Onychocryptosis in elderly client

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I am an FHP. I have an 80 year old lady who has the skinniest feet you ever did see, she is house bound and has awful pain on the medial side of each hallux nail, no infections are ever present, I have seen her several times but only managed to remove the offending piece of nail once on each foot successfully. Her nails are very brittle and thin. I have tried to do a PNA recently with little success because she really can't bear the pain of me trying to lift the edge of the nail then the nail splits. I have used the black's file to make sure there are no nail spikes but she still has the ingrowing digging in half way down the nail.I am nervous now of treating her, I am new to the business, I did advise her initially to go to a podiatrist and have even offered to take her as she can't drive etc, she is such a lovely woman. Am I doing it wrong? Any advice is very welcome.

 

Maybe you should talk with her family or G.P about your concern they could arrange for a podiatrist to visit her at home.

 

I think that you are doing very much the right thing. Even at her age, if her circulation is patent and she is reasonably healthy PNAs are indicated to ensure that the remainder of her life is comfortable.

Like you, I am firmly of the opinion that such treatment should be carried out in a clinic and it would be useful to explore if this facility is available through the local Primary Care Trust. As Jaynes suggests, the GP might also be helpful and I am sure that the family would be able to offer transport on a 1 off basis.

Congratulations on your care and willingness to refer on.

All the best

Bill Liggins

 

you tried to do a pna with no anaesthetic?!?!?!?!?!

I'd agree with Bill. A referral is appropriate. If not for clinic then a good conservative tx at home under la would be good.

 

Healandtoe

Sadly you give strength to all the reasons why an unregulated practitioner should not be allowed to practise on the general public. I cannot give you credit for referring on- you have no right to be treating a patient like this in the first place.

CM

 

Sorry to be blunt, but that's bullsh*t - and the same crap medical practitioners dish on to us.

If you really think it takes a degree to cut someone's nails and scrape off some some redundant epidermis, then maybe we should ban beauty therapists as well. While we are there, better rein in the hairdressers and barbers too.

If you were smart Cornmerchant, you would employ one of these guys in you practice so you could focus on other things and be available for an opinion. Its becoming increasing rare to find a dentist to do a 'scale and clean', and so too, the sooner we embrace assistants/hygienists/FHPs the better. Its $ and economics, and they fill a gap in the market. To compare and contrast, dental hygienists have evolved in Australia to now become a regulated activity, and a sub-tier of practitioners undertaking basic foot care is already here looking to do the same.

We either embrace the concept and bring them under podiatry, or lose input into their standards, and governments will allow them to self-regulate. There are just too many precedents across health care now.

Embrace or get left out of the argument. Its the same issue when we ask for surgical or drug prescribing privileges, and inevitably the same outcome.

LL

 

LL,
Normally you present some sound reasoning and common sense but this time, with respect, I think you are talking out of your Antipodean a£$e.

The argument is about an unregulated practitioner in UK attempting something that is obviously beyond their capabilities not pedicuring et al.

In UK we do have these persons in our practices but we call them "receptionists".

The situation in Oz does not mirror the situation in UK. In Oz you have a closed profession for Chiropody/Podiatry. The UK does not, neither does the HPC have any interest in regulating the myriad of footcare persons, of varying training levels, that exist.

What makes you think they want to come under the umbrella of Podiatry? Many are quite happy working anonymously "below the radar" and do not want regulation. Most claim they are self-regulated anyway and see statuatory regulation as uneccessary.

Heal & toe,
I wonder what your course taught you about referring on?

I am sure there must be a voluntary (hospital) transport arrangement in the area that your patient could access? I am also sure that the family could help here as BL says.
In any event, stop treating something you can't cope with and get her to a pod who can, asap. What you describe is nothing short of elder abuse.

CF

 

Folks Moderator hat on-

This issue has gone around and around - Just asking for it to be kept civil.

Maybe some of the passion should directed to those that make decisions rather than the individual.

Anyway carry on and please keep in civil - Thanks have a nice day.

Here end the moderation, I hope.

 

M.Weber,

so what person(s) are you referring to ?

And I was civil, I did post "a£$e" not "arse".

regards

Catfoot

 

Cat I´m not getting involved in the discussion or saying that anyone has crossed any boundaries, just keep it nice and don´t attack an individual Everyone

 

I think this thread shows two things.

1. Sometimes, even "routine" care needs the attention of a full Podiatrist with an LA certificate.

2. Some FHP's have both the integrity and the courage to know when they are faced with something beyond them and refer accordingly.

3. LA is an underutilised resource in everyday practice.

4. I'm dis numerate.

 

Thanks to all for your comments, I didn't realise I would stir up such up a storm asking for some experienced advice.

Yes a FHP's PNA refers to taking a small portion of the nail away not interfering with the matrix at all , to relieve pain and discomfort.

Surely the world has enough clients for us all to share, nail beauticians, FHP's and podiatrists. I work with other professionals in my area not against them and that includes the nail studios, if you work with them they refer clients to you, you get more business that way, and so on. I pass customers to the podiatrist in my area, she gets business from me and is quite happy.I know what my limitations are, some of my customers come back to me to show me what they have had done at the podiatrist, they do that because I care about them and they like me.

Thanks to you that have helped and I'm sorry for those of you that feel so venomous towards FHP's and other people treating feet.

It has made me think twice about using this website. I asked for advice from people more experienced and professional, but it seems some just use it to vent anger which is a shame.

 

I would also like to say something.....I have been visiting a podiatrist for 25 years with a soft corn between my 4/5 toe, it has grown over the years to huge proportions and has been extremely painful, I have seen numerous podiatrists, all have reduced the callus but done nothing to reduce the corn, it was soft and bled lots but never have I been given any advice or IDS to prevent formation. Now I am an FHP I have the knowledge which I have applied to my own condition and I have virtually no corn left, it has taken 6 months but I can wear shoes without pain, I have made myself a silicone IDS which is preventing re forming of the corn. Not all podiatrists are wonderful.
Please guys be nice to each other, anger is non productive and swearing ( even with *) is unnecessary, we are professionals and should behave in an appropriate manner.

Remember life's a learning curve and then you die.

 

David

You make a very interesting point when you say that the definition of a PNA is different for a FHP to that of a Pod.

Does that also extend to the definiion of an 'ingrowing toenail'?

FHPs invariably advertise they can 'treat' this condition can we now say they can treat their definition of an IGN but accept they cannot truly treat a Pods definition?

In which case we are back to the old smoke and mirror days of ' Fully qualified chiropodists', as opposed to State Registered.

Nothing changes eh? What would your FHPs say if they were offered the position of assistants working under the supervision of Pods? Even better what would the training establishments say?

Bob

 

David H,

So how can we have a meaningful discussion when the unregulated sector choose to use a different definition to those of us in the regulated sector? If FHPs want to be accepted by the Regulated Sector wouldn't it make sense if they were taught the same language? This would also help when they were referring on patients.

So how would that help when we know that the HPC has no interest in regulating FHPs either now or in the foreseeable future?

No-one is arguing about that, DH, please try and keep up.

Heal & toe, I cannot believe you are so stupid as not to know when to refer on, that you have not been taught your limitations and that you have not sought advice via your own networks before coming onto this forum.
I don't believe you are a real person, more likely a troll from a training school for FHPs who is testing the Profession to determine attitudes.

Well the response you have received should give you the information you seek.

regards

CF

 

[


I don't believe you are a real person, more likely a troll from a training school for FHPs who is testing the Profession to determine attitudes.



regards

CF[/QUOTE]

I happen to be a very caring person trying to help out an elderly lady, house bound etc. on my very first visit to her I asked her to see a podiatrist, she lives in a remote area , has very little money, I go and see her sometimes to keep her company as she she's no one for days on end. She does not qualify for NHS and I am not in the UK.
I don't think there is any need for you to be quite so nasty. It's a public forum and has been useful and interesting.

 

OK heal & toe,
So let's pretend you are a real person.

So what have you been trained to do by your training organisation in this situation? What have your tutors advised you to do, or haven't you contacted them?
Are you asking us to believe that you have been passed out as competent to practice as an independent practitioner when you cannot manage an everyday challenge in private practice?

I would be curious to know who trained you?

All FHP trainers advertise the fact that their graduates are passed out as "fully qualified" and able to earn a living in the private sector. What went wrong with you??

If you are not in the UK then it might be useful for you to mention where you are and then you might get a better response.

regards

Catfoot

 

I do not wish to enter into a third degree with you, I asked for help, if you have nothing positive to say to help perhaps it would be better to say nothing because your comments are very negative and hurtful.

 

H & T,
I can only repeat, if you are "not in UK" as you have said, then wouldn't it be sensible to say that in the first place ( and say what country you are in, as this is an international forum) so that posters could advise you better? If no-one know whether you are in UK, Hong Kong or Vladivostok how can you expect a useful response?

I fail to see why you are here and not asking for advice from your training organisation ? Don't they do "aftercare" for "graduates"?

If you can't even deal with basic patient management situations, and don't know what your scope of practice is or when to refer on, then I am not surprised that you don't want to reveal who trained you.

If you think I am being harsh, then welcome to the real world.

regards

CF.

 

Catfoot,

I wouldn't say you're being harsh, I would say blatently rude and obnoxious.

Is the standard of care for onychocryptosis management different between UK, Hong Kong or where ever else? If you were talking to a podiatrist, what differing advise would you be giving depending on where they were from?
At the end of the day, regardless of the pathology, if someone is out of their depth for whatever reason, the best thing to do is to refer onward. It seems fairly simple that this is all that needed to be said but you are clearly taking this as an opportunity to have a cheap pop at someone else.

Frankly, I find it quite embarrassing that you need to go so low as to drop to personal insults in what should have been a quick and easy thread. Your comments are neither constructive nor professional.
I was under the impression that this forum wasn't limited to podiatrists? If you have an axe to grind, why don't you take that up else where.

Ryan

 

Isn't an ingrowing dealt with in the same way wherever you go in the world?

I am a rookie in this forum, I wanted to start a thread, this is the only problem I have come across, I naively thought I might get some helpful hints.

My tutors are extremely helpful, yes I have learned a great deal since I left but don't we all, it comes with experience, I am sure I will learn a good deal more and embrace new ideas and welcome others to the world of feet.

In the real world most people manage to express their feelings and thoughts without anger, especially when responding to a plea of 'help'. I hope you do not teach or lecture trainees as they will be too scared to ask anything.

What I have learned is that there are many podiatrists that do not like the idea of FHP's. People have anger inside them and appear to be rude and swear even though they are well educated and proficient in the English language. I have confirmation that I did do the right thing from a podiatrist on the forum. Other than that have learned nothing else.

People should be able to discuss issues on forums without being referred to as a troll and stupid. You should really apologise.

 

Isn't an ingrowing dealt with in the same way wherever you go in the world?


Good question H&T but do you mean 'ingrowing as a section of nail piercing the sulci with accompanying hyper-granulation tissue' or a bit of an involuntary toenail that responds to 6 weekly cutting the sides out'?

I am a rookie in this forum, I wanted to start a thread, this is the only problem I have come across, I naively thought I might get some helpful hints.

Being naive is no excuse for anything, most of the Pods believe that anyone who falls for the private trainers claims has to be naive hence all FHPs are naive.

My tutors are extremely helpful, yes I have learned a great deal since I left but don't we all, it comes with experience, I am sure I will learn a good deal more and embrace new ideas and welcome others to the world of feet.

Most graduate Pods leave their very intense course of study ready to face the real world of feet and their pathologies, while everyone will 'learn' through their career the argument is at what point one starts to 'learn'. Should you be experimenting on people who believe you are competent and pay you?

In the real world most people manage to express their feelings and thoughts without anger, especially when responding to a plea of 'help'. I hope you do not teach or lecture trainees as they will be too scared to ask anything.

Rubbish what world do you live in? Daily fully qualified professionals are haled before disciplinary committees because the recipient of their professional interventions did not suit the recipient.

What I have learned is that there are many podiatrists that do not like the idea of FHP's.

True and they justify their concerns.


People have anger inside them and appear to be rude and swear even though they are well educated and proficient in the English language.

For goodness sake a classic FHP response

I have confirmation that I did do the right thing from a podiatrist on the forum.

Of course you have two Podiatrists closely involved with FHP training, arguably the whole point of this posting. ;

Other than that have learned nothing else.

Except that Robert said PNA without anesthesia??????????????????, what we Pods have learnt is that FHPs do not know what a PNA is!

People should be able to discuss issues on forums without being referred to as a troll and stupid. You should really apologise.

I think you will find that often people on this forum have been referred to as Trolls as far as being stupid who accused you of that?

 

Ryan

Thank you, I have advised my client to go to see her GP or Podiatrist and offered to take her, as I did the very first time I met her but it's too difficult for her. The last time I saw her, I cut her nails and had tea and cakes with her and spent an hour chatting. I am in the fortunate position to be able to do that, it's not because I don't have lots of clients because I do and very happy ones, lots pay but not all, I work when I want to, this is my second career, I retired early from my first professional career and I moved to a new country. I am 54 and do a good deal of community work voluntarily. I am fully qualified and should not need to explain myself to anyone, I just wanted some helpful hints so I could help those less fortunate.
I do agree Catfoot is behaving in a very unprofessional manner, her comments are unnecessary.

 

Thread closing in 5,4,3...

Ah the terminology. Often a problem.

Ok heelandtoe. Here are your learning points.

1. PNA is usually understood to be a minor surgical proceedure carried out under LA. Technically PNA could mean cutting the corner, but technically so could cutting nails.

2. Some pods admire fhps who ask for help and advice (like you)

3. Other pods won't admire fhps under any circumstances and are almost reflexively hostile.

4. LA can be a good option for dom OC.

Not a wasted thread for you I think. 4 valuable lessons.

 

Dear Heel and Toe,

To consider yourself fully qualified shows a high degree of ignorance and i might add a lack of comprehension.

When educated through the formal sector eg going to University to get a pod degree and HPC reg you are informed on graduation that:

YOU HAVE ATTAINED THE MINIMUM STANDARD REQUIRED TO BE DEEMED COMPETENT TO PRACTICE.

One can then go on and do further education whether that leads to an MSc and subsequent PhD as many are now doing , or have training outside of a formal examination process for your post graduate CPD.

So when we see an FHP advertise as fully qualified we consider you:

DELUSIONAL.:deadhorse:

So please consider that your FHP qualification as your organisations minimum standard .

Why do you not use accepted medical definitions when you refer to a t/t modality.

Partial = part of

Nail = nail

Avulsion = excison and removal of section of nail and matrix

So if all you are doing is removing a small section of nail from a sulcus and not interfering with the nail matrix then by definition it is not a PNA. So use of incorrect terminology leads to misunderstanding and confusion.

I also would be curious to find out in which country you practice.

When making a referral to another agent they would like you to use the common language and definitions as this enables them to understand your reason for referral.

To use incorrect language and definitions would compromise your referral and ultimately your relationship with the agent you referred to.

Many on here have tried to comment fairly on your initial post, some have , due to your incorrect use of terminology, made a rash assessment of your competence.

I hope you read this in the manner in which it is offered.

regards David:drinks

 

Thread closing in 5,4,3...


Why?


Ah the terminology. Often a problem.

Why

Ok heelandtoe. Here are your learning points.


Occurding to Robert!


1. PNA is usually understood to be a minor surgical proceedure carried out under LA. Technically PNA could mean cutting the corner, but technically so could cutting nails.

Not occurding to David

2. Some pods admire fhps who ask for help and advice (like you)

Prove it, admire is a very big word.

3. Other pods won't admire fhps under any circumstances and are almost reflexively hostile.

Judgmental, you are by your writings a good Pod however that does ot mean I admire you I may respet your opinions but no admiration, sorry

4. LA can be a good option for dom OC.

Mmm dom use of LA, how many people have the guts to do that?


Not a wasted thread for you I think. 4 valuable lessons.

Keep reading Robert H & T aint about learning, and will never be able to use LA. We cannot even get her to say what country she operate in, so any advise about referral is speculation.

When will you be advising your Trust to employ a FHP as a Pod? or even an assistant?

 

Hmmm. Going to take issue with you there Dave.

As I said in my last post.

So I agree on the whole.

However one cannot simply make up a definition as you did. Avulsion means

Can be any part of anything (as in avulsion fractures), the word avulsion does NOT refer specifically to nail and matrix. So TECHNICALLY, PNA could be used otherwise with accuracy. Granted its not standard terminology to use it that way but if we're chucking definitions about, lets make them real ones.

Hey Bob. You're feeling pugnacious this evening.

That was a prediction, not a request. Bet you a quid.

Well obviously occurding to me! Mine are the only views I'm at liberty to offer!

Oh come on, now you're just being obstreperous. Bill said

And if you really need more, then I admire FHPs who ask for help and advice.

I'm crushed. Really. You might think that's judgemental but again its my opinion. I think some people would flame an FHP if they cured cancer or dragged a grannie from a burning building.

Funny that. When she's been so warmly welcomed. Of course she can't use LA. But she CAN refer to someone who can, and it seems has done so.

Sorry Craig. Another UK FHP thread. I bet you love these.

 

Craig is on Holidays so I´m closing this thread he may decide to open it.