Reply To: Where the profession is heading…..

[Anonymous]

Playing with the forum this morning, and I see we cannot post photographs, unless by link, as above. (hope it is ok to post that Admin). Anyway, assuming it has been allowed, click on the link to view it, click on your back arrow in your browser to return to the forum topic.

When I qualified (1971) we had no recourse to local anaesthetic for ingrown nails. If you wanted to treat an ingrown toenail the patient had to hang on to the chair. Or be referred to Orthopaedics who would perform an old-fashioned, even then, procedure called a Zadicks. If successful it resulted in a toe which looked like the end of a sausage, as in the link. It was VERY painful post-op. Fast-forward to 1975 when a few of us qualified in local anaesthetics and skin surgery began carrying out a procedure for ingrown taoenails called a nail wedge resection. This was first described by Boll many years before, so the procedure wasn’t new. What was new was that it was being carried out as a walk-in, walk-out procedure by Podiatrists, and the results were much, much better, both from a pain-relief point of view, lack of post-op pain point of view, and a cosmetic point of view, than Orthopaedics could provide. Very exciting – and proof that our profession was better than everyone else with toenails!

The other exciting development for Podiatry hit the UK about the same time – Biomechanics, using the ROOT method. Prior to this we fitted arch supports, sometimes with a bit of deflection padding. Now all of a sudden we could, by positioning a wedge at the heel, influence forces through the foot and ankle, and treat not only foot pain, but leg, knee, even back pain. That much of Root theory was based on “science” rather than science, we only found out about later. And nowadays Root has been, I think undeservedly, throughly discredited by academia (some of whom, it should be remembered, may never have treated a patient out in the real world).

So what are we left with, and where are we going?
Injection therapy is very promising, and my own field of medicolegal Podiatry is vastly under-utilised, but what do others think?

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