I have never minded touching people's feet. I don't really look at them as feet, just a problem that needs to be sorted out. Some conditions and diseases affect feet first so, when anyone comes in, we check the pulse in their feet, and the nerves for damage because that can be an initial sign of diabetes – pins and needles or tingling in the toes. Changes in the form of the foot can indicate rheumatoid arthritis. Skin cancer can be quite prevalent on the feet, and often between the toes – where people don't tend to look.
The majority of our patients are diabetic or have rheumatoid arthritis, both of which affect the feet very seriously. With diabetes, if blood sugar is very high, it affects the myelin sheath that covers the nerve, and the patient can lack feeling. Wearing shoes that rub can stop them realising they have symptoms. Those with diabetes are also prone to developing ulcers on their feet. We need to treat these carefully because if an ulcer gets into the bones and infects them, it's highly likely that the foot will need to be amputated. Amputations are not always preventable though – the patient's blood sugar levels might be out of control, or they have been on the wrong medication or were diagnosed late when the damage has already been done.
On Tuesday, I had an assessment clinic. There were a lot of patients with ingrown toenails, which we check before booking them in for surgery. In the afternoon, I did home visits. [Last week] I saw a woman who has severe Parkinson's and rheumatoid arthritis, which can result in the foot becoming severely deformed, with toes clawing and overlapping each other. On Thursday, I had another assessment clinic. Ingrowing toenails are very common.
On Friday, I started a diabetic clinic at 8.30am. What I like about the job is that you never know what is going to walk or hobble through the door. It can be very rewarding. Quite often patients come in and they're in a lot of pain, and within 20 minutes they're much more comfortable.
As told to Emine Saner. Suzanne Grange is a podiatrist with Milton Keyes community health services.
