relieve any discomfort

Biomechanical assessments
We conduct assessments to investigate your posture and the way your lower limbs function. We look to see if you are compensating for any slight abnormalities.

Finding appropriate footwear
The importance of workplace-appropriate footwear shouldn’t be ignored, and for many jobs, safety or protective shoes are mandatory for good reason. We can provide expert advice to ensure you have maximum comfort at work.

Fitting custom orthotics
We can also fit you with custom orthotics to provide additional support and other therapies to relieve the burden of wear and tear.

**Information sourced from the Australian Podiatry Association

Is your heel causing you pain?

One of the most common questions we get asked by patients is “why does my heel hurt?”. While there can be many reasons for heel pain, we as podiatrists categorise heel pain into these primary causes: plantar fasciitis, Achilles tendonitis, bursitis and nerve pain.

• A very common cause of heel pain is plantar fasciitis, which is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. When people suffer from the condition, the fascia becomes irritated and then inflamed (swollen and red), resulting in heel pain or pain in the arch of the foot. Pain in the plantar fascia is a telling sign that there is a biomechanical issue going on in the foot. Plantar fasciitis is typically treated with nonsurgical strategies, such as stretching and strengthening exercises, rest, shoe inserts (such as orthoses) and footwear modifications.
   
• Achilles tendonitis is the inflammation of the Achilles tendon, and can also be a cause of heel pain. This condition is typically associated with 'overuse' and we see it most frequently in athletic patients who play sports with a high impact on the knees and ankles (such as tennis, netball or ballet). A sudden increase in repetitive activities can put too much stress on the Achilles tendon too quickly, leading to micro-tears or injuries of the tendon. Generally, Achilles tendonitis responds well to conservative treatments and can be aided by exercises which gently strengthen the tendon. If your Achilles tendonitis is linked to a biomechanical issue, our podiatrists can also help by providing orthoses to allow the foot to function in a position which minimises the abnormal forces being applied to the tendon, allowing it to recover and prevent recurrence in the future.
   
• Bursitis is another cause of heel pain we commonly see - where the 'fat pad' of the heel displays redness and swelling from inflammation of the bursa (the fluid-filled sac inside the heel). The bursa protects the heel from friction and can become irritated and inflamed from footwear (such as tight boots), repetitive use or overuse or from blunt force impact (such as falls or sporting injuries).  Additionally, biomechanical and gait abnormalities might also place additional stress on the bursa. Bursitis may be able to be treated with my simple home treatments, such as wearing broad shoes which aren't too tight on the foot. Rest, ice and elevation may also help to alleviate discomfort. If this doesn't help, a podiatrist can perform a full biomechanical assessment of your feet and gait, and may even refer you for further imaging (x-ray or ultrasound).
   
• A less common cause of heel pain is related to the nerves in the foot. Nerve pain in the heel will feel like a burning or electrical pain/sensations radiating down the foot from the heel towards the toes. Podiatrists will generally try conservative treatments in the first instance, which may include: a short course of anti-inflammatory medication, padding and offloading of the nerve entrapment site or stretching and strengthening exercises.

Whatever your heel pain, we encourage you to see a podiatrist for a proper diagnosis. We are experts in the foot, ankle and lower limb, and our training helps us effectively get to the cause of the pain.

International Women's Day - Women's Foot Health

Happy International Women's Day! In honor of the occasion, we thought we'd share some foot health information relating particularly to women's feet. 

There is quite a marked difference between men and women's feet - women commonly have a narrower heel and broader forefoot, and are generally more flexible in the foot and ankle than men.

Women also suffer more from certain types of foot problems than men. This is can be caused by  footwear (for example, wearing and walking in narrow-fitting shoes that have inadequate room for the toes). Problems may also be caused from the prolonged use of high-heels which cramp the front of the foot, shorten the muscles and tendons in the lower leg and ankle, and increase pressure on the ball of the foot - generating a host of foot and ankle problems.

Women may also be more prone to the following foot and ankle problems:

Morton's Neuroma - a thickening of nerve tissue in the ball of the foot resulting from compression and irritation of the nerve. This could be caused from wearing shoes which have a tapered toe, or high-heeled shoes which do not allow enough room for the toes.

Bunions - generally begin with a ‘leaning’ of the big toe, gradually changing the angle of the bones over the years and slowly producing the trademark bunion bump. Bunions are generally caused by a combination of issues (such as an inherited particular structure of the foot which is exacerbated by the way a person walks). Both men and women can get bunions, however the footwear worn by women often makes the issue progressively worse.

Heel Pain and Plantar Fasciitis - heel pain is most often caused by plantar fasciitis. Although a biomechanical foot structure issue is the most common cause of plantar fasciitis, in women, it can be worsened by wearing nonsupportive shoes (such as thongs or ballet flats).

Ankle Spain - whilst anyone can sprain an ankle, women are particularly vulnerable to this injury when wearing high-heeled shoes (particularly on slippery ground), platform shoes or other improper footwear.

Our podiatrists can help not only with diagnosis of any injuries or pain in your feet, but will also work with your GP and other allied health professionals to establish an appropriate management program. We are also able to advise on appropriate footwear and/or shoe inserts which help in reducing pain. If your feet are causing you concern, please get in touch with our team of skilled podiatrists today.

Podiatry and Ageing Feet

Podiatrists form an integral part of the health care team for ageing Australians. Podiatrists play a key role in assisting ageing Australians with general foot care, which would otherwise be left unattended and could lead to more serious problems, including infection, hospitalisation and, in worst-case scenario, even amputation.

Mobility in an ageing population is paramount to maintaining independence and quality of life. Podiatrists play a role in musculoskeletal assessment of the feet and legs of an ageing population and can assist in identifying and treating potential and active foot pathology that can reduce mobility.

It has been predicated that Australia, like most developed counties, will continue to experience a general ageing of the population. The proportion of Australians aged over 65 years grew from 8% in 1970-1971 to 13% in 2001-2. This is expected to reach and stabilise at about 25% over the next 30 years (1).

Below are listed some specific foot health problems that affect an ageing population:

1. Skin changes: As the skin ages, it looses some of its former qualities of elasticity, moisture balance and fatty padding. The skin becomes vulnerable to tears and, therefore, ongoing slower wound healing and infection. The foot is an area particularly vulnerable to skin break-down complications; being at the most distal part of a limb it has susceptibility to peripheral neurological and circulatory loss. A podiatrist is often the first health professional to thoroughly examine the foot and can be the first to detect skin changes, such as skin cancers, which are more prevalent in the aged foot.
    
2. Pressure areas: With the average person aiming for 10,000 steps per day, an 80-year-old foot could have tread over 290 million steps in a lifetime. It should therefore come as no surprise to learn that the fatty padding in the foot, either under the heel or the ball of the foot, can be considerably reduced in the ageing patient. The combination of pressure and reduced protection produces pressure-related problems unique to the foot; callouses and corns over boney prominences and metatarsal heads, heel pain from standing and walking, inter-digital neuromas and bursas or capsulitis.
    
3. Nail changes: Difficulties with bending down, eyesight or focal length and hand grip strength often are the initiating factors for a person to directly contact a podiatrist for assistance with foot care. Podiatrists regularly treat nails in the aged population, and offer professional care of nail pathology such as ingrown nails, fungal nail infections, and wounds related to excessively long or thickened nails.
    
4. Changing capability: As well as physical changes, there are often cognitive impairments related to chronic disease and complex medical presentations in the aged. Impairment in memory, loss of concentration, impairment in focus and judgment can affect personal care (2). These mental capacity deficits produce a higher risk profile for the aged foot, which often requires professional input of a podiatrist as a regular provider of foot care.
    
5. Orthopaedic changes: The foot shape and appearance can change with ageing due to changes in boney structure and weakness or loss of elasticity in the connective tissues, such as ligaments and tendons. Muscle strains and tendon pathology are common consequences of an active older person who is demanding a lot from an ageing body. Podiatrists are trained to assess and diagnose boney and soft tissue pathology of the foot. At times, orthoses can be prescribed to help support the tiring foot structure and these, along with footwear advice, can help maintain mobility in the aged population. Bunions and clawing toes are common presentations in the ageing foot. Other underlying chronic diseases such as arthritis and diabetes often exacerbate foot orthopedic problems. Complex feet of this nature require the professional care of a podiatrist as part of the health team for sustained mobility and quality of life. Changes in bone density with osteoporosis may affect the many bones in the foot. The combination of weakened boney structure and the forces the foot must endure in gait leave the foot vulnerable to stress fractures.
    
6. Gait changes: Falls in the elderly are a concern to people who have experienced falls, their families and the health system at a community level. It has been shown that people at higher risk of falls have a more variable pattern of minimum foot clearance, which could lead to trips and falls (3). Podiatrists have a role in footwear advice and maintaining the foot to be as pain-free and functional as possible.
    
7. Foot pain: Foot pain affects up to 24% of people over 65 years of age (4). Pain is associated with altered activities of daily living, balance and gait. Some of the risk factors for pain are gender (with women reporting more foot pain), obesity and chronic health problems.

Information sourced from the Australian Podiatry Association.

1. Australian Treasury. http://demographics.treasury.gov.au/content /_download/australias_demographic_challenges/html/adc-04.asp. Sighted August 28, 2014.

2. McIntosh IB. The ageing foot - a challenge for the Chiropodist and Podiatrist. Podiatry Review. 2014 May-June.

3. Barrett RS, Mills PM, Begg RK. A systematic review of the effect of ageing and falls history on minimum foot clearance characteristics during level walking. Gait & posture. 2010;32(4):429-35.

4. Menz HB, Gill TK, Taylor AW, Hill CL. Predictors of podiatry utilisation in Australia: the North West Adelaide Health Study. Journal of foot and ankle research. 2008;1(1):8. PubMed PMID: 18822163. Pubmed Central PMCID: 2553780.

Kids and Podiatry

Children are naturally active beings. Their young bodies are full of energy to jump, hop, skip and run around all day long. If your child is having trouble keeping up with the other kids, or is regularly falling over for no apparent reason, they might be having foot problems.

Problems with your child’s feet can impact them in their daily life. Foot conditions can be associated with knee, hip and back pain and may impact a child’s motor skill development and posture. Bones and joints in children are constantly growing and aren’t fully developed until adulthood. Incorrect movement patterns and untreated foot conditions can impact the development of young, supple bones and joints. Here are 10 tips for healthy feet in kids:

1. Babies’ feet develop and grow rapidly. Allowing babies to remain barefoot while crawling enables full contact between their skin and the ground, which assists the development of balance and proprioception, or the understanding of where their bodies are. Of course, make sure there are no hazards around that could injure bare feet.
    
2. When your child starts to walk, it’s a good idea to get professionally fitted shoes to ensure a good fit and to protect their feet from the environment.
    
3. Try to get shoes that fit both the length and width of your child’s feet, and that are made of breathable canvas or leather.
    
4. Sock sizes often change as frequently as shoe sizes. Make sure socks aren’t too tight and that they don’t bunch up inside shoes, as they can then rub and may cause blisters.
    
5. Little feet become big feet quickly, and your child can wind up wearing tight-fitting shoes before you’ve had a chance to even think about buying new ones! Measure your child’s feet regularly to be sure they are wearing shoes that fit properly. Shoes that are too tight may cause pain and discomfort.
    
6. The way your child’s shoes show wear and tear can give you a good indication of incorrect walking patterns or postural problems. Excessive wear and tear, for example, from the outside edge to the inside of the shoe or around the heel is indicative of problems that should be checked out.
    
7. Wash little feet daily in soap and water and dry thoroughly. Little feet often get sweaty, and little cotton threads or even long hair from mum can wrap around little toes inside socks.
    
8. Keep toenails trimmed and take care not to cut nails too close to the skin as this can lead to ingrown toenails that can become painful or infected.
    
9. Children rarely complain about painful or injured feet, so when they do it is a good indicator to get them checked out.

Information sourced from The Australian Podiatry Association.

Pregnancy and Podiatry

Nobody told you that your feet would hurt as well! The weight gain experienced during pregnancy places a huge amount of unexpected pressure on your feet. Your centre of gravity shifts as your baby grows, and it’s common for pregnant women to suffer from foot pain, swelling, leg cramps and varicose veins. The good news is that you may feel better after receiving proper foot care.

With extra weight and force placed on your feet, one of the main problems during pregnancy is flat feet. Increased weight causes the bone structures in your arches to flatten and your feet to roll inwards. This can be incredibly painful as other parts of your feet and legs — your tendons, ligaments and muscles — are all working harder to keep you upright.

Another issue during pregnancy is swelling. As your uterus grows to accommodate your baby, the flow of blood and fluids to your extremities can be compromised. Fluid can build up around your feet and ankles, and this can lead to painful swelling. As long as the swelling is the same in both feet, this is normal. If you have sudden swelling, swelling that is noticeably different between your feet, or that appears in your hands or face, contact your maternal caregiver immediately.

There are treatments available to relieve foot pain. Nine months is a long time to be uncomfortable and remember – your feet shouldn’t hurt!

1. Wear comfortable, supportive shoes with a cushioned innersole; your feet will thank you for them as they won’t have to work so hard to keep you stable. You may find that with swelling you will need a shoe size bigger that what you are used to. Get your feet professionally measured and avoid wearing shoes that are too tight.

2. Wear socks without an elastic cuff and avoid anything that will restrict circulation to your feet.

3. Take in regular exercise to keep the blood circulating around your body. Walking, swimming and yoga are good options as they are low impact and will be easy on your feet while giving you the workout your body needs. Swimming is particularly recommended because the force of the water on your body actually helps to bring swelling down. If you are sitting for long periods of time (e.g. at work) be sure to stand up and have a walk around throughout the day.

4. Stretch! If you notice cramps in your feet or calves stand up and have a good stretch to relieve the pain. Remember that your muscles and ligaments are working really hard, so show them some TLC by stretching just as you would after exercising.

5. Elevate your feet as much as possible to minimise swelling. Keep a footrest or a box under your desk at work so you can keep your feet up at the office.

6. Avoid crossing your legs as that will restrict blood flow and increase swelling.

7. Drink plenty of water. Drinking more water won’t make you retain more water, so keep up fluids.

8. Eat healthy! Make sure you’re eating loads of healthy foods and a well-balanced diet. Lay off the salt as it will cause you to retain more water.

9. Sleep on your left side; this opens up your blood vessels and will encourage more fluid to flow upwards from your feet.

10. Ingrown toenails can be a risk resulting from tight shoes that push the skin around nails cut too short. Keep your nails healthy and check them regularly for signs of injury.

11. Consider the use of compression stockings which may help prevent or lessen varicose veins.

Information sourced from The Australian Podiatry Association