Dealing with Thickened Nails

Dealing with Thickened Nails

 Nails are made from the same protein which makes up skin and hair known as keratin. Keratinisation, is the name given to the development of nails where cells multiply at the base of the nail and layer on top of each other before hardening. The shape, thickness, strength and growth rate of our nails is inherited from our parents however, lifestyle factors and events can contribute to the development of thickened nails. Increase in age is not necessarily the reason for the thickening of nails but does result in the likelihood of more life events and lifestyle factors influencing the presence of the pathology.

The following is a number of situations which can lead to the thickening of toe nails;
Trauma: Is the most common cause of nail thickening and can be associated with light repetitive causes or one significant blow. Habitual nail picking, sporting activities and footwear choices can all lead to trauma which may develop into nail thickening.
Fungal Infection: can lead to lifting of a nail from the nail plate and the thickening of the nail plate. Infections such as tinea can be transferred from one person to another with diabetics being at increased risk of developing an infection.

Physiological Changes: diseases of the lungs, kidneys, heart, liver and the thyroid can all lead to changes in nail quality, shape, colour and thickness as vitamins and hormones become unbalanced ending in change to the toe nails.

Nail thickness can be an irritation at best and a painful situation at worse but treatment of the condition can be addressed by your podiatrist with specialized tools designed specifically for the reduction of nail thickness and further education of useful products which may help further after an initial assessment and diagnosis. It is highly suggested that you seek professional advice before spending money on over the counter products.

Until Next Time,

Jackson McCosker
Director/Chief Editor

Technology in Practice: Video Gait Analysis

Technology in Practice: Video Gait Analysis

Technology is a wonderful thing, and bringing technology into an allied health environment has given better information and education to both practitioners and patients alike. In the last decade the use of video gait analysis has increased substantially within podiatry clinics. The burst of electronic recording devices has coincided with the release of the Apple iPad and SMART technologies which brought easy usability and portability to the medical profession.
The advancement of technologies which has brought these devices into an affordable market has also aided research in allowing better data to be collected about the motion and function of the foot. Notably is the addition of video gait analysis in conjunction with bone pin analysis and a multi-segmented foot structure as opposed to the solid block it was once pinned as.
Of course, the more expensive, laboratory placed, scientific research equipment which supplies quantitative data on three dimensional kinetics and kinematics is by far the Gold Standard. However, incorporating video gait analysis into a podiatry clinic which is capable of slowed content, frame by frame vision, measurement tools and comparative analysis is invaluable to the assessment process in identifying moments during gait which may be contributing to ailments or lack of performance.

A consistent message throughout the literature identifies the fact that video gait analysis cannot be completed in isolation. This is primarily due to three major concerns;
1) A misunderstanding or misinterpretation of what a normal gait may in fact look like. This is due to the teachings and interpretations of teaching through various allied health professions, with each physio, osteo, podiatrist and exercise physiologist having various belief of what constitutes this from a visual aspect.

2) Inter-rater reliability and repeatability was often identified as being questionable to poor, this was mostly dependent on the perceived establishment of the gait analyser and the theory of biomechanical function in which they follow.

3) Visualized movement coinciding with a contributing risk factor for a condition does not necessary correlate as there is not a measurable way to through pure video gait analysis to assess the of tissue stress which occurring.

To combat these identified factors (IV) proposed 6 areas which should be assessed when completing a visual gait analysis in practice;

  • Pelvic Rotation
  • Pelvic Obliquity
  • Knee Flexion in Stance Phase
  • Ankle Mechanism
  • Foot Mechanism
  • Lateral Displacement of the Body

Visual Gait Analysis as a tool for biomechanical assessment may not be able to be used in isolation, however as a contributing modality for an overall assessment is a much needed addition when comparing it to previous observational gait analysis. Additionally, the recording of material allows the practitioner to sit down with their client and discuss the movements which are taking place and how they may or may not be contributing to their complaint. The more a patient understands about their condition the more likely they are to be compliant to advice which is given.

The retail sector has also taken advantage of the increased affordability of assessment technology with shoe stores such as “The Athletes Foot” using force plates and motion analysis in store to identify areas of increase pressure and essentially the amount of pronation an individual goes through. This then apparently then correlates with one to three different shoes which you should be wearing. We will look further into my ideology of athletic footwear in another article however, in short my current belief is the addition of a slightly denser foam within a shoe is not going to stop the amount of pronatory motion you just witnessed while barefoot on they pretty screen. Podiatrist and other allied health professionals study how to analyse gait for years and continually review this information to keep it front of mind when assessing a patient. In many cases a retail assistant has completed a short online course or has been trained in store by a manager or store owner who has done short online course. The take away message is wear what’s comfortable! If you have issues, see a health professional and follow their advice.

The literature came across as quite negative when I read over it the first time, however the important thing to be aware of is the research was looking at the video gait analysis as an isolated modality for assessment and not part of a bigger picture. It is about using the available technology to add to the biomechanical assessment as an analysis and educational based tool.

Until Next Time,

Jackson McCosker
Director/Chief Editor


Bishop, C., Gunther, P., & Thewlis, D. (2012). Recommendations for the Reporting of Foot and Ankle Models. Journal of Biomechanics, 1 – 17.

Brunnekreef, J., VanUden, C., Moorsel, S., & Kooloos, J. (2005). Reliability of Video Taped Observational Gait Analysis in Patients with Orthopedic Impairments. BMC Musculoskeletal Disorders, 1 – 19.

Eastlack, M., Arvidson, J., Snyder-Mackler, L., Danoff, J., & McGarvey, C. (1991). Interrater Reliability if Videotaped Observational Gait Analysis Assessments. Physical Therapy, 465-472.

Here’s What Actually Matters When Shopping for Running Shoes. (2016, 07 25). Greatist.

Incorporating Video Gait Analysis into Your Practice. (2016, July 31). Australia: SiliconCoach.

Keenan, A.-M., & Back, T. M. (1996). Video Assessment of Rearfoot Movements During Walking: A Reliability Study. Archive of Physical and Medical Rehabilitation, 651-655.

Langer, P. (2011). Video Gait Analysis in Podiatric Sports Medicine. Current Topics in Sports Podiatry, 149-154.

Lee, L., & Grimson, W. (2002). Gait Analysis for Recognition and Classification. The Computer Society.

Toro, B., Nester, C., & Farren, P. (2003). A Review of Observatinal Gait Assessment in Clinical Practice. Physiotherapy Theory and Practice, 137-149.

Why Gait Analysis Doesn’t Work. (2016). Champions Everywhere.


Developing and Achieving Goals for Sport and Life

Developing and Achieving Goals for Sport and Life

Many people have heard of SMART goals. A way of developing well thought out and measurable goals which will make them easy to accomplish. It works well when done correctly but so many people write down the goal and place it in a draw where they will never see it again.

SMART stands for:
Specific:              The goal should be as precise as possible
Measurable:       The goal should have an element which can be measured
The goal should be as realistic as possible
The goal must sincerely mean something to you
There must be a time frame in which you wish to complete the set goal.

e.g.:       I will complete the Melbourne Marathon on October 13th in under 4hours.

Tgoal settinghe example here shows all the SMART goal principles within one short sentence. It also describes the goal in a positive way “I will”, to increase confidence in the statement.

So now you have your goal written down what do you do with it? To me, all that goal is at the moment is a sentence on a piece of paper. What you need to do is turn that goal into an action plan and the easiest way to do this, is to break it down into smaller goals and tasks which need to be complete in a specific amount of time.

Let’s break down the goal we began with:
“I will complete the Melbourne Marathon on October 13th in under 4hours”

Specific:              Melbourne Marathon

Measurable:      Under 4hours

Attainable:         I have been completing 10km a day 5 days a week and strength training.

Relevant:            I have wanted this since I began running

Timely:                October 13th – 3months away (12 weeks)

Of this break down of the primary goal there are 2 areas which we need to take into consideration; the time in which we wish to finish the marathon as this affects the type of training we wish to complete over the coming weeks, and how long we have until our set date for goal achievement is reached. The reason these are important is that, if we create 12 small goals in the lead up to the Melbourne Marathon we are more likely to stay committed to the larger goal which is set and not lose track of what we would like to achieve. This may look something like the following:
Week 1 –  I will to complete 60km in one week
Week 2 –  I will to complete at least 2 15km runs this week
Week 3 –  I will complete 70km this week and 2 strength sessions

Then of these established goals you break them down into daily tasks including the run itself, rehabilitation activities, dietary requirements and hydration/recovery. By doing this you always have your primary goal front of mind and something you will never forget in the lead up to the event date.

Other handy tips include writing the goal somewhere where you will always see it and be able to state it out loud three times every morning in a powerful and determined way. This is where writing the goal in a positive context becomes so relevant as speaking in positive terms out loud can really increase your confidence in completing the task ahead of you.

Until Next Time,


Jackson McCosker
Director/ Chief Editor

Diabetes and The Foot

Diabetes and The Foot

Diabetes is a huge public health problem for Australia. The chronic disease characterized by the inability to produce the hormone insulin or the body being unable to adequately utilize the insulin it does produce, costs the country over 6 Billion dollars annually. There is currently no cure for diabetes and impact of the condition becomes more prevalent to the individual the longer it is present. There are a number of different types oshutterstock_309584594.jpgf diabetes but over an extended duration they condition will affect the body in similar ways.

Type 1 is an auto-immune condition, presenting itself in early childhood or adolescents. It is important that good habits related to food and exercise are established early as people with this condition will have it for their entire life and risk serious complications if not managed appropriately.

Type 2 – is an inability for the body to utilize the insulin it produces. The condition has been defined as a lifestyle disease and is typically associated with obesity and poor cardiovascular health.

Gestational Diabetes – is first diagnosed during pregnancy and typically disappears once the baby is born. However, there is an increased risk of the development of Type 2 diabetes in following years.

As Type 2 diabetes is a lifestyle disorder associated with individual choices, it will be the primary focus of this article due to it being able to be prevented and treated with relatively simple interventions. Developing a good balanced and portioned diet like that of the CSRIO helps to reduce sugar intake and increase both soluble and insoluble fibre, while improving cardiovascular and general health. Due to the portion control and the increase of fibre into the diet, weight loss will generally occur as a by-product.

Additionally, completing regular moderate intensity exercise will also aid in weight loss and both aerobic and anaerobic fitness.

Neurological Impact
The nerves are the motor way of the body, responsible for delivering messages from inside and outside the body to the brain for processing. Unfortunately, the peripheral nerves (ending in the extremities like the toes) are most likely to be affected by diabetes. The damaging of nerves via diabetes can contribute to painful, numb or insensitive feet. This is of concern as injury to the foot can occur without an individual being aware and lead to continued ulceration. It should be mentioned that in many cases, nerve damage my display no signs or symptoms and go undetected for some time.
There are many practical implications due to peripheral neuropathy which affect individuals, most of which goes without consideration until it may be considered too late. These include your ability to drive (can’t drive if you can’t feel your feet), regular falls and restrictions on barefoot or uncovered footwear.

Vascular Impact

Diabetes can cause a reduction in blood supply to an individual’s feet as a result of poor circulation from the narrowing or hardening of arteries. This issue is further contributed to by increases in blood sugar levels, smoking and high blood fats (cholesterol).
The inability to supply blood to the legs and feet can lead to issues such as delayed healing, further complicating the presence of ulceration. A wound which is unable to heal in an efficient manner becomes susceptible to infection, necrosis (gangrene) and eventually amputation.
signs and symptoms of poor blood supply include; cold feet, discolouration of the skin, delayed healing, swelling around the ankles, reduction in hair/nail growth and painful calves during exercise.

Diabetes is the leading cause of non-traumatic lower limb amputation in the world. Those who have suffered from lower limb ulceration or amputation have a lower quality of life than their non-diabetic counter parts.
Amputation is a major issue for individuals and creates great stress. Finding appropriate shoes becomes the least of their worries as they battle with pain, increased chances of further amputation, balance and a reduction in their independence.

The impact of diabetes on not only Australia but the World is undeniable. The Global costs of managing diabetes is astronomical and will not continue to be sustainable unless serious changes take place. But it cannot take place through a Government initiative, yes they can help, but changes need to occur at an individual and familial level. They need to occur through community participation and encouragement, not just the subsidisation of healthcare products or services for those who are not willing to aid their management of a chronic lifestyle disease.

Until Next Time

Jackson McCosker
Director/Chief Editor



Diabetes – Foot Care. (2016, July 31). Retrieved from Better Health Channel:

(2012). Diabetes: The Silent Pandemic and Its Impact on Australia. Baulkham Hills: Novo Nordick Pharmaceuticals.

(2016). Global Report On Diabetes. Geneva: World Health Organization.

(2014). Prevent Diabetes Problems. Bethseda: National Institute of Diabetes and Digestive and Kidney Diseases.

Tennvall, G., & Apelqvist, J. (2000). Health – Related Quality of Life in Patients with Diabetes Mellitus and Foot Ulcers. Journal of Diabetes and Its Complications, 235 – 241.

Wallace, Q., Sullivan, K., Reiber, G., Hayes, S., LeMaster, J., Vath, C., & Smith, D. (2002). Incidence of Falls, Risk Factors for Falls and Fall Related Fractures in Individuals with Diabetes and a Prior Foot Ulcer. Diabetes Care, 1983 – 1986.