Month: June 2020

A problem with the plantar plate is something that often accompanies a bunion. The plantar plate is a strong ligament under the metatarsal heads and can often be strained or have a small tear. It most commonly is beneath the base of the second toe.

The symptoms are typically underneath and just distal to the joint at the base of the toe. It is painful both on weightbearing and on palpation. One somewhat weird sensation that many describe is that it can feel like the sock is scrunched up under the ball of the foot, but when they check its not.

The best conservative treatment for a plantar plate tear is strapping or the Fix Toe device to hold the toe so that dorsiflexion is limited. This needs to be worn for a period of time to allow the strained or torn plantar plate to heel. Sometime a rocker shoe is also helpful for this to prevent the toe from bending too much while walking. If this is not successful, then a surgical repair is often indicated.

Severs disease is a relatively common problem of the heel bone in children. However, there is plenty of discussions if it should be called Severs Disease or Calcaneal apophysitis. There is quite a trend away from the term ‘Severs disease’ as it not a disease and it is no longer appropriate to consider conditions named after people. The medical term of calcaneal apophysitis is probably more appropriate.

The condition is a strain or stress injury of the growing area at the back of the heel bone. It is the area of the bone that the Achilles tendon attached to the heel bone. As it is related to the growing plate, Severs disease is no longer a problem or issue after the child stops growing. Typically, it is no longer a problem after the mid-teenage years. It usually starts around the ages of 9-10 years. It is a relatively common condition. The classic symptoms are pain at the back and sides of the heel bone that are made worse with activity.

Severs disease treatment is normally pretty straight forward. The most typical approach is a cushioned heel pad to protect the area and a reduction in the activity levels. This will normally help most cases, but convincing a child to reduce their activity levels is never easy as all they want to when they get to school is run around with their friends. As the natural history is for it to get better on its own, it is all about managing those loads to keep the condition under control while it gets better. Occasionally you need to resort to more drastic means to restrict activity and use a plaster cast or a walking brace.

Chilblains are a common problem on the feet in colder climates, so they are seasonal. They most commonly affect the toes, but can affect the fingers, nose and ears. You often see questions in forums and online groups from people who are desperate for help, as a lot of treatments do not necessarily work for everyone. There is not a lot of research on chilblains being done to guide clinicians on the best approach to them.

Chilblains typically appear initially as reddish lesions that start to itch. As they become more chronic they take on a darker bluish appearance. They may eventually breakdown and ulcerate with an infection developing if they are not looked after properly.

The best treatment for chilblains is prevention. This means not allowing the feet to get cold and keeping them warm with footwear and socks that are well insulated. It is also important that if the foot does get cold that it be warmed up slowly and not put in front of a hot heat source after being outside in the cold. Once the chilblain has developed, there are various creams that can be used to help stimulate the circulation. If the skin has been broken, then proper care of the wound is important.

There are some food such as beetroot juice that have been recommended for those with chilblains as they can stimulate the circulation a little. In the more severe cases, there are drips that a doctor can prescribe that keep the circulation open. This can be very effective but it does have a number of side effects.

If chilblains become chronic and the self-care measures are not helping, then visiting a podiatrist may be a good idea to get more advice and the best treatment.