My ode to the beautiful Foot & Ankle Team at St Mary’s Hospital

The Foot and Ankle Team at St Mary’s.

As I have mentioned previously, when I am not in private practice, one of my other jobs is working one day a week in St Mary’s Hospital in Paddington. 

I want to give a shout out to the amazing team that I work with in the Foot & Ankle clinic. I have just recently celebrated my 11th anniversary at the hospital and I truly hope there are many more to come.

Who is in this team?

Initially when I joined the team, on a permanent basis, we had one foot & ankle consultant, one lower limb extended scope practitioner (physiotherapist) and myself (I did job share with another biomechanical podiatrist until 2014), and a registrar (who normally has a keen interest in foot & ankle surgery but they tend to rotate on a six month basis). To say that we are foot nerdy would be an understatement!

As a group, we tend to go out of our way to make the registrars feel very welcome to the team. The reason being, the foot & ankle conditions are highly complex. The foot is an extremely intricate structure – imagine, our feet carry our body weight for our whole lifetime. They must balance and support your entire body. There are several bones (28 to be exact) which means plenty of joints, various muscle groups, some of these muscles are so small, yet play a significant role to allow our toes to move; together with various different ligaments and fascia that keep our foot mobile. The physiotherapist and I guide the registrars best we can as it can be a daunting experience.

In mid-2014, we had the second foot & ankle consultant join our team of consultants. He had previously joined as a locum for us and knew the set up. He just slotted in really well. In his team, he has his Foot & Ankle Fellow (this changes annually). 

Earlier this year, the team has further grown to having a third foot & ankle consultant who was initially the Fellow to the second consultant. Over the last 5 years, we have grown and evolved as a team but also learnt to accept each other’s personality as we have also spent a numerous hours working together as professionals.

I can’t forget the people behind the scenes, the nurses, a plaster technician, radiographers and healthcare assistants as well as the administrators who ensure the clinic is run efficiently. 

Occasionally, we have a sports doctor too and sometimes a visiting Foot & Ankle Surgeon from abroad.

How does the clinic run?

It is definitely a very busy clinic. There can be up to 25-30 patients in a session, sometimes more. There can be a variety of simple to complex cases. I have already covered how we see the patients in a previous blog. It can be a highly pressurised set-up but at the same time it is very exhilarating. I tend to present all my cases to the consultant in a succinct manner – another skill I had to learn. 

How does it make me feel to be part of this Team?

I truly don’t have words to explain how I feel, but all I can say is that I am so proud to be a member of this team. I feel that I have grown with the team, and not only have I increased my knowledge and skills, but my experience has improved by leaps and bounds too. In my eyes, they have extensive knowledge in foot & ankle and no two days are ever the same. On a Wednesday, when I arrive into clinic, there is this great vibe inside the clinic from all the staff. All my worries seem to disappear and I am eager to start the day, with great anticipation as to what new knowledge will I learn today. I hold all these people in the highest regard.

All the consultants are excellent in professional terms as well as being thoroughly great people. They are approachable and always willing to teach. But what makes it so very special is that all three consultants tend complement each other and each one has an endearing quality about them. Every Wednesday, one of the Consultants asks how we are feeling on our own personal scale. (“What is Ratna’s score on the Ratna scale?” – i.e. how upbeat am I feeling this morning?) The other is always keen that we all integrate, outside the clinics. This usually means team lunches (I am usually very hungry post clinic, even earlier, so this kind of suits me and him very well) and generally, chats about his/our family life and the third, who is always willing to help out at short notice and answer any questions. Certainly, during these trying times in the COVID-19 pandemic, we have had regular catch ups and being there for each other during these strange times. Whilst at the same time, they constantly feed our hanger pangs.

How did I get to feel this way?

Having worked in a community setting for most of my early podiatry career, working in a hospital multi-disciplinary setting was quite an adjustment I had to learn to make! Working in the team and being a team player was an amazing feeling and it felt like I fitted in like a key to a lock in that regard. 

My main marvel, even to this day, is that the patient could have conservative measures recommended to them but if they have already been tried and failed, means that they could have a surgical opinion straight way or vice versa - a patient has come in with the idea that they would like surgery but are given a choice of other treatment plans that they did not know existed. There is no waiting for a referral or asking the GP to refer them for a surgical opinion. Talk about instant job satisfaction.

I liked the idea of being able to bounce ideas with fellow colleagues, but where I struggled, was that my knowledge was not up the same level as the team and I was a little timid and a little shy. My confidence was a little lacking too. But what I lacked in confidence, I made up in perseverance! And I was one willing student! It was a steep learning curve but with plenty of insightful learning moments on a weekly basis which did not arrive at a click of a finger. I am sure the consultants can verify that I got on their nerves quite a few times, probably several! This meant I had to research into the different foot conditions and learn them from an orthopaedic point of view. 

As a biomechanical podiatrist, I had knowledge in gait analysis and how the orthoses could alter the forces, but what I lacked was deeper knowledge of how to connect it all together in the orthopaedic world. 

For example, there is a patient who has had ankle arthritis, all conservative measures that failed. So what would be the next option- should the patient have ankle fusion or ankle replacement? What would be the best operation for him/her and how would I decide that? Or another example, if a patient has bunion, what would be the next stage for this? What factors do I need to present to the consultant to say that he/she qualifies for surgery? How do I read the x-rays or how do I order further imaging. After a few months of trying to blag on basic knowledge, I thought the best way was to create a dictionary of orthopaedic foot and ankle conditions and when I did not understand, I would ask the consultants again and again or ask for a reference for further reading. I also started attending any courses either with them presenting or any other consultant or lower limb physiotherapists who they had the same regard for, to show my keen interest.

I kept at it and it was a long haul. There were days when it felt there was no point and I could not do it (husband can testify to this as there were a few times when I was very tearful) but as time went on and my knowledge improved and so did my confidence did, I was proud that I stuck it out.

I want to give a really good shout out to all the foot and ankle consultants as well as the ESP physiotherapist as I would certainly not be where I am, had they not pushed me and offered me the constant encouragement. I have the highest regard for the whole team and greatly admire them. My time with them away from the clinical setting has also been invaluable as I am able to show my true side too.

These health professionals have been there with me every step of the way in my private practise and are the main reason for me starting up privately too. They have shared their insights into world of private practice too and shared their tips and ideas as well as sending patients my way, too.

Thank you team.