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Clinical audit of core podiatry treatment in the NHS

Lisa J Farndon, Andrew Barnes, Keith Littlewood, Justine Harle, Craig Beecroft, Jaclyn Burnside, Tracey Wheeler, Selwyn Morris, Stephen J Walters

Journal of Foot and Ankle Research 2009, 2:7

Abstract (provisional)

Background

Core podiatry is the treatment of nails, corns and callus and the delivery of footwear and foot health information. Though it is an integral part of current practice little evidence is available to support its efficacy in terms of research and audit data. This information is important to obtain in order to support the current NHS commissioning process where services are expected to provide data on standards including outcomes. We aimed to increase the evidence base for this area of practice by conducting a multi-centre audit in 8 NHS podiatry departments over a 1-year period.

Methods

The outcome measure used in this audit was the Podiatry Health Questionnaire which is a self completed short measure of foot health including a pain visual analogue scale and a section for the podiatrist to rate an individual's foot health based on their podiatric problems. The patient questionnaire was completed by the patient prior to receiving podiatry care and then 2 weeks after treatment to assess the effect of core podiatry in terms of pain and foot health.

Results

1047 patients completed both questionnaires, with an age range from 26-95 years and a mean age of 72.9 years. The podiatric clinical rating at baseline showed 75% of patients had either slight or moderate podiatric problems. The differences in questionnaire and visual analogue scores before and after treatment were determined according to three categories - better, same, worse and 75% of patients' scores either remained the same or improved after core podiatry treatment. A student t-test showed a statistical significant difference in pre and post treatment scores where P<0.001, though the confidence interval indicated that the improvement was relatively small.

Conclusions

Core podiatry has been shown to sustain or improve foot health and pain in 75% of the patients taking part in the audit. Simple outcome measures including pain scales should be used routinely in podiatric practice to assess the affect of different aspects of treatment and improve the evidence base for podiatry.

 

I always find it sad that the NHS (and probably other organisations) feel it necessary to have a 'core' and then break up that core to surround it with so many different 'specialist' areas that the core is either ignored or degraded. Perhaps they should just look at 'Podiatry' as a core unless of course their qualifications only relate to nail cutting and callus debridement?

I am glad to say that mine didn't so as a private practitioner my 'core' encompasses Podiatry as a whole and my patients are very glad to hear it.

Nick