Podiatry Assistants
While the future must produce podiatrists with wider diagnostic and treatment facilities, we should be careful to avoid isolation. That is not the future. We must learn how to use helper grades and learn how to refer our patients on to other specialties or even our own colleagues with subspecialty interests. Helper grades remain a hugely controversial subject,6 but the leaders of our profession must convince us that by creating hierarchy within the profession we will be re-branding podiatrists and their role, and that can only be positive for those willing to grasp such a role.
Local anaesthesia has revolutionised what podiatry can offer
Local anaesthesia is the jewel in the profession’s crown. Yet at present the majority of the profession is either restricted or reluctant to use it. Ankle blocks should be commonplace in routine practice to allow truly painless treatment and examination, while regional blocks should be used for diagnostic purposes. At the very least the patient’s respect for us would increase as they reconsider whether they could really perform the same treatment in their bathroom.
Patient-reported outcomes are now essential to prove our worth
As we move our scope of practice forward, we must provide evidence of the outcomes. Patient-reported outcome measures such as the Manchester Oxford foot questionnaire, soon to be incorporated into PASCOM, provide a validated patient-orientated outcome measure.7 In the future it is likely that funding of all NHS services may be partly based on proving how patients respond to treatment.8 The blanket approach of every patient reporting their foot health status prior to treatment and then at the end of treatment will also provide vital raw data for research across the whole profession. For the private sector the commercial potential of such data is also huge.
Patient-reported outcome data will inevitably lead to an evidence base for best practice, which in clinical terms will mean the development of care pathways providing a powerful argument for optimum resources to be available to ensure proven effective treatment wherever the location. Rather than stifling innovation and research, evidence-based care pathways will provide the baseline against which innovation can be measured.
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 Closure of the profession is a myth
Sadly, the future probably holds continued fragmentation of the profession. While we fight among ourselves it is easy for Government to disregard us and decide our future for us. The HPC’s attempt to close the profession has largely failed. 9 More frustrating is that, in the process, the HPC carelessly re-branded the profession’s graduates, all with podiatry degrees from schools of podiatry, as chiropodists. As ever, we must now look to ourselves for the solution; closure through a single podiatry organisation. While I would be delighted to see the SCP win the day, I think the only real hope for a single professional body for a closed protected profession is through a display of statesmanship on all sides; a coming together rather than a takeover bid. And the name of the new professional body: the General Podiatry Council.
Branding the profession
The last word; the ‘c’ word is the one that must go. While we continue to have any association with the arcane chiropody label we will continue to be underrated, disrespected and undervalued. Disappointingly, though many have tried, we cannot seem to convince the profession’s elected leaders that this should be seen as the single most important issue. Branding is everything and this profession must be rebranded - now.
References
- Klenerman L. Editorial: Podiatry. J Bone Joint Surgery Br 1991; 73B: 1-2.
- Podiatric dermatology group joins forces with dermatology nurses. Podiatry Now 2009; 12(3): 12.
- Borthwick AM. Challenging medicine: the case of podiatric surgery. Work, Employment and Society (Notes and Issues) 2000; 14(2): 369-383.
- Wise J. Everyone’s a radiologist now. BMJ 2008; 336; 1041-1043. doi:10.1136/bmj.39560.444468.AD.
- Bristow IR. Bowling J. Dermoscopy as a technique for the early identification of foot melanoma
Journal of Foot and Ankle Research 2009, 2: 14. doi:10.1186/1757-1146-2-14.
- Truman M. Letters: Patients to self refer for NHS treatment. Podiatry Now 2009; 12(6): 39-40.
- Dawson J, Coffey J, Doll H. A patient based questionnaire to assess outcomes of foot surgery: Validation in the context of surgery for hallux valgus. Quality of Life Research 2006; 15: 1211-1222.
- Department of Health. 292518 Guidance on routine collection of patient reported outcome measures 2008. www.dh.gov.uk/publications
- Sayegh C. Letters: Protecting the function of chiropody/podiatry. Podiatry Now 2008; 11(9): 54.
Legends
Figure 1. Diagnostic ultrasound should become a routine investigation in the management of foot pain, which will be the new ‘bread and butter’ of podiatry.
Figure 2. Local anaesthesia should be used more routinely by podiatrists to achieve truly painless treatment as well as assist in diagnosis.
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