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- Podiatry (Chiropody) ALL lower limb & foot problems
- Bio-Mechanics/Orthotics therapy
Podiatry (The modern term for Chiropody)Podiatrists diagnose and treat abnormalities of the lower limb and give Podiatryprofessional advice on the prevention of foot problems and on proper care of the foot. Clients will be of all ages from infants to the elderly. In the NHS particularly staff see many patients at high risk of amputation for example those who suffer from arthritis or diabetes.
There is no difference between a Chiropodist and a Podiatrist - look for B.Sc. (Hons)
The main aim of a Podiatrist is to assess, diagnose and treat abnormalities and diseases of the lower limb
Podiatrists treat people of all ages and from all walks of life. Some examples of this are:
- Children sometimes have pains in their legs or feet as they grow or have problems walking.
- People with diabetes may have problems with the circulation or sensation in their feet.
- Sports men and women often suffer from injuries to their legs and feet.
- Dancers with long hours rehearsing and performing put stress through their feet that can cause injury.
- People needing minor surgery - some nail surgery or laser treatment
- People wanting advice - some people do not need treatment but just want advice about footwear or foot health.
- Assess and treat footcare ailments, ranging from problems such as verrucas to deformity
- Analyse a persons walk or run and correct the anatomical relationship between the different segments of the foot. Orthotics-custom made soles-are often prescribed to achieve this
- Monitor and manage foot problems and deformities caused by diseases such as rheumatoid arthritis
- Advise and treat patients at high risk of foot problems and amputation such as people who suffer from diabetes
- Nail surgery using local anaesthetics.
Many symptoms, including corns, callus and pain symptoms are consistent with those caused by mechanical problems associated with posture and the way your foot functions when walking. These problems can sometimes be corrected with the use of functional orthoses/orthotics.
Biomechanics and Orthotic Treatments
Orthotics are designed to improve foot function and posture, thereby eliminating or reducing any abnormal movement and forces that may have caused your injury. Biomechanical problems in the feet can set off a chain reaction of imbalances that put stress on other body parts such as the ankles, knees, hips, back and neck. Stress can give pain even everyday activities with walking exerting 1 ½ times a person’s body weight, but during athletic pursuits; running exerts an impact of 2-4 times body weight.
There are many ways to assess the foot: one is a Direct Print Mat System, which depends on a person standing on the right place at the right time, and the copy/outline of the foot is imprinted onto a carbon type paper, the more weight, the darker the colour.
The second method is which involves pressure plates are put inside shoes, unfortunately this method means that electric cables are hanging from the shoes, and just like the mat system walking may not be “as usual”. The third method is that of load cell systems – not visual/optical in nature where pressure is registered via load cells usually in a large pressure mat. There are many on the market, which have their limitations.
Visualisation Systems e.g. pedobarograph use photographs or videos to record instantaneous pressure distribution. New systems have been developed where companies may offer an orthotic made from reading plantar pressure alone. Caution must be applied here, as effectively a 3-D image is being constructed from a 2-D impression.
Typically these systems are used in a shoe/sports shop environment via staff that are not trained Podiatrists and are not taking in the whole of the anatomy/physiology of the client into consideration. NONE of the above systems can read if a person has a leg length deformity (Previously broken bone/hip replacement/congenital problem) and many problems can be solved by treating this problem alone. Some problems can start to be alleviated by the podiatrist and can then be worked on by a sports masseuse, physiotherapist, chiropractor or osteopath.
A wonky table cannot stand straight by sanding the top, only if the legs are the same length will the table stand straight. Orthotics hold the feet in proper alignment, thereby providing a more stable foundation for the rest of the body. A surprising high percentage of athletes have no complaints of foot pain but even if a problem originates in the feet, it might first show up in the hip, knee or lower back. Before considering orthotics foot wear needs to be correctly fitted and of the right type.
Sometimes the footwear is all that needs to change to assist better foot function. Orthotics can be made from casts of your feet that exactly capture your foot profile and the resulting insole acts as a prescription device. Usually sent away to be made, and having little chance of change, these can be a costly mistake. The Optimum Podiatrist likes to firstly make a “Chairside orthotic” which can be made “while you wait”, at a reasonably low cost. Typically your foot wear and feet are assessed at your initial consultation and if your shoes are of the right type and in good condition you can leave that day with a well fitted orthotic. The foot is assessed in 3 areas, the rear mid and forefoot. At your first fitting typically just the rear foot areas are treated. The client will wear in the othotics (see below).
On the next appointment (typically 4 weeks) your footwear, orthotic and feet will be reassessed any changes can be applied to affect a small change (if necessary) is given. This method allows small changes in the biomechanical systems of the body (muscles/ligaments etc) without inducing pain. Many people soon wear the orthotic all day (and night) and have a reduction if not cessation of their pain. Patient information: Instructions for the issue of a new foot orthotics: Your symptoms are consistent with those caused by mechanical problems associated with posture and the way your foot functions when walking. These problems can sometimes be corrected with the use of functional orthoses.
These are designed to improve foot function and posture, thereby eliminating or reducing any abnormal movement and forces that may have caused your injury. Often orthoses will form only part of your treatment and you may also be prescribed specific stretching exercises. If this is the case, it is important that you do these exercises, as without them your recovery will be delayed. As the orthoses are intended to make adjustments in your posture and the way in which you walk, it is possible that you may experience minor aches and pains for the first few days.
This is because some muscles are being used differently, causing some to overtire. For this reason you are advised to undergo a breaking-in period. This period of adjustment may take a week or two and you should avoid unusually long walks for the first month while you muscles fully adjust. On the first day, the orthotics should be worn for only four hours. Increase the wearing time by an extra hour each day, until you are wearing them all day.
If you are going to wear them whilst participating in any sporting activities, you should be wearing them all day before using them for sport. Sometimes an orthotic makes a significant adjustment to gait (posture) and some people can experience more than the usual adjustment ‘pains’.
If this happens to you stop wearing the orthotics and contact your podiatrist, so that together you can review the orthotics and your breaking-in programme.
If you experience any back, hip or knee pains you should stop wearing the insole immediately and inform your podiatrist.
DIABETESDiabetes is a disease of the endocrine (hormone) system in which the available glucose in the blood does not go into the body cells to be used up.
Glucose is made in the liver when we have eaten starchy products such as yams, potatoes, bread, and sweet foods. The liver secretes the glucose into the blood stream and then the pancreas secretes insulin (a hormone) into the blood stream. Insulin works like a “doorbell” to allow the cell open for the glucose to go in and do the work in the cell.
Sometimes a person only has to reduce the glucose amount going into the body to help this condition – diet controlled diabetes. Unfortunately sometimes there is not enough insulin secreted, or it does not work effectively and medication is required to allow this to happen – e.g. Metformin.
Sometimes Insulin is not secreted at all and insulin needs to be injected by needle but whatever the cause the symptoms and consequences need to be addressed. Sometimes this system only fails during pregnancy.
The symptoms can be extreme thirst, going to the loo a lot for a wee, extreme tiredness, itching pubic area, thrush, blurred vision and slow healing wounds and weight loss.
The lack of insulin affects the blood supply in that it makes it stickier, and eventually causes problems in the arteries and veins.
The arteries which supply the nervous (vasum nervosa) system are usually the first effects to be noticed.
Numbness, tingling, burning and reduced sensation can be experienced in the legs and feet, and the kidneys or eyes are also affected (the eye only has one nerve – the optic nerve) and sight is lost/diminished. Diabetes is the largest cause of non-traumatic amputation, but many do have ulcers (a wound from the inside of the body) which are very difficult to treat.
As with many older people, lack of feeling in the feet is not apparent until it is tested – you don’t know you can’t feel pain, until pain is inflicted and you cannot feel it! This is why it is an important part of a diabetics care, to see a podiatrist regularly.
No everyone with diabetes will have problems but good foot care is important that is why the NHS gives a free annual check up to diabetics.
Diabetics are susceptible to ulcers, which are wounds from the inside of the body. Podiatrists can remove the dead, decaying and infected tissue (debridement). The use of specialised padding, casts and orthotics to change the way a person walks to redistribute pressure are vital to the healing of the wounds and in preventing reoccurrences.
GOOD FOOT HEALTHThere are many things a person can do, diabetic or not, to ensure good foot health:-
- Ensure that the shoes you wear are “good shoes” – see the Optimum good shoe guide- ensure they are in good condition, and check inside them every time you put them on to ensure there is nothing inside them that can cut or rub your feet.
- Ensure that the socks that you wear are in good condition and that the seams do not harm your feet.
- Wear clean socks every day to reduce the risk of fungal infections (which diabetics are more susceptible to). Treat fungal infections immediately.
- Cut your toe nails straight across; if you have trouble with this just use a disposable emery board. It is safer to use an emery board than to use sharp instruments especially if you are overweight and cannot sit in the bent condition long enough or perhaps you have poor eye sight.
- Do not use corn plasters. Although many seemingly reputable companies sell these products, people usually do not realise that they have acid inside – this is what dissolves the skin. With diminished sensation a person would not feel the burning and damage can be done so very quickly with these products. All corns and callus are formed due to abnormal pressure. A Podiatrist can assist you in removing the corn and preventing its return – much safer!
- Weight control – the heavier you are, the less you can see and treat your feet, and the more weight your poor feet will have to carry. The lighter you are, the easier it is for you to get around, and the better it is for the function of your heart.
See the Diabetes UK website for further information – or ask your Podiatrist (ME!).