DO I SEE A GP BEFORE A PODIATRIST ?

This would depend on the nature of the condition that the individual is seeking advice or treatment for, but there are some cases where it would be fair to say that the Podiatrist would be the first choice whilst in other cases the GP should be consulted first.

All GP’s will have a particular specialist area and also a broad knowledge base about a massive amount of other medical conditions but one shouldn’t expect them to be as well versed as any particular health professional who has trained and practices daily in one specific discipline. That is why if you do use your GP as a “first port of call” they will often advise that you seek treatment from the relevant health professional that they feel would best be suited to your particular complaint.

Below are several examples of perhaps “PODIATRIST FIRST”:

If a person were suffering from a suspected INGROWN TOENAIL then it would be far better to see the Podiatrist, more often than not GP’s will prescribe antibiotics and say that will do the trick which unfortunately not true. Whilst the antibiotics will quell any infection in the short term, the nail will continue to grow and pierce the flesh so the problem gets progressively worse in the medium term and if infection returns before the problem is resolved then the patient will need more antibiotics before the potential minor surgery under local anaesthetic can be performed. Incidentally surgery is the usual final outcome due to the delay and resultant increase in pain etc..

Corns/Callus : No need to bother the GP with this, it basically needs removing by the Podiatrist.

Orthotic provision : A podiatrist should be specifically trained to analyse gait problems and have the ability to prescribe the right orthotics for the condition presented. Often we receive referrals from other health professionals such as Osteopaths and Physiotherapists who have realised there is a gait problem causing a knock-on effect further up the frame and want us to have an in-depth look and prescribe accordingly.

VERRUCAE: At one time GP’s often ran Verruca or Wart clinics but this isn’t often the case now so better to visit a Podiatrist for diagnosis and treatment.

PLANTAR FASCIITIS: GP’S will often prescribe anti-inflammatory medication and maybe suggest cortisone injections, there is nothing wrong with this approach except that cortisone only masks the problem for a while but it doesn’t usually cure it. This condition needs more detailed treatment and advice for both the cure and future prevention so ideally the Podiatrist would be the first port of call.

Instances where the GP would be the best initial option would be for example in cases such as potential melanoma or deep vein thrombosis. These types of problem definitely warrant confirmation or referral via the GP to the appropriate specialist consultant who would then instigate the appropriate treatment. That is not to say that we as Podiatrists cannot identify these types of problems correctly, we often do, but even then our course of action would be to direct the patient towards their GP for confirmation and referral.


HOW TO AVOID INGROWN TOENAILS?

INGROWN TOENAILS are potentially one of the most painful foot conditions that many of us may at some time experience and in severe cases will require surgery to correct, this can be done by your Podiatrist under local anaesthetic but here at INSTEP we only advise it as a last resort if it is apparent that no other treatment will solve the problem. During this procedure we take a strip of nail from the offending side so that aesthetically the best result possible is achieved for the patient as well as relieving the pain !

However, as with anything, prevention is better than cure so here are some guidelines to avoiding ingrown toenails:

1: Don’t cut nails too short, cutting back behind the front edge of the sulcus (trough at the side of the nail) can allow the front edge of the nail to grow below the skin line and thus press in at the front corner. Some nails have a natural inclination to curve in (involuted nail) so removing this front corner in cutting is necessary to stop pressure and in such cases you should only just nip the front corner off then file round so no sharp edge is left.

2: Don’t poke or cut a long way back down the sides, this is how small spikes get left that grow forward into the flesh.

3: Don’t pick, bite or tear nails, these all leave potential jagged nails that can grow in.

4: Some nails have a natural right to left/left to right curve across the front edge (if you look from above) so cut following this i.e. Follow the nail shape when cutting without going back down the sides then file the corners, this is basically “cutting straight across” as we have all heard, straight across the natural line.

5: Make sure your foot-wear doesn’t squeeze your toes.

6: Toe-protector foot- wear often damages nails, make sure the toe-box is deep enough so as not to exert pressure on the nails.

7: If for any reason a toe-nail starts to hurt, get it looked at sooner rather than later as it will be quicker and less painful for your Podiatrist to deal with if caught early.

Unfortunately some people will be genetically predisposed to “curvy” or “involuted” (potentially in growing) toe-nails and it might be advisable for them to have their nails cut professionally so as to avoid problems going forwards.


WHAT CAUSES FOOT PAIN ?

There are many causes of foot pain, some obvious and some not so obvious so probably the best thing to do is to make a list of some of the more common causes of foot pain:

OSTEOARTHIRITIS : A breakdown of joint cartilage and wear of the underlying bone that therefore inhibits and limits joint movement and function e.g. bunions

BURSITIS : Bursae are sacs of synovial fluid occurring naturally in the body where tendons cross bone, or are created by the body as a means of protection to repetitive pressure or friction on a bony prominence. They can become inflamed and therefore very painful and can sometimes ulcerate. Bunions and other prominent joints such as on hammer toes often have associated bursae.

CORNS and CALLUS : These occur over pressure areas on toes and on the soles of the feet. Callus is an area of hard dead skin, it occurs as a result of overloading or pressure on that area, it is painful because it is hard and inflexible and presses on the structures beneath. A corn is just a much more concentrated and hard callus at the centre of the pressure point, it can often involve nerve and blood supply.

INGROWN and THICKENED NAILS: Ingrown nails press into or pierce the flesh at the side of the nails and can become infected, thickened nails bruise the nail bed under the nail and can therefore cause bleeding and/or corns beneath the nail itself.

CRACKED HEELS/FISSURES: Due to an excess build up of dead skin due to pressure and friction or due to e.g. Psoriasis. They can open up so much they bleed or become infected or both. Fissures can also occur on the fore-foot usually around the ball of the foot on the under-side.

RHEUMATOID ARTHIRITIS: An auto immune condition where the body’s immune system attacks itself causing inflammation in the soft tissues of joints and ultimately causes joint deteriation/destruction.

GOUT: Too much uric acid in the blood causes intense swelling, heat, redness in joints, usually (but not always) the big toe joint. It is extremely painful. Repeat attacks can result in joint distortion and acid crystals being laid down in the joints.

METATARSALGIA : A blanket term for pain in the fore-foot. This could be caused by anything from metatarsal head fracture, Morton’s neuroma, interdigital bursitis to name several possible causes.

PLANTAR FASCIITIS: aka Policman’s heel, heel spur. Pain slightly to the inside centre of the bottom of the heel that sometimes radiates forward into the arch of the foot. Very much like a muscle strain but can’t heel due to never getting rested. Podiatrists have a variety of ways to get resolution but often orthotic therapy is needed to keep at bay long-term.

ILL-FITTING FOOTWEAR: Causes pressure or friction on various foot structures leading to e.g. Blisters, callus/corns, bursae, ingrown toenails.

CHILLBLAINS: Not so common these days due to more consistent heat via central heating, these are very painful areas where the tissue effectively dies because the circulation shuts down due to cold but doesn’t open up again readily so waste metabolites are left in the extremities of e.g. fingers and toes and so poison the tissues resulting in very painful bluey black areas of dead tissue. Reynaud’s phenomena is a major cause.

VERRUCAE: Can feel like corns, they are a viral infection that causes an area of skin to grow and die more quickly leading to callus build- up in that area.

STRESS FRACTURES: Can occur in any of the foot bones but usually in the metatarsals, usually due to over-use injuries.

This is by no means an exhaustive list but merely mentions some of the more common problems leading to foot pain.


WHAT DO ORTHOTICS DO ?

The most basic explanation is that ORTHOTICS attempt to control or adapt the physical alignment and function of feet in order to obtain the best possible performance from those feet (and therefore all other parts of the musculoskeletal system) which in turn will ultimately bring the most benefit to the individual concerned during the gait cycle/everyday activities.

Put simply, they are devices that are prescribed/adapted by the Podiatrist (after a biomechanical assessment of the patient both moving and stationary, weight bearing and non-weight bearing), which are placed in the patient’s footwear and are designed to correct any abnormalities that may be affecting the patient’s musculoskeletal system during locomotion. These abnormalities would most likely have been causing discomfort and/or wear and tear from which the patient would have been suffering hence them seeking treatment to try to alleviate the causes of the discomfort.

The first thing a podiatrist will seek to ensure is that the orthotic keeps the heel bone approx. 90 degrees to the vertical when stationery weight-bearing if this isn’t the case naturally, after that all adaptations (such as “postings” to e.g. the heel or forefoot area) to the orthotics will depend on the findings from the biomechanical assessment.

Some common foot conditions that often require orthotics are:

Flat Feet (Pes Planus) where the foot lacks a longitudinal arch (from heel to ball of foot) and the heel splays excessively outwards, so it therefore lacks the natural ability to shock absorb and provide a “spring in the step”. This sends shock waves back up the skeleton potentially causing ankle, knee, hip or lower back pain, it can also cause early wear on knee cartilage amongst other things. Orthotic therapy in such cases would be designed to provide a “false arch” to address the problems mentioned.

High Arch (Pes Cavus): Here the feet are excessively high arched and tend to be quite rigid in structure so therefore also suffer from an inability to soak up “shock”. The heels are also often “inverted” (angled inwards when standing) The foot tends to overload on the heel and forefoot and can give rise to severe callosities and corns. In such cases a cushioning element would be key as well as potential heel postings.

Morton’s Neuroma: A thickening or pinching of the nerves serving the toes (causing toe pain or numbness) that occurs at the area of the metatarsal heads, more usually but not exclusively in lower arched feet. An orthotic would probably have some kind of arch raise but would definitely incorporate a METATARSAL DOME which is a raised area that spreads the metatarsal heads so creating space for the nerve thus relieving any impingement.

Limb Length Discrepancies: Either occurring naturally or post joint surgery, a difference in leg length causes a pelvic tilt that therefore puts strain on the lower back and (often) the joints of the opposing leg. A difference of 2cm or above is reckoned to be the bench mark for problems to potentially occur so orthotics to address this would be advisable.

Other conditions including e.g. Posterior Tibial Dysfunction syndrome (causing drop foot and tendinitis), various sporting injuries e.t.c., are all problems that can benefit from Orthotic provision.


What is Metatarsalgia?

Metatarsalgia is a general term used to describe pain or discomfort in the forefoot around the area of the metatarsal heads (ball of the foot area), however discomfort in this area can usually be attributed to a specific condition.

The instigation of pain in this area can often be attributed to one or more of the following factors : tight fitting foot-wear, being over-weight, high heels, high intensity exercise (e.g. squash, running) or a trauma such as stepping on a pebble or off a kerb leading to bruising or fracture. Abnormalities in the gait cycle may also cause problems.

Specific conditions giving pain in the forefoot:

Morton’s Neuroma: This condition is most commonly felt as a sharp pain that shoots up from the Metatarsal area towards the ends of the two toes involved. It can also be felt as a burning sensation, tingling or numbness in this area. It comes about because the Plantar digital nerve that serves the skin of the toes becomes irritated, inflamed or is pinched between the Metatarsal heads (imagine tight footwear squeezing the foot). In severe cases the nerve may thicken due to the trauma or because of a fibroma (fibrous lump) or lipoma (fatty lump) occurring.

The most commonly affected toes are the 3rd and 4th, but the 2nd and 3rd toes are also susceptible. It tends to be unilateral I.e. only one foot tends to be affected . Three out of four sufferers are female.

A Podiatrist will attempt to alleviate the problem by placing a shaped pad under metatarsals 2,3 and 4, the idea being to lift and separate the heads of the bones so that the nerve is free from irritation. If this proves successful a simple insole with padding can be created to provide long term relief. In most cases this will prove sufficient.

Ultrasound can be used to try to disperse the neuroma but is varied in it’s success rate and cortisone injections usually only mask the problem for several weeks without curing it.

In chronic cases that don’t respond to the treatments above, surgery may be the ultimate answer so that the neuroma can be physically removed from the affected nerve.

Interdigital Bursitis: A Bursa is a fibrous sac of fluid that arises between a bone and a pressure area. Inter digital bursae are found between the Metatarsal heads and can become inflamed if the Met heads lay very close together, they may also pressurise the digital nerves.
Again padding can help to spread the met heads which in turn brings relief.

Stress (March) Fracture : Comes about after a single or repetitive trauma that fractures the metatarsal head. Something as simple as stepping heavily on a bump or stone or off of a kerb can cause this, especially in the elderly where bone density may be reduced. Runners are also common sufferers.

Symptoms include the sufferer feeling a building pain within the area, mostly on weight bearing, swelling and tenderness in the area is common and sharp pain when direct pressure is applied is usual.

X-rays can prove the diagnosis but can be inconclusive so scans are often used instead.

Initial treatment involves RICE : rest, ice, compression, elevate. Ice the area for around 20 mins per hour. Activity must be halted to allow healing. A Podiatrist would provide appropriate padding and insole/orthotic provision if indicated.

Freiberg’s disease: Most common in teenage girls, this condition is brought about by osteonecrosis (bone death) due to restricted blood supply. The 2nd metatarsal is usually affected.
Surgery is implicated in such cases.

Gout and Arthritis: Gout is caused by an excess of uric acid in the blood , the uric acid crystals cause inflammation in the joints of the body including the joints of the ball of the foot , especially at the base of the big toe. This problem is managed with a change in diet and tablets prescribed by the sufferers GP. It is an extremely painful condition.

Osteoarthritis is due to wear and tear of the joints where cartilage wears away and new bone may be laid down, this all limits joint flexibility and function leading to distortions e.g. bunions and hammer toes. Corns and callosities often arise as a result and the sufferer may need to seek the services of a Podiatrist to deal with these lesions.

Rheumatoid Arthritis is an autoimmune disease whereby the sufferer’s immune system attacks the synovium (tissue surrounding a joint) causing swelling and inflammation. The joints of the feet including the forefoot are often involved. It affects women 3 times as often as men and onset is usually between 40 and 60 years of age.
The Podiatrist can help by removing corns and callus that arise over distorted joints and provide protective insoles or padding.

Diabetes: This can affect the function of nerves in the feet and lead to pain in the metatarsal region. Diabetics should seek regular Podiatry treatments to help maintain good foot health.

Abnormal Gait: If a person has a type of gait (walking) that varies from recognised normal limits, pressure may be unevenly distributed such as in the ball of the foot area causing pain and lesions here.
In such cases a Podiatrist would perform a biomechanical examination to determine the reason for the abnormal gait and prescribe and fit orthotics to try to combat this problem.

Biomechanics and Orthotics can also be used to treat problems higher up the skeletal system e.g. Knee pain, hip pain, lower back pain, and your podiatrist should be able to examine and advise or prescribe accordingly.

For information, advice or a consultation contact us on 01664 569708.


What to do if you have ingrowing toenails?

A toenail that presses into or pierces the flesh at the side of the nail is commonly called an ingrown toenail. The skin in the affected area becomes red, swollen and painful. If left untreated it will almost certainly become infected and too painful to touch.

WHAT CAUSES INGROWING NAILS?

Anyone can suffer from in growing nails and the most common causes are poor or over zealous cutting, digging down the sides of the nail, picking at the nails, injury to the nail, poor foot hygiene or tight footwear.

Also, some people are genetically predisposed to in growing nails meaning that they have toe nails that naturally curve in at the edges.

If you think that you have an in growing toe nail you should visit an HCPC reg. Podiatrist as soon as possible.

AVOIDING INGROWING TOE NAILS:

Don’t cut the nails too short or down too low at the sides of the nail, don’t poke down the sides of the nail, try to maintain good foot hygiene as sweaty feet make the skin softer and the nail can pierce the flesh more easily and always wear protective footwear if e.g. working with heavy loads, so as to avoid dropping something onto the toes and damaging the nail.

Avoid tight footwear.

SHOULD YOU VISIT THE PODIATRIST IF YOU HAVE INGROWING NAILS?

Yes! The sooner the problem is addressed the better, both to avoid too much pain and also to minimise the chance of infection.

If an infection is present it is important to visit your GP in order to be prescribed antibiotics.

Many in growing nails can be managed routinely with regular skilled cutting by the Podiatrist but some more acute cases may require the removal of the problematic part of the nail under a local anaesthetic, again the Podiatrist will be able to do this for you.

Often pain at the side of the nail may feel like an in growing nail but the discomfort is actually being caused by a corn or hard skin in the sulcus (gap between the nail and the skin) and these can be removed during a routine appointment.

So, if you are suffering with in growing or painful nails, pain around the nails, or  are just struggling with general nail care, give us a call on 01664 569708 and we will be glad to help.


Podiatrist or Chiropodist?

WHAT IS A PODIATRIST?

There is no difference between a Chiropodist and a Podiatrist, the term Podiatrist is just the more modern name for the same discipline.

It is estimated that the average person will walk approximately 115000 miles in a lifetime and factors such as footwear, man made surfaces and disease can all have detrimental affects on the feet, thus creating the need to seek the services of a Podiatrist who is specially trained to deal with foot health issues.

A Podiatrist’s role is to try to ensure that any foot problems are diagnosed and managed in the best possible way in order to achieve maximum benefit for the patient, or simply to keep healthy feet healthy.

WHAT ARE THE PROBLEMS THAT ARE TREATED BY A PODIATRIST?

A Podiatrist can treat a range of foot problems such as thickened, in growing or fungal nails, corns, callus, verrucas, bunions, abnormal foot function (e.g. fallen arches, flat feet e.t.c.), cracked heels, Plantar Fasciitis(heel pain) and so on.

WHAT DOES A PODIATRY APPOINTMENT INVOLVE?

The Podiatrist will ask about any foot problems you have been having and then treat them accordingly, most general problems causing discomfort such as corns or callus e.t.c. will be dealt with during a routine appointment which normally takes around 30 minutes.

If the problem is of a “functional” nature such as excessive pronation (collapsing arches/in- rolling) then it may be necessary for a longer appointment so that range of joint motion and Gait can be assessed. This in turn may lead to the provision of orthotics to try to manage the problem and alleviate the pain it has been causing in the lower limb and/or lower back.
Orthotics are devices that are worn inside the shoe and are designed to bring about normal foot function as much as possible.
Even if you don’t have any serious foot issues, it is a good idea to occasionally book a routine appointment in the same manner as a dental check-up, to have callus removed, heels smoothed, nails tidied and generally make the feet feel good.

AM I ELIGIBLE FOR NHS PODIATRY?

Podiatry is provided free by the NHS but is usually only available to those referred by a GP or practice nurse and those eligible for referral are generally from groups considered to be at a higher risk of developing foot problems, such as Diabetic and Rheumatoid patients.

Even if you are referred on health grounds, appointments are often infrequent and you should therefore only seek the services of an HCPC registered podiatrist for the extra treatment needed.

HOW DO I FIND A PODIATRIST?

The website of the Society of Chiropodists and Podiatrists or The Health And Care Professions Council (HCPC) will provide a list of registered Podiatrists in your area.

Richard Harris is qualifed DPodM, MRCPod and registered with the HCPC, no.CH09863. Steven Foster is also qualifed with BSc (hons), DPodM, MRCPod and registered with the HCPC, No. CH09555


InStep Melton

Certified and qualified Podiatrists based in the heart of Melton Mowbray. Book your appointment today.

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31 Sherrard St,
Melton Mowbray
LE13 1XH

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