An interview with Funmi Obi (ChilternWellbeing Foot and Ankle Clinic)
All buildings start with good, solid foundations and the human body is no different. Our feet provide an important base, supporting our balance, posture and mobility. And just like a building, weaknesses or structural damage can lead to more serious issues.
For foot related ailments, a podiatrist can set you on the right path to recovery. From diagnosis, treatment and aftercare, making an appointment with a skilled, qualified professional is the most critical step in getting better.
Based in Middlesex, ChilternWellbeing Foot and Ankle Clinic can treat the entirety of the foot – from sports injuries to paediatric feet. The team ensures that each treatment caters to the unique needs of their patients, while adopting innovative technologies, such as its gait analysis system to pinpoint the areas to tackle. We spoke to Funmi Obi to find out more.
Can you explain the role of a podiatrist?
A podiatrist is a health professional that specialises in the assessment, diagnosis, management and prevention of foot and ankle pathology. Our main aim is to improve the mobility, independence, and quality of life of our patients.
Our scope is vast and can extend from the management of nail and skin infections, to the surgical removal of painful ingrown toe nails, and the complex assessment of patients’ walking using digital gait analysis with the provision of orthotic therapy to improve the mechanical functioning of the foot and lower limb. We treat both children and adults.
What are the advantages of seeing a podiatrist rather than a general practitioner for foot and ankle concerns?
Seeking podiatric care directly, in most cases, could shorten the patient’s treatment journey and ensures a patient can return to full mobility quicker while increasing patient satisfaction.
For example, we would surgically remove a severely infected in-growing nail and prescribe antibiotics, whereas, on the NHS, you would likely wait weeks to see a GP for antibiotics before receiving a referral to arrange a permanent resolution to this condition.
As another example, if you are presented with an ankle injury, we would carry out an assessment and depending on the type of injury you could receive any or all of the following:
- Rehabilitative exercises
- Laser therapy to reduce pain, swelling and promote healing
- Specific footwear advice
- If appropriate, be prescribed an orthotic device to aid your foot and ankle
- On-site ultrasound imaging (certain locations)
- An x-ray or MRI scan could be arranged externally which could take place within 24-48 hours
The aim would be to create a seamless package of care for the patient.
In addition, a lot of podiatry clinics use shockwave therapy for the effective management of ailments, such as Achilles tendinopathy. All these therapies can be provided at clinic level without the need for multiple onward referrals that could take months.
What are the most common ailments of the foot and ankle?
The most common ailments are:
- Heel pain (plantar fasciitis);
- Arthritic pain at the big toe joint;
- Painful in-growing toenails; and
- Fungal skin and nail infections.
What technological advancements have you introduced to the clinic to diagnose or treat conditions?
Our MLS Class 4 Laser treats soft tissue, bone, and nerve pain. Our FootScan® is a sophisticated dynamic gait analysis system, used to detect high pressure areas at risk on the feet and subsequently produces Phits® 3D printed orthotics. SWIFT® Microwave Therapy effectively treats verrucas. 5 Minute Fungus provides a diagnostic test for fungal infections. We are also in the process of purchasing Shockwave Therapy.
Healthy feet are said to play a key role in good overall health. Can you explain why this is?
Feet provide a key insight into a patient’s general health. The colour, appearance and texture of the skin and nails can indicate an issue with circulation, the presence of an infection, or a systemic illness. The structural appearance of the foot, including any bone changes or deformity can also convey the risk of potential future issues, such as ulceration, sports injuries, or pain.
What conditions are best treated with a customised foot orthotic, and why?
Custom orthotics are prescribed following a thorough biomechanical assessment and is patient specific rather than condition specific. Many factors are considered when prescribing an orthotic, for example, the presenting problem or pathology, how the lower limb functions, the patient’s gait, weight, occupation, footwear, activity levels, and desired outcome both patient and podiatrist are trying to achieve.
Custom orthotics are generally more durable, contour the foot better and can be customised to a higher level than off the shelf devices, so if you need a very slim orthotic device for running shoes or football boots then a custom device may be something one looks to obtain.
How dangerous can a one-size-fits-all approach be, such as over-the-counter orthotics?
Most over the counter orthotics make big and false claims that they are able treat a variety of foot pathologies. However, without understanding the root cause of the foot pathology, long-term effective symptom relief is hard to achieve and can cause pain at other lower limb sites.
Additionally, in a clinical setting not everyone would benefit from an orthotic device, for example, heel pain patients. Depending on the patient’s medical history and results of diagnostic imaging; footwear advice, laser therapy, shockwave therapy or steroid injection therapy may be more beneficial for this patient.
Likewise, not everyone with a flat foot would require orthotics. If it is congenital, non-painful and a patient is able to carry out all their daily and sporting activities without problems, no intervention may be required.
Why are diabetics at higher risk of developing foot problems?
Diabetes causes the level of sugar in your blood to be higher than normal. Over time, elevated blood sugar levels damage your blood vessels and nerves, causing nerve damage and numbness referred to as diabetic neuropathy. Minor wounds can progressively worsen, forming ulcers without the person knowing because impaired circulation causes an inability to feel. This subsequently increases the risk of infection and amputation.
What’s your view on general footwear today? And what contribution, if any, do you think it has made to foot and ankle health?
There is greater variety of available footwear today, with ‘sensible’ shoes becoming less of a taboo choice. The footwear industry has finally understood the importance of ‘sensible’ footwear which is appealing to customers. Ill-fitting footwear is still the greatest contributor to foot pain and deformity. There is still a lot of work to do around educating patients on what to look for in a ‘good’ shoe. Patients are trying to buy shoes that claim to be ‘supportive’ or ‘wide fitting’ but are let down by retailers making unscrupulous claims when actually the shoe is not fit for purpose. I published an article in the Journal of Footwear Science in 2015 called Footwear Mismatch – Do we wear the correct sized shoes? The research found that 15% of subjects wore shoes that were too big for their feet whilst 35% wore shoes that were too small. The average volume of the subject’s feet was considerably higher than the available volume in the shoe. Within each shoe size category there was a significant difference in the internal shoe length.
Should endurance athletes, such as runners, pay attention to their foot and ankle health more than most? If so, why are they at risk?
The simplest way to answer this is by thinking about tissue stress. If healthy tissue, such as tendons are abnormally or excessively loaded or stressed, they will eventually dysfunction. Dysfunction can present itself as pain or weakness which would then hinder the athlete’s ability to perform efficiently. So, if a runner has very tight calf muscles and does not stretch effectively, the likelihood of obtaining an Achilles tendon injury will increase. Likewise, if an athlete trains in ill-fitting or unsupportive trainers, the ability of the trainer to absorb shock or impact is reduced and the stress applied to the foot anatomy increases, resulting in pain or injury.
How will the new addition of gait analysis to Chiltern Wellbeing Clinic help with diagnosis?
Gait analysis forms a crucial part of a biomechanical examination where our podiatrists quantifiably determine how efficiently your body moves when walking or running. Asymmetries or abnormalities in our foot strike and loading pattern can cause joint, muscle, ligament, or tendon soreness further up the body in the ankle, knee, hip and back. This assessment allows us to identify these issues and tailor your treatment plan to get you walking, running, or competing pain free, whilst offering the best advice to reduce the risk of future injuries.
We also use the gait analysis system to analyse plantar foot pressures in diabetic patients to ascertain if they have any areas of their feet under high and abnormal load which could increase the risk of a wound occurring at that site. This is repeated every year as part of the patients’ diabetic foot assessment. This technology improves the accuracy of diagnosis and enables the formulation of a robust treatment plan.
For more information on the clinic’s key treatments, or to schedule a consultation, please visit www.chilternwellbeing.com.