Osteomyelitis & Discussion on Social Media

Improving posts with social communication networks

A podiatrist posted a question on Facebook starting with “High-risk clinics and non-healing wounds”. She wanted to know if bone samples were taken for suspected osteomyelitis in the case of neuropathic ulcers. Secondly, the podiatrist asked how this was learned to be undertaken safely. The primary author of this social media group, dedicated to podiatry, did not intend to take bone samples.

The respondents, for the most part, launched into what TO DO rather than answer the question directly, and the number of comments caught my eye.

Do we answer the question or embark on education within the Facebook Group? A  series of posed questions and responses and referral pathways appeared confusing without a definitive answer. ConsultingFootPain discusses the subject of who does what and why.

 Responses

• Send for an x-ray/use orthopaedics
• X-ray changes are delayed. MRI is better or labelled WBC scans
• Use a podiatric surgeon
• Non-healing ulcers use an MDT
• Where are you based? Are you part of a team? Do you have a podiatric surgeon? Do you have experience with deeper tissue samples? What are you planning to do with the bone biopsy? Do the wounds probe to the bone? What clinical imaging do you have available?
•  I hope podiatric surgeons will assist in training (podiatrists)
•  Managed by the NHS, not in private practice. Follow Trust protocols and talk about virtual appointments, referral to acute services, x-rays, and bone fragments leading to culture via a GP if a private patient is involved. Emergency referral to local NHS podiatry.

The value of Facebook and forums is, without doubt, helpful. The respondents feel that they wanted to engage passionately. This particular thread came from a well-used social group and had the engagement of a wonderful community willing to express opinions professionally.

How is the subject taught?

Podiatry is a profession that deals with chronic problems over acute diseases. Most acute problems do not fall to (UK) podiatrists. The question around high-risk and non-healing wounds with osteomyelitis tends to place such a condition in the domain of the specialist podiatrist. 

There are two key specialists in podiatry. The diabetic specialist in podiatry will have extended knowledge and access to support within the NHS, as well as a podiatric surgeon with dedicated bone pathology training. Podiatric surgeons have extended their role in dealing with diabetes in some parts of the country. Bone disease and bone pathology with or without ulcers generally fall within the NHS because they may not be covered by medical insurance policies. The investigation process is expensive, and multi-disciplinary teams (MDT) tend to be better joined at the hip in the NHS. 

The Elements of Learning

Learning any skill comprises two elements: the didactic classroom theory and the practical, hands-on exposure. Classroom theory is important for recognising a problem, but experience in the field is essential for managing a problem and getting the job done.

The qualification of who can do what is predicated on an acceptance within society, firstly those who organise the professional service, that is to say, the professional body. Secondly, the actions of a profession are regulated and must meet the criteria for learning and monitoring ability.  The podiatrist must meet accepted standards. As managing ulcers falls to all podiatrists, this is relatively easy. How do you perform treatment, and how far does one act?

Who ranks where?

The podiatric surgeon carries a Fellowship qualification recognised by examination and award after a long period of educational exposure. The basic Fellowship takes 5-7 post-graduate years, while the honing to consultant adds another 2-3 years as part of advanced clinical exposure under supervision.

The diabetic specialist does not have the same rigorous training but has more of a working period, often close to the medical specialties. This includes vascular surgeons, physicians specialising in diabetes and endocrinology, and specialist surgeons, including podiatric or orthopaedic foot surgeons. 

While diagnosis is key – oral antibiotic management may not be enough for bone infection.

How far should a clinical podiatrist go?

Defining a role and executing a treatment plan does not just include performing a physical service. All podiatrists are trained in medical sciences. The principle of what one does is predicated on knowledge, training and exposure. The qualification, without doubt, aids action, but what if you do not have a fellowship? Those podiatrists who deal with lepromatous ulcers and, in particular, neuropathy should and can remove bone if this is observable because they understand tissue compliance.

Knowledge about infection and prevention can be assisted by prescribing antibiotics. The need to step up exposure, incision and drainage, together with undertaking investigations, does come down to access and the stability of the patient’s medical condition. Intravenous antibiotic management is largely undertaken in hospital settings.

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How helpful were the responses?

Social media can inform but tends to provide snappy answers that mean something to the respondent, not the audience. The reason for this is simply the speed at which the reply is made. Passion drives fast responses, failing to carry depth. Equally, those responding with alacrity often fail to read the question and only offer a monologue of personal opinion. 

Two podiatry respondents offered links. One was diagnostic imaging for diabetic osteomyelitis (A Spanish paper from 2017), and the other was the imaging of osteomyelitis (2016)

As a reflection, CFP suggests three areas of learning for all bloggers and those wanting to comment.

• Do provide useful direction
• Add useful links where you can 
• Avoid any critical judgement of a colleague

 

For further reading on the Career Opportunities about specialisms within podiatry – a new book, A Career in Podiatric Medicine, was published by Busypencilcase Communications.

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ConsultingFootPain (CFP)  is a free access website for all and produced by Busypencilcase Communications (Est. 2015)

David Tollafield is a former podiatric surgeon and educationalist and is now a published author. You can find more books from David on his author site. 

July 2024