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Future of podiatry?

Discussion in 'General Issues and Discussion Forum' started by andremichaeljohn, Jan 21, 2015.

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    Hi All,

    This thread may have been created already but I am interested to hear peoples thoughts on where they envision the podiatry profession to be heading.

    In the UK does anyone think we need to move to a more American model in providing it as a 'medical route' rather than an allied health profession?

    How do people see the profession strengthening over the next few years and building the professional reputation? It is clear the USA has built a model which puts the profession as one of the top earners and is also labelled as a profession of the future (which it will be I am sure everywhere considering obesity, diabetic and other chronic disease rates). In Australia the bio-mechanical aspects of podiatry appear to be the big thing.

    Does anyone think the surgical route in the UK will improve and allow more opportunities? In Ontario Canada, Chiropodists are able to do soft tissue surgery (although this is an area of debate as to whether people should be doing some of the surgeries they perform).

    I look forward to hearing everyone's input into this discussion and anything else they would like to add.

    Kind regards
  2. Elizabeth Humble-Thomas

    Elizabeth Humble-Thomas Active Member

    I too wonder where Podiatry is heading. It seems to me that, with the introduction of the degree course, the profession has crashed into the buffers.
    I recently worked alongside a first class podiatry degree graduate (7 years experience),who was unable to tackle gryphotic nails, neurovascular and id corns,simple cryptoses. What good is that to our patients?
    Podiatry Now magazine seems to be less and less about day-to-day practical approaches to patients problems, and more and more about esoteric and expensive procedures and orthotics.
    Perhaps the profession should split - those after the more American approach (I have many American patients arriving in Oxford who contact me immediately, because they cannot access regular "chiropody' in the States), and those who want to work at relieving foot pain with a scalpel based approach, using quality silicone toe orthoses etc. to resolve problems.
    I am not against change, I always try new techniques; needling vp's,improving nail surgery techniques etc, but I am afraid that within about ten years, most of the practical coalface skills of the profession will be lost forever.
    best, Liz
  3. Simon Ross

    Simon Ross Active Member

    "I recently worked alongside a first class podiatry degree graduate (7 years experience),who was unable to tackle gryphotic nails, neurovascular and id corns,simple cryptoses. What good is that to our patients?"

    Elizabeth, I completely agree with you. your above comment is deeply deeply worrying. I wander what the head of schools think to your comments?!

    I recently had a patient whose previous degree trained podiatrist didn't even touch the dry/fissured skin on B/calc. This was in another part of the country. She was satisfied with the previous person, but thinks that I am much more thorough.

    I have feedback from loads of patients that I do a better job than most on thickened toe nails. My weapon, that is called a drill with different sized burrs. But, it does the job. At Uni, I only used a drill once. Now. (except for DOMS) I use it almost all the time.

    I may not be the best at biomechanics, but............I feel that I do a bloody good job on those so called boring nails, callous, corns patients. I also spot problems that could well do with a biomech /surgical opinion, and refer on.
  4. horseman

    horseman Active Member

  5. Elizabeth Humble-Thomas

    Elizabeth Humble-Thomas Active Member

    I love my work too, and my patients.
    This is going to be quite contentious - I trained in the 1970s, mostly women, quite low-key, caring, good fine motor skills.
    In the mid eighties jobs we're hard to come by. Lots of men joined the profession. They weren't so keen on the fiddly stuff. They wanted technology and glamour (and a decent salary, nothing wrong with that) In came biomechanics, complex orthotics (no more appliances made by eye and judgement) and lots of jargon-bollocks.
    I know that what I do every day has an enormously positive effect on the lives of my (thousands of) patients, but I am made to feel by my professional journal, and everything else around me, that what I do is worthless and not good enough.
    When I retire, who will be able to do what I do?
  6. Rob Kidd

    Rob Kidd Well-Known Member

    I swore that I would not buy into this - but, dear Elizabeth, you made me do it. I opted out of practice very many years ago in 1979, but carried on teaching kids until 1999. I agree with you totally about the importance of decent motor skills, which, by the way, once honed properly, never go away. I learnt to deal with a corn and a nail properly when I was 17; now that I am nearly 60, those skills are still there, just a little slow due to non-use. It is your comment about "jargon-bollocks" that caught my attention - yes I agree with you. As a teacher of so-called biomechanics in the 80's and 90's, I put a huge amount of time in the class room and lab removing the jargon-bollocks (as you so nicely put it), form what actually was a really good subject trying to get out. I took some **** at the time mind, largely from those that loved the way it flowed from the mouth (the jargon-bollocks, that is); it was then that I coined the phrase: "The Emperor with no clothes hypothesis" I wonder if any of my ex-students out there would care to comment ? Rob (Happy Australia Day, by the way)
  7. cmatt

    cmatt Member

    I think to assume that all recent, degree-trained Podiatrists are unable to enucleate a corn or simply lack adequate skills in "routine" care is probably a bit unfair. To worry that once your generation of Podiatrists retire, patients will be unable to receive quality care strikes me as rather arrogant- though I may have misinterpreted what you were saying.

    I am a recent graduate, and got a first, and do have an interest in MSK practice, but I also spend a lot of my time on a more general caseload, treating nail pathologies and corns and callus etc. I enjoy this aspect of my job and I like to think I do a reasonable job. I would say that many from my cohort at Uni would say the same. I like to take pride in what I do, whether that be enucleating a painful corn or treating a complex MSK pathology. There are good and bad in every cohort. I do not think that in years to come, nobody will be able to enucleate a tricky corn.

    I think the problem with Podiatry Now and general practice issues, is not that people are disinterested in general practice, it is more that practitioners are not producing the content. I'm sure if practitioners were to submit short case studies or articles on interesting cases and techniques, the editorial committee would be only too happy to publish them. It could only serve to raise the profile and status of general podiatry practice within the profession.

  8. Ninja11

    Ninja11 Active Member

    I feel that this discussion always come from the basis of 'the grass being greener on the other side of the fence, when realistically, there are pro's and cons in every countries system of podiatry ie; as mentioned, where surgery is included in the training such as in America, that they then tend to focus more on biomechanical surgeries, than the run of the mill procedures (corns etc). This may also be largely due to the cost gains of doing more difficult procedures for greater income.
    In Australia at least, I would like to see a campaign take place, that promotes the profession in terms of what we do. I am satisfied with our profession and what we achieve, but I still feel we could go a long way to educate the Australian Medical Profession at large in a more direct fashion, as to what we do. Most of the frustrations I have, and my fellow colleagues discuss with me, surround the general medical practitioners lack of knowledge about us ie: they don't see the relevance of why we would require a patient's medical history or medications list. Or my recent favourite, were completely unaware that we perform toe nail surgeries.
    I think unless we address some of these issues, we shall continue to see podiatrists dropping out of podiatry, due to such frustrations.
  9. Elizabeth Humble-Thomas

    Elizabeth Humble-Thomas Active Member

    Hello, I'm sorry , I didn't mean to sound arrogant. I simply feel that in order to be able to grow and improve a set of practical skills, which is what our patients need from us, we first have to learn those skills by repeatedly practising them, and being shown how best to treat the many and varied problems presented, and which will need to be solved within a half hour appointment.
    As a first year in Cardiff, we started seeing patients within the first (of nine) terms. The patients had been graded by the third year students, so we saw the simplest nail cutting patients first. We were shown how to best cut nails, particularly so that the patient would remain comfortable for as long as possible before needing attention again - an important, if basic lesson.
    During that first term I well remember my tutor, Teresa Prudhum I think, who showed me in a twenty minute one to one session how to remove a subungual corn. First using nail nippers, then a medium burr, then a very fine burr. Finally a small curved Beaver blade to remove the corn. Then, by spraying the area with surgical spirit any remaining corn would show up as having a darker hue (I had to see this with my eyes - I could not describe it). She then packed the edge of the nail with a tiny worm of silicone.
    I have practised and improved my technique in the past 35 years, and I'm very, very good at it - but would I ever have been able to get to 1st base without her teaching? and the tutors who taught her? I doubt it.
    Just one example Matt, of many , many such practical lessons I was privileged to be taught.
    It is simply unfair to expect degree students to 'reinvent the wheel'. They have a right to be taught, so that they arrive in the job market with a real set of proven skills, handed down and improved upon by their forbears.
  10. daisyboi

    daisyboi Active Member

    What makes some of us assume that current students are not getting the kind of instruction that we got? I'm aware of current students getting one-2-one tuition from very experienced and patient lecturers. I can also remember the first few corns that I enucleated after graduation. Thinking about those patients makes me cringe now, but none of us left university with the skill set required to be good podiatrists, we were just pointed in the right direction. Such skills take many years to hone as has been pointed out in the thread already so its a bit unfair to expect students to leave university with those same skills already intact. I think the profession will do just fine when we all leave it as there is a diverse and talented bunch coming up right behind us who, with space and time to perfect their skills will perform as well as, or (perish the thought) better than we have.


  11. Elizabeth Humble-Thomas

    Elizabeth Humble-Thomas Active Member

    It's not an assumption Dave. It is as simple as this. On the diploma course, we spend 50% of our time treating patients under supervision and 50% studying anatomy, physiology, pharmacology, general medicine and surgery, dermatology and dissection.
    That meant that with 30 weeks per year at college, 15 weeks per year were spent treating patients - 2 to 3 per 3 hour session - lets call that 75 patients per year x 3 years - thats 225 patients treated under tuition and supervision.
    At the end of the third year we were slow, but pretty competent, and had the advantage of having seen a large number of different conditions.
  12. daisyboi

    daisyboi Active Member

    And how does that differ from now Elizabeth? I know that my local university runs blocks for patient contact time as well as community placements and speed clinics in the summer. I would be confident that every student is seeing 75 patients a year there too, possibly more.
  13. wdd

    wdd Well-Known Member


    15 weeks per year is 75 days/yr. 75 days/yr is 150 sessions/yr. At 2 to 3 patients/session let's call it 375patients/yr x 3 years - thats 1125 patients treated under tuition and supervision.

    And how does that differ from now Elizabeth? I know that my local university runs blocks for patient contact time as well as community placements and speed clinics in the summer. I would be confident that every student is seeing 75 patients a year there too, possibly more.

    I would think that you are correct in your statement. They are possibly 'seeing', ie not treating from beginning to end.
    Although they may be 'seeing' more than 75 patients per year they are neither 'seeing' nor treating 375 patients per year.

  14. daisyboi

    daisyboi Active Member

    I can honestly say in my first year (which wasn't yesterday!) I didn't treat anywhere near that number of patients. Also, here in Scotland anyway most students now do four years rather than three, which obviously increases their numbers. And without meaning to be rude, I think you are kidding yourself if you think that current students only see patients but we "treated" them. I can still clearly remember tutors stepping in on many occasions to tidy up the carnage left by a students "treatment"
  15. Adrienne

    Adrienne Member

    I am one of your students Rob, you taught me at Salford and Manchester Foot Hospital at the time Jill Phethean started (1985-88). I can testify that your teaching was jargon free - and yet, I never really got the hang of biomechanics I am afraid.

    However, I have enjoyed what most podiatrists on here would consider to be a very atypical career. Since 2008, I have supported the quality of clinical practice placements for non-medical students in the NHS with some PVI sector. My Masters and now PhD (half way through) are in applied psychology looking at the wellbeing of healthcare students in education. I now work as an academic in a healthcare Dept in a University teaching across a variety of programmes and yet, I still draw on the clinical teaching of what I learnt at Salford with you, Phil Laxton and Pete Bowden. My wider experience has allowed me to work in partnership with a practice and university educators of different professions. The introduction of the degree does (hopefully) what my apprentice type training never did - think critically! I hear off my experienced registrants regardless of profession that the newly qualified are 'not fit for purpose' this has gone on for years! In fact, dig around the UKCC archives - there was a report into Project 2000 in nursing exploring this. And what some of the 'old lags' forget is that the typical 'bread and butter' patient we see in the NHS would have been long dead and buried when I registered in 1988. Patient complexity has increased and our scope of practice needs to change accordingly. The 3 year degree will always be 'at fault' as it can never meet the increasing challenges of practice. But what it should do is give newly qualified the skills to identify their learning needs and do something about it! As I have grown in confidence about my own academic skills, I can say that anatomy, physiology and biomechanics underpin all podiatry practice. I take full responsibility for not engaging as fully as I should. I don't look at the young whizzes with envy or deride their lack of scalpel skills. We each have an important role to play in patient care, support our healthcare students in what ever profession they are as they need us to flourish.
  16. Hi Ninja11,

    I agree with your point about the grass being greener on the other side. However the reason I initially started this thread again was because I am one of those podiatrists who dropped out of the profession due to the surmounting frustration, however I did enjoy podiatry and am now looking to start again. I do believe we need to create more awareness of the profession with other medical colleagues and demonstrate that while a lot of our work maybe general palliative care, our skills set within the biomechanical and wound care areas is greatly required.

    In terms of developing the profession further I have seen some interesting models which we are starting to move towards, similar to a dental model using foot health nurses and podiatry assistants.

    In response to Elizabeth's post about graduates not coming out with the necessary skill set for basic general care, I can only comment on my experience as an undergraduate where the majority of our work was undertaken within NHS clinics providing general foot care. The NHS clinics were specifically implemented in Cardiff to improve the skills set of graduate coming out so they were prepared for the working style in the NHS. As Adrienne has kindly indicated above, I also don't believe in any profession a 3 year course is enough for a student to fully be ready for the cases they will be presented with. Which in turns brings me back to my original point of re-assessing our models of education and where the profession is heading. Maybe now we really do need to start looking at a medical model? or maybe just start by producing a longer course which can begin to provide more experience with the complex case loads of today?
  17. Dieter Fellner

    Dieter Fellner Well-Known Member


    Your posts, and those of my biomechanics mentor, Rob, resonate deeply. I am of an age of passing through the system in its entirety. From Diploma, to BSc(Hons) to FCPod(Surg). I now feel privileged, to have had the grass roots education and training, that seems to be denied to more recent graduates.

    I am a little puzzled by your observation about American patients. Now living, and working, in New York City there is no shortage of Podiatrists who can and will provide regular, good old fashioned general Podiatry care. Perhaps your clientele had an issue with insurance. The American market is plagued with hundreds of insurance carriers all with various covenants and restrictions, co-pay and conditions. Or, if a patient has no insurance, their eligibility under the Medicare/Medicaid system. This is the greatest frustration of work, in the US. Insurance, to a large extent, determines the type of service a patient can be considered for.

    It's insane.

  18. Elizabeth Humble-Thomas

    Elizabeth Humble-Thomas Active Member

    My American patients (not from New York generally) tell me that if they present with for example, a corn on the 5th toe (caused by footwear), the podiatrist will suggest surgery, rather than remove the corn, investigate the cause, and provide perhaps ,a custom made silicone device for future protection.
  19. Elizabeth Humble-Thomas

    Elizabeth Humble-Thomas Active Member

    How about this as a 'what if' question.
    How would you feel if your bright young dentist told you that they had 'seen' some root canal treatments, and they were now going to see if they could 'do'' it?
  20. wdd

    wdd Well-Known Member

    Isn't that still largely how things are done in medical education?

    "Seen one, done one, taught one" isn't totally or probably even nearly apocryphal.

    It's only lesser human beings who have to be shown how to do something twenty times and then have to have someone hold their hand to lead them through the procedure another ttwenty time before they can do it themselves and heaven forbid that they should ever think that they are competent to teach it.

  21. Dieter Fellner

    Dieter Fellner Well-Known Member


    Interesting. By and large, the U.S. Podiatrist will not be served with a surgical recommendation. Office based visits attract better compensation than a surgical intervention. Oftentimes a surgeon stands to loose money from surgery. I can only assume the recommendation is made in good faith.,

    That said, I agree with the silicone. After completing 4 years of US podiatry school I saw one silicone device. The silicone was kept hidden, the item dispensed under a veil of secrecy. American Podiatry students did not get exposure to this treatment modality.
  22. Elizabeth Humble-Thomas

    Elizabeth Humble-Thomas Active Member

    I'm amazed. You may be interested to see an article about the making of silicone orthotics in the British Podiatry Now magazine, published last November.
  23. Dieter Fellner

    Dieter Fellner Well-Known Member


    I'm good but thanks. I practiced Podiatry in England for 20+ years. Makes for an interesting comparison with US Podiatry. Feet will be feet but delivery of care can be very different
  24. Rob Kidd

    Rob Kidd Well-Known Member

    I have just found this quote by R J Mitchell, designer of,among other 'planes, the Spitfire. This was the advice he gave his chief test pilot re: information from the engineering team: "If anybody ever tells you anything about an aeroplane which is so bloody complicated you can't understand it, take it from me: it's all balls".

    This so applies to podiatric biomechanics; the phrase "Jargon-Bollocks" is on the tip of my tongue. Elizabeth, I thought you may appreciate it.
  25. davidh

    davidh Podiatry Arena Veteran

    "Jargon-Bollocks" is now my go-to phrase for 2018! :D
  26. Dieter Fellner

    Dieter Fellner Well-Known Member

    'Jargon-Bollocks' ...well, doesn't every facet of healthcare indulge in jargon?

    1. special words or expressions used by a profession or group that are difficult for others to understand.
    Not perhaps the 'jargon' to be concerned about, more the 'bollocks' that is pervasive in a profession.

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