Podiatry: Life as a foot expert keeps you on your toes
Thursday 06 May 2010
It may not be the most glamorous part of the body, but, to the UK's 14,000 practising podiatrists, the human foot stands centre stage when it comes to our overall health and well-being. "People don't much like feet," says Lorraine Jones, a member of council at the Society of Chiropodists and Podiatrists, "and podiatry doesn't tend to make it into the papers unless it's something like David Beckham's Achilles tendon injury or a celebrity's bunions. Yet despite our low profile, as many as four in five adults will need to seek help from a foot specialist at some stage in their lives simply to stay mobile and independent."
Although the terms podiatrist and chiropodist are interchangeable, the modern profession is more correctly known as podiatry – a branch of medicine devoted to the study, diagnosis and treatment of all disorders of the foot, ankle and lower leg.
While it's the often complex, sports-related foot and leg injuries that grab the headlines, the more humdrum work of the podiatrist – who will study for a BSc in podiatry at one of 13 recognised schools across the country – includes anything from ingrowing toenails or flat feet to athlete's foot, recurring knee problems and even amputation management.
While it's the elderly who continue to make up the bulk of the average podiatrist's caseload – particularly when they have severe mobility problems and cannot reach their own feet – in general, clients represent all ages, as Jones explains.
"The work may include vascular and neurological assessment for a middle-aged person who has developed chronic foot problems because of the work they do, or it may be wound management for an older diabetic who has developed a foot ulcer.
"But there again, the case may be about minor surgery for a teenager with an ingrowing toenail."
While podiatrists tend to be outspoken critics of impractical or unsupportive fashion footwear, Jones explains this is a reaction to the problems they see on a daily basis.
"If you wear really high heels all day, every day, or go to school in what amounts to little more than a couple of layers of fabric over your feet, you may well get away without any foot pain for many years. But in 30 or 40 years' time, your feet are likely to be in a really chronic condition – and, by then, it may be too late."
Podiatrists who yearn to become surgeons carry out an extensive period of postgraduate training and, like dental surgeons, are trained to operate on one part of the body. Podiatric surgeons perform thousands of successful foot operations every year.
Today, the bulk of the foot profession is split fairly evenly between podiatrists who work in the NHS and those working in a private setting or perhaps running their own businesses.
While most practitioners start their professional careers in general clinics, there is plenty of scope for them to specialise in such areas as rheumatology, diabetes, dermatology, wound care, biomechanics or sports injuries, which can be carried out on the NHS or privately. Says Jones: "Whether they work independently or as part of a multidisciplinary team, podiatrists are able to work practically anywhere – a hospital, an outpatient clinic, a GP surgery, in people's homes or via their own private clinic. And wherever you choose to work, you can rest assured that business will always be brisk."
'My family tell me off for looking at people's feet when I first meet them '
Emma Supple set up the London-based Supplefeet private clinic six years ago. A Fellow of the College of Podiatric Surgeons, she says her initial reaction on being advised to go into foot care was negative
"I was waiting for my A-level results, and while I wanted to do something vocational in healthcare, I can assure you feet were the very last thing on my mind.
But after a day's work experience at the Royal Liverpool Hospital, where I came face-to-face with gangrene, diabetic ulcers and saw everyone working through their lunch break as a matter of course, I was utterly hooked."
Despite more than 20 years examining feet on behalf of the NHS, Supple is still fascinated by the problems beneath our shoes.
"My family tell me off for looking at people's feet when I first meet them, and I try hard to look at their faces instead. But from time to time, I catch myself noticing problems in how people walk or stand and wondering if I can help them."
Supplefeet offers a range of treatments including foot surgery, reflexology, luxury pedicures and gait analysis. Supple is also the podiatric surgeon at Chase Farm Hospital in Enfield.
"We're expected to take 10,000 steps per day, yet many of us don't even know what a podiatrist is, let alone go and visit one. Even dentists get to see many of their patients twice a year."
While Supple has colleagues who have moved from podiatry into general medical practice, she says being a lower limb specialist is enough for now. "Once you realise you have the power to literally make people feel as if they're walking on air – with a nine in 10 success rate after just one treatment – it is difficult to imagine any other healthcare job being quite so satisfying."
'There's a lot to learn'
Trevor Prior was the podiatrist for West Ham FC for much of the 1990s, when players such as Rio Ferdinand and Frank Lampard were apprentices
Despite now running Premier Podiatry, a private practice which specialises in foot surgery, sports-related injuries and diabetes, as a teenager all he wanted was a Maths career.
"My parents were chiropodists, and, although I was determined not to copy them, my school didn't offer the second Maths A-level I needed for uni so I had to rethink my plans and swallow my pride.
"Ironically, I have learned over the years that foot surgery is all about angles, realignment and forces, so you could say that as an amateur Maths enthusiast, I got what I wanted in the end."
Though he has been qualified for 27 years, Prior believes he has yet to learn all the mysteries of the human foot.
"What with 26 bones, not to mention hundreds of tendons and muscles, there's an awful lot to learn in podiatry," he says. "The foot is unique to human beings, and I don't think I'll ever be bored by working with it."
As well as his own practice, which routinely treats Achilles tendonitis, hammer toe and ankle sprain among professional sports people, Prior is podiatric surgeon at Homerton Hospital in Hackney, east London.
Preventing foot damage, he says, is about choosing the right footwear. "Wearing the right size and shaped shoe with stability and support will prevent most of the problems I see every day and will prevent serious mobility issues in later life. Feet will never be seen as sexy, but that doesn't mean any of us should ever regard foot pain as normal."
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