New Year Resolution – Become a Podiatrist
In just under 7 hours time South Africa will welcome 2009. Will you make a resolution to become a podiatrist? Maybe one of your family or friends will?
Are you sitting with your ‘Matric’ results and not sure what to do next? South Africa has a serious shortage of podiatrists and as I wrote the other day even our new graduates are emigrating. There are fewer than 200 registered podiatrists for our population of about 48 million people.
However, with increasing access to health care and awareness of the benefits of a healthy lifestyle, there is a growing demand for foot care, especially for children and people with foot problems associated with diabetes and arthritis. Nevertheless, many sectors of the South African population still don’t know what a podiatrist is or what we do. As our population changes more people will need foot care.
A podiatrist is really a ‘doctor of the feet’. We diagnose and treat foot disorders and abnormalities. This is done in many ways. Biomechanical examination involves assessing the whole lower limb and its function and then prescribing the appropriate treatment to maintain or restore normal mobility or function.
Many systemic diseases affect the feet and may even be diagnosed from foot symptoms. As a podiatrist you may need to refer your patient to a specialist for further management. A large part of podiatry treatment involves the skilled use of sharp instruments to treat corns or callus or possibly perform detailed corrective surgical procedures on toe nails.
Some of the conditions that Podiatrists treat are fungal infections of the feet and toenails; corns and calluses; ingrown toenails; foot ulcers in diabetes; causes of foot pain in arthritis. Most podiatrists incorporate orthotics and insoles into their treatment when necessary.
The assessment and management of childrens’ foot problems forms an important part of a podiatrists work, whilst some podaitrists are skilled in the managemment of foot problems arising from sports. Nowadays, prevention of foot problems has become very important, so foot health education is also part of podiatry practice.
Although there is no official specialist register for podiatrists, many of us have developed ‘special interests’ in sports injuries, chronic disease, children or the elderly.
The day to day work of a podiatrist is interesting and varied. Giving relief from pain or diagnosing the cause of a foot problem is both challenging and stimulating. You do need to be able to work alone but also need to be a ‘people person’ to relate to the different patients you meet every day. Most podiatrists are in private practice, but we hope there will be an increasing deployment of podiatrists in the State Health services in future. For example Limpopo Province appointed their first graduate podiatrist.
To practice in South Africa you have to register with the Health Professions Council of South Africa.(HPCSA). This means that you become part of the Team of health care professionals providing care to South Africans and that you adhere to ethical standards.(By the way, it is illegal to practice as a podiatrist in South Africa if you are not registered with the HPCSA. So always check the credentials of a podiatrist).
To become a podiatrist in South Africa requires four years of full-time study at the University of Johannesburg. You will obtain a Bachelors degree and be able to go into practice immediately. Although bursaries are limited I believe this is changing as Provincial Health Departments begin to realise the value of foot care. Your entrance is dependent on your Admission Points Score (APS) or your M-score.
There are still vacancies for 2009 enrolment. So why not contact the University of Johannesburg – they reopen on 5th January 2009 – at 011 559 6167 or www.uj.ac.za
However you welcome in the New Year, dancing the night away, taking it easy at home with friends, walking on the beach on an exotic island or if you are unlucky, at work! Enjoy yourself and I wish you all good foot health and happiness in 2009.
TAKE CARE OF YOUR PAIR! SEE A PODIATRIST
Diabetic Foot Congress: Johannesburg 2008
Tomorrow morning sees the start of the first Diabetic Foot Working Group (DFWG) Congress in Johannesburg. In South Africa it is also a long weekend – meaning that Monday June 16 is a National Holiday, when we remember the youth of SA and their part in the struggle against apartheid. Especially the riots which broke out on June 16 1976.
For those of us dedicated to another great cause, we will spend the next 3 days learning, sharing and discussing the causes and effects of the diabetic foot, with a special emphasis on our local problems and solutions. We have speakers from Cameroon, the UK and USA, in addition to a variety of local speakers. The benefit of this type of congress is that you get to meet the members of the wider multidisciplinary team and the exchange of ideas and information will help to increase the core of health professionals available to manage the feet of people with diabetes in South Africa.
Recently I have been requested to try to assist with the development of training in foot health in Nigeria and have a new contact with an orthopaedic surgeon in Iraq. There are no podiatrists in Nigeria at all, where the population is more than 140 million. Furthermore there is no government support for foot care either.
I am very pleased to report that the lady featured in the ‘bean bag’ blogs, is making fantastic progress, thanks to the skill of my associate Tshidi Tsubane. We are also very proud of the fact we have had a paper published in a new journal – Wound Healing Southern Africa – Volume 1 No 1. visit www.woundhealingsa.co.za
Currently we are working onpapers concerning nail surgery for people with diabetes and the costs of ulcer care from a podiatrist.
Finally for Friday 13th! I spent the day as an examiner for the podiatry students at the University of Johannesburg. I’m not sure who was more tired the students or me. At the end of two sessions of assessing competency in clinical skills you actually feel quite sorry for them.
Have a great weekend.
Podiatry Students Under Threat?
University of Johannesburg 4th year podiatry students are in for a new experience on Tuesday 5th February! For the first time in 12 years I am returning to lecturing. I will be lecturing Private Practice Management, which is part of the course on Health Systems Management. I’m looking forward to re-joining the academic team, despite a dislike of marking. It seems to me that full-time academic life in 2008 is like a road full of potholes called "admin," so I hope I can avoid these potholes as a part-timer! Being burdened with too much "admin" was one my reasons for leaving in 1995!.
Podiatry education in South Africa started in 1977 at the Witwatersrand College for Advanced Technical Education (WCATE), as a 3-year Diploma plus a year of in-service training. Then it became a National Higher Diploma after 4-years of study after WCATE became Technikon Witwatersrand(TWR). It evolved into a 4-year Bachelor’s Degree at TWR and when TWR and the Rand Afrikaans University merged to form the University of Johannesburg(UJ), this became the latest home for the degree. The degree isn’t offered by any other University in South Africa, which is disappointing and leads to all sorts of difficulties in enrolling students from around the country. However graduates from UJ are distributed all over the world and many have gone on to become leaders in the profession in their new countries. In fact this week another young podiatrist is leaving Johannesburg for Australia, another went to Canada last Christmas and another two also left for Australia in 2007 whilst yet another relocated to Saudi Arabia (Hopefully this is only a temporary posting).
Fortunately there are some of us left in South Africa, mostly in private practice, but there are more posts being created in the State Health Services, including the Military, with students having to work back their bursary committments. As yet there is no requirement for podiatrists to do Community Service, mainly it seems due to the lack of available supervisors and posts. If and when Community Service becomes a requirement, podiatrists are well qualified to perform an important role in the management of foot problems associated with chronic disease and more importantly I think those affecting children.
South Africa’s New Podiatry Graduates
Today I managed to survive my day in the practice, but I am amazed at the number of times that I had to twist and turn my back just to perform my daily tasks. But it was good to remember to turn my whole body, use the full support of my chair plus the variety of positions available in the patients’ treatment couch. I am definitely going to look after my back from now on.
Hopefully the 10 new podiatry graduates of the University of Johannesburg will do the same as they commence their careers. This afternoon I attended the ceremony at the University where the newly graduated podiatrists swore the Hippocratic Oath as recognition of the completion of their studies and the commencement of their careers.
This is the first time that this has been done in South Africa and although a small event it was a very significant moment for the graduates and I believe the podiatry profession in South Africa. In the academic field this has been a bad year for podiatry and the University of Johannesburg is engaged in revitalising the BTech Degree with new staff and renewed enthusiasm for 2008.( Some might say desperation as I have been accepted as a part-time lecturer for 2008!).
Goodness knows where these new colleagues will find work, but some of them have bursary commitments, so the State will have to place them somewhere. It really is a disgrace that there is such neglect by the State in recognising the role and status of the podiatrist as a member of the health team. In some regions there are good posts while in others they don’t even know what a podiatrist is.This means that most graduates are forced into private practice immediately, an expensive option that is not usually possible for them, so they end up working part-time in shoe shops, for other podiatrists, emigrating or even leaving the profession.
The podiatrist doesn’t feature much in some South African cultures, so it is up to the profession to become much more visible (dare I say aggressive in marketting itself to the public). The role in the management of chronic disease is quite well established, as it is in sports. But there is a massive and unmet need in Occupational Health for example. How many people are suffering foot discomfort that distracts them from efficiently operating machinery or standing and walking in their safety footwear?
The solution lies with the podiatrists themselves – we must research and then write and publish our findings for scientific scrutiny. Discussion amongst the podiatrists will also give birth to more evedence based practice as well as best practice based on experience.
Certainly my hope is that these new graduates will find a meaningful place in the South African health community and be – proudly podiatrists!
What Does a Podiatrist Do?
A podiatrist diagnoses and treats foot disorders and disabilities. The primary objective is to return the foot to optimum health as quickly as possible. This is achieved by combining a thorough examination of the feet with skilled practical treatment, padding, insoles, orthotics and foot health advice.
When you visit a podiatrist the type and duration of examination depends on what is wrong with your feet – so how you describe your problem is very important.
A biomechanical examination and gait analysis is an assessment of the structure and function of the foot and the effect this has on the lower limbs. This takes about 1 hour and is usually necessary to assess sports-related injuries, the effect of arthritis or children’s foot problems. This enables the podiatrist to plan an appropriate treatment programme, provide detailed foot care advice or to prescribe the correct shoe, insole or orthotic.
If your problem is more medical than mechanical then your podiatrist will consider other factors.
Where Can I Find A Podiatrist?
There is a serious shortage of podiatrists in South Africa at present, with less than 200 registered with the HPCSA and about 160 in private practice. Some of the major hospitals have a podiatrist either full or part-time.
The South African Podiatry Association represents most podiatrists in matters of ethics, business and publicity.
You can use their website at www.podiatrist.co.za and the link under ‘Find a podiatrist in YOUR area’ to find the listing of registered podiatrists.
If you dont have web access then the Podiatry Association can be contacted at 0861 100 249 or Email: sapa@podiatrist.co.za.
You can also look in the Yellow Pages under Podiatrists.
What is Podiatry?
You may be more familiar with the name chiropodist, but the names chiropody and chiropodist were officially change changed to podiatry and podiatrist in 1984. This reflects the more scientific approach to the practice of the profession by the modern podiatrist.
The podiatrist diagnoses and treats foot disorders and disabilities.
A consultation and treatment by a podiatrist is more medical and is not a pedicure, for which you see a beauty therapist.
A professional board for podiatry was established in 1976 and since 1982 it has been compulsory for all podiatrists to register with the Health Professions Council of South Africa (HPCSA), to be allowed to practice, so always make sure that your podiatrist is properly registered.
Podiatrists in private practice must also register with the Board of Healthcare Funders, to obtain a practice number. This enables Medical Aid Schemes to recognise individual practitioners when claims are made and to reimburse against the new Recommend Price List for podiatry, which is put out by the Commission for Medical Schemes. Most medical aid schemes recognise podiatry and members can submit claims for reimbursement in accordance with the rules of each scheme.