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A Podiatrist?

Foot pressure evaluation using a Podoscope

Podiatry

Podiatry is a field of healthcare devoted to the study and treatment of disorders of the foot, heel and ankle, together with related conditions in the knee, leg and hip (collectively known as the lower extremity). A Podiatrist and a Chiropodist may nowadays be considered the same.

Foot Care Specialists

Early specialists in foot-related problems were called Chiropodists in the UK, once they had undergone 18 months intensive training to gain their diploma. At about the time the NHS wanted to employ these specialists, there was also the requirement to extend their study to a 3 year degree course. This allows an increasing depth of knowledge and of systemic conditions, since some warning signs appear first in the lower extremities. Over the past decade most of these degree courses have included a research component, as an endeavour to increase the evidence base of podiatry practice. Commensurate with this is the Honours part of the degree, the highest being 1st class, then upper 2nd class (or 2.1), then lower 2nd class (2.2), then a 3rd class pass degree.

Gary Denby

Your Podiatrist Gary Denby has upper 2nd honours degrees in both Computer Science and in Podiatry and is currently pursuing a Master of Philosophy in Education, researching the interprofessional education of students.

Treatments

Treatments include the routine care of nails, corns and callus, particularly for those who have difficulties reaching the feet. Your initial assessment also considers any mechanical or shoe related causes of any problems and may include explanations and footwear advice.

A fungal nail and its resolution with treatment over 12 months

Skin and nail infections

Treatments of skin and nail infections are undertaken (including athlete's foot, fungal nails, warts, verrucae and ulcers). Consideration is given to accumulated, arthritic wear of the joints, reductions in range of motion and any pressure points, callus and corns that may ensue. When appropriate, insoles or orthotics are prescribed and manufactured in-house, to change cushioning or the functioning of the foot, to provide effective rest and reduction of pain.

Joint problems

Restrictions to joints may be bony, or of muscular strain or tightness. In the latter cases podiatrists overlap with physiotherapists in the recommendation and demonstration of warm-up and stretching exercises. Bunions are a form of wear to the 1st toe joints with subsequent joint enlargement and possible crowding of the lesser toes. Attempts are made to treat these conservatively, for as long as possible. However, they may in time require surgical correction, which can be discussed prior to appropriate referral.

Muscle tightness

It is a part of normal development for young teenagers to grow rapidly, with resultant muscle tightness. Those who are most sporty may have consequential difficulties with their knees and backs of the heels, even affecting normal walking. This can be addressed with appropriate advice and stretching before and after activities. Other strains of the foot, ankle, knees and hips or associated muscle groups are also considered by your podiatrist.

Nails

Nails can change their normal saucer-shaped curvature with age, or as a result of sudden trauma or from long-term ill fitting footwear (or tight fitting football boots). Initial involution, or in-turning at the edges, simply makes them difficult to cut. More extreme examples or poor nail cutting, or picking at them can result in an in-grown nail where the edge splits and grows into the nail bed, with resultant pressure, pain and infection. Most can be treated conservatively. Some, however, may need a minor operation under local anaesthetic, to remove the spikule and deter future growth of that part of the nail. Appropriate options can be discussed with your podiatrist.

A Dermatoscope shines strong light through the skin to help judge depth

Dermoscopy

Podiatrists get a privileged view of your feet and lower limbs. They may encounter suspicious moles or dark freckles, with potential to become malignant melanoma (an invasive, spreading skin cancer) due to tanning or sun damage. Some podiatrists have extended their practice to include dermoscopy, allowing a detailed assessment of size, depth and development to determine when referral for excision is appropriate. Foot Wise Podiatry uses digital photography to further enhance this process and to carefully monitor progress for borderline cases.

As you can see from the above examples, your podiatrist has many and varied skills, extending far beyond a pedicure! Your feet are a wonder of engineering which should last a lifetime. If you have any worries or concerns, don't hide them away. You are welcome to bring them for a health-check or treatments as required - we really do like to have you walking on air!

 

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