Northcoast Podiatry

What is it? Prescription orthotic therapy is a managed podiatric treatment regime that includes specifically made custom inserts for footwear, together with exercise and activity prescription combined with a series of reviews on you the patient over a period of time. It is not a panacea (solution for all problems) but an important treatment option used expertly at NCP.
How does it work? It works by balancing, realigning and allowing the feet and lower limbs to function properly during walking, running and standing.

Highly repetitive movements with larger than normal forces as experienced when we are active combined with ‘less than perfect biomechanics’ can lead to pain and injury in the feet, legs, knees, hips and spine.  Probably even more important to the competitive athlete poor biomechanics can lead to poor performance! At NCP a static examination and most importantly analysis of your movement forms the basis for a diagnosis and formulation of a management plan to get you back to your personal best. A treadmill, cameras (front and behind) as well as ‘Silicon Coach’ software is often used to ‘slow mo’ the action to confirm analysis but also explain to the athlete what the NCP podiatrist is attempting to achieve with intervening with the athlete’s biomechanics.

Standing, walking or climbing occupations like teaching and the building trades for example, develop conditions like ‘heel spur syndrome (plantar fasciitis)’, Achilles tendonitis and even ‘Tibialis posterior insufficiency’ just by being ‘on their feet’ on hard surfaces all day.  NCP can accurately diagnose all foot conditions but more importantly do a treatment plan that encompasses any occupational health and safety issues in a patient’s workplace.

Dancers rely on their ‘connection to the ground’ putting feet and legs through various stresses and strains. Correct posture and technique is essential for longevity and prevention of injury as a dancer.  Foot posture correction with specific strengthening and ‘position awareness’ form part of a treatment plan for young dancers at NCP. NCP clinicians are experienced in  ‘Arch Angels’® prescription if determined necessary in dance slippers and Pointe shoes. These are also at times complimented with orthotic prescription for day time shoe wear.  Most amateur dances do their hard dancing work at the end of their day.  Poor foot posture throughout the dancer’s day fatique the leg and foot musculature and supportive structures, which in turn promotes poor technique at the days end when most dancers do classes.  This phenomenon forms the basis for prescribing ‘in shoe’ therapy for day time wear as well as for dance footwear.

NCP clinicians are trained in local anaesthesia and specific soft tissue surgical techniques and procedures to give a permanent cure to repatative or severely painful and or infected ingrown toe nails.  These techniques are surprisingly painless with minimal discomfort and only restrict the active patient for one day from activity or competition.  (Swimming is restricted for two weeks post surgery).  Many GPs (Doctors) in our region refer patients to NCP for such specific procedures.  Part of the treatment is education on how to prevent other toe nails suffering the same condition in future.

Many patients new to podiatry do present with good supportive footwear, some don’t.  Footwear will be investigated at the time of the consultations and the NCP clinician will advise as to why existing shoes are fine or why an alternative is needed.  An alternative will involve the development of a footwear prescription in the consultation and involves analysis of the patient’s ‘foot type’ occupation and recreational activity to arrive at footwear that compliments the rest of the podiatric management plan.  The footwear prescription is printed out and given to the patient whom then visits a reputable supplier.  The footwear prescription simplifies the process of selecting the correct footwear but also reinforces to the supplier that particular shoes are needed.  For some patients when their pedal deformity prevents the wearing of ‘stock’ shoes then patients are referred to the ‘Medical Grade Footwear Practitioner’ that consults at NCP on a monthly basis.  This practitioner is expert at fitting medical grade shoes for those patients that have very large bunions or other deformities.  At times he will even make custom shoes for severe cases.

Podiatrist Cliff makes himself available for talks about his profession(s) and research interests.  He also runs workshops for his Podiatry colleagues and is paid as a consultant for this.  If the talk is out of ‘billing hours’ often there is no charge, however any group requiring such a talk needs to supply the facility for a power point presentation. Examples of such groups includes the ‘North Coast Academy of Sport’, ‘Probus’, ‘Rotary’ and ‘The Athletes Foot’ management and staff.

Cliff ran a workshop at Charles Sturt University in Albury in November last year entitled ‘Advanced clinical evaluation of pedal ischaemia’ for 18 of his Podiatry colleagues. Cliff ushered delegates through learning new techniques with the latest equipment on actual peripheral vascular disease patients.  In May this year he will be working for Briggate Medical Company as a consultant at the National Biannual Podiatry Conference held in the Gold Coast Convention Centre.  Here he will be using this company’s equipment to do ‘mini’ workshops with colleagues and delegates.  His aim at the conference is to expose all delegates in a ‘hands on’ way to his findings of his Winston Churchill Fellowship completed in 2002.  
Cliff also does Medico-legal reports for personal injury insurance cases and can assume the role as an expert witness in cases of injury and pathology in the foot and related lower limb biomechanical competencies and ‘life long’ prognosis, especially those aspects that have impacts on a patient’s musculoskeletal abilities.

Patients that have Workers compensation insurance companies taking responsibility for their podiatry diagnosis/treatment costs, are welcome at NCP.  In the initial consultation such patients will be charged privately and need to pay on the day.  However, once the patient’s responsible Workers compensation Company has contacted our NCP clinic in writing with advice to proceed with treatment then the patient is not required to pay for any further treatments.

Muscular skeletal injuries and conditions

While the focus is on foot function all lower limb joints and structures are considered in diagnosis and treatment.  Chronic and ‘over use’ injuries for example plantar fasciitis or patella-femoral pains usually have poor foot function as the major aetiology.  At times patients will be referred by NCP to other paramedical clinicians for complimentary diagnosis of spine, pelvic and hip pathology.

Paediatric conditions
Conditions from continuing complications of congenital dislocated hips to the various osteochondroses in lower limbs can be diagnosed and treated.  Sever’s disease, pes planus as well as intoed gait (pigeon toe) respond to podiatric intervention.  Early detection and palliative podiatric intervention for hallux valgus (bunions) can reduce associated pain or future need for surgery.

Nail/skin care
NCP diagnose all epidermal manifestations of pressure in the foot including corns, callous and ulceration with treatment including enucleation debridement and prevention advice.  Onychocryptosis (ingrown toe nails) are managed with continual palliative care or by nail wedge resection and cauterisation of the respective germinal nail matrix.  Fungal and other infections including verucca pedis will be accurately diagnosed and treated.

Diagnostics
NCP use a full clinical range of skills to develop a differential diagnosis, for example evaluation of functional radiographs and video gait analysis for biomechanical afflictions.  Doppler ultrasound and photoplethysmography are also used ‘in office’ to generate segmental systolic pressures to measure even the most distal vascular segment – the feet, of patients with suspected peripheral vascular disease.

Management
The presenting complaint and your accompanying referral information/opinion form the starting point for formulation of a differential diagnosis.  In the case of muscular/skeletal pain following examination and testing of gait and biomechanics, initial treatment may consist of diagnostic temporary insoles, taping, footwear prescription, with advice to return for review.  In the review a definitive diagnosis is decided upon or your diagnosis confirmed.  Often if the patient has responded to initial management, prescription thermoplastic foot orthoses made from neutral position casts of patient’s feet form part of a continuing comprehensive therapeutic plan.

Treatment
It is the sincere aim of the NCP team to administer effective treatment to the patient’s you refer. We will also  endeavour to keep you informed about your patient’s foot health.