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Management of Achilles tendinopathy in runners-LER 
By Howard Kashefsky, DPM
Achilles tendinopathy is a common lower extremity injury in athletes as well as nonathletes. The Achilles tendon is often a site of injury in runners and is the second-most common running-related musculo¬skeletal injury, after medial tibial stress syndrome, with an incidence of 9.1% to 10.9%.
1 The lifetime risk in former elite male distance runners is 52%.
2 Factors that may contribute to Achilles tendinopathy include overuse, systemic disease, older age, sex, body composition, and biomechanics.
3 Elevated biomechanical load has been shown to cause both microscopic and macroscopic failures.4-6

 

1. Lopes AD, Hespanhol Junior LC, Yeung SS, Costa LO. What are the main running-related musculoskeletal injuries? A systematic review. Sports Med 2012;42(10):891-905.
2. Zafar MS, Mahmood A, Maffulli N. Basic science and clinical aspects of Achilles tendinopathy. Sports Med Arthrosc 2009;17(3):190-197.
3. Magnan B, Bondi M, Pierantoni S, Samaila E. The pathogenesis of Achilles tendinopathy: a systematic review. Foot Ankle Surg 2014;20(3):154-159.
4. O’Brien M. Functional anatomy and physiology of tendons. Clin Sports Med 1992;11(3):505-520.

VIEW ICB ORTHOTICS

 

Courtin Total Footcare

Why Courtin?

A skincare line based on 100% pure Tea Tree oil. Excellent treatment to help many skin problems. Compact and complete series of products.
Courtin has developed a special total skin care and foot care line containing Original Australian Tea Tree oil. The Courtin Tea Tree range includes a wide variety of salon and direct sale products.

What is Tea Tree oil?
Tea Tree oil is produced from the leaves of the Melaleuca Alternifolia by means of a technological process using steam. This process is subject to painstaking quality controls. The result is a purity level of 100%. Since it is a pure and natural product, the colour of the pure oil product can vary from colourless to light yellow.

Tea Tree oil can stimulate the healing of the conditions listed below
• Bacteria, fungi and viruses
• Ingrown nails
• Itching
• Cracked/chapped skin
• Corns
• Inflamed cuticles
• Psoriasis
• Chilblains: toes, feet or hands
• Warts
• Excessive sweating of feet
• Athlete’s foot

Pure Tea Tree Oil

Ways to use Tea Tree Oil 

Nail Infections - Apply a few drops of Tea Tree oil to the infected area twice per day and allow to penetrate. Can be used on both hands and feet. Place the hands or feet in warm water bath containing approximately 10ml of Courtin Foot Bath and add 1-2 drops of Pure Tea Tree Oil to the bath. After bathing, pat the hands and feet dry and massage with Courtin Hand & Foot Cream. Retreat the infected areas with Pure Tea Tree Oil.

Sprains - Rub Pure Tea Tree Oil directly on the sprain to ease the pain. Thoroughly wash and dry the feet. Apply Courtin Hand & Foot Cream and massage until absorbed. Apply Pure Tea Tree Oil to the affected areas twice per day.

Perspiring feet - Add 5-10 drops of Tea Tree oil to warm water. Take 5 minute foot bath every evening with Courtin Foot Bath. After the foot bath, apply Courtin Hand & Foot Cream and massage until absorbed. Put several drops of Tea Tree Oil in your shoes or apply some Courtin Foot Deo Spray.

General applications for various conditions:

Vaporisation
To purify the air, place a few drops on a handkerchief, sheet or cloth placed on a radiator or in the hanging radiator humidifier.

Foot Bathing
2 – 3 drops of Tea Tree oil in the bath water combined with the Courtin Footbath.

Compresses
Add 2 – 4 drops of Pure Tea Tree Oil to 10 cl. of water mixed with Courtin Footbath. Mix well. Soak the compresses in the Tea Tree oil solution and place them on the site to be treated for several minutes; repeat several times. Adjust the temperature of the water to the ailment being treated.

Massage
For massages, Tea Tree oil must always be mixed with:
■ For the Feet – Courtin Hand & Foot Cream.

When massaging the face, do not exceed a maximum concentration of 3% essential

 

Courtin treatments with your pedicure
Your pedicure offers various treatments with the wide range of Courtin Tea Tree products. The Courtin treatments not only act preventively but are exceptionally effective for many foot conditions.

Spa Foot Mask

Cosmetic Spa Foot Care Treatment - For most of the day, our feet are enclosed in footwear. This treatment with the unique Spa Foot Mask is a real blessing and you can actually feel the energy flowing back into your feet. A cosmetic and nourishing foot treatment providing total relaxation for body and soul.

Foot Mask - For some extra pampering, you can treat your feet with a nourishing foot mask. After a foot peeling, the toenails and cuticles are massaged with nail oil. After that, a foot mask is applied followed by a massage with a specially formulated, nourishing foot cream.

Courtin Foot Care Home Products

Pure Tea Tree Oil

100% Pure Tea Tree Oil - The 100% PureTea Tree Oil is made using natural processes and without additives. It is extremely versatile to use and has cell-renewing, pain relieving and soothing effects.

Courtin Hand & Foot Cream

Hand & Foot Cream  - This Hand & Foot Cream both cleanses and soothes. In addition to it’s cleansing and soothing properties, it also prevents odours. After cleansing, apply to dry feet and massage until absorbed.

COURTIN Chapped Skin Cream

Chapped skin Cream - The perfect cream for feet with highly chapped soles which can lead to cracks and fissures of the soles. With regular use, this cream softens the chapped skin, helps to prevent cracking and stimulates the healing of your feet. also ideal for raw skin on top of the feet. After cleansing apply to dry feet and massage until absorbed.

 

Courtin Foot Bath

Foot Bath - For intensive cleansing and reinvigoration of tired feet, use Courtin Foot Bath. Your feet will feel smooth and fresh again. Prevents unpleasant odours. Mix a spoonful of the gel into approximately 4 litres of water. Bathe the feet in water for 5 min.

 

Courtin Nail Oil

Nail Oil - Contains extremely nourishing active ingredients. Returns a natural shine to the nails. Apply once per day and massage for several minutes until the oil has been absorbed by the nail.

Courtin Ice Gel

Ice Gel- For the invigoration of tired, heavily stressed and burning feet or legs. The Ice Gel is directly absorbed through the skin. It prevents unpleasant odours and stimulates the circulation. Massage from the sole of the foot upward toward the thigh.

Courtin Foot Deo Spray

Foot Deo Spray - The Foot deodorant Spray keeps the feet fresh and any unpleasant odours are neutralised. Spray the Foot Deo on the tops and soles of the feet and rub it in. Don’t forget to apply between the toes.

 

 

hapla

Before applying tape it is important
to remember to round the corners
of each piece.
Rounding the corners prevents the
tape from catching on clothes and
peeling back which may reduce the
time the tape will stay adhered to the
patient.
How to cut hapla tape
Directions for use – Rounding Corners
1 Plantar Fasciitis - Hapla Wave Tape 2 Plantar Fasciitis - Hapla Wave Tape

Patient will be experiencing pain either on the central or medial portion of the heel. Ensure the foot is in a dorsiflexed position.

Cut a full width piece of tape long enough to go from the metatarsal heads up to the mid calf.

 3 Plantar Fasciitis - Hapla Wave Tape 4 Plantar Fasciitis - Hapla Wave Tape

Tear and remove the backing paper from one end of the tape.

Place an anchor point at the metatarsal heads applying zero stretch.

5 Plantar Fasciitis - Hapla Wave Tape 6 Plantar Fasciitis - Hapla Wave Tape

Remove the first part of the remaining backing paper.

Apply 50% stretch to the tape.

7 Plantar Fasciitis - Hapla Wave Tape 8 Plantar Fasciitis - Hapla Wave Tape

Apply the tape down to the heel.

At the heel reduce the stretch down to 25%.

9 Plantar Fasciitis - Hapla Wave Tape 10 Plantar Fasciitis - Hapla Wave Tape

Apply tape to the Achilles.

Place an anchor point with zero stretch on the achilles tendon and apply friction to all areas of the applied tape.

11 Plantar Fasciitis - Hapla Wave Tape 12 Plantar Fasciitis - Hapla Wave Tape

Cut a six inch length of tape, tear and remove the central part of the backing
paper.

Apply a 50% stretch across the site of pain. Make sure you apply each end (anchor points) with zero stretch.

13 Plantar Fasciitis - Hapla Wave Tape 14 Plantar Fasciitis - Hapla Wave Tape

Apply another six inch length of tape at a slightly more oblique angle to the first
across the site of the pain.

Apply friction to all areas of the applied tape and ensure patient is comfortable.

15 Plantar Fasciitis - Hapla Wave Tape

Alternatively, if they are able, you could put your patient into this position to ensure dorsiflexion of the foot.

 


Baby Frankie
Congratulations to Joanna and Luke who gave birth to Frankie on 6th November at 2.28am , 5lb 12oz. We are all looking forward to meeting Frankie soon here at DLT.

Summer Orthotics

With Summer now in full swing, the warm weather and longer days brings a season of parties and outdoor activities.  With this in mind, our patients’ footwear will have undoubtedly changed – from winter boots and enclosed styles, to sandals and casual ‘slip-ons’. Often these summery footwear styles offer little or no support to the foot.  So what can be done to keep patients on track with their treatment regime, and reduce the re-occurence of existing biomechanical conditions or injuries, during the summer months?

WOMEN’S FOOTWEAR

For women, sandals and ballet flat styles of shoes can easily be fitted with ICB High Heel Orthotics.  Although, as the name suggests, this orthotic style was originally designed for fitting into high heels, its narrow slimline design makes them ideal for flat (or low) heeled sandals. Each pair of ICB High Heel Orthotics are supplied with velcro dots to hold the orthotics in place inside the sandal.

HIGH HEEL ORTHOTICS

Ideal for fitting into summer sandals and ballet flats.

Ladies Orthotics

Tip: Add a 4° ICB Rearfoot Varus Wedge medially on the plantar surface of each orthotic – this will assist in providing additional pronation control.

 

ICB Rearfoot Wedges

Can be attached to the orthotic when additional rearfoot control is required (more than the 5° inversion built into 2/3 and full length ICB Orthotics). Patients who pronate more than 5° may require additional rearfoot posting to give optimum results. Sizes available: 2° & 4° (2 or 10 pack with double-sided tape).

Rear-foot Wedge

MENS FOOTWEAR

‘Boat shoes’ and slip-on mocassin styles are popular summer shoes for men. A common problem with these can be that they are often narrow through the shank of the shoe.  The ICB Dress Style Orthotic is a good choice for such styles, as the lateral skive (i.e. no lateral border) accommodates for broader feet, and fits much easier to narrow shoe types.  The dual density design offers excellent support and comfort for the burliest of blokes.

MENS ORTHOTICSDress Style Orthotics – Ideal for fitting into mens boat shoes and mocassins.

VIEW ALL ICB PRODUCTS

 

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A common complaint amongst patient’s who have been prescribed foot orthotics is ‘pain in the arch’. This type of pain can be the result of 4 common issues:
1. Pain can be due calcification (similar to dupuytren’s contracture)
or a fibroma in the body of the Plantar Fascia, or a Ganglion cyst
may be present.

TREATMENT:

If there is calcification in the fascia, use manual therapy to break it down.
For a fibroma or Ganglion cyst, a deflection will need to be heated into the orthotic to accomodate and relieve any pressure from this area.

 

IMAGE1.11

VIEW VIDEO:

2. Plantar fasciitis pain can be experienced at the attachment to the calcaneus.

TREATMENT:

Control rearfoot pronation using orthotics with intrinsic rearfoot posting to realign the feet to the Subtalar Joint Neutral Position (STJN).  If additional inversion is required to control and achieve STJN, add extra rearfoot wedges (2° or 4°) to provide additional Calcaneal control2.

REAR-FOOT-WEDGES

A medial arch infill can also be applied to the orthotic to provide increased arch support.

The Plantar fascia may be tight, and during gait (at mid stance to toe-off), compressing into the medial longitudinal arch of the orthotic causing discomfort and pain.  To test for a tight fascia use the ‘Windlass Test’ (pictured below).

 

plantar-test

 

 

VIEW DEMO

 

TREATMENT: Create a plantar fascial ‘relief’ or ‘groove’ in the arch of the orthotic using heat or by grinding the orthotic. Place the groove 1cm from the medial edge through the arch contour.

4. The patient may exhibit unilateral excessive pronation as a possible compensation or due to plantar injury.

 

TREATMENT: Create a plantar fascial ‘relief’ or ‘groove’ in the arch of the orthotic using heat or by grinding the orthotic. Place the groove 1cm from the medial edge through the arch contour


TREATMENT

 

Unilateral arch pain can be associated with a leg length difference3 due to long leg compensatory excessive pronation.  If a structural leg length discrepancy is identified, a heel lift will need to applied to the orthotic on the shorter leg.

heel-lift

VIEW ICB ORTHOTICS

 

References:
1. FROWEN, P., O’DONNELL, M., LORIMER, D., BURROW, G. (2010) Neales Disorders of the Foot 8th Edition, p130
2. FROWEN, P., O’DONNELL, M., LORIMER, D., BURROW, G. (2010) Neales Disorders of the Foot 8th Edition, p127
3. MICHAUD, T.C. (1997) Foot Orthoses and Other Forms of Conservative Foot Care, Sydney: William & Wilkins, p.114

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Plantar Fasciitis (PF) is a degenerative syndrome of the plantar fascia resulting from repeated trauma at its origin at the calcaneus1.

It is reported to be the most common cause of inferior heel pain in adults2.

Plantar fasciitis is also known as painful heel syndrome, heel spur syndrome3, runner’s heel, policemen’s heel, subcalcaneal pain, calcaneodynia and calcancal periostitis.

Treating the causative factors of plantar fasciitis is key to designing a treatment for your patient.Using the point of pain test will indicate if the pain is Lateral, Central or Medial.Valmassey refers to plantar fasciitis as affecting both pes planus and pes cavus foot types4 with opinion being that different pain regions may be suffered depending upon the foot structure (watch video).Generally speaking the following often applies:

Lateral Heel Pain is often associated with an uncorrected forefoot valgus and pes cavus foot type.

Central Heel Pain often indicates a forefoot valgus is present, in addition to rearfoot pronation.

• Medial Heel Pain generally indicates the patient will exhibit excessive rearfoot pronation.

ICB-HeelSpur-DIG_web

 Point of Pain TEST

Drawing-Plantafaciitis-test-1-web

In each case, treatment will involve prescribing an orthotic device to control rearfoot pronation and provide biomechanical correction. In the cases of Central and Medial pain, a heel deflection (referred to as a ‘horseshoe deflection’) in the orthotic can also assist by relieving pressure on the attachment. Low Dye Strapping can be used to provide short term pain relief, as it mimics the support and control offered by an orthotic device.
Shockwave therapy has also been used to some effect in breaking up scar tissue. Anti-inflammatory medications, massage and surgery are generally less successful in the long term treatment of Plantar Fasciitis.

TREATMENT SOLUTION: ICB MOULDING ORTHOTICS

23_DL-web

ICB Sports Orthotics  have an intrinsic 5° rearfoot varus angle to assist in controlling rearfoot pronation, and a horse shoe deflection making them ideal for treatment of Plantar Fasciitis.

VIEW ICB ORTHOTICS

References:
1. Cornwall MW. McPoil TG., Plantar fasciitis : Etiology and Treatment.  Orthopaedic Sports Physiotherapy (1999);29:756-76
2. Singh D. Angel J. Becky G. Trevino SG.,Fortnightly review. Plantar fasciitis. BMJ (1997):315:172-17.S.
3. Lemont H, Ammiiati KM, Usen N. Plantar Fasciitis: A Degenerative Process (fasciosis)
Without Inflammation. American Journal Podiatric Medicine Assoc (2003); 93:234-237
4. R.L. Valmassey, Clinical Biomechanics of the Lower Extremities. (1996) p76

Your Orb Box Contains:
• Orb
• 1 x Base Plate With Plug
• 2 x Product Cupsview THE ORB
warm-wax1
Step 1: Unpack ORB and switch on
warm-wax2 warm-wax3
Step 2: Directly place the POD into ORB Step 3: Place ORB on plugged in dock
warm-wax4 warm-wax5
Step 4: Put on lid Step 5: Wait until light is solid (20-25 min)
warm-wax6 warm-wax7
Step 6 : Add oil to cup Step 7: Massage Oil onto feet
warm-wax8 warm-wax9
Step 8: Brush wax onto skin Step 9: Brush REALLY SLOWLY
warm-wax10 warm-wax11
Step 10: Cover desired area with wax Step 11: Cover foot with plastic sheet
warm-wax12 warm-wax13
Step 12: Cover feet with towels/booties Step 13: After 10min, gently massage & loosen
warm-wax14 warm-wax15
Step 14: Remove all wax Step 15: Massage in Ureka Footcare Cream

Download The ORB FAQ – What if the product feels too warm?

Introduce the Prendē Warm Wax Therapy experience to your patients with an Orb Starter Kit.
Everything you need to get up and running and create a new revenue stream.

VIEW OUR ORB STARTER KIT

Change your pedicure routine forever:

Pedicures are done for cosmetic, therapeutic and medical purposes. They’re extremely popular throughout the world. Pedicures are not just limited to nails; dead skin cells on the bottom of feet are gently buffed, followed by granular exfoliation, application of moisturizing creams, completed with a relaxing leg massage and nail paint.

Why a podicure is different to a standard pedicure ?
Designed by a team of podiatrists and beauty professionals. Our carefully chosen products and ingredients are backed up by techniques to help you deliver the most amazing and luxurious foot therapy while allowing efficacy in portion control, hygiene as well as adhering to treatment times.

The Prendē ORB forms an integral part of the Podicure treatment.  A hand held skincare warmer for unique warm brush application.

The Prendē ORB gives
*enhanced efficacy of product,
*portion control,
*hygiene,
*a beautiful and totally new product delivery sensation.

Anti Fungal Shoe Spray

The basic function of the Hyperion spray products is to offer protection against bacterial, fungal and viral infections.
The action initially is to provide an instant kill of dangerous microbes and the nano products prevent re occurrence of new infections for many months*

The main ingredients in Hyperion are composed of complex surfactant chemistry with a polymer backbone and the inclusion of nano particles and ions which were a spin off of the NASA Neemo 6 space program where aquanauts and astronauts operating in confined spaces, were unable to wash their clothes for periods as long as 6 continuous weeks.

The inclusion of nano particles and ions proved to be successful in preventing infections and nano particles and ions are now a mandatory inclusion in all astronaut clothing.

*Depending on application and operating conditions

 

What is the difference between Hyperion F and D?

Hyperion D Diabetic Shoe infection sprayHYPERION D (DIABETIC) 50ML BOTTLE (2 PAIRS OF SHOES)
HYPD    £8.95    NOW £8.05     10% OFF Until 1/9/16

Hyperion D is specifically designed to offer maximum protection against foot infections which arise from infected footwear. It makes little sense for a podiatrist or doctor to treat the foot and then put the foot back into an infected shoe.

Hyperion D not only provides instant kill but also residual protection and should be used on all the patient’s  shoes, socks, bandages, insoles and other items related to footwear.  It can also be applied directly to the unbroken skin or nails at the discretion of the podiatrist or doctor.

VIEW PRODUCT

 

Hyperion F Shoe Odour SprayHYPERION F
50ML BOTTLE (2 PAIRS OF SHOES)     HYPF
£7.95  NOW £8.05     10% OFF Until 1/9/16
Hyperion F is a shoe treatment that offers protection against bad odours caused primarily by  bacterial and fungal  breakdown of sweat.

The spray is mainly used in sports shoes  or work shoes which are worn intensively and where bad odour is generated by excessive sweating.

VIEW PRODUCT

Hyperion products are NHS and EU approved. The main ingredients of Hyperion products have been tested independently, according to EU standards and legislation and within clinical NHS.

Hyperion has the highest safety credentials and antimicrobial efficacy (Log Kill of 6!!!) and was recently declared the “Winner” of the Smart Solutions HCAI (Health Care Associated Infections) in trials performed by TrusTECH, The North West of England NHS Innovations Hub, on behalf of the Department of Health’s HCAI Technology Innovation Programme and supported by the NHS National Innovation Centre.

“ Probably one of the most accomplished anti-microbial treatments available and an utterly fabulous product to use……..”

Please note due to UK Pharmaceutical supply guidelines governed by MHRA, before we are able to sell certain “pharmacy sale only” products to practitioners we must verify that they are qualified to purchase them. These checks include, noting HCPC Number for Chiropodists and Podiatrists or a scanned copy of the Qualification Certificate from Foot Health Training Schools. For more help please call our office on 01484 641010 if you are unsure of your status before placing the order.

FAQ – Pharmaceutical Sales Of Restricted ‘P’ Products

  1. Why are certain products now restricted, I’ve bought them for several years and was trained in their use as part of my training.
  2. The MHRA rules have not changed. For many years practitioners who have undergone training have been allowed to dispense certain products that are predominantly foot health related, their role was similar to that of a qualified pharmacist. With a vast increase in online supplies of pharmaceuticals MHRA guidelines are now much stricter when it comes to checking the actual purchaser of the products.

 

  1. I’m HCPC Registered – Can I buy as before?
  2. You can buy the same items as previously, but we do need a copy of your HCPC registration number on file, this can then be checked independently by MHRA should their inspector request it.

 

  1. I’m a Foot Health Practitioner Trained With Certain Restricted Products – How do I prove my qualifications?
  2. If you are registered on the Foot Health Practitioner Register, then we require your registration number similar to HCPC above. For non registered practitioners we require a scanned copy of your qualification certificate from your training school.

 

  1.  Does this now allow me to buy POM medicines/Anaesthetic?
  2. No – The only practitioners allowed to purchase Anaesthetic for Nail Surgery use are those who have the correct certificates of additional training in prescription only medicines or  anaesthetic use and nail matrixectomy.

 

VIEW ALL PHARMACY SALE ONLY PRODUCTS

 

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