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.

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.