Hands that heal feet

“No. In general, people really don’t look after their feet. They truly don’t have a notion of the importance of day-to-day maintenance for feet”, says Ivo Brochado.

When something goes wrong, “people normally go to see chiropodists, pedicurists, or other types who generally have no formal education or training in anatomy, physiology, biochemistry or pharmacology”, he adds.

And the truth is, there is a difference. Podologists are specialised health technicians in “podopathies” (diseases of the feet), which they treat according to a clinical approach – not according to any aesthetic or “beauty” criteria.

“Very often, you can’t remove the whole problem. A corn, for example, is a form of protection. It’s a bit like a fever. When something goes wrong with our feet – when there’s excessive pressure on points, what happens is that the foot creates a layer of skin (hyperkeratosis). So what do people do? They go to a chiropodist to have it cut off. Of course, they’ll feel some relief, because the corn causes an inflammatory process – but it’s not the solution, and the body will return to making the corn again, over time”, he explains.

“I had a 30-year-old patient with problems with her feet. She had two enormous callouses – really quite horrendous, as they’d caused deformity. She’d been to all kinds of specialists and doctors didn’t seem to be able to help her with the problem. All it took were two custom-made insoles, made to her measurements, to alleviate the pressure and resolve the problem. She telephoned me in tears. It had been such a long time since she’d walked without pain! So, you see, there are solutions”, he guarantees.

But even common problems have their complications. “People come to me who think they have corns – when, more often than not, they’ve got a form of “papilloma virus”, otherwise known as a “verruca”. This virus passes from foot to foot, and to other people”, he explains.

“And a large part of the Portuguese population suffer from fungal problems on their feet. It makes their skin itchy and leads them to seek help. When it affects the nails, people simply try to mask it by, in the case of women, painting their toenails. Men don’t seem to worry about it. But we’re actually talking about a problem that affects public health”, he warns.

Feet also suffer from today’s sedentary way of life – which means muscles atrophy. Then there’s fashion – particularly when it comes to women – which also causes harm to feet. “Some high-heeled shoes are way too tight and cause terrible suffering”, he tells.

“A recent US study shows that 9 out of 10 women that use high heels suffer foot deformities and osteoarticular pain throughout their lives”. Even so “many people prefer to suffer today, in order to wear different shoes tomorrow”. Men, normally, have problems related to the shoes/ footwear they wear to work.

While we’re on the subject of fashion, Ivo Brochado knows there are those who consider the foot the least attractive part of the body. “It’s true. There are so many people who don’t like looking at their feet. Maybe, throughout their lives, they’ve stuffed their feet into inadequate footwear and so, of course, they’ll look at them one day and see bunions, claw toes, scrunched up toes. And, truthfully, they’re not a pretty sight”.

Although Podology is a science that covers a huge spectrum, Ivo Brochado has a special interest in so-called “diabetic foot” – a problem that affects people suffering from diabetes mellitus.

Excess sugar levels in the blood cause what is termed “diabetic neuropathy” (lesions that affect the peripheral nervous system) and so patients lose sensitivity in their lower limbs, or extremities (hands).

Feet can “in the most banal situations – like having a stone in one’s shoe” then become subject to real harm. Someone with full sensitivity would immediately stop to take the stone out of their shoe – but a diabetic person could walk, for an indeterminate period, this way”.

Brochado previously worked at Oporto’s “Hospital de Santo António” – which pioneered clinics for “diabetic foot” as far back as 1981. He tells us he saw “ridiculous situations – difficult to imagine”.“I saw a bottle top, with the spiky bits pointing upwards; pills, bits of their grandchildren’s Lego, stuck in patients’ feet. One day, a man came in with a nail going right through his foot. It looked like the crucifixion. We couldn’t get his shoe off. It had literally been nailed to his foot!”

There is no cure for “diabetic foot” – but there are ways of looking after it, ways of saving patients from losing full sensibility. It’s an effort that involves educating patients and health professionals.

“At the moment I am involved in a project that takes in the Algarve and the Alentejo – directed at doctors and nurses – which involves theoretical and practical teaching, during which I run clinics for “diabetic foot” in the various health centres”. One has already taken place in Faro – with some success, and in the upcoming weeks, Brochado will be at Tavira and Vila Real de Santo António health centres.

Podology has been taught in Portugal since 1994. Indeed, Portugal was one of the first countries to create a graduate course in podology. In neighbouring Spain, the science has become increasingly popular and podologists are now able to pass prescriptions. The only problem, one that Ivo Brochado recognises, is that podology has still not been incorporated into the national health system. Thus, whoever needs the help of a podologist, has to pay for it …