Elevating the status of the profession.

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Dear All,
I make no apolology for stealing the idea of this thread from another forum (Thatfootsite in fact! ).
There has been a question raised as to whether podiatry practitioners embracing new modalities, such as botox, prolotherapy and collagen injections (for cosmetic as well as for medical reasons) would enhance the status of the profession.
The thread on the other forum seems to have floundered, as no-one can define what exactly "the profession" is.
However, despite that, I think it is an interesting subject for discussion, so I am throwing it open to a wider audience.
Dido

 

Hi Dido,

Better add another modality which is currently being discussed (but not on TFS), that of injecting sclerosing agents to destroy thread-veins. This was being done by a (very) few Pods in the 70's, and seems to have been resurrected.

IMO what would elevate the status of the UK profession, certainly in the UK, is better training.
This starts with weeding out the applicants who will never make the grade, rather than Schools going for bums on seats, which is what seems to be happening currently.

I'm sure that Botox, dermal fillers etc will not elevate the status of the profession, but even with cosmetic procedures thrown in as a side-line, provided the training is good and the clinician is skilled I think they will elevate the status of individual practitioners, which reflects back on the profession.

The thorny issue of FHPs (Foot Health Professionals for those outside of the UK) also crops up frequently, and I cannot see why we cannot have a two-tier profession in the UK, but given that many Pods are practicing beneath their skill-level I can see how some people feel threatened by FHPs.

I'll let someone else define our profession.

 

Hi Dido and David

The status of the profession is suffering at the moment because of confusion by the public and the medical profession as to what we actually do! How is the public going to react when we tell them we can fix their crows feet at the same time we fix the feet on the end of their legs?

I cannot see any of these modalities being pursued by more than a handful of practitioners who are either more adventurous or want to make more money than routine podiatry can offer. It will be after all a very small minority that will benefit podiatrically and personally , if I was choosing a cosmetic proceedure I would tent to select a practitioner with a more appropriate/relevant background.


David, in what way do you consider that many Pods are practising below their skill level?
There is a lot of routine work in the profession due to an ageing population, and not all of us are going to be dealing with the specialised areas all of the time. But that does not mean we are working below an acceptable skill level.

Cornmerchant

 

Hi Cornmerchant,

You said:
"The status of the profession is suffering at the moment because of confusion by the public and the medical profession as to what we actually do!"

I disgree, and futhermore would suggest that the public is no more confused about our profession that it was 20 or 30 years ago. At the risk of repeating myself (which I'm about to) if the professional bodies got together and did a big Public Relations number there would be no confusion whatsoever. That is very unlikely to happen now - reasons documented elsewhere on this forum.

Then you asked:
"David, in what way do you consider that many Pods are practising below their skill level?
There is a lot of routine work in the profession due to an ageing population, and not all of us are going to be dealing with the specialised areas all of the time. But that does not mean we are working below an acceptable skill level."


Everyone who has done a degree and is not using the knowledge gained from that degree is working below their skill level - perhaps I meant that - sorry for the confusion.
This includes being able to understand research papers, using LA on a regular basis, probably in conjunction with other modalities, and prescribing orthoses - prescription being based on rational thinking, and not (as some do) maintaining that "biomechanics doesn't work" or sentiments to that effect, without actually looking at the rationale behind biomech as practiced today.

Admittedly there are some pods who prescribe because it makes money, without actually knowing why they are prescribing, other than what they read on the box (of orthoses) and these too are practicing below their skill level.

You asked:
"How is the public going to react when we tell them we can fix their crows feet at the same time we fix the feet on the end of their legs?"

And although this is off-topic I would like to answer. What is interesting is that a Pod Practice which is piloting this type of work has found that many patients are first of all interested, and then want to know more. Of the ones who go on to have a cosmesis consultation, over 50% will elect to have treatment. These figures are anecdotal I'm afraid, but they make sense - our patients place a great deal of faith in us and our operating skills after all.

 

David
Thanks for your reply.
I still maintain that as a degree Pod, not all of my skills can be utilised all the time but I am a generalist practitioner amd have to do the work that comes through the door.

As for cosmetic proceedures- most of my 80 year olds are well past the stage of wanting to look younger- now if I had the secret to life , well, that would be a different matter!

I believe that each practise will depend on the demographics of that area, and for me that means a great deal of palliative work. It does not mean that I do not understand research, I do perform LA on a regular basis and orthoses where appropriate.

cornmerchant

 

Sclerotherapy sounds interesting and certain closer to our area of practice than fixing frown lines!
Coincidentally, a colleague of mine attended a CPD lecture recently for which the speaker was a vascular surgeon. This technique was mentioned and questions were asked about performing the procedure. From the response given it seems that vascular surgeons are non too happy about podiatrists encroaching into their speciality. Possible complications were discussed in detail, included embolisms from fragments of the hardened sclerosing agent.
It would be interesting to hear from any podiatrists in UK, and other countries, who perform this (and the other procedures previously mentioned).
Dido

 

There is always a bandwagon of the year that many jump on; promote heavily; get blinded to the evidence due to the hype; use it to cure everything; and after a year or two it always finds it proper place (I have seen that pattern too many times).

The Podiatry section in any USA yellow pages is a good place to see what the current bandwagon is. A year or so a go, shockwave therapy was all the rage (and is following that familiar pattern; its use is starting to settle down to something more sensible now).

Is that good for the profession? .....depends on how much litigation results (minimal incision surgery followed that pattern and came back to haunt the profession in the USA due to the litigation; who remembers the yellow pages adverts and TV commercials and the promises they made for this?)

 

I'm sure that people will hate this...but to me, someone who a 'supposed' specialist in one area- (lower limb) doing something completely different from their specialist field (botox injections) just seems like a Jack of all trades, what springs to mind is the old fashioned 'quacks' who used to turn their hand to dentistry etc.........good for the status of the profession?

 

Must say that I agree with Cheesy 100%.

'The job, the whole job and nothing but the job' = professional integrity.

This does not restrict us from expanding our area of expertise or adding to that expertise.

Origins of the profession in Britain perhaps, but we do need to get away from doing a bit of chiropody along with reflexology, aromatherapy, botox, ear-piercing, etc, etc... Perhaps we do need a two-tier profession to free Podiatrists to be Podiatrists?

The profession of podiatry is finding it difficult to shed the Cinderella image that attached to its predecessor, chiropody. Chiropody is not Podiatry, whatever the definition of a government regulator stipulates.

I cannot agree that anyone in general practice in Podiatry can be engaged so deeply in regular palliative work that they have little room to exercise other aspects of their learning. Why do lesions need constant palliation? Are all modalities really fully employed to find resolution? Not just biomechanics, but materia medica, shoe modification, etc......

 

I suppose the issue here is what we consider to be acceptable areas to expand into. Cheesey you stated that you consider botox to be completely different from Podiatry and John bundled it with aromatherapy and ear piercing.

What, then, of the stroke patient with severe contracture of the flexor digitorum muscles leading to fixed clawing of the toes? What of the toe walkers who react so well to the combination of botox injections and serial casting? What as yet unexplored possibilities are there for the use of botox in biomechanics?

There are other areas with little or no evidence to support their use which podiatrists have embraced quite happily. Homeopathy springs to mind. There are those who will prescribe a 30C solution (or WATER as a mass spectrometer would call it) of a homeopathic remedy for care of corns, yet we balk at injections of a recognised drug!

Why?

Regards
Robert

 

no, I didn't mention aromatherapy or ear piercing.......

 

Robert

I feel that the original poster was commenting on the cosmetic application of botox- provided mainly by Pods who hold LA . Now this would obviously be in the private sector as it would not be affordable on the NHS.It seems to me that it was being promoted as an additional money spinner for those wanting to branch out. (Begs the question why if one is running a successful practise anyway)

The case you quote of contractures may well benefit from botox but would he NHS offer this as routine treatment and would there be a practitioner on place to provide it? I think not.

In my opinion, it does absolutely nothing to enhance the status of the profession because it is just blurring the edges even further.

Cornmerchant

 

My mistake. That was another.

At present? No they probably would not. But the same could once have been said of all sorts of other interventions. Pod surgery springs to mind as something which was brought in in the face of vigerous opposition from the established Orthopeadic clinicians. Now it is commonplace.

There must always be those who try something first. Perhaps it will wither as many interventions before it have withered. Perhaps it will become a useful mainline modality. But without brave souls who challenge the status quo, whether their motivations be money, advancement, respect or simply to carve a niche, how will new treatments gain prominance?

Regards
RObert

 

David,

I have some experience of this and to an extent agree with your point. Which school did you initially train at and have you been back there recently?

 

Robert

Not sure that you can actually compare Podiatric surgery with Botox?

Simon
Interesting quote from David h- on the one hand he is saying that the schools need to be more selective and only pick those students who can make the grade. But on the other hand, he himself is very closely allied to a private trainer who actually takes anyone prepared to pay the fee regardless of ability.

Just my thoughts

 

I was involved in a study of botox into calf muscles in CP children about ten years ago.

 

"I can't see for the tear gas, & the dollar signs in my eyes
Well, whats a man got left to fight for when he's bought his freedom..."
The the: Angels of Deception
http://www.youtube.com/watch?v=kJ-1TZrh_nA

 

This is exactly why we need functional closure of the profession, then we all know where we are and who does what.
Dido

 

Hi Simon,

I trained at Glasgow (68-71) and have been back once. I do have more recent experience of the student intake at Durham, where (this was not only my opinion but that of several lecturers too) a far part of the intake was never going to finish the course.

 

Off-topic, but interesting all the same that whilst you felt it necessary to point out my (rather loose) connection with SMAE, you neglected to mention two qualifying facts:
1. I do not train, or have anything to do with training Podiatrists. As you are probably aware, this can only be done by a University.

2. I do not train, or have anything to do with training FHPs.

 

What do you do for them then?

 

Classic, coming from someone who prefers to remain anonymous

 

Unpaid student mentoring, as needed.

 

Oh dear, I thought I was on a forum where there could be a free exchange of ideas and opinions without "sniping" and where one's anonymity was respected.
Must have logged into TFS by mistake. I'd better go and check.
Dido

 

???????????????

 

Off-topic, but I'll clarify.... just once.

Mentoring can take many different forms.
In this case I have been approached to mentor students, should they need it, on the new FHP Course. Nothing to do with teaching, everything to do with helping them with mundane day-to-day queries ("who should I ask about this?" - "where do I go for that?").

As I said, this is unpaid, although in fairness I have yet to be approached by any students.