Podiatric sports medicine a future career choice

Inspiring clinical excellence through Innovation & Science

ConsultingFootPain welcomes Professor Nat Padhiar to write about his passion for podiatric sports medicine and a new specialty that has emerged supported by like-minded colleagues. For those considering a career in podiatry and those already practising, he presents his insight into this exciting field.

Introduction

Most podiatry graduates start their careers in the NHS to gain experience and later branch into the private sector and academia. There is a more structured training and career pathway in Podiatric Surgery, which is also the only speciality within the Podiatry profession, which after robust training and various examinations, leads to a Certificate of Completion of Specialist Training in Podiatric Surgery (CCSTPS) and the fellowship of the Faculty of Podiatric Surgery within the RCoP.

Sports & Exercise Medicine (SEM) in the UK exists as a speciality in Medicine and, an academic qualification in SEM has been offered for the last 4 decades in the UK.  In order to identify and differentiate from SEM which is primarily practised by medical doctors; Sports Medicine practised by podiatrists, has been termed Podiatric Sports Medicine in order to have its own identity.  

Podiatric Sports Medicine (PSM) currently exists as a Specialist Advisory Group within the RCoP and, FPM RCPSG also offer either associate or, membership, to the successful graduates of PSM. PSM is relatively new and still in its infancy. Historically, clinicians have referred to themselves as ‘Sports Podiatrists’ due to their association with sportsmen as their patient group but have had no formal qualifications or training in PSM.

The Birth of Podiatric Sports Medicine 

“Inspiring clinical excellence through Innovation & Science, thinking beyond biomechanics”                        
The podiatry team at the London 2012 Olympic & Paralympic Games

 

From left to right – Kelly Ma, Dowlina de Ronde, Nat Padhiar, Anne-Marie O’Connor, Ron McCulloch. Nick Knight, Trevor Prior, Suzy Spiers, Sophie Roberts, Ian Griffiths, Katriona Macklin, Sonja Cimelli, Nicola Wilson, Sandra O’Malley, Stephanie Benjamin, and Simon Otter.

The London 2012 Games acted as a catalyst to an idea that was floating around for many years, to set up a specialism in PSM within the Podiatry profession. A team (picture above) led by Professor Nat Padhiar, consisting of four podiatric surgeons and 12 podiatrists of varying experiences took part as volunteers and delivered excellent care for the athletes during the Games. Prof Nat Padhiar was also a member of the Medical Services, London Organising Committee of the Games (LOCOG) since 2008. The question was repeatedly asked whether PSM as a specialty existed in the UK?

In the same year, the first conference in sports medicine for podiatrists was organised by Maire Murphy and Steven Childs (responsible for the design of the logo) on behalf of the Royal College of Podiatry, in London. It was attended by approximately 120 delegates. The experience of the London Games and the enthusiasm showed by the delegates at the conference, was a ‘Road to Damascus’ moment for me. It became clear that in order to provide podiatry care at this level, there was a great need to establish a specialty in this field. This marked the birth of PSM and the start of a formal 10-year plan to establish it as a specialty in the United Kingdom & Ireland.

10 Year plan  

  1. Defining the scope of practice,
  2. Post-graduate qualification, 
  3. Fellowship programme within one of the colleges,
  4. Annual PSM Conference, 
  5. Meaning full employment within the NHS & the Private sector.

The Scope of Practice.

This includes management of common and uncommon musculoskeletal foot, ankle, and leg disorders (see panel of conditions below) encountered in sport as well as within an active population. The main skill and expertise are required to make a diagnosis & differential diagnosis based on the knowledge of the conditions, knowledge of anatomy, good history taking, clinical examination, ability to request and interpret various investigations and then having a structured plan of management. Justification is based on the evidence thus encouraging evidence-based practice.

The decision-making process is also an important part of the scope, especially at the elite and professional end of the sports spectrum. In addition to diagnosis and management of MSK conditions affecting the foot, ankle, and leg; Podiatrists are experts in biomechanical and gait analysis, prescribing orthoses and providing advice on sport-specific shoes.

Podiatry is an autonomous profession and as such under the Professions Supplementary to Medicines Act 1960, can administer local anaesthetics and, under the provisions of Schedule 5 to the Prescription Only Medicines (Human Use) Order 1997, can supply and administer specified medicines. In addition, most podiatrists undergo training at the under-undergraduate level, in requesting and interpreting radiology following IRMER – Ionising Radiation Medical Exposure Regulations (2000) and IRR99 – Ionising Radiation Regulations 1999, awareness and training.   

Post-graduate education & qualification.

Podiatric Sports Medicine (PSM) has never been formally structured as a discipline within the UK & Ireland. Through post-graduate education specific to PSM, the aim is to start the process of formalising and underpinning the training of podiatrists in PSM. This formal training with a specific qualification, will in some way lead to recognition of PSM as a specialisation, which will be accepted within the UK, Ireland, and perhaps, Europe

In order to establish it as speciality, there needed to be a uniform and robust post-graduate University qualification in PSM. This was established in 2016 as a Post-graduate certificate and in 2021, a diploma and an MSc in PSM. The proposed course content reflects the scope of practice and covers detailed assessment, examination, and management of sports injuries of the lower limb, especially foot, ankle, and lower leg with imaging in sports medicine to assist in supporting the clinical diagnosis. The course is designed to introduce new skills in suturing, cannulation, phlebotomy, radiology, medical emergencies, therapeutics, pharmacology, taping, manipulations, research, literature review, comprehensive teaching in injection therapy. Podiatrists spend an afternoon in a cadaver laboratory practising 15 different injections of the foot, ankle, and the leg, both image and clinically guided until they are confident and comfortable. The examination is held at the end of every semester and, successful candidates are indemnified for injections by the RCPod.

The programme is delivered by Centre Sports and Exercise Medicine (CSEM), William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary, University of London (QMUL).     The course is modular offering a Diploma and an MSc in PSM. Working in sports is a largely practical discipline and the programme’s emphasis lies firmly on regular clinical experience. Students benefit from regular contact with members of Sports and Exercise Medicine at QMUL, as well as visiting clinicians and lecturers who are experienced Sports Medicine specialists. This course is designed to offer a mastery of foundation concepts and skills in Podiatric Sports Medicine.

The beauty of working in an academic department for the last 33 years, you come across a lot of bright people, really bright people

Trevor Prior joined the Centre for Sports & Exercise Medicine, QMUL in 2016, the same year we set up the course and remains an integral part of developing the PSM curriculum. It is important to acknowledge the contributions made in the past by Simon Costain, Anne Marie O’Connor as well as many other podiatrists who came and lectured on the course. Ian Griffiths has recently joined as a Senior Lecturer and plays a major role in developing PSM as a speciality within Podiatry. Working within a team enhances our stature and position within SEM. 

 Common foot, ankle & leg conditions encountered by Podiatrists

FOREFOOT: Plantar and other bursitis, Morton’s neuroma, Metatarsal stress fracture, Plantar plate tear, Freiberg’s infraction (avascular necrosis of metatarsal head), Sesamoiditis, Sesamoid stress fracture, Hallux Rigidus/valgus (bunion)/limitus, Tailor’s bunion, Metatarsal and Phalangeal fractures  Ingrown toenail and osteoarthritis of joints. 

MIDFOOT: Lisfranc disruption, Stress fracture of the navicular, Crisp-Padhiar Syndrome (Os naviculare syndrome), Tibialis anterior and posterior enthesopathy,  Midfoot osteoarthritis, Cuboid compression syndrome, avulsion fracture of the styloid, 5th metatarsal base fractures, Osteoarthritis and Stress fracture of the metatarsal base.

HINDFOOT: Plantar fasciitis, Partial tear of plantar fasciitis, Stress fracture of the calcaneum, Flexor hallucis longus tendinopathy, Tibialis posterior tendinopathy, Tarsal tunnel syndrome, Medial calcaneal nerve entrapment, Deltoid ligament strain/partial tear, Medial malleolus stress fracture, OCD of talus, Anterior impingement syndrome, Posterior impingement syndrome, Sinus tarsi syndrome, Lateral ligament strain/tear/laxity, Peroneal tendinopathy, Peroneal tendon subluxation and Lateral malleolus stress fracture.

ACHILLES: Haglund’s deformity, Classical mid-portion Achilles tendinopathy (AT), Insertional AT, Musculo-tendon AT, Intra-substance tendon tears, Achille tendon ruptures.

EXERCISE INDUCED LEG PAIN (EILP): Stress fracture of tibia/fibula, Medial Tibial Stress Syndrome (MTSS), Chronic Exertional Compartment Syndrome (CECS), Superficial Peroneal Entrapment Syndrome (SPNES), Radiculopathy, Muscle hernia, Myopathy and Anterior tibial muscle syndrome.

Fellowship of the Royal Colleges

Fellowship programmes for PSM within the 2 colleges are still at a discussion stage. It is envisaged that in the future the University qualification will prepare candidates who may wish to go further, to sit the Fellowship examination in PSM.

In 2015, the Specialist Advisory Group (PSM) was set up within the Royal College of Podiatry (RCP) under the guidance of Mr Matthew Fitzpatrick, the then the Dean of Faculty of Podiatric Medicine.  Matt, along with Dr Jane McAdam, Dr Emma Cowley and Dr Paul Chadwick continue to support the development of PSM SAG within RCPod. The Faculty of Podiatric Medicine, Royal College of Physicians & Surgeons of Glasgow (RCPSG), at present also offer either an Affiliation or, a Membership status to eligible PSM graduates.   

The Annual PSM Conference

This is a valuable part of the PSM, in providing a platform for relaxed learning, interacting with the experts, networking and above all, friendship. It is a multidisciplinary meeting attracting sports doctors, physicians, physiotherapists, and podiatrists.

It is usually a two-day conference which includes lectures, workshops and informal discussions delivered by experts from across Europe and the world.

These conferences have been very successful and have highlighted and raised the status of the profession via exposure to multi-disciplinary speakers, delegates, and sponsors. It is very much a non-profit making event with under-graduate students subsidised by 50%, post-graduate students paying the cost price and other delegates paying just enough to cover the costs. It is also an opportunity to network and reunite with like-minded people to enhance their expertise in PSM.

The 10th Anniversary of PSM will be celebrated in Glasgow, on 8-9 December 2022

Employment prospects in Podiatric Sports Medicine

At present, most jobs in PSM are likely to be in the private sector and are mostly created by clinicians themselves. There are no formal jobs within the NHS in PSM, but discussions are taking place with Primary Care Networks and Podiatric Surgery departments to create tiered care by employing PSM podiatrists.

Read Podiatric Sports Medicine in focus Professor Nat Padhiar’s career journey
You can read other great podiatry journeys on this site – what career to choose after school
About the author, Professor Nat Padhiar

Thanks for reading “Thinking Beyond Podiatric Biomechanics” by Professor Nat Padhiar

Find out more about podiatry and how it all started with foot surgery. ‘Podiatrist on A Mission’ is available from AMAZON books 

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Published by Busypencilcase Communications Est. 2015 for ConsultingFootPain