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Podiatry presentation

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Thomas Hutchinson

on 21 November 2016

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Transcript of Podiatry presentation

As we age, we naturally develop more problems with our feet due to normal daily wear and tear of joints, but also because the skin starts to become thin and loses its elasticity, as well as being dry and much more fragile.


All patients should be assessed as soon as possible that have foot pain or established foot deformity and should be considered for accommodative foot orthoses, functional foot orthoses, footwear advice or specialist footwear depending on the severity of the pathology.
Biomechanical Assessment
Graduated from Brighton University in 2003 with a BSc (Hons) in Podiatry

Completed Masters Modules in foot biomechanics/ foot orthoses and Rheumatological disorders of the lower limb.

Over ten years experience working in the NHS community setting and as a clinical lead Podiatrist in the Royal Victoria Hospital and Musgrave Park Hospital.
My Backgound
A Footwear Assessment/Advice Sheet was developed to aid with:
- patient education and advice
- suitability of potential orthotic intervention based on the Footwear Suitability Scale (Nancarrow 1999)

Presented by Ian Hutchinson

Clinical Lead Podiatrist
for Sperrin Care Clinic

Cookstown MWI Presentation

This group collaborates with:
Podiatry Rheumatic Care Association (PRCA)
National Institute for Health and Clinical Excellence (NICE)
The Arthritis and Musculoskeletal Alliance (ARMA)
This group is a main stakeholder in developing national standards of care and clinical guidelines
Patient reported outcome measures were evaluated using VAS pain scales and a questionnaire was developed based on the
Salford Rheumatoid Arthritis Foot Evaluation Instrument
to measure impact of foot problems on the lives of people with RA.
Pre Intervention - Ranged from 20 - 95
Post Intervention - Ranged from 0 - 80
21st November 2016
Clinical Intervention

Footwear Advice




Everyone's feet are getting older
A Podiatrist will assess vascular, neurological and foot structure/function before considering treatment options that include:
Wound management
Pressure relief
Footwear/Orthotic assessment
Optimum foot ulcer management needs a holistic and integrated multidisciplinary approach for positive clinical outcomes
What is a Podiatrist?
Foot pain can be debilitating. As we only have one pair of feet, it’s important to take good care of them.

Foot pain can also lead to issues with walking, exercising and mobility.

If we have trouble with mobility, this can impact on getting out and about and involvement in social activities which become ever more important as we get older.

As long as we take routine care of our feet, serious problems can usually be avoided, however, ageing can also mean that we develop other conditions, such as diabetes and arthritis, which in some cases can affect the foot and lead to requiring treatment. Healing may also take longer.
How do I know I have it?
General signs of ageing feet include more regular aches and pains, developing bunions, signs of clawing of the toes along with general circulatory problems.
Keeping warm is also important, but do not warm them too close to the fire! Warm stockings or socks can help and avoid anything too tight which can restrict your circulation or cramp your toes. Wearing fleece-lined boots or shoes or even an extra pair of socks will also keep you warm but do make sure your shoes aren’t tight as a result. Bed socks are also a good idea.
Checking your feet regularly, daily if necessary, and moisturising them (but not between the toes) will help them keep supple.
How do I prevent it?
Pain and uncomfortable feet aren’t a natural part of growing old or something to ‘put up with’. A lot can be done to improve comfort, relieve pain and maintain mobility.
Keeping toenails cut and under control is key as nails that become too long can press against the end of the shoe and the constant pressure can cause soreness, infection and ulceration.

Toenails that have been poorly cut can also become ingrown.
We're not keen on these either!!!
What should I wear?
It is important to wear a shoe which is comfortable, well-fitting and holds your foot firmly in place to give adequate support. A pair of running shoes is the best option as these provide a good amount of shock absorption and stability and also support the arch.
Many people wear slippers if their feet are hurting but this can make things worse as slippers encourage you to shuffle rather than letting the joints work as they should.
Avoid plastic ‘easy clean’ uppers which don’t allow the foot to breath and won’t stretch to accommodate your own foot shape.
Many shoes have cushioning or shock absorbing soles to give you extra comfort while walking. When buying shoes, ensure that you can put them on and take them off easily. Check that the heel is held firmly in place, you’ll find that a lace, strap, buckle or Velcro fastening shoe will give more support and comfort than a slip-on.
Your shoes should be roomy enough, particularly if you intend to wear them every day. If you suffer with swollen feet, it’s a good idea to put your shoes on as soon as you wake up, before your feet have had a chance to swell.
What common problems will a Podiatrist treat?
When we walk or stand, our body weight is carried first on the heel and then on the ball of the foot, where the skin is thicker to withstand the pressure. When this pressure becomes excessive, some areas of skin thicken in the form of corns and callus, as a protective response to the body’s reaction to the friction of skin rubbing against a bone, shoe or the ground.
Callus (or callosity) is an extended area of thickened, hard skin on the soles of the feet. It is usually symptomatic of an underlying problem such as a bony deformity, a particular style of walking or inappropriate footwear. Some people have a natural tendency to form callus because of their skin type. Elderly people have less fatty tissue in their skin and this can lead to callus forming on the ball of the foot.
Corns are caused by pressure or friction over bony areas, such as a joint, and they have a central core which may cause pain if it presses on a nerve. There are five different types of corns:
Hard corns – these are the most common and appear as a small area of concentrated hard skin up to the size of a small pea usually within a wider area of thickened skin or callus. This may be a symptom of the feet or toes not functioning properly
Soft corns – these develop in a similar way to hard corns but they are whitish and rubbery in texture and appear between toes where the skin is moist from sweat or from inadequate drying.
Seed corns – these are tiny corns that tend to occur either singly or in clusters on the bottom of the foot and are usually painless.

Vascular corns – these can be very painful and can bleed profusely if cut.

Fibrous corns – these arise when corns have been present for a long time and are more firmly attached to the deeper tissues than any other type of corn. They may also be painful.

Nail Pathology
Toenail abnormalities can tell you a lot about your health. They're often a sign of a fungal nail infection or injury, but can sometimes indicate a more serious underlying disease.

If your nails have changed in colour, texture, shape or thickness and you don't know why (you haven't injured your nails or been biting them), then a Podiatrist can help with diagnosis and treatment of the condition
The most common nail problem a Podiatrist will see is an ingrown toenail.
An ingrowing toenail is one that pierces the flesh of the toe. It can feel as if you have a splinter, be extremely painful and inflamed or infected. In more severe cases, it can cause pus and bleeding. Ingrowing toenails most commonly affect the big toenail, but can affect the other toes too.

Whereas a nail that is curling (involuted or convoluted) into the flesh, but isn’t actually piercing the skin, isn't an ingrowing toenail but can feel very painful and also appear red and inflamed as well.
Before you are seen by a podiatrist, you can relieve the discomfort by bathing your foot in a salty footbath which helps to prevent infection and reduces inflammation. Then apply a clean sterile dressing, especially if you have a discharge and rest your foot as much as possible.
How a podiatrist will treat you will depend largely on the severity of your condition:

For the most basic painful and irritable ingrowing toenail, the offending spike of nail will be removed and covered with an antiseptic dressing.

For toes too painful to touch, a local anaesthetic will be injected before removing the offending portion of nail.

For involuted nails, part of the nail that is curling into the flesh is removed and then the edges of the nail are filed to a smooth surface.

For any bleeding or discharge from an infection, or even excessive healing flesh (hypergranulation tissue) around the nail, antibiotics will be prescribed to beat the infection as well as having the offending spike removed.

For those particularly prone to ingrowing toenails from underlying problems such as poor gait, partial nail avulsion (PNA) may be recommended.

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