Nick Howsam, 26th July 2018.

Nick Howsam, 26th July 2018.

Nick Howsam MSc, BSc (Hons), BSc (Hons), Dip FHID – Podiatrist, Forensic Podiatrist & PhD Researcher

Nick (on the left pictured with Volunteer Coordinator David Robinson) was diagnosed with Type 1 diabetes 31 years ago in 1987 and so is aware of the effects that diabetes can have on the whole body, including the feet.

With poorly controlled diabetes and blood sugar levels running high for long periods of time, this can damage the arteries affecting the blood supply to the feet. This happens where sugar and glucose attaches’ itself to proteins in the walls of the arteries. This causes damage to the inside of arteries contributing to high blood pressure. The arteries then harden and become narrowed instead of being flexible and elastic. This increases blood pressure even more, with damage occurring long before people are diagnosed with diabetes.

The two arteries supplying blood to the foot are the dorsalis pedis artery (on top of the foot) and the posterior tibial artery (inside the ankle). These can be checked by a health care professional feeling or palpating the artery or by listening for a pulse with a Doppler Ultrasound device.

Damage to nerves, also known as Peripheral Neuropathy, can also occur and is looked for by testing the sensation in the feet.  Reduced or loss of sensation can occur which may show as numbness, tingling, pins and needles or a burning sensation. This is sometimes referred to as Sensory Neuropathy. Damage to the autonomic nervous system can affect the sweat glands causing dry skin.  Where this occurs’ the skin is weak resulting in reduced protection, hence the need to use a daily emollient or foot care cream that will prevent water loss from the skin and promote hydration. Motor neuropathy can cause changes to the nerve supply to the muscles which may result in a limited joint motion or even joint deformity, putting the feet at risk of damage to the skin from pressure.

Foot infections can occur in people with diabetes because of the elevated sugar level in the blood. With loss of feeling in the feet, hard skin or callus can form leading to breakdown of tissue and development of foot ulcers. These can become infected because bacteria thrive and multiply on the high sugar levels in the blood. Points to look out for are redness of the skin, swelling, heat, pain and loss of function. Wearing good footwear is essential to good foot care. The feet are very individual, so shoes should not be tight, they should instead be supportive, have a good fastening (to stop chaffing) and a good heel cup. They should also be long enough and deep enough to cover any deformities. Ideally shoes should fit the shape of the foot. It is vitally important for those with diabetes to be regularly checked for vascular disease, peripheral neuropathy (loss of feeling) and infections to reduce their risk of serious damage. Patients with diabetes should check their feet daily for any colour changes in the skin or cuts and redness. If any of these are seen, then patients should see their health care professional immediately to get checked out. If you protect your feet, you prevent problems. 

Nick has also recently been developing his skills as a Forensic Podiatrist which is a specialist area of Podiatry. There are currently four areas of forensic podiatry practice. These usually involve the analysis, comparison and evaluation of forensic evidence relating to the feet and to walking and may include:  

  • Bare footprints (both static and dynamic prints).
  • Impressions and wear of the feet in the shoes.
  • Podiatrists clinical records.
  • Forensic gait analysis (usually covering the examination of CCTV footage of persons captured by cameras).

The evidence that is left behind at a crime scene is the main area that a forensic podiatrist can focus their attention. They usually work with the police to provide an opinion on evidence, which can be submitted to a Court.

Forensic Podiatry is usually used to assist in the process of forensic human identification. It can be employed to help address issues relating to questions that have arisen within the context of forensic enquiry and other matters involving the podiatric interpretation of relevant evidential materials. Such questions could include whether or not a shoe could have had multiple wearers.

At present Nick is involved in a PhD research study at the University of Huddersfield which is focused on validating a technique to analyse the impression of feet within shoes. The aim of this is to show that it is a robust and reliable method.

As ever with a well-informed speaker there was a long and valued question and answer session.