Where the profession is heading…..

[Anonymous]

https://www.facebook.com/photo.php?fbid=1717528898316521&set=pcb.1721309781283598&type=3&ifg=1

[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?

• This reply was modified 5 years, 11 months ago by .

[Anonymous]

Forgot to add, degrees – which are not exclusive to Podiatry. All the PAMs were given degree status at the same time, and POMs, which are also not exclusive to Podiatry.

It’s easy to forget that when we started using LA in the early 1970’s it was very cutting edge. The only other people who could legally obtain and use LA were Dentists and Doctors/Consultants.
Orthotic therapy was similarly cutting edge, but gradually Physio’s and Orthotists, Osteopaths and Chiropractors smelled a profit and got in on the act. Commercial Labs (and eventually the High St) were happy to sell to anyone of course.

[Admin IOCP]

Hi David
The link isn’t working for me so unsure if we can post links on here
Best wishes
Julie

[Admin IOCP]

Hi David
The link isn’t working for me so unsure if we can post links on here
Best wishes
Julie

[Anonymous]

Ji Julie,

Works from my end.

Regards,

David

[Anonymous]

Some of the treatment modalities offered to Podiatrists are expensive to purchase, and may not live up to sales claims. I’m thinking particularly of laser therapy for fungal nails. This is a treatment which I discussed at length with a member at Conference the year before last. It is not particularly highly thought-of amongst those “in the know”.

I was thinking about laser therapy last week for some reason, when something else which has been on the periphery of my new treatment modality radar popped up, in the shape of a rep wanting to publicise his diagnostic ultrasound machines.

These are expensive! the black and white basic model is over £4,000.00. The top-of-the-range colour hi-definition model is over £10,000.00. But they do work. They can be found in various NHS departments where they are used to pinpoint soft tissue injury, and to grade severity, and I think they can also be used to guide a needle for cortisone injections.

So, useful in Podiatry? In general footcare, no. But in a Sports Podiatry practice, or injection therapy, probably.

[Anonymous]

An item on FB caught my attention last week. The College of Podiatry (the Society education arm) had a vote and decided to drop the “Chiropody” label from their title. This was much-vaunted as heralding a new dawn for UK Podiatry. Will it? Probably not, but lets wait and see.

What annoys me is that the College of Podiatry insist they represent all UK Chiropodists and Podiatrists, when they clearly don’t. They represent the biggest professional body, and can shout the loudest, is all.
Let’s not forget that it was the Society who, in 1968, “saw no reason for properly-trained chiropodists to have access to local anaesthesia. Or in 1975 wanted to limit our use of local anaesthetic to 1% lignocaine. I will also mention an underhand attempt to poach Institute members in 2003.

I concede that one initiative from the Society, that of helping to establish a Faculty of Podiatric Medicine at the Royal College of Physicians and Surgeons of Glasgow, has been a good move for the UK profession – so well done to them for that.

However, in spite of all the rhetoric from the Society about being hand-in-hand with the HCPC and the Dept of Health, I don’t see NHS Podiatrists being paid any more. Neither do I see, apart from a few far-sighted individual members of the Society, a genuine desire to bring the three main professional bodies together and accept that FHPs are indeed part of our overall UK footcare profession.

What would make a huge improvement (IMO) to the UK profession is the formation of a national General Podiatry Council where we all had a say in how the profession develops. Until we have a professional bodies balance-of-power change though, that is unlikely to happen, at least in my professional lifetime.

• This reply was modified 5 years, 10 months ago by .

[Rita-Hallam CH19497]

Hi David
I am following your posts with interest, I do hope others are too.
Just wanted you to know that they are being read as not many responses are posted.

[Phil]

Good morning all from a very warm Rugeley.

Like Rita, read your well written comments with interest. I am not a political animal and maybe very naive about may things with our profession so your posts informative cheers David.

I am dismayed that the profession I trained for and qualified in, A chiropodist in the field of Chiropody is almost becoming a dirty word. The case of Mark Russell is an interesting one in this case:

https://www.hcpc-uk.org/mediaandevents/pressreleases/index.asp?id=706

He has a BSC in Chiropody, appropriate at the time, he decides not to join the HCPC and they prosecute him for using his title he is very well formally recognised for being able to carry out appropriate footcare.

So simply put I am a chiropodist, it says so on my qualification certificate. I am a member of the HCPC who also confirm this is my title I now have to pay for the privilege of having every year. However it is becoming an unpleasant smell within the profession and the Society dropping the title condones the sneering carried out by many Podiatrists who look down their noses at practitioners like me.

A General Council is a possibility but like a coalition government I feel is destined for failure. I don’t perceive that there will ever be a mending of the deep and long standing divide of the professional bodies as long as it is encouraged to have a 3 tier system of professionality. I.e: FHP’s, Chiropodists, Podiatrists.

How many folk do we see now still clinging to the title ‘state registered’ over HCPC registered because old descriptions, though obsolete, are still recognised…? As younger folk come through the ranks am sure it will become a memory and an article in history books but cannot deny IMO in the current day and age chiropodists still have their place….

[Anonymous]

Hi Rita and Phil,

Rita, thanks for those kind words.
Phil, the reality is that in the uk we have four tiers of foot-carers: FHPs, Chiropodists/Podiatrists, Specialist Podiatrists/Consultants, and Podiatric Surgeons. I bet not too many of our members look down their noses at you btw.

I see nothing wrong with having a tier system. For me it’s a nice ladder which anyone can progress forward on, as far as they like. Our own professional body offers training which will allow you to move into the Specialist Podiatrist band, if you choose to do so. If you want to remain as you are, they will support that too. Really, the strike-out of “chiropody” by the Society is meaningless, unless the HCPC decide to do the same. The “State Registered” title is a defunct title, but yes, some people cling onto it!

Forget the professional bodies for a minute – our real professional stability comes from being registered with the HCPC. Chiropody and Podiatry – that’s what we are all registered under – even the Pod Surgeons!

[Anonymous]

A FB post by Somuz caught my eye over the weekend. The IOCP are about to offer a Certificate in ultrasound-guided injections. I had no prior knowledge of this when I made my post about diagnostic ultrasound (see above).

So that members are aware – we are streets ahead of any other UK Podiatry professional body in this area.
Question were also asked about availability of dermal fillers, and what we may need or not need in the way of independent prescribing rights. This is NOT my area of expertise. I do know that if a Podiatrist has a local anaesthetics Certificate he/she can already legally obtain a 1% solution of cortisone for administration by injection.

One can see which direction we are heading in. It is a good thing, in my opinion, and it is right that the IOCP are leading the way.

[Anonymous]

Correction – that should read – ultrasound diagnostics – assume it will lead on to US-guided injections. DH

[Author]

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