Welcome to “Peak Pages” from Peak Podiatry Subiaco.

We are now half way through 2015! Where has this year gone?
As we enter July there is only a matter of weeks until Perths iconic “City to Surf”.

With many races and fun runs scheduled over the upcoming months we are sure many people have started to increase their training load. And if they haven’t, may feel forced to do so too quickly! Unfortunately an increase in training load can correlate to an increase in injuries when not done correctly or if there are a few dents in your lower limb function.


Need some help for your next race?

If you are concerned about any lower limb issues we are here to help. Here at Peak we offer video gait analysis and footwear assessments to ensure that you are well supported when running to help minimise your risk of injury.
Injury Profile – Mortons Neuroma
The natural anatomy of the forefoot includes an intermetatarsal bursa. This is a fluid filled sac that sits between the joints of the forefoot. The digital nerve passes between the metatarsal bones and at the level of the met heads (joints of the forefoot) the nerve bifurcates to supply the adjacent border of each toe. For example the nerve of the third intermetatarsal space supplies the outer margin of the third and inside margin of the fourth toe.

This condition generally presents as a low level burning sensation under the ball of the foot in a affected area. Bruising may also be experienced which is from irritation of the bursal distention. As this occurs, the interdigital nerve becomes compressed with symptoms of pins and needles. This can vary from a slightly altered and annoying sensation of the toes through to sharp and signification stabbing pains. Often patients cant quite work out which toe is mainly affected as it influences adjacent margins of both toes.

Pain is often reproduced with lateral compression of the foot and palpation of the inter-metatarsal space. Removal of shoes and tight footwear will often provide some or complete relief of symptoms. Occasionally a “click” may be noticed and felt. This is known as “Mulders Click”.

This is very common with cyclists, often known as “hot foot”. Prolonged rides can see toes go numb, be very painful and in some cases prevent activity.

Predisposing factors:
The exact cause of Morton’s neuroma is not known. It does seem to be a design flaw with this accounting for over 60% of all nerve entrapment conditions within the foot. It is thought that there are a number of factors which could lead to this condition:

  • High-heeled shoes
  • Tight/narrow shoes
  • Excessive pronation – flat feet (causes movement of bones in the forefoot)
  • Excessive supination – high-arched feet (rigid feet with poor FFT loading)
  • Trauma – injuries of the forefoot
  • Sustained focal pressure
During examination the podiatrist may feel a palpable click between the toes. This is known as a “Mulder’s click” which can confirm the diagnosis. Manipulation of the foot may also be performed to attempt to reproduce the symptoms to try to locate the affected nerve.
Outward signs of Morton’s neuroma, such as a lump, are extremely rare. In many cases ultrasound investigations may be required to confirm the size and presence of the neuroma.
  • Ice
  • Massage of intrinsic and intermetatarsal muscles
  • Mobilisation
  • Taping
  • Anti – inflammatory medication
  • Properly fitting footwear (i.e. increased width)
  • Metatarsal dome
  • Orthotic therapy – to control movement and distribute focal load
  • Cortisone injection
  • Chemical ablation
  • Surgical removal (as shown below)


Peak Athlete Profile-
This month our feature athlete profile is Female Triathlete of the Year Katey Gibb.

Katey is a professional triathlete who is a fierce competitor and an inspirational athlete to many. Katey has had a challenging 12 months, rising against adversity to claim Triathlon WA Female Triathlete of the Year.

How long have you been doing triathlons?
I have been doing triathlons for about 7 years. With my first one being the Women’s Triathlon in 2008.

Most memorable race?
It would probably have to be the 2015 Busselton 70.3. It was only my second 70.3 professional race with a really strong field, I went into the race just to have fun and see how I would go. I managed to somehow get myself onto the podium with a 3rd place! It was such a surreal experience and I enjoyed the race from start to finish

Toughest Race
My toughest race would have to be the 2014 Mandurah 70.3. It was my professional debut and an event I had been training towards for over 6 months. Unfortunately a month out my life was turned upside down when my partner was killed cycling. I wasn’t sure if I would be able to compete, but I made the last minute decision to give it a try. It was by far the toughest race I have had both mentally and physically. It really made me appreciate the mental strength that goes into racing and endurance sports.

I made it to the finish and gained a whole lot more appreciation for the sport!

… Did I also mention it was stupidly hot! 🙂

Favourite distance?
My favorite distance would have to be Olympic distance. Not too long and not too short!

Favourite pre-race food?
Oats with grated coconut, honey and banana.

Favourite leg of the triathlon?
Definitely the run!

Any pre-race habits?
I always keep my routine exactly the same pre-race. With the usual packing of my race bag the night before and checking over my gear. But I am hugely pedantic about having a clean bike! I always clean my bike before a race and make sure the chain is sparkling, I don’t leave anything to chance and it gives me the opportunity to ensure everything is running correctly.

A clean bike is a fast bike.

Most influential sporting person?
Anna Meares. She is an awesome athlete, that has overcome set backs to be one of the worlds best athletes. She also gives a huge amount back to the community… It would also be great to be that good on a bike 🙂

In one word what does Triathlon mean to you?
Challenge – No race is ever easy, no matter what the distance. The thing I love about triathlon is how challenging it can be and the satisfaction you get when you cross the finish line.

Thanks Katey. No doubt many more podiums to come.