Best foot forward

When your feet start playing you up it's time to visit a chiropodist, says Anne Woodham

Looking after your feet is one of the most important things you can do for yourself. Most of the time keeping them clean and dry and your toenails trimmed is enough, but if problems like bunions, heel pain or corns develop then it's time to seek professional help.

Foot specialists are known as chiropodists, though many now prefer to call themselves podiatrists, which is the internationally recognised term. Many foot problems, such as athlete's foot or corns are relatively easy to deal with, but some conditions are potentially life-threatening.

Diabetes and arthritis problems
Older people with diabetes or poor circulation who can't (or won't) wash their feet or cut their toenails may develop infections that can lead to ulceration and even amputation. Chiropodists can recognise the danger signs and alert doctors. According to the Society of Chiropodists and Podiatrists, chiropody can prevent 40 per cent of amputations in diabetics.

People with arthritis can develop bony deformities on their feet that make walking difficult. Chiropodists are trained to take casts of the feet from which to make a special foot support, or orthotic, that fits inside the shoe and can make walking virtually pain-free and even relieve associated back and hip pain.

How does it work?
State-registered chiropodists practise either within the NHS or in private practice. You may go to a clinic or health centre or, in some cases, particularly if patients are elderly and immobile, the chiropodist will come to the home.

The chiropodist will question you about your foot problem, your medical history and lifestyle and ask you to remove all your footwear in order to examine your feet. Treatment will depend on the nature of the problem and could include the prescription of orthoses (special shoe inserts), topical chemotherapy, cryotherapy (freezing), electrosurgery, ultrasonics, specialised dressings and exercises.

For example, if a verruca is getting larger or painful, the chiropodist may remove it surgically under local anaesthetic, by freezing or by forms of electro-surgery that are quick and usually completed in one visit. You will be prescribed chemical lotions or ointments to apply at weekly intervals to destroy the wart virus.

Chiropodists may specialise in various forms of treatment. Those trained in surgical techniques (podiatric surgeons) deal with problems such as bunions and in-grown toenails under local anaesthetic at NHS and private clinics. Others are particularly interested in sports medicine, diabetology (problems associated with nerve damage from diabetes that causes burning, tingling or numbness in the feet) or biomechanics (the preservation, restoration and development of foot function).

Advice is also given about caring for your feet. If you have an in-grown toenail, for instance, the chiropodist will show you how to cut it, not too short or down the sides, to prevent recurrences. You will probably be advised to stop wearing tight shoes with high heels that are the cause of many foot problems.

What is it good for?
Chiropody can help all kinds of foot and lower limb problems, such as corns, verrucae, athlete's foot, chilblains, sweaty feet, calluses, in-growing toenails, heel pain (plantar fasciitis), gout, bunions and other toe deformities, as well as problems associated with diabetes, rheumatoid arthritis, osteoarthritis and elderly feet.

What to watch out for
Looking for a chiropodist in the Yellow Pages reveals a confusingly wide range of letters after names. Only state-registered chiropodists who have a three-year Bachelor of Science (Honours) in Podiatry are recognised by the NHS and are entitled to call themselves 'state-registered.' They are members of the Society of Chiropodists and Podiatrists and their qualifications approved for NHS practice in 1954.

Look out for the letters SRCh (State Registered Chiropodist) and MChS or FChS (Member or Fellow of the Society of Chiropodists and Podiatrists). FCPod(Surg) means a Fellow of the Faculty of Surgery of the Society of Chiropodists and Podiatrists. DPodM (Diploma in Podiatric Medicine) is an older qualification that has been replaced by BSc (Hons) Podiatry.

Other practitioners call themselves chiropodists and podiatrists and even say they are 'registered' or 'fully qualified', but their training is not as thorough as state-registered practitioners. Some have gained diplomas after a two-year distance learning or one-year full-time course, but others may have done as little as 12 correspondence lessons and ten days' practical training. State-registered chiropodists are concerned that inadequately trained practitioners may cause damage by prescribing the wrong kind of shoe inserts that can make a situation worse, failing to recognise symptoms of diabetes or not maintaining adequate standards of hygiene or sterilisation of instruments.

How much does it cost?
If you are elderly or suffer from diabetes, rheumatoid arthritis or osteoarthritis, you will be a priority for NHS foot care, although it may not be available in all areas. Private fees vary according to location and the practitioner's experience, but £25-£30 for 30-40 minutes is average.

Find out more

The Society of Chiropodists and Podiatrists
1 Fellmonger's Path
Tower Bridge Road
London SE1 3LY
Tel: 020 7234 8620
www.feetforlife.org

The society represents 8,500 state-registered practitioners, of whom 3,700 work full time in the NHS.

Institute of Chiropodists
27 Wright Street
Southport
Merseyside PR9 0TL
Tel: 01704 546141
www.inst-chiropodist.org.uk

Podiatrists courses are accredited by the Open and Distance Learning Quality Council. Look for letters MInstChP or FInstChP (Member or Fellow of the Institute of Chiropodists and Podiatrists) or DChM (Diploma in Chiropodial Medicine).

The British Chiropody and Podiatry Association
The New Hall
149 Bath Road
Maidenhead
Berkshire SL6 4LA
Tel: 01628 632449

Members have completed a two-year distance learning or one-year full-time course and use the initials MSSCh, FSSCh or MBChA, which stand for Member or Fellow of the British Chiropody and Podiatry Association.