Foot Health Professional

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Hello my name is Krystyna Keen and this is the first time I have been on this site!
I have beeen practising for 6 years but still find some ingrowing nails difficult to deal with! I wondered if anyone uses the Ingrotoool from Canonbury or has any advise to make it easier on the patient and myself?

 

Hi Krystyna, welcome to the forum.

You need to use nippers instead. The Clauberg Solingen 5201-7 sold by Hilary Products will allow you to reach most splinters and see what you are doing.

 

Hello Christina,
Firstly, I am a bit concerned that after 6 years in practice you are still finding these a problem and have waited so long to do something about it. Were you not taught to deal with them when you trained? I also wonder why you are raising your query here and not with the tutors at your training organisation?

In addition, I am also not sure what you mean by "ingrowing toenail" which is such a blanket term? Do you mean that the nail is involuted or that there is a tight/deep sulci or there are corns in the sulci or that there is a nail spike that has actually penetrated the flesh?

In the latter case, this should be referred to a podiatrist as it is outside your scope of practice and a local anaesthetic may well be needed to remove the nail spicule.

Does your training organisation provide any practical CPD days on this topic? If so, then you might find these useful.
All the gadgets in the world will not help if you don't know how to use them properly. Digging down the side of a patient's nails willy nilly can be a recipe for disaster as you can create problem where none existed and complicate those that do.

I do hope you will realise the limits of your training and refer on where appropriate, as this will give a better outcome for your patients.

regards

Catfoot

PS Johnpod,
If this practitioner has not been trained to use nippers for these procedures then there isn't much point in advising them to do that, is there? You might as well advise then to use a chain saw - then at least there would be permanent results.

 

Catfoot,

You have a patronising attitude that needs reigning in. You take everyone for fools, which assuredly they are not!

You must hope that you do not ever end up in one of my clinics or classes. We can all read (and quote) the text book. My bet is that you are not as clever as you think yourself to be, and I strongly suspect that I could better your 'clinical expertise' without exerting too much effort. Kindly desist from 'teaching' everyone to suck eggs.

This is a forum - not a CF teach-in. Get thee to a cattery.

 

Johnpod,
The OP asked for advice which I gave. If they don't like it that isn't my problem.

I consider it ill-advised (bordering on stupid) to give advice re treatments to a poster when we don't even know what condition they are talking about.

I also have concerns that this practitioner seems to be offering treatment modalities to the public, which by their own admission, they are not comfortable with.

If one is not 100% proficient, competent and confident with any treatment/procedure then it should not be offered. To claim to be able to perform a treatment/procedure when this is not the case is misrepresentation and and Trading Standards Offence - but then I am assuming you would familiar with the workings of the Trading Standards Dept(s) ?

I spend a considerable amount of my time (as do my colleagues) putting right the c@ck-ups (mainly IGTN) made by the unregulated sector who for some reason, known only to themselves, refuse to refer on to someone more competent.

I notice that instead of challenging my opinions you have chosen to bring this discussion down to a personal level. This tells me that you have no challenge to my very valid criticisms.

And as for "my clinical skills are better than yours" - just grow up. This is supposed to be a professional forum, not a playground.

regards

Clever Cat

 

Hi Catfoot

"I spend a considerable amount of my time (as do my colleagues) putting right the c@ck-ups (mainly IGTN) made by the unregulated sector who for some reason, known only to themselves, refuse to refer on to someone more competent."

As originally a SMAE trained person, who may once have been considered unregulated, I can claim the same for resolving cockups of people who were state trained, even back in those days. But what is to be gained by going over this?

Okay so maybe some of the FHP's will lack skill, and I agree that is concerning, but I think the commendable thing was that this person took the balls to ask advice and on that should be praised and guided. The manner in which this latter can be done is a matter of choice of the respondee. Without becoming personal, you chose your manner and I find myself disappointed by it and suspect it served more to put them off "referring" (which you feel they should do). Perhaps if they meet this manner frequently then this could be the "reason" known to them!

Nothing personal

 

hi Krystyna,
In answer to your post are you struggling with ingrowing toenails because of not wanting to cause discomfort to patient?
I've been going a couple of months now (so please dont take my word for anything just a comment) and where ingrowing toenails are concerned i've definately been chucked in at deep end. When training (and taken on as NHS newbie) you have some one there where you can say 'i cant quite manage this can you take over?' where as now its a case of if someone presents with an O/C theres you and only you to sort it. I've found that in these situations you need a good pair of nippers, trim the nail up to the O/C bit then i always say 'this may hurt a little' and quickly, dig down and get the spike out and the relief felt by patient outways the temporary discomfort and lets face it most of the patients have been digging away for years at their ingrowings and know it hurts while you take it out. (i have an ingrowing toenail meself and it kills to dig it out but once its done aaaaaaah the relief) you just have to be brave.
If you go to dentist it can be painful/uncomfortable, if you go have blood taken its uncomfortable;
patients expect that takin out a spike is gonna hurt a little.
I just go for it, i know what i bin trained to do, i can see what i need to do, i have no one to take over so i say 'this may hurt just for a second' then get the spike out, sometimes you have to be a bit brutal but if that pt books an appointment for an ingrowing toenail you have to sort. Of course an ingrowing thats completely impacted further down to nail bed and infected etc i would refer on for nail surgery.
For example i had patient a few weeks ago with bad O/C to L/1st , so i got down with the nippers (which was uncomfortable for pt) and said 'this may hurt a little' but got the spike out and then it bled!! so dressed toe and informed pt to remove dressing etc and contact if any probs. So left with tail between legs thinkin this pt only wanted nails sortin and i've caused an injury. Anyways he rebooked and on next appt he said ' whatever you did last time my toe has bin brilliant can you do again?'
So be brave and do what yer trained to do
clod

 

Ian,
With all respect to your good self, I think you are trying to defend the indefensible.

It is not the responsibility of the regulated sector to help those who choose to circumvent legislation by taking a lightweight course that leads nowhere. Caveat emptor.

Those who chose to join the unregulated sector should take their problems back to their private trainers who passed them out (according to the advertising speil) as "fully qualified with all the skills needed to run a successful business" - and got well-paid for doing so.

regards

Catfoot

 

Clod,

This is the whole point - we do not know what the OP is "trained to do" and, judging by what has been written, neither do they.

regards

Catfoot

 

Ian

The difference between a FHP that doesn't know what they are doing and a pod/chiropodist thatdoesnt know what they are doing is that the pod/chiropodist is accountable, thus the public is protected and at least has a comeback . What happens when a FHP causes a problem or fails to delive the appropriate treatment. . Answer- nothing,they carry on doing what they do while the GP /NHS pod picks up the pieces.

FHPs should not be misled into believing they can deal with everything once they have done their training.
It is the patient that suffers in all this- so many patients attend an unregulated practitioner in the belief that they are getting the best treatment available. You and I both know that this is not the case.

As you point out, nothing to be gained by going round and round. The profession in this country is finished. As time goes on, it is becoming more and more diluted, the remits of the profession are being taken on by other disciplines and by the unregulated, so what are we left with?

I am not whinging Bel, before you have a go, I am just saying it how it is. For me personally I still have a thriving practise and I love the work. But I can see discontent brewing amongst the newly qualified who will be wondering soon why they even bothered to train.

CM

 

I have just seen an FHP course online where you can train in a week???? and learn how to 'deal' with diabetes! Good grief, surely that's putting pts at risk. I was under the impression they did at least 1 years training. Disappointing.

 

I agree fully CM,
Even in the days prior to the inaugueration of the HPC there was a route of accountability for State Registered Chiropodists via the CPSM (Council for Professions Supplementary to Medicine). No similar mechanism existed for the privately trained sector.

To return to the OP whose posting sparked this debate :-

Using the internet, I have found in 2 mins that they are a member of a professional organisation.

In another 2 mins I have found that this professional organisation :-

a. has local branches to facilitate networking between members
b. holds a Branch AGM in the same city as the OP lives in !
c. provides CPD both locally and at their head office
d. holds practical courses about the treatment of ingrowing toenails
e. has a private members forum for interaction between members
f. has several members in the area where the OP lives who could be approached for mentoring

All this information is in the public domain and was easily accessed by myself before my cup of coffee even started to cool.

If the OP has not the brains, wit or common sense to get off their backside and utilise all the very comprehensive help on offer from their own professional organisation then they seriously need to question their suitability for the job they have chosen.

If they have done just that and in 6 years still find o/c "difficult" then I am at a loss for words.

:bang:

regards etc

Catfoot

PS Unfortunately Clod, these minimalist FHP courses are springing up all over the place like mushrooms after an April shower. IMO (and judging by the fees charged) this shows that there is more money to be made training FHPs than being one.

 

I and several colleagues have had to deal with the poor treatment the OP has inflicted on her patients. In one instance the damage resulted in a TNA with phenolisation! I am sure she could have mentoring but has chosen to avoid asking those who have had to deal with the consequences of her actions!

As far as a painful IGTN is concerned, surely the obvious method to deal with this painful problem is with LA to make the process less traumatic for the patient!

Krystyna, perhaps you need to return to the SMAE to update your skills so you become more competent!

Regards to you all,
Angie

 

Hi CM,

Not `having a go`, and I appreciate that your post was directed at Ian...but seeing as you mentioned myself I would actually agree with the majority of what you say. Just added my tuppence worth in blue...

 

Blinda,
This is an old, old argument but you said,

This may well be correct but the process is not transparent.

If a pod is alleged to have fallen below acceptable standards and a complaint is put in to the HPC, then the world and his dog know about it. The allegation is on the HPC website in the public domain until the case is heard. If there is "no case to answer" then the HPC don't often put that information into the public domain.

I am not going to get into a discussion about the rights & wrongs of this, but sufficient to say that there is no comparable process for FHPs.

I have seen FHPs come and go in my area, with monotonous regularity, ever since the title was created and have no way of knowing why it happens. Is is because of poor performance or have they just re-located? Who knows?

I put in a complaint about one FHP in my area who was putting huge garish posters in red capital lettering in various locations. These were not reflective of the professionalism of the organisation they were a member of and were therefore in breach of the Code of Ethics. I took pictures of these and sent them to their Membership Body. The organisation did not answer my letter, and when I rang them said they had spoken to their Member and were assured that these were "old marketing materials", and as they quite clearly said "Foot Health Practitioner" on them there was nothing they could do, but I had their permission to remove them.
I did just that and they speedily reappeared at a rate of knots, so I sent a bundle of them to the Membership Organisation who again ignored my letter. Again I rang them and the person I spoke to got rather stroppy and asked what it was I wanted them to do. I said that they should tell their member to use more professional advertising, as they were in breach of their Code of Ethics. They said that they couldn't act purely on my say-so.

So now we are in the silly situation of these posters etc being replaced as fast as I remove them and this is person blatently flouting the rules of their own professional organisation. At this rate I will have a nice big bundle to get the bonfire going on 5th November.

So please don't tell me that FHP's membership organisations are interested in maintaining standards, because, in my experience, they are not.

regards

Catfoot