Written by Michelle Champlin BSc Pod., M.Ch.S., S.R., Ch., (UK)

• Your feet will be on display in open toe’d shoes or sandals. Get your feet ready for show by trimming your toenails (straight across or as advised by your Podiatrist), removing dead skin with a gentle foot file and moisturizing your skin with a urea-based foot cream. Natural, healthy nails look fabulous, with no need for nail polish (which can cause yellowing and encourage fungal toenails). Moisturise your toenails with a urea-based gel or Vitamin E oil. You will find everything you need for summer feet in professional home-spa packages such as Dubai Podiatry Centre’s ‘Essential Feet’ Package or ‘Odour Control’ Package.
• Be careful going barefoot on the beach or in parks to avoid trauma from broken glass or other sharp objects.
• Wear sandals or other open shoes to allow feet to breathe. If wearing enclosed shoes for work, make sure the uppers are of a man made breathable fabric (such as Gore-Tex) or leather. Alternate between 2-3 pairs, avoiding wearing the same pair 2 days in a row to let them dry out and air.
• Use a deodorizing, bacterial and fungal fighting shoe spray in shoes.
• Use a deodorizing foot cream or spray to keep feet smelling fresh.
• Try a cooling leg balm or foot gel that is quick drying, non-greasy and revitalizes hot, tired feet.
• Limit flip-flops to the beach / poolside to avoid verrucas that thrive in warm, moist areas. However, try to avoid wearing them when doing a lot of walking as they encourage biomechanical issues such as toe clawing and over-pronation (find out more here). Try comfortable walking sandals with Velcro straps, cushioning and arch support, such as Teva, Rockport, Clarks, Merrell and Salomon.
• Ensure socks are changed daily and cotton-rich (more than 70%) to wick sweat – toe socks are even better and keep between your toes dry.
• Leave your shoes outside to dry and air in the direct sunshine – sunshine helps kill odour-causing bacteria
• If you notice a rash, dry white skin or tiny little brownish ‘spots’ these can all be signs of bacterial or fungal skin infections on your feet. Dry sand can harbor fungal spores and bacteria so see your Podiatrist straight away for the right diagnosis and fast, targeted treatment.
If you have any issues with mobility or are Diabetic – reaching your feet to care for them – daily, your Podiatrist can also carry out routine medi-pedis to keep corns and callous at bay and prevent ingrown toenails from incorrect toenail cutting. Dubai Podiatry Centre offers expertise in infections and conditions that thrive in hot climates – fungal skin and toenail infections, viral verrucas (or ‘plantar warts’), sweaty feet and bacterial infections. The clinic offers a range of specialist products and treatments hand-picked to keep your feet summer-ready and baby-soft, available for purchase online or in the Clinic on Sheikh Zayed Road in Dubai.
To get your feet summer-ready, contact Dubai’s UK qualified foot and leg experts on +971 4 3435390.

 

أفضل ١٠ نصائح لأقدام الصيف

بقلم ميشيل شامبلين

سيتم عرض قدميك في أحذية أو صنادل مفتوحة الأصابع. اجعل قدميك جاهزتين للظهور من خلال تقليم أظافر قدميك (بشكل مستقيم أو كما ينصح طبيب الأقدام)، وإزالة الجلد الميت بمبرد لطيف للقدم وترطيب بشرتك باستخدام كريم القدم المعتمد على اليوريا. تبدو الأظافر الطبيعية والصحية رائعة، دون الحاجة إلى طلاء الأظافر (الذي يمكن أن يسبب الاصفرار ويشجع على فطريات أظافر القدم). رطبي أظافرك باستخدام هلام يحتوي على اليوريا أو زيت فيتامين E. ستجد كل ما تحتاجه لأقدامك الصيفية في باقات السبا المنزلية الاحترافية مثل باقة “الأقدام الأساسية” أو باقة “التحكم في الرائحة” من مركز دبي لعلاج الأقدام.

احرص على السير حافي القدمين على الشاطئ أو في الحدائق لتجنب الصدمات الناجمة عن الزجاج المكسور أو الأشياء الحادة الأخرى.

ارتداء الصنادل أو غيرها من الأحذية المفتوحة للسماح للقدمين بالتنفس. إذا كنت ترتدي حذاءًا مغلقًا للعمل، فتأكد من أن الجزء العلوي مصنوع من قماش صناعي يسمح بمرور الهواء (مثل Gore-Tex) أو جلد. قم بالتبديل بين ٢-٣ أزواج، وتجنب ارتداء نفس الزوج لمدة يومين متتاليين للسماح لهم بالجفاف والهواء.

استخدمي رذاذ الأحذية المضاد للروائح الكريهة والبكتيريا والفطريات في الأحذية.

استخدمي كريم أو رذاذ مزيل للروائح الكريهة للقدمين للحفاظ على رائحة القدمين منعشة.

جربي بلسم تبريد الساق أو جل القدم الذي يتميز بجفافه السريع وغير الدهني وينشط الأقدام الساخنة والمتعبة.

اقتصر ارتداء النعال على الشاطئ/بجانب حمام السباحة لتجنب الثآليل التي تنمو في المناطق الدافئة والرطبة. ومع ذلك، حاول تجنب ارتدائها عند القيام بالكثير من المشي لأنها تشجع على حدوث مشكلات ميكانيكية حيوية مثل مخالب أصابع القدم والإفراط في الكب (اكتشف المزيد هنا). جرب الصنادل المريحة للمشي المزودة بأشرطة الفيلكرو والوسائد ودعم القوس، مثل تيفا وروكبورت وكلاركس وميريل وسالومون.

تأكد من تغيير الجوارب يوميًا وأن تكون غنية بالقطن (أكثر من ٧٠%) للتخلص من العرق، كما أن جوارب أصابع القدم أفضل وتحافظ على جفاف ما بين أصابع قدميك.

اترك حذائك في الخارج حتى يجف وتعريضه للهواء تحت أشعة الشمس المباشرة – حيث تساعد أشعة الشمس على قتل البكتيريا المسببة للرائحة.

إذا لاحظت طفح جلدي أو جفاف الجلد الأبيض أو “بقع” صغيرة بنية اللون، فقد تكون جميعها علامات على وجود عدوى جلدية بكتيرية أو فطرية على قدميك. يمكن للرمل الجاف أن يؤوي جراثيم فطرية وبكتيريا، لذا راجع طبيب الأقدام الخاص بك على الفور للحصول على التشخيص الصحيح والعلاج السريع والمستهدف.

إذا كان لديك أي مشاكل في الحركة أو كنت مصابًا بمرض السكري – الوصول إلى قدميك للعناية بهما – يوميًا، يمكن لطبيب الأقدام الخاص بك أيضًا إجراء علاج روتيني للقدمين للحفاظ على مسامير القدم والقسوة في مكانها ومنع أظافر القدم الغارزة في الجلد من قطع أظافر القدم بشكل غير صحيح. يقدم مركز دبي لعلاج الأرجل الخبرة في علاج الالتهابات والحالات التي تزدهر في المناخات الحارة – مثل التهابات الجلد الفطرية وأظافر القدم، والثآليل الفيروسية (أو “الثآليل الأخمصية”)، وتعرق القدمين، والالتهابات البكتيرية. تقدم العيادة مجموعة من المنتجات والعلاجات المتخصصة المنتقاة بعناية للحفاظ على قدميك جاهزتين للصيف وناعمتين، وهي متاحة للشراء عبر الإنترنت أو في العيادة الواقعة على طريق الشيخ زايد في دبي.

لتجهيز قدميك لفصل الصيف، اتصل بخبراء القدم والساق المؤهلين في المملكة المتحدة في دبي على الرقم ٠٤٣٤٣٥٣٩٠

Written by Michelle Champlin BSc Pod., M.Ch.S., S.R., Ch., (UK)
Golf’s world number one and defending champion Rory McIlroy has pulled out of the Scottish Open starting next week. He has reportedly suffered a rupture of his left ATFL – or ‘anterior talofibular’ ligament whilst playing football with friends. The ATFL runs from the fibular malleolus to the talus bone. As one of the lateral ligaments of the ankle – at the outside of the ankle – it stops the foot sliding too far forward. Anterior Tibiofibular Ligament (Left) – connecting the tibia & fibula
This ligament is the most common ligament injured in an ankle sprain.
Diagnosis
As part of McIlroy’s assessment, his medical team will have carried out a number of orthopaedic tests, including a ‘drawer test’ in addition to understanding the mechanism of the injury, a thorough physical exam and radiographic / MRI scans.
Ankle sprains such as McIlroy’s, to the outside of the ankle, are the most common sports injury, thought to account for 10-15% of sports injuries and responsible for up to 10% of emergency room visits.
How Does an ATFL Sprain Happen?
The extent of damage that occurs during an injury such as McIlroy’s depends on the direction and magnitude of the forces and the position of the foot and ankle during the trauma. Ankle sprains occur significantly more often in athletes who have had previous ankle sprains.
Michelle Champlin, Chief Podiatrist at Dubai Podiatry Centre says that there are also different foot postures and biomechanics that can increase your risk: “Pes cavus (high arches), rearfoot varus, tibial varus, and previous sprains are factors that may raise your risk of an ankle sprain.”
McIlroy’s type of ankle sprain tends to occur when the foot and ankle are ‘plantar flexed.’ This means that the toes are pointed downwards. (The ankle joint is a hinge type joint that only allows two movements – plantar and dorsal flexion, or in other words, toes pointing down or toes pointing up). The actual bones of the ankle joint keep it stable, along with ligaments on the outside and inside of the ankle.
When your foot is ‘plantar flexed’, or pointing downwards, the ankle joint is much less stable. This is when the ankle is most at risk of a sprain. The ankle joint is much more loose and less stable when pointed down. Try pointing your foot upwards and moving your foot side to side (lateral). Then do the same with it pointing downwards. You will notice how much freer your foot is to move side to side when it’s pointed downwards.
This is why women are much more likely to sprain their ankle in high heels – the ankle is put into an unstable position – and why your ankle is more unstable hiking downhill than uphill.
Whilst McIlroy hasn’t disclosed exactly how his footballing injury happened, it’s likely that his foot was plantar flexed at the time – most injured athletes describe ‘rolling’ their ankle to cause injury. In sports, we tend to see this type of outside ankle injury also when a player lands awkwardly on an opponent’s foot, catching the outside of the foot on the ground, or a sliding tackle that contacts the inside of an opponent’s weight bearing leg. The injured ankle tends to also, unfortunately, be the athlete’s leading, or dominant leg.
Ankle Sprains – the signs
Ankle sprains are graded 1-3 in severity. Signs and symptoms include:
• Popping sound at the time of injury
• Swelling, pain and bruising to the ankle / foot
• Inability to bear weight on the injured ankle
• Reduced range of motion at the ankle
Grading of the sprain depends on whether the ligament(s) are stretched, partially torn, or completely ruptured. McIlroy is already in a lightweight ‘aircast’ type brace that provides stability and support to the ankle, allowing it to heal. The ligaments can take 6 weeks or more to heal plus time for physical rehabilitation, including strengthening exercises.
Treatment
Sprains can be just as serious as fractures to the bone and should be treated with immediate RICE (see here for more information), taping and/or bracing and follow up physical therapy. In addition, patients should be assessed for any underlying biomechanical anomaly that can place you at greater risk of ankle sprains. Long-term effects of ankle sprains can include chronic ankle pain, arthrosis and ankle instability. Most often, a combination of RICE, bracing and physical therapy is enough to heal – in some severe cases though, surgery can be necessary.
We recommend visiting a qualified Podiatrist specializing in biomechanics and/or sports podiatry even after you are healed. We can carry out a full lower leg and foot exam amongst a range of tests to determine if there are any residual effects from the sprain and provide a rehabilitation program to get you back to training, sports and every day life safely. This may include the prescription of custom sports orthotics designed specifically for the motion and dynamics of your sport (rapid cutting / change of direction seen in football, or lots of lateral movement as in tennis for example) as well as correcting any biomechanical anomaly with your foot / ankle. Mrs Champlin says that in terms of golfing related ailments, issues such as plantar fasciitis tend to be common.
McIlroy seems to be on the road to recovery – possibly with further tests and scans scheduled to determine the extent of his injury and involvement of any other structures. We’re wishing him a speedy recovery and return to the game.
If you’ve found yourself in a similar painful condition with any form of ankle injury, it’s never too late to seek help from the experts at Dubai Podiatry Centre. Contact us on +971 4 3435390.

Written by Michelle Champlin BSc Pod., M.Ch.S., S.R., Ch., (UK)
Onycholysis is the name used to describe separation of your toenail from the pink nail bed. This happens gradually over time and is painless. Usually, it’s the big toe (hallux) that is affected, as this tends to be the longest and largest toe and most exposed to trauma.
Causes
One of the most common causes is due to repeated, minor trauma to the toenail, commonly from wearing enclosed shoes that are too small in the toe box. When walking, your toe will repeatedly tap off the top of the inside of the shoe and cause bruising and eventually the nail to start to lift off.
• We often see repeated trauma in athletes – sports such as netball, where there is a lot of stop/start forefoot motion
• Wearing work boots with steel toecaps that aren’t roomy enough for the toes
• A side effect of some medications, such as tetracycline, followed by sun exposure
• A fungal toenail infection (onychomycosis) left untreated can eventually worsen if left untreated and cause the nail to thicken and separate from the nail bed
• Underlying medical conditions, such as an overactive thyroid
• The skin condition psoriasis
• Over-pedicuring – the use of hard metal or wooden pedicure tools underneath the nail can result in progressive separation of the nail from the bed.
• Excessive moisture.
Symptoms
You may notice that the white portion of the nail increases – it will sometimes even turn green or yellow. The pink border may look irregular. The skin of the nail bed may be thickened, and nail itself may appear bruised, pitted, ridged, dented or thickened. If there is also a fungal infection co-existing, the nail may also be dry, brittle, flaky or yellowed amongst a range of fungal nail symptoms.
What to do
Visit your licensed podiatrist – we look at toenails and feet all day, every day and will be able to diagnose the nail problem accurately, as well as any underlying cause of the onycholysis and any co-existing infection or anomaly. We will advise the most appropriate treatment(s).
Treatment
Treatment advised may range from:
• Trimming the nail back to its attachment
• Complete or partial avulsion
• Addressing any underlying cause – such as investigation of and treatment for any suspected underlying cause, such as thyroid medication
• Footwear / foot care advice.
Prevention
Your Podiatrist as part of the overall diagnosis and treatment plan will identify the cause and advise on how to protect your nail from future recurrence. Your Podiatrist may advise on sports footwear and sizing, to foot and toenail care and medication. Toenails can take circa 9 months to fully regrow.
Top Tips
• Ensure all footwear, especially safety/uniform shoes and sports shoes are the right size. Sports shoes should be half a size to one size bigger, depending on your preferred shoe brand, sport etc.
• If you must wear a particular uniform shoe for work, protect toes from friction using protective in-shoe silicone gel toecaps.
• Never use, or allow a pedicurist to use, a sharp or hard instrument under your toenails.
• Don’t cut away your cuticles – their job is to stop infection causing micro-organisms and spores from entering the matrix, where your nail grows from.
• To keep underneath toenails clean and free from debris build up – use a nailbrush. Or better still, Chief Podiatrist Michelle Champlin has a secret tip: ‘Buy a cheap battery run toothbrush specifically for your toes. These will clean gently and safely underneath your nails and you can run them across the top of your nails too for lovely, clean nails. Just be careful to keep it well separated from your oral toothbrush!’
• Avoid wearing nail polish on toes except for special occasions – remove it after a day or two and never keep it on for weeks. Long term nail polish provides a perfect breeding ground for fungal nail infections, as well as staining and drying out the nail. You remove your make up every night – treat your nails with the same hygiene.
• Keep toenails trimmed short and straight across, filing to remove sharp corners.
• Never cut down the sides of your toenails.
• Try home pedicures by filing your feet with a gentle foot file every second day, keeping toenails moisturized (and polish-free) with an oil such as Vitamin E and trimmed short and straight. Moisturize your feet with a urea-based foot cream. Treat yourself to a home spa treatment with silicone moisturizing bootees that will rival any beauty salon’s treatment and are worn around the house for only half an hour in the evening.
• See your Podiatrist for routine foot care every 3-6 months, as well as if you experience any toenail issues after taking up a sport.
If you experience any pain with your toenails, or they look bruised, discoloured or like they might be lifting off from your nail bed, make an appointment with your Podiatrist. Your Podiatrist can also carry out ‘routine maintenance’ for your feet to top up your home pedicures – safe and sterile removal of callous, painless toenail correction and maintenance and spotting early any underlying infections or issues. Dubai Podiatry Centre’s UK trained and qualified Podiatrists are licensed by the DHA and able to assess, advise and treat a wide range of toenail issues including onycholysis. Contact us on +971 4 3435390.

 

انحلال الظفر – رفع أظافر القدم

بقلم ميشيل شامبلين
التفكك الظفري هو الاسم الذي يُستخدم لوصف انفصال ظفر القدم عن قاعدة الظفر الوردية. يحدث هذا بشكل تدريجي مع مرور الوقت ولا يسبب الألم. عادةً ما يتأثر إصبع القدم الكبير (الإبهام) بذلك، حيث أنه يعتبر الأطول والأكبر والأكثر تعرضاً للصدمات.
الأسباب
إحدى الأسباب الأكثر شيوعًا هي الصدمات المتكررة والخفيفة على الظفر، وعادةً ما تكون نتيجة ارتداء أحذية مغلقة ضيقة في منطقة الأصابع. عند المشي، يصطدم الإصبع بانتظام داخل الحذاء مما يسبب الكدمات وفي النهاية يبدأ الظفر في الرفع.
• نرى الصدمات المتكررة في الرياضيين – مثل الرياضات التي تتطلب حركات توقُّف/انطلاق سريعة في مقدمة القدم.
• ارتداء الأحذية الثقيلة ذات رؤوس الأصابع المعدنية التي لا توفر مساحة كافية للأصابع.
• تأثير جانبي لبعض الأدوية مثل التتراسيكلين مع التعرض لأشعة الشمس.
• العدوى الفطرية في الأظافر (الفطريات الظفرية) إذا تُركت دون علاج يمكن أن تتفاقم وتتسبب في زيادة سمك الظفر وانفصاله عن قاعدة الظفر.
• حالات طبية أساسية، مثل الغدة الدرقية المفرطة النشاط.
• حالة الجلد الصدفية.
• الإفراط في العناية بالأقدام – استخدام أدوات باديكير معدنية أو خشبية قاسية تحت الظفر قد يؤدي إلى التفكك التدريجي للظفر.
• الرطوبة الزائدة.
الأعراض
قد تلاحظ أن الجزء الأبيض من الظفر يزداد، وفي بعض الأحيان قد يتحول إلى اللون الأخضر أو الأصفر. قد يبدو الحافة الوردية غير منتظمة. قد تتسم قاعدة الظفر بالسمك، وقد يظهر الظفر نفسه متضررًا أو متجعدًا أو مرتفعًا أو سميكًا. إذا كان هناك أيضًا عدوى فطرية مصاحبة، قد يصبح الظفر جافًا، هشًا، متقشرًا أو مصفرًا بالإضافة إلى أعراض فطرية أخرى.
ماذا يجب أن تفعل؟
قم بزيارة اختصاصي الأقدام المرخص – نحن نعمل على أظافر القدمين والأقدام طوال اليوم ونتعامل مع جميع أنواع مشاكل الأظافر بدقة، بالإضافة إلى تحديد أي سبب أساسي لتفكك الظفر وأي عدوى أو مشاكل مصاحبة. سنقدم لك العلاج الأنسب.
العلاج
العلاج الموصى به قد يتراوح من:
• تقليم الظفر حتى يتصل بالقاعدة.
• الإزالة الكاملة أو الجزئية.
• معالجة أي سبب أساسي – مثل فحص ومعالجة أي سبب محتمل مثل علاج الأدوية المتعلقة بالغدة الدرقية.
• نصائح حول الأحذية والعناية بالقدم.
الوقاية
سيحدد اختصاصي الأقدام كجزء من خطة التشخيص والعلاج السبب ويوجهك حول كيفية حماية الظفر من التكرار في المستقبل. قد ينصح اختصاصي الأقدام باختيار الأحذية الرياضية المناسبة وتناسب الأحذية وكذلك العناية بالقدم والأظافر والأدوية. يمكن أن يستغرق الظفر حوالي 9 أشهر لينمو من جديد بشكل كامل.
نصائح هامة
• تأكد من أن جميع الأحذية، وخاصة الأحذية الواقية/أحذية العمل وأحذية الرياضة، تكون بالحجم المناسب. ينبغي أن تكون أحذية الرياضة أكبر بحجم نصف إلى حجم كامل، حسب الماركة والرياضة المفضلة.
• إذا كنت مضطرًا لارتداء حذاء موحد للعمل، احمِ أصابعك من الاحتكاك باستخدام قبعات سيليكون داخل الحذاء.
• لا تستخدم، أو تسمح لمصفف الأظافر باستخدام، أداة حادة أو صلبة تحت أظافر قدميك.
• لا تقم بقص الجلد المحيط بالأظافر – وظيفتها هي منع دخول الميكروبات والجراثيم إلى المصفوفة التي ينمو منها الظفر.
• للحفاظ على نظافة الأظافر أسفل القدمين من تراكم الحطام، استخدم فرشاة أظافر. أو بشكل أفضل، لدى ميشيل شامبلين، أخصائية الأقدام، نصيحة سرية: “اشترِ فرشاة أسنان تعمل بالبطارية خصيصًا لأصابع قدميك. ستنظف بلطف وأمان تحت أظافرك ويمكنك تمريرها عبر الجزء العلوي من أظافرك أيضًا لتنظيف الأظافر بشكل جميل. فقط تأكد من إبقائها بعيدة عن فرشاة أسنانك الشخصية!”
• تجنب وضع طلاء الأظافر على أظافر القدمين إلا في المناسبات الخاصة – قم بإزالته بعد يوم أو يومين ولا تتركه لأسابيع. الطلاء طويل الأمد يوفر بيئة مثالية للفطريات ويؤدي إلى تصبغ الأظافر وجفافها. كما أنك تقوم بإزالة المكياج كل ليلة – عامل أظافرك بنفس القدر من العناية والنظافة.
• حافظ على تقليم أظافر قدميك قصيرة ومستقيمة، وقم بتلميع الزوايا الحادة.
• لا تقم أبدًا بقص جوانب أظافرك.
• حاول إجراء باديكير منزلي عن طريق استخدام ملف قدم ناعم كل يومين، وحافظ على ترطيب أظافرك (خالية من الطلاء) باستخدام زيت مثل فيتامين E وقصها بشكل قصير ومستقيم. رطب قدميك بكريم قدم يحتوي على اليوريا. دلل نفسك بعلاج سبا منزلي باستخدام حذاء سيليكون مرطب يعادل أي علاج في صالونات التجميل، وارتديه في المنزل لمدة نصف ساعة فقط مساءً.
• قم بزيارة اختصاصي الأقدام للعناية الروتينية بالقدمين كل 3-6 أشهر، بالإضافة إلى حال تعرضك لأي مشاكل في أظافر القدم بعد ممارسة الرياضة.
إذا كنت تعاني من أي ألم في أظافر قدميك، أو إذا بدت مشوهة أو متغيرة اللون أو قد تكون منفصلة عن قاعدة الظفر، حدد موعدًا مع اختصاصي الأقدام. يمكن لاختصاصي الأقدام أيضًا أن يقوم بالصيانة الروتينية لأقدامك لتكملة باديكير المنزل – إزالة النسيج الخشن بطريقة آمنة ومعقمة، تصحيح الأظافر غير المؤلم والكشف المبكر عن أي عدوى أو مشاكل أساسية. أطباء الأقدام المدربون والمعتمدون في مركز دبي للعناية بالأقدام مرخصون من قبل هيئة الصحة في دبي وقادرون على تقييم وتقديم الاستشارة والعلاج لمجموعة واسعة من مشاكل أظافر القدمين، بما في ذلك التفكك الظفري. اتصل بنا على٠٤٣٤٣٥٣٩٠

‘Pes Cavus’ is the medical term used to describe a foot with a high medial long arch. This is the most well known and most visible arch of your foot – there are actually three. The other two are your transverse arch and your lateral arch – you can find out more about those arches here, in an article by Dubai Podiatry Centre’s Chief Podiatrist Michelle Champlin.

Pes literally translates to mean ‘foot’ and ‘cavus’ is exactly as it sounds – your arch forms what looks like a cave, or hollow. This is the biomechanical opposite of a ‘flat foot’ or ‘Pes Planus’. Although much less common than ‘flat feet,’ studies estimate that around 10% of the population have high arched feet.

Pes Cavus – a high arched foot

Signs of Pes Cavus

Typically, people with Pes Cavus foot types can show some or all of the following signs:
• Excess wear pattern on the outside edge of shoes
• Plantar (downward) flexed 1st metatarsal bone
• An ‘adducted’ forefoot – the foot bends inwards, almost banana shaped
• Retracted, or ‘clawed’ toes

What Causes Pes Cavus?
A Podiatrist or Orthopaedic Surgeon is able to distinguish which type of Pes Cavus a person has. A number of factors can contribute to Pes Cavus, according to Chief Podiatrist Michelle Champlin:
• An underlying neuromuscular condition, such as Charcot-Marie-Tooth disease or cerebral palsy
• Due to illness such as poliomyelitis
• Inherited (genetic) high arched foot type
• Previous trauma such as fracture to the foot’s calcaneum or talus bones

Pes Cavus Symptoms

Whatever the underlying cause of a high arched foot type, a person can experience a range of issues, mainly due to the fact that a high arched foot is less able to absorb shock – less of the foot is in contact with the ground, the foot is more rigid and a lot more pressure is placed on the forefoot and metatarsal bones. Due to this, those with high arches can be more at risk of:

• Metatarsal stress fractures or pain
• Lower limb fracture
• Tripping and ankle sprain
• Plantar fasciitis
• Lower back pain
• Knee pain
• Callous build up behind the toes
• Foot / ankle arthritis
• Difficulty finding deep enough shoes to fit – lace up styles tend to be more comfortable
It’s also possible, especially with flexible pes cavus, that there may be no pain or symptoms.

Pes Cavus Treatment

It’s recommended that people with high arches and experiencing symptoms see a qualified biomechanics Podiatrist for a full assessment, diagnosis and treatment. Treatment will seek to address the underlying cause. Custom orthotics, made specifically for the person’s feet, will offload and re-distribute too much weight away from the forefoot and metatarsals.

The Podiatrist will also be able to advise on specific footwear and brands for each foot type, so that custom orthotics only a few millimeters thick can be worn discretely within work, sports or school shoes. Your Podiatrist will also be able to advise on muscle strengthening and stretching to improve foot and ankle posture, flexibility and balance. She will also be able to safely and painlessly remove any corns or callous that high-arched feet can be prone to develop, especially behind the toes or on the top of toes. If appropriate, she may also make custom toe props to correct toe alignment and provide protective gel toe sleeves for wearing in your shoes.

Contact the foot and leg experts at Dubai Podiatry Centre if you, or your child, trips a lot or is ‘clumsy’, has difficulty finding shoes to fit, shows a lot of wear on the outside edge of shoes or has any form of foot pain.

Foot pain should always be investigated and at Dubai Podiatry Centre, we’re here to help just that – contact us on +971 4 3435390.

بيس كافوس – الأقواس العالية

بيس كافوس هو المصطلح الطبي الذي يُستخدم لوصف القدم ذات القوس الطولي الأوسط المرتفع. هذا هو القوس الأكثر شهرة ووضوحًا في قدمك – في الواقع هناك ثلاثة أقواس في القدم. الأقواس الأخرى هي القوس العرضي والقوس الجانبي – يمكنك معرفة المزيد عن هذه الأقواس من خلال مقال لميشيل شامبلين، أخصائية الأقدام الرئيسية في مركز دبي للعناية بالأقدام.
كلمة بيس تعني حرفيًا “القدم” وكافوس تعني كما يبدو تمامًا – حيث يشكل قوس قدمك ما يشبه الكهف أو التجويف. هذا هو العكس البيوميكانيكي لما يُعرف بـ “القدم المسطحة” أو Pes Planus. وعلى الرغم من أن القدم المرتفعة أقل شيوعًا من القدم المسطحة، إلا أن الدراسات تشير إلى أن حوالي ١٠% من السكان يعانون من أقدام ذات قوس مرتفع.
بيس كافوس – القدم ذات القوس المرتفع
علامات بيس كافوس
عادةً ما يظهر الأشخاص الذين يعانون من نوع القدم Pes Cavus بعض أو كل العلامات التالية:
• نمط التآكل الزائد على الحافة الخارجية للأحذية.
• انثناء (توجه لأسفل) لعظم المشط الأول.
• انحراف القدم للأمام (إصبع القدم مائل إلى الداخل)، بحيث تصبح القدم شبه شكل الموز.
• أصابع القدم المنسحبة أو “المقوسة”.
ما الذي يسبب بيس كافوس ؟
يمكن لأخصائي الأقدام أو جراح العظام تحديد نوع بيس كافوس الذي يعاني منه الشخص. هناك العديد من العوامل التي قد تسهم في الإصابة بـ بيس كافوس وفقًا لميشيل شامبلين، أخصائية الأقدام الرئيسية:
• حالة عصبية عضلية أساسية، مثل مرض شاركوت-ماري-توث أو الشلل الدماغي.
• نتيجة مرض مثل شلل الأطفال.
• نوع القدم المرتفعة الموروثة (الوراثية).
• إصابة سابقة مثل كسر في عظام الكعب أو عظم الكاحل.
أعراض بيس كافوس
بغض النظر عن السبب الكامن وراء نوع القدم المرتفعة، يمكن أن يعاني الشخص من مجموعة من المشاكل، ويرجع ذلك أساسًا إلى أن القدم ذات القوس المرتفع أقل قدرة على امتصاص الصدمات – حيث أن جزءًا أقل من القدم يلامس الأرض، مما يجعل القدم أكثر صلابة، وبالتالي يُوضع ضغط أكبر على أصابع القدم والعظام المشطية. نتيجة لذلك، فإن الأشخاص الذين لديهم أقدام مرتفعة قد يكونون أكثر عرضة للإصابة بـ:
• كسور الضغط في العظام المشطية أو ألم.
• كسور في الأطراف السفلية.
• التراخي أو التواء الكاحل.
• التهاب اللفافة الأخمصية.
• آلام أسفل الظهر.
• آلام في الركبة.
• تراكم الجلد الخشن (الكالو) خلف الأصابع.
• التهاب المفاصل في القدم أو الكاحل.
• صعوبة في العثور على أحذية ذات عمق كافٍ لتناسب القدم – غالبًا ما تكون الأحذية ذات الأربطة أكثر راحة. من الممكن أيضًا، خاصة في حالة بيس كافوس المرن، ألا يكون هناك أي ألم أو أعراض.
علاج بيس كافوس
يوصى بأن الأشخاص الذين يعانون من أقدام مرتفعة ويعانون من أعراض أن يستشيروا أخصائي أقدام مؤهل لإجراء تقييم كامل وتشخيص وعلاج. سيكون العلاج موجهًا لمعالجة السبب الكامن. يمكن أن تساعد الأجهزة التقويمية المخصصة، التي تُصنع خصيصًا لقدم الشخص، في توزيع الوزن الزائد عن الأصابع والعظام المشطية.
سوف يتمكن أخصائي الأقدام أيضًا من تقديم نصائح بشأن الأحذية المناسبة والعلامات التجارية المناسبة لكل نوع قدم، بحيث يمكن ارتداء الأجهزة التقويمية التي لا يزيد سمكها عن بضع مليمترات داخل الأحذية الخاصة بالعمل أو الرياضة أو المدرسة بشكل مريح. كما يمكن لأخصائي الأقدام تقديم نصائح بشأن تقوية العضلات والتمدد لتحسين وضع القدم والكاحل والمرونة والتوازن. بالإضافة إلى ذلك، يمكنها إزالة أي مسامير أو كالو قد تتطور على الأقدام ذات القوس المرتفع، خاصة خلف الأصابع أو على رأس الأصابع بشكل آمن وغير مؤلم. إذا كان ذلك مناسبًا، قد تصنع أيضًا دعامات أصابع مخصصة لتصحيح محاذاة الأصابع وتوفير أغطية جل لحماية الأصابع عند ارتداء الأحذية.
اتصل بخبراء الأقدام والأرجل في مركز دبي للعناية بالأقدام إذا كنت، أو طفلك، تعاني من كثرة التراخي أو صعوبة في العثور على أحذية ملائمة أو إذا كان هناك تآكل واضح على الحافة الخارجية للأحذية أو إذا كنت تعاني من أي نوع من آلام القدم.
يجب دائمًا التحقيق في أي آلام في القدم، وفي مركز دبي للعناية بالأقدام، نحن هنا للمساعدة في ذلك – اتصل بنا على ٠٤٣٤٣٥٣٩٠.

Written by Michelle Champlin BSc Pod., M.Ch.S., S.R., Ch., (UK)
What is Ankle Equinus?
Your ankle is a ‘hinge’ joint that is designed to move in only two directions: foot up (dorsiflexion) and foot down (plantar flexion). You’ll notice when you point your toes up and then down that your foot has much more range downwards than it does upwards. Normal range of motion is about 20° when pointing toes up and more when pointed down – about 50°.
Ankle equinus is the term used to describe reduced range of upwards motion, or dorsiflexion, in the ankle. It can occur in one or both ankles and to various degrees. Chief Podiatrist Michelle Champlin explains “The term ‘equinus’ was borrowed from horses – equine – whose feet are plantar flexed and essentially walking on their toes.”
What are the signs?
People will not tend to know that they have ankle equinus. Instead, they tend to visit a Podiatrist or Doctor complaining of other foot, ankle or leg problems. At Dubai Podiatry Centre, we thoroughly assess patients for any underlying biomechanical causes in order to thoroughly treat and address the root cause.
Patients with ankle equinus will commonly compensate (or alter) for the reduced upwards flexibility or motion of their ankle joint, without realizing it when they are walking or running. This ‘compensation’ in walking style often results in other foot, leg or back problems.
Heel strike with your toes pointing up off the ground is the first part of how we take a step when walking. With reduced ability to point the toe up, this means that people with ankle equinus may:
• Be prone to toe walking
• Pick the heel up early when walking
• Bend abnormally at the hip or knee when walking
• Have flattened foot arches
Causes of Ankle Equinus
• Tight Achilles tendon
• Tight calf muscle(s) – the solus and/or gastrocnemius
This tightness can be
• Inherited (congenital)
• Acquired due to injury – especially after being in a cast or on crutches
• Bone fragments from an old ankle break can block or adversely affect full range of motion
• Excessive use of high heels (Dolly Parton famously cannot walk without high heels due to overuse and tightness of the Achilles)
• Diabetes – can cause tightness of the Achilles
• Due to a significant leg length discrepancy
• As a result of an underlying neurological disorder
Ankle Equinus can result in other foot and leg issues, largely due to the ‘compensation’ when walking as other muscles, tendons and ligaments change how and when they move to help walking:
• Plantar fasciitis
• Achilles tendonitis
• Metatarsalgia
• Bunions
• Hammertoes
• Callous or sores on the forefoot (behind the toes)
• Ankle pain
• Shin splints
• Collapsed medial long arch of the foot
• Calf muscle cramps
Treatment for Ankle Equinus
When you see your Podiatrist, most likely for one or more of the above symptoms, she will identify a reduced range of motion in the ankle and diagnose ankle equinus, if that’s the underlying cause. There are many other causes of any of the issues above, so it’s important to see a qualified, reputable biomechanics Podiatrist for a thorough and specialized lower limb assessment and diagnosis as well as appropriate treatment.
Treatment to address ankle equinus will aim to address the muscle / tendon imbalance and tightness, as well as the resultant increased pressure on your forefoot. Depending on each person, this may include heel lifts to reduce strain at the back of the heel / calf, custom orthotics to redistribute pressure from the forefoot and correct foot posture and gait. A custom orthotic will be designed to control your foot motion when walking or running and you’ll normally be asked to return to the Podiatrist for review to check on your progress. The Podiatrist can also advise on stretching exercises for your calf muscles. In some cases, Chief Podiatrist Michelle Champlin says “you may be referred to a specialist foot and ankle surgeon in cases where the equinus is due to bone fragments, for example.”
If you are concerned about stiffness in your ankle joint, or pain in your legs or feet, contact the UAE’s leading foot and leg specialists, Dubai Podiatry Centre, on +971 4 3435390.

Written by Michelle Champlin BSc Pod., M.Ch.S., S.R., Ch., (UK)

What is a verruca?

A verruca is a skin infection commonly on the feet or hands and is caused by a virus. Also sometimes called a plantar wart, they are caused by the human papilloma virus. The virus causes your skin to produce excess keratin, a hard protein that helps build your skin, nails and hair.

Michelle Champlin, Chief Podiatrist at Dubai Podiatry Centre explains, “Depending where the verruca is on your foot, it will either stick out, causing a bump or remain pushed into your skin. If it’s on an area that you stand on – your heel or ball of your foot for example – it’s likely to be pressed into your skin. It’s more likely to stick out on the arch of your foot for example, or your fingers or toes, as they aren’t being pressed in when you stand.”

How do you catch a verruca?

The virus enters your body through even invisible scratches, cracks or abrasions in your skin. It survives best in moist areas, such as poolside, shower trays and damp towels. You can also catch it through direct skin-to-skin contact. It is not uncommon for us to see a person with a verruca on their foot then report that it has spread to their fingers, from picking at or touching the verruca.

Warts are much more likely to affect children and young people.

Are verrucas painful?

Whether a verruca is painful or not mainly depends on where it is on your body. Mrs. Champlin advises “If it’s on an area that takes weight – such as your heel – it’s more likely to cause discomfort when you’re standing or walking, just like a corn in the same area would or even a little stone in your shoe.” On areas such as your finger, it can be painful or bleed if you catch it on an object.

Will a verruca go away on its own?

Some verrucas do go away on their own, in time. It will depend on the person’s immune system. However, it is not uncommon for patients to report that they have had a verruca for ten years or more.

 

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Verruca

What does a verruca look like?

Sometimes people will confuse a wart from a ‘corn’ but they are two very different things, with different causes and treatments. It’s important to get the right diagnosis and treatment – a Podiatrist is very used to dealing with both corns and verrucas every day and can easily distinguish between the two and explain how, as well as what to do to treat it.

A verruca is caused by a virus, whereas a corn is build up of hard skin due to excess pressure on an area of skin – from friction in shoes on top of your toes, or maybe in the middle of your forefoot from pinched skin, due to a collapsed transverse arch. So corns can be traced back to constant friction from an outside force, such as tight shoes, or a biomechanical problem in your feet such as collapsed arches or retracted toes. Therefore – you can catch a verruca; you can’t ‘catch’ a corn. (Your Podiatrist can safely and painlessly remove a corn, identify what caused it, and how to help stop it from coming back, from footwear choices to protective toe sleeves or custom orthotics).

A verruca (plantar wart) on your foot can:

• Look either raised or flat and be pale/white
• Have one or more tiny black ‘dots’ in the centre (these are blood vessels)
• Be painful when you stand on them or squeeze them.

Another type of wart (verruca vulgaris) is more common on your knees, fingers etc. and can be:

• Hard and raised
• Rough and misshaped, almost like a ‘cauliflower’
• Less than a few millimeters to the size of a dirham coin
• One or many grouped together

Other types of warts include ‘plane warts’ that tend to occur on the legs and be more yellowish, smooth and flat. Another type of wart we see in the clinic are ‘periungal’ warts that occur under or around the nails of the fingers or toes. They are quite rough, and can affect the shape of the nail, causing discomfort. Mosaic warts tend to grow on the palms of the hands or soles of the feet. They grow in groups, or clusters, and have a ‘tile’ like pattern.

 

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Verruca Treatments

Verrucas sometimes go away on their own. However, if it spreading, becoming painful or causing you embarrassment, you can have it treated.

It’s important to note that because a verruca is caused by a virus, no virus of any sort can be killed by any medicine. What any verruca treatment tends to do is harm the verruca site, to trigger your body’s immune system into recognizing the virus and attacking it. Podiatrists can also safely reduce the hard skin over the site to make it less painful to walk on, but this doesn’t remove the virus and the hard skin will build up again if left untreated.

Older treatment options included:

• Cryotherapy
• Salicylic acid
• Homeopathic treatments (thuja)

Dubai Podiatry Centre is renowned for research and innovation in the field of foot, toe and nail health. The clinic has moved on from treatments such as salicylic acid or cryotherapy, due to their relative ineffectiveness.

Cryotherapy can be quite painful for the patient, as the skin is basically being ‘burned.’ It tends to require quite a few follow up visits over many months – sometimes 10 or 12 sessions.

Salicylic acid, whiter painted on or in a plaster, can also burn healthy skin and tissue outside of the verruca site, causing healthy skin to become ‘macerated’ – soft, tender and mushy. No further or alternative treatment can take place if a site is macerated, infected or damaged and this must be left to heal before reviewing for any other treatment strategy.

Cryotherapy is not recommended for children, as it can be too painful and distressing. If after 12 weeks of cryotherapy the verruca has not gone away, it is unlikely to be successful and therefore should be discontinued. Treating verrucas under or near nails requires extra care and expertise, so that the nail growth is not damaged – cryotherapy should be avoided in these areas.

Dubai Podiatry Centre specializes in difficult to treat foot and nail problems, especially verrucas that have not responded to other treatments such as salicylic acid or cryotherapy.

Latest Treatment

Sometimes, your Podiatrist may recommend a short course of specific, targeted Vitamin therapy prior to and during verruca treatment, which can aid the body’s healing process and address any vitamin deficiency that can contribute to the body’s reduced immune response.

Dubai Podiatry Centre recommends the latest in verruca therapy – Dermojet. This is a needle-less device that looks like a steel pen, which discharges a range of medicines depending on what it is being used to treat. It is sometimes, for example, used by Doctors to administer vaccines virtually pain free and quickly.

Dermojet can also be used to specifically target specialized areas such as small verrucas on the feet and has been adapted for use by Dermatologists in treating a range of skin conditions. It only takes a few seconds, is sterile and has proven highly effective in the fight against verrucas, with generally only one follow up visit required to either deliver a ‘top up’ treatment or to check that the verruca is gone and discharge the patient.

 

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Caution

It is very important that verrucas should never be surgically removed or ‘cut out’. Not only is this in an ineffective way to tackle a virus, this can lead to long term issues that are far more problematic than the original verruca – particularly scar tissue on weight bearing area of your feet, which can cause ongoing pain and require long term scar reduction therapy.

Also, if you are pregnant, trying to get pregnant or breast-feeding, leave the verruca alone. If it’s painful, see a qualified, licensed Podiatrist, such as at Dubai Podiatry Centre, to safely reduce the hard skin of the verruca to reduce pain when walking or standing on it. You can also seek advice from your midwife or obstetrician.

Avoid catching / spreading verrucas

• Do not touch or pick at your (or anyone’s) wart – this is a great way to spread it! Wash your hands thoroughly straight away if you forget.
• Do not share towels, shoes or socks.
• Wear flip-flops around the pool and in shared shower / changing areas.
• Avoid pedicures or manicures in salons if you have a wart or verruca on your hands or feet to avoid spreading it to the pedicurist’s hands or to other customers through contaminated instruments.
• Only attend accredited salons that have been inspected for hygiene standards and which properly sterilize and autoclave instruments between customers.
• Avoid sharing razors or waxing/sugaring materials as these can harbor the virus and introduce it into tiny cuts or breaks in your skin when removing hair.
• Follow a good daily foot care regime – dry skin is more prone to crack and allow in infections such as viruses. File feet to keep hard skin at bay, moisturize with a urea-based foot cream and try silicone gel based moisturizing socks around the house for baby soft feet.

 

If you think you, your child or partner has a verruca, contact the UK qualified Podiatrists at Dubai Podiatry Centre on +971 4 3435390 or book an appointment online (click here).

Written by Michelle Champlin BSc Pod., M.Ch.S., S.R., Ch., (UK)

What is gout?

Gout is a medical condition caused by increased levels of uric acid in the bloodstream. The uric acid crystallizes, and these crystals then collect in joints, tendons and surrounding soft tissue. Gout has been called the ‘disease of kings’ due to its association with a rich diet. King Henry VIII of England was a well-known sufferer.

The joint at the ball of the big toe – the metatarso-phalangeal joint (MTP joint) – is most commonly affected. Gout results in recurrent painful ‘flare-ups’ of inflammatory arthritis. The affected joint, in over 50% of cases at your big toe, becomes hot, swollen and tender. However, other joints such as the heels, knees, wrists and fingers can be affected.

Gout is unfortunately becoming more common, with 1-2% of the population being affected. This increase may be due to:
• Longer life expectancy
• Dietary changes
• Increase in metabolic syndromes (such as hypertension, diabetes)

People with gout frequently have other conditions such as high blood pressure, diabetes and heart disease. It’s therefore important to see your GP as soon as you suspect you may have gout. They will carry out necessary diagnostic tests, recommend a course of short-term medication to alleviate and advise on longer term dietary and lifestyle changes to control the gout as well as any other co-existing conditions such as diabetes.

Symptoms

• Pain usually worse at night (due to the body’s lower temperature)
• Long-term gout can cause permanent hard, painless deposits of crystals at the joints, called tophi
• Tophi can result in damage to the bones – arthritis
• Crystals collecting in the kidneys can cause kidney problems, including kidney stones

 

Causes of Gout

• Lifestyle (including diet rich in seafood, alcohol, fructose-sweetened drinks, meat)
• Physical trauma / surgery
• Genetics
• Under-excretion of urea by the kidneys

Gout is confirmed by a test at your GP – the characteristic uric acid crystals will be visible in your joint fluid. X-rays can be helpful in someone with chronic gout.

Gout Treatment

During an acute attack, treatment tends to consist of:
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Steroids
• Colchicine

Long term, gout is controlled by diet and lifestyle changes. Consuming coffee, Vitamin C and dairy products are understood to lower the risk. Being more active and increasing your fitness also helps. Aim to lose weight if you’re overweight. Avoid fructose based drinks and other food triggers such as alcohol (especially beer and spirits), meat and seafood.

If you do experience pain to your big toe joint, or any area of your foot or leg, you can also make an appointment with the expert Podiatrists at Dubai Podiatry Centre on +971 4 3435390. Your Podiatrist can also rule out any other issues that can appear similar to gout, even biomechanics issues causing big toe pain such as hallux rigidus or bunions. If necessary, they can also refer you to an appropriate specialist, such as a rheumatologist, your GP or an orthopaedic surgeon, depending on diagnosis, investigation and treatment required.

Written by Michelle Champlin BSc Pod., M.Ch.S., S.R., Ch., (UK)

Find out what our feet have in common with frogs
• It’s normal for baby feet and legs to bow inwards – this is because of how they are lying in the womb
• All babies have ‘flat feet’ with fatty padding where their arch will eventually form
• Arches start to form at about 2½ years old
• By 12 years old, a child’s foot is about 90% of its adult size
• That foot-measuring device in kids shoe shops? It’s called a Brannock Device, after its inventor
• Average clothes sizes are getting bigger – and so are shoe sizes! Shoe sizes are up by one full size compared to 30 years ago
• About 35% of us underestimate our shoe size (and are wearing the wrong size – here’s our tips on sizing work shoes)
• Toenails grow about 1mm per month – but they speed up during teenage years, pregnancy and in hot climates like Dubai
• Louise Hollis of California holds the world record for the longest toenails – 6 inches long!
• Toenails can tell your Podiatrist if you’re anaemic (indentations), have psoriasis (pitted) or have decreased blood circulation (hairless toes)
• In 2008, 25 year old Jessica Cox of Arizona who was born without arms, became the first person to pass her pilot’s license by using her feet at the controls
• The palms of your hands and soles of your feet have the thickest skin on your body
• A third of all the bones in your body are in your feet (26 in each foot)
• Each foot has 33 joints, 19 muscles, 10 tendons and 107 ligaments (and your Podiatrist at Dubai Podiatry Centre knows what each of them are, how they should work and how to fix them!)
• Humans are plantigrades – walking on the entire surface of their feet. Just like alligators, bears and frogs. Digitigrades walk on their toes – like horses, dogs, cats and birds
• There has never been a ‘centipede’ found that actually has 100 feet
• Rock climbers know all about ‘Elvis foot’ – where your feet and legs shake on a rock hold from muscle fatigue. All shook up….
• Elephants use their feet to hear – picking up ground vibrations
• Butterflies taste with their feet
• When you run, the force through your feet can be 3-4 times your body weight
• Smoking cigarettes can harm your feet – causing peripheral vascular disease with problems healing, poor circulation, even ulcers and gangrene
• The 250,000 sweat glands in your feet produce about half a pint of sweat daily
• Ancient Romans were the first to make different shoes for the left and right foot – before that shoes were interchangeable
• King Edward II of England invented shoe sizes that we still use today. In 1324, he stated that he diameter of a barley corn (1/3 inch) would equal one shoe size
• There are an estimated one trillion (1,000,000,000,000!) bacteria on each foot – it’s bacteria breaking down sweat that can cause smelly feet.
The best source for foot facts and healthcare tips are your expert Podiatrists at Dubai Podiatry Centre, led by Chief Podiatrist Michelle Champlin. Contact the UAE’s leading foot and leg clinic on +971 4 3435390 for every foot problem: from kids’ feet, to flat feet, verrucas and ingrown toenails

Written by Michelle Champlin BSc Pod., M.Ch.S., S.R., Ch., (UK)

Osteoarthritis in the knee joint
Osteoarthritis is a condition affecting the joints of our bones, where the surfaces of the bone become damaged over time and don’t move quite as smoothly, or to the full range, that they should.
The protective covering of our joints is cartilage and this can become thinner and rougher as we age. Osteoarthritis is a fairly normal part of the aging process, which is why it’s also sometimes called ‘degenerative joint disease’ or even just ‘wear and tear.’
As the cartilage covering the joints become thinner and rougher, other tissues in your joints may try to help repair the area. The bones at the edge of the joint may grow outwards, creating ‘spurs’ or osteophytes. The joint capsule containing ‘synovial fluid’ may become enlarged, causing the joint to appear swollen. The ligaments that surround every joint in your body and help to stabilize and control its movement can thicken and contract, as they help the joint stabilize.
Symptoms
Mostly, the body copes with most osteoarthritic changes with no problems or symptoms – we all will develop some degree of joint wear and tear as we get older. It tends to be as the damage gets more severe that you may notice symptoms, although some people with relatively ‘minor’ appearing damage on x-rays can experience great pain advises Chief Podiatrist Michelle Champlin. Symptoms can be similar to rheumatoid arthritis. Symptoms include:
• Pain at the joint(s) – tends to be worse when you move it or at the end of the day
• Stiffness – you may feel more stiff after resting, easing as you move
• A grating or crunching sound in your joints – called ‘crepitus’
• Swelling around the joint(s) – either soft (from the fluid build up) or hard (from the bony spurs)
• Reduced range of motion in the joint – all of our joints are designed to move in certain specific directions and within a certain maximum angle each way. For example, the knee is a hinge joint designed to extend (calf to hamstring) and flex (straighten the leg out). It is the body’s biggest joint and also the joint most commonly affected by arthritis. You may notice you can’t bend a joint as far as you used to.
Risk Factors
There are certain things that can increase the risk of developing arthritis, make it worse or cause it to develop earlier. These include:
• Excess bodyweight (places more force through the weight bearing joints, such as knees and ankles)
• Hereditary / genetic
• Previous injury or trauma to the joint
• Muscle weakness
• Biomechanical misalignment – musculo-skeletal imbalances in how we walk or run. Most commonly, people over-pronate which is likely to cause increased forces through the medial (inside) of the foot and leg joints. On the other hand, supinators are likely to have increased force through the lateral (outside) of their foot and leg joints. Both supinators and over-pronators are at higher risk of arthritic damage to their ankle, knee and hip joints.
Treatment
Your Doctor may refer you to a Podiatrist for a full biomechanical lower limb assessment to diagnose any contributing misalignment, and to make your own discrete orthotics to wear within your work or casual shoes. Alternatively, you can present straight to the foot and leg experts at Dubai Podiatry Centre without a doctor’s referral (unless your health insurance requires it). Custom orthotics re-distribute the weight and forces through your feet, legs and hips without any conscious effort from you, tightening and toning muscles that have been previously underused, such as raising the arch of your foot if you have fallen arches (sometimes called ‘flat feet’).
If you are experiencing pain or any of the symptoms described above in any of your joints – hip, knee, ankle or toes, make an appointment with your Podiatrist or Doctor. They will be able to diagnose osteoarthritis and rule out any other conditions that can have similar symptoms, such as rheumatoid arthritis, hallux rigidus (of your big toe), stress fractures, runners knee or gout. Joint pain in children, such as knee pain, should always be investigated with your Paediatric Orthopaedic specialist or Podiatrist, to rule out rheumatoid arthritis, Severs Disease and other possible causes of joint pain in children.
Custom corrective foot orthotics, prescribed and made by competent and experienced biomechanics Podiatrists such as the team at Dubai Podiatry Centre can reduce osteoarthritic damage, alleviate pain and increase activity levels by correcting the biomechanical alignment.
It is important that all children are checked at school age for any foot/leg biomechanical anomaly as a matter of routine, to correct any issue that may damage their joints in later years if left untreated. Your Paediatrician or Podiatrist will be glad to carry out this routine screening.
Contact the team at Dubai Podiatry Centre today on +971 4 3435390 to start on the road to recovery, or to have a kid’s foot and leg screening.

Written by Michelle Champlin BSc Pod., M.Ch.S., S.R., Ch., (UK)
What is ‘Tarsal Tunnel Syndrome’?
The ‘tarsal tunnel’ is the canal between one of your ankle joint bones and a special band of ligaments that stretch across your foot. The ankle bone involved is called the medial malleolus – that’s the bone that sticks out on the inside of your ankle. The band of ligaments is called the ‘flexor retinaculum’ – also known as the internal annular ligament. It’s a strong band of fibres that extends from the malleolus at the tibia bone to the calcaneus (heel bone). It encloses the tendons of the muscles that help your foot to flex, as well as blood vessels and nerves for your tibia. This important tunnel holds the nerves, blood supply and tendons that control the foot’s movement and flexibility.
Tarsal tunnel syndrome is the ankle equivalent of ‘carpal tunnel syndrome’ which is caused by compressed nerves in the wrist joint.
Symptoms
The main nerve contained in the tunnel is the tibia nerve. This nerve’s job is to provide the feeling, or sensation, for the sole of your foot. When this nerve gets compressed, this can lead to:
• Tingling
• Numbness
• Burning sensation or pain
usually along the sole of the foot or inside of the ankle. Symptoms may come and go, getting worse after long periods of standing or walking. Symptoms can go beyond just the one ankle area, to reach the toes, heel or even calf area.
Causes
Tarsal tunnel syndrome results from a compressed tibia nerve, so anything that compresses or squeezes this nerve can cause it:
• Flat feet – whether over-pronation or pes planus. The biomechanical malalignment from a fallen long arch in your foot causes your heel bone to tilt out, in turn putting pressure on the tarsal tunnel.
• Pressure on the area from a varicose vein, cyst, ganglion, swollen tendon or osteoarthritic bone spur.
• Injury such as an ankle sprain causing swelling and pressure on the nerve
• Diabetes or arthritis – related swelling at your ankle joints / lower limbs
Diagnosis & Treatment
See your Podiatrist if you experience any of the symptoms above. (S)he will carry out a number of tests as part of a complex lower limb assessment to test your nerve function and any sensation problems. (S)he will be able to differentiate between any other ailments and distinguish the underlying cause.
Treatment will depend on the underlying cause of the compressed nerve. Usually, non-surgical treatment will resolve it, including:
• Rest – limit your activity until the Podiatrist gives you the all clear
• Ice – protect the skin with a damp towel and ice for 20 minutes, allowing 40 minute breaks between icing
• NSAID painkillers
• Custom orthotics have proven especially effective where an underlying biomechanical issue is the cause. By correcting the over-pronation, or lifting the collapsed arch for example, the heel bone will be aligned correctly with the rest of the bones of the foot and ankle to maintain correct posture. This alleviates pressure on the tibia nerve.
• Sometimes, surgery may be recommended and your Podiatrist can refer you to the correct specialist orthopaedic surgeons who specialise in feet and ankle surgery, whether here in the UAE or abroad.
Chief Podiatrist Michelle Champlin of Dubai Podiatry Centre says, “I’ve seen quite a few cases of tarsal tunnel syndrome linked with biomechanical causes here in Dubai, possibly due to the number of patients with collapsed arches that we treat. The symptoms of tarsal tunnel syndrome can be very worrying for patients, and we work pro-actively with the patient to resolve these as soon as possible.”
If you are worried about any new or different sensation in your feet contact the UK trained Podiatrists at Dubai Podiatry Centre on +971 4 3435390. If you are diabetic, remember to see your Podiatrist at least every year for your annual foot sensation tests too as part of your diabetic assessment