A typical day
A typical day, starting at 8am, is a combination of chiropody – dealing with corns, calluses and ingrown toenails – and podiatry, working on bio-mechanical issues. A lot of the work is psychological. You’re trying to reassure people and help them. So I never look at just the foot: I treat the person as a whole. People come in and bare themselves to you. They can be quite vulnerable.
Reassurance is a big thing. I see a lot of people with chronic pain issues. There’s a gentleman I’m treating who has had pain for the past four years, throughout his legs and back. He retired recently and all the symptoms have got worse. No one has been able to help him. I believe we can.
A lot of his problem is down to his muscular strength being poor. As a result, he has stiffened up. While his foot mechanics have a role, they’re not as important as his muscular issues. That’s where physiotherapy comes in. I work with a physiotherapist in the clinic who is driving the treatment with this man.
If patients come in looking for cosmetic treatments, we try to make them understand that’s not what we do. You don’t go to your dentist to make your teeth look pretty.
We are getting busier because people are exercising more. Since the recession, we notice that people are running a lot more. It’s much cheaper than going to the gym. Running is generally good for your health but people embark on it while having muscular, skeletal or strength issues. They’re not strong enough and not flexible enough. We tend to see them when their issues become chronic.
I deal with a lot of other clinicians such as GPs and consultants. A good one-third of our work comes from other clinicians. We always keep in touch with them and let them know what’s going on, sending them emails and reports.
Also, when dealing with a patient for anything other than routine chiropody, we always email them a report. We want to educate the patient. Studies show that if you educate your patients, they’ll get a better outcome because they’ll be more compliant. That takes up a lot of time but it’s worth it.
I like to go home knowing I did for my patients what I’d do for my own family. This year, we’re expanding and hiring another physiotherapist and a podiatrist.
I can’t continue to work for 60 hours a week. I’ve been working those kinds of hours for seven years.
In my training [at University College London], I was never taught how to run a health business. I recently listened to a podcast about how to do it. It talked about how a lot of health business owners are just slaving away, treating patients, with no time to run the business.
There is another way of doing it and that’s what I’m trying to do. I want to step back and hopefully end up giving better quality treatment to patients.
Excess of tension
I would say that a quarter of the biomechanical issues we see are cases of plantar fasciitis. The commonly used term for that is a heel spur. It’s excess tension on the sheets of fascia across the arch of the foot. You need to find out why there is this excess tension.
We also see people with pronation, known as fallen arches. It’s a normal thing that’s often overtreated. If a patient is not in the normal category, they must be treated with orthotic insoles (to align the foot).
People of all ages come into us. The youngest patient I’ve seen was six months old and the oldest was 96. Children are born with extremely flat feet which become less so as they grow. Parents, being parents, worry, and come in to get their children’s feet checked.
In a lot of cases, you’re treating the parent as much as the child. In 80 per cent of cases involving kids under 10, it’s a case of just reassuring the parents that their kids’ feet are normal.
In some cases, we might recheck the child 12 or 18 months later. Being a parent, I understand. You’re inclined to think the worst.
Sprained ankle
The 96-year-old patient had a sprained ankle. I asked him when he sprained it and he said it happened in 1932. I don’t know why all of a sudden he decided he wanted treatment. Because of the sprain, he had severe osteoarthritis in the ankle and foot. I gave him some stability, taking some of the force off with orthotics. The man also had some weak muscles in his lower leg so the physiotherapist got involved and gave him exercises. After two or three months, he was discharged.
I did all sorts of training while I was at college; even treating leprosy patients. Diabetes is a growing problem. There’s a statistic that says if you have a foot amputated as a diabetic, you have a 50 per cent chance of being dead in five years. Ella Fitzgerald had diabetes and didn’t look after herself and had both legs amputated. It also happened to Zsa Zsa Gabor.
We recommend healthy shoes. It’s easy for men to find shoes that are healthy and are still okay to look at.
For ladies, it’s difficult to find shoes that are both healthy and fashionable. A lot of that is because shops are not all asked to stock them.
We don’t recommend particular brands. Instead, we educate a patient on what makes a good shoe.
It should physically fasten and not have too high a heel, probably nothing higher than an inch.
The shoe should bend when the foot bends through the ball of your foot. A surprisingly large number of shoes don’t do that.
Unhealthy shoes
We ask patients to bring in all their shoes. The men would usually have two or three pairs that would be fairly sensible. They’d listen to what you say.
The women bring in one or two suitcases of shoes and 90 per cent of them wouldn’t be very healthy. We try to educate them and advise that they minimise the use of unhealthy shoes. Wear them for a night out, but know there’s a price to pay. We’re pragmatic rather than dogmatic with people.
What I like most about the job is the biomechanics of how the body moves. I love working out why an Achilles heel is under stress or why a patient’s hip is giving them trouble.
What I really like is seeing a patient who hasn’t been in for a year or two. You know you can fix them.
On the downside, there are the troublesome patients who have something else going on in their lives. I don’t like the administration side of the job either.
I always knew I wanted to work at something medical. I kind of drifted towards podiatry. I was qualified for a year before I realised it was what I loved.
Fixing people gives me satisfaction. We seem to get what other clinicians haven’t been able to fix.
At the moment, there is no legal protection for either a chiropodist or a podiatrist.A register is supposed to be coming in. It has been talked about for a long time.
Out of hours
I have three young children and we seem to be going to a lot of kids’ movies these days. I fell asleep during ‘Penguins of Madagascar’. I read a lot about my job. I have no time to read novels. I run a 5k or 10k race every eight weeks or so, and train in between. I recently took up cycling and I like an occasional hike.
