When did you last have your feet measured for a pair of shoes in a shoe shop? We are seeing the demise of the independent shoe shop, sadly, many are closing, this week 3 children’s shoe shops have closed.
The footwear industry has very few specialists, presently you don’t have to be trained to sell shoes and approximately 90% of those in the industry know nothing about feet or fitting shoes and no legal obligation to do so. The Society of Shoe Fitters are trying to change that and are campaigning for training to fit shoes, by appealing to the government to take steps to educate the public and improve the footwear industry: http://www.shoefitters-uk.org/ .
Imported cheap shoes will often offer no support, combined with not being fitted can lead to foot problems. Shoe brands will often vary in sizes as there is no standardisation and no 2 pairs of feet are the same, you can even measure the length and the width but the volume your foot fits into a shoe is another matter and that takes skill and knowledge. It’s hard to describe an ideal shoe but as a golden rule the toe box at the front of the shoe should be foot shaped and deep enough also sufficient room to wriggle toes. ‘wear the right shoe for the right occasion’ and ‘change your heel heights regularly as the different heights will exercise your arches, your leg and back muscles’. Although ideally heel height should be no greater than 4cm with a broad base of shock-absorbing material and fitting snugly around the heel. Ideally a shoe is best secured onto the foot with laces, straps with either buckled or Velcro fastenings.
As podiatrists we see many patients in our clinics on a daily basis wearing shoes that do not fit their feet and the resulting damage. When we put on weight on our body feet will too, altering the size or width, the foot can also elongate due to the arch dropping. Some have been wearing the same size shoe all their lives regardless of the changing foot shape, length or width. Fortunately, the youngsters of today are kicking off their ballet pumps and putting on their trainers as the retro styles are becoming trendy again. I did go shopping for these last weekend with my granddaughter for just a pair of these and our experience was:
We looked at the shoes on the shelf and picked 2 styles she had in mind to try on, the assistant collected them in a size 5. He loosened the laces handed them to us and then walked back to the till to chat to another colleague. Are we only going to be left with buying online, supermarket and retail shops, is this kind of service we want for our children or ourselves?
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.