tfsc-v2

Wart you need to know about Warts

thefootscienceclinic@gmail.com (Andrew Wilson) — Wed, 05 May 2021 02:00:02 GMT

Now, firstly, I should probably apologise.

Not, for that rather awesome pun (which, I rather am pleased with). But rather, the 6 months it has been since the last blog.

Rest assured, I haven’t just been watching Netflix (well the odd episode here and there) but also working hard to help more and more patients get on top of their bothersome foot troubles. New Paragraph

With that in mind, we should probably get into today’s topic…..Warts!

Where do I begin…. Wikipedia? Google? Youtube (Dr Pimple Popper perhaps)?

We should probably start at the very beginning (a very good place to start!).

When you read, you begin with ABC.

With a wart, you begin with yuk, ouch, freeze!

Sound Familiar? Have you maybe started humming? ...... Do Re Mi? I digress.

What is a wart?

A wart, also known as a verruca (which I think sounds much nicer) is a growth of skin tissue that is caused by a virus infection. Not just any virus, but a strain of HPV (Human Papilloma Virus), there are over 100 different strains known.

We can get warts all over the body, varying with different types of strains, however we will focus on those that affect the hands and feet.

How do you catch the virus that causes warts?

When a wart appears, it can only mean one thing, you have come in contact with the wart virus. Now, this can occur through a couple of different pathways. The first is through direct skin-to-skin contact. The second is through contact with surfaces that have been in touched by the virus.

Where are you most likely to catch a foot wart?

As it is possible to transfer the pesky wart virus through surfaces, communal foot surfaces are the hot spot of transmission. Places such as public change rooms/showers/shared footwear are the most likely.

While touching a virus or contaminated surface, increases the change of developing a wart, it is not a guaranteed. Our skin is generally a very effective barrier, however, injuries to the skin, such as blisters, cuts, scrapes, provide easier access for the virus. Our feet and hands are constantly on the go, so, as a result, it is not uncommon for cracks, cuts, blisters to occur.

Close but yet so far…

Our immune system is generally effective at destroying virus attacks to our skin. The catch, is our immune cells are located in the deeper layers that receive more blood supply. Unfortunately, foot warts grow on the outer layers of our skin, evading, our immune system, just out of reach.

I smell something funky!

A quick google of wart treatments, quickly can lead into a rabbit hole of wonder. Some of the more notable remedies include duct tape, banana skins, potato juice and apple cider vinegar.

Here’s a quick story for you. .

I had a patient come to see me for some advice with their foot warts. Before the shoes had come off, we had gone through the standard history gathering. While having a look at the pesky warts, I was pleased to see they weren’t award winning in size. However, something else caught my eyes….well rather my nose! A peculiar smell filled the room. Somewhere between a turmeric latte and mi-goreng noodles.

To which, after asking, what they had been trialling at home, I was told (with gusto), garlic and turmeric paste, homemade of course.

I was intrigued, I made a note, and once I had some spare time, quickly jumped online to check the research world for any studies. Alas, I never found one.

A variety of treatments

For those of us who have had or are currently in possession of a foot or hand wart, the chances are, you have come across several treatments. You may have even trialed most, if not all of them.

There’s liquid nitrogen, salicylic acid cream, cantharidin, needling, laser, just to name a few.

There are pros and cons to each. Unfortunately, they all come out to have around the same reported success rate (hovering around 60%). There is often a trade-off between physical pain and mental pain. That being, the less painful the treatment, the more hassle it becomes.

“I have had multiple treatments….but nothing has worked”

When I see a patient wanting help with a foot wart, I am almost never the first to see it. While there can be many reasons a treatment may have not worked, I thought I would offer an insight into some common pitfalls.

A simple misunderstanding that occurs around wart treatments, is how it actually works. Unfortunately, wart treatments don’t actually directly kill the virus. What they actually do, is kill the infected cells that have been taken over by the virus. So, in order to be successful, the treatments have to kill your cells. Once they have been killed, the body then responds by healing the area and shedding the dead cells.

If some of those infected tissue cells are left behind, these will be what can lead to the warts coming back and continuing to grow.

Where to from here?

I think I will have to do a part 2 on the treatment we offer here at the clinic. I am thinking of calling that blog “Bazooka that Verruca” what do you think?

Until my next available Sunday afternoon, here is the link to the treatment page https://www.footscienceclinic.com.au/swift-therapy

If you have questions, please feel free to get in touch.

Bye for now

Andrew Hadley

Have you tried Shockwave Therapy? A shocking question!

thefootscienceclinic@gmail.com (Andrew Wilson) — Tue, 27 Oct 2020 11:32:06 GMT

“Would you like to stick your toe into the mains socket !?!”

Is probably what many patients hear when they get told “shockwave therapy is another treatment option”.

As a practitioner using shockwave therapy just about every day, it is easy to forget that many people haven’t come across the therapy let alone know how it works.

Last week I had a rather interesting consult with a patient suffering with chronic heel pain (plantar fasciopathy for those who like to do extra reading).

This patient had ended up in the my consultation room as they had been advised by their orthopaedic surgeon that there was one more treatment option left before surgery would be all that was left.

As with all my consults, we began with the “show and tell” (history taking, to be technically correct). The longer we spoke, the longer it became clear, this heel pain was not going to go away without a fight! New shoes, custom orthotics, stretching, strengthening, activity reduction, ice packs, pain killers, cortisone injections and even vinegar soaks (luckily for me, this was not a recent treatment). I start thinking to myself “okay, this is not going to be easy”.

After concluding both the history and assessment parts of the consult, I without much thought asked “have you tried Shockwave Therapy”. Now I can only describe what I saw as the face of complete fear. The blood almost instantly drained from their face and no louder than a whisper they replied with “I thought that was illegal”. I quickly joined the dots and realised the patient thought I had offered ElectricShock Therapy a drastically different treatment. I am pleased to report that after lengthy clarification the patient returned to their normal self and we proceeded with the treatment.

So where am I going with this, well, I thought at that moment, I should probably write a 101 for this therapy and perhaps take a page from our American colleagues.

Pulse wave Therapy

I don’t know about you, but to me, Pulse Wave Therapy sounds almost relaxing, while Shockwave Therapy sounds like I’m going to get strapped into some torture chair. This, surprisingly is one of those times the Americans are saying something right!

So what the hell is Shockwave Therapy (or Pulse Wave Therapy)?

Put simply, Shockwave Therapy uses acoustic pressure waves to trigger the body’s natural healing capability. The technology which was originally used to break up kidney stones has evolved for the treatment of chronic non healing pathologies of the musculoskeletal system.

There are 2 methods used to produce these waves, Radial and Focused. The names tell us everything we need to know. With Radial shockwaves the pressures waves radiate from the hand-piece (like a speaker, the closer you get, the stronger the wave). In contrast, Focused shockwave are precise (like a magnifying glass under the sun, the wave focus onto a small target).

You can tell the difference as one sounds like a jack hammer used to break concrete (Radial) and the other produces a ticking sound (Focused). If you are one of the few that have already had shockwave therapy, you have probably had the former, which while it achieves results it is unfortunately a more unpleasant experience. Here at the clinic, we use a Focused machine, more powerful and more importantly less painful.

What does it do to the body?

1. New Blood Vessels

By applying pressure waves to areas of chronic non healing pathology, shockwave therapy can stimulate the body to produce new blood vessels. By increasing the number of blood vessels in the area the body can deliver higher amounts of healing factors found in the blood.

2. Activation of a fresh inflammatory cycle

Now, inflammation gets a bad name as it is so commonly the cause of pain. However what we tend to forget, is that, inflammation when new, is the body’s way of identifying areas that need healing. One of the key components to inflammation is the ability to increase the sensitivity of an area to pain. The trouble comes when the inflammatory cells stick around. When exposed to the sudden pressure change caused with shockwave therapy these lingering inflammatory cells become activated and get back to work.

3. Reduction of Substance P

Substance P (the P just stands for Preparation), anticlimactic I know, is a substance produced by the body involved in the early stages of pain production. However, this substance also plays a role in promoting blood flow and healing. Now shockwave therapy works a little like “you’ve got to go backwards to go forwards”. Following a treatment of shockwave pulses the treated area becomes a little “angry”. This temporarily increases the release of Substance P (which can make the area a little more tender), however by temporarily increasing Substance P concentrations, the bonus function of promoting tissue healing can occur.

4. Hyperstimulation Anaesthesia

This is a fancy way of saying, we get the pain nerves to say “the computer says no”. As a treatment will generally consist of 2-3 thousand pulses, the nerve fibres (especially those that produce pain) become overwhelmed. As these nerve fibres can’t keep up with the number of pulses, they decide to take a break for a short period of time. As a result, the overall pain produce by the tender area reduces.

"So does that mean shockwave can wave any pain goodbye?"

I am afraid not. Trust me, if I could use it on and also improve every pain condition that affected the feet I would. The key understanding when it comes to Shockwave Therapy is the distinction between Acute and Chronic pain. When we have just injured ourselves, our bodies jump to action and conduct all the steps I mentioned above. The last thing we need to do, is come along and start poking the already angry bear! However, when we have an injury that happened months or even years ago, our body needs a helping hand or a “shock” to get back to work.

What conditions can benefit from it then?

So I don’t end up sounding like some boring Wikipedia page I have summed up the clinical applications below. This is just a simple overview, if you have a particular question, please, get in touch:

Tendon pain

(I won’t list them all, ain't nobody got time for dat!) hamstring, patella, achilles to name a few.

Fibroma

Or to impress your drinking buddies (Morbus Ledderhose)

Nodules within in the bottom of the foot

Bone conditions

Conditions such as shin splints, stress fractures and non unions (non healing fractures)

Muscles

Tight muscles with or without trigger points.

Probably time I wrap it up as I could go on and on and on and bore you silly. I hope this brief intro into the world of Shockwave Therapy can help demystify what it is all about. I am always happy to answer any questions, so please feel free to reach out.

Bye for now,

Andrew Hadley

Be a Podiatrist - Said no one ever!

thefootscienceclinic@gmail.com (Andrew Wilson) — Wed, 14 Oct 2020 07:28:08 GMT

"Eww! I couldn’t do that job!"

We have all been there, admit it, you know you have. You look at the person opposite you, and you think to yourself, “I couldn’t do that job!”. This fleeting thought will generally bring about that blunt question I’m sure you can already hear yourself thinking……..“What made you want to do that profession?”.

I had a patient today, and halfway through the consultation that question reared its head. Now, unlike most people (speaking mostly about my peers/colleagues), I invite the question, in fact, I love it! What better opportunity can there be to teach someone about the actual job you do, not the one people think you do.

Have you ever seen those memes, the ones about different professions, the ones with “what my parents think I do, what society thinks I do…what I think I do”. Well the Podiatrist is no different, in fact, it is probably one of the most boring. Why……because pretty much our starting point is “cutting toenails”.

Yes, I said it! “Cutting toenails” In fact I would be lying if I said we didn’t. But just like a hairdresser does more than just cut hair and a GP deals with more than just coughs and colds, cutting toenails is just the tip of the iceberg that is, Podiatry.

Now, back to that moment when I got asked “why would you want to be a podiatrist”. It’s almost like the split second just before a race, you go through your game plan and visualise the execution. Well, sort of. For me it's a little more embellished, in my head I am thinking “this is it! This is the moment I convert them into a believer! Don’t F it up! Make them see the light!” Ok Maybe that is a little over the top, but, nevertheless, it is a chance to showcase what you do!

The quick witted reply

This changes depending on the instigator of the question. But, for the most part, I simply say “I can think of worse things out there……DENTISTS…..you feel me!” Now, I am not hating on Dentists, in fact, what they do is extremely important, however it highlights the preconceptions we have of almost everything.

I then will generally follow up with “my sister works in childcare…..nappies…..POO…..!” At this point there has generally been enough said that poor questioner has become, just that little bit shocked.

Going in for the kill!

I don’t know at what point I have decided to tell this narrative in the frame of mind of a hunter, but let’s run with it.

With my victim stunned, and contemplating the existence of the phrase “in one end….out the other”, I take my time and carefully illustrate the joys of the Podiatry profession.

How to sum up a whole profession in a few quick sentences?

In reality, when I get asked “why would I be a podiatrist” I generally only have a couple of minutes before the consultation will come to an end. So with that In mind let me tell you, what I say in clinic.

Our feet are quite literally the connection to the world around us. As a Podiatrist we have the privilege to help maintain and improve that connection. We get to provide care to a part of the body many forget about. While cutting toenails is certainly a simple part of the job, the fact is, it can facilitate a deeper conversation on more complex foot health issues. Toenails can become ingrown, ingrown toenails can cause walking compensation, changes to walking patterns can cause muscle and tendon inflammation, years of joint imbalances could lead to arthritic joints. All these could be helped (not always fixed, but helped) by us Podiatrists.

The joy of variety

The great thing about the world we live in is variety. There are so many permutations that allow us to find just the right fit. Podiatry can be taken into the world of sports, hospitals, aged care, children, chronic pain and many more. More over, as Podiatrist, I can get a front row seat into my patients lives and what jobs they do. How boring would life be, if we all did the exact same thing!

So with that hopefully funny insight into just one of the many questions we get as Podiatrists, I hope I have inspired some of you to ask each other not “WHAT made you do that profession” but instead “What gets you EXCITED about your profession”

As always, if you have any questions, don’t hesitate to ask!

Bye for now,

Andrew Hadley

P.s For those wondering about the Podiatry Job Meme.....

Foot Health Week - Diabetes

thefootscienceclinic@gmail.com (Andrew Wilson) — Tue, 13 Oct 2020 08:31:54 GMT

Foot Health & Diabetes - What’s the connection?

This is a question that I hear almost every day, and for most people the answer is condensed down to the phrase “you will end up having an amputation”. I can’t count how many patients I have brought up this question with and recoiled when the only answer they have been given is that one. In my opinion, that is like saying “lose weight - it’s good for you”. Sure, we all know the end result, but knowing and understanding are two very different processes. If the only reason we know, is a fact of fear, then are we really going to be any more inclined to break down the question at hand.

With Foot Health Week 2020 here and in full swing, it got me thinking, rather than just saying why it is important to get your foot health checked (and that whole spiel of “book an appointment now”), perhaps I could help breakdown the “why”.

So without any further rambling, let’s see if I can help answer any questions.

The 2 main players we’re watching - Blood & Nerves

In a practical sense, these two components are the big culprits that lead to troubles later down the road. We all know that blood is the stuff that is important for healing, and nerves relate to sensations. But how does diabetes join the party and cause all these scary problems we hear about.

Part 1.

“Excuse me, you’re blocking my way”

The first stop we take on this learning journey is the blood vessels. I personally like to think of blood vessels as our internal plumbing. They are tubes that carry liquid stuff around the body. The stuff, blood, is made up of many different components, the end result, a juice that helps fight infection, heal injuries, keep tissue alive and so on.

Now with diabetes, the main trouble maker is high levels of sugar within the blood. Unless you're a vampire in the town of Mystic Falls (Vampire diary reference, do forgive me) this increased sugary blood isn’t actually a good thing. While we do need a small amount of sugar within our blood (to give energy to our cells), the story gets interesting when the levels get too high.

After a certain point, the glucose (fancy term for blood sugar) begins to damage the insides of our blood vessels (the arteries and veins). The body tries to rectify this, it begins to patch up the damage with plaque. Now, you can imagine, when you start to fill up a pipe with a sticky/putty like substance, it gets harder to squeeze water through it. The same occurs with our own vessels, our blood cells find it harder and harder to reach their destination. The further away from our heart we travel, the pipes get smaller and smaller (sort of like taking the freeway out to the country, you start off with 4 lanes and end up on some backroad travelling at 100 miles an hour!)

With our vessels getting blocked up, all our cells start to notice and get a little bit stressed. The real struggle starts when the amount of blood our cells need is more than what our vessels will allow. In those really small vessels (such as those in our feet), getting blocked means vital blood supply to the tissue just isn’t enough to get by. When this increased demands begins, our body struggles to do its normal tasks. These tasks such as healing a wound, fighting infection, keeping tissue healthy, fall behind, eventually if no help is provided (in the form of medical intervention) the conclusion can be that dreaded 10 letter word……amputation.

Part 2.

“I’m afraid I can’t feel anymore, I’ve been hurt too many times”

Do forgive those terrible segway, I am not a literary genius you see.

So, too much sugar in our pipes leads to plaque blocking the way. The next frustrating part is that nerves, are made up of cells, cells that need the same blood supply as the rest of our tissue to survive. Unfortunately, the nerves that are further away from the spine (the nerves in our feet are a prime example) rely on the some of the smallest blood vessels we have to give them what they need. If you have ever forgot to water your plants during summer, you’ll now how quick they start to wilt. In the case of our nerve cells, not getting enough nutrients and blood supply, means they begin to degrade.

When the nerves begin to degrade (sort of like a rusting cable) they become really bad at conducting and transmitting signals. What ends up happening is like a postman who doesn’t deliver any mail. The nerves try to send a signal, however they never get through. It becomes worrying when those signals/messages are about a cut on the bottom of your foot. If you don’t get told about it, how can you know to help it.

Do not fear - the Podiatrist is here!

How pompous is that statement! What I mean to say, is that, it isn’t all bad news. Detection and monitoring are our most important weapons. Podiatrists are like investigators, we go looking, and if something doesn’t seem right, we can get the attention of others, letting the right person for the job know.

How do we Podiatrists look for trouble?

It probably sounds really simple, because truthfully, it is! We break our assessment into 2 parts: Neuro (for the nerves) and Vascular (for the plumbing).

So with this in mind, here are the crucial Steps your Podiatrist should take to provide a thorough foot health assessment:

The Fishing Line Test (or technically speaking, the monofilament 10 gram test). This is a quick simple test that uses a monofilament (pretty much a bit of fishing line) that is specially calibrated to apply 10 grams of pressure. We put this along the bottom of the foot, if you can feel it we know the nerves still work
The vibration test . A quick tap of a special tuning fork (128hz for those musicians among you), allows us to check the dorsal column nerves (another type of nerve).
The reflex test . A simple tap against a couple of your tendons and your muscle contracts making you move involuntarily. This allows us to check the spinal reflex arc.
ABI (short for Ankle Brachial Index, a long term for blood pressure assessments). We take your blood pressure at your arms then measure the pressure at your ankles. By comparing these two measurements we can assess for major blockages in your lower leg arteries.
Hand held doppler . A cool piece of equipment that allows us to hear the blood flow through the foot arteries. From this we can also listen to the regularity of the heart beat.
More physical assessments . Rather than talking about everything else I will just quickly mention them here. Capillary refill, joint range of movement, visual hair growth, visual skin appearance, nail growth and muscle strength.

The take home message

While diabetes has serious impacts on our overall health it also plays a strong role in our foot health. A yearly assessment from your local Podiatrist should include all the above. If you feel that perhaps you haven’t had these tests, ask! The sooner we can spot a problem the less of a problem it actually is.

If you have any questions, please feel free to reach out and contact us.

Bye for now,

Andrew Hadley

Greetings

thefootscienceclinic@gmail.com (Andrew Wilson) — Thu, 08 Oct 2020 01:52:28 GMT

How to start? What do I say? Who the hell will read this? What good, could it possibly do?

Questions I asked myself when I came across the topic of “blogging”.

“It is an important marketing strategy” says one article, “Gets your voice out there” said another, “People just want them” shouts a guy on a how-to video.

So, still no further forward with my understanding, but 3 hours later, and after reading countless sites, I figure “there must be something to it?”.

Right! I’m here at the computer, my clinic has been open for 7 days, let’s give this a go!

Who a m I?

For those that know me & for those that don’t, here is my 11 second elevator pitch/bio/self trumpet blowing (I hate doing it, so I'll make it quick).

Do I mention my age? Why not! I’m 26 almost 27. I grew up overseas (Asia), landed in Aus for high school and that whole jazz. I went on to do my BSc and then persevered for another 3 years to complete my DPM at UWA (I think that sounds so terribly elitist, so no more of that). My parents are British, therefore I have unavoidably picked up odd phrases & accents (like garage as in fridge, not garage as in large). I play a bit of piano, even used to dabble in teaching it, but those days are long gone.

Now onto the professional side. I graduated from the UWA DPM (Doctor of Podiatric Medicine, to sound super posh) I spent 4 years working around Perth. Over the years, I have tried to not focus on a particular field of practice but keep general and across the board. However I always get drawn to the complex cases commonly involving pain. I find the body such a fascinating subject and am humbled when reading knowledge from far smarter minds than I.

Why start up my own practice - The Foot Science Clinic?

After 4 years working for others, I got fed up with the overall lack of progression and development within the Podiatric community. I felt whenever I’d bring up a new technology or way of working, I would most often be met with “interesting, but it works as it is”. So with enough money saved, I decided to take the plunge and literally put my money where my mouth was and bring my ideas to life!

There are researchers around the world, producing papers on topics such as pain science, shockwave therapy, laser therapy, patient driven care and much more. There are new technologies discovered and their treatments discussed. Obviously it would be impossible to stay on top of it all, but my goal is to move with research, investing in the treatments that are shown to achieve results.

What will I blog about?

This was a hard one, there is already so much out there online. Just a quick google search for “Podiatry blogs” and you’ll find a plethora of hits. However the closer you look, more and more of them begin to follow the exact same formula and arrive at the same point…..”book an appointment NOW!”.

Will I make that same conclusion at times, undoubtably, but I also want these blogs to be a discussion. I don’t want these blogs to be a transparent gimmick aimed at booking patients in. I want to encourage patients to ask questions, to keep me asking questions, to shed light on topics people actually ask about in clinic. I want to take the reactive approach and respond to questions I actually get asked, not those that I want.

Reading that back to myself, it almost sounds like a 60 minutes/A current affair breaking news headline.

Wrapping it all up

I look forward to embarking on this bloggers journey with you, bringing insights, answers, theories etc to the table. I love to chatter, so if I ramble on and these articles become too long, please, tell me! I have read it is important to be consistent with blogs, and to not over commit. So I am going to aim for 1-2 a month, I haven’t decided on a particular day, or even the next topic, but what I do know is that I will stick with this “dear diary” format, keeping it informal and easy to read.

As always, if you have any questions, I would love to hear from you. If don’t have the answer, I am sure we can find someone that does.

Bye for now,

Andrew Hadley