% of typical patients of the podiatrist

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I am curious to see what types of people podiatrists treat, just an approximate indication of those who are elderly, with diabetes and children or are getting treatment for sports related activities.

There is of course the stereotype of the elderly person getting there toe nails clipped being the overwhelming majority but I would like to be proven wrong !

 

Hello Product Engineer at Delcam,

In my role working in Podiatric Foot & Ankle Surgery i see a the whole range of patients from elderly patients needing a toe amp, to sports enthusiasts needing a post tib repair.

In my private practice i consult with and treat patients (non surgical) with musculoskeletal foot and ankle problems, from children, sports injuries, elderly degenerative change and a little of Aesthetic Podiatry in the form of dermal filler and silicone injection therapy for those ladies in eternal high heels.

I also volunteer for a homeless charity where general footcare needs are warranted by all age ranges.

At the university where i lecture the clinic there again sees the whole plethora of patients, although first years will mainly see elderly patients for palliative foot care.

 

Actually the bulk of my private patients are under 50 years of age, with maybe only 10% being elderly (70 years +).

In my experience (with private practice at least) many older people's first consideration is price. Many have told me they would rather save £10 and book a FHP or someone unqualified, rather than a podiatrist. So whilst I get an awful lot of enquiries from older folk, very few actually book me.

 

Delcam,
The bulk of my patients are those of retirement age (over 55) - not sure what age-group you would class as "elderly" as folks are living longer, healthier lives these days?

However, I do treat all age groups and all Podiatry conditions except sports injuries, which I refer to a physio or MSK Pod and injection therapies which I refer to a practitioner trained in that area.
When I say "injection therapies" I mean dermal fillers and cortisone injections, not basic LA which I can perform myself
Obviously those patients who I feel need an imput from a Pod Surgeon will also be referred.

With the increase in the incidence of Maturity Onset Diabetes in recent years, I would now estimate that 10% of my patients are Diabetic Type 2.

Catgut

 

Naturally, as an FHP, the scope of my work is more limited to routine foot care, nail care, corns, callus,verrucae,fungal infections and so on. Generally, with aging, comes difficulty bending , gripping, moving etc, and also that is often when nails thicken and pressures begin to build up, causing corns etc .: most of my patients fall into the >55 bracket.

Incidently, my work comes vitually all by recommendation. I am NOT cheap, but offer good all round basic foot care, leaving my patients feet feeling great; which therefore allows me to charge what I do.

 

Footsie,

So what conditions would fall outside your scope of practice, and what would you refer on to a Podiatrist?

Curious Cat

 

An ingrown nail not managed conseravtively and requiring surgery. Someone needing a gait assessment for prescription orthotics. I may refer to physio for spinal assessment. Thats not an exhaustive list...

 

You can´t be serious - you have gone over this area time and time again . If history is correct , It will only end in a closed thread. Maybe keep this one the the thread question.

Ps 95%of my patient are Biomex or MSK problems. Average age really depends on the time of the year.

The other 5 % are corns and callous patients.

When the snow melts and people start running again the average will drop, strange but what Ive noticed over the last couple of years.

 

I'm presuming of you would have dealt with multidisciplinary teams when referring to other specialists. Does documentation become difficult or have you devised some "common format" which travels around with the patient and mutually understood by all?

Following on from Catfoot's comment. I sense Podiatrists and FHP all have certain skillsets/conditions they can treat and some they can't. Is there some 'decisions' that are set in stone for things that you would always defer to a person better suited to make a judgement? - for instance a particularly bad lower foot ulceration or a knee problem?

 

It depends on what or if you have choose a specialist field- ie Foot ulcer - I will try and make comfortiable and refer to a specialist team - Which has been proven to have a better result - Ive seen 1 ulcer in 4 years so not that likely.

Knee problems - I might work with a physio as a team , but I´m not likely to refer, Podiatrist are specialist in foot and leg biomechanic issues, I think lots of people forget that. But this changes if the patient needs surg. not our area refer.

 

I agree with you Mike, Podiatrists are (or should be) specialists in lower extremity biomechanics. However I do disagree about not referring patients to Physio - I would have no problem with this. Yes they are not necessarily the specialists with respect to lower extremity biomechanics, but by the same token we are not the specialists in tissue normalisation, neuro-muscular rehabilitation/education and exercise prescription. All things which our theoretical patient with a knee issue may require.

Think of it less as 'referring on' and more as 'shared care' (or multidisciplinary working)

Ian

 

I think we said the same thing ?

I was meaning out right referral as in we are not involved - but the 3 head approach - Patient , Podiatrist and Physio.

 

I would think/hope we would still be involved with the episode of care even if we referred them out? This is the basis of how a multidisciplinary team works, no?

I was always taught that working 'in a team' was classed as interdisciplinary care, as opposed to multidisciplinary care described above. Sounds like nit-picking with respect to the terminology but it is clear they are different things and have different benefits.

So are you saying you only work with Physios in an interdisciplinary way (and not multidisciplinary)?

Just interested - not looking for a fight. Infact I'm in a great mood as I have just seen my boyhood hero Mr Gary Lineker signing copies of his new book in Canary Wharf. I only went out for a sandwich. Result.

 

No, No fights.

so if I understand this correctly.

Interdisciplinary - consult between 2 or more health providers and the patient at the same time

Multidisciplinary - consult on the same patient by 2 or more heath providers at seperate times with correspondence between heath care providors about said patient.

If I´ve got that correct I take the multidisciplinary approach, and still would call this the team approach but I get you point. So will stop referring to this as the team approach.

ps what you % of patient and average age.

PPS congrates on the getting Gary´s scribble - I guess - Gary who

 

Delcam,
The basic Standards for Chiropodists/podiatrists are detailed below. These are set by the Government Regulator the HPC and available to the public on thier website.

http://www.hpc-uk.org/assets/documents/10000DBBStandards_of_Proficiency_Chiropodists.pdf

FHPs have no equivalent Standards (that I have seen) as they are not regulated by Statute . Hence my question earlier that seemed to cause a problem to a Moderator.

Not all Pods are annotated on the HPC register to use Local Analgesia or prescription only medicines so that could impact on their Scope of Practice. Alternatively some Pods decide to specialise in Foot Surgery and train as Podiatric Surgeons.

I don't believe that everyone can be good at everything hence my reluctance to be drawn into knee, hip and back problems.

I send all recalcitrant (Diabetic) ulcers to the specialist podiatry team at the local hospital as, not only do they have access to surgical facilities if required, it removes the cost implication to the patient.

CF

 

Yep, with respect to the inter/multi thing thats about the size of it. I'm sure I have some articles somewhere about the key differences and benefits etc - will dig them out. I guess the main point for me was that I believe Physio's have a big role in the rehab of musculoskeletal complaints (concurrent to ourselves of course )

For me, 99% sports injuries and age barely falls outside of the 18-45 bracket.

GARY WHO? pah. You bloody antipodeans (or are you officially Scandinavian yet?) and your ignorance about footballing legends...

 

I´ll always be a lad from the land down under and always be ignorant of soccer () legends.

 

You see Mike, in the U.K. soccer is a gentleman's game for ruffians, whilst rugby (union) is a ruffian's game for gentlemen.

This is different to Oz, where all games - even cricket - are for ruffians.

By the way, have you clocked the England v Pakistan Tests in Scandiland? I seem to recall that Pakistan did rather well recently against a certain southern hemisphere country. Was it NZ?, or South Africa?

All the best

Bill

 

Not long now we will be able to begin the 2010-2011 ashes thread.

As you found out when the Pakistan team are on they are unstoppable then only problem is it happens not very often, but their bowlers did the job on you top order I noticed.

 

Yeah, well that was only because the air was like soup and the ball bent like a banana! It won't in the Ashes.

Bill