Conversation with an NHS podiatrist

I had this conversation with NHS podiatrist Robyna King, answering your most asked foot questions! This blog post is in support of the We are the NHS campaign. If you enjoy it, please do share on Instagram! If you have any further questions, please visit NHS Live Well.

Robyna King graduated from the University of Plymouth in 2012 with a first class honours degree in Podiatry and currently works in the Solent NHS Trust. Since qualifying as a Podiatrist, Robyna has experience of working in a variety of NHS Podiatry roles, with both clinical and management responsibilities. She particularly enjoys the opportunity to make a real difference for people; either providing direct patient care, supporting staff or service development. Robyna is looking forward to supporting staff through a Podiatry Apprenticeship Degree later this year and is excited by the personal development this will also provide.

1. Any advice for preventing blisters? What should you do once you have them?

Blisters for runners are very common as well as for many people when they start wearing a new pair of shoes for example.

There can be some ways to prevent blisters when running and exercising such as:

• Wearing 2 pairs of socks or there are some double layer socks you can purchase. These can help reduce the friction on areas of the foot prone to blistering for example under the ball of the foot, heels, and toes by putting the stresses on the sock rather than the skin.
• Using Surgical Spirit, applying to vulnerable skin with a cotton pad 2-3 times a week, which helps strengthen skin. This can also be used between the toes to prevent them become sore and too soggy when they get hot and sweaty in your trainers. Follow the guidance on the bottle and do not use on broken skin.
• Ensuring your trainer and shoes fit you correctly. We advise footwear with a fastening such as laces to ensure they are tied and tightened to support the foot and prevent the foot from moving in the shoe causing friction of the tendons and joints from having to overwork to keep your shoe in place. Having the footwear wide enough at the toes and ball of the foot is very important so that they don’t get too much pressure in the wrong places. If you are struggling with getting footwear to fit it can be worth finding shoe or sport shops that help fit shoes.

When treating blisters, you should try to avoid bursting or popping them, instead allow the blister fluid to be reabsorbed into the skin and heal naturally.

If, however, they have already burst and the skin is open, it is very important to clean the area carefully and apply a sterile plaster or dressing while the area heals. This will not only prevent further friction on the skin but also reduce the risk of an infection by keeping it clean and dry.  If you have a large intact (not burst) or open blister, then it is worth having a rest from running or exercising where you are weightbearing (on your feet) to give the skin chance to heal.

If the skin or blister area becomes red, hot, swollen, has increased discharge or smell then it may be a sign you have an infection. If you notice these signs or the blister is taking a long time to heal, it is important you contact your GP surgery for guidance and likely will need some antibiotics. 

2. If you have a collapsed or weak arches, how do you strengthen them?

It is important to know that many people naturally have lower arches or flat feet. Most people inherit this from their family and are born with this foot shape, some with no pain and do not need treatment such as insoles. 

However, if they become painful or your feet have started to become flatter over a period of time then it is worth contacting a podiatrist for an assessment to see what individual treatment you may need and what may be causing the pain. 

If you have painful arches it is best to avoid any strenuous exercises such as running as is high impact on your feet and joint and could make it worse or more painful.

Some people find intrinsic foot muscle strengthening can help to strengthen the muscles in the feet to support the arches. There are many strengthening exercises available including videos online including ‘the big toe stretch’. If you decide to try these start them gradually and only do a small amount at a time. Its best to try get do them regularly and get the into your routine but remember if you start getting any increased pain or side effects stop. 

3. Many runners lose toenails in training or races – is this harmful? How can you stop it?

It is very common for runners to lose toenails, which to the person can cause some worry and pain. Losing the toenail itself does not always cause any harm, however if the skin on the nail bed is broken which would need a sterile dressing or plaster applied and follow similar advice to above when discussing looking after blisters that burst (Q1).

Over time if you damage a nail through regular trauma, where the nail is repeatedly knocked or the nail falls off, it can damage the nail cells (where the nail grows from) meaning the nail will grow back thicker or a different shape. This can make the individual feel the nail is unsightly or can be painful. If the nail is thicker you can help by filing over the surface of the nail to carefully thin the nail slightly as they can be difficult to cut.

If this does not manage it, I would advise they contact a podiatrist for advice on treatment whether that be how to prevent the trauma to the nail, cutting/filing the nail in a way to manage it or have the nail removed permanently to prevent it growing back.

Ways to prevent it include ensuring your running trainers fit correctly, avoiding running downhill or on rough terrain as this often puts increased pressure on the nails and cutting your toenail carefully straight across so they are not too long and pressing on ends of the trainer.

4. Should we all be moving towards zero-drop/barefoot shoes? What are the benefits, if any?

For some people this can be the right option but for many it is not. There is little research to say moving toward zero/low drop or barefoot shoes can help with performance or for any other practical reasons. Therefore, unless you have been advised to for other reasons and you are used to running in this way then I would not advise to just start this without getting further individual guidance.

5. How can runners deal with bunions? Are they always problematic?

Similar to low arches and flat feet, one reason we can get bunions is because we inherit them as part of our foot shape. They are not always problematic even if they are quite prominent or not aesthetically pleasing. 

Depending on the cause of the bunion it can change how a podiatrist would advise you manage them. Pain from a bunion could be from the joints or tendons being inflamed, or it could just be that because skin on top of the bunion gets rubbed and sore and could cause blisters.

Some find bunion supports or protectors to help with the bunion and skin getting sore.

Others may find insoles/orthotics can help to reduce pressure and workload on the bunion area and encourage the rest of the foot to do more. The main thing to help to reduce pain or you getting a problem is to follow guidance on footwear, including wider fitting shoes with a fastening and a stretchy material upper of the shoes that sits around the bunion to avoid pressure.

If you would like further advice on individual management of your bunions or joints in the feet then contact a podiatrist for an assessment to see what other options may be available including insoles and surgery options.

6. How did you get into podiatry?

I always wanted to do something in the health field to help make people better. I was lucky enough to do some work experience when I was 16 in a private Podiatry clinic and an NHS physiotherapy department.

I loved both but my choice was Podiatry as I felt it was a bit unusual and that there were so many opportunities for different roles in the future in the  NHS. I completed my A levels at sixth form including Biology and Psychology and then applied to university to complete a Podiatry BSc(Hons) Degree. It is a 3-year course and included both theory and practical skills which I really enjoyed, as I went on placements to different NHS Podiatry Services to learn on the job experience with NHS Podiatrists. When I qualified as a Podiatrist, I then applied using the NHS Jobs website to find roles in my local area and a couple of years later ended up in the Solent NHS Trust which is where I am now. I have loved being able to develop my skills and continue to learn things every day, which most importantly helps patients and support them with their foot conditions making a real difference for them!

As a podiatrist I have great opportunities to use all different skills including wound care, nail surgery and MSK (musculoskeletal) care. We can work in patient’s homes, hospital and health centres, meeting a variety of people along the way. 

So, I would say if you are interested in health care and do not mind looking at feet all day this is the job for you! If anyone is interested in podiatry as a career or any health profession look on https://www.healthcareers.nhs.uk/ which shows all the amazing careers out there and what to do to have a health career including going to university or even apprenticeship courses which are available for some professions.

7. Should runners be doing anything specific to look after their feet? Creams? Massage?

You will see a lot of this has already been answered in some of the other questions for example how to prevent blisters, prevent painful arches and bunions. 

Here are my top tips to look after your feet if you are a runner:

• Wear good fitting trainers that are wide enough, have a fastening and good cushioning sole for shock absorption. 
• Air out your trainers and footwear after wearing them and rotate the use of your shoes (so you are not always wearing the same pair) to ensure they have chance to breath and dry, which prevents bacteria and fungal spores growing.
• Don’t save your new trainers to wear for a race or long training session. It can be best to wear them in gradually over a few shorter sessions preventing blisters and allowing your foot to get use to that style/shape of footwear.
• Wear good quality socks to protect your skin and prevent friction.
• Wash your feet and change your socks daily and after exercising, this can prevent fungal infections on the skin or nails and will keep the skin condition healthy and clean. 
• If you think you have a fungal infection also known as ‘athletes foot’ speak to your pharmacist about treatments available over the counter. If not improving, then consider discussing with a podiatrist or your GP.
• Dry feet well all over and between toes after washing them. This again prevents fungal infections and the spaces between your toes from getting too soggy and sore. Using surgical spirit as advised in question 1 can help too.
• Using a urea base foot cream can help hydrate the skin on the feet, preventing hard skin and calluses. It is best to use daily all over your feet but not between toes after you have washed them. 

8. Plantar Fasciitis. What is it and how can it be helped? Are there any injuries assumed to be PF that are actually something else?

Plantar Fasciitis (PF) is a painful condition where there is inflammation of the plantar fascia, which is a structure that supports the foot from the heel to the toes. It can affect both feet or just one foot and the pain is normally felt around the heel and can sometimes be felt into the arch or into the calf. It is a very common condition and can affect both those that do and do not exercise regularly.

Check out the NHS website for further guidance but here are some simple ways that can help if you believe you have or have been diagnosed with PF.

• As tight calf muscles can exacerbate and potentially cause PF therefore stretching your calf muscles (the gastrocnemius and soleus muscles into your Achilles tendon) may help. You can find safe, gentle stretches for these muscles and the Achilles Tendon online. It is important to start any exercises or stretches slowly and gradually build up. If you start getting more pain or any side effects, then it is important to stop. 
• Footwear being changed to more supportive shoe as advised in previous answers
• Choose more non weightbearing exercises such as swimming and cycling, whilst the foot is inflamed and painful
• Ice to reduce any inflammation that may be present. 20minutes daily recommended either in form of frozen peas or similar wrapped in damp cloth or foot rolling over a chilled bottle or can. This can really help discomfort especially after a day on your feet.

Often with these treatments and over a couple of weeks it can resolve and reduce in pain. But if these treatments do not help it may be that you do not have PF and could instead have another issue or need more individual advice or care. It is important to contact your GP for further advice or contact a local podiatrist. The podiatrist would be able to do an assessment to look at the lower limb and foot structures, review your gait (the way you walk) and much more to help to diagnose PF, another condition and give more treatment options including insoles/orthotics and specific exercises.

9. What’s the most common issue you deal with as an NHS podiatrist?

At the moment in my local NHS Podiatry clinics, we are prioritising the most poorly feet in the service during the COVID-19 pandemic, therefore, the main conditions we manage are foot ulcerations using our wound care skills and knowledge. This is often for patients with medical conditions that cause reduction in circulation to the foot and/or loss of sensation due to nerve damage. Our main goal the podiatry treatments we provide is to aid with wound healing and reduce, where possible, infection and amputations from occurring. 

The second condition we see a lot of are ingrowing and painful toenails conditions. We complete a lot of nail surgery clinics where we carry out a minor surgery under local anaesthetic to remove a painful toenail. Those are only two areas of specialisms we deal with in podiatry and we do so much more with supporting the management of foot and lower limb conditions including pain management and mobility support.

10. What’s your favourite foot fact?!

My favourite foot fact is your feet can continue to ‘grow’ even into older age. Meaning there is always an excuse to go shoe shopping and buy new shoes! The reason behind this change in size despite normally finishing their growth stage by age of 20, is that feet can either swell or your tendons and ligaments loosen in the feet causing the feet to spread, making the foot wider and longer. This can happen with age, certain medical conditions or even pregnancy! 

Many thanks to Robyna for answering these questions!

Robyna is supporting NHS England’s ‘We Are The NHS’ campaign. To find out more about a career in the NHS, please search ‘NHS Careers’ or visit We Are The NHS to find available roles and training support on offer.