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About lewisham.fh

Experienced Podiatrist with skills in musculoskeletal injury and pain diagnosis and treatment.

Foot Care Hot Climates

Foot Care in Hot Climates

Hot and arid climates can take a toll on your feet. Not looking after your feet when abroad in hot and arid climates can cause all sorts of problems.

From local infections to blisters and foot and ankle pain. In this blog we will be talking about how to look after your feet in hot and dry climates.

Looking after your feet when in hot and dry climates is so important to enjoying yourself and keeping active when abroad. Getting a painful foot can stop you doing all the activities you had planned for your holiday and can make for a miserable time when you least want that.

Foot wear

Flip flops are the most basic type of foot protection and are particularly not recommended when walking any amount of distance. It is very easy to sprain your ankle, get forefoot pain but also get blisters or friction burns from simple rubber flip flops. A ‘gladiator sandal’, a sandal with adjustable straps  across the foot is a better option. If the sole is a little thicker and more built up you will protect the foot from overuse injuries if walking any distance. Walking sandals are your best option for comfort and support.

Skin protection

The most obvious injury is sun related burns. Remember to put sun factor on the tops of your feet  – this is easily forgotten and bitterly regretted in the evening!!

If you have dry skin already applying a urea based foot cream daily such as ccs foot cream or flexitol can prevent your feet from getting painful cracks that can lead to infection and pain.

Feet that get blisters and cuts should be cleaned and a dressing changed every day to stop dust and dirt getting to the exposed underlying skin.

Calluses and corns: make sure you see your podiatrist before you go, or if you can self treat, use a pumice stone and daily foot cream to reduce hard skin. Cracked heels can often be the result of a fungal infection. See your podiatrist if you do.

cracked heels
Cracked heels can get infected

Insect bites

Keeping your feet free from insect bites is important. Especially in the evening when you’re wearing sandals, and the weather starts to cool bringing the insects out. An insect repellent is advisable, preferably not containing DEET (toxic and also stains clothes if has a high percentage). Itching these later will cause breaks in the skin and is a potential source for infection.

Swelling of the Legs

Being in hotter climates causes the blood vessels to dilate. This is to help cool your body. However this can make your legs and feet swell, especially if you have a heart or kidney condition or you are pregnant.

Below are some points to consider if this applied to you

  • Soak your feet in Epsom Salt daily
  • Elevate your feet when your resting
  • Magnesium and B6 can help (speak to your doctor first before taking)
  • Reduce salt intake in your food
  • Wear compression stockings. Even simple flight socks from the pharmacy can add that little bit of compression to stop your feet and legs from swelling
  • Massage and movement  – both help for swelling. Gentle exercises help to reduce swelling


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Stress Fractures of the Foot and Ankle

Foot or Ankle Pain


Forefoot pain can be a stress fracture of the bone. A stress fracture is a small crack or severe bone bruise in the foot or ankle. Stress fractures, unlike an acute fracture, is brought on by overuse. The bones in the body are constantly being replenished with bone stock, but if you have been much more active than usual a stress fracture may occur. This happens as a result of the body not having time to rebuild the bone.


Stress fractures are more common in sports people and athletes, and more common in women than men. If you have increased your training volume, training intensity or changed running or training surface you may get a stress fracture. Wearing shoes that reduce the foot’s ability to absorb stress can cause a stress fracture.


Other causes of stress fractures can be a less than optimal bone stock. This can occur if you have had or have health issues, have spent very little time weight bearing or have a poor nutritional intake.


You may have a stress fracture of the foot or ankle if you:


  • Experience pain when weight bearing
  • If there is swelling of the foot or ankle
  • You see a bruise on your foot or ankle



Stress fractures are usually caused by repetitive stress on the foot or ankle that it is not used to. Increasing your training volume too quickly or starting a new sport without giving your body time to get used to the new activity your bones and muscles haven’t got time to increase in strength to gradually adapt to the new activity. Your bodies weight bearing bones are especially vulnerable to stress fractures as they absorb repetitive forces from running, walking and sports.


If you are getting pain in the foot, it’s not advised to try to walk through the pain. A stress fracture that is ignored can lead to an complete fracture. See your podiatrist who can ultrasound scan your foot or ankle for stress fractures. An ultrasound scan is usually more accurate than an x-ray for stress fractures as an x-ray will not show a stress fracture until a few weeks have gone by. An x-ray can sometimes be requested in particular circumstances.

Treating bone injuries depends on the severity, the bone that’s injured and your overall health. You should in all cases stop any high impact exercise to let the bone heal: See the podiatrist.

The most common areas for stress fractures are the metatarsals, the heel bone and the tibia and fibula.


x-ray of metatarsal stress fracture

Preventing stress fractures

If you are starting a new sport or starting running, we recommend a strengthening program. You can alternatively try some cross training as this can have some effect on increasing your bone and muscle strength.

In particular novice runners are advised to see the podiatrist for a running analysis where some minor adjustments can be made to reduce the risk of a stress fracture or soft tissue injury. A podiatrist can also give you a strengthening program.

Start your new activities slowly. This will give your body time to adapt. Don’t train every day if you haven’t been active for a while even if you start to see improvements early on.

Mix up your activities so your body gets trained in different ways. This will reduce the risk of overtraining certain parts of your body.

If you get pain and swelling, stop your activity for a few days and if you get the same pain recurring when you train again, see the podiatrist.


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Ankle Sprains Can Become Chronic

Ankle Sprains

Ankle Sprains are very common. They occur when you roll, twist or turn the ankle in an awkward way. This might lead to a tear or stretch the soft tissue bands that hold the foot and ankle bones together. These soft tissue bands are ligaments and they help stabilise the foot and ankle.

Self treatments might be indicated in very mild sprains.  With more serious injury especially if you were unable to weight bear immediately afterwards or you are limping warrants a medical examination from a podiatrist or medical doctor. This is to assess the amount of ligament and soft tissue damage, but also any movement and balance deficits you may have suffered with your injury. In addition how the structural injury can lead to stability issues.

Signs and Symptoms

  • Pain – more when weight bearing on the injured foot
  • Swelling
  • Bruising (not always)
  • Restricted Range of Motion
  • Instability of the Ankle
  • Popping sound or sensation at the time of injury

When To See a Podiatrist

If your pain is severe and doesn’t go away within the next couple of days you should come in for an evaluation. As well as ligament damage you may have a fracture. These can be a straight forward fracture of the bone or an avulsion fracture. An avulsion fracture is where the ligament has torn off a piece of bone, and neither of these are uncommon in ankle sprains.

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Causes of ankle sprains

  • A fall that causes your ankle to twist
  • Landing awkwardly on your foot after jumping or turning
  • Someone stepping on or landing on your foot while you are moving
  • Walking on or exercising on uneven surfaces
Other factors that contribute to ankle sprains
  • Participating in sports activities any activity that involves jumping, cutting and quick changes of direction can result in an ankle sprain
  • Uneven surfaces walking or running on uneven surfaces may cause an ankle sprain. This is especially important if your not used to moving on these surfaces
  • Prior Ankle Injury previous injury is a risk factor. In particular if you haven’t properly rehab’ed the ankle first time around
  • Poor Physical Condition poor strength and flexibility can increase the risk of an ankle sprain
  • Inappropriate Shoes shoes that aren’t made for the activity you are undertaking can lead to instability and ankle sprain. The best example is a high heeled shoe on cobbled roads

Not treating an ankle sprain properly after injury can lead to:

  • Chronic pain
  • Chronic Ankle Instability
  • Arthritis of the Ankle Joint
How to prevent ankle sprains
  • Warm up before exercise or play sports
  • Wear ankle support or brace on a weak or previously injured ankle
  • Try to wear high heeled shoes as little as possible
  • Practice stability training, such as balance exercises
  • Maintain good conditioning and muscle strength

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Diagnosis and Treatment – Click here ->

Ankle Injury Diagnosis and Treatment

Ankle Injury, Diagnosis and Treatment

During the examination the podiatrist will examine your foot, ankle and lower leg. The Podiatrist will touch the areas that are most sensitive to find what structures are injured. The podiatrist will also move your foot and ankle in different positions to find out movement deficits and where pain is coming from.

If the pain is severe we may offer you an ultrasound scan in the clinic.

  • An Ultrasound uses sound waves to create real time images. These images can show how badly you have injured your ligaments and if you have fractured your ankle or foot.



Treating your injured ankle depends on the severity of the injury. Treatment is aimed at

  • Reducing swelling
  • Improving Range of Motion
  • Improving tissue healing
  • Addressing strength, balance and movement deficits


Treatments can be:

  • Foot and ankle mobilisation
  • Stretches and strengthening exercises
  • Shockwave treatment for tissue healing
  • Splints – Braces – Ankle supports


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Knee Pain

Knee Pain 

There are many causes of knee pain and one of the most common is anterior knee pain. Pain occurs behind and around the knee cap.  More men than women are affected and its most common in athletes, runners and people involved in high impact sports where jumping and changing direction occurs frequently. However you can get anterior knee pain by walking only and you may be get pain while sitting.  ‘Jumpers knee’ is most frequent in people in their twenties to thirties, but it can affect all ages.

Pain comes on due to overload of the patella tendon or due to pain behind the knee cap when the knee cap pushes against the thigh bone.   There may or may not be swelling at the front of the knee.


The Patella Tendon

The patella tendon sits below the knee cap and can be seen here.


Patella Tendon

How is patella tendinopathy diagnosed?


The podiatrist will examine you and the clinical findings are backed up with imaging. This can include an ultrasound scan or an MRI study. You will also have a biomechanical assessement that will show any movement and strength deficits. These are recorded and worked into your treatment program.


Why Have I got anterior knee pain?

Anterior knee pain can be brought on by previous injury. It can be caused by a deficit in muscle strength, endurance, reduced flexibility or aberrant movement patterns can all play a part in anterior knee pain.


  • Activity modification
  • Exercises to stretch and strengthen supporting structures
  • Orthotics
  • Shockwave treatment
  • Taping/bracing
  • Movement modification
  • Foot wear



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Big Toe Pain

Big Toe Pain


Pain in the big toe can be many things. However, a very frequent cause of big toe pain is a restriction of upward motion of the first toe joint in walking. Your big toe joint will feel sore in shoes, sometimes without shoes and mostly painful when you are walking or running.


The pain can come on immediately upon weight bearing activities or afterwards there may be a dull, aching or sharp pain in the joint. Sometimes there is swelling or redness of the joint and in some patients’,  there isn’t.


The medical term is hallux limitus and it can be caused by


  • injury
  • biomechanical factors
  • genetics
  • autoimmune disease or systemic arthritis




Often you will have pain in both big toes at the same time. If you are seeing a bump on the top of the joint its most likely a pain that will get worse as it progresses – increasing joint stiffness and increased pain is the usual course.


Once the problem becomes more involved, gait compensations can occur.







  • The first issue we will look at is changing your foot wear to something more supportive for your foot. A stiffer soled shoe is important to help reduce tension in the joint. A deeper toe box with an adjustable strap or lace across the midfoot will reduce any friction on the joint.


  • If your foot and ankle have restrictions we will aim to reduce these restrictions with foot and ankle mobilisations


  • A home exercise program to strengthen and improve the range of motion of your foot and ankle


  • Foot orthotics to reduce the internal compression in the big toe joint thereby improve pain and mobility


  • Shockwave treatment for cartilage repair and reduction of pain of the big toe joint


  • Steroid injection


Other causes of big toe pain are

  • Nerve entrapment
  • Ingrown nail
  • Tendinopathy
  • Infection
  • Sesamoiditis (small circular bones under the big toe joint)
  • Restricted blood supply
  • Muscle cramps
  • OCD (piece of bone or cartilage that has broken off and is in the joint)


The type of treatment you will be advised on depends on your age, activity levels and how restricted the big toe joint has become. The main aim of treatment is to reduce the pain and improve your quality of life so you can enjoy your favourite activities again.


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Heel Pain in Children

Heel Pain in Children


Children between the age of 8 and 12 years old years old are vulnerable to heel pain. The pain is located at the back of the heel bone and is called Severs disease. This is by and large a self-limiting swelling of the growth plate of the heel bone. The injury should improve within six weeks if the right treatment is given.

Pain usually comes on during or after activity. It may stop the child doing  sports activities and can cause a limp when progressing to become more painful. There can be a palpable lump at the back of the heel and usually there is no visible inflammation. Certain shoes can make the condition worse.

Boys are more affected than girls and usually have the condition between the age of 8 and 12 years of age, whilst girls are more affected between the age of 10 and 12 years of age.

The Cause of the Problem


In children the heel bone is composed of two parts. These two parts are separated by cartilage. As the cartilage grows the edges of each side ‘ossifies’ and becomes bone thereby allowing the bone to grow over time.

When your child is very active and has a growth spurt, the soft tissue grows quicker than bone and extra force is put on the heel bone. This can result in an overuse injury where the achilles tendon attaches to the back of the heel. The heel growth plate swells and is painful. The swelling is sometimes seen seen at the back of the heel.


You may find that your child stops enjoying running or jumping sports and doesn’t enjoy being active.



Heel Pain Location


The area marked in red is where the pain most often is located

Treatment is aimed at reducing and modifying activity levels, stretching and strengthening exercises, heel lifts and orthotics.

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School Shoes For The Kids

Getting the right shoes for your child



Shoes are possibly the most important ‘clothing’ you buy for your child. A child can wear clothes that are too small or large, be uncomfortable but not get long term problems from them. However not wearing the right shoes can cause long term and even permanent damage to your child’s feet. Gait compensation as a result of foot pain and deformity can lead to painful knees, hips and lower backs. No wonder there are so many teenagers and young adults with painful knees and backs!


Therefore, getting the right shoes for your children is a responsibility that should be a high priority for all parents. Many parents rush to the shop, especially just before school start, and are shopping for the cheapest shoes. This is not advisable as sturdy, good quality shoes are oftentimes a little dearer. Following is a guide for parents when getting shoes for their children and also how to maintain good foot health.

Childrens Feet and Foot Wear


Remember to:

  • Have their feet measured by a qualified fitter. Make sure both feet are measured for size and width. One foot maybe different from the other. Buy shoes for the larger foot


  • A fitting gauge is just a guide – all gauges vary in calibration – and also all shoes vary in sizes. There is no standardisation and therefore a fitter that is qualified is so important to get the right shoe for the shape of the foot
  • Assessment should be made standing as the foot spreads when weight is applied


  • Buy foot wear from natural materials – cotton, leather etc. These materials allow the foot to breath and mould to the shape of the foot


  • Adjustable – lace, strap or Velcro fastener – across the midfoot. This allows better fit and for thicker/thinner hosiery and more room if the feet get hot and swollen


Don’t Forget to:

  • not rely on the question ‘do they feel comfortable?’ for very young children. Toe and foot distortion can occur without feeling pain and cramping


  • Check for fit – Childrens shoes should be professionally checked for correct fit every 3-6 weeks for infants (0-3 years), 6-8 weeks (3-4 years) and every 10-12 weeks thereafter. A qualified shoe fitter will not sell you shoes if the current ones are a good fit. Don’t be afraid to get a fitting; as they will be happy to measure and give advice accordingly. Never take advice from a shop that asks your child’s shoe size and takes your word for it without checking themselves


  • Wearing new shoes can lead to blisters. Make sure they wear their shoes with socks. Their school shoes should be worn for short periods indoors before wearing them all day at school


Some Pointers: 

  • The shoes should bend at the big toe joint. This is important for good foot function


  • Sturdy supportive sole and upper – including the heel counter


  • Check your child’s sock drawer regularly and discard outgrown or misshapen socks. Check for seams that can create a knot that rubs on your child’s toes. Socks that are too small can restrict growth and circulation


  • A fingers breadth of space to the longest toe of the foot


  • The right shoe for the right occasion. Trainers for sport, school shoes for school, mountains shoes for hill walking and wellies for wet weather!


We are happy to see your children for an assessment. Please contact us below or

call 0203 6022640


When searching for a shoe shop with a qualified fitter go to:


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Forefoot Pain

Forefoot Pain


Can be pain in the toes, the toe joints or as a result of the nail units impinging on the sulcus of the toes. This are of pain can also be pain in the ball of the foot and is then called metatarsalgia. The pain can be aching, stabbing, electric ‘like’, radiating, a dull pain or bruise ‘like’ pain.


Foot Wear

Forefoot pain is often caused by a poor choice shoe. Shoes that are:

  • Wide at the toe box
  • Deep enough to allow your toes to move around
  • Have an adjustable strap or lace across the mid-foot to stop the foot sliding forward
  • Have a firm and cushioning sole


High-heeled shoes are probably the worst type of shoes to wear if you have forefoot pain as they transfer all your body weight towards the forefoot. If you have to wear a high heeled shoe, wear one with an adjustable strap across the mid-foot. Gel pads for the forefoot can also help to alleviate pain in the ball of the foot.


Square forefoot shoes from the Mary Rose

Even the Tudors knew to wear sensible shoes as we can see here, an example from the recovered Mary Rose Warship. The front of the shoes are square, to accommodate the shape of the foot. Getting shoes quite as roomy as these can be difficult, but there are brands on the market that accommodate the foot to a large extent. We can discuss this when you arrive in clinic.




Can be either a soft tissue pain or a bony or osseous pain.


  • An irritated nerve, otherwise called a Morton’s neuroma
  • A torn or damaged plantar plate
  • Flexor or extensor tendinopathy
  • Distal plantar fasciitis
  • Intermetatarsal bursitis
  • Vascular malformation
  • Stress fracture
  • Plantar metatarsal pad bruising
  • Foreign body
  • Osteoarthritis of the metatarsal joints
  • Systemic inflammatory arthritis




  • Poor foot wear as mentioned earlier
  • The type of foot you have; foot posture – high or low arches
  • Standing for prolonged periods
  • Overtraining or training on hard surfaces alone
  • Moving from a ‘normal’ running strike pattern to a forefoot striking pattern
  • An accident or injury during sports
  • Jumping or cutting movement in sports
  • Getting older as the plantar fat pad reduces with age and provides less cushioning
  • Painful verrucae or corns


Gait Assessment for Forefoot Pain




At Lewisham Foot Health we treat forefoot pain by assessing the cause first. This may include a biomechanical assessment with gait analysis, and an orthopaedic assessment with ultrasound scanning to check for soft and bony tissue disease.


  • Foot wear modification
  • Chiropody
  • Activity modification
  • Orthotics or insoles
  • Foot and ankle mobilisations
  • Exercise prescription and home exercises
  • Shockwave treatment
  • Steroid injections


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Plantar Fasciitis or Heel Pain

Plantar fasciitis or Heel pain



Plantar fasciitis is a very common problem. So common in fact that many patient come in saying they know one or more people who have the same problem!

Many patients decide to self-treat for six months to a year sometimes before seeking professional help. These self-treatments are often very poor and often do not lead to resolution of symptoms.

What is Heel Pain  – in actual fact!

First things first, when having heel pain, plantar fasciitis is just one of many causes of heel pain. The many structures in and around the heel can be the cause of the heel pain. There is also a condition called radiculopathy where there is referred pain from nerves in the lower back. Having said that, the most common cause of heel pain is plantar fasciitis. The plantar fascia is a band of connective tissue that starts at the heel bone and attaches into the toes via the plantar plates:

Plantar fascia

Heel Pain is most commonly plantar fasciitis

When the plantar fascia gets overstrained microtears and inflammation will form you may get pain where the circle is shown. You can also get pain along the mid-substance of the fascia – more towards the arch of the foot.


The cause of your heel pain


Causes of plantar fasciitis can be your foot type, low or high arch profile, overtraining, putting on weight, prolonged standing, poor foot wear or foot wear not suitable for you and injuries of the foot and ankle.


What else can your heel pain be?

Some other problems that could be your heel pain are Achilles tendinopathy, subcutaneous bursitis, heel bone fracture, peroneal tendinopathy, tarsal tunnel syndrome (nerve entrapment), posterior tibial tendinopathy, heel pad bruising and tumours to mention a few.


For plantar fasciitis home treatments can include taping the foot and stretching exercises. You can take NSAIDS for short term pain relief. See below:


Standing Calf Stretch

Stretching Calf Musculature for Plantar Fasciitis

Stand placing hands on wall for support. Place your feet pointing straight ahead, with the involved foot in back of the other. The back leg should have a straight knee and front leg a bent knee.



Toe Extension and Arch Massage

Vigorous Massage can Help Sit with involved leg crossed over uninvolved leg. Grasp toes with one hand and bend the toes and ankle upwards as far as possible to stretch the arch and calf

See us at the clinic and we can offer you a definitive diagnosis

We can offer

  • Insoles or orthotics. These are arch supports especially made for you (we also do ready made devices)
  • Exercise prescription tailored for you
  • Steroid injections for quick pain relief
  • Shockwave treatment. You can read about this here: Heel pain treatment


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