In a series focusing on medical specialisms, Mike O'Neil talks about podiatry.
'Foot pain is increasing'
Chiropodists and podiatrists deal with the assessment, diagnosis and treatment of the lower limb and are qualified to carry out nail surgery and to treat people with arthritis, diabetes and sports injuries.
There is no difference between a chiropodist, and podiatrist. The latter is the term used by other English speaking countries for a chiropodist.
WHAT IS YOUR JOB?
I am a podiatric surgeon based at the Thames Valley Nuffield Hospital and the Princess Margaret Hospitals in Berkshire. I also work for the NHS at Newham General Hospital.
My job is primarily looking after people with foot pain and other muscular skeletal problems associated with the way they walk and how the foot functions.
WHAT IS THE MOST COMMON CONDITION?
The most common condition I see is probably the correction of hammer toe deformities and bunions.
Hammer toes produce large corns and calluses either on the top or end of the toe causing problems when both walking and wearing any normal footwear.
The most common non-surgical problems that I see is heel pain (plantar fasciitis).
This is where a ligament on the inside of the foot attaching to the heel bone becomes very inflamed, usually causing severe discomfort on arising from bed in the morning.
It can also lead to pain developing on the inside of the arch and heel after standing for several hours.
Treatments for these usually involve the production of a special insole called an orthotic device which helps to control and improve the foot function.
It is also very important that I teach these patients how to help themselves through a rehabilitation programme involving stretching and strengthening exercises and helping them choose the correct footwear.
WHAT IS THE MOST COMMON PROCEDURE?
The most common procedure is the surgical management of ingrowing toenails.
These affect a very high percentage of the population at some time in their life.
WHAT IS THE HARDEST THING ABOUT YOUR JOB?
People with foot pain unfortunately nearly always have to get better while continuing to use the feet.
Educating patients that some treatments require rest, either with the foot elevated or a change of footwear and activity levels, is sometimes very difficult, even for a short period.
WHAT WAS YOUR MOST SATISYING CASE?
It is always nice when dealing with elite athletes when you help them recover from an injury and then see them achieving at the peak of their career.
Podiatry also has the ability to give the immediate relief of foot pain to many patients presenting with corns, calluses or ingrowing toenails.
However it is more satisfying when you see a patient that has been attending for regular chiropody treatment every month for the last five or six years undergoing a relatively simple procedure which results in them getting back to normal footwear and not requiring to attend for regular monthly treatments.
WHY DID YOU CHOSE THIS SPECIALITY?
I enjoy working with people. And the complexity of foot mechanics makes the feet a very interesting and challenging part of the body to work with.
I enjoy mixing the surgical practice with the muscular skeletal injuries that can be dealt with by non-surgical methods.
IF YOU HAD YOUR TIME AGAIN WOULD YOU CHANGE YOUR SPECIALITY?
No, I am passionate about feet.
HOW DO YOU SEE THE ROLE DEVELOPING IN THE FUTURE?
There are currently about 12,000 podiatrists in the UK, but only 150 Podiatric Surgeons, with less than 60 NHS Podiatric Surgical units.
Foot pain is on the increase due both to people standing many hours in their jobs, wearing poor footwear. Also, increased sporting activities produce extra stresses and strains on the feet and lower limb.
Hopefully one day every major hospital will have a department of surgical podiatry and podiatric biomechanics.
CV - Mike O'Neil
1981: Graduated from the Chelsea School of Chiropody
1987: Gained members of the Surgical Faculty of the College of Chiropodists and Podiatrists
1997: Became Fellow of the Surgical Faculty of the College of Podiatrists
2001: Became board member of the National Executive of the Society of Chiropodists and Podiatrists