Restoring physical freedom.
Why us?
Dr Angus Chard PhD leads our team. He is an internationally recognised, second-generation Sports Podiatrist and Honorary Associate of The University of Sydney. His extensive clinical experience and Doctorate distinguish him as a leader within the Podiatric profession and a Specialist in Lower-Limb Musculoskeletal Medicine with an emphasis in Paediatrics.
"We balance the latest evidence-based medical treatments and interventions with a wealth of clinical experience."
"We are about offering solutions to people suffering foot and leg pain. We pride ourselves on providing cost-effective treatments for the conservative management of acute and chronic foot and leg musculoskeletal conditions."
Our Team
Dr Angus Chard PhD
Is a second-generation Sports Podiatrist, awarded PhD by The University of Sydney (USYD) in Biomechanics, emphasis, Paediatric Pathomechanics in 2018
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Dr Michelle Cuthbert
Educated in Johannesburg and has accumulated over 20 years of clinical experience
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Dr Michael Gumatay
Perused podiatry after suffering chronic foot pain for most of his growing years.
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Genevieve O'Brien
Is responsible for the practice running smoothly and is passionate about ensuring patients have a world-class customer experience...
Read MoreOur Values
Team First
We are humble, function as a team
Credibility
We balance evidence with experience
World Class
We strive to exceed expectations
Above the Line
We do what we say we will doVideos & Blogs
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Foot and Leg Pain Centre
At the Hills Foot and Leg Pain Centre
Effects of Gastrocnemius/Soleus and Achilles Tendon Tension on Ankle and Subtalar Joint Moments and Forefoot Ground Reaction Force![]()
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Contractile activity within the gastrocnemius and soleus muscles, and the Achilles tendon tension that results by their contractile activity, is important for the performance of nearly all weightbearing activities. Since the cross-sectional area of the gastrocnemius and soleus muscles is larger than all the other muscles of the leg combined, the gastrocnemius and soleus muscles exert a powerful influence on the biomechanics of the foot and lower extremity during weightbearing activities.![]()
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Achilles tendon tension produced by gastrocnemius and soleus muscle contractile activity produces moments at both the ankle joint (AJ) and subtalar joint (STJ). Since the Achilles tendon is posterior to the AJ axis, contractile activity of the gastrocnemius and soleus muscles will produce an AJ plantarflexion moment. In addition, since the Achilles tendon is medial to the ankle joint axis, contractile activity of the gastrocnemius and soleus muscles will also produce a STJ supination moment.![]()
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Therefore, Achilles tendon tension produces both an AJ plantarflexion moment, which tends to plantarflex the ankle, and a STJ supination moment, which tends to supinate the STJ. In order for the weightbearing bipedal human to counterbalance these internal moments that arise from gastrocnemius and soleus muscle contractile activity and create AJ and STJ stability, equal and opposite AJ and STJ moments must be generated by some other source.![]()
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If ground reaction force (GRF) is going to be the source of the equal and opposite AJ and STJ moments necessary to exactly counterbalance gastrocnemius and soleus muscle contractile activity, then the location of that GRF must be centered (i.e. center of pressure) at an area on the plantar foot that produces both an AJ dorsiflexion moment and a STJ pronation moment. For GRF and the center of pressure, this location must be anterior to the ankle joint to produce an external AJ dorsiflexion moment and must be lateral to the STJ to produce an external STJ pronation moment.![]()
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In the case of my illustration below of a foot with a normal STJ axis location, Achilles tendon tension produces both an AJ plantarflexion moment and a STJ supination moment. In order for a GRF vector acting at one plantar location at the metatarsal head level to produce the correct amount of counterbalancing external AJ dorsiflexion moment and STJ pronation moment, it must be on a line drawn from the center of Achilles tendon force, through the intersection of the AJ and STJ axes, and extended anteriorly toward the lateral forefoot. Where this imaginary line intersects the plane of the metatarsal heads is where a single GRF vector may exactly counterbalance the AJ and STJ moments from Achilles tendon tension so that AJ rotational equilibrium and STJ rotational equilibrium are both achieved.![]()
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These biomechanical concepts regarding the internal function of Achilles tendon tension are very apparent during the neutral suspension casting technique used for making negative casts for custom foot orthoses. During the neutral suspension casting technique, the examiner's hand, pushing lateral to the STJ axis at the 4th and 5th metatarsal head level (i.e. producing an external STJ pronation moment), can easily counterbalance the STJ supination moments and AJ plantarflexion moments arising from Achilles tendon force. ![]()
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However, in the foot with a very medially deviated STJ axis (i.e. flatfoot deformity), this same pushing force plantar to the 4th and 5th metatarsal heads from the examiner's hand will produce STJ pronation instability due to the medial STJ axis position which makes negative casting much more difficult. In this scenario which only occurs in feet with excessively medially deviated STJ axes, the STJ pronation moments arising from the examiner's hand are of greater magnitude than the STJ supination moment from Achilles tendon tension so that the STJ accelerates in the pronation direction during attempted negative casting.![]()
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Understanding the biomechanics of gastrocnemius and soleus contractile activity and Achilles tendon tension force that results is critical to understanding the biomechanics of the foot and lower extremity during weightbearing activities.
This is why femoral retroversion mattersHip Impingement in maximal hip flexion occurs on the anterior-inferior proximal femur in patients with femoral retroversion. Hip Impingement is more than cam and pincer. University of Bern ow.ly/BzO550KIfTB
Nice one Blues congratulations 🥳💥U14 Blue - SJRU 14A Premiers for 2022 💥![]()
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Congratulations to 14 Blue for an undefeated season and an impressive points margin over second place.![]()
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Solid performances every round of the competition capped off with a final series 80 points for to 12 points against shows the calibre and work ethic of these players.![]()
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A great result for the club, but more so a fantastic achievement for each and every player in the team and one for them to savour.![]()
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Bring on 2023!![]()
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#duralrugby #eastwoodjuniorrugby #sjru
U12s girls lost to the Stags in our grand final of the bottom four teams. Super proud of the girls, they hands down played their best game of the season and only lost 12:8 to a team that beat us 30:8 only two weeks ago. Amazing finish to a great season
Prescribing Better Custom Foot Orthoses: Sinus Tarsi Syndrome![]()
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The sinus tarsi is located just anterior and inferior to the tip of the lateral malleolus and is the lateral entry into the subtalar joint. During subtalar joint (STJ) supination, the lateral process of the talus slides posteriorly and superiorly along the posterior facet of the calcaneus. This STJ supination motion will enlarge the volume of the sinus tarsi. ![]()
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During STJ pronation, the lateral process of the talus slides anteriorly and inferiorly along the posterior facet of the calcaneus until the lateral talar process contacts the floor of the sinus tarsi of the calcaneus, effectively closing the sinus tarsi and minimizing its volume (see my illustration below).![]()
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Once the lateral talar process contacts the floor of the sinus tarsi, the STJ has reached the end of its pronation range of motion, or the maximally pronated position. At this maximally pronated position, further pronation moments acting across the STJ axis will not produce STJ pronation (i.e. motion of the talus relative to the calcaneus), but will, rather, produce increased interosseous compression force between the lateral talar process and the floor of the sinus tarsi of the calcaneus (Kirby KA: Rotational equilibrium across the subtalar joint axis. JAPMA, 79: 1-14, 1989; Kirby KA: Subtalar joint axis location and rotational equilibrium theory of foot function. JAPMA, 91:465-488, 2001).![]()
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In addition to being the anatomical location where the abrupt end to pronation motion of the STJ occurs, the sinus tarsi also contains a number of strong ligamentous structures between the talus and calcaneus that serve to guide the motion of the STJ during its normal physiological motions. The cervical ligament, inferior extensor retinaculum and interosseous talo-calcaneal ligaments are all located within the sinus tarsi acting to guide normal STJ range of motion and to restrict abnormal talo-calcaneal motions (Sarrafian SK.: Anatomy of the Foot and Ankle, J.B. Lippincott Co., Philadelphia, 1983).![]()
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"Sinus tarsi syndrome" is the name most often used for the relatively common condition of pain that occurs within the sinus tarsi with increased weightbearing activities. I divide sinus tarsi syndrome (STS) into two different types of injuries. The first type of injury is what I call post-traumatic sinus tarsi syndrome (PTSTS) where there has been a traumatic injury to the foot and/or ankle which preceded the onset of pain in the sinus tarsi, with the most common inciting injury being an inversion ankle sprain. The second type of injury is non-traumatic sinus tarsi syndrome (NTSTS) where the patient has no recollection of specific injury to the ankle or foot but instead reports a more gradual onset of pain. In both PTSTS and NTSTS, patients will describe increased pain in the sinus tarsi with increased weightbearing activity, decreased pain with walking in moderately heeled shoes and may often complain of pain with walking on uneven surfaces.![]()
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During non-weightbearing clinical examination of sinus tarsi syndrome, patients will have increased pain with inversion of the STJ and will have little to no pain with maximal pronation of the STJ. Manual palpation into the sinus tarsi always reveals increased tenderness, and often this tenderness is quite significant to even light palpation of the sinus tarsi. Localized edema at the sinus tarsi is present in some patients and radiographs are invariably negative for any sinus tarsi pathology.![]()
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My treatment plans and prognosis for these sinus tarsi pathologies are based on my hypothesis that PTSTS and NTSTS are two distinct types of injuries that cause nearly identical clinical symptoms in the same region of the foot. In NTSTS, the clinical examination of the weightbearing foot always demonstrates a foot with a lower than normal medial longitudinal arch (MLA) and a significantly medially deviated STJ axis which is maximally pronated at the STJ. In these feet that develop sinus tarsi pain without any known foot or ankle trauma, the most likely etiological mechanical scenario is that excessive magnitudes of interosseous compression forces between the lateral talar process and the floor of the sinus tarsi of the calcaneus occur over time causing bone and/or ligament injury within the sinus tarsi (Kirby 1989).![]()
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Excessive external STJ pronation moments from ground reaction force acting across the medially deviated STJ axis will jam the lateral talar process forcefully into the floor of the sinus tarsi with each step which is very likely to happen when the STJ supinators are not functioning properly, such as is commonly seen in posterior tibial tendon dysfunction (PTTD). Feet with NTSTS are treated with an identical foot orthosis to one that would be used to treat PTTD, with a medial heel skive, inverted balancing position and stiff orthosis shell so that the foot orthosis can act to reduce the interosseous compression forces within the sinus tarsi (Kirby KA: Prescribing Better Foot Orthoses: Posterior Tibial Tendon Dysfunction, Precision Intricast Newsletter, May 2010).![]()
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In PTSTS, on the other hand, my clinical experience is that the patient often has a foot that is maximally pronated at the STJ during standing and during gait but does not necessarily have the extent of medial deviation of the STJ axis that seems to always be the case in the NTSTS patients. It is likely that patients with PTSTS develop sinus tarsi pain due to scarring of the ligaments within the sinus tarsi and tarsal canal due to ligamentous tearing that occurred during their inversion ankle sprain or other traumatic sinus tarsi injury. Since this pathologic scar tissue now occupies more space or is in an abnormal location within the sinus tarsi, pain may occur with even mild compression forces within the sinus tarsi at the end range of STJ pronation. In other words, the sinus tarsi forces of walking in the maximally pronated position may compress the sensitive scar tissue and cause chronic sinus tarsi pain.![]()
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In these patients with PTSTS, I combine a series of 3 cortisone injections into the sinus tarsi, at 4 week intervals, with the goal of reducing the bulk of the scar tissue within the sinus tarsi along with milder anti-pronation foot orthoses (e.g. 2 mm medial heel skives, 16 mm heel cups, 3 mm heel contact point thickness and 1-20 inverted balancing position) to reduce the compression forces on the inflamed scar tissue during weightbearing activities. Even though I have found sinus tarsi symptoms to respond more readily to foot orthosis treatment in the NTSTS cases, foot orthosis therapy can also be invaluable in making the symptoms of PTSTS resolve completely over time.![]()
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[Reprinted with permission from: Kirby KA: Foot and Lower Extremity Biomechanics IV: Precision Intricast Newsletters, 2009-2013. Precision Intricast, Inc., Payson, AZ, 2014. pp. 99-100.]![]()
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My five Precision Intricast Newsletter books may all be purchased from the Precision Intricast website at www.precisionintricast.com/shop.
EXCELLENT
39 reviews on
Robert Jennings
19/04/2022
Verified
This was my first treatment which was a wonderful experience. Such welcoming, friendly staff who took great care of me. Excellent service, excellent treatment. I felt so well looked after.
I definitely recommend this service.
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Robin Widoyo
07/03/2022
Verified
Dr Angus is very kind, attentive. The advice given is very well explained. Most importantly, it works! My feet feel so much better now. Thank you Dr Angus and the team.
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Kew Somerville
18/02/2022
Verified
I went with a foot issue that I was quite embarrassed about but was met with nothing but kindness, professionalism and understanding. From being greeted warmly on arrival then meeting with Michael who took the time to thoroughly examine the issue and proceed to explain the treatment needed, I could not be more grateful. I'm looking forward to my return and progress. Many thanks.
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Phillip Roberts
16/02/2022
Verified
I have visited specialists, had surgery, seen so many medical practitioners & podiatrists to get help with my very painful feet. I made a first visit to see Dr Angus Chard a week ago, and I was so pleased with the help he gave in just one visit. I was very happy with the way he listened to me and all the positive things he started & told me to help me. I will certainly be keeping a regular time with him as I feel that his treatment will help me. He is a very pleasant & knowledgeable person and his staff are very pleasant and helpful. I would have no hesitation in recommending him to anyone with nail or painful wart problems
Regards Di Roberts
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Ann Flegg
02/02/2022
Verified
A passionate, friendly & caring team of people who are excellent at their work. I don't think there is a better place for foot care.
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Bill Heinrich
12/01/2022
Verified
friendly and pleasant experience. Gentle handling of my extremely troublesome ingrown toenail. Excellent explanation of my situation, and clear advice for future treatment, including promise of oversight of any further needs.
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Calvin Brodie
23/07/2021
Verified
Cannot recommend Angus highly enough. Over the years he has assisted me with leg, ankle, and foot sporting injuries with genuine care and expert knowledge. If you’re not getting the results you need from your current provider, go and see Angus.
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