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What's the difference between a podiatrist/chiropodist and a foot health practitioner?

Updated: Dec 4, 2023

Before we get started, we'll just address the elephant in the blog space - what's the difference between a podiatrist and a chiropodist? Nothing. Absolutely nothing. And so the difference between a podiatrist/chiropodist and a foot health practitioner (FHP)is what then?

A podiatrist/chiropodist and a foot health practitioner are both healthcare professionals specialising in the care of the feet and lower limbs, but they differ in terms of their training, scope of practice, and the level of care they can provide. The terms podiatrist and chiropodist are interchangeable, and protected by law. This means, when an FHP advertises themself as a chiropodist on Google, this is illegal. Let's whip through the key differences: -

1. Education and Training:

- Podiatrist: In the UK, a Podiatrist has completed an undergraduate degree in podiatry or podiatric medicine at University. This is a three or four year medical degree program specific to the foot and lower limb. Of note, the course covers human biomechanics, physiology and anatomy to enable the Podiatrist to understand how other systems can affect the feet. Additionally, Podiatrists are licensed to diagnose, treat, and perform minor surgery. A Podiatrist commits to continuing professional development - that is, they must maintain a portfolio of further education such as courses and webinars that they attend, journals they read or contribute to, meetings with colleagues, supervision and mentorship, etc, to evidence that they are staying abreast of recent developments in and around the profession to offer best practice to their patients.

- Foot Health Practitioner: Foot health practitioners, on the other hand, typically undergo shorter, non-medical training programs that are certificate or diploma-based. Programmes can be completed within a year in most cases. Foot health practitioners focus on general foot care, such as nail trimming, callus removal, and basic foot hygiene.

A foot health practitioner is not expected to continue their professional development throughout their career as part of their professional registration, although courses and updates are available for foot health practitioners to attend.

2. Scope of Practice:

- Podiatrist: Podiatrists have a broader scope of practice and can diagnose, treat, and manage a wide range of conditions related to the feet and lower limbs. This can include issues like diabetes-related foot problems e.g. from dry skin to neuropathy and foot ulcers, sports injuries and musculoskeletal conditions, and surgical procedures for ingrowing toenails. Some podiatrists will extend their scope of practice further to perform minor skin surgeries and offer injection therapy (e.g. steroids, hyaluronic acid), or undertake further education to become podiatric surgeons.

- Foot Health Practitioner: Foot health practitioners generally provide more basic foot care services, like toenail trimming, callus and corn removal, and providing general advice on foot hygiene. They are not licensed to diagnose or treat complex medical conditions or perform surgical procedures. They are also not qualified to make recommendations or prescribe medications.

3. Licensure and Regulation:

- Podiatrist: Podiatrists are licensed healthcare professionals. Their practice is regulated by the Health & Care Professions Council (HCPC). They are authorized to prescribe medications, order diagnostic tests, and perform certain surgical procedures (within their scope of practice; varies from podiatrist to podiatrist). Under the HCPC, podiatrists must maintain certain Standards of Proficiency, which includes particular hygiene standards.

- Foot Health Practitioner: There is no statutory regulation of training, standards or the professional actions of foot health practitioners in the UK.

In summary, the main difference between a podiatrist and a foot health practitioner lies in their education, training, and the range of services they can provide. Podiatrists are highly trained practitioners with a broader scope of practice, while foot health practitioners are typically trained in basic foot care and maintenance.

Felicity's Comments There is room for both specialisms within the field of foot care. Ultimately, the choice of which professional to see depends on the specific foot or lower limb issues the patient is experiencing and the level of care required.

However, in my experience, the patient does not always appreciate their particular needs - and without the in-depth knowledge of anatomy and physiology and a broad experience of different foot conditions (such as those seen in the NHS, where foot health practitioners are not eligible to work), foot health practitioners can be ignorant to a patient's true need too. I must admit, I am concerned when I see a foot health practitioner advertising diabetes checks, or stating that they can treat people with diabetes. No doubt, they have been taught that they can as part of their training programme. In my opinion, without experiencing first-hand the effect of inappropriate foot care in a person with complex needs such as in diabetes, a foot health practitioner cannot be qualified to manage and treat a person with this condition. Certainly, diabetes is a spectrum - there are some folks whose circulation is tip top, they are neurologically intact and they have minimal foot care requirements. There is an argument here that this patient would be suitable to be cared for by a foot health practitioner. And I don't totally disagree - but what worries me is would the foot health practitioner pick up on the patient stating that sometimes they experience a feeling of walking on 'pebbles' or 'cotton wool' and know to refer this patient on? Would the foot health practitioner note the blueish discoloration in the toes and know that they must not cut this person, and if they did - would they know how to dress the toe to prevent infection and arrange a follow-up a few days' later? Perhaps this is ultimately a training issue - but this is not without it's complexities. If a foot health practitioner is trained to diagnose neuropathy and misses it, does this open the floor to litigation? What does this mean for their insurance?

In podiatry, we are often advised to 'stay in our lane'; that is to refer refer refer if we see a patient who is presenting with an issue outside of our scope of practice. Foot health practitioners shouldn't see it as a slight when we suggest they refer these patients over to us; they are potentially dodging a bullet! I truly feel there is room for both podiatrists and foot health practitioners in the foot health workforce - but it is critical to identify and work within the limits of our particular scopes of practice, and make these more obvious to the public. In this utopia, we can offer the most appropriate care in a timely manner, the patient can avoid wasting money on unnecessary appointments, and potentially avoid injury. Although the elephant in the room here is that not all podiatrists are as professional as they should be... but that's a discussion for another time, perhaps! Personally, I don't want to just cut toenails in an otherwise healthy individual. That's not what I've trained for. This is where we could work with our foot health practitioner colleagues and refer more routine cases on to them, including the lower-risk (circulation intact, non-neuropathic, normal nails) diabetes patients; on the proviso they refer them back if there is a whiff of anything afoot (pun intended).

Within the general medical field, podiatrists can be perceived as the lowest of the low. I recall a child's birthday party quite recently, where a physiotherapist looked at me as if I was actual dog doody when I said I was a podiatrist. And what's with GPs rarely referring to us? That patient you've been prescribing course after course of antibiotics for their ingrowing toenail? Yeah - a podiatrist can sort that out in one appointment. Anyway, I digress.

So - how do we set about improving relations between podiatrists and foot health practitioners and informing the public about who can do what? I have no idea. But it's like with recycling, all you can do is do your bit. I endeavour to build good relationships with both podiatrists and foot health practitioners in my local area - after all, it's a blummin' weird job. Your partner, lifelong friend or dog isn't going to want to hear about the stonking corn you removed from a patient's foot today - but a fellow pod or foot health practitioner? They'll want to know all the gory details.

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