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Podiatry Treatments

One of the first things that we are taught at podiatry school is anatomy. We start off learning the anatomy as this then allows us to be able to accurately diagnose the problems our patients come in with. 

The only part of the examination that is more useful is the 'patient history'. I can confidently say that 8 times out of 10, I know exactly what is going on with you before I have touched your foot. This being said, it relies on me allowing you the time and respect to discuss your concerns and share your story in detail. 

Once I have heard about all of your concerns, I will then assess your foot, lower limb, and sometimes even some functional movements around your hips and spine. From here, a treatment plan will then be developed and you will then be able to decide on how you would like to proceed. 

I will never use any pressure selling techniques and I will always cover all of the most appropriate treatment modalities, whether I offer them or not.

Clinical examination

Clinical examination is probably the most fundamental skill a clinician can offer their patients, however if poorly applied, can lead to poor (or even disastrous) outcomes.

Prehabilitation focuses on identifying your potential strengths and weaknesses and looking at ways to prevent these turning into problems. 
As a clinician, it is imperative that I do not medicalise a non-issue.. So I will not just say "you should have insoles for those flat feet" or that you need to buy an expensive pair of trainers because your big toe joint might have a bit of limited movement. 
I will work with you to identify your short, medium and long-term goals; discuss factors that may lead to you struggling with your lower limb, and suggest a program of exercises that you can follow to prevent you developing issues. 
The most important point is education though. If you understand the way that injuries develop, you are more than half way to having a long and active athletic career, whether you are 18 or 80... I will still treat you so that you are optimised to the level you want to be, rather than a cookie cutter approach that you can download from anywhere online.


Prehabilitation is more important than rehabilitation. Almost. The idea of prehabilitation is that you are preventing the need for rehabilitation.

Magnets have 'poles' - so like a north and south pole. Likewise, MRI scans do too; they work by flipping the polarity of the magnets rapidly and that 'flipping' means that the water molecules inside of you react to the magnetic field flipping and so an image is produced. 

MRI  gives a huge amount of information and can sometimes be unhelpful as it may show problems that are unrelated to why you have come in and, as a result, you may end up with new symptoms!

MRI Scans (Magnetic Resonance Imaging)

MRI Scans can be extremely useful sometimes, but can even be 'too' useful.
I have arrangements with local hospital facilities to Berkshire & Buckinghamshire to organise MRI Scans.

The healthcare world is putting a real emphasis on identifying healh-changing lesions and diseases earlier, and I try to make sure that I keep up! 

Dermoscopy has been around for a very long time however is infrequently used by podiatrists and doctors alike. It is highly effective for assessing skin lesions that may be cancerous and can also be used to reassure you of lesions which are not. 

Clearly the best placed clinicians for assessing these lesions are dermatologists and GPs who specialise in dermatology, however getting in to see one can be expensive and mean long waiting times. As a result, I purchased a dermatascope and will often assess lesions with it for greater reassurance or for justifying onward referral. 

It is not yet a 'specialist' service which I offer, however I have developed the skills to use it safely for identifying 'concerning' and 'not-concerning' lesions. Whilst this is not the strongest sales pitch - I owe it to you as a potential patient to be up-front about my skillsets, and so I will advise you that I offer dermoscopy for differentiating malignant from benign lesions, but my use of it for complex diagnosis is limited and I will always be honest with you on this. 

The use of a dermascope is significantly more accurate and useful than using a magnifying glass or 'loupe' as is used in a lot of clinics. This is because the lesion is not obscured by external light sources and the dermascope is engineered so as to ensure that all aspects of the structure can be visualised. 

Any images I take which are for cataloguing purposes can be made available to you upon request. 

Any lesions which cause me concern will have a referral letter written.


Dermoscopy is a method of looking at the skin through a specialised tool called a 'dermatascope'. A dermatascope allows your podiatrist to look at lesions at a higher magnification and make diagnoses with far greater confidence.

Verrucae are a benign virus that do not cause any harm. One could even argue that they do not actually need treating. They can be painful and unsightly, and these would be good reasons to treat a verruca.

There are many treatments available for verrucae, including doing nothing, however for painful lesions, or those lesions that have been hanging around a while: verruca needling can be an excellent treatment option. 

Using local anaesthetic, either the area where the lesion is or the whole of the foot will be numbed. Lesions in the forefoot are numbed from the top of the foot and lesions under the heel or arch will be numbed at the ankle, meaning that the whole foot is made numb. Alternative options are available if the whole foot cannot be made numb for safety reasons (stability or needing to drive etc). 

The lesion is then punctured multiple times and wrapped in a large dressing to keep the region clean and infection free. The procedure is quick - taking only 5-10 minutes and the time allocated is often as little as 30 minutes and rarely more than an hour (the number and size of lesions are a factor for this). 

My patients have often found Swift (microwave therapy) to be very painful as well as expensive, and as a result have opted for needling if they have not had partial / total resolution within a set number of sessions - usually no more than five. 

I can however offer: Debridement, curettage, cryosurgery, caustics, Swift and needling.

Verruca Needling

Verruca Needling, also known as Falknor's needling, and incorrectly known as 'Dry Needling' - is a method whereby a verruca is punctured multiple times under a local anaesthetic block to stimulate the necessary immune response for it's resolution.

Vascular assessment involves looking at the arterial, venous and microvascular supply of the foot, leg and lower limb. 

Beecause the vascular system is effectively a highway that feeds from very large vessels down to much smaller vessels, we are able to tell the health of your lower limb through assessment of the blood supply further down; a good blood supply at the feet will mean that your vascular health further up your leg is fine. If the blood supply at the feet is poor, then I will try to identify how far up the problem is so that you can be referred appropriately. 

The most basic vascular assessments for feet include a visual check to assess skin quality and health as well as looking at (toe) hair and nail growth. I will also assess the temperature of the feet, checking for differences in temperature, how long it takes for the skin to 'pink up' after I press on the skin, and also check your pulses. 

If your pulses are poor, I will listen to them with a Doppler machine, this allows me to hear the quality of movement of blood. It also allows me to check for certain cardiac irregularities such as atrial fibrillation - a leading cause of strokes (however I can also do this with my fingers, but by listening to your pulses, I have an extra layer of certainty to write to your GP with. 

I may also assess your Ankle-Brachial Pressure Index. This is a method of assessing the ratio of your blood pressure in your arms and the blood pressure in your ankles. We then try to work out how evenly distributed the blood pressure is, and if there are differences, then further assessment from a vascular specialist may be required.

Depending on the severity of your symptoms, I can assess your blood supply as far up as your femoral artery. If you are coming in for vascular assessment and have been a heavy smoker, had extended periods of poor control of your diabetes, or get a numb / cramping / tingling pain in your buttocks, thighs, or calves whilst walking which goes within a minute or two of stopping, please ensure you wear loose fitting clothes to your appointment so that I can assess higher up your leg. Your dignity will be maintained at all times if this is necessary and you will be informed of all actions that may need to be undertaken.

Vascular Assessment

Essential for those with diabetes, current or ex-smokers, those with kidney failure or cardiovascular disease.

Rehabilitation is often sold as being something that physiotherapy offers, rather than podiatry… and that's really stupid. 

The purpose of rehabilitation is to take you back to the level you were at before your injury. There are several ways to do this: protecting the foot with a cast, using insoles, doing exercises, taping and strapping the foot and ankle. 

The most effective treatment is education though, and this is something that I focus on for you. When you understand what causes your symptoms and how these relate to your daily function: you are then able to start to become more independent of me for treatment. I rarely find that patients who have been educated about their condition and taken on board what has been explained require more than three treatment sessions to get them comfortably on the road to recovery. 

If you needed more, I'm always there for you, but I should be the most expensive part of the treatment, not the custom orthotics you you buy, and if you understand what is going on, and why you have developed your injury, I'm confident that you will be able to keep yourself from darkening my door! 

Also, you will find that I am releasing lots of free resources for patients I see, and that there are other resources that are affordable and, if you understand them, will really help to get you better and you can use me for the times when your symptoms are not changing.


Rehabilitation is the process of returning someone or something to 'normal' after a period of injury.
I like to make it into something far more useful though…

Ingrowing toenails can be extremely painful, and whilst they are sometimes the result of poor cutting technique, they can also occur due to injury to the toe, misshaping of the nail, or damage to the bone under the nail. 

Nail surgery is a highly effective way to prevent and resolve ingrowing toenails so that you do not have to keep managing them yourself. 

By opting to have nail surgery, instead of conservative treatment, you are reducing your long-term risks of recurrent infections and pain. More importantly, you are able to select when you have the procedure and ensure that you are not held hostage by your ingrowing nails.

Nail Surgery

Nail surgery is primarily performed for ingrowing toenails. It can also be used for severely and permanently damaged nails, fungally infected nails and where trauma has occurred.

X-rays form part of the electromagnetic spectrum. Their use has been associated with developing cancer in the past, however, these days the accuracy of an X-ray beam and the doses that get used are highly regulated and well controlled. 

X-rays are generally considered to be the first line investigation following a foot injury, and although this is the generally accepted scenario; there are other imaging modalities that are more accurate and can give better information that what is seen via x-ray.

X-ray imaging

X-rays use very low dose radiation to assess structures within your body. For the foot, x-rays are primarily used to look at structure and check for fractures. It can calso be used as part of an assessment of infection and soft tissue health - especially arterial health.

With gait analysis, I will sometimes be able to extract huge amounts of information from just videos of a patient moving on a treadmill or even just walking along the road. 

In more complex circumstances, I may wish to see how the foot pressures load and at what points in the gait cycle different parts of the feet load. Some examples of this would be for a person who walks a lot and always gets forefoot pain on their right foot. If they are on their right foot for 1000ms and their left foot for 800ms, that means they spend 200ms more time on their right foot, which means there is 200ms more time with the foot impacting the ground... This being said, it may also be that they actually spend 600 ms on their forefoot on the right meaning that 75% of their time on the right foot is spent on the forefoot. This means that the treatment - rather than more cushioning under the forefoot or telling them to walk quicker, may need to be a heel raise so that they spend less time with just their forefoot on the ground and so that the force gets evened up. 

Using a foreceplate before and after running gait analysis can also be helpful for objectively identifying changes to foot functioning and musculature.

Force plate analysis

Force plate and in-shoe podobarography (foot-force measurement) is useful for looking at how different parts of the foot interact with the ground and also in what order you start to use different parts of the foot.

When a tendon problem fails to resolve within a period of approximately three months, the condition is then described as chronic. This has various implications, but one of which is that the injured area is then described as 'degenerative'. 

Although this sounds particularly worrying, the 'degeneration' does not mean poorer long term outcomes - it is just a bit of medical terminology.  

By using shockwave, we are able to break down the damaged and unhealthy structures, and (combined with excellent rehabillitation, can then optimise the healing process for you. 

It is uncomfortable and can be painful in the early stages of treatment, however do not let this put you off. It is remarkably effective and has actually meant that surgeons have been able to stop doing as much surgery.

Shockwave therapy

Shockwave therapy uses a system of soundwaves to create localised soft tissue inflammation. Although inflammation may sound like the last thing that you would want to be applied to your irritable foot, it can very effective for reducing pain levels in the short term as well as encouraging damaged structures to heal.

Gait analysis is often thought to be the panacea of care and diagnosis. I have seen it described on patient forums as being the 'Gold Standard', however I have to mostly disagree with this.

Gait analysis can be extremely useful in identifying 'poor movement patterns' that result in pain, however, if doing detailed gait analysis on someone who is currently in pain, then all I am doing is seeing what their movement pattern is for whilst they're in pain. 

Given that the treatment may end up in a suggestion that you have insoles - and these can be costly - it does not make sense for me to start you down this route of costly treatment when your gait may change once you are out of pain. 

I only really use gait analysis in the early phases of injury when my patients will definitely see a benefit. Mostly, I recommend my patients have a standard musculoskeletal consultation and gait analysis if recommended. 

NB: Gait analysis can range from putting you on a treadmill for 2 hours if you are marathon training to watching you walk across the room a couple of times. I will be writing a guide on how to take videos for remote gait analysis. If you are wanting this before the blog is written, please get in touch below.

Gait Analysis

Gait analysis is most useful for patients who do long distance walking or running and do not develop pain until later in their walk / run.
It can also be useful for people who develop recurring issues such as heel pain, ankle pain or knee pain despite doing plenty of physiotherapy or rehabillitation.

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