Revolutionizing Podiatry Education: A Call to Action
The rising incidence of foot and ankle disorders, including a significant increase in diabetes-related complications, has created an urgent need for developing and expanding podiatry as a critical medical discipline in India. India is currently home to approximately 101 million people living with diabetes, of which 50 million suffer from diabetic peripheral neuropathy, and 15 million are affected by peripheral arterial disease. The toll of diabetes in India is devastating, with an estimated 1.3 million amputations occurring annually and 1 million deaths due to diabetes over the past five years. Additionally, an annual expenditure of USD 10.5 billion is incurred in managing diabetic foot ulcers alone. These statistics underscore the immense need for better foot care management and a more structured approach to training podiatric professionals to reduce the burden of diabetic complications.
Expanding the Scope of Podiatry: Beyond Diabetic Foot Care
While traditionally associated with diabetic foot care, podiatry is a comprehensive field encompassing a wide range of conditions and treatments. Despite these critical roles, podiatry remains largely underdeveloped in India, and there is a significant gap in awareness and training compared to other medical specialties. The conditions they manage can be broadly categorized as follows:
Structural and Functional Disorders: Includes flatfoot, high arch, bunions, hammertoes and clawtoes, heel spurs, and neuromas.
Infectious Conditions: Involves fungal infections like athlete’s foot and onychomycosis, bacterial infections such as cellulitis, and viral infections like plantar warts.
Inflammatory and Degenerative Conditions: Covers osteoarthritis, rheumatoid arthritis, gout, Achilles tendonitis, posterior tibial tendonitis, and plantar fasciitis.
Circulatory and Neurological Disorders: Encompasses peripheral arterial disease, diabetic foot conditions, peripheral neuropathy, and Charcot foot.
Dermatological Conditions: Includes corns, calluses, blisters, ingrown toenails, psoriasis, and eczema of the feet.
Traumatic Injuries: Such as fractures, dislocations, sprains, strains, sports injuries, and stress fractures.
Biomechanical Issues: Addresses gait abnormalities, overpronation and supination, and limb length discrepancies.
Paediatric Conditions: Treats in-toeing and out-toeing, clubfoot, and Sever’s disease.
Surgical Interventions: Involves reconstructive surgery, arthroscopic surgery, soft tissue repair, and amputations.
Preventive Care: For at-risk populations like diabetics and the elderly, including guidance on proper footwear and orthotics.
Revolutionizing Podiatry Education: A Structured Approach
Given the extensive scope of conditions managed by podiatrists, it is essential to develop a comprehensive and well-structured education and training program to ensure thorough knowledge and competency in this field. To meet this goal, a three-tier training model is proposed to cultivate the necessary skills and clinical expertise.
Tier 1: Podiatry Consultants
A 15-day internship at a leading podiatric hospital can be designed to benefit foot and ankle orthopedic surgeons, podiatric or diabetic foot surgeons, and plastic surgeons, focusing on practicing evidence-based podiatry with specializations in diabetic foot care or sports injuries.
Tier 2: Fellowship Program Doctors/Physicians
A fellowship program for MBBS graduates in a multidisciplinary environment is another in depth course structure. This training can enhance the ability of fellows to independently manage foot and ankle cases by conducting physical exams, titrating medications, and managing patient histories effectively.
Tier 3: Podiatric Clinicians and Technicians
Aimed at creating “physician extentions” to doctors, paramedical staff like as nurses, physiotherapists, and orthotists, can be trained who can perform minor procedures and provide essential home care. Additionally, training podiatry technicians in performing foot-related assessments such as pressure scans and temperature touch assessments is vital for supporting independent clinicians.
The Way Forward: A Call to Action
Podiatry, as a formal field, is recognized in fewer than 10% of countries worldwide, including India. By implementing this three-tier approach to podiatry education, we can establish a clear roadmap to address this gap, ultimately enhancing the management of foot-related disorders globally and increasing limb salvage rates. Collaborative efforts across the medical community are crucial to achieving this goal. The rise in diabetic cases, sports injuries, aging populations, and various foot and ankle disorders makes the need for trained podiatrists more urgent than ever.
Conclusion: A Time for Change
As the prevalence of diabetes, sports-related injuries, and age-related mobility issues continues to rise, the demand for skilled podiatric care is becoming increasingly evident. The proposed three-tier model for podiatry education offers a strategic solution to meet this demand, ensuring comprehensive care for patients with foot and ankle issues. By advancing training, fostering collaboration, and promoting innovation, we can revolutionize podiatry education in India, prevent amputations, and save lives. The time to act is now.