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We all train for various reasons: to keep fit, to increase our distance, to compete in a number of different racing platforms, or to just have a more active lifestyle. Whatever category you fall into, we just all want to achieve one thing: to reach our goal injury-free!


We find that a lot of injuries occur due to repetitive stress – when soft tissues (muscles or tendons) are loaded repetitively or incorrectly. This creates an increased force over a tendon, joint or ligament for prolonged periods and it can ultimately cause these structures to fail.

Fortunately, there are some clever training tips and shoe advice that can help us achieve that one goal when it comes to running training. Check out these tips to stop repetitive forces from ruining your run:



When you are running, make sure to throw in some sprint training into your runs. You can also mix up a long distance run with some interval training which can help you strengthen your stamina. You can also take yourself to a track and just focus purely on interval training.



If, for instance, you continually run the same route, then this means that you are continually running that same road with the same camber, and the same hill at the same time in the whole course of your runs. This also means that you are undergoing the same force patterning every time you run on that route. You can try and change routes once in a while.



When you are running, do you swap the surfaces you run on? Or perhaps you continually run on the pavement, or the grass, or even on the sand? Studies have found that trail runners basically experience less repetitive stress runs than other runners. Why? Because their terrain changes all the time, and so their force input changes as well.



Taking everything above into account, changing the shoes you wear for your different training scenarios is also a must. For instance, if you are constantly running in just one pair of shoes, then your force input and loading are the same for your every run. You should look for shoes that have a thicker midsole, and a higher heel height. You need such shoes if you are doing long distance running if you want to get more miles under your belt. Smaller, lighter weight shoes with reduced heel stack racing will work better for faster runs or speed work.


If you need more help on which footwear you should look at for your different training needs, then our podiatrist, Sheldon H. Nadal, DPM, can surely help you out! Setup an appointment with him today.



Oftentimes, it takes a lot of effort to get sufficient information from our kids about how their legs and feet are feeling. And most of the time it is much harder to consider the proper and effective questions to ask! Keep in mind though, it is also hard for our kids to express how their legs and feet are feeling too.


To makes things a bit easier for kids and parents alike, we have come up with a couple of helpful hints to guide you into knowing if your kid needs a visit to the podiatrist:


#01. Your Child Avoids Activities That Involve Running, Standing or Walking

While your child might not be a natural-born athlete, he or she should not actively avoid walking, running or standing. If he or she does, then you should consider seeing a podiatrist. Able-bodied children are known to participate in a physical play. If your child, however, does not show interest even in light play, or he or she specifically decline it, then you might need to visit a podiatrist.


#02. Your Child Complains of Sore or Tired Legs

Leg discomfort and fatigue can result from foot misalignment, gait issues and other podiatry problems. It is important to see a podiatrist if your child experiences multiple strains or sprains, develop shin splints or cannot stand due to leg soreness.


#03. Your Child Complains of Foot Pain or Discomfort

Similarly, foot pain and discomfort can also result from flat feet, improper shoes and a number of other podiatry-related issues. If your child complains that his or her feet, toes and ankles hurt often, then you should consult Sheldon H. Nadal, DPM.


#04. Your Child Exhibits Disordered Standing or Walking Behaviours

Observe how your child walks and stands. Any motion should appear comfortable and natural. Take your child to see a podiatrist if you notice any of these behaviours:


*Knock knees or bowed legs

*Constant shifts from one foot to another when he or she is standing in place

*Flat feet

*Constant toe walking or tiptoeing

*Toes turned in when standing or walking


While it is true that your child may grow out of some of these behaviours, such as tiptoeing everywhere she or he goes, other behaviours might only become more pronounced over time. Flat feet, bowlegs, and other podiatry issues, when left untreated, can cause pain, reduced mobility and diminished flexibility.


#05. Your Child Sustains a Lower Limb or Foot Injury

Children can experience a range of injuries while growing up, from bumps and bruises to broken bones. Some injuries are serious and must have professional medical attention. If your child sustains a strain, a sprain, tendonitis, shin splints, a broken leg or foot or other lower extremity injuries, then you should consult a podiatrist.


Onychomycosis is known today as a major cosmetic concern. It is rarely seen for patients with nail fungus to have any pain—although quite often, these same patients will present themselves to a clinic with the concern of an unpleasant looking, discoloured and thickened nail; or they are just merely concerned that the fungus might spread.


Adverse Effects of Onychomycosis

Be that as it may, what kind of negative outcome can nail fungus have on someone’s overall health? Even though onychomycosis by definition is some type of an infection, clinical studies show no serious detrimental effects caused by this condition. Yet, for many years, there have only been limited success rates on treating nail fungus with conceivably toxic and harmful oral medications.

In the immense majority of cases studied, toenail fungus proves to be cosmetic. What happens if onychomycosis is left alone and goes untreated? Simple—the nail becomes worse. The development of lysis comes into place and the nail becomes bulky and crumbly with slightly more discolouration. It is really up to them if people want to move on through life with a discoloured or thickened nail. Help and treatments are always available for those who want to have a clear nail.

In the interim of the primary consultation for onychomycosis, the condition is usually broken down by type and severity of fungus. In addition, the condition is categorized into three levels—mild, moderate or severe—in order to simplify it. Most of the time, a superficial white onychomycosis is included in a mild nail fungus, but this should not be confused with nail dehydration. An ordinary nail fungus may occupy at least 20% of the nail and is usually thicker and discoloured with a noticeable presence of minimal lysis and subungual debris. On the other hand, patients that reveal a rather severe nail fungus have 60 to 100% involvement of nail that extends to the matrix, malodor, lysis, and subungual debris.


Possible Treatments for Onychomycosis

A nail polish holiday is usually performed as a treatment protocol for mild nail fungus until such time that the condition has cleared; followed by topical antifungal medication—efinaconazole, ciclopirox, or other antifungals. Mild Onychomycosis may go away with these kinds of treatments. If the problem persists, laser treatment may be recommended. Avoid nail salons during these treatments.

A treatment program is often utilized for moderate and severe nail involvement. This program involves everything that has been discussed for mild nail fungus treatment with the addition of a home program, oral medication, and/or lasers.



There is a controversy in the podiatry industry as to whether bunionectomy can be performed for purely cosmetic reasons. Let’s say a patient does not experience any joint or bump pain, but he or she is interested in surgical intervention, should this be considered medically necessary or cosmetic? When it comes to foot surgeries, cosmetic approaches are now emerging, and they are moving full steam ahead.


The American College of Foot and Ankle Surgeons (ACFAS) are against aesthetic treatments for bunions because it does not have any medical benefit. Other foot and ankle surgeons, however, are for performing correction of foot deformities for hammertoes and bunions for their patients to fit better into shoes, and to have narrower, aesthetically-appealing feet.

Whether you are in favour of cosmetic foot surgery or not, it is important to keep in mind that it is our obligation to disclose all to the patient – the potential risks, pros and cons, and complications. We are also obliged to outline the proposed course of treatment carefully and to provide the best surgical outcome we can.


The bottom line is, some bunionectomies are necessary for medical purposes while other bunions are an aesthetic concern. Bunions, nonetheless, are legitimate concerns of the patient population and these patients come to us for advice.


When patients present to our Toronto Podiatry office, there are usually four main reasons why they take the initiative in making the appointment:


#01. The patient has pain at the big toe joint. These are the patients who have no pain and limitation of activity. Most of them have no problems when they are wearing shoes. It is important to educate these patients about the condition and to discuss all their options.


#02. The patient finds it difficult to fit shoes comfortably.

These are the patients who have tried conservative care, but to no avail, and they are now ready for surgery. This is definitely not just a cosmetic case, and these patients need to have surgery to reduce the symptoms and to be able to get back to having pain-free activities.


#03. The patient does not like the way the deformity looks.

These patients can often relate to the inability to fit into their shoes. Now, this actually becomes the gray area of controversy. So, if the patient cannot fit into his or her shoes, does this then support the need for surgery? If the patient has a wide forefoot and narrow rearfoot, then he or she has limited shoe choices. There are many wider shoes on the market, but it can be difficult for them to find shoes that fit. In such circumstance, does a surgeon who does not believe in bunionectomy for a pain-free foot agree now that the procedure is warranted?


No matter which side of the discussion you are for, it is always best to practice with sincerity and ethics. We try to disclose all relevant information to our patients.

#04. The patient experiences some combination of numbers one, two and or three.


Have you ever felt any pain in the bottom of your heel? It can be caused by plantar fasciitis. The plantar fascia is a thick ligament that connects the heel to the front of the foot. It is the part the supports the arch of the foot and helps us walk.


Plantar fasciitis is a common orthopedic complaint. Our plantar fascia ligaments are no stranger to wear and tear, especially since our feet do a lot of work on a daily basis. Normally, plantar fascia ligaments act as shock absorbers. They support the arches of the feet. If there is too much pressure on the feet, then the ligaments can be damaged or torn, resulting in an inflamed plantar fascia. The inflammation, then, causes heel pain and stiffness.



Generally, the major complaint of patients with plantar fasciitis is the pain on the bottom of their heels. Some people also experience pain at the bottom of their midfoot area. At first, it can affect just one foot and eventually, it may affect both feet.Some patients experience dull pain, while others, sharp pain. Some patients can even feel a burning or ache on the bottom of their feet extending outward from their heels.


The pain can usually be felt (and is worse) in the morning when the first steps for the day are taken, or if one has been lying down or sitting for a while. Climbing stairs can also be extremely challenging due to heel stiffness.


After prolonged activity, the pain and inflammation may increase. One may not feel the pain during the activity, but once that person stops with the activity, then the pain will start to kick in.



If a person is overweight or obese, then he or she is at a greater risk of developing plantar fasciitis. For overweight patients, there is an increased pressure on the plantar fascia ligaments. Pregnant women mayto experience bouts of plantar fasciitis, particularly around the time of late pregnancy.


Long-distance runners or athletes who use their feet and put too much pressure on their feet are also more likely to develop plantar fascia problems. Those who have an active job that involves being on their feet may also be at risk.



Our podiatrist, Sheldon H. Nadal, DPM will take a thorough history and perform a physical exam to check for any tenderness in your foot as well as the exact location of the pain rule out other foot problems. He may ask you to flex your foot while he pushes on the plantar fascia to see if the pain worsens when you flex and betters when you point your toe. He will also note if you have any mild redness or swelling.


You should not suffer from plantar fasciitis. Sheldon H. Nadal, DPM can definitely correct this foot problem! Set up an appointment with him today!


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