The Yorkshire Foot Surgery and Biomechanics Clinic

The Yorkshire Foot Surgery & Biomechanics Clinic

Basic Chiropody Care

What is a Podiatrist?

A podiatrist is a highly trained professional that is able to provide comprehensive foot and ankle care. A podiatrist is intensely educated in the diagnosis, treatment, and prevention of disorders and diseases of the foot and ankle. The podiatrist diligently works to provide the highest quality, most effective, comprehensive care of the foot and ankle, and is also rigorously trained to perform surgery on the foot and ankle, when necessary. Please find pictures of real-life patients who have sought treatment at our clinic (PERMISSION HAS BEEN GIVEN FOR PHOTOGRAPH PUBLICATION FROM ALL patients).

	Structural conditions
	A heel spur. Spurs can be symptom free or render a patient immobile. If caught early enough spurs are actually quite easy to treat. A specially designed pair of insoles called orthotics nearly always cures this problem. Spurs can be hard to treat and sometimes multiple methods of treatment are needed to rectify this condition.
	Acquired Conditions
	En Pointé. Feet from a Ballet dancer - This patient had very tight tendons and muscles from walking on her toes from the age of 3 this patient was in her 30`s. A comprehensive series of muscle stretching exercises and a custom made pair of insoles helped to relieve the patient's pain.
	Trauma-related injuries
	Onychcryptosis. Ingrown toenails. (Please also see the nail surgery fact sheet) - Three ingrown toenails from a fell walker, trauma from walking boots caused this problem. Basic chiropody was used to heal this patient within three weeks of the first visit.
	Nail conditions
	Onychomycosis. Fungal nail infection. (Please see the Nail Surgery fact sheet) - This patient had been ashamed to show their feet. After a rigorous full medical history and a quick chat to the patients GP, a course of Lamisil tablets were prescribed and now this patient is making a steady recovery.
	Surface skin conditions
	Infected ulcer with Raynaulds Syndrome. A Podiatrist can do nothing for the Reynaulds syndrome itself but we can treat other things such as the ulcer. This patient received basic chiropody care and shoe education. The ulcer healed, this patient now receives regular care.
	Psoriasis – This is a condition in which the skin replaces itself at a far quicker rate than normal. A Podiatrist can do very little about this condition except monitor it and give advice on medication, which is available. Patients with Psoriasis can also suffer from Psoriatic arthritis. This is a condition which if not monitored can become extremely debilitating, occasionally podiatric surgery is needed to improve foot function.
	Anhydrotic Skin – Here a patient displays very dry skin. There are lots of reasons why a patient may loose fluid content from the skin. A good emollient and regular chiropody care can give patients back a normal looking foot. This may take a little time and effort from both the patient and the practitioner.
	Blisters – This is a simple blister. A podiatrist may come across many forms of blister these can be quite superficial to quite deep where the skin simply separates at the dermal-epidermal junction. Fungi to major systemic illness can cause all manner of blisters (vesicles and bullous varieties). Careful history taking is needed to screen out possible medical illnesses, serious cases are usually referred immediately to a dermatologist.
	Circulatory Problems
	Raynaulds Syndrome - Patients may present with multiple conditions, this patient also has Lupus a connective tissue disorder. This patient suffered multiple joint pains we examined her biomechanics and found some minor problems. A pair of flatbed insoles with a plastazote covering (known for it's thermal properties) was prescribed. The vast majority of time this patient is comfortable, however there are times when she is less comfortable. The moral of this case is, we may be good at treating feet but we are not GOD!
	Haemocidderohis - A mottled brown skin complaint on the top due to not being able to remove the waste product `Haem` from the skin. Podiatrists can do nothing here except monitor this patient's cardiovascular system and when needed refer the patient on to specialist care
	Congenital conditions
	Brachymetatarsia - Congenitally shortened bones. Two different cases of this condition. Each case is unique, as each patient will have different complaints depending upon which toes are affected. Treatment in the past has revolved around basic chiropody, orthotics (special custom made insoles), ankle rehabilitation, padding and strapping, shoe education, and surgery. Patients, which present with this condition usually, have very few complaints giving the external appearance of the foot
	Congenital curly toe - The fifth toe overrides the fourth toe. This is quite a common condition, which is congenital, meaning it is inherited from birth. The patient was is no pain whatsoever therefore this toe has simply been left alone. Problematic toes may be amputated or have a tendon transfer depending upon what the Podiatrist decides upon.
	Surgery based problems
	Amputation - Sometimes patients suffer horrific incidents to their feet. A large pallet dropped on this patient's foot. A large amount of damaged was sustained to the small bones (phalanges) of the toe, an amputation was needed. Podiatrists sometimes need to amputate digits to preserve a patient's quality of life. Surgery should always be reserved as the last method of treatment.
	Athrodesis - Creation of a new joint. Elderly patients can become very arthritic as they grow older and may need some joints to be fused to alleviate pain. This patient underwent such an operation and now occasionally gets the odd pain. Surgery does not always `cure` things but it can massively improve a patient's quality of living. This patient is happy with their current pain level and has returned to many activities previously abandoned.
	Peroneum - An accessory bone. This patient complained of pain to the base of the fifth toe. There was a long history of taking anti-inflammatory drugs, changing footwear, physiotherapy, and steroid injections. After an x-ray was taken an accessory bone was found, after a simple operation this was removed. To date the patient has remained completely pain free.
	Unicameral Bone Cyst - A benign cyst. A bone cyst within the main anklebone, the calcaneus. After a routine X-ray this cyst was found in a perfectly healthy patient who reported to the practice with a completely different condition. The patient was informed about the cyst and now this patient receives a regular foot health check to monitor any changes.
	Dermatological (Skin) conditions
	Pitted keratolysis - A bacterial infection of the skin. Individuals can work long hours, which usually mean they have the same shoes on for many hours. This can produce an environment, which is ideal for bacterial and fungal replication. Dark, damp, moist conditions produced this patient's infection. Waste products are produced which gives a very distinct smell. A new pair of shoes, a lesson in foot hygiene, and a prescription of Daktarin helped clear this case.
	Peroneal Tendon Subluxation - This patient came along complaining of a snapping sensation just beneath his fibula. Upon examination a dramatic hardened lump was found. It had transpired that this patient had am accident and decided against treatment at hospital. His symptoms got progressively worse and as a last resort he came along to a Podiatrist. After a full biomechanical examination has was prescribed a pair of orthotics (custom made insoles). To date this patient remains happy with his outcome, there are still some symptoms and the patient has been informed that surgical repair would probably be the best option.
	Osteoarthritis
	Osteoarthritis - An extremely common condition which can affect any joint, in this X-ray we have marked deformity of the bone, and the space in between the bones has also diminished. As a side effect patient can develop Hallux Rigidus (no movement at all in the big toe) or hallux limitus (reduced movement within the big toe). Both conditions are extremely common this patient had hallux limitus. Side effect includes changed walking style, lower back pain, and marked tightness in the posterior muscles in the legs. Predictable areas of hard skin under the feet occur because of changed walking style. A pair of orthotics was prescribed and the patient resumed normal activities.