Daniel Patience Podiatry

Foot Conditions

At Daniel Patience Podiatry we treat a range of foot conditions

Achilles Tendinopathy

The achilles tendon is the most important tendon connected to the foot. The tendon is continuous from two calf muscles (gastrocnemius and soles) and inserts into the back of the heel (calcaneus). Achilles tendinopathy is classically seen in middle aged, overweight individuals, and in the running population. Pain and sometimes swelling is felt 4 cm's above the attachment where the blood supply to the tendon is reduced.
Treatments include: stretching and strengthening programs, orthotics if there are foot posture concerns, massage, footwear advice, and a review of activity training levels.

Posterior Tibial Tendon Dysfunction

The Posterior Tibial Tendon serves as one of the major supporting structures of the foot and ankle. Again, like Achilles Tendinopathy, there is a zone of reduced blood supply which is 2-4cm proximal to the insertion (navicular). It is most commonly seen in middle aged, overweight people who report that their arch has collapsed and the inside of the ankle is sore. This condition is progressive in nature and will get worse if not treated early. Pain is felt when walking, running, climbing stairs, and rising from a seated position.
Treatment of this condition is complex as it depends on the stage of intervention. There definitely has to be imagining done to investigate the integrity of the tendon.
Treatments include: stretches and strengthening programs, footwear advice, orthotics therapy, bracing in later stages, icing, relative rest from high impact activity.


A bunion (referred medically as Hallux Abducto Valgus) is a progressive genetic deformity of the big toe joint which affects woman 3 times more than men. The deformity usually starts around 20-30 years of age and symptoms are often felt when there are joint angle changes. Again, this condition is related to ligamentous laxity. Footwear fitting can be a problem for ladies in particular.
Treatments include: Footwear advice, orthotics to control flexibility of big toe joint, and surgical intervention.

Flat Foot

Is a common presenting complaint and comes in varying degrees of deformity and disability. Generally, it is identified by a collapsing of the medial longitudinal arch on weight bearing. Most people have a flexible flat feet which is from a result of ligamentous laxity and muscle/tendon laxity. Flat feet does not always exhibit pain, however if you are an active individual it might cause arch pain, ankle pain, skin pain, and knee pain. Flat feet has been linked to arthritis in the foot and ankle.
Treatments include: Footwear advice and orthotic therapy.

Plantar Fasciitis

The most common form of heel pain is Plantar Fasciitis which is reported to have an incidence of 10-15% in the population. Is is most commonly seen in the middle aged, overweight, people who stand on their feet for a living, and people with a history of ankle sprains. The plantar fascia is a ligament which has similar properties to a tendon and originates from the heel bone (Calcaneus) and inserts into the balls of the feet (metatarsal heads). Its main role in the foot is to act as an arch stabiliser/ supporter. It can become injured for a variety of reasons but the most common being overuse.
Treatments include: Massage, stretching, heat, orthotics, footwear advice, night splint, cortisone injection, and rest of high impact activity. 80-90% of people improve over a 1-6 month period.

Nail Pathology

Fungal Nails

A fungas is an organism that lives in warm moist areas of the body. Fungal nails can affect people of any age, however the elderly are mostly affected. Generally nails are infected because of previous nail trauma which gives a portal of entry to the fungus. The toe nail will exhibit a yellowish colour and be crumbly/ chalky when cutting it.
Treatments include: Topical anti-fungal agents, oral anti-fungals, and routine Podiatry care.

Ingrowing Toenail

Is when a toenail is ingrowing into the skin which causes redness, swelling, and pain. This usually occurs on the great toe. When there is infection present there is usually a break in the skin which causes a bacterial infection. Generally Ingrowing toenails are caused from Improper nail cutting, trauma from footwear, or a badly shaped nail.
Treatments include: Cutting out offending nail spike, partial nail avulsion (minor nail surgery), antibiotics, and addressing the causative factors.

Skin Pathology


A callous is a thickened area of skin on the foot which is primarily caused from repeated pressure from shoe or ground reaction forces. It is actually the bodies protective way to lay down more skin when extra forces are at play.
Treatment generally includes: Debridement with scalpel and pressure redistribution


A corn is a small circular thickening which generally presents over boney areas of the feet. Most commonly they are seen on the 5th digit and the metatarsal heads (balls of the feet).
Treatments include: Debridement and pressure redistribution.

Plantar Warts

A plantar wart is a benign tumour of the outer layer of skin which is caused when the skin is infected with a virus. The are usually painful and have an overlying callous. They may exhibited a "cauliflower" appearance and be painful on medial and lateral compression of the wart lesion.
Treatments include: Cryotherapy (freezing), and acid treatments (salicylic acid).

Shin Pain

Medial Tibial Stress Sydrome

Medial Tibial Stress Sydrome is the most common cause of shin pain. The area affected is the lower, distal third of the tibia (shin) where pain can be reproduced on palpation of this area. Generally it is an injury of "Too much too soon". Classically, it is seen in the athletic population where the sport is high intensity in nature. Clinically I am looking at a range of things which include, calf strength, calf range of motion, activity levels, footwear, and foot posture.
Treatments include: Activity modifications, strengthen and stretching exercises, orthotics, footwear advice, and massage.

Morton's Neuroma/Intermetatarsal Bursitis

A neuroma is a thickening of nerve tissue that can develop in various areas of the body. Specifically, Morton's neuroma occurs in the third webspace and is usually irritated from the intermetatarsal bursa which compresses it. This can lead to pins and needles/ numbness/ pain of the 3rd and 4th toes. Symptoms are often relieved once footwear is taken off. Clinically, the instances in females is much higher due to narrower toe boxes in footwear and ligamentous laxity. I will firstly send patient's off for an ultrasound scan to confirm diagnoses. After diagnoses is confirmed I will look at footwear, off-load with orthotics/ padding and refer off for a cortisone/ other injection therapies if i think it is needed.

Paediatric Foot Problems

Flat Foot and Children

The appearance of flat feet is normal and common in infants, partly due to "fat" which masks the developing arch and partly because the arch has not yet fully developed. The human arch develops in infancy and early childhood as part of normal muscle, tendon, ligament and bone growth. Training of the feet, especially by foot gymnastics and going barefoot on varying terrain, can facilitate the formation of arches during childhood, with a developed arch occurring for most by the age of four to six years. Flat arches in children usually become proper arches and high arches while the child progresses through adolescence and into adulthood.

Because young children are unlikely to suspect or identify flat feet on their own, it is a good idea for parents or other adult caregivers to check on this themselves. Besides visual inspection, parents should notice whether a child begins to walk oddly or clumsily, for example on the outer edges of the feet, or to limp, during long walks, and to ask the child whether he or she feels foot pain or fatigue during such walks. Children who complain about calf muscle pains or any other pains around the foot area, may be developing or have flat feet. Pain or discomfort may also develop in the knee joints.

Toe Walking

Refers to a condition where a person walks on his or her toes without putting much weight on the heel or any other part of the foot. Toe-walking in toddlers is common. These children usually adopt a normal walking pattern as they grow older. If a child continues to walk on his or her toes past the age of three, he or she should be evaluated by a doctor.

Toe walking can be caused by different factors. One type of toe walking is also called "habitual" or "idiopathic" toe walking, where the cause is unknown. Other causes include a congenital short Achilles tendon, muscle spasticity (especially as associated with cerebral palsy) and paralytic muscle disease such as Duchenne muscular dystrophy. It may also be one way of accommodating a separate condition, foot drop. Persistent toe walking in children has been identified as a potential early sign of autism.

Pigeon Toed

Many toddlers walk ‘pigeon-toed’, with either one or both feet turned inwards (in-toeing). In most cases, this is simply a sign of developing posture and balance, and should resolve by itself (without the need for medical intervention) somewhere between the ages of three and five years. If the in-toeing is severe, seems to involve the leg and hip as well as the foot, or isn’t improving by the time your child is around one and a half to two years of age, see your podiatrist for assessment. Excessive in-toeing may be caused by a variety of underlying difficulties, such as hip joint problems. Natural correction should occur over time and most rotation of the lower limb by the age of 6.

Sever's Syndrome

The most prominent symptom of Sever's Syndrome is heel pain which is usually aggravated by physical activity such as walking, running or jumping. The pain is localised to the posterior and plantar side of the heel over the calcaneal apophysis. Sometimes, the pain may be so severe that it may cause limping and interfere with physical performance in sports. External appearance of the heel is almost always normal, and signs of local disease such as edema, erythema ( redness) is absent. The main diagnostic tool is pain on medial- lateral compression of the calcaneus in the area of growth plate, so called squeeze test. Foot radiographs are usually normal. Therefore the diagnosis of Sever's disease is primarily clinical.

Sever’s disease is directly related to overuse of the bone and tendons in the heel. This can come from playing sports or anything that involves a lot of heel movement. It can be associated with starting a new sport, or the start of a new season. Too much weight bearing on the heel can also cause it, as can excessive traction since the bones and tendons are still developing. It occurs more commonly in children who over-pronate, and involves both heels in more than half of patients.