Wednesday, 8 February 2017

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.  

Friday, 11 September 2015

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.


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.



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!

Friday, 28 August 2015

Special Olympics World Games in Los Angeles

This summer I was honoured to be chosen along with another colleague to represent Scotland , indeed the UK, as part of the Fit Feet screening program at the Special Olympics World Games in Los Angeles.

 So on the 28th July we flew out to LA to join the Fit Feet team to get to work screening feet! The Special Olympics has provided free health screening and products to athletes for 15 years and is the largest public health organization in the world for athletes with intellectual difficulties. Healthy Athletes offers health screening in a number of key areas with volunteers from professional backgrounds including, dental, ophthalmology, podiatry, physiotherapy and healthy eating.

We were fortunate to have spent 3 full days at the Fit Feet headquarters within the very picturesque University of Southern California campus where we participated in the screening of athletes to evaluate a number of areas including; Shoe Exam and Shoe Size Measurement, Biomechanics, Joint Range of Motion & Static Biomechanics and Skin, Nail, Toe and Foot Exam from which we were able to recommend follow up care based on the review of our findings during screening.

The athlete’s attendance at the screening program was completely voluntary and for their efforts they were given a new pair of New Balance trainers. We in turn endeavored to accommodate every athlete who came to visit us by providing a seamless and rapid screening service with minimal waiting times for athletes, carers and coaches in what were quite difficult working conditions. We were in fact working in a large tent, with minimal equipment, grass underfoot and extremely high temperatures however the atmosphere between everyone was so positive and good fun that the time literally flew in!

This is easily one of the most life-changing, positive experiences I have had the privilege to have been a part of and something that I will never forget. I urge anyone who has the opportunity to get involved, you will not regret it!

Check out our blog here for some entries and pictures and if you have any questions I will be happy to answer them as best as I can.

Friday, 14 August 2015

Shin Splints - A Runner's Curse

The problem. 

Shin splints are an extremely common problem particularly in runners who are increasing their mileage or those who have just started to run. Shin splints are a soft tissue injury where the muscles that control the slow lowering of you foot at each step  (deceleration) and also help to maintain the longitudinal arch of the foot are under severe pressure from the increased, repetitive strains placed upon them.

The two main muscles involved are tibialis anterior and tibialis posterior. Most soft tissue injuries are caused by the structures either being too weak or too short to do the job you're expecting from them. So by increasing your mileage the likelihood is they're going to start to break down.

Each bone has a covering called periosteum. This lining can become inflamed in relation to the injury, this is called periostitis. Many podiatrists and other healthcare professionals see this as a precursor to higher levels of injury such as tibial stress fractures.

Can you still run if you have shin splints? 

If you MUST run, you should do so on a treadmill with a slight incline. This will work better for you as the forefoot has less distance to travel from the shin on landing and the forces will be reduced through your deceleration. Don't run downhill, this is likely to aggravate the problem. Run for 5 minutes, stop and stretch, always remember to do stretching, not strengthening at this point. Repeat the process 5 or 6 times while you have little or no pain. As you progress you can start skipping your stop intervals and be able to run for extended periods.

If, after following this advice you still experience shin pain, you should consult with your podiatrist. If you have had another from of injury it is important to rule out other causes.

Assuming your pain is shin splints and hasn't developed from a problem in the bone itself, you should get great results from following these easy stretches for tibialis posterior and tibialis anterior. You should also consider 'foot control' and rule out a biomechanical factor in your symptoms. Prescription orthotics can help in many instances with range of motion limitations and other functional anatomy problems.

Wednesday, 24 June 2015

Sharon Mc Quillan and the Special Olympics 2015

Did you know that people with intellectual disabilities (ID) get less, lower quality, and often, no health care? Furthermore, these are the very people who experience higher rates of preventable disease and are sufferers of chronic pain and premature death regardless of demographic population group.

Did you realise that 40% of the athletes in Special Olympics have untreated tooth decay, with 40% needing, but not having, corrective lenses and that 33% would fail a hearing test? There are a number of barriers to health equality for people with ID including their own restricted ability to communicate, and a lack of training and understanding among health professionals.

All too often this population are missed out of routine services commonly available including vaccinations and mammograms despite the fact that these are the very people who have to cope with additional difficulties including increased risk of bone fracture, earlier onset of Alzheimer’s and increased levels of obesity, yet these are the people currently getting the poorest levels of health care.

The Healthy Athletes programme, started by the Special Olympics, has provided free health screening and products to athletes for 15 years and is the largest public health organisation in the world for people with intellectual difficulties. As a result, through Healthy Athletes, more than 100,000 health care professionals have been trained to treat people with ID. The Healthy Athletes programme currently offers health screenings in a number of key areas with health expertise volunteers spanning the complete spectrum of medical disciplines.
Since 1997 Healthy Athletes has been delivering its services in a fun and welcoming environment where screenings allow athletes to be educated on healthy lifestyle choices whilst also identifying any problems that may need additional follow up.

I am delighted to have been selected to participate as part of the team who will be providing these screenings in Los Angeles this year. It’s a fantastic opportunity to gain invaluable insight to athletes with ID while being able to provide part of such a fantastic service.

Thursday, 4 June 2015

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.

Thursday, 14 May 2015

Ingrown toe nail - you cannot be serious??

Ingrown toenails. We’ve all at least heard of them and quite a few of us will have had one in our life. In general, ingrowing toe nails can be dealt with quickly by podiatrists. Nail surgery is a cause of great anxiety and we understand that, especially if your perception of nail surgery is having your nails “ripped off’, which we’ve heard more than a few times!

Most podiatrists theses days will have prescription only medication annotation in addition to their professional qualification. This means that those podiatrists can administer local anesthetic and perform nail surgery painlessly. If you need them the Podiatrist can  supply you with antibiotics if your nail is infected.

Most of the time ingrown nail are regarded as an annoyance and part of growing up. But there is a more, albeit rare, serious side to ingrown nails if left without intervention. 

This case highlights the plight of a 16 year old male patient who hid his ingrown toe nail at all costs. This is common and I’ve come across similar stories in the clinic a few times. Often its a fear of the treatment, and worries about not being able to take part in sporting activities is also another major factor in the delay of treatment.

For something so simple the risk is that left alone, infection can set in and is potentially very dangerous. This MRI shows the same toe which has become infected. In this case the infection has made its way into the distal phalanx of the big toe. This is known as osteomyelitis. This is potentially a whole different level of medical problem which can require admission to hospital for aggressive antibiotic therapy and poses a risk to the toe itself if it advances. Osteomyelitis can cause systemic illness involving fever and sepsis as the infection is then carried around the body from the original site.

The moral of the story is, don’t hide or ignore ingrowing nails. Trivial as it seems left unattended for long enough they can cause you a whole new level of problem which could have much more serious consequences. All avoidable with simple, painless nail surgery. So DONT hide it, show it to your PODIATRIST.