FOOT HEALTH PRACTICE AND PODIATRY – The difference
Foot Health Practice is the occupation by which the lower limbs and feet are serviced, and their minor ailments recognised and treated. The work of a Foot Health Practitioner (FHP) is non-invasive. Onychocryptosis falls within the remit, as does gait analysis and other external examination techniques for assessment of the structure and condition of the limb and foot.
Much of the work is routine and often requires repeat at determined intervals. In the majority of the cases seen and attended by the practitioner there is little or no morbidity of the leg and foot. In many cases, there is need for routine maintenance occasioned by diabetes mellitus, arthritic hands, eye troubles, ankylosis of the spine, obesity, pregnancy, etc. Many patients will simply have difficulty reaching their feet for routine maintenance – others appreciate the help of a practitioner who they can trust to trim and maintain their nails properly. Much of the morbidity that is encountered is directly attributable to the ageing process. Hip and knee pathologies contribute considerably to the need. As a trained observer, the FHP contributes to the health of the populace by screening and alerting other practitioners to indicated diabetes mellitus, potential ulceration, malignancies, etc.
The major part of uncomplicated foot and leg care need would be within the capability of the Foot Health Practitioner. Immediate access by self-referral and early availability of their services make the FHP working in the private sector an important facility and resource for the general public. Foot Health Practitioners listed on the public Accredited Register of Foot Health Practitioners work to approved standards and are fully accountable.
Knowledge of the patient’s medical status is taken into account in order to execute the work safely. Hygiene, instrument skills, communication skills, and dexterity are important to the task, as are record-keeping and regular updating. Dressing/padding/offloading skills are essential, as is the ability to manage minor wounds.
The need of referral of cases requiring the expertise of other medical professionals including Podiatrists is well understood and practiced. Ethics consistent with the medical professions are held, recognised and respected.
Podiatry is the profession by which recalcitrant external conditions and unfavourable internal structure, disease and pathological conditions are addressed. The podiatrist takes on those cases requiring specialist leg and foot support that cannot be delivered by the Foot Health Practitioner. The full skills of a Podiatrist would be needed and utilised in only a small proportion of the total of presenting cases. Podiatrists are trained to a higher level (BSc degree) than the FHP (Level 4 diploma) and should reasonably be expected to have a deeper understanding of issues that threaten the viability of foot and limb.
The Podiatrist has all the skills required of a practiced FHP, but the exercise of these skills is supported by greater academic preparation, not all of it useful in any other than academic circles. Ethical behaviour extends to FHPs and other members of the care team, and referral to an FHP should be an appropriate and practiced care pathway.
Gait analysis in greater depth and detail would be within the scope of the Podiatrist. So too, would vascular studies, acute diabetic support, and paediatric developmental conditions. Due to the nature of the understanding required by these latter conditions, it will be seen that the Podiatrist may choose to specialise in these and other areas.
The Podiatrist working within the NHS would often have direct access to the facilities of Haematology and Cytology Departments and Pathology laboratories, in addition to liaison with Surgeons, Physicians, Radiologists and other medical professionals. This is not the case where a Podiatrist works in the private sector.
Prescribing of drugs and medication and local anaesthesia lies within the remit of the appropriately qualified Podiatrist. Many podiatrists choose not to practise these areas of their remit.
Wound management skill is important since there will be a need for aftercare following nail surgery. A small percentage of Podiatrists will qualify by further study to perform invasive surgery in order to correct foot structure, compressions, non-unions and mal-alignments, or engage in limb salvage procedures.
John Falkner-Heylings BSc (Podiatric Medicine), DipPodM, FPSPract, Podiatrist
