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Celebrating Podiatry

Today we celebrate podiatrists and the life-changing treatment they provide for adults and children.

From debriding severely ulcerated diabetic feet in at risk clinics, removing painful, ingrowing toenails in nail surgery clinics, reducing painful corns and callus with a scalpel and diagnosing and treating musculo-skeletal problems in biomechanical assessment clinics.

These are just a small selection of foot-related conditions that the podiatry team in Milton Keynes see on a daily basis and are skilled in treating.

And while treating painful feet maybe the podiatrists' bread and butter, the profession has developed a more holistic outlook and offers advice to patients on general health and wellbeing, such as attending smoking cessation courses if they are smokers, preventing falls in the elderly, providing footwear and footcare information for all ages and specific foot health education to manage conditions that have acute and chronic effects on the feet.

"We didn't used to discuss lifestyle choices when I first qualified twenty years ago but now it's an inevitable and essential part of health care because so many choices that patients make can have a direct impact on a their foot health. Sometimes patients are happy to hear it and know they need to be told and sometimes they aren't," say community and acute team managers Navdeep Grewal and Susan Laybourn.

With up to 500 referrals a month, the team's day officially starts at 8.15am but for the team leads it starts at least half an hour before this to give them time to work through the triaging of patients into at risk, urgent and non-urgent cases that will be added on to the caseload.

The vast majority of the at risk and low risk caseload consist of elderly patients - which is to be expected. However, most low risk cases in Milton Keynes are related to working conditions and footwear such as in-growing toenails relating to either steel toecaps - worn on building sites and warehouses for instance - or painful skin conditions and lesions on the feet caused by wet working conditions.

Once the team have completed the paper triage, it's then admin time and one-to-ones with members of staff to make sure any staff issues are addressed followed by call backs to patients with queries on a broad range of areas. Some of these have included praise for staff from patients.

One of these call backs turned into a safeguarding alert after the team realised that an elderly patient was unable to care for himself and was not registered with a GP. The team had called the patient because he had not attended a clinic appointment.

Following a management team meeting, Nav and Susie then treat up to 10 patients in the afternoon. Different risk categories of patients have different time appointments so at risk patients with ulcers and amputations may have a 45 minute appointment whereas low risk patients may have 20 minutes.

"Sometimes clinics can go from one extreme to the other. You've got patients with completely neglected toenails either because they have mental health problems or are physically unable to cut their nails and tend to their feet. Then we have diabetic patients who because of complications from their condition may have no pain response and or severely restricted lower limb blood circulation. In this case you may have bits of bone sticking through an ulcer and you need to debride the ulcer (using a scalpel to remove the dead tissue to allow healing to take place). This is one of our key specialist skills," he says, adding that another skill is looking for the problems that are masked. For instance high blood glucose levels causes damage over the long term but patients don't feel the damage being done until it's too late, then they see the end result.

Other patients may have musculo-skeletal pain and need a biomechanical assessment that involves observing how the patient walks and the range and quality of motion of the joints and muscles to assess whether specially designed insoles and orthotics might relieve pain in the foot, knees and hips.

It's a long but satisfying day.

Unseen by all is the work involved in producing the central timetable, which is done by Service Manager Karen French and Admin Manager Fiona Lennie.

Every week they pull together all the waiting time stats, staff leave, room availability, and risk management of capacity for twelve different types of clinics across 13 different locations.

This is produced four weeks in advance to allow booking clerks to book appointments so patients can be treated.

"All of our staff say that the most satisfying part of the job is when we provide instant pain relief to patients who are in acute or chronic pain that nobody has been able to help them with," says Nav.

Editors' notes

The attached photo shows  from left to right: Fiona Lennie - Podiatry Admin Co-ordinator; Karen French - Podiatry and MSAS Service Manager: Susan Laybourn - Podiatry Team Lead and Navdeep Grewal - Podiatry Team Lead

Central and North West London NHS Foundation Trust
Stephenson House, 75 Hampstead Road, London NW1 2PL
Tel: 020 3214 5700 e-mail:communications.cnwl@nhs.net