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.

Podiatric surgery: a canary in the coalmine for professional monopolies.

What is known about the topic?  The health workforce and health tasks are highly contested and largely controlled by regulation. Since the introduction of medical regulation in the mid-19th century, the practice of surgery has been largely dominated by medically trained surgeons. A small group of Australian podiatrists have defied these historic boundaries by creating their own colleges of training and convincing government and regulators of their safety and efficacy in surgical practice. The Podiatry Board of Australia commissioned an independent review of the regulation and regulatory practices of podiatric surgeons in Australia. What does this paper add? This paper discusses the implications of a regulatory review of the role of podiatric surgeons for professional role boundaries. What are the implications for practitioners? Despite historic role boundaries and definitions, with appropriate training, regulation, and financing, the health workforce can be mobilised in different ways to meet population needs, overcoming a professional monopoly over roles.

History of the team approach to amputation prevention: pioneers and milestones.

BACKGROUND: This historical perspective highlights some of the pioneers, milestones, teams, and system changes that have had a major impact on the management of the diabetic foot during the past 100 years. In 1934, American diabetologist Elliott P. Joslin noted that mortality from diabetic coma had fallen from 60% to 5% after the introduction of insulin, yet deaths from diabetic gangrene of the lower extremity had risen significantly. He believed that diabetic gangrene was preventable. His remedy was a team approach that included foot care, diet, exercise, prompt treatment of foot infections, and specialized surgical care. RESULTS: The history of a team approach to management of the diabetic foot chronicles the rise of a new health profession, Podiatric Medicine and Surgery, as well as the emergence of the specialty of Vascular Surgery. The partnership between the diabetologist, vascular surgeon, and podiatrist is a natural one. The complementary skills and knowledge of each can improve limb salvage and functional outcomes. Comprehensive multidisciplinary foot care programs have been shown to increase quality of care and reduce amputation rates by 36% to 86%. The development of distal revascularization techniques to restore pulsatile blood flow to the foot has also been a major advancement. CONCLUSION: Diabetic foot patients are among the most complex and vulnerable of all patient populations. Specialized diabetic foot clinics of the 21st century should be multidisciplinary and equipped to coordinate diagnosis, off-loading, and preventive care; perform revascularization procedures; aggressively treat infections; and manage medical comorbidities.

Interprofessionalism A Cornerstone of Innovation and Medical Education at Scholl College of Podiatric Medicine.

In 1912, the Illinois College of Chiropody and Orthopedics was founded, and is today known as the Dr. William M. Scholl College of Podiatric Medicine. It has been an integral part of Rosalind Franklin University of Medicine and Science in North Chicago, Illinois since 2001. Through the ensuing decades, Scholl College alumni have been instrumental in moving the profession forward.

Future of gait analysis: a podiatric medical perspective.

Despite the plethora of information on human gait analysis, its continued use as a clinical tool remains uncertain. Analysis of gait dysfunction has become integral to podiatric medical practice, and, like many specialized fields, it is rapidly changing to meet the needs of the future. Practice in the 21st century is predicated on the concept of multidisciplinary working approaches and a growing trend toward evidence-based practice, in which gait analysis could play a prominent role. This article provides a historical synopsis of instrumented gait analysis and its associated subcomponents and discusses the salient issues concerning its future role in podiatric medicine.

Podiatry: a medical care specialty in quest of full professional status and recognition.

Podiatry as a medical specialty has received little sociological attention. This omission leaves a sizeable gap in our understanding of the total health care system. Given the functional importance of this speciality and the growing need for the services of podiatrists this report represents an attempt to increase our knowledge in this area. The paper attempts to fill that gap by presenting a discussion of the development of podiatry as a health profession; documenting the educational and political development and attempting to explain the reasons which have inhibited the process of professionalization. Our findings suggest that podiatry as a profession has been unable to attain full autonomy over its anatomical area of expertise and this along with other factors has prevented podiatry from attaining full professional status and recognition.

Glancing back, striding ahead. The history of the American Academy of Podiatric Sports Medicine: part 1.

This article provides a succinct but comprehensive review of the history of the American Academy of Podiatric Sports Medicine. Three time periods are described: the pre-academy era, the early years of podiatric sports medicine leading up to the academy's founding, and the academy's founding and the 1970s. An appreciation of the academy's past facilitates understanding of its present state and future direction.

The residency in podiatric medicine. A brief historical overview.

The author provides a general overview of the development of postgraduate residency training in podiatric medicine since 1956. The evolution of residency standards and requirements of the Council on Podiatric Medical Education are discussed. Integration of specialty organizations in the residency evaluation process also are reviewed. The author notes that the current positive number of entry level residency positions available to graduates of colleges of podiatric medicine may be a dubious facade in view of increasing college enrollments and the potential conversion of rotating podiatric residencies to residencies in primary podiatric medicine. He cautions the profession not to overlook these events as it considers the development of the PGY-1 concept in the restructuring of entry level residency training.

1998 William J. Stickel Gold Award. The effects of extrinsic muscle forces on the forefoot-to-rearfoot loading relationship in vitro. Tibia and Achilles tendon.

The effects of muscular activity on the distribution of forces under the foot, as well as within the foot, are of great importance for determining the mechanisms of foot pathologies. Limited data exist concerning muscle forces during the gait cycle and the effects of muscle forces conveyed to the ground-reactive forces of the foot. The authors developed a cadaveric loading system to determine the effects of force applied to the Achilles tendon on the forefoot-to-rearfoot loading relationship in eight cadaveric specimens. The study indicated that, during axial loading of the tibia, force was inherently transferred from the rearfoot to the forefoot. However, the observed forefoot-to-rearfoot loading relationship did not match the predicted loading relationship from a rigid-body diagram, as would be observed in a class I lever. The results indicated that, as the force was increased on the Achilles tendon, the change in loads on the forefoot and rearfoot was not linear. Specimens with calcaneal inclination angles greater than 20 degrees demonstrated a more linear increase as compared with those with inclination angles less than 20 degrees.

History of residency selection issues in podiatric medicine.

Issues related to residency interview and selection processes have concerned the podiatric medical profession for nearly 20 years. This article presents a chronology and summary of efforts undertaken to address these problems, including a discussion of legal ramifications of residency approval requirements related to establishment of a uniform notification date and participation in a resident-matching service.

1997 William J. Stickel Gold Award. Morphological and biochemical properties of metatarsophalangeal joint cartilage.

Although there is sparse information concerning the properties of foot-joint cartilages, knowledge of the morphology and biochemistry of these cartilages is important in the study of changes that occur in the development of osteoarthritis. Normal first and fifth metatarsophalangeal joints were chosen for comparison because of the difference between these two joints in the prevalence of osteoarthritis, particularly with advancing age. The authors' study shows that there is no age-related decrease in articular-cartilage thickness; however, there is an age-related decrease in the chondrocyte density in the superficial zone in both joints. There is, however, a difference between the two joints in the level of expression of matrix-degrading enzymes. This difference may indicate differences in specific chondrocyte activity that precedes or accompanies the development of osteoarthritis or other degenerative morphological changes.

The past, present, and future of podiatric biomechanics.

The author places the history and development of podiatric biomechanics, as well as current thinking about its underpinnings and future, in the context of a theoretical framework drawn from the philosophy and sociology of science. This analysis sets the stage for an exploration of the possible future directions in which podiatric biomechanics could develop.

1998 William J. Stickel Silver Award. Mechanically assisted, delayed primary closure of diabetic foot wounds.

The authors evaluated the time to healing and prevalence of complications in patients undergoing mechanically assisted, delayed primary closure of diabetic foot wounds compared with a similar population who received standard wound care. A total of 55 patients were enrolled for study, with 25 in the experimental group and 30 in the control group. Patients in the experimental (stretch) group underwent mechanically assisted primary closure of their wounds using a skin-stretching device. There was no difference between the stretch and control groups with regard to any descriptive characteristics, including wound chronicity. Although the wounds were over three times as large on average in the stretch group (P < .001), the stretch group reached full epithelialization approximately 40% sooner than the control group (26.4 +/- 16.0 versus 42.5 +/- 19.9 days; P < .002). Eighty-eight percent of patients in the stretch group experienced wound dehiscence, at a mean time of 1.8 +/- 0.6 weeks following mechanically assisted closure. However, patients who experienced dehiscence in the stretch group healed significantly faster than patients in the control group (27.4 +/- 16.7 versus 42.5 +/- 19.9 days; P < .007). The results of this study suggest that mechanically assisted closure of diabetic foot wounds may result in reduced healing time compared with healing by secondary intention.

Inhalation of nail dust from onychomycotic toenails. Part I. Characterization of particles. 1984.

Nail dust particles were analyzed by scanning electron microscopy for size and topography. The percentage of "fines" that could be inhaled and deposited in the alveoli and bronchioles were determined by quantitative particle size analysis. Distribution representing the largest total mass was graphed between 1 and 2 microns. The authors found that 86% of nail dust would reach the bronchioles and alveoli, and 31% could be expected to deposit in these areas.

Nail dust aerosols from onychomycotic toenails. Part II. Clinical and serologic aspects. 1984.

The podiatric procedure of burring hyperkeratotic fungal infected toenails results in large quantities of nail dust aerosols. An extremely large percentage (31%) of podiatrists who were analyzed for immunoglobulin E (IgE) by antibody radioimmunoassay were found to have abnormally high levels. Incidence of precipitin antibodies to Trichophyton rubrum in sera of those in practice from 0 to 15 years was 23%, and those in practice 16 years or more was 29%. In this study, podiatrists who were chronically exposed to nail dust aerosols after years of practice presented with symptoms of conjunctivitis, rhinitis, asthma, coughing, hypersensitivity, and impaired lung function.

1997 William J. Stickel Bronze Award. Comparison of strategies for reducing pressure at the site of neuropathic ulcers.

Few scientific data are available on the effectiveness of commonly used modalities for reducing pressure at the site of neuropathic ulcers in persons with diabetes mellitus. The authors' aim was to compare the effectiveness of total contact casts, half-shoes, rigid-soled postoperative shoes, accommodative dressings made of felt and polyethylene foam, and removable walking casts in reducing peak plantar foot pressures at the site of neuropathic ulcerations in diabetics. Using an in-shoe pressure-measurement system, data from 32 midgait steps were collected for each treatment. There was a consistent pattern in the devices' effectiveness in reducing foot pressures at ulcer sites under the great toe and ball of the foot. Removable walking casts were as effective as or more effective than total contact casts. Half-shoes were consistently the third most effective modality, followed by accommodative dressings and rigid-soled postoperative shoes.

1997 William J. Stickel Silver Award. The anti-inflammatory action of locally injected ketorolac.

Locally injected steroids are used to treat inflammatory conditions, in spite of the complications associated with their use. Ketorolac tromethamine, an injectable nonsteroidal anti-inflammatory drug, has not previously been evaluated for treatment of musculoskeletal inflammatory conditions via local administration. Eighty Achilles tendons of rabbits were traumatized in a controlled fashion. At the time of trauma, a single dose of ketorolac (1, 3, or 5 mg/kg) or normal saline was administered peritendinously. Three days later, the tendons were harvested and examined histologically to evaluate the degree of inflammation present in the tissue. No statistically significant difference was found between the experimental and control groups. The authors conclude that locally injected ketorolac does not prevent the onset of an inflammatory process.