How will the profession of podiatry develop in the future? According to Tim Kilmartin, Consultant Podiatric Surgeon at Ilkeston Hospital, it is vital for the podiatry profession to consolidate and make the right alliances with other healthcare professions. The consequences of not doing so are fragmentation and devaluation of the profession. Rebranding the podiatry profession is the key to ensuring acceptance and survival of the profession. In his recent article in Podiatry Now, Tim Kilmartin firmly points the podiatry profession in the right direction. The key points of the article are summarised below.
"We have diagnostic privilege and clinical autonomy, and we have medicines and surgery, and it is these that should push us closer to the medical and surgical professions."
In certain circles Podiatry is considered not important and without value. Fortunately this is not so in all cases. Podiatry is well thought of by those involved in the treatment of diabetes and rheumatology. Podiatric surgery and nail surgery under local anaesthetics are excellent examples of what podiatry can achieve. However, whilst podiatry is doing well in these areas, it falls short of covering one of the main areas in footcare. Podiatrists should be dominating foot pain in the general public.
Foot pain is a vast area of practice and in many cases patients are not being referred to podiatrists when they should be. This is largely due to poor diagnosis of many conditions, such as Morton’s neuroma and capsulitis of metatarsophalangeal joint. Podiatrists in musculoskeletal or specialist biomechanical posts often find foot pain is treated haphazardly outside of podiatry. There are a great many people suffering from a variety of conditions which cause foot pain. These conditions, such as Achilles tendinopathy, metatarsalgia, heel pain and flat feet are difficult to treat and could engage a large number of podiatrists.
Podiatrists should align themselves with the field of medicine. This must start by re-designing undergraduate podiatry courses to focus on the investigation, diagnosis and comprehensive management of foot pain. This training must be taught along exactly the same lines as medical students are taught. Podiatry students should share the pre-clinical foundation training of medicine and dentistry. Podiatrists should see podiatric surgery as a necessary part of the treatment of foot pain in cases where basic methods fail.
Continuing professional development offers an excellent opportunity for podiatrists to push the boundaries of the profession. Improved diagnosis could be carried out if podiatrists learnt how to use ultrasound scanners and hand-held dermatoscopes. The profession needs to understand the use of diagnostic imaging techniques, diagnostic blood tests, disease staging and management and gait analysis. Further to these fluoroscopy can be used for dynamic evaluation of the foot.
In order to push the boundaries of podiatry, podiatry assistants need to have a place in the hierarchy. Using helper grades will help push podiatrists to higher level. Podiatrists must also learn to refer patients other podiatrists who specialise in particular fields within podiatry.
"Local Anaesthesia is the jewel in the profession’s crown."
Ankle and regional blocks should be used routinely to allow painless, treatment, examination and diagnosis of conditions of the feet. Many podiatrists are restricted or reluctant to use LA, however its use would increase the patients respect for the podiatrist.
In order for the podiatry profession to flourish, evidence based data in the form of patient-reported outcomes are essential. Not only will these reports improve best practice the development of better care pathways, they will also lead to improved innovation and research within the profession. In order to best assess the outcomes patients must report their foot health status both before and after podiatric treatment.
The cost of not implementing patient-reported outcomes for every patient could be high if NHS funding is partly based upon proving how patients respond to treatment.
"While we continue to have any association with the arcane chiropody label we will continue to be underrated, disrespected and undervalued."
It is essential that the podiatry profession come together and consolidate through a single professional body. Vital to taking this step is chiropody – this word must be dropped. A single, new professional body must be created to represent podiatry and it should be called the General Podiatry Council (GPC).
Kilmartin, T. (2009). A Future for Podiatry?, Podiatry Now, 12, 10, October 2009.