"Podiatrists... don't have a medical background or the experience to look at the complexity of the f

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Found this

http://www.timesonline.co.uk/tol/life_and_style/health/article5675591.ece

on the Times Online (uk) website dated 7th Feb, written by an Orthopod called Mark Davies who calls himself a "foot surgeon"

he says....

" Invariably, the right person is an orthopaedic surgeon specialising in foot and ankle surgery, but people tend to think first of podiatrists and chiropodists (two names for the same profession). They don't have a medical background or the experience to look at the complexity of the foot in relationship to the rest of the body. That is fine if you want a corn removed, but they often don't get to the cause of the corn."

and....

"Corns and calluses are usually the result of a bone prominence rubbing against another bone, causing hard skin. You can get that corrected surgically, so the corn doesn't come back. It is an easy condition to treat and you won't have to spend the rest of your life visiting the chiropodist".

Seems to me he hasnt heard of biomechanics or orthoses? Seems a bit drastic advising people to visit a surgeon before a Podiatrist!

 

Every profession has underrated weaknesses. Orthopaedic surgeons (I haven't dealt enough with pod surgeons, but I will lump them in the same boat) for instance, most of them anyway, have no idea about rehabilitation. "Peroneal strength" and "proprioception" is the dogmatic prescription. They can cut, drill, sew, and read an MRI report. The have the best understanding of tissue healing rates pertaining to a situation. They can say "put up with it". They can say lose weight.But that is really the book-ends of therapy. They have no idea about the early warning signs post-surgery that things aren't going well. Just A and Z. Its the 24 letters in-between that often makes them look like rabbits in headlights. There are exceptions of course.

As for physiotherapists, well its core strength or nothing these days. Do they know enough below the knee?

As for podiatrists, do we know enough above the STJ?

As for chiropractors, most of them are spino-centric.


I feel sorry for the lay person with a musculo-skeletal problem.



Ron
Physiotherapist (Masters) & Podiatrists

 

Excellent, excellent! Well done that man (if anyone didn't get the heavy use of sarcasm upto this point, I was being sarcastic :dizzy. I would have put my house on that being a quote from an orthopaedic surgeon. It's a shame that the media tend to publish these types of story without publishing the other side's take on the situation, but that might not make such an interesting story?

This article is a poor attempt for Mark Davies to publish his private foot surgery clinic by rubbishing the efforts of a set of people who provide a more complete set of treatments for foot and ankle pathology. We could spend time arguing each of the ridiculous claims he makes, or we could spend time feeling sorry for the podiatrists (and podiatric surgeon) that work with him in his private clinic, or we could spend time working towards making sure the public are aware that podiatrists and podiatric surgeons are best placed to treat foot and ankle problems.

I recognise that some orthopaedic surgeons may offer good foot surgery. Not all are quite as bad as my local orthos. I hope Davies is good at what he does for the sake of his patients. Shame he has to put down the work of GPs and pods to attempt make himself look better.

 

It is such a shame that our profession is being rubbished off so readily, yet we study so hard. Perhaps this person should have visited the Podiatric Universities to find out exactly what we study, maybe even take a few of the modules and see they fair!!

 

such a shame to still see Medical Practitioners stooping low to bag others. . . No respect - i wander what his patients are being misled to believe - scary thought

 

Best thing to do is get some advertising done for your services, and put some friendly pressure on your professional body to get some marketing done to offset this load of old cobblers.

Hope all your practices have a good year

 

Say it costs Minimum of $1500 for ortho surgery on that Boney Prominence, IF you divide , say $40 into it thats about 38* ($40) podiatry cut and come agains, divided by 4 (every 3 months) you have about 9 and a bit years of Pod Rx , where we also help any other problems and modif shoes insole etc etc etc .....along the way..... What was the regression rate for surgery of bunnions etc again? I have heard about a local Ortho who tossed a referral letter from a local pod in the bin (without even opening the envelope) infront of the Patient.......The Beat goes on...................

 

Wonderful thing Google...

Mark S. Davies http://www.londonfootandanklecentre.co.uk/specialists/our_specialists.php

Sounds impressive...

What scares me that there are TWO podiatrists that work in his clinic.

Less surprising is that there is an ex-president of the British Orthopaedic Foot Surgery Society there too...

Somehow reminds me of the recent story about the British orthopaedic surgeon who recently took part in a hunting trip to Africa that killed an entire herd of elephants.

Medical politics...:bang:

LL

 

Orthopaedic surgery for corns? Seems a bit aggressive treatment to me. Isn't surgery the treatment of last resort. He must think he is a primary health care provider. At least he is upholding the standing of surgeons as being arrogant twits.

 

Not surprised at all. I work as a Podiatrist in the NHS in the West of Scotland and occassionally have patients come back for replacement orthotics because they have been to see an ortho surgeon who has thrown thier orthotics in the bin because"they are useless".......then paitients pain returns as the don't have their orthotics and frantically call for an urgent appointment toget new ones!!! I'm sure this "phenonimon" is not restricted to the WoS :bang::boxing:

 

My 2 cents on this subject (for USA practitioners at least),

The orthopedic Foot & Ankle surgeons I know (one's that have had a fellowship in Foot and Ankle surgery) are VERY VERY well trained for just what they say they are - orthopedic foot and ankle surgery. The only slight problem I see with these specialists is that most also do general orthopedics and take ER call and do a fair amount of general ortho surgery, so they are not 100% foot and ankle. Some are.

On the other hand you have the Podiatric trained Foot & Ankle surgeons. There seems to be a disparity in training for us where some are VERY well trained and some not. It also depends on the post training practice they are able to have. Some of these have incredibly good training and spend half their time doing general podiatry so the lack of experience factors in. I would have to agree that the general medical background for orthopedic foot & ankle surgeons is better than a DPM's.

When either one is a referral destination for "tough" foot and ankle cases then, by experience if nothing else, they improve with time.

BTW: I'd like to comment on the "corn" issue as well.
If I see a patient with a corn they are a surgical patient because that is why they came to me.
I think there is a misunderstanding about conservative care vs surgery, at times, in these threads. When a patient is referred to a foot and ankle surgeon they usually are expecting a surgical consultation and a suggestion, at least, on a surgical treatment for their problem. If they want palliative care they normally go somewhere else.
Speaking only for myself and my practice of course, we do not perform palliative or routine care. New patients know this prior to their visit so if they are expecting palliative care they do not make an appointment.

Steve

 

This funnel effect can be created by the attitudes of the health professionals a patient sees, not necessarily their own preferences. You end end up with people who have been "sent" to you as well as people who are there by their own choice. It is a little naive to pretend otherwise, the degree of influence of "doctors" over their patients is enormous. One quote I like is that"If all you have in your tool bag is a hammer, suddenly everything you see is a nail"
This principle tends to apply to all of us one way or another.
regards Phill Carter

 

I contacted the Society of Chiropodists & Podiatrists re the article and asked them what action they would take re the article in the paper, I very quickly got a reply as follows -

Thank you for your email to The Society of Chiropodists and Podiatrists about the article in The Times over the weekend. We are dismayed that these old arguments have been given column space. Together with the Dean of the Faculty of Surgery, we have written to the editor, a copy of this letter is attached, this will also be published on our members website. Historically, we have had a positive relationship with The Times Body & Soul, and they have published many, many articles with quotes from our Society spokespeople, who are podiatric surgeons/ consultant podiatric surgeons. We have also noted in the past few months that there seems to be greater effort from some orthopaedic surgeons to discredit podiatrists and podiatric surgeons. Fortunately, analysis of the negative publicity shows that it is far outweighed by positive coverage, never-the-less, in the medium to longer term, we are working on strengthening our relationships with the health editors and medical journalists at the broadsheets in particular. With the Faculty of Surgery, we are also publishing a brochure about podiatric surgery, and have boosted the information about surgery on the public website and will continue to work with podiatric surgeons to increase this information. The Faculty are also working to improve the relationship with orthopaedic surgeons in England and Wales. I note the broadly supportive comments from readers/patients in The Times Online. The more patients who are able to add positive comments such as these will support our position. Once again, thank you for contacting the Society, and I trust that our approach has reassured you of our commitment to publicise the profession's expertise. Yours sincerelyNita ParmarDirector of Marketing and CommunicationsThe Society of Chiropodists and Podiatrists


Here is the letter -

11 February 2009

The Editor
The Times
1 Pennington Street
London
E98 1TT




SIR

FOOT PAIN

We read with some disappointment the article "Doctor,Doctor: foot pain
that won't go away". It is misleading, at best, to suggest that chiropodists / podiatrists are not skilled in considering the cause of corns. Podiatrists (and chiropodists) undergo extensive training in the assessment, diagnosis and management of foot pathology and its relationship to systemic disease.

Surgery is not suitable for everyone and is not without risk and complication. In many instances, patients undertake a course of conservative care before considering surgery, as this may be sufficient to allow pain free activity. Indeed, podiatrists are the only professionals trained specifically to manage foot related pathology. Podiatric surgeons are podiatrists who will have undertaken a degree in podiatry and eight years postgraduate study and, at consultant level, will have considerable experience of operating on the foot and ankle. Furthermore, they have the additional benefit of the foundation of conservative care, which is all but absent in the training of doctors.

Access to podiatrists and podiatric surgeons is available in both the
private and public sectors and prospective patients should be reassured
that they will receive a comprehensive assessment and opinion.

Yours sincerely


Ms Joanna Brown
Chief Executive
The Society of Chiropodists and Podiatrists

 

Nice one! Well done, and well done to socap for the response. I wonder if the Royal College of General Practitioners have also responded to Davies' slur? Anyone know their forum or a GP that might be interested to see the attitude of this ortho?

 

Podiatric surgeons UK, seems your time is drawing to a close. Game over; they (FRCS) really do want their balls back, and I've no doubt they'll castrate you to get them, shame that we'll all get caught up in the process.

 

What are you on about Simon? Why be divisive in the face of adversity? It seems a funny attitude to take. Hope you're feeling OK.

 

Simon

This is just the same old school yard bullying stuff that happens just as much between medical specialties, as it does with between 'them and us'.

When confronted with a bully, it is better to give them a whack on the noggin' then let them have their way.

Heaven forbid we go back to the bad old days of outrageously poor quality orthopaedic foot surgery without any other alternative for patients who require some degree of understanding of foot function to fix their problem...let alone letting the public think we don't understand what causes a corn!

Providing surgical care is just a matter of getting appropriate training and exposure.

LL

 

Just an opinion, Bob. Time will reveal it's accuracy.

 

Dear All,

Over the last 20 years of Pod Practice i have only two kinds of patients who have had Foot Surgery from an Orthopaedic Surgeon.

They are :

A: They want to marry him/her.:drinks

B: They want to kill him/her.:butcher:

Never met anybody in between.

There are many options to choose prior to surgical intervention, and IMHO surgical intervention should the option of last resort as the result is final and permanent what ever the outcome.

So start with a decent pair of well designed and made shoes.

Then if appropriate Orthotics and ensure footwear is suitable for the orthotics.

Regular Podiatric Care to provide symptomatic relief from any skin lesions.

Should syptoms become such that surgical intervention is indicated then consider it EXTREMELY CAREFULLY, as there is no going back after surgery. One also has to consider that the surgical intervention is lifed so age of pt is important otherwise if too young they will need a revision at a later date.

regards a HUMBLE CORN CUTTER:bash:

 

Got to agree with Simon on this one. In Scotland "they" never really gave up their "BALLS" in the first place. Up here there was/is supposed to be a memorandom of agreement between SoCaP and the TWO Royal Colleges of Surgery about introducing Podiatric Surgery in Scotland . Can't remember how long ago this "happened" but still no sight of said Surgeon!! Perhaps someone working in Glasgow knows more as i believe it was in that city that they had to build their own theatre etc as the other side didn't want to share their "Balls"!!!!!!!!!! Then again the wheels of evolution do turn slowly up here and it still might happen:bang::boxing:

 

In the US many Podiatrists like myself were intelligent admitted to both Medical and Podiatric school. There were many orthopedists in the US who were not admitted to a US medical school (they went to Italy or Mexico) and some then became orthopedists because of their poor ability at medicine.
I do not know of the level of medical knowledge of orthopedists in the UK but would like a response from UK internists to ascertain their opinion of Orthopedists.
These are generalities and do not apply to all Podiatrists Orthopedists or Medical doctors there are good and bad in all fields. But we must not make blanket statements about an entire group of any one speciality. My surgical ability would compare well to any Orthopedist on foot surgery and I have assisted on many hips ankles and legs as well to know that all Orthopedists are not equal.
WE must not make blanket statements about an entire group of any one speciality.

 

It seems that he needs to wake up and get a life in the real world. :craig:

 

Face the facts...it is all about territory and $$$. I have worked with many orthopedists and with rare exception, they don't want to do feet. The only Orthopedist I know who did a foot/ankle fellowship was surgically inept and had uniformly poor outcome on knees and hands and what ever else he touched with a scalpel. I am not certain as to what made him think doing a foot/ankle fellowship was going to improve his surgical skills. I do not mean to take away from foot/ankle fellowship trained orthopedic surgeons. Most of them are very good at what they do and most of them don't want to waste their time with a hammer toe. But...I have not met very many foot/ankle fellowship trained orthopedic surgeons. More money in hips/knees/hands/spines. Those orthopedists that can work in those arenas, do. Those that can't.....do foot/ankle fellowships. As an aside, my best friend is well known Orthopedic Surgeon who specialized in spine. Lectures worldwide. Authored many articles. Holds patents on spine surgery implants. Had no interest in feet. Had no need to. Makes more money doing spine. The bottom line.....it is all about economics.

 

Les,

my understanding was that the "failure" to appoint a pod surgeon in Glasgow was nothing to do with orthopaedic opposition or their stance on podiatric surgery.

I think the post was advertised and the job was actually offered to an individual who subsequently turned down the job.

Have to say, that is greater progress than in N.Ire which seems to be even further behind. Having said that, podiatric surgery there is going well in the private sector. Orthopaedics probably don't like it but that's their problem and they do not have the authority to prevent it. They can, I am sure make it difficult but that is different to preventing it!

Maybe I have my facts wrong but that is my current understanding on the matter.
I am confident and optimistic that podiatric surgery will continue to progress and offer a high standard of care to patients.
I am the 1st to admit that I have a bias opinion on the matter but it's an opinion none the less!

Regards,
Ryan

I'm a Celtic fan so I know all about success and am the ever optimist!!!

 

Hi Ryan,

Thanks for the update about pod surgeon. Not sure how accepting the ortho surgeons are, as just over a year ago??? was at a meeting & one of the speakers talked about the "obstacles" he/they had to overcome to get pod surgery off the ground!! At same venue it was intimated(no more than a rumour) that Ortho surgeons were encouraging their trainees to specialise in foot & ankle surgery to keep the pod surgeons out!!! like i say it was rumoured in the coffee chit-chat nothing official.:butcher:

Cheers

Les.

P.s.Will you still know all about success & be ever the optimist on Sunday night??? I know how i will be feeling............ it's only the Hibeeees!!!! Like i said I know all about dis...................:bang::drinks:deadhorse:

 

Happy Mardi Gras!
It appears these quotes from an orthopedic surgeon got "under your skin."
In the US, there is some conflict between orthopods doing foot and ankle surgery vs. podiatrists trained to do the same type of surgery.
I have seen excellent outcomes from both groups, and horrible outcomes from both groups, as well.
For some reason, I was blessed and continue to be blessed with exposure to great surgeons and exposure to amazing conservative practitioners. I have learned a great deal from both. Not everyone needs surgery, and not everyone will benefit from orthoses. Age, activity, medical history, all factor in when developing treatment plans.
A "corn," as it was referred to, should be treated differently for different people. In a 23-year-old NFL cheerleader, active, healthy, enjoying her off-season, having tried wider shoes and orthotics, a simple digital arthroplasty solves her problem and gives a great outcome. The same "corn" on her grandmother's foot, a 77-year old diabetic with neuropathy, CHF, and PVD, will not have the same surgery from me... she will probably have extra-depth shoes, custom, accomodative orthoses, and careful education to her and her family...

If the negative comments bother you, they shouldn't. If you are secure in your knowledge that you are well-trained, his dumb comments will roll right off your back--- they are rooted in limited exposure and ignorance.
Did I say "Happy Mardi Gras!?"
-John

 

Oh Hell, looks like I'll have to change my last name!!!

KIWI AD

 

"In a 23-year-old NFL cheerleader, active, healthy, enjoying her off-season......."

John: If she needs a second opinion PLEASE send her over!!!!! I won't even charge her.

Steve

 

My understanding was that the post was cancelled prior to interviews

 

MON THE HOOPS

 

I believe that as health professionals we are accountable for public statements we make, expecially when in this case the Orthopod surgeon was clearly putting down Podiatry to make himself look better. I am an Australian Podiatrist working in Perth, and we all shake in fear of our Registration Board who must investigate every complaint made to it. I wonder whether there is a Registration Board or similar that could make this guy accountable? After all, his comments reflect badly on his profession. A complaint from the local Podiatry association would carry more weight.

cheers

Burke

 

I agree that most podiatrists in England have only a BSc. However, this is specifically related to the foot. Personally, I trained as a nurse, worked for many years in the NHS, then went to university & did 3 years clinical course (no accreditation of prior learning), so that I could function as a podiatrist. I have no illusions of being a 'foot doctor'. I look after the feet of people in my care to the best of my ability, and use the experience I gained as a nurse, to consider the whole patient. My patients are not rich, nor are their needs addressed by the NHS. I try to be co-operative and use humility. I know a GP has far wider experience than do I. I know that a GP needs to know what is going on with his patient. I understand that they are the lynchpin and gateway. What I may think is a problem, given my limited diagnostic tools, may be nothing, but I want the best for my patient, and want to work with the system. Sometimes, you know, a decent pair of shoes will sort out those corns, and if we all referred corns to an orthopaedic surgeon, what would happen? Please don't take us for charlatans, we do have skills, and we want to work with you, not against you. I regularly refer patients to relevant surgeons because I know I can offer nothing, and surgery may be their only option. I also tell people that surgeons are not magicians, and sometimes, neither can they.

 

Quick update on this situation!

In this months issue of Podiatry Now, in the letters section, there is a letter from Jo Jackson of Gosport, hilighting Mark Davies' comments, but also bringing to the Editor's attention that the very same Mark Davies is due to lecture at the 'Refresh' MDT conference on 20th - 21st May at Birmingham NEC and he will actually be addressing his lecture to the Podiatry and Chiropody programme, which is being chaired by the SCP Chairman.

The editor, in their response to Jo Jackson's letter does not address this fact, but does say that Mark Davies has contacted the Chief Executive of the SCP to say that 'he was misquoted by the Times journalist and stating that he holds Podiatrists in high regard'!

When I first read his Times article a few weeks ago, I immediately recognised it as a way to drum up business for his private practive, because if patients are seeing Podiatrists, then those are patients whose income may be lost to the surgeons. However, I thought I recognised his name as being associated with the London Foot and Ankle clinc and, as previously mentioned he actually works with Podiatrists in his private practice (if you are one of them, please, please, tell us how you feel about this!), which makes his comments all the more disturbing.

If this was the other way around and a Podiatrist had published detrimental comments about Orthopaedic Foot and Ankle Surgeons, their representative body would have gone bananas and launched a very public attack in response to the comments, however, the SCP, although they have very ploitely responded to his comments, cannot kick up a storm because Orthopaedics are a larger and more powerful group of people than Podiatrists and I think it would be fair to say that we all work with Orthopods who are not like this (at least, not to our faces!)

What I think would be much more poignant would be for anyone going to the Conference to do one of 2 things:

1) Bombard him with questions relating to his comments before, during, or after his lecture.
2) Boycott the lecture entirely

or, at the very least, we should be contacting the SCP chairman expressing our disquiet on this issue......it makes me want to go to that conference just to sit there and ask him to explain his comments!!!