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In the United Kingdom, the terms chiropodist and podiatrist often cause confusion, both for patients and sometimes even for healthcare professionals. People frequently wonder whether they are seeing the “right” practitioner, or if one title implies a higher level of training or a different scope of practice. In reality, the distinction in the UK is largely historical and linguistic rather than clinical. Today, for most practical purposes, a chiropodist and a podiatrist in the UK are the same type of practitioner, provided they are properly registered. However, understanding how these titles developed, how they are regulated, and how they are used in practice helps clarify the situation.

Historical background of the titles

The term chiropody has been used in the UK for many decades and was the traditional name for the profession concerned with the assessment and treatment of foot problems. Chiropodists historically focused on issues such as corns, calluses, nail problems, minor skin lesions, and general foot care. The word itself comes from the Greek “cheir” (hand) and “pous” (foot), reflecting early practices that sometimes involved both hands and feet.

The term podiatry emerged later and was adopted earlier in countries such as the United States, Australia, and New Zealand. It comes from the Greek “pous” (foot) and “iatros” (physician or healer), and was introduced to better reflect the expanding scope of the profession. As the understanding of foot and lower limb pathology grew, and as practitioners took on more complex roles in biomechanics, sports injuries, diabetes care, and minor surgery, the profession sought a title that conveyed a more modern, medically aligned identity.

In the UK, the shift from “chiropody” to “podiatry” began in earnest in the late 20th century. Professional bodies and educational institutions increasingly adopted the term podiatry to align with international usage and to signal the broader clinical and academic scope of the profession. Over time, “podiatrist” became the preferred title for newly qualified practitioners, although many existing practitioners continued to use “chiropodist,” especially where the public was more familiar with that term.

Regulation and protected titles

A key point in understanding the difference between chiropodists and podiatrists in the UK is the role of regulation. In the UK, both chiropodist and podiatrist are protected titles. This means that only individuals who are registered with the Health and Care Professions Council (HCPC) are legally allowed to use either title.

From a regulatory standpoint, there is no difference in status between a chiropodist and a podiatrist. The HCPC does not maintain separate registers for the two titles; instead, it holds a single register for practitioners who may choose to describe themselves as either chiropodists, podiatrists, or both. To gain registration, practitioners must meet the same educational and professional standards, regardless of which title they use. Typically, this involves completing an HCPC-approved degree in podiatry (or chiropody/podiatry, depending on the historical naming of the course) and demonstrating competence across a defined scope of practice.

This regulatory framework is crucial: it means that the difference is not about qualification level or legal scope of practice. A registered chiropodist and a registered podiatrist in the UK have met the same regulatory standards and are, in effect, the same profession under two different names.

Scope of practice and clinical work

In terms of day-to-day clinical work, there is no formal difference in scope of practice between a chiropodist and a podiatrist in the UK, assuming both are HCPC-registered. Both are trained to assess, diagnose, and treat a wide range of foot and lower limb conditions. Their work typically includes:

• Management of skin and nail problems (corns, calluses, ingrown toenails, fungal infections)
• Biomechanical assessment and treatment of gait and posture issues
• Provision and prescription of orthoses (insoles) and footwear advice
• Management of high-risk feet, particularly in people with diabetes or peripheral vascular disease
• Minor surgical procedures, such as nail surgery under local anaesthetic
• Participation in multidisciplinary teams in hospitals, community clinics, and private practice

Where differences do appear, they are usually not because of the title itself, but because of individual training, experience, and areas of special interest. For example, some practitioners—whether they call themselves chiropodists or podiatrists—may focus heavily on musculoskeletal and sports injuries, while others may specialise in diabetic foot care or wound management. These differences are driven by postgraduate education and clinical roles, not by whether the practitioner uses the term chiropodist or podiatrist.

Educational evolution and the shift in terminology

Although the titles are equivalent in regulatory terms, the profession in the UK has increasingly moved towards using podiatrist as the preferred term. Modern university courses are typically titled “BSc (Hons) Podiatry” rather than chiropody. The curriculum reflects the broader, more medically integrated nature of contemporary practice, including modules on pharmacology, imaging, systemic disease, and advanced clinical skills.

As a result, newer graduates almost universally describe themselves as podiatrists. Many older practitioners who trained when the term chiropody was standard may still use “chiropodist,” sometimes alongside “podiatrist” (for example, “Chiropodist/Podiatrist”) to ensure public recognition. The public’s familiarity with the term chiropodist, especially among older patients, means that some clinics deliberately retain it in their branding and marketing, even while the practitioners themselves are fully qualified podiatrists.

In this sense, the difference between the terms is often generational and marketing-related rather than clinical. “Podiatrist” signals a modern, internationally aligned profession; “chiropodist” is a more traditional term that some patients still search for and recognise.

Public perception and practical implications for patients

From a patient’s perspective, the most important issue is not whether a practitioner calls themselves a chiropodist or a podiatrist, but whether they are properly qualified and registered. The HCPC register is the key reference point: if a practitioner is listed there under chiropody/podiatry, they have met the required standards of training and professional conduct.

In practice, patients may notice that:

• NHS services and hospital clinics are more likely to use the term podiatry and refer to staff as podiatrists.
• Private practices may use chiropodist, podiatrist, or both, often depending on how long the practice has been established and what terminology their local community recognises.
• Information leaflets, professional guidelines, and academic publications increasingly use podiatry as the standard term.

For patients searching for care, understanding that the titles are effectively interchangeable in the UK helps reduce anxiety about “choosing the right one.” The key is to check HCPC registration and, if needed, ask about the practitioner’s specific areas of expertise (for example, sports injuries, diabetic foot care, or routine nail and skin care).

International context and why the distinction persists

The UK’s dual terminology is partly a legacy of history and partly a reflection of the profession’s evolution. In many other countries, particularly outside Europe, podiatry is the only commonly used term, and in some jurisdictions podiatrists have an even broader scope of practice, including more extensive surgical and prescribing rights. The UK profession has aligned itself with this international terminology to a large extent, which is why universities, professional bodies, and many practitioners prefer podiatry.

However, language changes slowly in public usage. Many members of the public still search for “chiropodist near me,” and older generations may never have heard the term podiatrist. As a result, UK practitioners often keep both terms alive in their marketing and signage to ensure that people with foot problems can find them easily. This practical consideration is one of the main reasons the distinction persists in everyday language, even though it has little regulatory or clinical significance.

In the United Kingdom, the difference between a chiropodist and a podiatrist is largely a matter of terminology and history rather than qualification or scope of practice. Both titles are protected by law and refer to practitioners who are regulated by the HCPC under the same standards. Modern education and professional practice increasingly use the term podiatry, reflecting a broader, medically integrated role that includes not only routine foot care but also complex management of musculoskeletal, diabetic, and high-risk foot problems.

For patients, the practical takeaway is straightforward: a registered chiropodist and a registered podiatrist in the UK are, in effect, the same type of foot health professional. The important questions are whether the practitioner is HCPC-registered and whether their particular training and experience match the patient’s needs, rather than which of the two titles they choose to use.

Chinese foot binding is one of the most striking and disturbing practices in medical and cultural history. For centuries, it shaped not only the bodies of millions of women in China, but also their social status, marriage prospects, and daily lives. When people ask whether Chinese foot binding is still done today, they are often reacting to shocking historical images of severely deformed feet and wondering if such harm could still be occurring in the modern world. The short answer is that traditional Chinese foot binding as a widespread, socially accepted practice has effectively ended, but its legacy persists in cultural memory, in a very small number of surviving women, and in ongoing debates about beauty standards and bodily modification.

Historically, foot binding is believed to have begun around the 10th century during the Song dynasty, although its exact origins are debated. The practice involved tightly wrapping young girls’ feet—usually between the ages of four and nine—with cloth to break and compress the arches and toes. Over time, the bones would deform, creating what was known as the “three-inch golden lotus,” an extremely small, pointed foot that was considered highly attractive and a symbol of refinement and status. Bound feet were associated with femininity, obedience, and desirability. For many families, especially in certain regions and social classes, binding a daughter’s feet was seen as essential to securing a good marriage.

The process itself was painful and medically damaging. The toes were folded under the sole, the arch was forced upward, and the foot was repeatedly wrapped tightly to maintain the shape. This caused fractures, chronic pain, infections, and lifelong disability. Women with bound feet often had difficulty walking, were prone to falls, and could develop serious complications such as ulcers and osteomyelitis. From a modern clinical perspective, it was a form of repeated trauma and long-term musculoskeletal deformity. Yet within the cultural context of the time, it was normalized and even idealized. Mothers bound their daughters’ feet not out of cruelty, but because they believed it was necessary for their daughters’ future security and social acceptance.

Efforts to end foot binding began in the late 19th and early 20th centuries. Missionaries, reformers, and Chinese intellectuals increasingly criticized the practice as backward, harmful, and incompatible with national modernization. Anti–foot binding societies formed, pledging not to bind their daughters’ feet and not to allow their sons to marry women with bound feet. The movement gained momentum alongside broader social and political reforms. After the fall of the Qing dynasty in 1911, the new Republican government issued bans and discouraged the practice. However, enforcement was inconsistent, and in many rural areas foot binding continued into the 1920s and 1930s.

The decisive turning point came after the establishment of the People’s Republic of China in 1949. The Communist government under Mao Zedong strongly opposed foot binding as a feudal, oppressive practice. It was formally outlawed, and the state actively promoted women’s participation in labor and public life, which was incompatible with the severe disability caused by bound feet. Local officials, propaganda campaigns, and social pressure all contributed to making foot binding socially unacceptable. As a result, the practice rapidly declined and essentially disappeared as a living tradition within a few decades.

By the late 20th century, the only women with bound feet were elderly, mostly in rural regions that had once been strongholds of the practice. Researchers and journalists who visited these areas in the 1990s and early 2000s documented small groups of women in their 80s, 90s, and beyond, whose feet had been bound in childhood and never unbound. These women provided first-hand accounts of the pain, the family pressures, and the social expectations they experienced. Many expressed ambivalence: they recognized the suffering it caused, but also remembered that at the time it was seen as necessary and even honorable.

Today, traditional Chinese foot binding is no longer practiced in any organized or socially accepted way in China. There are no mainstream communities where parents bind their daughters’ feet, and the practice is illegal and widely condemned. The remaining women with bound feet are extremely elderly, and their numbers are shrinking each year. As they pass away, they take with them the last living physical evidence of the practice. Museums, photographs, oral histories, and academic studies now serve as the primary sources for understanding foot binding.

However, the question of whether foot binding is “still done” can be approached in a broader sense. While the literal practice has ended, the underlying themes—social pressure to conform to painful beauty standards, the control of women’s bodies, and the medical consequences of fashion—remain relevant. Many scholars and commentators draw parallels between foot binding and other forms of body modification, such as high heels, cosmetic surgery, extreme dieting, or certain forms of cosmetic procedures that carry health risks. The comparison is not perfect, but it highlights how cultural ideals can lead individuals to accept discomfort, pain, or even long-term harm in the pursuit of beauty or social status.

In contemporary China, foot binding is often discussed as a symbol of a feudal past and as an example of how harmful traditions can be overcome. It appears in school textbooks, historical dramas, and museum exhibits as a cautionary tale. At the same time, there is a growing academic interest in understanding the practice more deeply, not just as a form of oppression but also as a complex social institution that shaped gender, class, and identity for centuries. Some researchers emphasize that many women with bound feet took pride in their appearance and status, even as they suffered physically, reminding us that people’s experiences of cultural practices are rarely simple.

Outside China, foot binding continues to capture public imagination, often through sensationalized images and stories. This can sometimes lead to misunderstandings, including the mistaken belief that the practice might still be common or hidden somewhere in modern China. In reality, the combination of legal prohibition, social change, and economic modernization has made the continuation of traditional foot binding virtually impossible. Any isolated attempt to revive it would be met with strong social disapproval and legal consequences.

In summary, Chinese foot binding as a traditional, widespread practice is not still done today. It was effectively eliminated in the mid-20th century through legal bans, social reform, and changing attitudes toward women’s roles and bodies. What remains are a small and dwindling number of elderly women who bear the physical marks of the practice, historical records that document its long and complex history, and ongoing discussions about what it tells us regarding beauty, power, and the human body. The story of foot binding is important not only as a chapter in Chinese history, but also as a reminder of how deeply cultural norms can shape health, autonomy, and the lived experience of pain.

Proper shoe fitting for children is more than just a matter of comfort—it’s a critical aspect of healthy foot development. Ill-fitting shoes can contribute to a range of problems, from blisters and discomfort to more serious issues like ingrown toenails, bunions, and long-term musculoskeletal complications. As podiatrists and health professionals, it is our responsibility to educate parents and caregivers on the importance of choosing the right footwear for children.

Understanding the Anatomy and Growth of Children’s Feet

Children’s feet are not simply smaller versions of adult feet. At birth, the foot is composed mostly of cartilage, which gradually ossifies into bone as the child grows. The bones, muscles, and ligaments are flexible and susceptible to external forces, making correct shoe fit essential during the developmental years.

Children’s feet also grow rapidly, especially in the first five years of life. It is not uncommon for a child’s foot to increase by half a size every few months. Growth spurts can be unpredictable, so regular monitoring is necessary to ensure shoes continue to fit properly.

The Risks of Ill-Fitting Shoes

Wearing shoes that are too small, too large, or poorly constructed can negatively impact a child’s foot health. Common issues include:

• Blisters, calluses, and corns from excessive friction or pressure
• Ingrown toenails caused by cramped toe boxes
• Bunions and hammertoes resulting from restrictive footwear
• Altered gait and posture due to improper support or fit
• Delayed or abnormal foot development if shoes do not accommodate natural growth

These problems can not only cause immediate discomfort but may also predispose children to chronic foot issues in adulthood.

Key Principles of Proper Shoe Fitting

Ensuring a proper fit involves more than just selecting the correct size. The following principles should guide every shoe fitting for children:

1. Measure Both Feet Regularly

Children’s feet can differ in size and shape. Always measure both feet while the child is standing, as weight-bearing causes the foot to elongate and widen. Use a professional measuring device to determine both length and width, and fit to the larger foot if there is a discrepancy.

2. Allow Adequate Growing Room

There should be a thumb’s width (about 10-12 mm) of space between the longest toe and the end of the shoe. This allows for natural movement and growth without risk of the toes hitting the front of the shoe. Shoes that are too large, however, can cause instability and tripping.

3. Assess the Shoe’s Fit in Multiple Areas

• Toe Box: Should be wide and deep enough for toes to wiggle freely.
• Heel: Should fit snugly without slipping.
• Width: Should accommodate the widest part of the foot without squeezing.
• Instep: Should not be constricted by the shoe’s upper or laces.

4. Choose the Right Shoe Type for the Child’s Activity

Different activities require different footwear. School shoes, sports shoes, and casual shoes should all provide appropriate support, flexibility, and protection for their intended use.

5. Prioritize Quality Materials and Construction

Opt for shoes made from breathable, flexible materials such as leather or mesh. The sole should provide adequate grip without being overly rigid. Avoid shoes with heavy, inflexible soles or poor stitching.

The Shoe Fitting Process: Step-by-Step

1. Schedule Fittings Later in the Day: Feet naturally swell throughout the day, so fitting shoes in the afternoon ensures a more accurate fit.
2. Have the Child Wear Usual Socks: The thickness of socks can affect fit, so use the type the child will normally wear.
3. Measure Both Feet: As discussed, measure while standing and fit to the larger foot.
4. Try Both Shoes On: Have the child walk, jump, and move to assess comfort and fit.
5. Check All Key Areas: Ensure there is adequate space at the toes, a secure fit at the heel, and no pressure points.
6. Reassess Frequently: Children’s feet grow quickly; check fit every 2–3 months for younger children and every 4–6 months for older children.

Common Mistakes to Avoid

• Hand-me-down Shoes: Shoes mold to the original wearer’s foot and may not provide proper support for another child.
• Buying Shoes to “Grow Into”: Oversized shoes can cause tripping and improper gait.
• Ignoring Complaints: Children may not always articulate discomfort, but reluctance to wear shoes, limping, or redness can indicate a problem.
• Focusing Only on Length: Width, depth, and overall shape are equally important.

When to Consult a Podiatrist

If a child experiences persistent pain, frequent tripping, unusual walking patterns, or visible foot deformities, seek professional advice. Podiatrists can assess foot development, recommend appropriate footwear, and address any underlying conditions.

Properly fitting children’s shoes is a foundational aspect of foot health and overall well-being. By understanding the unique anatomy of children’s feet, the principles of good shoe fitting, and the risks of ill-fitting footwear, parents and caregivers can make informed choices that support healthy development. Regular measurement, careful assessment, and attention to quality are key. When in doubt, consult with a podiatrist to ensure every step your child takes is a step toward lifelong foot health.

Hallux valgus, commonly known as a bunion, is a progressive deformity of the first metatarsophalangeal (MTP) joint characterized by lateral deviation of the hallux and medial deviation of the first metatarsal. This condition frequently results in pain, impaired function, and difficulty with footwear, prompting many patients to seek surgical intervention. Among the array of surgical options, the Chevron osteotomy has emerged as a reliable and effective procedure for the correction of mild to moderate hallux valgus, particularly in patients with a congruent joint and minimal degenerative changes.

Background and Indications

The Chevron osteotomy, also referred to as the distal metatarsal “V” osteotomy, was first introduced by Austin and Leventen in 1981. It is primarily indicated for patients presenting with mild to moderate hallux valgus, typically defined by an intermetatarsal angle (IMA) of less than 15 degrees and a hallux valgus angle (HVA) of less than 30 degrees. The procedure is not generally recommended for severe deformities, significant joint degeneration, or where there is marked instability of the first ray.

Ideal candidates are those who have failed conservative management—such as footwear modification, orthoses, and physical therapy—and continue to experience pain or functional limitations. The Chevron osteotomy is particularly valued for its predictable correction, relatively low complication rate, and preservation of joint motion.

Surgical Technique

Preoperative Planning

Accurate preoperative assessment is critical. Weight-bearing radiographs are used to evaluate the extent of the deformity and to measure the HVA and IMA. The integrity of the first MTP joint and the presence of any associated pathologies, such as sesamoid subluxation or degenerative changes, should also be assessed.

Operative Steps

1. Incision and Exposure:
   A dorsomedial incision is made over the first MTP joint, taking care to avoid injury to the dorsal cutaneous nerves. The joint capsule is incised, and the medial eminence is exposed.
2. Osteotomy:
   The Chevron osteotomy is performed at the distal metatarsal metaphysis, approximately 1 cm proximal to the articular surface. The osteotomy is V-shaped, with the apex directed distally. The distal fragment is then shifted laterally, correcting the metatarsal alignment.
3. Fixation:
   Once the desired correction is achieved, the osteotomy is stabilized using a screw or Kirschner wire. The medial eminence is resected as necessary, and the capsule is repaired.
4. Closure:
   The wound is irrigated, hemostasis is achieved, and the incision is closed in layers.

Postoperative Care

Postoperative protocols vary but generally include protected weight-bearing in a surgical shoe for 4–6 weeks, followed by gradual return to normal footwear and activities. Early mobilization of the MTP joint is encouraged to prevent stiffness.

Outcomes and Efficacy

Numerous studies have demonstrated the Chevron osteotomy’s efficacy in correcting mild to moderate hallux valgus deformities. Most patients report significant pain relief, improved function, and high satisfaction rates. Radiographic outcomes typically show substantial reduction in both HVA and IMA, with maintenance of correction over time.

Complication rates are low but can include delayed union, malunion, avascular necrosis of the metatarsal head, and recurrence of the deformity. Meticulous surgical technique and appropriate patient selection are critical to minimizing these risks.

Advantages

• Joint Preservation: Unlike more proximal osteotomies or arthrodesis procedures, the Chevron osteotomy preserves the first MTP joint, maintaining normal biomechanics and range of motion.
• Predictable Correction: The procedure offers reliable realignment for mild to moderate deformities.
• Low Morbidity: The minimally invasive approach and stable fixation enable early mobilization and a relatively quick recovery.

Limitations and Considerations

• Not Suitable for Severe Deformities: The Chevron osteotomy is less effective for severe hallux valgus, high IMA, or significant joint degeneration.
• Technical Precision Required: Accurate execution of the osteotomy and fixation is essential to avoid complications such as undercorrection, overcorrection, or joint stiffness.
• Recurrence: As with all bunion surgeries, recurrence can occur, particularly if underlying biomechanical factors are not addressed.

Comparison to Other Procedures

In comparison to other distal metatarsal osteotomies, such as the Scarf or Mitchell procedures, the Chevron osteotomy is technically simpler and associated with fewer complications. However, for larger deformities or in cases requiring greater correction, proximal osteotomies or more complex procedures may be indicated.

The Chevron osteotomy remains a mainstay in the surgical management of mild to moderate hallux valgus. Its joint-preserving nature, predictable results, and low complication profile make it a preferred choice for many podiatrists and foot surgeons. Careful patient selection, thorough preoperative planning, and meticulous surgical technique are essential to achieving optimal outcomes. As surgical techniques and fixation methods continue to evolve, the Chevron osteotomy is likely to retain its important role in the treatment of bunion deformities.

Charcot’s Foot, also known as Charcot neuroarthropathy, is a severe, progressive complication of diabetes mellitus, predominantly affecting individuals with peripheral neuropathy. It is characterized by bone and joint destruction in the foot and ankle, leading to deformity, instability, and a significant risk of ulceration and amputation. Early recognition and appropriate management are crucial to prevent long-term disability and preserve limb function.

Pathophysiology

Charcot’s Foot develops as a result of neuropathy-induced loss of protective sensation and autonomic dysfunction. The inability to perceive pain or trauma allows repetitive micro-injuries to go unnoticed, while increased blood flow from autonomic neuropathy accelerates bone resorption. The combination leads to bone weakening, fractures, joint dislocation, and ultimately, the classic “rocker-bottom” deformity.

Clinical Presentation and Diagnosis

Patients with Charcot’s Foot typically present with a warm, swollen, erythematous foot, often with minimal or no pain. The condition is frequently mistaken for cellulitis or deep vein thrombosis. Diagnosis is clinical but supported by imaging—plain radiographs may be normal in early stages, while MRI can detect bone marrow edema and subtle fractures. The Eichenholtz classification system is commonly used to stage Charcot’s Foot:

1. Stage 0 (Prodromal): Clinical inflammation, no radiographic changes.
2. Stage 1 (Development): Fragmentation, joint subluxation/dislocation.
3. Stage 2 (Coalescence): Healing, new bone formation.
4. Stage 3 (Consolidation): Remodelling, residual deformity.

Principles of Treatment

The goals in managing Charcot’s Foot are to halt the destructive process, prevent ulceration, maintain foot stability, and preserve function. Treatment can be divided into acute and chronic phases.

Acute Phase Management

1. Offloading and Immobilization

The cornerstone of acute Charcot’s Foot treatment is immediate offloading and immobilization to prevent further bone and joint destruction. This is typically achieved through:

• Total Contact Casting (TCC): Considered the gold standard, TCC evenly distributes pressure, restricts movement, and protects the foot. Casts are changed regularly to monitor skin integrity and edema.
• Removable Walker Boots: Useful when TCC is contraindicated, though patient compliance is critical.
• Wheelchair or Crutches: May be necessary for non-ambulatory patients or when both feet are affected.

2. Monitoring and Medical Management

Regular follow-up is essential to assess for resolution of inflammation (reduction in temperature and swelling), monitor for complications, and adjust treatment. Control of blood glucose and management of comorbidities are also vital.

3. Duration of Immobilization

Immobilization continues until clinical signs of inflammation resolve and imaging demonstrates consolidation—often several months. Premature weight-bearing can exacerbate the deformity.

Chronic Phase Management

Once the acute inflammatory process subsides, attention shifts to maintaining foot architecture and preventing recurrence or complications.

1. Custom Footwear and Orthoses

• Custom-Made Shoes: Designed to accommodate deformities, reduce pressure points, and provide stability.
• Orthotic Devices: May include insoles, braces, or ankle-foot orthoses to support weakened structures.

2. Surgical Intervention

Surgery is reserved for cases with severe deformity, instability, or recurrent ulceration unresponsive to conservative measures. Procedures may include:

• Exostectomy: Removal of bony prominences to prevent ulceration.
• Arthrodesis: Fusion of joints to restore stability.
• Osteotomy: Realignment of the foot.

Surgical risks are higher in this population due to poor bone quality, infection risk, and vascular compromise, so careful patient selection and multidisciplinary planning are essential.

Multidisciplinary Approach

Optimal management of Charcot’s Foot requires a team approach, involving podiatrists, endocrinologists, diabetes educators, orthopaedic surgeons, and vascular specialists. Early referral to specialized diabetic foot clinics improves outcomes.

Complications and Prognosis

If not promptly and properly managed, Charcot’s Foot can lead to:

• Severe deformity (e.g., rocker-bottom foot)
• Chronic ulceration
• Infection (osteomyelitis)
• Amputation

With early intervention, limb salvage rates improve, and many patients regain functional mobility. However, recurrence is possible, and lifelong vigilance is required.

Patient Education and Prevention

Education is crucial for patients with diabetes, particularly those with neuropathy. Key messages include:

• Daily foot inspection
• Prompt reporting of swelling, redness, or warmth
• Avoidance of trauma and inappropriate footwear
• Regular follow-up with foot care professionals

Charcot’s Foot is a devastating but often preventable complication of diabetes. Early recognition, aggressive offloading, and a multidisciplinary approach are essential to halt disease progression, minimize deformity, and preserve limb function. With advances in both conservative and surgical management, outcomes for patients with Charcot’s Foot continue to improve, but prevention and patient education remain the foundation of care.

Circulation boosters—devices that claim to improve blood flow in the legs and feet—are widely marketed to people experiencing poor circulation, swelling, or discomfort in their lower limbs. With increasing rates of diabetes, sedentary lifestyles, and vascular conditions, many people are searching for solutions to enhance circulation and reduce associated symptoms. But do these devices actually work, and what does the clinical evidence say?

What Are Circulation Boosters?

Circulation boosters, sometimes called “leg circulation machines” or “electrical stimulation devices,” typically use electrical muscle stimulation (EMS) or similar technology. The user places their feet on electrode pads or platforms, and the device sends gentle electrical impulses through the soles of the feet. These impulses cause the muscles in the feet and lower legs to contract and relax, simulating the effects of walking or calf exercises.

Manufacturers claim that this process can:

• Increase blood flow in the legs and feet
• Reduce swelling (oedema)
• Alleviate pain, cramping, or discomfort
• Improve overall foot and leg health

Who Might Benefit from Circulation Boosters?

Circulation boosters are often marketed to:

• Older adults with reduced mobility
• People with diabetes or peripheral neuropathy
• Individuals with chronic venous insufficiency or mild peripheral arterial disease
• Anyone experiencing swollen feet or legs after long periods of sitting or standing

It’s important to note that these devices are not intended to replace medical treatment for serious vascular conditions, but are often positioned as an adjunct to standard care.

The Science Behind Circulation Boosters

How Do They Work?

The primary mechanism is electrical muscle stimulation (EMS). When muscles contract, they help pump blood back toward the heart, counteracting the effects of gravity and sedentary behaviour. This “muscle pump” action is vital for healthy circulation in the legs.

What Does the Evidence Say?

The clinical evidence on circulation boosters is mixed, but several studies offer insight:

• Increased Blood Flow: Some small studies have demonstrated that EMS can temporarily increase blood flow in the lower limbs. For example, research published in medical journals has shown that EMS devices can enhance venous return and reduce pooling of blood in the legs, especially in people with limited mobility.
• Reduction in Swelling: There is evidence that regular use of EMS devices can help reduce swelling in patients with chronic venous insufficiency or those recovering from surgery.
• Symptom Relief: Anecdotal reports and some clinical trials suggest that users experience reduced discomfort, cramping, or fatigue after using circulation boosters.

However, most studies are small, short-term, and often funded by device manufacturers. There is a lack of large-scale, independent research proving long-term benefits or superiority over traditional exercise.

Limitations and Considerations

Not a Substitute for Exercise

While circulation boosters can mimic some of the effects of muscle movement, they are not a replacement for regular physical activity. Walking, calf raises, and other forms of exercise remain the gold standard for promoting healthy circulation.

Not Suitable for Everyone

People with certain conditions—such as deep vein thrombosis (DVT), pacemakers, or specific neurological disorders—should avoid EMS devices unless cleared by a healthcare professional.

Placebo Effect and User Experience

Some benefits reported by users may be due to the placebo effect or the relaxing sensation of using the device. It’s essential to set realistic expectations and understand that results may vary.

Clinical Recommendations

As podiatrists and foot health professionals, our approach is to recommend interventions supported by clinical evidence and tailored to each individual’s needs:

• For mild swelling or discomfort: Circulation boosters may offer temporary relief, especially for those unable to exercise due to mobility issues.
• For ongoing symptoms or underlying conditions: A comprehensive assessment by a podiatrist or healthcare provider is essential. Circulation boosters should be considered as an adjunct, not a replacement, for medical treatment and lifestyle modifications.
• For healthy individuals: Regular movement, hydration, and foot care remain the most effective strategies for maintaining good circulation.

Circulation boosters can provide some benefits for specific individuals, particularly those with mild symptoms or limited mobility. Clinical evidence suggests they may temporarily increase blood flow and reduce swelling, but they are not a substitute for exercise or medical care. As with any health product, it’s important to consult with a qualified professional to determine if a circulation booster is appropriate for your needs.

Cancer is a complex disease that can affect virtually any part of the body, including the foot. While cancer in the foot is less common than in other anatomical regions, its presence can significantly impact mobility, quality of life, and overall health outcomes. Understanding how cancer might affect the foot—either as a primary malignancy, a metastatic lesion, or through systemic treatment side effects—is essential for both clinicians and patients seeking comprehensive foot care.

Types of Cancer That May Affect the Foot

1. Primary Malignancies

Primary cancers originating in the foot are rare but possible. The most common include:

• Skin cancers: Such as melanoma, squamous cell carcinoma, and basal cell carcinoma. The foot, particularly the plantar surface, is a frequent site for acral lentiginous melanoma, a subtype more prevalent in people with darker skin and often diagnosed late due to its subtle presentation.
• Bone and soft tissue sarcomas: These include osteosarcoma, chondrosarcoma, Ewing’s sarcoma, and various soft tissue sarcomas (e.g., synovial sarcoma, liposarcoma). These malignancies may arise in the bones or connective tissues of the foot.

2. Metastatic Disease

The foot can also be affected by metastatic cancer, though this is uncommon. Cancers of the lung, breast, prostate, or kidney may spread (metastasize) to the bones of the foot, presenting as pain, swelling, or pathological fractures.

3. Hematological Malignancies

Leukemias and lymphomas may manifest with foot symptoms, including swelling, pain, or skin changes due to infiltration of malignant cells or as a result of treatment.

Clinical Presentation

Cancer in the foot can present with a variety of symptoms, many of which overlap with benign foot conditions:

• Persistent pain: Not relieved by rest or typical interventions, and often worsening at night.
• Swelling or a palpable mass: Especially if it is firm, irregular, or growing.
• Non-healing ulcers or wounds: Particularly concerning on the plantar surface or around the nails.
• Skin discoloration or changes: Such as pigmented lesions, bleeding, or ulceration.
• Pathological fractures: Fragility fractures with minimal trauma may signal underlying bone involvement.
• Numbness or neurological symptoms: Tumor growth may compress nerves, leading to altered sensation.

Due to the nonspecific nature of these symptoms, cancer in the foot is often misdiagnosed as more common conditions like plantar fasciitis, infections, or benign tumors (e.g., ganglion cysts).

Diagnostic Considerations

Early and accurate diagnosis is critical. Diagnostic steps may include:

• Clinical examination: Assessing for masses, skin changes, and neurological deficits.
• Imaging: X-rays, MRI, CT scans, and ultrasound can help delineate the extent of the lesion and differentiate between benign and malignant causes.
• Biopsy: Definitive diagnosis requires tissue sampling, either by needle or surgical excision, to identify cancerous cells.
• Laboratory tests: Bloodwork may be indicated for systemic symptoms or suspicion of hematological malignancy.

Impact of Cancer Treatments on the Foot

Even when cancer originates elsewhere in the body, the foot may be affected by cancer treatments:

• Chemotherapy-induced neuropathy: Many chemotherapeutic agents can cause peripheral neuropathy, leading to numbness, tingling, burning, or pain in the feet. This can impair balance, gait, and increase the risk of injury.
• Radiation therapy: Radiation to the lower limb may cause skin changes, fibrosis, ulceration, or impaired wound healing in the foot.
• Immunosuppression: Cancer therapies can increase susceptibility to infections, including fungal or bacterial infections of the toenails and skin.

Functional and Psychosocial Implications

The foot plays a crucial role in mobility and independence. Cancer-related changes can lead to:

• Reduced mobility: Pain, weakness, or structural changes may limit walking and daily activities.
• Risk of falls: Neuropathy or bone involvement increases fall risk, especially in older adults.
• Psychological impact: Visible changes, chronic pain, or amputation (in severe cases) can affect self-image and mental health.

Management Strategies

Optimal management requires a multidisciplinary approach:

• Medical and surgical interventions: Depending on cancer type and stage, options may include excision, amputation, chemotherapy, radiation, or targeted therapies.
• Podiatric care: Regular monitoring, custom orthotics, wound care, and footwear advice are essential to prevent complications and maintain function.
• Rehabilitation: Physiotherapy and occupational therapy can help restore mobility and independence.
• Supportive care: Pain management, psychological support, and patient education are integral to holistic care.

Prevention and Early Detection

Awareness and vigilance are key. Both clinicians and patients should:

• Monitor for unusual changes: Persistent pain, new lumps, or non-healing wounds warrant prompt investigation.
• Practice good foot care: Especially in immunocompromised or neuropathic patients.
• Seek specialist input: Early referral to podiatry, oncology, or orthopaedics improves outcomes.

While cancer of the foot is uncommon, its consequences can be profound. Early recognition, accurate diagnosis, and multidisciplinary management are essential to preserve function and quality of life. For patients with a history of cancer or unexplained foot symptoms, a high index of suspicion and prompt specialist evaluation are warranted. Through clinical expertise and patient education, the impact of cancer on the foot can be mitigated, supporting better health outcomes and mobility for those affected.