Chiropody/Podiatry: Interprovincial Differences in Profession Formation.

The regulation of foot health care professionals varies across provinces in Canada. In Ontario, the regulated health profession is chiropody. Chiropodists are foot specialists with a limited scope of practice. In contrast, British Columbia and five other provinces regulate podiatrists, who are highly trained foot physicians with an extensive scope of practice. This article explores the history of chiropody/podiatry in Ontario and British Columbia from the early 1900s through the 1980s in order to understand how professional development in this field took such divergent paths within Canada. In so doing, it not only sheds light on a health practice that has received little scholarly attention, but it also highlights the centrality of inter-professional conflict and state actors' agendas to professional regulatory outcomes.

Changes in the parameters of gait after a mechanical debridement of a plantar callosities.

INTRODUCTION: Plantar callosities are a common cause of pain in the forefoot and also a cause of alterations in plantar pressure. Mechanical debridement with a scalpel can relieve pain and increase functional capacity. OBJECTIVE: The aim of the study was to analyse if debridement of plantar callosities and corns modify walking. METHODS: Thirty four patients with plantar foot pain due to callosities and corns, and up to 5 in the visual analogical scale (VAS) of pain, (20 women, age 29 ± 11.57 years) were analysed by taking into account the changes of their gait. The outcome measurement was the VAS scale and the Win-track system, cycle of the gait(milliseconds), angle(degrees), cadence(number/minutes) and step(centimetres) were measured, 24 h before and after the debridement with a scalpel. RESULTS: There were significant differences in foot pain (mean 67.7, p < 0.001) but there were no significant differences in measures of gait variables before the debridement of the callosities, and 24 h after the procedure, being all those above 0.05. CONCLUSIONS: Our study shows that the debridement with scalpel does not change the variables of the gait 24 h after the procedure.

Tissue Oxygenation Measurements to Aid Scalpel Debridement Removal in Patients With Diabetes.

BACKGROUND: Callus formation in the diabetic foot increases the risk of ulcer onset. It is standard procedure to remove these dead tissue layers to reduce rising pressures. In a surgical procedure known as scalpel debridement, or chiropody the callus tissue is removed up to the epidermal layer. Factors may influence the outcome of this surgical process such as clinician inexperience. In an effort to standardize the debridement process, tissue oxygenation (TO) measurements are obtained before and after to study the effect of debridement on callus tissue. METHODS: Fifteen debridement cases were analyzed using near infrared (NIR) imaging to study changes in TO. The NIR-based device used in this study estimates effective changes in TO in terms of oxy-, deoxy-, total hemoglobin, and oxygen saturation. Weber contrasts between callus tissue and the surrounding normal tissue were compared following debridement for all TO parameters. In a secondary analysis, callus tissue was segmented into quadrants and a percent of significance (in terms of total TO change) was calculated using a t-test. RESULTS: Results show majority of cases displayed greater than 80% as the significant change in TO following debridement, except in cases with the presence of blood clot (a common precursor for ulceration). In cases where incomplete debridement was suspected, a significant change in TO was still observed. CONCLUSIONS: With extensive systematic studies in the future, NIR imaging technique to measure changes in TO may be implemented as a low-cost hand-held imaging device useful for objectively assessing the effectiveness of the scalpel debridement process.