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
When you cross the finish line and realize that you’ve just won your 10th national champion title. Emma Coburn, steeplechase, 9:10.63. 2022 USATF Outdoor Championships. ![]()
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#emmacoburn #emmabosshard #usatfoutdoors #usatf #worldchampion #steeplechase #trackandfield #athletics #jeffcohenphoto @emmacoburn @usatf
Sinus Tarsi Syndrome in the Pronated Foot: How Does Subtalar Joint Rotational Equilibrium Explain It?![]()
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Pain within the sinus tarsi is often a symptom seen in patients with severely pronated feet, such as in the case of posterior tibial tendon dysfunction (PTTD). Why would pain in the sinus tarsi be caused by excessively pronated feet that have a more medially deviated subtalar joint (STJ) axis?![]()
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33 years ago, I authored a paper that discussed the physics concept of rotational equilibrium and how this concept could be useful in explaining some of the abnormal internal forces that occur within the structural components of feet that have excessively medial or lateral deviations of the STJ axes. Rotational equilibrium across the STJ axis was also used in my paper to explain how medial STJ axis deviation may cause abnormal STJ pronation moments and how lateral STJ axis deviation may cause abnormal STJ supination moments. Specifically, I discussed in this paper how sinus tarsi syndrome is biomechanically produced in patients with excessively medially deviated STJ axes (Kirby KA: Rotational equilibrium across the subtalar joint axis. JAPMA, 79: 1-14, 1989).![]()
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In the case of sinus tarsi syndrome, the end range of pronation of the STJ occurs when the lateral process of the talus strikes the floor of the sinus tarsi of the calcaneus during STJ pronation motion. With more severe medial deviation of the STJ axis, the compression forces between the lateral process of the talus and the floor of the sinus tarsi of the calcaneus increases. This increase in interosseous compression force between the lateral process of the talus and the floor of the sinus tarsi of the calcaneus at the maximally pronated STJ position may cause bone bruising or painful soft tissue compression within the sinus tarsi over time The result is the complaint of pain within the area of the sinus tarsi which is seen in patients with more severe pronated feet and sinus tarsi syndrome.![]()
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In the illustration below is a model of the posterior foot with a medially deviated STJ axis. I created this model of the foot in 1988, while writing my paper "Rotational Equilibrium Across the Subtalar Joint Axis". The model consists of the calcaneus inferiorly, connected by a hinge-like STJ axis to the talus and tibia in a combined unit superiorly, which I called the "talar-tibial unit".![]()
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At rest, the medially deviated STJ axis causes excessive STJ pronation moment which is resisted by an internal STJ supination moment from the floor of the sinus tarsi of the calcaneus by the lateral process of the talus exerting a compression force on the floor of the sinus tarsi of the calcaneus (left illustration). With a mild increase in posterior tibial muscle contractile activity, the compression force between talar lateral process and floor of the sinus tarsi of the calcaneus is lessened but the STJ is still maximally pronated, with less compression force now within the sinus tarsi due to the posterior tibial tendon tension force (center illustration). With even more posterior tibial tendon force, the talar lateral process will supinate away from the floor of the sinus tarsi of the calcaneus, completely eliminating the interosseous compression force within the sinus tarsi (right illustration).![]()
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Custom foot orthoses, with anti-pronation design features such as a medial heel skive, works similar to the posterior tibial muscle by increasing the STJ supination moment to relieve some or all the interosseous compression force within the sinus tarsi in patients with sinus tarsi syndrome. My model can be used to very easily illustrate many biomechanical concepts pertaining to medial and lateral STJ axis deviation and rotational equilibrium of the STJ. ![]()
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References:![]()
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Kirby KA: Methods for determination of positional variations in the subtalar joint axis. JAPMA, 77: 228-234, 1987.![]()
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Kirby KA: Subtalar joint axis location and rotational equilibrium theory of foot function. JAPMA, 91:465-488, 2001.
Stop suffering forefoot pain from metatatarsalgia,Morton Neuroma, intermetatarsal bursitis, joint capsulitis and arthritis and planetar plate tare can be treated!Biomechanics of Metatarsal Pads on Metatarsal Bending Moments and Metatarsal Stresses![]()
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During normal weightbearing activities, ground reaction force (GRF), which is considered an "external force", acts vertically upwards on the metatarsal head causing an upward-directed bending moment on the metatarsal shaft (illustrated on the left in the drawing below). A bending moment is defined as the reaction induced within a structural element when an external force or moment is applied to the element causing the element to bend.![]()
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www.mem50212.com/.../Bendin.../Bending_Moment.html...![]()
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The upward-directed bending moment on the metatarsal shaft will tend to cause the metatarsal to bend upward so that the superior surface of the metatarsal shaft becomes more concave and the inferior surface of the metatarsal shaft becomes more convex. In turn, the dorsal bending of the metatarsal causes an increase in compression stress (indicated in the drawing as a "+" symbol) along the dorsal shaft of the metatarsal and an increase in tension stress (indicated in the drawing as a "-" symbol) along the plantar shaft of the metatarsal.![]()
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The more narrow the cross-section of the metatarsal (i.e. metatarsal neck) the greater the stress within the metatarsal shaft. The greater the stress within the metatarsal shaft, the greater the likelihood of metatarsal stress fracture.![]()
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skyciv.com/.../calculate-bending-stress-of-a.../...![]()
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One method that may be used to reduce the stress within the metatarsal is the application of a metatarsal pad to an orthosis (illustrated on the right in the drawing below). The metatarsal pad moves GRF more proximally on the metatarsal or, in other words, the metatarsal pad shifts GRF more from the metatarsal head and towards the midshaft level of the metatarsal shaft. In moving the GRF more proximally on the plantar aspect of the metatarsal, the moment arm (i..e. lever arm) for GRF to cause a metatarsal bending moment is decreased which, in turn, decreases the compression stress along the dorsal metatarsal cortex and decreases the tension stress along the plantar metatarsal cortex.![]()
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As a result, an appropriately placed metatarsal pad, or other similar custom foot orthosis modification, has the mechanical ability to reduce the metatarsal bending moments, reduce the metatarsal stresses and help prevent or help heal metatarsal stress injuries (i.e. metatarsal stress reaction and metatarsal stress fractures). ![]()
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Understanding how the external forces of GRF acting on the plantar foot can be altered to change the internal forces and stresses acting on and within the structural components of the foot and lower extremity is the key to becoming an expert in the multiple therapeutic applications possible with custom foot orthosis therapy.
Orthosis Modifications for Chronic Peroneal Tendinopathy![]()
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Peroneal tendinopathy encompasses the disorders of peroneal tendinitis, peroneal tendon tears and subluxing peroneal tendons. From a biomechanical standpoint, it is easy to understand why the peroneal tendons are often injured since the peroneus longus and peroneal brevis muscles are the only two significant pronators of the subtalar joint (STJ). Because of their unique ability to actively generate STJ pronation moment, the peroneals may either accelerate STJ pronation motion, decelerate STJ supination motion or stabilize the STJ against excessive STJ supination moments. As such, the peroneals serve as the main mechanical source of STJ pronation moment when there is a mechanical need for this rotational force during weightbearing activities.![]()
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Peroneal tendon injury can occur due to a single traumatic event or can occur due to repetitive microtrauma or chronic overuse. When the peroneals function with more contractile force over a longer period of time, the chronically high peroneal tendon tension loading forces may subject the peroneal tendons to increased tendency toward injury.![]()
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For example, in a foot with a laterally deviated STJ axis, not only will ground reaction force (GRF) tend to cause increased STJ supination moment, but also the reduced STJ pronation moment arm length of the peroneal muscles caused by lateral STJ axis deviation will necessitate greater magnitudes of peroneal muscle contractile force and peroneal tendon tensile force to generate a given magnitude of STJ pronation moment. Therefore, not only does the foot with a laterally deviated STJ axis tend to have increased supination moment from GRF, but it is also has less muscular potential to counterbalance these excessive STJ supination moments due to the decreased pronation moment arms of the peroneal muscles that result from lateral deviation of the STJ axis (Kirby KA: Subtalar joint axis location and rotational equilibrium theory of foot function. JAPMA, 91:465-488, 2001). ![]()
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Even though orthoses are not particularly effective at treating patients with subluxing peroneal tendons, I have found orthoses to be very effective at treating peroneal tendinitis and many peroneal tendon tears. The philosophy behind treating peroneal tendon disorders with orthoses is to specifically design the orthoses to decrease the tension loading forces on the tendon during weightbearing activities. In other words, if the foot orthosis can be designed to decrease the pathologic tension loading forces on the injured peroneal tendons, then the foot orthosis should not only be able to immediately make the patient walk with less pain but may also allow the tendon to heal and prevent injury in the future.![]()
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In order to accomplish the goal of reducing peroneal tendon loading forces during weightbearing activities with a foot orthosis, the orthosis must not be designed using the concept of “balancing the heel vertical” that has been traditionally taught in podiatry schools. Instead, the orthosis should be designed based on the STJ axis location/rotational equilibrium theory which states that the orthosis should be designed to reduce the magnitude of abnormal STJ moments that are the cause of the injury and pain within the anatomic structure that is resisting this pathologic rotational force.![]()
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Over the past three decades of trying different orthosis m![]()
modifications, I seem to have arrived at a foot orthosis design that not only improves the patient’s symptoms but also improves their gait function with a minimum of orthosis irritation problems. The orthosis is designed with the goal of increasing the STJ pronation moment during gait so that the peroneal muscles will not need to contract so vigorously and the peroneal tendons will, as a result, not be subjected to such large magnitudes of tension loading forces during weightbearing activities.![]()
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The orthosis I use for patients with a laterally deviated STJ axis and chronic peroneal tendinitis consists of a 3/16” to 4/16” polypropylene shell made with a flat rearfoot post and a 2-4 mm lateral heel skive (Fig. 1). The positive cast is modified with extra medial expansion plaster thickness to decrease the medial longitudinal arch height of the orthosis and the heel is balanced 3-5 degrees everted so that there will be increased forefoot valgus correction in the orthosis. ![]()
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I routinely use a full-length topcover and add a korex forefoot valgus extension plantar to the 2nd -5th metatarsal heads (from 1/8” to 3/8” thick plantar to the 5th metatarsal head) that is gradually tapered to paper-thin at the medial 2nd metatarsal head. Finally, korex filler material is added to the plantar aspect of the lateral arch of the orthosis to prevent deformation of the lateral arch of the orthosis during the stance phase of gait. All of these orthosis modifications are designed to shift GRF laterally on the plantar rearfoot, midfoot and forefoot so that STJ pronation moments are increased and STJ supination moments are decreased.![]()
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Using this orthosis, the peroneal tendons are subjected to decreased tension loads so that pain is decreased, more rapid tendon healing occurs and further tendon injuries are prevented. Over the past 20 years, this “anti-supination orthosis” has given me a very predictable conservative method of treating this often disabling injury in the many patients who otherwise might have only been given surgical options for treating their chronic peroneal tendon pain.![]()
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(Kirby KA: Orthosis modifications for chronic peroneal tendinopathy. January 2007 Precision Intricast Newsletter. In Kirby KA Foot and Lower Extremity Biomechanics III: Precision Intricast Newsletters, 2002-2008. Precision Intricast, Inc., Payson, AZ, 2009, pp. 165-166).![]()
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Dr. Kirby's five books may be purchased from Precision Intricast Orthosis Lab at www.precisionintricast.com/shop.
What came first the foot alignment to cause the knee arthritis or the new arthritis.? Doesn’t matter approving foot alignment can help your knees
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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