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The Rise and Fall of Podiatry?

Discussion in 'United Kingdom' started by Dieter Fellner, Nov 24, 2017.

  1. Dieter Fellner

    Dieter Fellner Well-Known Member

    Members do not see these Ads. Sign Up.
    I stumbled across this news item.

    Is this a correct assessment of UK Podiatry education costs?

    I hail from a glorious era in British education when this was provided to a student free of charge. I never took for granted the value of free education, like free health care, grounded in the belief that education (and health) should be available to all, irrespective of the ability to pay.

    An innate right provided by a civilized society, not a monetized privilege reserved for the well-heeled few.

    Netizens in the UK, tell me this is a misquote, an exaggeration ... tell me something.

    “The UK is struggling with two major threats to the future of podiatry,” according to keynote speaker, Professor Chris Nestor, University of Salford. “1. A lack of awareness as to what a podiatrist is and 2. Privatizing healthcare as a priority in the podiatry profession. The cost of University for a podiatrist could be 50,000 pounds for a 3-year degree, leading to historically low applications.”

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  2. Johnpod

    Johnpod Active Member

    From Alliance Journal 60, Autumn 2017....

    'It is interesting to read in Podiatry Now that the Society of Podiatrists has recognised the uncertainty of the future of podiatry in the light of the withdrawal of NHS bursaries. Just like ourselves, they must wait to see if Podiatry training at university can survive the change. From 1st August 2017 universities will be charging something like £9,250 per year, making the formal cost of a full-time 3 year BSc Podiatry course close to £30,000, to which other incidental and living expenses and the cost of three years without income must be added. Prospective (often mature) students beginning training after 1st August will instead be offered repayable student loans, and it will be interesting to see just how many students will wish to study Podiatry at this expense, and then agree to pay back the loan. Given that 50% of degree graduates end up doing exactly what we do the answer should be obvious….. this is quite possibly the end of the era of establishment-training in Podiatry at the nations’ expense. The obscenity of a technically bankrupt NHS funding training of personnel that they cannot now afford to employ will finally cease. When the BSc was introduced in 1960, many then felt that the degree programme was unnecessary. It may yet turn out that degree podiatry has been no more than a 60 year ‘blip’ that has divided our occupation, helped to ruin the NHS, and set practitioner against practitioner. It is our belief that we shall see several universities dropping the BSc Podiatry course, as they will most probably have difficulty recruiting enough students to make the course viable. The average debt incurred by 2016 students on graduation is given by several sources as being circum £44,000. Three quarters of student debt is never repaid. Time will tell.'
  3. Dieter Fellner

    Dieter Fellner Well-Known Member

    JohnPod, thank you for your post. I wonder who authored this item, which at face value is somewhat idiotic.

    Funded establishment podiatry education 'helped ruin the NHS'? - dude, you are smoking too much whacky baccy. How about the overpaid, underperforming fat cat multi-layered bureaucracy of lower, middle and upper-level management inefficiency and incompetence that helped to ruin the NHS.

    I have an idea: Hey, listen up, Mr. NHS bureaucrat, how about you take a pay cut to provide the funding for necessary clinical staff that provides a key role in the reduction and containment of morbidity and mortality.

    Hey Mr. NHS bureaucrat how many below knee amputations will pay for the NHS Podiatrist. How interesting is it to see your parents or grandparents in the intensive care unit fighting life-threatening septicemia caused by that entirely preventable but 'interestingly' neglected, infected diabetic foot ulcer? Kiss your grandma on the cheek, as she draws her last breath, and console her with your tales of that 'obscene' disparity of NHS funded training and NHS mismanagement of funds that caused the employment crises. Yup, wouldn't that be 'interesting' to see. What a cock.

    Setting aside this hysteria, for a moment. Podiatry can absolutely survive, as it has done in the past. In America, podiatry, like most other forms of education, is also self-funded. A wholesale withdrawal of NHS funded Podiatry services might be the savior of the profession. A patient can opt to pay for services and/or take advantage of private health insurance provisions. Can this provide for equity of services?

    No, of course not. It's survival of the fittest and the richest. Its dog eat dog. Is that your plan, oh mighty and wise NHS bureaucrat fat cat? Ponder on that, as you sip your public funded cocktail while you bathe in the soothing sunshine and dip your toes in the dulcet waters of a sandy, exotic beach on your public funded management retreat.

    This will undoubtedly require a mind shift for both service provider and service consumer. It is quite possibly, the only option available and the necessary vehicle to provide that wake-up call that podiatry is not simply an optional bolt-on nail clipping, NHS pedicure.
  4. davidh

    davidh Podiatry Arena Veteran

    Interesting thread.

    John, if I may correct you the BSc came in after 1980, not 1960. I was there, saw it happen, and took advantage of a top-up degree offer.
    Prior to 1966 of course, there were too few NHS chiropodists in the UK - hence the 1st chiropody grandparenting. My own State Registration Cert shows that I was no 5775 on the register by 1971 - for clarity I was NOT grandparented. Did we (the profession) allow too many podiatrists to train and qualify? I suspect, with hindsight, that we probably did. In 1966 there were many Ministry of Pensions war pensioners from the 1st and 2nd-World Wars who needed regular chiropody palliative care. Most if not all are gone now. Italian-styled footwear was de-rigeur in the 60's, and responsible for many minor foot problems which chiropody was able to deal with. Now also long-gone.

    The UK profession has of course changed beyond all recognition.

    In retrospect I am optimistic.
    Students graduate with some knowledge of research methods, which has to be a good thing. Our regulator has some teeth - not saying they are perfect btw. With the inception of prescribing we now go some way towards becoming self-sufficient in podiatric medicine. We have the support of a Royal College (membership or fellowship if we choose), and a some (a very few) of us are able to work in the field of forensic podiatry.

    There is always a downside of course, and in this case the biggest downside must be the parlous state of the NHS, which is both badly-run and wasteful. However we as a professison are not responsible for that, and because we have a long history of working alongside, but outside, of the NHS I do not see that that needs to worry us overmuch.
  5. Dieter Fellner

    Dieter Fellner Well-Known Member

    Nice to reminisce, David ... about the 'research methods' - how much has this really helped?

    I went through a phase of being that annoying research 'junkie', evidence based practice etc. The more I learned the more I grew disaffected.

    Perhaps I am overly jaundiced now but: what research has surfaced that significantly changed common-garden, day-to-day Podiatry work?
    Also in the surgical arena: a paper gets published that would totally trash a favorite and hitherto seemingly very useful procedure, because of and on the strength of statistical evidence. Number crunching ... statistically meaningful and clinically irrelevant data. There is lies, damn lies and then: there is statistics. And when all is said and done, no paper is ever definitive.

    But wait: also my patients did really well with that now tarnished procedure. I often felt a disconnect of the research process with clinical work.

    So, in case I am mistaken: what has changed to propel forward our Podiatry practice, aided and abetted by the research process? And how credible is the work that gets published?
  6. davidh

    davidh Podiatry Arena Veteran

    I tend to agree about credible research, and in the case of surgical-based research I guess, as in pharma-based research, there are hidden forces at work skewing results, or in some cases simply making them up.

    My point is that exposing a podiatry student to research methods gives him or her a choice - learn about them and learn to evaluate published work, or don't bother, and either ignore published work, or accept everything they read, good or bad.

    To answer your first question about what research significantly changed podiatry work I point to the 1966 Root et al paper, warts and all. It changed the profession in two ways - it brought about widespread use of podiatric biomechanics, and it stimulated many podiatrists to research the various aspects of foot function highlighted in that paper for themselves.

    "Friday night at the Mechanics Institute" type-research is not much use to anyone, and yes, there is plenty of this stuff being published. And not just by podiatry.
  7. Rob Kidd

    Rob Kidd Well-Known Member

    If you would be so good as to allude to the Root paper (1966) that you allude to, I will try to make a comment. I taught that stuff for so many years, it is scary!
  8. davidh

    davidh Podiatry Arena Veteran

    Not sure what you mean Rob? Happy to elaborate as needed. I will add that although the Root paper was published in 1966, we students at Glasgow Foot Hospital (1968-71 cohort) were still prescribing simple insoles with "D" pads to fill the arch. About as technical as it got was the double wing PMP. Contralateral wedges were mentioned, but no-one seemed to have much idea about the foot inverting or everting. Axes were certainly not mentioned in the three years I was a student.
    Last edited: Dec 5, 2017
  9. Dieter Fellner

    Dieter Fellner Well-Known Member

    Odd you should focus on Root. Is this 'research' in the conventional sense? Oh the irony when so many workers have since looked to discredit the assumptions made by Root et al. Oh boy, but that's a big can of worms, lol. But a good talking point since I am less than convinced the Root 'haters' have offered much credible work either.
  10. Rob Kidd

    Rob Kidd Well-Known Member

    In reply to both David and Dieter above. David, I no longer have an off-print collection - I gave it away when I "retired"; I cannot place the paper that is being referred to. Dieter, I have spent a load of years debunking Root theory and I have to accept that I have not really put much up in its place apart from "common sense". To me the saddest thing is that while some parts of Root theory are laughably ridiculous - such as the tautological definition of S/T neutral. they are (in my opinion) very useful clinical findings. Perhaps the mistake was the attempt to make scientific things that simply were not scientific?
  11. davidh

    davidh Podiatry Arena Veteran

    Dieter, that is surely the point. Not that the Root paper was valid research, but that some of it was useful, and that the whole stimulated (is still stimulating) further podiatry research and debate.

    Rob, the paper is the Root el al Axis of motion of the subtalar joint. JAPA Vol 56, 4, (1966).
    And I agree with you. Some Root devices work - why, if the whole shebang is so hopelessly flawed?
  12. Catfoot

    Catfoot Well-Known Member

    Who on earth writes this inaccurate and misleading rubbish? Someone who has never worked in the NHS for a start...:rolleyes:

    The degree course started in the 80's, so to claim it was a '60 year blip' is arrant nonsense.

    "It may yet turn out that degree podiatry has been no more than a 60 year ‘blip’ that has divided our occupation, helped to ruin the NHS, and set practitioner against practitioner. "

    The 'ruination of the NHS', as you emotively described it, was not caused by the above.
    It began when the NHS started to slowly evolve from a patient-centered, quality driven service into an unweildy Hydra whose ultimate purpose was to provide statistics for Central Government. Mico-managing of professional staff (not managers) continued accountability and justification for professionals' existence, and the continual buearocracy this generated only served to created a work environment that was untenable for many, including myself.
    "Given that 50% of degree graduates end up doing exactly what we do the answer should be obvious….." Not sure who the 'we' is here and I would like to see the evidence for this statement.

    Please get a writer for your journal who bothers to do some background research, before submitting such utter tripe for publication.

  13. davidh

    davidh Podiatry Arena Veteran

    Very well put, and exactly my experience.
  14. efuller

    efuller MVP

    The protocol to make an orthotic is different than the theory on why the orthotic works. Reading Eric Lee's paper on the Root paradigm, and reading Root himself, there is a gap between theory and what is actually done. Root et al, found a protocol that worked. However, many of the disciples can't agree on why the orthotic works. But it does work some of the time.
  15. fishpod

    fishpod Well-Known Member

    Who wrote degrees in 1960 what a complete and utter womble. Dont go to university and incur costs just do a distance learning course and get out there churning out the cash. I think ive heard this for the last 35 years tell me something new. Doing a diploma / degree has definitley moved the profession forwards why wish to take it backwards.
  16. davidh

    davidh Podiatry Arena Veteran

    Just to put the record straight, the person who wrote about degrees in the 60's was mixed up about the dates, but I believe he is/was a Pod Surgeon.
  17. fishpod

    fishpod Well-Known Member

    we should encourage young people to emulate his success then and push onwards and upwards
  18. davidh

    davidh Podiatry Arena Veteran

    My information is that Pod Surgery in the Uk is not perhaps the success that we all think. In Scotland there are a couple of Pod Surgeons working under an Orthopod in Edinburgh, but none anywhere else. Don't know about N.Ireland or Eire.

    Podiatric Medicine, encompassing injection therapy and prescribing is the one to watch out for (in a good way).
  19. Dieter Fellner

    Dieter Fellner Well-Known Member

    ohhhh David, fighting talk! lol

    Can't speak for the present time, but Podiatric Surgeon / Consultants had a fab time. I was one of them. Has much changed since I left in 2009? Might have done, just asking ....
  20. davidh

    davidh Podiatry Arena Veteran

    Hi Deiter,

    I have nothing against Pod Surgeons, and several are close colleagues. I suspect though, that things may not be quite as rosy nowadays as they used to be. I was pretty shocked at the lack of Pod Surgeons in Scotland TBH. Especially with the MSc in Pod Surgery theory having run in Edinburgh for a good few years now.
  21. Dieter Fellner

    Dieter Fellner Well-Known Member


    For Scotland (as elsewhere) the answer is probably political. I recall, some years ago, venturing out to Glasgow for an interview when I met with the Orthopedic guy. Several people were interviewed, nothing ever came of it. I believe the strategy was to get close, in order to monitor and control. Same old BS.
  22. davidh

    davidh Podiatry Arena Veteran

    Sounds about right. There are 2 Pod Surgeons for the whole of Scotland I believe. Both in Edinburgh, both working under an Orthopod.
  23. Daiowife

    Daiowife Welcome New Poster

    Learning is certainly expensive. It will be insulting if a good teenager can not learn only because he does not have enough money to pay for his studies. He can be an excellent specialist.

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