PODIATRY AND OSTEOPATHY

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Interview of David Holland

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.