Tarsal Tunnel Syndrome (Nerve Damage)

The tarsal tunnel is a narrow tunnel that lies on the inside of the ankle and allows many structures such as the posterior tibial artery and vein, posterior tibial tendon , flexor digitorum longus and flexor hallucis longus tendon and the posterior tibial nerve, to run through from the leg into the foot.Tarsal Tunnel Syndrome

The structures within this tunnel are maintained and protected by a thick ligament band (flexor retinaculum).

Compression of the posterior tibial nerve, as it travels through this tarsal tunnel gives rise to the condition known as Tarsal Tunnel Syndrome (TTS). The posterior tibial nerve passes through the tarsal tunnel and separates into three different branches going into the foot to provide feeling and feedback in the following areas:

  1. Calcaneal nerve– continues to the heel.
  2. Medial plantar nerves– continues to the inside sole of the foot.
  3. Lateral plantar nerves– continues to the outside sole of the foot.


Patients with TTS typically complain of neurological symptoms in the foot, traveling to the big toe and the 3 lesser toes. Sometimes if the compression or impingement to the nerve is higher up in the ankle it can affect the arch, heel and even calf.

Inflammation or swelling can also occur within the tarsal tunnel for various reasons. This increased fluid can take up room within the tarsal tunnel causing compression on the posterior tibial nerve.

TTS can greatly impact patients’ quality of life if not treated. Depending on the severity, simple tasks such as walking short distances can become almost unbearable.


Causes of Tarsal Tunnel Syndrome (Nerve Damage):

TTS is caused by anything that compresses the posterior tibial nerve, such as:

  • Flat feet– rolling in of the ankle can place compression on the posterior tibial nerve on the inside of the ankle.
  • Abnormal tissue growth– within the tarsal tunnel region (varicose vein, benign tumor, ganglion cyst, swollen tendon sheath, and/or arthritic bone spur).
  • Physical injury– such as an ankle sprain, or fracture causing inflammation and swelling in or near the tunnel, resulting in compression of the nerve.
  • Systemic diseases– such as diabetes or arthritis can cause swelling, and impingement of the nerve.
  • Strenuous activities– especially involve sprinting and jumping due to the ankle being put in certain positions at high forces.
  • Neurofibromatosis- fibrous masses that can form around nerves and have the ability to invade the tarsal tunnel.
  • Idiopathic– unknown cause.


Symptoms of Tarsal Tunnel Syndrome (Nerve Damage):

  • Neural sensations, such as tingling, burning, pins and needles, hot and cold and/or stabbing pains around the ankles.
  • Symptoms may be felt in the toes, arch, heel, and even the calf depending on the level of impingement to the nerve.
  • Numbness and possible swelling of the foot.
  • Cramp sensations, as small muscles within the foot lose their nerve supply.
  • Sudden onset of symptoms and often brought on or aggravated by overuse of the foot, prolonged standing and/or beginning a new exercise regime.
  • May be exacerbated during driving, when the foot is in a upward lifted position.
  • Positive Tinel’s sign (tapping over the affected nerve on the inside of the ankle will produce a tingling or electric shock sensation over the area and sole of foot).


Diagnosis of Tarsal Tunnel Syndrome (Nerve Damage):

  • Patients pain history and a positive Tinel’s sign when you tap over the inside of the ankle.
  • Abnormal foot biomechanics, such as flat feet +/- swelling in the foot.
  • Palpation around the area to feel if a small mass is present.
  • Advanced imaging studies (X-ray, Ultrasound or MRI) may be ordered if a mass is suspected or if initial treatment does improve symptoms.
  • Electromyography and nerve conduction velocity tests (EMG/NCV) may be ordered if the condition shows minimal improvements with non-surgical treatment, however this alone is not a 100% reliable diagnosis for TTS.


Treatment for Tarsal Tunnel Syndrome (Nerve Damage):

Should be undertaken as soon as possible, to prevent further injury and permanent nerve damage. The symptoms of TTS may mimic other more commonly encountered foot conditions. Therefore it is important to have a proper evaluation by a podiatrist to make the correct diagnosis and get the appropriate treatment.


Non-Surgical Treatment:

  • Rest/ Ice/ Nonsteroidal anti-inflammatory drugs – such as ibuprofen, to help reduce pain, inflammation and aid healing.
  • Customised foot orthoses- to correct the rolling in of the ankles and reduce compression of the nerve.
  • Immobilisation (cast/ bracing) – for severe cases immobilizing the foot will allow the nerve and surrounding tissue to heal.
  • Injection therapy- local anesthetic to provide pain relief, corticosteroid may be useful in treating the inflammation, prolotherapy to assist with repair of the nerve.
  • Supportive footwear that is professionally fitted, as shoes that are too tight can lead to increased pressure on the tibial nerve.
  • Prescription medication- such as Neurontin, Lyrica and Lidocaine patches for symptom relief.
  • Physical therapy- Ultrasound therapy, stretching (especially prior to exercise) and strengthening exercises of muscles in the legs (tibialis anterior, tibialis posterior, peroneus and  flexor digitorum longus).
  • Tibial Nerve Mobilisation- sitting on the edge of a table in a slumped position, the podiatrist can help mobilise and free the nerve (the ankle is taken into dorsiflexion and ankle eversion with the knee extended and flexed).


Surgical Treatment:

If conservative treatment fails, surgery may be recommended to release the nerve within the tarsal tunnel. The incision is made behind the ankle bone, where the posterior tibial nerve can be identified and separated from the surrounding artery and vein. Soft tissue growth that is causing increased pressure within the tarsal tunnel is removed.

If scar tissue is evident within the nerve or its branches neurolysis (water technique) is used to remove it. The foot is dressed and non-weight bearing is advised for 1-2 weeks, stitches will be removed around 3 weeks.

Surgery is often the last resort with TTS as some patients experience no improvement or symptoms become worse. Long term management, such as appropriate footwear and customised foot orthoses may be used, as the healing process continues over the next year after surgery.


At Proactive Podiatry we are experienced in assessing, diagnosing and treating nerve impingement injuries of the feet. We will also encourage a referral to a neurologist if deemed necessary.


Related Topics

  • Ankle Injury/ Sprains
  • Peripheral Neuropathy
  • Plantar Fasciitis
  • Posterior Tibial Tendon Injury
  • Orthotics and Arch Support Therapy
  • Foot Mobilisation Therapy

Do Podiatrists Cut Fingernails?

do podiatrists cut fingernailsThis weeks blog aims to clarify a commonly ask or misunderstood question about “Do Podiatrists Cut Fingernails?”

As a podiatrist I have been asked this question more times than I can keep count, and always feel horrible when I politely decline. However after reading this weeks blog I hope you better understand as to why this is the case.



A podiatrist by definition from the Podiatry Association is:

Podiatrists are university educated health care professionals specialising in the prevention, diagnoses, treatment and rehabilitation of disorders, medical and surgical of the feet and lower limbs”.

Therefore anything below the knee within medical reason can be treated by a podiatrist and is covered by our professional indemnity insurance.

However the cutting of fingernails is not part of a podiatrists job description, or covered by our insurance, if anything was to go wrong.

This is why as much as your podiatrist understands that it may be difficult for you to cut your own fingernails, and as much as they would like to help, we are not allowed to undertake this procedure during your podiatry consultation.

Fingernail cutting comes under an activity of daily living and may be carried out by either a family member, friend, carer, paramedical aid, nurse or beauty salon. Fingernail cutting is also not covered under your health fund, so no rebate is given for this service.

If you are unsure about what services are available for fingernail cutting within your area speak to us at Proactive Podiatry during your next consultation.


Related Topics


If Proactive Podiatry Helped You, Please Tell Us About it!

At Proactive Podiatry we aim to do as our name says and treat the cause of your condition, combining proactive strategies of prevention rather than treating just the symptoms of pain itself.

We believe in the theory of proactive prevention rather than reactive treatment. Our treatment regime entails correctly assessing and diagnosing your condition, providing you with various treatment options to improve your symptoms and get you back to enjoying a healthier lifestyle.

So this week Proactive Podiatry would like to dedicate our blog post to thanking all of our clients that have come to see us, for either a once off opinion or for ongoing podiatry management.

proactive podiatry

We hope each and everyone of you had/have a pleasant and informative experience, and would be very grateful for any feedback you may have.

If you could take 3 minutes to leave a kind review, to help us continue to provide a great service to our customers. Please click on the PDF below which has a basic instruction chart on how to leave us your feedback.


Alternatively you can click on either of the two links below that will take you directly to our true local and yelp review pages.

True local


Thank you very much and we hope to see you at Proactive Podiatry again soon.


Proactive Podiatry has formulated a list of reason, we think will be important to you when deciding “why choose us as your podiatrist?”

  • Our podiatrist has over 5 years experience and is a member of Sports Medicine Australia and Australian Podiatry Association SA.
  • Trained in dry needling (acupuncture) foot mobilisation therapy and prolotherapy.
  • HICAPS machine for on the spot claiming with you private health insurance.
  • Medibank Preferred Provider, with discount rates for members.
  • Member of More for Feet Program offering HCF members a fully covered NO GAP initial consultation.
  • Bulk billing available to those on a Chronic Disease Management Plan and Department of Veteran Affairs (DVA) clients.
  • Ample on and off street parking facilities with ramps for easy access in and out of the building.
  • Short waiting periods and reminder calls 24 hours before your appointment.
  • Range of supportive footwear, arch support slides/thongs and sandals, that can be professionally fitted by the podiatrist.
  • Early opening hours for before work appointments.
  • Access to a range of health and medical providers in the one location (GP’s, clinical practice nurse, diabetes educators, psychologists, dentists, physiotherapists, dietician and visiting audiologist).
  • Access to Health Scope pathology services.
  • Home visits for eligible clients unable to attend the clinic.
  • Large flat screen TV, water machine, magazines and a play area, with toys for the children in our waiting room.
  • Close to shopping centre, supermarket, pharmacy, post office, bank and other amenities.

podiatristIf this suits your needs and you are looking for a podiatrist who will care and cater to all your foot care needs then please call us on (08) 8265 2227 to make an appointment today or make an online enquiry and we will call you.


The National Diabetes Services Scheme (NDSS)

“The National Diabetes Services Scheme (NDSS), which began in 1987, is an initiative of the Australian Government administered by Diabetes Australia. The NDSS delivers diabetes-related products at subsidised prices and provides information and support services to people with diabetes. Registration is free and open to all Australians diagnosed with diabetes” (NDSS Website).

national diabetes services scheme



What Services are Available to You?

  • Information about diabetes self-management.
  • Ordering NDSS products and information on services available in your local area.
  • Programs and activities for people with diabetes such as healthy eating programs and physical activity programs.
  • Group support programs, such as peer support for people with type 1 diabetes or young people with diabetes.
  • Fact sheets, brochures and other resources about diabetes.
  • A variety of health professional resources.


How Do I Register for NDSS:

  • Click on the link below to download the registration form and follow the instructions provided.

             NDSS Registration Form

  • Call NDSS Infoline 1300 136 588.


What Services are Available for Health Professionals and Support Care Workers?

The NDSS provides training for workers who care for or support people with diabetes. This includes allied health professionals, Aboriginal health workers, bilingual community educators, teachers supporting children in school and pre-school, and disability or aged care workers.

The Myrtle Beach workers comp attorneys at Laird Hammons Laird will make sure that you get the full compensation you are entitled to and are treated fairly and with respect during the process.

Topics covered in the training sessions include:

  • Medications for diabetes management.
  • Insulin injections and initiation.
  • Blood glucose monitoring.
  • Diabetes complications screening.
  • Prevention and treatment of diabetes complications.
  • Healthy eating and dietetics.
  • Physical activity, exercise and diabetes management, balancing food, insulin and activity.
  • Chronic condition self-management skills.

Printable fact sheets are also available to NDSS members, with topics including basic information on how to self-manage your diabetes, healthy eating tips, advice for work and travel, and how to manage the stress when you need to change a tire with air compressors every time you go on vacation to a Twiddy: Outer Banks Rentals & OBX Vacation Rentals NC house by car, or when you don’t have access to the manhattan apartment cleaning services when you are in a rush.

Below is an example of one of the printable fact sheets covering sick days for people with diabetes and precautions to take.

Please note: The following information is of a general nature only and should not be substituted for medical advice or used to alter medical therapy. It does not replace consultations with qualified healthcare professionals to meet your individual medical needs.

Sick Days

When you’re unwell, you need to take extra care. As a person with diabetes when you are sick, your body’s increased production of stress hormones will cause your blood glucose levels to rise.

Make sure you keep a list of contact numbers for your doctor, credentialed diabetes educator, hospital and ambulance by the phone. If possible, have a friend or relative come and regularly check on you.

Taking Insulin when Sick

When you’re sick continue to take your usual dose of insulin. Never stop taking or reduce your insulin dose.

Sometimes when you are sick you may need more insulin or extra doses of insulin. Contact your doctor or credentialed diabetes educator if your illness lasts for more than one day, or if you vomit more than three times in a day, to discuss whether your insulin needs to be changed.


Eating when Sick

Eat according to how you feel and what food you can tolerate. If you can’t eat your usual meals, make sure you have small low-fat snacks at regular intervals throughout the day, e.g. toast, crackers, boiled rice, soup, low-fat custard or ice-cream.

If you can’t eat food, have sips of fluid every few minutes.

Include carbohydrate drinks (such as fruit juice or lemonade) if your blood glucose level is below 15 mmol/L or unsweetened fluids (such as soda water or diet lemonade) if your blood glucose level is above 15 mmol/L. 


Dehydration when Sick

High blood glucose levels, vomiting and diarrhoea can all lead to dehydration. You will need to drink more, but it is important what you should drink, based on your blood glucose levels.

If your blood sugar level is more than 15 mmol/L then you should drink unsweetened fluids like water, clear soups, weak tea, or diet lemonade.

If your blood sugar level is less than 15 mmol/L then you should drink sweetened fluids like ordinary lemonade, cordial or apple juice. 


Exercising when Sick

People with diabetes are generally discouraged from strenuous physical activity if they feel unwell or have ketones present in their blood or urine.


Testing Blood Glucose Levels when Sick

When you are sick, you need to test your blood glucose levels more frequently, e.g. every 2-4 hours, and record all results. Illness or high blood glucose levels can lead to a serious condition called ketoacidosis.


When to Seek Medical Assistance

If you have diabetes and are sick you should immediately contact your doctor or go to hospital if you have any of the following symptoms:

  • Breathlessness.
  • Abdominal pain.
  • Nausea and vomiting.
  • Sweet fruity smell on the breath.
  • Drowsiness.
  • Your blood glucose level is higher than 15 mmol/L for two consecutive readings (in a 2-6 hour timeframe).
  • There are moderate to large ketones present in your urine or your blood ketone level is ≥ 1.5 mmol/L.
  • You can’t keep down any food or fluids.


For more information click on the link below to redirect you to the NDSS website http://www.ndss.com.au/

Proactive Podiatry advises you have your diabetes foot assessment undertaken by a podiatrist every 3 to 12 months, depending on your risk category, which our podiatrist will advise you on.



Geko- The New Blood Booster

geko blood boosterThe new “Geko” blood booster, a battery powered, neuromuscular electro stimulation unit, with proposed mechanisms similar to the circulation booster has been designed to:

  • Increase blood circulation.
  • Prevent venous thrombosis.
  • Prevent and treat oedema.
  • Promote wound healing.
  • Treat venous insufficiency and ischemia.
  • Promote healing of tendon and ligament injuries.

Unlike most of the circulation boosters, the Geko, powered by OnPulse technology has undergone clinical trials and is now available for use in Europe, Australia, New Zealand and Canada.


How The Geko Blood Booster Works:

The Geko triggers the body’s built in mechanisms to increase blood circulation by administering gentle electrical impulses to stimulate the common peroneal nerve behind the knee.

This then activates the muscle pump of the lower leg that return blood towards the heart. It is designed to emulate the same mechanism normally achieved by walking but without the patient having to move or exert energy and without discomfort.

“The OnPulse™ technology has significantly increased blood flow and blood velocity which is relevant for the prevention and treatment of oedema, wound healing, the prevention of DVT and a range of other circulatory disorders” (A.T.Tucker et al. Int. J. Angiol. 2010; 19 (1); e31-e37).


How to Use The Geko Blood Booster:

A simple, disposable, self-adhesive device that is applied to the back of each knee,  designed to avoid the need for more complex procedures.

After simple preparation of the skin, the Geko device is applied via its self-adhesive gel to the outside of the leg (fibular head).

Small, light and comfortable, it allows full freedom of movement, while its operation is barely noticeable. Set up to 24 hour use, the Geko is designed to be safe and hygienic.


Click here to find out more and review clinical trial/case studies:


Note: Proactive Podiatry advises the Geko should not replace walking around the block but be use in conjunction to physical exercise or in those cases where weight bearing is not an option either temporarily or permanently.

Turf Toe – Painful Big Toe

Turf toe is a sprain of the ligament underneath the big toe joint, resulting from injury during sporting activities. The injury usually results when the big toe is forcibly bent up into hyperextension.

The condition can be caused from either jamming the toe, or repetitive injury from pushing off when running or jumping. When running or jumping, each subsequent step is started by raising the heel and moving body weight forward by “pushing off” the big toe.

Injury can result during this “pushing off” phase  if the big toe “gets stuck” and remains flat on the ground, causing bodyweight to go forward and so bending the toe up past its normal range of motion.

This injury is most commonly reported in football players who play on artificial turf, hence the term “turf toe.”  Artificial turf is a harder surface than grass and does not have much “give” when force is applied. Therefore the toe is more likely to get stuck or jammed.

However, turf toe still occurs in a wide range of sports such as soccer, basketball, wrestling, gymnastics and dance.


Causes of Turf Toe (Painful Big Toe):

  • Sudden upward bending of the big toe causing a sprain or tear to the ligaments underneath (i.e If you are tackled or fall forward and the toe stays flat, causing hyperextension of the toe).
  • Hyperextension, repeated over time causing eventual wearing and spraining of the ligament under the big toe.
  • Non-supportive flexible soled shoes.
  • Increased range of motion in the ankle joint.


Symptoms of Turf Toe (Painful Big Toe):

  • Swelling and pain around the big toe joint.
  • Limited joint range of motion of the big toe.
  • Pain and tenderness when bending or pulling the toe upwards, typically lasting for two to three weeks.
  • Sudden onset of signs and symptoms that intensify over a 24-hour period if direct trauma is the cause.
  • Gradual onset of signs and symptoms that progress over time will be evident if repetitive trauma is the cause.
  • Sometimes if the injury is great enough a “pop” can be felt. Usually the entire joint is involved, and toe movement is limited.


Diagnosis for Turf Toe (Painful Big Toe):

  • To diagnose turf toe, the podiatrist will ask a series of questions about how the injury occurred, type of footwear worn, surface played on, sport played etc. to better understand the presenting condition.
  • The podiatrist will then examine your foot, palpating for areas of tenderness and noting any swelling compared to the other foot.
  • Range of motion of the joint will be examined.
  • X-ray may be requested to rule out any other damage or fracture. Bone scan, CT scan, or MRI may be required in some circumstances.

Turf toe once diagnosed is then graded from 1 to 3 depending of severity.

  • Grade 1. The ligament on the base of the big toe has been stretched causing pin-point tenderness and mild swelling.
  • Grade 2. A partial tearing of the ligament with more diffused tenderness, moderate swelling, and bruising. Range of motion is limited and painful.
  • Grade 3. The plantar ligament is completely torn causing severe tenderness, swelling, and bruising. It is difficult and painful to move the big toe.


Treatment for Turf Toe (Painful Big Toe):


Nonsurgical Treatment

Grade 1.

  • Rest, ice, compression, and elevation (RICE) protocol is recommended initially for all gradings of turf toe.
  • Taping or protective brace is worn to restrict bending motion.
  • Non-steroidal anti-inflammatory medications to relieve pain and swelling.
  • Stiffed soled sports shoe.
  • Non-flexible rocker soled shoe is the most appropriate choice of footwear for casual wear while recovering.
  • Orthotics, such as a thin graphite shoe insert, will restrict bending of the big toe joint and reduce stress on the plantar plate.
  • Pain is usually tolerable and sports participation can be continued.

Grade 2.

  • Immobilisation of the big toe, using crutches, moon boot or plaster cast may be prescribed for up to a week.
  • Afterwards, these injuries are managed with a taping regime and the grade 1 treatments discussed above.
  • In most cases, grade 2 injuries require 3 to 14 days of rest before returning to physical activity.

Grade 3.

  • Immobilisation for a period of 6-8 weeks. Moon boot or plaster cast is used to keep the big toe in a partially pointed down position.
  • As the injury heals, treatment will follow that of a grade 2 and then to grade 1 protocol.
  • After the toe has been offloaded and healed, podiatry review may be required to re-establish joint range of motion, strength, and conditioning of the injured toe.


Surgical Treatment

Is required if symptoms of pain and dysfunction persist effecting sporting abilities. Surgery is generally suggested for grade 3 injuries or any of the following injuries:

  • A severe tear of the plantar ligament of the big toe.
  • Fracture of the sesamoid bones.
  • Instability (unusual up and down motion) of the big toe joint.
  • Damage to the cartilage, or bony spurring of the joint.

The surgical procedure will vary according to the injury. The aim of surgery is to repair the soft tissues and restore the big toe joint motion, so that normal function can be preserved.


Prevention of Turf Toe (Painful Big Toe):

  • Shoes with better support and a stiffer sole to help keep the big toe joint from excessive bending and force with pushing off.
  • Custom made foot orthoses that your podiatrist can prescribe for you to offload pressure to this area and correct any abnormalities in gait that can lead to further injury


Proactive Podiatry is trained and skilled with treating pathologies occurring below the knee and can help heal and prevent the painful big toe.




Crash Course on Skin Cancer on the Feet and Toenails

A melanoma is a malignant tumour (cancer) arising from the pigment producing cell of the skin, know as the melanocyte.

Melanomas are a life threatening, but potentially treatable form of skin cancer on the feet, if diagnosed or detected at an early stage.

However, skin cancer on the feet, particularly within the nail and plantar sole can be difficult to recognise. Consequently, this can lead to a delay in diagnosis and a poor outcome, when compared to other body sites. This problem is increased when there is a lack of pigmentation in suspected lesions, known to occur on the feet.

The diagnosis of a skin cancer on the feet can only be certain though a tissue biopsy, histological examination and specialist interpretation. This is why it is very important to get any suspicious lesions on your lower limbs and legs checked by a health practitioner.

Furthermore the number of cases of malignant melanoma worldwide is increasing faster than any other form of cancer amongst Caucasians. The current statistics are 1:120 for men and 1:95 for women.

Melanoma is a rare occurrence before puberty, but shows a gradual increase in incidence from the age of fifteen, peaking at around the age of fifty. Around 80% of lesions occur between the ages of 20-74 years. 30% of these skin cancers occur on the lower limb, 3-15% of these will occur on the foot or ankle region.

If you are concerned about a unusual lesion on your foot or lower limb do not delay. If the melanoma is < 1 mm thick there is a 95% survival rate at 5 years. Lesions > 4 mm thick hold a 50% chance of survival at five years.

There are Four Types of Melanomas (Skin Cancer on the Foot):

 Acral Lentiginous Melanoma (ALM)

Running as a layer of malignant melanocytes within the superficial layer of the skin. This type of melanoma is found equally across all skin types and is frequently observed in darker skin, representing about half of the melanomas occurring on the hands and feet.

Clinically appears as a ill defined mole or patch of light brown or grey discolouration of the skin and can often be missed.

Nodular Melanoma (NM)

Clinically appears as a nodular lesion, often seen in older patients.

Superficial Spreading Melanoma (SSM)

Is the most common of the four types because of its rapid growth phrase (lateral spread), before becoming invasive. It may arise as a new lesion or in a pre-existing mole. This type has been most frequently reported arising on the top of the foot.

Letingo Melanoma (LM)

Is a type of melanoma, found almost exclusively on the face and neck of older adults as a result of sun damage.


Risk Factors for Skin Cancer on the Feet:

  • Intense sunlight and UV radiation exposure.
  • High number of moles.
  • History of 3 or more severe sunburns.
  • Immunosuppressant (including organ transplant recipients).
  • Blue or green eye colour.
  • Freckles and/or the inability to tan.
  • Red hair colour.
  • Pre-existing moles on the soles of the feet.
  • History of penetrating injury.
  • Exposure to agricultural chemicals.
  • Any mole or solitary vascular lesion whether new or pre-existing which is growing or changing shape or colour should be referred for a specialist opinion.

skin cancer on the feet


The ‘ABCDE ‘ Rule in Diagnosing Suspected Skin Lesions:

  • Asymmetry, one half of the lesion is not identical to the other.
  • Border, a lesion with an irregular, ragged or indistinct border.
  • Colour, lesion has more than one colour present within it.
  • Diameter, the lesion has a diameter of greater than 6 mm.
  • Evolution, any change in the lesion in terms of size, shape or colour.


The “CUBED” Rule for Diagnosing Suspected Skin Lesion on THE FEET:

  • Coloured, lesions where any part is not skin colour.
  • Uncertain diagnosis, any lesion that does not have a definite diagnosis.
  • Bleeding, lesions on the foot or under the nail, which bleed or ooze fluid.
  • Enlargement, or deterioration of a lesion or ulcer despite therapy.
  • Delay, in healing of any lesion beyond 2 months.


Differential Diagnosis for Skin Cancer on the Feet:

  • Foot Ulcers
  • Warts
  • Ingrown toenail
  • Tinea Pedis/ Onychomycosis (fungal nail infection)
  • Foreign body
  • Bruising
  • Corns/ callus
  • Ganglion

As many of the above benign conditions are very common, identifying a rare occurrence of skin cancer of the feet amongst them can be challenging. However when individual skin lesions do not respond to a treatment in a normal, timely manner the original diagnosis should be re-considered.

Requesting a histological assessment of any lesion that does not resolve in 2 months, but which oozes or bleeds or has no clear diagnosis is advisable.


Melanomas Found in Toenails:

Pigmentation and melanomas can also be found within the nail bed so must also be monitored or checked by a health professional.

It must be noted that typically in a dark skinned person, benign nail pigmentation becomes increasingly common with age and is typically found in varying degrees of intensity on several digits.

Harmless pigmentation in the nails may also be caused by certain drugs, trauma, fungal infection and inflammatory diseases, such as lichen planus or psoriasis.

Pigment that does not change is not necessarily benign, however lesions that increases in size or change are more likely to represent malignancy and should be checked promptly. One exception to this in children where the pigment arises in the nail and can change quite dramatically  as the child matures.


The “ABCDEF” Rule for Melanomas in the Toenails:

  • Age, in the 5th to 7th decade of life.
  • Band, longitudinal brown or black streak that measures 3 mm or more.
  • Change, in the nail or lack of change in a nail despite treatment.
  • Digit, most commonly the big toe.
  • Extension, of the pigment onto the adjacent skin or nail fold.
  • Family, history of melanoma or vascular nodule.


Podiatrist are often the first on the scene to see or alert their patients on lesions that need further investigation on the soles of the feet, as they are inspecting the area.

At Proactive Podiatry we routinely check if there are any unusual lesions on the feet, including in-between the toes if you are unable to reach or inspect for yourself.

National Diabetes Week 13th-19th of July

National Diabetes Week is a time to check your risk and speak to your GP about screening test available for early diagnosis!

Diabetes is under diagnosed, with 50% of people unaware of their condition. This means that they can not take preventative measures against some of the most shocking and realistic facts associated with diabetes:

  • Every 20 seconds a diabetic related amputation in undertaken.
  • Diabetes kills more people annually than breast cancer and AIDS combined.
  • Every 7 seconds someone dies from diabetes related conditions.


Podiatry Relevance:

Diabetes mellitus is a condition in which the pancreas no longer produces enough insulin, or the cells stop responding to the insulin that is produced. This results in increased levels of glucose in the blood that cannot be absorbed into the cells of the body.

The two types of diabetes are referred to as Type 1 (insulin dependent) and Type 2 (non-insulin dependent), although people with Type 2 diabetes may eventually need to go on insulin therapy.


Long Term Lower Limb Complications of Diabetes:

Therefore if you are diabetic it is very important that you get your feet assessed by a podiatrist every 3 to 12 months, depending on your risk category, which the podiatrist will advise you on.


Neurovascular Diabetes Foot Assessment Includes:


Neurological Testing:

The podiatrist will assess you protective sensation and balance using a 10g monofilament and vibration tuning fork. Sensation in your feet  is important as it is responsible for:

  • Pain.
  • Pressure.
  • Temperature.
  • Blood flow/ sweating regulation.
  • Muscle strength/control.
  • Balance.

They will let you know if you have any neuropathy (nerve damage) and where this loss of sensation has occurred.


Vascular Assessment:

At Proactive Podiatry we will check your circulation and give you preventative education and treatment strategies to manage poor circulation, which is responsible for:

  • Delayed healing.
  • Cold feet, cyanosed (blue).
  • Chilblains.
  • Muscle cramping/pain when walking or at rest.
  • Poor skin/nail conditions.
  • Hairless.

The combination of numb, insensitive feet (neuropathy) and poor circulation means cuts or injuries may go unnoticed and progress to infected ulcers which may heal poorly.


The podiatrist at Proactive Podiatry will educate you in respect to monitoring for infection, giving you extensive education on diabetes and foot related risks. They will provide you with advice on daily diabetic foot care and preventative strategies for diabetic foot complications.


Related Topics


WARNING: This information should be used as a guide only and does not replace professional podiatry advice. The content is provided by Proactive Podiatry for educational purposes only and does not in any way replace the need for a face to face consultation with a podiatrist in order to accurately diagnose and treat the condition. Treatment and outcomes will vary between patients depending on the nature of the presenting complaint and subsequent diagnosis of condition.


Aloe Vera to the Rescue

Aloe Vera Aloe Vera “the green spiky plant” has been recognised for years for its healing properties and health benefits.

With Aloe Vera being a hardy plant that is relatively easy to grow it is a popular household pot plant.

Aloe Vera has at least six natural antiseptics, which are able to kill mould, bacteria, fungus, and viruses.

It was named the “plant of immortality,” by the Egyptians 6,000 years ago and is still being used today to treat many conditions including; burns, skin conditions, inflammation, hair problems and oral hygiene.

This powerful plant if taken orally has also been found to lower blood sugar levels and reduce cholesterol for a healthy heart. This health benefit has prompted the recent study of Aloe Vera’s effect on aiding wound healing for patients suffering from diabetes.

This study has shown positive result when tested on an animal model (rats). A combination of oral and topical application of Aloe Vera gel ethanolic extract, at a dose of 300 mg/kg body weight was administered daily to diabetic rats, for a period of 9 days.

This resulted in a significant reduction in fasting blood glucose, significant improvement in plasma insulin and significantly increased DNA and glycosaminoglycans (GAGs) to improve the ulcer wound healing rate.

To find out more and read the complete article, click on the article below.

An in vivo and in vitro investigation of the effect of aloe vera gel ethanolic extract using animal model with diabetic foot ulcer.


At Proactive Podiatry we have a fond interest in diabetes foot care and wellbeing. We keep up to date with the latest in diabetes research and treatment modalities to try to provide the most relevant information and care to our patients.

If you have had a success story with Aloe Vera, especially with the new health benefits mentioned we would love to hear about it!