URBAN HEALTH METHOD

Stephanie: Hello and welcome to the Urban Health Podcast, Beeping busy city executives and entrepreneurs healthy and fabulous. I'm Stephanie Webster. I'm nutritional therapist on Hardy Street, London, specialising in gut health, hormone optimization therapy and fat loss for the over forties.

Today we are talking with Mr. Steven Thomas regarding Podiatry. Mr. Thomas graduated with honors in Podiatry and is a member of the HCPC college of Podiatry and the Royal college of physicians and surgeons of Glasgow.

He's an honorary member of the Pediatric surgery unit at Guy's hospital and is currently undertaking a master's degree in Podiatric surgery. Mr. Thomas specialises in muscular skeletal abnormalities of the lower limb with expertise in video gait analysis and custom orthotic treatments.

He has a specific interest in minor surgery including ingrown toenails as well as therapeutic injections and shockwave therapy.

The reason why I brought him onto the show is a lot of my clients who are over a hundred kilos, maybe 120, 140 and have over 40% body fat. A lot of my clients have problems with their feet. So, a lot of my clients do have Podiatrists already. Some of them are happy with what they have. Maybe they want a second opinion and that's why I bought Mr. Thomas onto the show. So, thank you for coming onto the show. 

Steven: Thank you for inviting me. It's a pleasure. 

Stephanie: For those that don't know, please explain what a Podiatrist does and how they may help if you have a concern with your feet or lower limb pain. 

Steven: So, Podiatrist's are healthcare specialists and trained to assess, diagnose and treat the conditions of the foot and lower limb. There are different areas of specialty within the profession so they can help in a variety of ways. To give you a few examples, if you have an ingrowing toenail, a Podiatrist can perform nail surgery to prevent it returning and supply you with antibiotics if required.

They can usually find and address the underlying cause to a musculoskeletal condition and prescribe custom insoles known as orthotics, if required. There are also specialist teams set up treating wounds for diabetic foot. Then there’s others that can request imaging of the foot. We can treat certain problems using shockwave therapy or perform therapeutic injections like myself. There’re others that have had extensive further training who can carry out elective foot surgery for conditions like Bunyan's. 

Stephanie: Later I'm going to be asking you about three different types of clients. One, those who are obese. Two those who are very fit but running and they get problems with their feet because they run, or they exercise almost too much for the feet’s liking. Also, over 70’s and the problems they may have with their feet. But firstly, let's talk about what's happens in the consultation and what's the process that you go through. 

Steven: Okay, so when you come to see me, it's your opportunity to give me as much information as you can so that I can take a detailed history, to understand you as an individual and the problem. Then I will look at your foot, have an examination and try to figure out what is causing you the problem and ideally try and identify what's the underlying cause.

If necessary, I may request further imaging such as x-ray, MRI or ultrasound if I think this will help with the diagnosis or alter the treatment plan. Then once we have a firm diagnosis, I can discuss with you the available treatment options then we can decide together what would be the most suitable plan for you. 

Stephanie: Let's talk about different muscular skeletal abnormalities. Is this something that's present from birth or is it something that's lifestyle induced? 

Steven: Sometimes people are born with certain conditions at birth, which we call congenital. A young condition that affects around one in a thousand is Talipes Equinovarus, commonly known as club foot. However, most musculoskeletal problems I see in clinic are usually sports or overuse injuries. Typically, things like tendinopathies like Achilles tendonitis, ankle injuries or plantar fasciitis, which is a common heel pain, and other things like a stress fracture. 

Stephanie: So that would be for the second type of client that I spoke about earlier. I said client number one, obese, client number two, fit but over-training and client number three, the aging. So, when it comes to client number two with being fit but they're over-training, the feet get overused. Let's talk about those conditions again. What's the most common one that you would say you see? 

Steven: With people who are fit, it depends on to what degree. Some patients are off the charts. Fit and healthy. When they're out there running marathons all the time, they can develop stress factors. I see quite a lot of Achilles tendinopathy. This can be really debilitating and probably plantar fasciitis. I probably see that every day. 

Stephanie: That must be quite difficult to treat?

Steven: Yes, it can be, depending on the severity of the injury. Whether there's some damage in the fascia or whether it's just an acute attack or whether there's a lot of damage or just a little bit of inflammation there. You vary on the patients. Like you said with the other patient groups, if they're very overweight, you are treated slightly differently as opposed to somebody maybe a lighter in weight. 

Stephanie: So, if somebody is overweight or obese, they have certain conditions that tend to recur more often. What conditions have you seen more frequently with the overweight or the obese? 

Steven: With the overweight patients, the typical one is around January and February time. You have patients starting their new year's resolutions and they start getting out to keep fit and join gyms. A lot of them are very motivated to get back into shape and they just overdo it. They do too much. The body is not accustomed to their weights doing that amount of exercise, so they start to develop certain problems associated with that. 

Stephanie: Okay, the final group, the over 70’s. Are there certain conditions that you see quite a lot in someone who's over 70? 

Steven: With the over 70’s, it's good to keep an eye on your sensation. Diabetics tend to have a loss of sensation in the foot so it's good to keep an eye on that and make sure you can feel everything and you're not going to injure yourself. It's also good to keep an eye on the vascular supply to the foot and the ankle to make sure you get enough blood supply. Usually, with a lot of elderly patients, you see a lot of corn development which is like a compressed hard piece of skin, which gets compressed under the foot and can be painful to walk on. 

Stephanie: I have that. I'm not over 70 yet, but I have high heels and I think that they can offer a lot of problems with the feet. 

Steven: Yes, exactly. That's exactly right. 

Stephanie: Your expertise lies in video gait analysis, which is cool. So, let's explain what this is and what role it plays in diagnosing lower limb conditions. 

Steven: Gait is the way in which we walk or run; everyone is slightly different. Video gait analysis is the way of analysing someone's gait by filming them usually on a treadmill and playing it back slow-motion frame by frame. This allows me to break down exactly what's happening when you walk, or you run and try to identify any underlying causes to your problem.

Then once, once I can see what's happening dynamically, we can potentially intervene and prevent the problems occurring. This can include stretching and strengthening exercises potentially with a physiotherapist or maybe a prescription of custom Orthotics to coincide with your footwear. 

Stephanie: That can really change people's lives if they've been unaware of how they've been walking all their lives. Then suddenly they realise that when they walk, their left foot performs differently to their right foot. Is that correct? 

Steven: Sometimes people will walk differently, and they may never get any problems. So, it's not as clear cut as that. I tend to analyse people that have problems and then I try and figure what I could do to intervene and improve that. Sometimes it could be, patients have chronic knee pain or lower back pain for a large amount of their life. So, when you identify something, maybe there's one leg a lot longer than the other one or they're hyper mobile, their knees are really pointing inwards. When you can address these things, sometimes they see a huge improvement in their systems. 

Stephanie: It's interesting because two months ago I trained with Margo Wells who was responsible for Alan G. Wells winning the Olympics in Mosco, sprinting for the UK. She was shocked that I wear Orthotics. Mine are not custom made. I have had custom made before, but they got damaged. So, I probably need to come and see you to get a prescription and a proper Orthotic done because I have shop bought and it's just not the same. It really isn't.

So, she was really horrified. She said, you don't need Orthotics, you don't have anything wrong. It's because you have weak muscles or you're not using your body functionally, that's why you need Orthotics. So that's a controversial point I'm throwing in. What's your response to something like that? 

Steven: You're right, you don't always need Orthotics. Not everybody needs some. It's one of those things that if it's not broken, don't fix it. So not everybody does need them. There's also a difference between the off the shelf pairs you buy, and the custom pair.

Stephanie: I'm open minded to what Margo has to say. However, I have hypermobility and when I started my fitness journey, I had the diagnosis that I did not have enough muscle around my knees to support the knee when I was doing, say squats for example. So, I was getting a lot of knee pain. The minute I got prescription Orthotics or bespoke Orthotics, that knee pain went away altogether and suddenly my training improved massively. I don't know if you've seen case studies like that in your own practice where you've seen that transformation in your clients? 

Steven: Yes, absolutely. I see this quite frequently actually. Patients will come in with certain problems and it also automatically makes me suspect certain underlying causes. For mobile patients, they often just need some stability and maybe some strengthening exercise like yourself, if you can do a mixture of things. Some people may be fine just doing physiotherapy and strengthening exercises. Other people who are extremely hyper mobile probably would benefit from having insoles to go in their shoes just to help stabilise them. Especially if they're doing a lot of sports and there's extra forces coming through the feet and the lower limbs.

Stephanie: I think what the audience doesn't always appreciate is how pivotal the feet are in relation between the ankle, the knee, the hip and how it all communicates. If you have the wrong angles, it can cause weaknesses or other muscles overcompensate, which can lead to injuries, discomfort or pain. I certainly have to say, that bespoke Orthotics has certainly helped me and continue to make me feel more supported and grounded in my shoes when I'm doing exercises, particularly heavy deadlifts or weight training. I think I need Orthotics because I don't treat my feet well. I'm sure you have top three tips on how best to look after our feet. If I'm wearing heels and I'm not looking after my feet generally, then maybe that's why I must lean on these things in order to give me the support that I need. So, do you have some top three tips of how we should look after our feet? 

Steven: There’s a few simple things you can do like keeping your nails trimmed. Try not to cut down the sides of the toenails as this may cause ingrown toenails. Just keep on top of hard skin. Don't let them become too thick. For footwear advice, you could tighten the shoelaces and make sure the foot doesn't slide forward. Make sure there is a one centre metre gap between your longest toe and the end of the shoe. With exercise, if you are deciding to go out and start to increase your activity, do this gradually and take your time. Let your body to respond to the increased activity before you increase it further. 

Stephanie: Can I ask you, what got you into feet altogether? Why have you chosen feet as your loved subject in medicine? 

Steven: Well originally, I wanted to do something in healthcare. I talked to a few different people. My cousin's wife is a medic and she recommended that I investigated Podiatry. I have to say I didn't find the thought of it very appeasing but then I went away, I read about it and I investigated it. I just found it interesting. It seems like a real good niche of the market and it's a nice specialty which still has a lot of development to go. 

Stephanie: Yes, and there's so many bones in the feet. The feet are beautiful.

Steven: Yes. 

Stephanie: They hold the whole body. They’re so interesting. The articulation of each joint, it's just deeply fascinating. Yet we think “Ewe feet!”, a lot of people have that reaction when it comes to feet.

Steven: Exactly. Leonardo DaVinci said the feet are masterpieces of engineering. So, the more you investigate it, the more you realise how complicated it is.

Stephanie: I would say it's one of the least appreciated parts of the body that we just disregard. Now let's talk about some of the treatments that you offer. Some of the treatments that you offer are therapeutic injections and shockwave therapy. What are they and would a combination of both be best for treating some conditions?

Steven: I'll go through what they are first. Shockwave therapy is a treatment that sends a mechanical audio wave through the skin to the injured site. This works in a regenerative way by increasing blood flow to the area and speeding up recovery. Then you have therapeutic injections. They tend to work by either lubricating your joints, reducing inflammation or promoting healing. There are three main types of products that we tend to use for this. The first is sodium hyaluronate. The other one is steroids and the other is a is called platelet rich plasma, which is also known as PRP. The sodium hyaluronate can be injected into the synovial joint which affectively aids with lubrication and shock absorption. This can be typically used for symptoms of Osteoarthritis. Then the steroids, these can be used to reduce inflammation of something like a painful joint or a soft tissue structure.

Then finally the PRP, which is a platelet rich plasma which is a regenerative therapy and is attained by taking blood sample. We then spin it a machine to separate the plasma, the white blood cells and platelets, which contain the growth factors. These are effectively your body's natural healing cells so; these are injected into the injured site to promote healing. So, depending on the problem and the individual, of course you could use a combination of some of these in some isolated cases, but in most cases I would start with one treatment and see how the patient responds before moving on to something else. 

Stephanie: So, what was the name of the first one again?

Steven: Sodium hyaluronate.

Stephanie: Okay. Is that a like injectable fillers for the ladies who are listening? 

Steven: I'm not converse with the cosmetic end of the spectrum of treatments, but I do believe they do use this. It's the salt version of Hyaluronic acid. 

Stephanie: So, if we inject that between two joints, would that help for someone who's been told that the cartilage has reduced?

Steven: It can help. The evidence is a bit patchy and it's on an individual basis. But it’s one of those things that if somebody is getting a lot of joint pain and you're training lots of different treatments, one of the who's may be trying this to see if the patient responds to it. 

Stephanie: One thing that really upsets me as a practitioner is when I hear, my cartilage has gone, I get this pain and I've been told there's nothing I can do about it. I sit here and I start to think, what if we just inject some filler or WD 40?  Coming from my property development background or filling my own face with fillers, I start to think, well, can we do this? Can we do that? But apparently you can't. I'm constantly informed by much more qualified doctors that it can't be done.

However, steroid injections are fantastic for acute inflammation, not recommended ongoing but I have seen them with great success there. PRP, platelet rich plasma, that's been used cosmetically in facials to rejuvenate the area. This is all about rejuvenating, increasing blood flow and activity in the skin. Shockwave therapy, I've seen it being used ironically for erectile dysfunction. Is it the same idea where you're just bringing more activity to the tissue so that it heals itself?

Steven: Yes, so in the device, it’s almost like a gun barrel. There’s usually a ball bearing in the barrel, which gets fired up towards the end and it hits the metal plate. You can change the strength and the speed of this so, when you apply it to the injured site, it's repetitively hitting the area and those vibrations go to the tissue. When you're holding it on there for maybe 2000 strokes, what happens is all the blood starts flowing and rushing into the area. That's what they think is speeding up the healing. 

Stephanie: You sound like you enjoy doing that. It sounds because it sounds like a fun gun to play with.

Steven: I haven't really thought about that, but I suppose it's quite a manly! 

Stephanie: Thank you so much for coming onto this show and for putting up with my odd questions. You've been a wonderful source. How can we get in touch with you if we want to look after our feet better? If we want an appointment, what's the best way to book one?

Steven: If you want to book an appointment, you can book in at our fantastic clinic, which is Podogo located at 79 Wimpole street in the Marylebone area of central London. I also have Instagram if you want to follow me there, its thelondonpodiatrist, it’s all one word. We also have a podogo_london Instagram account as well. You can follow that one there as well. 

Stephanie: That's cool. And your website is Podogo.com. Not many podiatrists are on Instagram, that's a cool way to showcase your wonderful work. Thank you very much for coming on.

Steven: Thank you so much.

Stephanie: Thank you for everyone who's been listening to the Urban Health Podcast, Keeping busy people healthy.