Copies of articles that Peter has written for Professional Journals and Local newspapers/magazines alike will appear here.
We hope this page will become an interesting resource for our site visitors.
“Heel Pain (Plantar Fasciitis)”
Talkabout Publishing (Chester) Ltd. Brief: / Peter’s Monthly Foot and Ankle Column, pp / Overleigh Roundabout Magazine April 2010
This month we’re going to discuss one of the most painful foot conditions – Plantar Fasciitis. If you have suffered from this (or are currently suffering from this) then you will know how debilitating it feels to walk on a foot that is completely sore across the sole and heel areas.
What is Plantar Fasciitis?
Quite simply, plantar fasciitis is a chronic inflammation [of the sole of foot muscles] at the site of the attachment of the plantar fascia to the medial tubercle of the calcanuem [heel bone]. 
If you had a muscle inflammation in other body locations, like your arm or neck, you could simply rest the affected area until it subsided and got better. However, with a muscle inflammation on the sole of your foot, you have little opportunity to rest it as you aggravate the problem with every weight-bearing step you take!
How can it be treated?
When you first feel the onset of heel pain, you probably reach for the anti-inflammatory tablets (if you can take them) and pop some extra padding in your shoe. You then realise the inflammation is progressing and nothing seems to help!
This is where your Podiatrist can help. After a biomechanical assessment, your podiatrist will be able to tell you what the cause of the problem is. This is an important factor to bear in mind: Plantar Fasciitis can arise because of different reasons. Each cause has a different treatment plan. Your podiatrist will be able to locate whether your pain has come from a limited range of ankle movement, tight calf muscles, a rheumatoid or “human leucocyte antigen” process or a heel spur / fascial enthesis. 
Your heel pain or plantar fasciitis may also be caused by a bad walking pattern. Your podiatrist will especially want to check your mechanics at ‘push-off’ and changeover at the mid-stance phase of gait (walking).
Once the cause of your pain has been isolated, your podiatrist can then provide appropriate treatment – including orthotic insoles. These specialist insoles fit inside your footwear and are made from an impression of your foot. Bespoke orthotics are the indication for mechanically caused plantar fasciitis, as the ‘arch’ area of the thin shell needs to perfectly fit your foot’s arch to mimic the action of the plantar fascia. If you use over-the-counter orthotics, foot pads, gel supports, shock absorbers, etc, you will be unlikely to achieve the same perfect ‘arch contour’ fit.
If you would like an assessment or an appointment please call 01244 37 37 57.
1: Merriman CM, Turner W (2002) Assessment of the Lower Limb 2nd Edition. p419
2: An Enthesis is the site of attachment of a tendon or ligament to a bone [Medcyclopaedia]
“Ball of Foot Pain (Metatarsalgia)”
Talkabout Publishing (Chester) Ltd. Brief: Peter’s Monthly Foot and Ankle Column, pp, Overleigh Roundabout Magazine Jan 2010
This month, we look at an affliction that affects most people at some point in their lives: Metatarsalgia (or Pain in the Ball of the Foot.)
Metatarsalgia is a general term that simply denotes a painful condition in the metatarsal region of the foot.
It’s always best to have your ball of foot pain diagnosed specifically by a medical or health professional, because the proper treatment can only really be established after accurate diagnosis. Here are a couple of causes of ball of foot pain:
This is where a painful growth occurs in between any of the the ball of foot ‘metatarsal head’ bones. It usually occurs on the digital nerve in the inter-metatarsal space near the little toe causing pain in the foot and nearby toe/s. It occurs four-times more frequently in women than men, and tends to present most in people aged 40-50. Morton’s Neuroma sufferers usually find obvious relief by removing their shoes and manipulating the foot.
Your Podiatrist can provide Orthotic Insoles with features to widen intermetatarsal space areas, and to off-load the painful area. Referral for confirmation of size and location by ultrasound may be needed in stubborn cases.
This is the commonest of the foot deformities. It is recognised by the big toe bending towards the little toe (sometimes moving under the second toe) along with some degree of a bunion at the base of the joint. There is usually a stiffness of this first MTP joint too, along with pain when walking.
Adolescents with family history and older patients with arthritic changes can develop Hallux Valgus with or without an accompanying bunion.
As with Neuromas, Your Podiatrist can provide Orthotic Insoles to off-load any painful toe joint, with extra design features to mobilise a slightly stiff joint as a starting point… or immobilise and support a very painful toe joint at the other extreme. A good Podiatrist will also advise when surgical opinion may be indicated.
After taking a good case history, along with physical examination, your Podiatrist may make other diagnoses concerning your ball of foot concern. These may include: Freiberg’s Disease, March fracture, Claw Toe, Sesamoiditis, or conditions secondary to any medical issues (like Peripheral Neuropathy in Diabetes).
Don’t conclude that you have to live with foot pain! Many useful treatments are available, and we are happy to provide advice.
If you would like an appointment with Peter, please contact his secretary directly on 01244 37 37 57.
“Flat-Foot and Overpronation”
Talkabout Publishing (Chester) Ltd. Brief: Peter’s Monthly Foot and Ankle Column, pp, Overleigh Roundabout Magazine Nov 2009
I am alarmed when I read running magazines today. They – and the corporate giant trainer retailers – speak of ‘Pronation’ as a disease that needs to be avoided at all costs.
In this month’s article, I will discuss what pronation is, why it is normal, and when a “high foot posture index” of pronation reaches an extreme level that needs treatment.
What is pronation?
Pronation a medical term affecting several joints in the body. In terms of our feet, it is basically a flattening of the long arch of the foot, coupled with an everted rolling inward of the heel (specifically the sub-talar joint) and a slight ‘out-splay’ of the whole foot. Pronation is ‘tri-planar’ in that it makes the foot move in the three planes of anatomical function.
The thing I want to stress it that a degree of pronation is normal and necessary during the gait cycle. It allows the foot to adapt to the ground and puts us into “Shock-absorbing” mode. Pronation is natural and not a biomechanical curse. Do not buy trainers or ‘off-the-shelf- insoles just because you think you should decelerate pronation. For one thing you may not need such deceleration… in fact, you may even be a ‘fixed supinator’ who needs to be thrown into pronation!
When it comes to pronation, you only have a problem if you are rolling inwards too much and noticing symptoms or pain.
You usually have painfully pronated feet if you leave a complete “flat foot wet print” when you look at a tiled floor surface after showering/swimming etc. The low arch in this foot type is usually associated with pain symptoms and this is when the foot strikes on the outside of the heel and then rolls inwards too far (NB: other foot types can pronate). If this is allowed to continue it can cause many different types of injury. With overly mobile pronating feet, the arch flattens, collapses, and soft tissues stretch. This causes the joint surfaces to articulate at improper angles to each other. When this happens, joints that were stable can now become hypermobile.
At first, this may cause fatigue. Symptoms can then manifest in many different ways. The associated conditions can depend on the individual lifestyle of each patient. As the problem gets worse, strain on the muscles, tendons, and ligaments of the foot and lower leg can cause permanent problems and deformities. When standing, your heels lean inward, this is turn makes one or both of your knee caps turn inward. Permanent conditions such as a flat feet or bunions may occur. This may affect your pelvis and lower back. You can also quickly wear out the soles and heels of your shoes.
After your condition has been confirmed by a biomechanics podiatrist, management can take several forms. Some bespoke orthotics (insoles) made from a flexible carbon-fibre shell can support your subtalar joint, mid-foot joint and medial arch during gait. If the heel and ankle collapse is making your big toe joint stiffen (with or without bunions), an extra orthotic feature will start to promote movement at that joint too. Be careful about using off-the-shelf orthotics in shops until you have taken podiatric advice… you could make the condition worse.
Your podiatrist can also provide you will exercises to strengthen your medial arch and relieve pain in any lower limb (foot/leg/hip) joints. Onward referral for musculo-skeletal care or even surgery may sometimes be indicated.
Good footwear advice is also essential. Over-pronating walkers and runners should look for straight or semicurved shoe soles which have firm midsoles and medial arch control features and support. Avoid excessively cushioned, fully curve-lasted trainers which will promote instability stability and poor control during the pronatory phase of gait.
Would you like a podiatric assessment? You can book online or via 01244 37 37 57. Peter consults with patients in office hours, but if you have any questions prior to making an appointment, it is recommended you email email@example.com