Choosing Your Podiatrist
Choosing your podiatrist is far more difficult than you might have imagined!
What is the difference between a podiatrist and a chiropodist?
In the UK, both titles are synonymous and there is no difference between the new, now legally protected titles, “podiatrist” and “chiropodist”, which replaced the old, more familiar, legally protected title, “State Registered Chiropodist”. Podiatrist is simply the new name for a chiropodist and is now used in most English speaking countries world-wide.
When I qualified in 1966 and became a State Registered Chiropodist, it was quite easy for patients to choose their chiropodist. They either went to a State Registered person who they knew had been trained for at least 3 years or to one of the unregistered ones, colloquially known, in those days, as “quacks”, many of whom were actually quite competent in their treatments, having been practicing for many years, but who had not been to “college” and therefore had not passed the State Registration examinations.
In the 1990s, I was elected to the Council of the Society of Chiropodists and, with the help of my M.P. David Alton, now Lord Alton, I spent the next nine years trying to get the new title “Podiatrist” onto the Statute books for the sole use of those already on the State Register and for all future graduates on 3 year full time courses at a recognised institution (university). The old title “Chiropodist” would then be used for those who had not trained to this standard and who were to be “grand-parented” onto the new Health Professions Council (HPC) register, when that eventually came into being. This would protect the public and enable them to make an informed choice when seeking treatment, by making it easy to differentiate between those who had been trained for at least 3 years full time to State Registration standard (the podiatrists) and those who had not (the chiropodists). These new “chiropodists” would, if they so desired, then have the chance to be trained-up and take the relevant examinations, which, when passed, would enable them to use the title “podiatrist”.
Recently, The Government decided to finally “close” our profession by “grand-parenting-in” all of those who had been working in private practice for a minimum of 3 years as non State Registerable chiropodists and who wished to be added to the new HPC register.
Unfortunately, at the eleventh hour, our original idea to use the newly protected titles in the way we had wanted, was dropped and the many thousands who were “grand-parented-in” were immediately allowed to use the new title “podiatrist”.
So rather than making it easier for the public to differentiate, the new legislation has made it even more difficult for patients to make that very important ”informed choice” when seeking treatment.
HPC registration, what is it?
The Health Professions Council (HPC) replaced the old CPSM (Council for the Professions Supplementary to Medicine) on 9th July 2003. The CPSM used to set the standards for State Registration and NHS employment which, for podiatrists/chiropodists, was a minimum of 3 years full time training at an approved institution (university), leading to a degree or diploma in podiatric medicine.
Does HPC registration provide an adequate safeguard for patients?
No, unfortunately not!
Choosing a podiatrist has actually been made more difficult by the HPC, which insists that the obvious differences in training are to be ignored and will only state that all podiatrists meet their new “minimum standards of proficiency”.
HPC registration only ensures that the practitioner meets certain minimum standards of education, but, unlike the CPSM, it does not guarantee that the podiatrist/chiropodist holding that registration has completed an approved 3 year full-time course to degree/diploma standard, however, the HPC holds the list of approved courses which are now, without exception, 3 year minimum, B.Sc. degree courses. This could well lead members of the public to expect that all registered podiatrists are degree educated, but, as you have read, this is not the case and many may well have been practicing privately for only 3 years with little or no formal training whatsoever. Despite these shortcomings, patients seeking treatment are still advised to choose only from those on the HPC register which is available on line at www.hpcheck.org.
Level of Training
There is no requirement for a podiatrist/chiropodist to declare their level of training and it is up to the patient to ask them if they are an HPC Registered Podiatrist. It is a criminal offense to falsely claim they are. If they are using the title chiropodist or podiatrist and they must be HPC registered and you can further ask if they have a degree or a 3 year diploma in podiatry (B.Sc. or D.Pod.M). It is a breach of HPC regulations to falsely claim they have. If there is any show of protest at this or if they will only insist that they are “fully qualified”, but won’t be specific, you may draw your own conclusions.
In the past, only those trained for 3 years full time to diploma/degree standard, were legally allowed to obtain local analgesics, used routinely for nail surgery, etc. This is no longer the case and those who have been “grandparented-in” and even “foot health practitioners” (see "Others" below), can now undertake courses in local analgesia.
When making “informed choice” from the Register, check in the column under “Local Anaesthetic”, if it says "yes" here, then that person, although now not necessarily diploma/degree trained, will have been trained to a higher level than the others. You can then ask them about their qualifications and level of training.
What about all the others you see advertising in Yellow Pages, Thompson’s Directory etc?
Many of those previously using the titles chiropodist and podiatrist, who have not gained HPC registration, either through choice or because they were not eligible, have now adopted the titles “Foot Health Practitioner” or “Foot Health Specialist” to replace chiropodist/podiatrist which they can no longer legally use. These titles are not protected in law and anyone, trained or not, can use them. These people will advertise widely that they can give the same medical treatments as those offered by podiatrists, however, it is clear that any such person is not to be confused with and cannot be compared to a 3 year full-time degree trained podiatrist.
Does it matter who I see?
Yes, it does matter!
You should always seek treatment from the most highly trained podiatrist possible, even if your general health is good. If your health is less than perfect and you have problems such as diabetes, rheumatoid arthritis, poor circulation, or conditions which have altered the way you walk, like strokes or MS, or if you are on high risk medication such as Warfarin, it is imperative that you are treated by a highly trained podiatrist.
Podiatrists not only treat nails, corns and callus, many often specialise in biomechanics, dealing with problems arising from the way joints are aligned and the muscles function, podopaediatrics, the diagnosis of lower limb disorders in children, surgery, on nails, bones and joints, orthotics, making custom-made insoles to cure biomechanical problems, sports injuries and treating high risk patients with diabetes, neurological and circulatory problems.
If you are in good health but simply can no longer reach your feet to care for them yourself and only have minor needs such as nail cutting and possibly a little hard skin to remove, you should still seek treatment from a highly trained podiatrist who will be able to spot and diagnose any problems about which you might be unaware and treat them effectively before they develop into more serious conditions. You should feel confident that the podiatrist you see understands any problems you might have and can offer you effective treatment.