Outpatient Podiatry

Foot problems are very common, and their prevalence is only increasing with time among multiple patient populations. If left untreated, foot problems can substantially impact an individual’s life and work. For example, in the United Kingdom, among people with rheumatoid arthritis, foot problems were reported by over 90% of the study sample ¹. In addition, many people with diabetes tend to have a very high risk of foot-related complications and frequently consult outpatient podiatric services ². Outpatient podiatry provides important services for individuals with foot issues. 

In the treatment of foot problems, if the problem is minor, it is not always necessary to travel to a hospital. Outpatient podiatry is a very viable alternative for patients who need foot care in some contexts, even for some types of surgery. In particular, it is easier to access, cheaper, and easier logistically.  

A Canadian podiatric healthcare network has demonstrated that the general benefits of podiatry include 1) reducing secondary care intervention, 2) maintaining the independence of vulnerable groups through good foot health, and 3) preventing mobility difficulties through earlier intervention, thereby allowing patients to remain in their own homes ³. 

This said, outpatient podiatry presents with a number of risk factors as well. First and foremost, infection remains a risk in outpatient podiatry ⁴. To this end, the American College of Foot and Ankle Surgeons (ACFAS) collaborated with the Centers for Disease Control and Prevention (CDC) to adapt, expand, and disseminate CDC instructions related to infection prevention and control in the context outpatient settings ⁵.  

Education and prevention are an important aspect of outpatient podiatry. Indeed, patient instruction and preventive measures provided individually by a podiatrist lead to significant improvements in knowledge and foot self-care scores, in addition to improvements in the prevalence of certain minor foot problems. 

Patients presenting with a foot or ankle disorder in a podiatric medical and surgical practice may have elevated risk for suicide, given risk factors of debilitating injury and chronic pain ⁶. Therefore, some researchers have pointed out that it is very important to screen for and identify patients at risk of suicide in outpatient podiatric care settings. In a recent U.S.-based study, suicide risk screening was implemented in an outpatient podiatry clinic and met with significant success. In particular, screening with the “Ask Suicide-Screening Questions” instrument provided valuable information that would not have been ascertained otherwise, guiding clinical decision-making and resulting in improved care for podiatry patients. 

Outpatient podiatry remains a critical aspect of foot care among patients with a variety of conditions. Advancements in surgery and anesthesia allow more and more procedures to be performed on an outpatient basis, providing time and cost savings. 

References  

1. Wilson, O., Hewlett, S., Woodburn, J., Pollock, J. & Kirwan, J. Prevalence, impact and care of foot problems in people with rheumatoid arthritis: Results from a United Kingdom based cross-sectional survey. J. Foot Ankle Res. (2017). doi:10.1186/s13047-017-0229-y 

2. Linton, C., Searle, A., Hawke, F., Tehan, P. E. & Chuter, V. Nature and extent of outpatient podiatry service utilisation in people with diabetes undergoing minor foot amputations: a retrospective clinical audit. J. Foot Ankle Res. (2021). doi:10.1186/s13047-020-00445-5 

3. A guide to the benefits of podiatry to patient care. https://mbpodiatry.ca/wp-content/uploads/2023/01/Podiatry-Benefits-SOCAP.pdf 

4. Centers for Disease Control, C. Guide to Infection Prevention For Outpatient Settings: Minimum Expectations for Safe Care. 

5. ACFAS – Infection Prevention for Outpatient Podiatry Settings. Available at: https://www.acfas.org/practice-management/office-operations/adopt. (Accessed: 31st August 2023) 

6. Spector, A. K. et al. Making the Case for Suicide Risk Screening in Outpatient Podiatry Patients: An Opportunity for Injury Prevention. J. Am. Podiatr. Med. Assoc. 112, (2022). Making the Case for Suicide Risk Screening in Outpatient Podiatry Patients: An Opportunity for Injury Prevention. DOI: https://doi.org/10.7547/21-062