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Do physiotherapists understand podiatry? Frustrated.

Discussion in 'Biomechanics, Sports and Foot orthoses' started by MissB, Apr 23, 2012.

  1. MissB

    MissB Active Member

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    Hello all,

    I am new to the forum as a member, however I have been reading your interesting and informative posts for a while. This really is a fantastic resource 

    My question is regarding your experience with physiotherapists. Before I begin I would like to stress that I am in no way generalising the physio profession. I understand that as human beings any profession will have good and bad members, in fact my experience with NHS physiotherapists was very good.

    Currently I am working for a private practice which is run by two physiotherapists. Last week we were chatting about a range of MSK issues that they want me as a podiatrist to treat. Many of the conditions/injuries discussed were not appropriate for podiatric intervention, as the treatment required was either surgery or physiotherapy (e.g. broken tibia). Now there were at least fifty of these conditions, all of which must have been lifted from a physiotherapy manual. I explained that these conditions were not appropriate for a podiatrist to treat as the treatment was more often than not casting and/or surgery and the rehab was ‘hands on’, such as mobilisation accompanied with appropriate exercise etc. (I am trained in neither of these). I explained that podiatrists in the UK do not qualify with the ‘hands on skills’ associated with physio. The reply I got was “this is the problem with podiatrists”. The problem as I see it is that I am not a physiotherapist (??!!)

    I do plan to undertake joint mobilisation and joint manipulation courses in the near future, but I do not and will not undertake treatment protocols outside my scope of practice.

    Has anyone else experienced this? I feel undermined as a podiatrist and am at a loss as to how to get the message of what a podiatrist is and does across. Any advice would be greatly appreciated!! :bang:
  2. Kenva

    Kenva Active Member

    Hi MissB

    I have to underline that there could be a lot of work for a podiatrist, working together with physio's, manual therapists, ...
    From my experience we have a quite unique knowhow on biomechanics of the lower limb. This could be a great sur plus value in the long term treatment of patiënts with musculoskeletal problems.
    I also think you should manage your scope of practice the way you want to as you can only be good in so many things...
    Personally, I know a lot of physio's who make 'orthotic devices'. But is you see the quality, relative function and service provided with these devices - a Patient would be better of if the physio would do his job as good as possible and work together with a Podiatrist doing his/her job as good as possible...
    This can only be a win/win situation i think.
    Or you try to make clear to this group what your surplus value is and they get it, or you start looking somewhere else...
  3. MissB

    MissB Active Member

    I agree with you 100% Ken, I think that together physiotherapists and podiatrists make a great team, and we both have a lot to learn from each other. I have learnt a great deal from other health professionals and this has benefitted the way I practice in many ways.

    Podiatrists are definitely best placed to prescribe orthoses, IF appropriate. I don't feel however that the majority of UK podiatrists are skilled to do every specialism within podiatry, as well as physiotherapy!! I certainly am not!

    The problem I have encountered is (I think) due to the fact that the particular physiotherapist in question does not understand podiatry. Unfortunately all my attempts to explain the profession go unheard.

    Your last point mentioned perhaps looking elsewhere...

    As a matter of fact I do have an interview for a job on Friday to be a part of a MSK clinical assessment team :) Fingers crossed.

    Thank you for your reply.
  4. Ian Linane

    Ian Linane Well-Known Member

    Hi Miss B (an easier name would be helpful)

    To answer your opening question: some do, some don't.

    However most of the physio's I have worked with do wonder why we do not train in and develop manual therapy skills in Uni when the low leg, foot and ankle present with so many MSK issues.

    As to do they understand the type of hands on podiatry skills you do possess and your substantive clinical abilities, then it is likely no.

    My experience with physio's has always been positive but then (some 15 years plus ago) their understanding of what they wanted out of a podiatrist was quite clear in their minds, mainly BMX/orthotics.

    It may well be that today some physio expectations are different and they expect some manual therapy skill base or understanding.

    I think you are right to suggest to them that you will only be working within your skill base. I'm surprised if they would want it any different. But now map out how and when you are going to develop your manual therapy skills. Which ones you are going to start with. Let them know about the plan. This way you take control of the situation more.

    Hope this helps. The multidiscipline experience can be really rewarding.
  5. MissB

    MissB Active Member

    Thank you for your response Ian.

    I too have wondered why some manual therapy techniques are not taught on the undergraduate programme, so I can understand why a physiotherapist may want or expect this. The fact is they aren't. My personal opinion is that the more tools we have available in our treatment tool kit the better, and as a result I plan to develop manual therapy skills.

    I suppose I am just a little deflated/frustrated at defending the valuable skills podiatrists possess. At the moment it feels very much a 'me and them' situation, which is crazy because I think MDT working can be, as you say, very rewarding.

    P.S. is Miss B really a difficult name?! :)
  6. physiocolin

    physiocolin Active Member

    Hi Miss B

    Interesting question, particularly as I am a physio with a specific interest and practicing in lower limb biomechanics. I have always felt the field of biomechanics, as to podiatry per se, is a very important omission from physio training.
    Yes, we need to have comprehensive MSK skills but it's the understanding of the biomechanical cause in the absence of any recalled incident that makes for a better outcome. Especially the chronic and recurrent conditions.

    So it's a combination of both and from that point I would suggest you gradually involve yourself in MSK diagnosis (propose it for in service training - great for CPD)and treatment of the lower limb.

    Not forgetting to include the techniques for differential diagnosis (I have occasionally been requested to treat lower limb pathology when the real cause was lumbar referral!!).
  7. To be fair, I'm not sure a lot of podiatrists understand podiatry.

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