Chiropodists look forward to foot care review

Chiropodists Tina and Patrick Rainville hope pending changes to the model of foot care in Ontario will result in a better appreciation of their expertise by doctors and patients.

Chiropodists Tina and Patrick Rainville hope pending changes to the model of foot care in Ontario will result in a better appreciation of their expertise by doctors and patients.

Archaic designation will more than likely be abandoned in favour of podiatry

Chiropodists Tina and Patrick Rainville, a husband and wife team practicing in Timmins, are hoping that a Health Profession Regulatory Advisory Council (HPAC) review of foot care in Ontario will give them and 600 other chiropodists in the province some respect.

Chiropody, an archaic designation that no one else in the world uses and few people are familiar with, will more than likely be abandoned. Chiropodists in Ontario will be known as podiatrists. The Rainvilles hope that with a better understanding of who they are and what they do, more doctors will refer to them and more patients in need of foot care will seek their services.

The origin of the chiropody designation in Ontario dates back to 1981 when the province sought to resolve a shortage of foot care specialists. Aside from some U.S. trained podiatrists, foot care was provided by family doctors, dermatologists and orthopedic surgeons. At the time, there was no training of foot care professionals in the province.

The British model of chiropody was chosen rather than the U.S. model, a chiropody program at the Michener Institute for Applied Health Sciences was launched and the College of Chiropodists of Ontario was established.

But fast-forward 34 years and a lot of Ontarians still don’t know what a chiropodist is, complain the Rainvilles.

In every other province, foot care specialists are called podiatrists. Even the British have relegated the chiropody designation to the dustbin of history, they noted.

Then there’s the issue of whether chiropodists or podiatrists can be called doctors.

Podiatrists in the U.S. are allowed to call themselves doctors. So are podiatrists in Saskatchewan. However, in the U.S., the training is more extensive, and includes a surgical residency qualifying podiatrists there to do bone surgery.

In Ontario, “chiropodists are not considered doctors,” said Patrick. “We can’t use that title, but when you get down to the gist of it, we are foot doctors.

“Chiropodists and podiatrists have the highest level of foot health training of any of the regulated professions. We’re trained to provide the most comprehensive care. We treat diabetic foot wounds, we do foot screening and surgery, prescribe medications and fit patients with offloading devices, orthotics and walking braces.”

The current review is unlikely to allow the Rainvilles to call themselves doctors, but the switch from chiropody to podiatry will help more patients get the specialized care they need.

Currently, most of their patients are self-referred. “They aren’t coming to us from family doctors. It’s all word of mouth,” said Patrick.

If someone in Timmins has a foot problem and tries to find a podiatrist in the Yellow Pages, they’re going to come up blank and assume they have to go to Toronto for treatment, he complained.

Some will go to their family physician. Others will put off seeing anyone until their problem is so severe that they end up in the Emergency Department.

Training

“Family doctors typically don’t enjoy dealing with warts, ingrown toenails, and diabetic wounds,” said Tina. “Our profession is the most expertly trained in treating and surgically repairing ingrown toenails, but we’ll often see patients who have gone through a lot of uncomfortable and painful treatments that didn’t result in resolution because they sought treatment in the ER. It doesn’t mean they’re doing anything wrong. It’s just not their area of expertise and they probably don’t want to see (these patients) anyway. Finally, they land on our doorstep and say, ‘If I had only known,’ and I say, ‘If you had to have a tooth pulled, you’d probably go to the dentist, not to Emerg.’”

If more patients turned to chiropodists and podiatrists, the wait time to see family doctors would be reduced, Emergency Departments would be less crowded and there would be fewer amputations resulting from untreated diabetic foot complications, say the Rainvilles.

Doctors recommending orthotics for their patients should also be aware that chiropodists are the only regulated health care professionals with the provision of orthotics within their scope of practice.

Currently, there’s nothing to stop anyone from selling orthotics. Chiropractors, physiotherapists, pedorthists and even some foot care nurses sell them, despite the fact that it’s chiropodists who have expertise in the biomechanics of the lower extremities, and writing proper prescriptions for orthotics.

“Chiropractors don’t have that expertise,” said Tina. “Just like I don’t adjust people’s backs. It all comes down to what’s in the best interest of the patient. When someone requires orthotics, you want the most accurate and precise prescription to resolve the patient’s foot condition. You want the most expertly trained provider.

“Also, when treating foot conditions, orthotics is only one modality. If someone has foot pain and the only treatment is a prescription for orthotics and nothing else, then there’s less of a chance that the condition is going to resolve. When they see a chiropodist or podiatrist, we also offer therapeutic treatments. We have laser therapy. We can prescribe medications. We can do cortisone injections.”

Insurance fraud

The Rainvilles also call attention to a recent incident of insurance fraud involving an orthotics business in Toronto that conspired with Toronto Transit Commission employees to bill the transit operator’s employee benefits plan for up to $4 million worth of bogus claims. The business created fake invoices for orthotics, knee braces and socks, then split the cash with the employees.

Insurance companies generally require a prescription from a doctor or chiropodist, but don’t always insist that the actual provider of the orthotics is qualified.

“Some patients will go to their family doctor and ask for a prescription for orthotics…but it’s not a detailed prescription…and the patient goes to Joe down the road who is not trained,” said Tina. “This is how doctors can get unknowingly involved in fraud.”

Patrick, who is from Timmins, met Tina while both were enrolled in the chiropody program at the Michener Institute for Applied Health Sciences in Toronto. They began practicing in Timmins in 1997 and are the only chiropodists, or podiatrists, in the city.

Despite the lack of understanding about chiropody, there is no shortage of clients.

“We fly people up from Toronto to help us out because we need another chiropodist and can’t get anybody because the program only graduates 25 people a year.”

The Health Professions Regulatory Advisory Council submitted its report on the regulation of chiropody and podiatry and the model of foot care in Ontario to the Ministry of Health and Long-Term Care on August 31, 2015. The Ministry is now reviewing its recommendations and is expected to move forward with changes in the near future.

Filed in: Complementary Medicine, News Tags: , , , , , ,

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