David Holland BSc(Hons),
MSc(Dunelm), MChS, is a Consulting Podiatrist (foot doctor) with
practices at 140 Harley Street, London, and in the Midlands, where
he has practising privileges and Consultancy status at two large
private hospitals.
David has worked with feet since his
first medical qualification back in the 70's. His current field of
practice is devoted to foot and lower limb mechanics, and the
treatment of, often, persistent foot, knee, hip and even back pain,
with prescription shoe inlays.
He works closely with other
health professionals, both conventional medical and alternative, and
finds the combination of osteopathy and podiatric care particularly
effective, especially in relieving long-standing back pain.
David has written papers for professional journals, and is
currently working on a book, which traces the links, particularly in
the leg and foot, between modern day man (homo sapiens) and our
distant ancestors.
David's client list includes players from
several Premier Division Football Clubs. He is also Podiatric
Consultant and advisor to Runners World running magazine.
David, you are a Consulting Podiatrist. What exactly
do you do? I specialize in the fields of gait analysis
and gait correction. This involves computer examination of the way a
patient walks, and the correction of any gait anomalies with special
insoles, called orthoses.
That sounds interesting.
Do you only treat feet, or would someone use your services if, for
example, they had a knee problem? Good question!
Although I work principally with feet, I see many patients who have
trouble with their knees, hips, even their backs. These patients do
not normally consult me initially, but are referred by other Health
Professionals when direct treatment, physiotherapy for example, has
not been as effective as the therapist might have expected. Often in
these cases there may be an underlying problem with gait.
So it's true to say that most patients who consult
you directly do so for foot problems? Yes, foot and
ankle problems. Heel pain is probably the most common condition I
treat, closely followed by painful ankles and painful insteps.
How long might a typical patient have had their
problem before they came to see you, and how severe would the
condition have to be to warrant an examination by a
Podiatrist? A typical patient with heel pain might have
had their problem between one and three years. You must understand
that most of these chronic foot conditions are not painful all the
time, perhaps only first thing on a morning, or after a period of
prolonged standing. So there is always the tendency to put off
making an appointment in the belief that things are getting better.
The problem with any kind of foot condition is that the foot is a
weight-bearing structure, and as such it is not easy to rest it
enough to allow normal healing to take place. That's why, in most
cases, these conditions simply grumble on and on. As to the second
part of your question - foot conditions are really best looked at by
an experienced Podiatrist. In the UK the undergraduate podiatry
degree is pretty comprehensive, and includes anatomy and physiology
of the whole body, as well as general medicine and pharmacology. We
are trained to recognize when a foot problem is localized and when
it may be part of a more involved, systemic complaint.
So you could refer the patient back to their Doctor,
or another Specialist if necessary? Yes. We tend to work
with orthodox medicine where necessary, or with recognized,
regulated alternative health disciplines such as osteopathy.
I presume that an osteopath would look at the
patient's back while you attend to the feet? Something
like that. I'm very fortunate to be able to work routinely with a
talented young osteopath called Sean Durkin. Sean and I have found
that the right type of osteopathy, in conjunction with "balancing
the foundations" can work wonders, even on chronic back conditions
that have been present for years. Many of our back pain patients
have tried everything else and come to use without much hope of
being treated successfully. In fact for some it's a choice between
one final go at conservative treatment before their last option -
surgery. Generally we get good to excellent lasting results on these
patients.
That sounds very impressive. Is there
anything that makes the way you work special or
different? Yes, I believe there is. I tend to look at
patients from a "fine-tuning" point of view. What this means is that
I believe many of the foot problems I see, and many of the postural
problems which are referred to me, are the result of repeated
walking and standing on hard, unyielding surfaces, such as
pavements, as opposed to there being anything structurally wrong
with the leg or foot. Think about it…. We've been walking on
pavements for how long? A couple of hundred years… a little over?
The question we have to ask ourselves is "have our feet and legs
adapted for life on a hard, flat surface in this time?" I don't
believe we have. You know, there are casts of the fossil leg-bones
of a specimen called Homo Erectus in most university anthropology
departments. Now he was the forerunner of Homo Sapiens, modern man.
His fossil leg-bones have been accurately dated at 1.6 million years
old - and yet they are pretty similar to modern human leg-bones. Our
legs and feet developed as an adaptable survival feature. They can
carry us, at different speeds, over a variety of terrains, including
grass, rock, sand and concrete. In fact, even with modern technology
we can't come close to building a machine that duplicates the
adaptability, strength and endurance of a healthy leg and foot. Yet
we city-dwellers, who stand or walk on concrete and other hard
surfaces for between 85% and 95% of our time wonder why we develop
foot, leg, hip or back pain!
I see your point. But
surely age or footwear, or activity levels cause problems
too? Absolutely. Generally it's a combination of factors
that cause the problems in the first instance. Some of these factors
cannot be altered. I can't make a patient younger, for example. But
I can ensure that the foot is not continuously having to adapt to a
hard, flat surface. By fitting a balanced foot orthosis I can
effectively removes the potentially harmful compensatory twist,
which the foot undergoes in an effort to conform to a hard flat
surface step after step. It's amazing how many aches and pains
resolve, without specific treatment or medication, once the right
foot orthoses are fitted.
If I understand you
correctly, are you saying that if we live in a city we should all be
wearing foot orthoses? I wouldn't go quite that far! But
I think it extremely likely that those who spend a large part of
their daily lives on hard, flat surfaces may develop symptoms in
their feet, knees, hips or backs at some stage in their lives. These
people would certainly be helped by wearing orthoses.
What
does a foot orthosis look like, and how does it differ from the
old-fashioned arch supports or supports sold in chemists? There are
many different types of foot orthosis. Some are prescription-made,
some are sold over-the-counter (OTC). OTC orthoses tend to be bulky,
and are not made for an individual patient, while prescription
orthotics are individually made. They can be designed for one type
of sport, or one pair of shoes, high heels for example. All foot
orthoses are designed with a special wedge, which allows the foot to
conform comfortably to the ground. A correctly fitting foot orthosis
can actually strengthen the foot over time. An arch support on the
other hand is a simple support, which pushes the arch upwards. This
makes the foot dependant on the support, actually weakening the
overall foot structure.
I assume prescription foot
orthoses are more expensive. Do they last longer or work better than
over-the-counter orthoses? Most prescription orthoses
are guaranteed to last for the patient's lifetime. In my experience
they work far better than OTC orthoses. This is partly because a
good orthosis laboratory will carry out free adjustments if there
are any problems with fit. Sometimes the prescription may be right,
but the fit may need a slight adjustment, just like a new pair of
prescription glasses. Prescription orthoses cost around the same as
a pair of quality glasses. There are additional costs such as
casting and gait analysis, but medical insurance will normally pay
for this work.
David, we haven't mentioned children,
but I know you do some corrective work with children's feet. What
does this entail? Most of the children I see have foot
pain, or knock-knees or flat arches. With children the treatment
goal is to maintain a healthy foot shape until the child has stopped
growing. We do this with special paediatric orthoses. These are made
in fun colours, and children can wear their normal shoes so they
don't appear different from their friends.
How do
you monitor progress in children? We do this in two
ways. The first is by clinical examination, usually every six to
nine months. The second is by computer assessment of gait. Using a
specialized computer programme we can record footprints as the child
walks. These readings are highly accurate, and can be taken yearly,
providing a rolling record of progress.
That sounds
quite comprehensive. I believe you treat sportspeople
too? Yes. A number of my patients play professional
football at the highest level in the UK. I'm also Podiatric
Consultant for Runners World magazine.
Coming back
to qualifications - you mentioned an undergraduate degree. What
qualifications does one need to become a Podiatrist? The
undergraduate degree is a BSc(Hons) in Podiatry. Once the podiatrist
has graduated he or she can elect to undergo further training in a
specialized area. Biomechanics (the science of how the body moves
itself) and Biomedical engineering (applying engineering principles
to how the body moves itself) are two closely-related examples of
specialized post-graduate study.
…. And one last
question. If someone wanted to consult you, how would they go about
it? I have practices at 140 Harley Street, London W1,
and in Leicester. Patients can ring directly for an appointment, or
they can email me with specific queries. I'm always happy to answer
questions!
This has been an interesting interview. Thank you
David.
Consultation appointments with David can be made on
the following numbers: Harley Street, London. 0207
4866553. BUPA Hospital Leicester. 0116 2720888.
If you
have a query about treatment you can email David directly on:
davidholland@140harleystreet.co.uk. David also has a clinic
website: www.ortho-pedclinic.com.
I am stronger on the pitch and have noticed a great improvement in my playing since training with him. Rio Ferdinand
