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What We Can Learn From International Practices Of Podiatry

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Robertisaacs, Dec 24, 2010.

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    This was the title of a recent podiatry today article.

    Got me to thinking. Podiatry has undergone a parallel evolution in different countries. I even remember Reading that in the US there is an "east coast/west coast" divide.

    So what are the differences? And indeed the similarities? And what can they teach us?

    By way of introduction, I think the UK can teach the rest of the world something about "outside the box" orthotics.

    The nhs gives the podiatrist the freedom to make whatever they think the patient needs without worrying about the cost to the patient. So if you want to use gels or foams which are so soft they only last 6 months, you can. If you want to make something a bit experimental, you can.

    This, of course, is not limited to the nhs! The people who cut their teeth in the NHS take those skills and that ethos into private practice. The companies that sell to the nhs offer the same products to everyone.

    That, for me, is what us limeys do best.

    What do other countries bring to the party?
  2. G Flanagan

    G Flanagan Active Member

    Hi Robert

    You beat me to it, i read that article last night and was going to post it today.

    Anyway, I made a number of observations in comparison to our American colleagues this year whilst in the States (East Side).

    1) Whilst they have physician status and are fantastic at complex pathology, trauma and reconstruction it seemed to me that this took the place of basic care and orthoses. Patient who required orthoses were sent to a C.Ped for both assessment and provision. The basic care standard whilst provided seemed to have no structure and resulted in just some "hacking" with a 6 blade.

    2) Also a very weird one was there classification of "corns", they stated that corns only arise on the dorsum of the toes and what i would class as a plantar HD was always an IPK and not a corn! very odd. I suppose its regional teaching.

    3) Whilst here we are very delicate and learn our LA techniques to perfection, there they seemed to put the patient under conscious sedation and just throw it in, often with the result of the patient constantly moving during the op. One resident i worked with really had no idea how to do a simple Partial Nail Avulsion with chemical matrixectomy yet could ORIF a calcaneal #?

    Can i just say that there are too many advantages to US Podiatric Medicine to list. As such i only listed ill comparisons with ourselves for discussion ammunition.

    This was only my little observation and before any DPM's start to jump down my throat i understand there will be major differences all over the country.

    I am planning on a small write up in Pod Now when i get round to it.

  3. Graham

    Graham RIP

    Have to disagree Robert! While I was trained in the UK and worked for five years in NHS and Private practice there, my major professional development, especially in Diabetes and Biomechanical management, has been 100% influenced and directed, for the past 20 years, by USA DPM Podiatry!

    Yes we have surgical specialists here but many are just as expert at the types of orthoses and practices you are describing. I would suggest that it is the "Limeys" who have had to do the catching up by increasing their surgical scope.

    Unfortunately Managed Care in the US has in some cases meant the need to use CPeds. Also, the mish mash of Podiatry in Canada has lead to a huge discrepancy in raining and abilities. This, however, may eventually develop into a more balanced surgical/biomechanical and general practice approach eventually, as suggested by Martin College in Manitoba. Perhaps!

    My biggest observation though is the total lack of understanding of professional development both here and in the UK. I have many "colleagues" teaching and practicing in the UK, Australia, US and Canada, who have never heard of Podiatry Arena and think and orthotic is an arch support.:mad:

    How do we get the majority of our profession, especially the educators, involved in this discussion? Because we need them here for this to be more than just an arena academic exercise!

    Great idea for a thread though!
  4. bob

    bob Active Member

    Not wanting to sound too much like an old hippy, but we can all learn equally from each other. There is no panacea for podiatric patients. As we all know, every patient is different and their treatment is tailored towards their presenting problem. The thing that keeps our jobs interesting is managing this variation and coming up with an appropriate solution.

    Podiatry Arena is an excellent method for bringing together different international ideas on patient management. It's certainly more convenient than visiting each other as George has stated above, but each of these methods have their distinct advantages and disadvantages. People may benefit greatly from learning a certain surgical technique, orthotic modification or hints and tips on so called 'routine' work when visiting anyone else in any country (or even your friend around the corner). It is unfair to assume that the UK scope of practice in surgery is less than that in the US given the immense variation in practice in both countries (and likewise for orthotic manufacture, etc..). Without direct and current experience of all podiatrists in all countries, you can not assume that one is more advanced or better than another. One thing that many will find surprising when visiting colleagues overseas is how advanced sections of your own practice are. It is possible that the nature of many podiatrists' work (many are isolated practitioners working in private practice alone) leads them to question their ability from time to time. Getting together with your peers can help to affirm your abilities and learn from your colleagues in a positive way, whether this is on the internet or in person.

    I have spent time with colleagues in this country and in the US and my experience is that there is a massive variety in practice within both countries. Many podiatrists in the US will do as much 'routine' work as many of the podiatrists in the UK, others have a full surgical caseload. No one country offers the best version of podiatry, but we can all learn from each other equally. I would love to go to Canada at some stage and spend some time with a local podiatrist, but work is a bit to busy for the moment. Very nice to speak with you all on here and I look forward to learning from everyone in the New Year. Merry Christmas.
  5. G Flanagan

    G Flanagan Active Member

    I agree with Bob, practice and specialisation not only differ from country to country but really from Podiatrist to Podiatrist.

    What does intrigue me about our American friends is the diversity of practice. In the morning they maybe debriding a mycotic nail and then in the afternoon might take ER call for a Pilon #. I think this is the key to being a true Foot & Ankle specialist.

    In the UK most (but not all) Podiatric Surgeons only practice surgery.
    I'm still undecided whether or not i think this limits our practice or enhances it by focusing on one particular specialism.

  6. Graham

    Graham RIP


    With no disrespect, and not to denigrate the incredible advances in the UK with regards to Surgery, but the surgical scope and experience in US Podiatry is far ahead of that in the UK and elsewhere. This is, however, how we all advance, by learning from each other and pushing for advances in our own situations.

    Too True! And perhaps, with this Arena, and our mutual appreciation and desires, Podiatry around the world will represent the uniqueness or our situations while offering a cohesive and comprehensive set of skills.

    exciting times!
  7. bob

    bob Active Member

    Graham, how do you know this? Your previous post said you left the UK 20 years ago, so how do you know what all podiatric surgeons in the UK are doing right now? I have lived here for those 20 years and operated for more than half of that time and I could not make the same statement with conviction. I admit that my range of practice is probably much narrower than many of my American colleagues, but I am quite sure that there are UK surgeons who's range is in excess of many US surgeons - hence my previous post about everyone learning from each other. I believe that a healthy respect for all practitioners from all countries offering a range of interventions for people with foot problems is the best way to improve our own practice by learning from each other. I am more than willing to learn from some of my very talented colleagues in the US and have done so in the past. It is without doubt that podiatric surgery in the UK owes a great deal of gratitude to our US counterparts for its development, but I do not believe that UK surgery today is any less advanced than the US or anywhere else in the world. There will always be elements of everyone's practice that can be improved upon which brings me back to the central theme in my previous post, as individual practitioners we can not rest on our laurels and can all learn equally from each other so no one model of care delivery can or should be held up as a panacea.

    Apologies for a slight diversion from the overall topic. I am now going to prepare myself to eat far more food than I really should. I wish all my international and British colleagues a Merry Christmas and a Happy New Year. I look forward to meeting some of you someday and I hope that you have a prosperous and stress-free 2011! :santa:

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