The awkward conversation

We need to talk.....about fees.....

 My first blog entry for a year, or over a year and its an awkward one. It's one that we need to discuss and one which I know frustrates a lot of my peers in the profession. 

Every couple of weeks or thereabouts I deliver a short talk to various community groups about podiatry, how it has changed and how it might differ from a pre-existing perception. Its fair to say that the feedback from the talks, which are generally to church guilds and woman institute groups, is good. They find it interesting and educational and perhaps even a little tiny bit entertaining. I demonstrate to them how things have changed and that podiatry has moved on. I show them some of the modalities at our disposal and the investment that a modern, forward thinking podiatrist will make. Shockwave therapy and ultrasound for example represent significant financial investment in order to bring services to the client or patient group. To frame that more clearly, a reasonable diagnostic ultrasound machine will set you back in the region of about £25, 000 and a decent patient chair to sit on.... anywhere between 2 - 5 thousand pounds. 

It wasn't until I read a facebook post a few days ago where someone talked about going to see a podiatrist for her heel pain which was so bad she could 'barely walk'. She went on to say.....'but its £36 for a 30 minute appointment and insoles on top of that at £45......that's pretty expensive". 

Of course 'expense' is a subjective thing. But therein lies the real problem. Its not the price, or the expense of an item or service. Whats is wrong with this statement is that the lady completely misunderstands the difference between 'price' and 'value'. What is the cost of pain relief in any case? What is the limit that a person is prepared to pay? And scratching further beneath the surface, what price do we place on the skill of the clinician. And now, were getting down to brass tax. 

Think for a moment, if you will, about your washing machine at home, just as an example. It breaks down, but you need it! How will you wash your laundry. It's a household essential. You go online and start looking for the engineer in your area. They agree to come out to see it but you have to pay a call out fee. Typically anywhere between £50 - 90. Once he gets there you'll be billed for the parts he needs and the time spent to fix it. So where are we, £120 - 150? 

Fees for podiatry treatment remain among some 

of the most modist private healthcare fees with 

a national average of around £40. 

Now just hold that thought, and add to it the statement ' I can barely walk. I am in so much pain - but the podiatrist is ...well pretty expensive'. 

Podiatry forms one of our greatest yet most unsung allied health professions. I admit we have a massive identity crisis facing us. One which we are desperately trying to move away with the perceptions of old. Having to justify the clinical skills and re-enforce daily, hourly perhaps in some cases our entitlement to charge fees for our skills and the services we deliver. We are often asked or expected to do work for free, albeit mundane, simple foot care tasks. But how insulting is that. Would any other professional person, whose invested time and money in a university education be expected to work for free?  

There are many examples and parallels that can be drawn, much like the washing machine engineer, the hairdresser being another favorite that springs to mind. But I will resist, because this was never supposed to be some kind of rant. It is, however,  important to talk about the difference between 'price' and 'value' and the overall attitude that we have towards our health and well being. When the skills of the tradesmen (no disrespect to them of course they too, are skilled), are valued greater than those of the health care professional who, within their armory can remove pain, prevent falls, educate and ultimately improve the quality of your life, I suppose in much the same way clean clothes do.  

Pain in the Butt? - Piriformis dysfunction for amateur/professional athletes.

Piriformis dysfunction for amateur/professional athletes.

This week Mr Frazer Donaldson gives us the lowdown on an all too common problem, piriformis dysfunction.

Frazer's primary interests within Foot Medic is biomechanics and sports injury. His passion for both functional anatomy and problem solving  make him an outstanding sports podiatrist.
 

Read on to find out what exactly the condition is and how you can prevent and treat it.

The piriformis is a flat, pyramid-shaped muscle that lies parallel to the gluteus medius muscle's back margin and underneath the gluteus maximus muscle in the hip area. The piriformis laterally rotates the femur with hip extension and abducts the femur with hip flexion allowing body weight to shift to the other side when walking in single limb support. However when the hip is fully flexed to 90 degrees or more piriformis does the opposite function and internally rotates the femur. And the function during walking is primarily to externally rotate the leg at late stance to allow the foot to ‘lock’ making it a rigid lever.  

So basically it is an important muscle in how your hip moves when you walk and move!

In terms of activity, ie; Running, the piriformis plays an important role in the various rotations of the hip and can commonly be injured or through weakness/tightness to the area cause knock on effects elsewhere ie over pronation due to a poor ability to externally rotate at late stance phase (weakness) or supination of the foot through stance phase as thee leg is too externally rotated (tightness).

As the muscle runs adjacent to the sciatic nerve the symptoms often include:

1. Shooting pain/electric shock
2. Some numbness/tingling sensation
3. Dull ache across the mid portion of the glutes during or after exercise.
4. ‘Trendelenburg gait’ whereby during walking there is minimal support to the opposing swinging leg causing instability. Julia Roberts has it don’t feel bad!
5. Over pronation of your foot or flat footed-ness (weakness)
6. Supination of the foot (tightness)

Symptoms can be due to tightness or weakness of the muscle or poor stretching before and/or after exercise.

You’re local Podiatrist should be able to assess weakness and tightness, however if these symptoms compute to your own it is important to stretch and strengthen the muscle. RICE therapy (rest, ice, compression and elevate) should be applied post exercise or when most painful) As well as this ask to be assessed for other foot conditions and review footwear and orthotic options.

STRETCHING

Sit on a normal chair and cross your left foot on to your right knee, then slowly lean forward, with a straight back, and hold for up to 60 seconds. Complete stretch daily on each side, repeat more frequently pre and post exercise.

 

INCREASE TONE & STRENGTH

Lie on your side, bend your knees and put your feet together. Keeping your feet in contact, lift your knee, as shown above as high as you can very slowly and hold at the peak for 3 seconds then bring your knees into contact again. Repeat 15 times on each side daily. It is important to maintain strength in the muscle even if there is no weakness especially athletes or runners.

For more information on foot conditions why not try out our fantastic, free new web application by clicking HERE!

The perils of self treatment

If you have a sore tooth you see the dentist, if you have an eye problem you make an appointment with your optician. So why is it that when it comes to our feet we often neglect or treat them ourselves. 

It's often said we take our feet for granted. Let’s face it, without our feet in good shape just think about how miserable daily life could be. Unfortunately, this message still struggles to get through to a large proportion of society. There are a number of reasons why patients don't seek professional help sooner. Some people think the problem will get better by itself, some people don't even know they have a problem. Occasionally, some people feel that they can manage problems by themselves. 

This image is of a patient who self treated plantar warts using vinegar, garlic and duct tape. The result was a nasty irritant contact dermatitis. Given that plantar warts are generally painless I know in this instance which one I would choose- self treat or see my podiatrist. Podiatrists are lower limb and foot experts and as far as health care goes, private podiatry consultations are some of the lowest costing and best value for money consults available. Typically, appointments can last for up to 30 minutes and more in some cases. The cost of treatment remains relatively low so we would urge anyone with a foot or lower limb problem to speak to your podiatrist in the first instance and not to self medicate or treat without getting the right advice first. Whether its a typical skin or nail problem or a pain inside your foot or limb, they really are the experts with the deepest level of understanding when it comes to injury, diseases affecting the feet and anatomy of the lower limb. 

Pick up the phone and make your appointment with your expert today.

Don’t Be Embarrassed About Feet Urge Podiatrists

Feet are one of the hardest working parts of the body and in a lifetime you will walk in excess of 150,000 miles which is about five times around the world. As a result, foot problems are common and if untreated can cause discomfort and wider health problems.

As part of its annual Feet for Life month in June 2013, The College of Podiatry ilooked to raise awareness of common foot complaints. The College is encouraging people to become more foot aware and not be embarrassed about seeking help where needed.

Some of the most common foot problems that can cause embarrassment include foot odour, verrucae, corns and callus, fungal infections, ingrowing toenails, bunions and cracked heels.

“Our feet are one of the most neglected parts of our body, but it’s important to keep an eye on them and to know what’s normal for you so you can spot any problems. Feet are not supposed to hurt so if you do experience ongoing pain then you need to have this investigated. Don’t be embarrassed about seeking professional help, it’s a podiatrist’s job to treat feet so there will be nothing we haven’t seen before. Follow our tips to spot some of the symptoms of common foot problems so you don’t have to suffer in silence or hide your feet away in the summer!”

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Common foot problems

- Foot odour: to keep foot odour at bay, wash feet at least once a day and dry carefully between the toes. Wear clean socks made from at least 70% cotton or wool. Alternate shoes daily to allow them to dry out. If odour persists try an antibacterial soap.

- Verrucae: a verruca is a type of wart that looks like a small, dark puncture mark in the early stages but later turns grey or brown. It’s contagious through direct contact. You can buy over-the-counter remedies from your pharmacy; ask for products with salicylic acid. If at any stage your verruca becomes painful and the surrounding skin goes red, stop treating immediately and see a podiatrist.

- Corns and calluses: corns and calluses occur as a result of pressure on the foot. Corns appear over a bony prominence such as a joint and a callus usually occurs on the sole of the foot. Do not cut corns yourself and don’t use corn plasters or paints which can burn the healthy tissue around the corns. Commercially available cures should only be used following professional advice. Calluses can usually be kept at bay by using a pumice stone or non metal foot file gently in the bath.

- Fungal infections: fungal infections such as athletes foot can lead to intense itching, cracked, blistered or peeling areas of the skin. If left untreated it can spread to the toenails causing thickening and yellowing of the nail. Fungal infections are highly contagious so avoid handling and do not use the same towel for your feet as the rest of your body. You can buy over the counter remedies but nail infections do not often respond to topical treatments so you may need oral medication. See a podiatrist if your infection persists.

- Ingrowing toenails: ingrowing toenails pierce the flesh of the toe and can be extremely painful and lead to further infection. They most commonly affect the big toenail but can affect other toes too. To reduce risk use nail cutters and cut nails straight across and don’t cut too low at the edge or down the side.  If you have an ingrowing toenail, see a podiatrist who can remove the offending spike of nail and cover with an antiseptic dressing. If you have bleeding or discharge, you may require antibiotics.

- Bunions: a bunion is a condition where the big toe is angled excessively towards the second toe and a bony prominence develops on the side of the big toe. Contrary to popular belief, bunions are not solely caused by shoes. They are caused by a defective mechanical structure of the foot which is genetic, although footwear can contribute to a bunion developing. Some treatments can ease the pain of bunions such as padding in the shoes, but only surgery can correct the defect. To avoid exacerbating a bunion, try not to wear narrow shoes with pointed toes. If you experience frequent pain, see a podiatrist.

- Cracked heels: cracked heels can be extremely painful and occur where the skin has become dry or has experienced excessive pressure. To prevent them moisturise regularly and use a pumice stone or non-metal file in the bath or shower. If the problem worsens see a podiatrist as some severe cases can require strapping of the cracks in order to allow the feet to heal.

Diabetes - brace yourself for the diabetes tsunami!

A busy week at the clinic!

We see our fair share of diabetic patients at the clinic most weeks. Sometimes the patients we see are not so sure about just how diabetes affects their feet or just how important it is to have regular foot checks.

So we've put together a few points that everyone should know about diabetes, in plain english so that everyone reading it can understand.

The first thing to note is that diabetes is generally split into two groups called type 1 and type 2 diabetes. Treatment guidelines have changed of late and many people who would have been considered type 2 diabetic now use insulin as part of their treatment plan.

Diabetes is a condition resulting from either, the absence of insulin in the body to help break down and use glucose from the blood, or having some insulin but having too little or poor quality.

Diabetes can have serious implications for your feet and legs. If you have poorly controlled blood glucose particularly over a long period of time changes can happen to the nerve and blood vessel tissues in your lower limbs. So what! you might say.

Well, if the nerve tissue changes and becomes less conductive, this is called peripheral neuropathy. Having peripheral neuropathy increases the risk of injury. Because the feeling can be absent in the foot injuries are common, although often the sufferer is unaware of injury to the foot. The result of this can lead to breakdown of the tissue, or as we call it, ulceration.

Ulceration is complicated because of the hardening of the arteries which is also caused by prolonged poor glucose control. Sufferers will lack the ability to supply damaged tissue with a sufficient blood supply. This prolongs healing, increasing the risk of infection and ultimately leads to gangrene and amputation.

Now heres the scary part...statistically, the mortality rate (chances of death related to the disease) is greatly increased if an amputation has been required. What we find is that, in general, because diabetes is a 'silent' disease', often without any outward signs, people either dismiss it, deny it, or just don't understand enough about it. It is that serious. Diabetes, if poorly controlled or neglected for periods of time can seriously impact on your foot health and ultimately lead to your premature departure.

Finally, the best way that you can prevent these changes happening for as long as possible is to maintain good blood glucose levels. What we mean by that is your average blood sugar levels. Daily readings will fluctuate, this is normal even in a person who doesn't have diabetes. The average blood sugar is measured by HbA1c. Because the recommended level can change sometimes there's little point in writing it down here, but we would encourage all patients we come across in the clinic to discuss their blood glucose levels with the GP. Ask the GP for your HbA1c levels, learn about getting it to the best levels you can, and finally, own your disease, take control of it, don't allow diabetes to control you, or to destroy your quality of life.

If you have diabetes and are worried about your feet, or if you have any other questions about your feet please contact the clinic to arrange your assessment today. We will be happy to advise you and to carry out your diabetic foot check.

For more information about diabetes visit http://www.diabetes.org.uk/

Hard work pays off.

It's official! 

This week we received confirmation that Foot Medic is now an Accredited practice. 

That's all very well but what does that mean to our patients? 

For our practice to have been accredited by the Society of Chiropodists and Podiatrists we have reviewed our standards to ensure that they comply with national standards and best practice within the profession. This means that we try harder to provide the best service and highest clinical standards for our patients.
 
We applied for practice accreditation so that our clients know that their care is being provided within a safe environment. The accreditation scheme amongst other things also requires that:

• All reusable instruments to be properly cleaned and sterilised before they are used

• Staff engage in continuing professional development to keep their
knowledge and skills up-to-date

• Patient confidentiality to be respected and proper care taken with
patient records, both when used and later when they are destroyed

• We explain treatment options, where appropriate, and cost, so that you can make informed choices about the treatment you receive

• Appropriate referral pathways exist for clients who need specialist care

• Our practice working methods are constantly reviewed.

Peer review and inspection 

In achieving accredited status, we not only undertook a careful review of the practice, our working methods and systems, we asked another, independant registered podiatrist to check our findings.we also agreed to the practice being inspected by independent inspectors appointed by the Society of Chiropodists and Podiatrists. Therefore we feel that you can be confident in the care that you receive within this practice.

The Society of Chiropodists and Podiatrists is the largest professional body for chiropodists and podiatrists within the United Kingdom, and is committed to public safety and enabling its members to practice effectively. The Society’s standards are published in the public domain, and are available from their website, www.feetforlife.org.