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Scope of Podiatry

Working as a podiatrist can be exciting and rewarding because it involves working in a variety of environments with a number of other health care professionals and many different groups of patients who have a wide range of podiatric problems.
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The scope of practice of a podiatrist is often much wider than many people realise. The work falls in to five key categories:

    1. General Clinics
    2. Biomechanics
    3. Children
    4. High Risk Patient Management
    5. Foot Surgery

General Clinics

Podiatrists all start off their careers working in general clinics. This involves providing essential assessment, evaluation and foot care for a wide range of patients. Many of the patients have long-standing problems for which there is no cure. Podiatrists therefore play a big part in keeping these people mobile and make a real difference to their lives.

This work uses many of the clinical and assessment skills you are taught in training. Once you start work you will quickly develop more confidence and speed. You may work with foot care assistants who provide basic foot care and patient advice whilst you treat the more complex problems. This work is very varied and rewarding and each clinic presents you with different pathologies to treat. It is an excellent place to start straight after graduation.

Most podiatrists have some general practice work in their weekly rota’s, but as time goes on they find areas of clinical practice they want to focus on for their future career development. The opportunity may arise for you to develop your skills in an area of clinical specialisation e.g. sports, children, diabetes etc.


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Biomechanics

Biomechanics is concerned with preservation, restoration and development of the function of the foot and its associated structure. Biomechanics refers to an understanding of the mechanics in the body and podiatrists use this to diagnose and treat the lower limb. This is a subject that interests a lot of practitioners and covers a number of areas of practice.

One area of clinical practice that focuses on biomechanics is sports injuries. There is currently a big demand for podiatrists to treat sports injuries.  Most of those working in this area are self-employed private practitioners. The work can involve working with individual athletes or working for sports teams e.g. rugby or football clubs.

There are many biomechanical investigations podiatrists use to help them assess and evaluate the patients they treat. A lot of biomechanical problems are treated with orthotics. These are custom made insoles specifically for each patient that aim to improve function and reduce symptoms. Some podiatrists manufacture orthotics themselves but many will use commercial of NHS orthotic labs where orthotic technicians produce the device based on the prescription written by the podiatrist.

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Children

Many children present with developmental biomechanical problems. Working with children is called Podopaediatrics. Many lower limb problems children have are biomechanically related. Podiatrists who specialise in working with children have to have an in-depth understanding of this area of practice.

Some podiatrists work using biomechanics in general clinics where any people visit a clinic with functionally related problems. A biomechanical assessment can often help a podiatrist pinpoint the problem and develop a diagnosis which enables them to treat it appropriately.

Other groups of patients are prone to developing biomechanical problems as a result of a disease they have. An example of this is rheumatology patients.  Rheumatoid arthritis is a disease that deforms joints including those in the legs and feet. Podiatrists undertake biomechanical assessments of these patients in order to devise appropriate treatment plans that will reduce discomfort, increase stability and ultimately keep the patient as mobile as possible.

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High Risk Patient Management


Many podiatrists specialise in working with patients who are classed as being high risk. These patients have an underlying illness or condition that puts their legs and feet at increased risk of injury and disability. Many have very poor circulation which means their skin is very fragile and can be injured easily. Once an injury occurs it can take a long time to heal. Some patients have reduced or no sensation in their feet and they can injure themselves without knowing.

 For example, walking with a stone in their shoe for 30 minutes can result in ulceration. Patients classed as high risk include some patients with diabetes, rheumatoid arthritis, cerebral palsy, peripheral arterial disease and peripheral nerve damage. Podiatrists have a vitally important role to play in the care of these people. They provide assessment and treatment along with patient advice in order to reduce the long term and sometimes very serious problems that could lead to amputation. Podiatry intervention in the care of these patients can reduce amputation rates by 40%.

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Foot Surgery

This is an area of clinical practice that many podiatrists are involved with at some time or other. There are two levels of surgical practice. As an HPC Registered Practitioner a podiatrist is qualified to administer local anaesthetic and is trained in a number of surgical procedures. These include nail and minor soft tissue surgery.

Some podiatrists go on to develop this interest and train as a podiatric surgeon, who surgically manage bone, joint and soft tissue disorders within the foot. Podiatrists can only do this after graduation and have to undergo rigorous surgical training taking a number of years.

 

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