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From the address by AMANDA CRANE, podiatrist, to the February meeting of The IN Group, held 14/2/95 at 4 Alandale Avenue, Balwyn. JHG
Previously podiatrists were known as chiropodists but now podiatrists qualify through a three year degree course. We treat anything from the ankle down. We are employed in a number of different areas - hospitals, day hospitals (of which I am a part of), community health centres and private practice.
To see a podiatrist at a private practice you don't need a doctor's referral but some hospitals and day centres do, just as a way to screen patients. Unfortunately at the day centre I work, Mt Eliza, there is a three months' waiting list so therefore we do try and screen patients.
If you qualify through the Department of Veteran Affairs you are entitled to receive podiatry through them - I think it is six free visits per year.
One of the commonest is the CORN.
Corns can be very painful and generally occur at prominences such as the little toe. You get pressure marks from the shoe rubbing on the prominence that results in a corn. There is another sort, often misdiagnosed, which develops between the toes. If you have this problem it is likely to develop in hot weather when your feet sweat. The usual treatment is surgical excision by a podiatrist (we remove with a scalpel blade).
You can get corn pads and corn cures from the chemist but keep in mind if you have any circulation problems or suffer from diabetes please refrain from using them. They contain quite strong chemicals and, rather than removing the corn, can cause irritation around the corn.
The second most common complaint is the CALLOUS. They usually occur underneath the foot, due to shearing pressures. They are also usually removed by the scalpel blade.
Unfortunately with both corns and callouses, they will come back unless the problem of the bony structure underneath is addressed. This is where podiatrists have a big role to play in that we love to make devices. Such devices worn in the shoe take the pressure off the affected area.and redistribute over the whole foot. As a result your visits to the podiatrist should be less frequent.
Other things you can try at home for callouses are Dr Sholl's products. Some are quite good. One is a pumice stone which you use to abrade the callous in between visits. They tend to work better after a shower when the skin is moist.
Then there are BUNIONS. They usually occur under the big toe. They are not caused by footwear but by an inherited bony structure. Improper footwear, such as high heels with narrow toes, can increase the rate at which they occur.
Over the top of a bunion can be a BURSA which is a fluid-filled sac. On hot days or when wearing shoes that are too tight, that fluid-filled sac will inflame and that is when you get your bunion trouble.
Then there are dry, cracked heels, usually due to wearing thongs or sling-back sandals. If you have circulation problems or delayed healing then you have a perfect environment for infection.
If you use a moisturiser on your feet it is important that you use it
regularly. Two good products are Calmuric Cream and Sorbaline Cream.
People often come to podiatrists with foot pain. They may have been to their doctor and told they have a spur or they have just got this pain that has gone on and on. Finally they come and see us. What we often do then is have a look at how they walk, often using a video camera, and then assess whether they need orthoses, often previously called arch supports. They are custom-made devices to fit your foot type that go into the shoe to support the arch for those people whose arches have collapsed. They control the movement in the foot.
We see many children these days. There are children who walk with their feet partly rolled which puts a lot of strain on the legs and the muscles of the lower limbs. They may need some orthotic device to overcome their rolling gait.
Footwear is a huge problem. Factors to keep in mind are: (1) buy leather shoes because synthetic shoes don't allow the escape of water vapour; (2) high heels and sling-back sandals are a "no-no" (high heels also move your centre of gravity forward, putting your body weight on to the front part of your feet, causing excess pressure and resultant pain); (3) lace-up shoes are better than "slip-ons" because the foot is more secure and does not tend to move around to produce callouses and toes to "claw".
People with disabilities can get shoes to suit through going along to a day centre after a doctor's referral. They are provided by PADP and are often custom-made.
With neuropathy you sometimes cannot feel pain so it is important to have a good look physically at your feet each day, including under your feet. Standing on a towel is not good enough.
Also it is important to have your feet checked from time to time by a podiatrist, say every six months if you have no particular foot problems.
Particularly in hot weather it is important to dry thoroughly between the toes to avoid tinea. If you have difficulty getting down to your toes get a 30cm ruler and tie some towelling around the end.
Insoles can be helpful by being shock-absorbing provided they don't flatten out.
Feet will swell during the day, particularly in hot weather. This is particularly so if your leg muscles have been affected and fluid tends to collect. This is why you should buy shoes in the afternoon. Also you may need a wider fitting than is available in the normal shoe shop but there are shops that do stock the wider fittings.
People with foot-drop need to consult the specialist prosthetist, the orthotist, who will prescribe the appropriate splint to keep the foot up and so help walking.
Medicare does not cover podiatry. People with health cards can get a slight subsidy. If you are privately insured you should check whether it covers podiatry.
When cutting toe nails try and cut straight across. This avoids ingrowing toe nails. Also don't cut them too short. Cut them after a bath as the nail is then softer. If you have really tough and thick nails (rams horn nails!) you probably need to see a podiatrist. You can try filing them first, an electric drill with a grinding attachment can even be used.
There are many different types of nail scissors. Some find the type with a lever action helpful. One member reported that the scissors on his Swiss knife was very effective.
Fungal infection can easily be picked up. One ointment named Lamisil has just come on the market and is very effective but it needs a doctor's prescription as it is expensive ($80 a tube). There is also Gordochon Solution which is quite good and available from the chemist.
The proposal to use a hospital's computer system to advise a patient when diagnosed as to what support group may be available has received acceptance in principle by the Alfred Hospital Medical Administration. We are now awaiting the wheels to turn to place it into operation. The Head of the Alfred Neurology Department and IN Group Patron, Dr Bernard Gilligan, has been helpful in the negotiations.
We now have an eye-catching A3 size colour poster to publicise the existence of The IN Group.
A professional artist was commissioned to create it. The artist's background as a nurse helped her realistic depiction of half a dozen experiences that may befall GBS and CIDP sufferers - intensive care, wheel chair, hydrotherapy, electrical testing, Intragam treatment and an IN Group meeting .
The laminated posters have been well received by the medical and nursing staff at the Alfred Hospital and already adorn the walls of its EEG/EMG Department, Haematology Procedure Room and Wards 3A and 3E.
We now hope to distribute copies through our Contact Members to other Melbourne major hospitals. If any member would like their own copy they are available at $5 ($10 laminated) from:
Director, The IN Group
138 B Princess Street KEW 3101.