Time to discuss a clinical topic Section

Why do you want to know that?

human body organs & msk post only

Many patients ask me why I ask questions about other parts of their body and what this has to do with their feet.

‘It’s my bunion, ingrown toe nail, heel I have come for!’

This is where I have to educate my patients to ensure they know as podiatrists that we take regard of their general health and don’t see just them as a pair of feet. It is not possible to isolate the foot from the rest of the body’s functions.

Majority of the time foot pain is relegated to the foot alone and bears little relationship elsewhere. As a foot surgeon who specialised in podiatry I know that medical problems affect joints, skin, bones and if I am to recommend surgery I need to take account of what is going on elsewhere. There are many examples that can be cited, from working out if some type of skin treatment or oral medication is causing a skin allergy in the foot, to whether some undiagnosed problem such as diabetes is likely to result in changes in blood supply to the foot or affect the quality of nerve sensation. I found it hard once to clear an infected wound on the foot as the patient had a bowel problem.

One thing I do know with some sadness is that there is greater pressure on specialists such as myself to consider areas of medicine often not spotted owing to brief GP consultations.

A lady patient in her late sixties presented to clinic and it was only through testing her blood that the true diagnosis behind her rather red face was revealed. She had a rare condition caused by clumping of clotting cells. Had we performed surgery this could have had fatal consequences around the site of her tourniquet ( and of course limb) or to the serious effect the general anaesthetic would have had on her oxygen supply to the brain. One might have found this information in the GP letter. However the greatest surprise was the fact her husband was a medical doctor and had missed the signs.

I have spent most of my career telling patients that I am not a medical doctor but when the chips are down there is no side stepping where responsibilities are starting to lie.

I strongly believe it is not so much the doctors at fault here but a system derived from a political will to make health savings and changes with unforeseen consequences. Mind you, as a podiatrist what do I know about politics let alone medicine!


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