‘Toeing the line’

  • By Judith Sullivan
  • 05 Apr, 2017
  • 10 Mar, 2017

  • Author/blogger Reggie Simpson

Parliament debates workplace dress codes

Remember when Naomi Campbell tripped and fell on the catwalk wearing super high platform shoes during a Vivienne Westwood show in 1993? She laughed it off; we guffawed. Here was one of the top supermodels dubbed the ‘Trinity’ purported to ‘not wake up for less than $10,000 a day’.

I suppose Campbell’s ‘fall from grace’ was an occupational hazard.

Speed forward to 2017. The average woman can hardly afford to lounge in bed, and she most likely (and sensibly) will not totter around in platform shoes in the workplace. However, high heels and other compulsory dress code attire for women have become symbols of workplace sexism and discrimination.

In a week that celebrated International Women’s Day (‘Be Bold for Change’), Parliament convened a meeting on 6 March to consider an e-petition submitted by Nicola Thorp focused on high heels and workplace dress codes.  The petition had 152,420 signatures.

In December 2015, Ms Thorp was sent by Portico for a job as a temporary receptionist at the headquarters of PriceWaterhouseCoopers in London. When she arrived, Ms Thorp was told that the smart black shoes she was wearing were unacceptable because they were flat; at the time, Portico’s dress code specified a heel height of between two and four inches—for women, not men. She was offered the opportunity to go out and buy a pair of high heels. When she refused, she was sent home without pay.

Speaking on behalf of the petition, Helen Jones (Warrington North, Lab) MP said:

‘There was never a suggestion that Ms Thorp was not smartly dressed … Secondly, it was clear that wearing high heels was a requirement that impacted far more on women than on men.  In fact, most of Portico’s dress code at the time was about how women should look.  Not only were women to wear high heels but they were compelled to wear make-up’.

When the issue was first raised with the parliamentary Petitions Committee and the Women and Equalities Committee this past January, there was shock and disbelief that such workplace attitudes and practices still exist.

Make-up and dress aside, we at Betafeet Podiatry and within the wider foot care profession take particularly interest in High Heel Gate (or is that High Hell Gate?).  

According to the Hon MP Jones:

‘There are people who think that we should not have investigated this at all—in fact, they think it is a bit of a joke. Yes, it is true that women sometimes wear high heels, but there is plenty of evidence about the damage from wearing heels long term; that is well known and has been for some time. We received written evidence from the College of Podiatry and individual podiatrists on our web forum setting out just what that damage is. Wearing high heels long term alters balance, reduces flexion in the ankle and weakens calf muscles. Over time, that can make women much more prone to a number of problems, including stress fractures, Morton’s neuroma, ankle sprains and bunions, and it causes a reduction in balance that lasts into old age, putting people more at risk of falls’.

See Betafeet Podiatry’s previous blog on the effects of wearing high heels:


From a corporate risk assessment standpoint, companies should review their dress code policy, not least for health and safety reasons, but also reputational risk and/or litigation consequences. To its credit, Portico has since changed its dress code policy.

Watch this space for further steps, hopefully in the right direction.

Note: Men, please forgive me for not commenting on any of your own possible workplace dress code issues. That is for another parliamentary debate.

By Judith Sullivan 18 Jul, 2017
Andre was an associate podiatrist at Betafeet for five months.  His contributions to the practice were considerable.  Sadly we lost him to a higher professional and personal calling.

After a stellar educational background and career, Andre joined babylon Healthcare Services, UK based, with a view to helping them set up and deliver the first digital healthcare pilot services to the NHS.   Digital healthcare is a cluster of new and emerging applications and technologies that exploit digital, mobile and cloud platforms for treating and supporting patients. Digital Healthcare is being applied to a  wide range of social and health problems, ranging from monitoring patients in intensive care, general wards, in convalescence or at home – to helping doctors make better and more accurate diagnoses, improving drugs prescription and referral decisions for clinical treatment.

Rwanda then beckoned.

Since joining babylon Rwanda in April 2016, Andre has been instrumental in successfully setting up and launching Africa's fastest growing digital healthcare service.  According to Lindsey McConaghy, babylon's PR manager, 'Rwanda has a population of around 12 million but doctor numbers are in the hundreds. There’s an imbalance between supply and demand'.  

Digital Healthcare is not without its sceptics nor controversies - at what point do you let an app do the diagnosis?  Will GPs embrace technology in this way?

Here is Andre's report about his experiences in Rwanda:  

Rwanda is a small ambitious country known as the land of 1000 hills with a population around 12 million and a rapidly growing economy. It has rolling hills for as far as you can see, a rain forest, gorillas and volcanoes, making for quite the site to any visitor. However, it is also known for the 1994 genocide in which over 1 million people were killed in 100 days across the country.

This tragic event has led to some very big health issues, which the country still faces, but thanks to a range of donor funding and strong political leadership, the country is on its way to quickly becoming a middle-income country.

As countries shift from low incomes to middle income economies, health issues become complex, where the country can face a mix of communicable disease (ie. malaria, HIV, TB) and the introduction of non-communicable disease (ie. diabetes, high BP, cholesterol) with changes in lifestyles.

Now you are probably wondering what this has to do with podiatry?

Well, as clinicians we play a role in the overall wellbeing of every patient that walks through our door for treatment and we become advocates for a number public health issues. While our specialist area is focused on the foot and ankle, an understanding of the bodily systems is imperative for understanding the impacts on the lower limb. This allows us to transition from clinical practice to other work streams such as health policy, public health programmes, service management and research.

As a podiatrist with a public health background, the increase of diabetes and chronic conditions in developing nations has become of personal interest. In many of these countries, diabetes is poorly understood and without proper prevention and care, can lead to a large economic burdens on the healthcare system. In 2012, the UK alone spent a whopping £639 million on foot ulcers and £662 on lower limb amputations, so the prevention and monitoring of these conditions is of paramount importance in the developing world.

The quality of life for individuals with diabetes is also drastically affected if not controlled, impacting mobility, footwear and overall lifestyle. Additionally, chronic ulceration and limb amputation, creates an increases risk (approximately 80%) of mortality within the first 5 years post amputation.

How did all this lead me to Africa, I hear you say?

In April of 2016, I (sadly) departed from the Betafeet clinic to implement an mhealth project in Rwanda in partnership with the Ministry of Health. This project, allows patients across the country to speak with a doctor and receive a prescription via SMS through their mobile phone, reducing the travel time, wait time and expense of receiving care from one of the local physical hospitals. The system is also working on monitoring both communicable and non-communicable disease using artificial intelligence, engaging patients to take ownership of their health.

This could be a major milestone for a country with stretched resources. To put things into perspective, over 80% of the population lives in remote areas of the country and works in the ‘in-formal’ sector as subsistence farmers with an average income of 2-3 dollars per day, which is not very much. To receive care, a patient may travel over an hour to reach their nearest hospital where a doctor is present and then wait anywhere from a few hours to a few days to receive the care they need. However almost 80% of the population already has a mobile phone.

Appropriate access to clinical care is a large part of the prevention and management of many conditions and undertaking this project has been a great experience. As a clinician, I have had the opportunity to utilise my knowledge to develop operational pathways and input into the technology development to shape the way patients receive their care. 


It is with this experience I now look to move on to my next adventure focusing on Aboriginals and the utilisation of technology in the prevention of major non communicable disease such as diabetes.

Final comment from Reggie Simpson and Betafeet Podiatry

 We wish Andre the very best in his future and thank him for this interesting blog account.  We look forward to his next blog focused on his work with the Aboriginal population.  

By Judith Sullivan 12 Jun, 2017
By Reggie Simpson
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