What does your work involve?
As a podiatrist I assess, plan and deliver treatments for foot problems in people with arthritis.
The most common type of foot problems I see in clinic are as a result of rheumatoid arthritis. When it affects the feet, which it usually does, RA can cause not only painful deformities but also altered foot function (such as flattening of the feet), resulting in changes to a patient’s walking.
In combination, the inflammation, deformities and altered function can result in hard skin (callus), corns, ulcers and even infections on the feet.
A change in the shape of the feet can cause further difficulties for patients in getting comfortable shoes which fit their feet and don't make their problems worse – so advice on how and where to get shoes is also part of my role.
What is your typical day?
My average day involves seeing patients in both hospital and community health centre clinics. At a patient’s first appointment I will assess their feet, make a note of medical conditions and current treatment, ask how long they have been diagnosed with arthritis and agree a podiatry treatment plan with the patient.
Depending on the patient’s foot problems this may require advice regarding self care, regular podiatry follow up or referral on for further treatment with other health care departments or combination of all of the above.
Why did you choose this work?
The main reason I chose to be a podiatrist was because I wanted to help to improve patients’ symptoms and activity levels. We walk on our feet up to 16 hours a day and with every step the feet are supporting the whole of our body weight.
Deformity-altered walking patterns, skin and nail problems and foot pain can make life intolerable and going out of the house almost impossible – but the work I do can make a big difference to many patients.
What is the best thing about your job?
The best thing about my job is the patients. All patients are individuals and often have a variety of medical, foot and personal needs. I enjoy the challenge of working with each patient to plan and review their individual treatment to make sure it’s the best for them.
What is the worst thing?
Many healthcare colleagues have the preconceived notion that: 'it’s only feet'. They don't realise the impact foot problems can have on a patient. Often the patients I see in clinic will have had rheumatoid arthritis for many years and have complex foot problems.
It would be really positive for more co-ordinated care of treatable foot conditions with timely referrals for podiatry review.
How has research informed your work?
Research showing how the multidisciplinary approach improves the management of foot problems has led to the development of our combined rheumatology podiatry foot clinic at the Bristol Royal Infirmary. We've been running the clinic for four years, and patients are reviewed jointly by a podiatrist (me), the professor of rheumatic diseases and our orthotist.
The clinic assesses and recommends treatment plans for patients. Often care plans involve co-ordinating with a number of healthcare professionals in both the hospital and community health centres. This experience has made me aware of how important it will be to have good research evidence for improvement in foot care in the future.
Following a recent national award I am now able to start a PhD research training programme myself, centred on the foot care needs of patients with rheumatoid arthritis.
Oonagh Wilson is podiatry clinical lead for rheumatology at Bristol Community Health.