Introduction Podiatry Singapore
The field of podiatry is relatively new in Asia. Being based in Singapore, where podiatry has been present for less than 20 years, many medical practitioners are still unaware of what podiatry is, and how it can help treat lower limb injuries.
Podiatry can be divided into 3 broad fields - Diabetic foot care, General care and Biomechanics.
When treating lower limb issues, a holistic approach is preferred to ensure an effective recovery. All too often, it is too easy to target the affected area without paying any attention to any of the factors that led up to the injury. The vast majority of us are born with healthy functional bodies, but yet by the time we reach middle age, a lot of us are bruised and battered.
Many patients has walked through the door complaining of pain, and placing the blame squarely on age.
But is this really the case? - Introduction Podiatry Singapore
Despite the protests of many patients, bunions and arthritic knees do not magically appear overnight. Many factors must be considered. If risks were identified earlier on, the need for surgery can be offset. When diagnosing an injury, the following factors play a part in building up the cause of the injury: - age, gender, race, profession, weight, footwear, social and family
history. The risk factors to the typical housewife will be vastly different to those of a triathlete.
Therefore it is not appropriate to apply the same treatment plan to the two individuals even if the injury is the same, as the needs of the patient will vary from person to person.
Coming from New Zealand, the majority of lower limb injury referrals are often casual walk in patients. Podiatry is well established and people are aware that they can see a podiatrist for non-invasive treatment of their injury. If need be, further specialists, such as an orthopedic surgeon can be involved if the injury is not recovering as expected. The same rule applies to physiotherapy.
However in Singapore, the opposite is true. Often patients are referred post surgery by orthopedic surgeons for supportive footwear and orthoses. Patients are generally not aware of their options, so the typical referral process for persistent injuries is from general practitioner to specialist (sports or orthopedic doctor) and then to rehabilitation (physiotherapy and/or podiatry).
Due to this lack of awareness, rehabilitation is the last step when ideally it should be the first step, as by the time the patient is seen, it has been months, if not years since the onset of the injury. Early intervention can greatly reduce the need for surgery as well as the identification and treatment of contributing factors.
For a patient with persistent lower limb pain, footwear, rest, stretches/exercises therapy, taping and orthoses is recommended. And always in that order. The patient is often referred to a physiotherapist for the stretching/exercise component, as patients with heel pain often present with lower limb muscle imbalances that need to be addressed if the patient is to remain injury free.
The causes of lower limb injuries are multitudinal, but the common thread is the over-loading of joints and muscles. To combat this mechanical means is used to offload the affected areas. Our feet are the first thing to touch the ground. They support our body weight and propel us during gait. They are the body's foundation, and if there are problems with these foundations, problems can manifest themselves not only in the feet, but all the way up to the lower back.
Thinking about the way we walk - Introduction Podiatry Singapore
Think of it this way. How many times have we walked, stepped off a curb and thought nothing of it? But what happens when our foot misses the curb and lands awkwardly? Often the resultant pain seems out of proportion to the action that has just occurred. So if the foot strikes the ground incorrectly during gait, it seems logical that pain will occur, no matter how slight the infraction.
Combine the thousands of steps we take daily, add in risk factors such as poor quality footwear, age, body weight, joint mobility and we can begin to see how injuries begin to formulate.
Of course everyone is different, and the same rule cannot be applied to all. But one easily modifiable risk factor is footwear. Being a tropical country, people in Singapore tend to wear lightweight shoes, that typically provide minimal support. Recent arrivals to Singapore from colder climes often find their feet hurting. Switching from enclosed firm shorts to soft flexible sandals
is usually enough to overload the soft tissues of the foot. Try walking along the beach in wet sand. It feels nice and relaxing initially, but after ten to twenty minutes, it unsurprisingly becomes tiring.
Does what we walk in matters? - Introduction Podiatry Singapore
Look at your feet. You'll see them pronating and supinating excessively. Now try walking on the pavement or grass. It is a lot easier walking on a firm surface. Our feet work more efficiently on a firm surface. And if our gait is more efficient, then muscles are not being stressed to the point of injury. Try walking in a pair of flip flops for half a day and then try walking in a sports shoes for half a day.
Patients always report that it is much more comfortable when using sports shoes. There is no hard and fast rule when choosing shoes, as there is a bewildering array of choices that often leaves patients confused. Just as long as the shoe has a good level of support, it will help with efficient gait. As sport shoes are not deemed acceptable at a business meeting, it
is about the appropriate shoe for the occasion.
Flip flops vs Sports Shoes - Introduction Podiatry Singapore
Try bending a flip flop in half and side to side. Contrast that to a reputably branded sports shoe. The sports shoe will be noticeably firmer. Whether for work, leisure or play, a good shoe will have a level of support and rigidity similar to that of a sports shoe. After recommending proper shoes, a suitable period of rest and stretches/exercises, the foot is taped to offload affected areas. The low-dye method with a semi rigid sports tape is utilised. This method is quick and easy, and also be performed with ease by patients themselves. Taping the foot provides increased organic stability.
The majority of injuries seen are from overuse, such as plantar fasciitis, posterior tibial tendon dysfunction and achilles tendinopathy. Rigidity allows the foot to function more efficiently, which in turn provides relief to injured areas. This method can also provide relief to other areas apart from the foot. For example a dancer presented with knee pain secondary to pes planus.
Does taping help? - Introduction Podiatry Singapore
To provide relief her trainer had taped her knees, which whilst effective, gave discomfort due to it being overly constrictive. After taping her feet, she found not only that she could move more efficiently, she no longer needed to tape her knees.
If pain still persists, then orthoses will be considered to be of benefit to the patient. As with shoes, there are a multitude of brands and styles of orthotics available. Orthoses by nature should be supportive, comfortable and above all practical. If the orthotic fails to meet any of these requirements, then the patient will stop using it, and quite probably stop seeking a podiatrist's
Insoles and orthoses - Introduction Podiatry Singapore
Older designs typically have a firm high arch, with minimal heel support. Newer methodology dictates less arch support but with increased heel support. By supporting the heel, arch height can also be dictated. Grab a heel, invert it, and see what happens. One of the biggest complaints with orthoses is the arch is too high, akin to walking with a stone in your shoe.
Newer designs negate this issue. Custom semi rigid orthoses is preferred, as these contour well to the patients foot and provide a high level of support, all the while remaining comfortable inside whatever shoe the patient is wearing. If the patient cannot afford custom orthoses, then an over the counter orthoses made from EVA foam will at least provide an extra level of support not afforded by footwear alone. Good examples of these would be either vasyli, formthotic, e-thotic or bauerfiend brands of orthoses.
If the patient is still not recovering, a physiotherapist will be consulted with, and if necessary, a foot and ankle surgeon (or orthopedic surgeon) as well, to provide further treatment options. By focusing on the body as a whole, and not the feet alone, the patient will have a greater chance of a speedy recovery. For example, by applying this mantra to an overweight patient with foot in, not only would supportive footwear and orthoses be provided, but a dietitian and physiotherapist would be involved to help manage ight loss for a better chance of injury recovery and prevention.