Introduction

There have been various literary references to people cutting their nails throughout history, but the tool of choice was almost always a small knife or a blade. Depending on social status, cultural tradition, and place in history, carrying a knife to cut your nails may have been as common as putting on clothes.

The human foot has 26 bones, making it one of the most intricate areas of the body. Nevertheless, it is estimated that humans walk 150,000 miles in their lifetime, roughly the equivalent of walking around the world six times. Your feet and mine take a lot of daily abuse from walking, running, jumping, and climbing (although to be honest with you, I don’t do many of those things today), so naturally, they are subject to many different types of problems. But that’s not a new thing.

Archaeologists have discovered evidence of foot doctors in Greek ruins and ancient Egyptian tombs. In the more recent past, Abraham Lincoln (whose foot doctor – Isachar Zacharie – helped care for his ingrowing toenails and “troublesome corns”), the King of France, Napoleon Bonaparte, and other notable historical figures have written about the care they received from special foot doctors. Queen Victoria had a Surgeon-Chiropodist, named Lewis Durlacher – in 1845, he wrote A Treatise on Corns, Bunions, the Diseases of Nails and the General Management of the Feet^[1].

The London Foot Hospital opened in 1911. Now there are 13 schools of Podiatry in the UK, one of which is at the University of Brighton. On average, it takes about 1,000 supervised clinical hours of training to become a Podiatrist.

What is Podiatry? ^[2]
Podiatry is a medical speciality concerned with the diagnosis and treatment of foot disease and deformity. References to physicians who treated abnormalities or injuries in the foot are found in ancient Greek and Egyptian writings.

Image Credit: Public Domain, downloaded from: https://wellcomecollection.org/works/b43cq87f

The first modern text on Chiropody (podiatry’s previous name) was published by D. Low in England in 1774 and titled Chiropodologia^[3]. It was described as:

‘Chiropodologia, or, A scientific enquiry into the causes of corns, warts, onions, and other painful or offensive cutaneous excrescences: with a detail of the most successful methods of removing all deformities of the nails; and of preserving, or restoring, to the feet and hands their natural soundness and beauty. The whole… systematically confirmed by the practice and experience of D. Low, chiropodist.’

Chiropodologia

When did Foot Care start?
Archaeological finds confirm that doctors were caring for feet in ancient Egypt. But Greece is where it started – Hippocrates wrote about removing corns and calluses from patients’ feet with scalpels of his own invention and creation to help scrape skin and remove hard skin spots. Celsus, a Roman scientist and philosopher, was probably responsible for giving corns their name.

Scissors were invented a long time ago and were even around during the time of the Babylonian kingdom, but they were for cutting hair and trimming beards. Breaking your own nails was commonplace.

Physicians specialising in foot treatment appeared first in England in the late 18^th century. Later, during the 19^th century, so-called corn cutters sought business in the rural areas of America. These often-untrained and itinerant therapists travelled here and there offering help for those who had corns, bunions, blisters, and other discomforts of the foot.

The word podiatrist comes from the Greek prefix pod-, meaning foot, and the Greek root iātrós, meaning physician. The use of the term podiatrist was first recorded around 1910–15.

What do Podiatrists do?
Podiatrists are medical specialists – like gynaecologists, ophthalmologists, cardiologists, etc. They are the best-qualified medical professional to examine your feet, ankles, and lower legs, as well as to diagnose and treat any illnesses or injuries to this part of your body. Podiatrists will often deal with many different foot conditions ranging from ingrown toenails, corns, and verrucas to the complexities of diabetic foot disease.

For example, a podiatrist can^[4]:

• Check your feet and medical history.
• Treat the foot-related impact of whole-body illnesses such as diabetes, peripheral arterial disease^[5] (PAD), and arthritis.
• Perform foot and ankle surgery.
• Diagnose and treat foot and ankle injuries and fractures.
• Diagnose and treat skin conditions such as plantar warts, athlete’s foot, and fungal infections.
• Help you to manage foot pain caused by plantar fasciitis and other conditions.
• Fit and create custom orthotic devices for cushioning and support.
• Deal with toenail problems – such as thickened toenails, fungal nail infections or ingrowing toenails (also known as onychogryphosis or unguis incarnatus).
• Supply orthotics (tailor-made insoles, padding and arch supports) to relieve arch or heel pain.
• Deal with verrucas and hallux valgus (bunions).

While PAD is not immediately life-threatening, someone with PAD is up to six times more likely to have a heart attack or stroke. People with type 2 diabetes are three to four times more likely to develop cardiovascular conditions such as PAD, so early detection and management of diabetes are absolutely vital.

Other risk factors for PAD include:

• smoking
• obesity or being overweight
• inactivity
• high blood pressure
• high cholesterol.

Picture Credit: “7/105 Nail Clippers” by bellemarematt is licensed under CC BY-SA 2.0

You may want to see a podiatrist for advice and treatment if you have painful feet, thickened or discoloured toenails, cracks or cuts in the skin, growths such as warts and verrucas, scaling or peeling on the soles, or any other foot-related problems^[6].

Podiatrists can also supply orthotics – tailor-made insoles, padding, and arch support to relieve arch or heel pain. The orthotic is put into your shoe to realign your foot, take pressure off vulnerable areas of your foot, or simply make your shoes more comfortable.

Even if your feet are generally in good condition, you might consider regular sessions of podiatry – for example, you may want to have any hard skin on your feet removed or have your toenails clipped. Don’t forget, a podiatrist can also advise you about the right shoes to wear, and they’ll check that you’re looking after your feet properly.

At your first consultation, the podiatrist will note your full medical history, check the medication you are taking and carry out basic tests, such as checking the blood circulation and feeling in your feet. They may also look at how you walk and move your lower leg joints. They’ll discuss your concerns with you and then make a diagnosis and treatment plan. Any minor problems that are picked up can usually be treated on the spot, including removing hard skin, corns and calluses. The session is usually completely painless and takes 30 to 60 minutes.

Foot Problems
The most common foot problems of older adults include bunions, corns, calluses, hammertoes, ingrown, thickened or discoloured nails, diabetic foot conditions, poor circulation, and heel pain. Regular visits to a podiatrist can help you maintain your foot health as you age. The Royal College of Podiatry website^[7] has a comprehensive list of foot problems. Two common problems are diabetic retinopathy and athletes foot, and these are discussed below;

Diabetes^[8]
A person with diabetes is at a much greater risk of developing foot problems. But understanding how diabetes affects feet can help you avoid these complications. Raised blood glucose levels, also known as blood sugar, can damage the sensation in your feet.  This can also affect your circulation, leading to you getting less blood supply to your feet. Without a good blood supply, you may have problems with cuts and sores healing. You may also get cramps and pain in your legs or feet. If you don’t get these foot problems treated, they could lead to foot ulcers, infections and, at worst, amputations. Most foot problems can be prevented with good, regular foot care.

If you’re high risk and see a change or problem with your feet, you need to know what to do to stop it from getting worse. It’s good to take time out to sit down and have a good look at your feet every day. If you notice any changes or that you feel unwell, you should do something about it straight away. Someone with diabetes is 20 times more likely to experience an amputation.

If you spot any of the following changes, you need to see your GP:

• tingling sensation or pins and needles (like numbness)^[9]
• pain (burning)
• a dull ache
• shiny, smooth skin on your feet
• hair loss on your legs and feet
• loss of feeling in your feet or legs
• swollen feet
• your feet don’t sweat
• wounds or sores that don’t heal
• cramp in your calves when resting or walking

If you notice any of the following changes, it’s best to see your podiatrist or GP urgently:

• changes in the colour and shape of your feet 
• cold or hot feet
• blisters and cuts that you can see but don’t feel
• foul smell coming from an open wound

Athlete’s Foot^[10]
Itchy, stinging, and burning feet and toes may be signs of athlete’s foot. This contagious condition appears after you have contact with fungus, usually in wet environments such as locker rooms, public showers, and swimming pools. You may also experience foot blisters, crumbly toenails, and cracked, dry, and raw skin on your feet. The condition can sometimes be difficult to treat. Start with an over-the-counter (OTC) product, but if that doesn’t solve the problem, you may need something stronger to be prescribed by your GP.

Chiropodists, Podiatrists and Orthotists
Until the 20^th century, doctors who focused on feet, ankles, and legs were called chiropodists and considered separate from other types of organised medicine. There is no difference between a Podiatrist and a chiropodist, but podiatrist is a more modern name.

There is a great deal of cross-over between the work of a podiatrist and an orthotist, and they will often work closely together. Generally speaking, an orthotist will be concerned about the whole body and how bracing and splints (orthoses) can be used for people who need extra support for body parts that have been weakened by injury, while a podiatrist deals primarily with feet.

Professional Organisations
The Royal College of Podiatry is the premier podiatry organisation in the United Kingdom. It is a learned society, incorporated on 17^th November 1945 with several branches across the UK and overseas. All the College’s members in professional practice are registered with the Health and Care Professions Council (HCPC).

In 1938, the Institute of Chiropodists and Podiatrists was formed – several professional chiropody organisations throughout the United Kingdom came together in London to create a national professional body – initially called then the Joint Council of Chiropodists (JCC) – its purpose was to standardise training, enforce ethics, introduce professional indemnity insurance and both raise the profile of and guide the future development of the profession of Chiropody.

In the USA, the National Association of Chiropodists (NAC) was founded in 1912. In 1917, M. J. Lewi coined the name podiatry, and in 1958, the NAC was renamed the American Podiatric Association to reflect the greater popularity of the new term. The American Association of Colleges of Podiatric Medicine(AACPM) is the collective union for the nine colleges of podiatric medicine in the USA and the more than 200 hospitals and institutions that offer postdoctoral training in podiatric medicine.

In Australia, graduates of recognised academic programs can register through the Podiatry Board of Australia as a “podiatrist”, and those with additional recognised training may also be allowed to prescribe or administer restricted medications and seek specialist registration as a “podiatric surgeon”.

Is podiatry available on the NHS?
The NHS website provides guidance on the availability of podiatry on the NHS^[11].

On 1^st April 2013, clinical commissioning groups (CCGs) were given the power to decide what footcare services to authorise for their local area. Guidance by the National Institute for Health and Care Excellence (NICE) recommends that footcare services related to long-term conditions such as diabetes, peripheral arterial disease and rheumatoid arthritis should be available on the NHS.

The NICE guidance does not cover foot health provision that isn’t associated with a long-term condition – it means that each individual CCG will decide what to make available on the NHS, depending on local need.

If your condition isn’t affecting your health or mobility, such as a verruca that looks ugly but doesn’t hurt when you walk, you’re unlikely to be eligible for NHS podiatry.

You should speak to your GP to determine if you qualify for NHS podiatry treatment.

Sources and Further Information

• There’s an interesting Infographic available online. If you are worried about your feet, it could be helpful for you. https://pharmj.wpengine.com/wp-content/uploads/2021/02/1073552.pdf
• The Ebers Papyrus is an Egyptian compilation of medical texts dated about 1550 BC, one of the oldest known medical works. The scroll contains 700 magical formulas and folk remedies meant to cure afflictions ranging from crocodile bite to toenail pain and to rid the house of such pests as flies, rats, and scorpions^[12].
• https://www.nhs.uk/live-well/healthy-body/foot-problems-and-the-podiatrist/
• https://www.encyclopedia.com/medicine/divisions-diagnostics-and-procedures/medicine/podiatry
• https://www.diabetes.org.uk/guide-to-diabetes/complications/feet
• https://www.hriuk.org/health/learn/cardiovascular-disease/peripheral-artery-disease
• https://www.healthline.com/health/foot-problems#common-conditions
• https://rcpod.org.uk/common-foot-problems
• https://www.nhs.uk/conditions/foot-pain/

Picture Credit: “File:A chiropodist treating a patient’s foot, a crowd of people a Wellcome L0018618.jpg” is licensed under CC BY 4.0

Caution: No advice is implied or given in articles published by us. This guide is for general interest only – and should never be used as a substitute for obtaining advice from your doctor or other qualified clinician/medical practitioner. The facts are believed to be correct as at the date of publication, but there may be certain errors and omissions for which we cannot be responsible.

1. The book, last published by Franklin Classics, is available on Amazon at: https://www.amazon.co.uk/Treatise-Corns-Bunions-Diseases-Management/dp/0343234467 ↑

2. Source: Mainly from Encyclopedia.com at: https://www.encyclopedia.com/medicine/divisions-diagnostics-and-procedures/medicine/podiatry ↑

3. Download book from: https://wellcomecollection.org/works/b43cq87f ↑

4. Source: https://www.encyclopedia.com/medicine/divisions-diagnostics-and-procedures/medicine/podiatry ↑

5. Peripheral artery disease (PAD), also known as peripheral vascular disease, is a type of cardiovascular disease in which the narrowing of arteries results in reduced blood flow to a body part outside of the heart or brain. It mainly occurs in the arteries leading to the legs and feet, and is often the result of atherosclerosis, where fatty deposits build up in the walls of arteries. Source: https://www.hriuk.org/health/learn/cardiovascular-disease/peripheral-artery-disease ↑

6. Source and further information: NHS at https://www.nhs.uk/live-well/healthy-body/foot-problems-and-the-podiatrist/ ↑

7. See: https://rcpod.org.uk/common-foot-problems ↑

8. Source and further information: DiabetesUK at https://www.diabetes.org.uk/guide-to-diabetes/complications/feet ↑

9. This symtoms are signs of diabetic retinopathy, which is damage to the nerves because of unregulated high blood sugar. Maintaining proper blood sugar levels helps reduce the risk of diabetic neuropathy. Learn more about diabetic neuropathy at: https://www.healthline.com/health/type-2-diabetes/diabetic-neuropathy ↑

10. See: https://www.healthline.com/health/foot-problems#common-conditions ↑

11. See: https://www.nhs.uk/live-well/healthy-body/foot-problems-and-the-podiatrist/ ↑

12. See: https://www.britannica.com/topic/Ebers-papyrus ↑