Limitations & rules for treatment above the knee

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Hey folks

Could someone clear up for me

In Australia are we as podiatrists limited by only being allowed legally to treat conditions pertaining to the foot and lower leg ONLY , not including above the knee?

I have had this discussion with a collegue about the issue, as I have a patient with a hamstring strain who I have been advising treatment for?

I was taught at ubniversity how to treat thigh, hamstring, glut injuries so have been treating accordingly under the assumption that we are able to as podiatrists to treat lower limb conditions bellow the hip??

any help would be appreciated

thank you
Bren

 

Bren,

I am pretty sure none of the state regestration acts contain a definition of podiatry anymore, and the National act does not. The only professions that have such limitations are Dentistry and Optometry.
This means there is no direct limitation on what you can treat. It will come down to a mixture of community expectations, professional expectaions, you competance, what the university teaches etc.
So if the profession thought it OK for podiatrists to treat the thigh that is OK. It really becomes a grey area if such practises are not seen as core podiatry work.
As podiatrists we regularly use orthotic therapy to treat back problems (even if by just providing a heel lift) so treating the rest of the body via the foot is OK, but you also have to treat the whole patient.
clear as mud?

 

I'd go with that Stephens reply. When such a definition did exist, I understood it to be no invasive treatment knee or above.

As for myself, I am employed by physio and work in a paediatric MD clinic F/T and I happily and routinely treat up to the 'waist' for want of a better boundary. or L5 if you want to be specific. Clinically, I prefer to see the hips in our Joint clinic with both physio and myself, and the odd knee, although knees are not too bad when you see enough of them.

I justify this by:
a) university training was fully comprehensive for all structures below L5 and so am adequately trained to assess these structures
b) the type of treatment I would use in these situations is mostly muscular rehabilitation (stretching/strengthening agonist and antagonist relationships) and directly related to their gait. I would not do anything invasive.
c) working in a MD team, the physios and I work very closely and frequently inter-refer. It also means we have an instant source to refer to should there be any queries/oddities. This leads to a natural progression of each individuals skills and blurring of boundaries.

If I were not working in this environment, I might feel less comfortable being solo pratitioner for as many hip and knee problems as I see now, and would more likely to perhaps assess them, do what I can, determine their needs and refer on.

 

Is there a limitation implied in regards to indemnity insurance??
Do the insurance company you are insured by have a definition as to what THEY define as your area expertise?
You may need to check this out as it could mean an increase/change in level of insurance. I've been meaning to look into this as a chiro friend has asked if my insurance is appropriate, as I do hamstring/quad/TFL etc soft tissue release and trigger point therapy.
Regards
Liz

 

You should find that your insurance will cover you, as long as you meet the criteria above. ie: you should be covered for the practice of podiatry.

 

And fingernails?

As was pointed out to me by a Director of Nursing the other day - podiatrists are the best trained in cutting nails, they have the most suitable equipment with them all the time, they meet the infection control procedures - why aren't they routinely doing fingernails along with toenails?

Tricky to define podiatry and also hard to understand "community expectations" - most people are surprised we don't cut fingernails

Personally I'm happy working alongside physios for knees and hips and most seem happy to work together on patients - doesn't appear to be a shortage of available patients!

RStone

 

Regarding finger nails:
1)because our area of expertise is defined as geographical (ie. lower limb), not pertaining to tissue type or structure eg nails
2) insurance covers you for lower limb, not upper

 

Then why not get universities to include a lecture on 'fingernail cutting' (heaven forbid). Or hold a CE event - not sure who would teach it...?

Pathology, anatomy and other relevant medical issues are covered in current curriculum.

Problem solved.

LL

(bring on the podiatric hand surgeons now )

 

LL RStone and Sally,
The main issues with finger nails is they are not often pathalogical, so it is a hygiene issue (the same as non pathalogical toe nails) and in a hospital should be part of nursing care. Even if we look at the pathalogical, people with Diabetes and PVD develop ulcers and have amputations, such things for the upper limb are extremely rare, so hard to stuff up.
The Vic Board's position on finger nails, is that it is not part of the accepted scope of practice of podiatry, though there is nothing stopping a pod cutting finger nails, as long as no one complains

 

I read my insurance (UK) and fairly sure that I recall it said that we were allowed to do anything on the hand as long as it was analogous to the foot. Therefore -we can cut finger nails and be covered for it. I also thing it often better me doing it for a pt. than my pt - one inparticular doing it with a pen knife. Also in terms of age care -I do finger nails if they are long as I find that skin is often thin and can be scratched badly esp in the elderly with long sharp nails. I do however not advertise the fact that I will cut finger nails -and i know a lot of Pods who won't.

As for the hip thing I often seek physio advice for more complicated hip issues. But do what I feel confident with with what I feel competent to practice through my experience erring on the side of caution usually.

Interestingly enough my dry needling insurance is only covered to the knee - which is silly as we were taught to the hip.

I don't feel we do enough at Uni on the back. I certainly wouldn't do too much to do with the back.

 

Hi Guys,

I have just completed my first year of podiatry training here in the UK (BSc Hons Podiatry).

In our second year we cover orthopeadic & sports injuries (assessment & management) from the waist down and are examined and assessed in those subjects.

We also asked the question from our tutors about finger nails. Apparently the Society for Chiropody/Podiatry insurance does cover you to treat/cut/manage finger nail conditions.

Regards

Colin