Podiatric Practice Research Articles

The Podiatric procedures in graduates the Bolivarian Higher University Institute of Technology

Introduction: The training updates knowledge, provides support in informatic, biomedical and communication technologies, develops practical skills, ethical and moral values.Objective: This study is aimed at optimizing podiatric procedures in graduates the Bolivarian Higher University Institute of Technology.Methods: This is mixed research, which is based on the dialectical-materialist conception for the application of theoretical method in obtaining and processing the required data and information.Results: The process of professional development is closely linked to the professional performance of human resources. In this sense, when health technologists are particularized in the Podiatry profile, the need for the process of overcoming them to be aimed at improving professional performance is recognized, which in this profile presents insufficiencies that transcend in the quality of their services provided. Conclusions: The graduate in podiatry must be trained to treat a large number of diseases and pathologies of the feet, considering the genesis of them and applying the appropriate treatment for each patient depending on the event and it is also important to highlight that there are diseases that can be acquired by graduates due to bad procedures, that is; occupational hazards in podiatric practice, some of which have been studied and others have not.

6.94 Familiar Methods in Novel Settings: Implementing Pediatric Suicide Risk Screening in a Podiatric Practice

6.94 Familiar Methods in Novel Settings: Implementing Pediatric Suicide Risk Screening in a Podiatric Practice

An Appraisal of Opioid Treatment Agreements for the Podiatric Physician.

Opioid treatment agreements are written agreements between physicians and patients that represent strategies enumerating the risks associated with opioid medications. These opioid treatment agreements set expectations and obligations, as well as identify responsibilities for both patient and prescriber for opioid therapy. Some critics assert that these agreements are cumbersome and degrade the patient once they enter into these agreements. A systemic literature search and review using the Preferred Reporting Item for Systematic Reviews and Meta-Analyses (PRISMA) tool was used to find citations describing opioid treatment agreements and their use. Then eligible and appropriate citations were dissected and analyzed. Using the available federal and state opioid prescribing policies, best practice guidelines as well as positive aspects of reviewed literature citations and avoiding bias, degrading, or macroaggression language, a non-cumbersome opioid treatment agreement specific to podiatric medicine was created. A balance argument for the use of opioid treatment agreements to avoid opioid use disorder that is grounded in clinical literature and commentaries are presented. A one-page sensible opioid treatment agreement specific to podiatric medicine, which is similar to more complex cumbersome ones that are found in the literature, and that may be used as part of any podiatric procedural or surgical inform consent, was created and is presented for review. The perception of defending opioid treatment agreements as documents of disclosure to assist patients in their autonomy was offered. Building on the systemic review findings and concept of using elements of disclosure, a model for an analgesic treatment as a one-page informational document to enhance podiatric physicians to create a specific individual analgesic treatment agreement mirroring the scope of podiatric practices that can be incorporated into procedural and surgical inform consent documents was offered.

A literature review of the use of phenol for nail matrix ablation on pregnant and breastfeeding patients: implications for safe use

Background Nail surgery using phenol to chemically ablate the nail matrix is a technique that has been performed for many years. The phenolic technique of nail surgery has been refined and established as a safe and effective procedure. Although it is used in small quantities podiatrically, phenol is readily absorbed through multiple routes such as ingestion, dermal absorption, and inhalation - the latter two being the most likely in podiatric practice. However, given its pervasiveness as a caustic agent in nail surgery, there is a paradoxically small narrative on the safety aspects of phenol's use in pregnant and breastfeeding patients. This paper reviews the available literature to provide a narrative response to this concern. Method A literature search to identify research evidence from electronic databases and reference lists was performed. Evidence was also sought using Google Scholar free text keywords. A narrative review of the literature was then performed, with agreement from all authors. Discussion Although patient safety concerns have been raised for the clinical use of a range of phenols, humans are environmentally exposed to such compounds in food, cosmetics, plastics, and resins. For the general population, cigarette smoke and smoked food products are the most common sources of phenol exposure. The data on phenol exposure during nail surgery and potential health consequences to the foetus are discussed. Conclusion Following calculations for the potential absorption of phenol via an EZ swab, the authors suggest that the purported risks associated with the podiatric use of phenol are overly cautious given that there is no clear association between occupational exposure to phenol and adverse pregnancy outcomes. Although phenols are ubiquitous in the environment, these exposures have previously not been compared to those of phenol matricectomy. Future research in this area would be highly beneficial, for example, the urinalysis of phenol before and after nail surgery in non-pregnant females.

An audit of the prescription and supply of medicines by podiatric surgery teams in the UK

Aim To gain a greater understanding of the methods used by podiatric surgeons to access medicines in the UK. Within that, it is also relevant to establish the range and quantity of medicines utilised to support patient care. With the advent of independent prescribing for podiatrists, the authors were keen to identify whether prescribing was being adopted by a sub-speciality of the podiatry profession and whether alternate means of accessing medicines, such as Patient Group Directions or exemptions remain relevant in clinical practice. Methods The PASCOM 10 system was accessed to generate reports for the 2019 calendar year relating to podiatric surgery. The following reports were requested; procedures, fixations, anaesthesia, demographics, medications, post-treatment sequelae, patient satisfaction (PSQ-10), Manchester Oxford foot/ankle questionnaire (MOXFQ), providers and referrals. Results In 2019 there were 11189 admissions for podiatric surgery in England recorded on the PASCOM 10 database. A total of 103 surgery centres contributed data resulting in 18497 procedures. Care was primarily offered in NHS settings accounting for 91% of activity, 94% of these procedures were performed under a local anaesthetic block. 18576 medicines were supplied, administered or prescribed from a list of 70 individual items. 29% of all medicines were prescribed by a podiatrist. Controlled drugs accounted for 28.7% of all recorded medicines. Conclusions Through analysis of PASCOM 10 data, the range of medicines accessed by podiatric surgeons and their teams to support patient care perioperatively and the routes of accessing these medicines have been identified. Encouragingly, independent prescribing appears to be a frequent choice for accessing certain medicines. There is thorough evidence of a need for greater prescribing rights. Of note, it appears the management of postoperative pain could be improved with wider access to controlled drugs, namely opioid analgesics. PASCOM-10 has the capacity to provide revealing data on prescribing in podiatric clinical practice that is unique in the UK, though more work is required to ensure the validity of the dataset.

Efficacy of a Single Corticosteroid Injection for Morton's Neuroma in Adults: A Systematic Review.

Morton's neuroma is a common condition that routinely presents in podiatric practice. The aim of this study was to systematically synthesize the evidence relating to the effectiveness of a corticosteroid injection for Morton's neuroma. Studies with a publication date of 1960 or later were eligible, and searches were performed within the Turning Research Into Practice database; the Cochrane Central Register of Controlled Trials; the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register; MEDLINE (Ovid); PubMed; Embase; Cumulative Index to Nursing and Allied Health Literature; and the gray literature. Study selection criteria included randomized and nonrandomized controlled trials where a single corticosteroid injection for Morton's neuroma pain was investigated. The primary outcome was Morton's neuroma pain as measured by any standard validated pain scale. Ten studies involving 695 participants were included. The quality of the studies was considered low and subject to bias. Of the included studies, five compared corticosteroid injection to usual care, one compared corticosteroid injection to local anesthetic alone, one compared ultrasound-guided to non-ultrasound-guided injections, three compared corticosteroid injections to surgery, one compared small to large neuromas, six assessed patient satisfaction, four measured adverse events, one studied return to work, and one examined failure of the corticosteroid injection to improve pain. Overall, these studies identified a moderate short- to medium-term benefit of corticosteroid injections on the primary outcome of pain and a low adverse event rate. A single corticosteroid injection appears to have a beneficial short- to medium-term effect on Morton's neuroma pain. It appears superior to usual care, but its superiority to local anaesthetic alone is questionable, and it is inferior to surgical excision. A very low adverse event rate was noted throughout the studies, indicating the intervention is safe when used for Morton's neuroma. However, the quality of the evidence is low, and these findings may change with further research.

Does the Australian Tertiary Admissions Rank score (ATAR) predict academic performance in a podiatry course?

Introduction: Universities within Australia use the Australian Tertiary Admission Rank (ATAR) score to guide student selection into degrees. This process assumes that students with higher ATAR scores are more capable of the academic requirements of tertiary study. This study investigated whether ATAR predicted grades in individual subjects within a university podiatry course. To our knowledge, this research is novel within this discipline in Australia.Methods: The academic records of four intake cohorts into the podiatry program (2009, 2010, 2011 and 2012; total n = 328) were retrospectively analysed. Whether student ATAR scores predicted grades achieved in each subject was examined using multiple linear regression analysis, with secondary schooling type, entry type, gender, socioeconomic status and year of course commencement considered as potential covariates.Results: Higher ATAR score was predictive of stronger academic performance in 21 of 29 podiatry subjects, although the strength of the relationship varied from weak to moderate across year level of subject and subject type. The strongest associations were in second year bioscience subjects for Microbiology (r = 0.54, 95% CI: 0.32–0.77), Normal and Pathological Movement (r = 0.52, 95% CI: 0.35–0.66) and Human Bioscience B (r = 0.50, 95% CI: 0.32–0.69). Three of the six clinical subjects (Podiatric Practice A, D and E) did not produce statistically significant associations. Conclusion: This study identified that ATAR score moderately predicted grades of biosciences subjects, however it did not predict grades in clinical subjects. Provision of academic support targeted at bioscience subjects may be useful to improve the performance of students with lower ATAR scores.

What factors are associated with physical activity promotion in the podiatry setting? A cross-sectional study

ObjectiveTo describe the status of and identify factors associated with physical activity promotion by podiatrists. DesignCross sectional survey. MethodIn 2016−17 Australian podiatrists were invited to complete an online survey. Items assessed by Likert scale included; frequency of assessing and promoting physical activity and podiatrists’ intentions, attitudes, social norms, confidence, barriers, role beliefs and perceived knowledge and skills regarding the promotion of physical activity. Data were analysed using descriptive statistics, exploratory factor analysis and structural equation modelling. ResultsOf 316 respondents, 62% reported always/or often giving general and 39% specific physical activity advice. Attitudes to physical activity promotion were mostly positive and 83% agreed it was part of their role. Many believed they have the knowledge 62%) and skills to promote physical activity. Most podiatrists were confident to carry out basic physical activity promotion activities (83%), but fewer were confident assessing physical activity levels (54%), providing specific advice (47%), monitoring patient physical activity levels (49%) and carrying out physical activity counselling (41%). Modelling revealed intention to promote physical activity was most strongly influenced by experiential beliefs (β=0.35, 95%CI 0.20−0.51) and instrumental beliefs (β=0.27, 95%CI 0.15−0.40), whereas physical activity promotion was influenced by intention (β=0.45, 95%CI 0.35−0.55) and behavioural control (β=0.43, 95%CI 0.33−0.53). ConclusionPhysical activity promotion is feasible and regularly practiced in the podiatry setting, however current practice appears suboptimal. Attitudes and behavioural control appear influential in engagement and deserve consideration when designing strategies to improve delivery in podiatric practice.

The Perception of the Scope of Practice of Podiatric Medicine in a Large Teaching Hospital Demonstrated by Internal Medicine Residents and Patients.

The scope of podiatric practice has changed significantly in the past couple of decades. Despite the increased quality of training, many people outside of podiatry may not realize what our scope of practice entails. We conducted a survey consisting of 10 items and asked internal medicine residents at Rush University Medical Center and patients whether they would feel comfortable consulting podiatrists, or being treated for each issue. The results for residents are as follows: 1) toenail fungus, 35% yes and 65% no; 2) diabetic wound care, 87.5% yes and 12.5% no; 3) bunion surgery, 90% yes and 10% no; 4) ankle fracture surgery, 25% yes and 75% no; 5) calcaneal fracture surgery, 50% yes and 50% no; 6) tarsal tunnel nerve surgery, 62.5% yes and 37.5% no; 7) lower extremity arterial bypass, 5% yes and 95% no; 8) below-knee amputation, 5% yes and 95% no; 9) transmetatarsal amputation, 67.5% yes and 32.5% no; and 10) venous stasis wound care, 65% yes and 35% no. The results for patients are as follows: 1) toenail fungus, 72.5% yes and 27.5% no; 2) diabetic wound care, 70% yes and 30% no; 3) bunion surgery, 62.5% yes and 37.5% no; 4) ankle fracture surgery, 57.5% yes and 42.5% no; 5) calcaneal fracture surgery, 55% yes and 45% no; 6) tarsal tunnel nerve surgery, 50% yes and 50% no; 7) lower extremity arterial bypass, 32.5% yes and 67.5% no; 8) below-knee amputation, 27.5% yes and 72.5% no; 9) transmetatarsal amputation, 52.5% yes and 47.5% no; and 10) venous stasis wound care, 32.5% yes and 67.5% no. Internal medicine residents and patients do not have an accurate perception of the scope of podiatric medicine. This proves that, as a profession, we need to raise awareness about what the podiatric scope of medicine actually entails.

POINT: podiatry for international diabetic foot teams

The Point Project is an initiative between the two organisations: D-Foot International and the International Federation of Podiatrists (FIP-IFP). Both organisations promote the role of evidence-based foot care for patients with and at risk of diabetes. This collaborative work highlights the podiatric skills needed in order to deliver comprehensive evidence-based care to patients with diabetic foot disease. The statements along with the relevant skills and behaviours are based upon the guidance documents produced by the International Working Group on the Diabetic Foot (IWGDF), thus meaning while this is a consensus document it is also evidence-based. Representatives from both organisations with a multidisciplinary membership met early in 2017 to discuss the different areas of practice and to define which skills and behaviours were required at different levels of practice. Using the TRIEpodD-document (UK) and IWGDF guidance as the basis for discussion, the team identified which knowledge, skills and behaviours could be considered podiatric in nature. Once identified as podiatric, we discussed at which level of podiatric practice they could apply. The members of the team came from a variety of locations which represented practice at the different levels. Following the initial meeting, further discussions took place via email in order to consolidate initial discussions and complete the document. Cognisant of the large volume of guidance in relation to all areas of practice, this document is aimed to assist clinicians by pointing them in the direction in which they need to develop services rather than being a set of rules which must be followed. The POINT team feels that this document supports clinicians globally on three levels: As a benchmarking tool for existing teams to critically reflect upon their practice and identify where quality improvements can be made As a tool for clinicians who wish to establish a diabetic foot team to highlight the skills needed in order to provide care across the breadth of diabetic foot practice highlighting the specific roles in which podiatrists can help For national and local decision makers, to identify which skills can be provided by podiatrists to promote the development of the profession. While this is a consensus relating to podiatric skills, the team is aware that, in the absence of podiatrists, skills will be provided by other health professionals. We support this practice and while such professionals can not be considered podiatrists, they are providing podiatric skills to the diabetic foot team. The delivery of the relevant skill to the patient is the important factor, not the health professional is delivering it. The development of this document is merely the first step to identifying areas where skills need to be developed. Both D-Foot and FIP-IFP are committed to developing podiatric skills further across the globe. The aims and objectives of the two organisations are mutually beneficial to those suffering from diabetic foot disease. People with diabetes deserve the best care that they can receive, irrespective of the resources available. By working together we have been able to identify the podiatric knowledge, skills and behaviours required to provide evidence-based care. The next step is to work together to ensure consistent delivery of these globally for the benefit of those suffering the debilitating consequences of diabetic foot disease.

Subungual Exostosis

The coexistence of deformity of the nail bed and subungual exostosis (SE) is a frequent finding in podiatric practice in the fourth and fifth decades of life. However, it has been described by other specialists as being an uncommon osteocartilaginous tumor most prevalent during the second and third decades of life. This study attempts to determine the causes of this discrepancy. Two authors independently conducted a systematic bibliographic review in multiple databases, podiatry sources and others, and key words were chosen to achieve a broad search strategy. Studies reporting on epidemiology and treatment of SE lesions in lower extremities in ten or more patients were selected. Initially, 197 articles were identified through database screening, with 23 meeting all inclusion and exclusion criteria. Seven articles with the ages of all of the patients were included in the analysis of age data. A comparison was then made between the diagnostic criteria for the selected 23 articles. Model results reveal that, although there are some significant differences between individual studies, the main factor tested (patient's age) was clearly significant ( F1,5.2 = 78.12, P < .001), showing that studies coming from the podiatry speciality were conducted on individuals with a mean age of 37 years higher than in studies from other specialties. Clinical and radiologic characteristics and treatment described in the podiatry literature also contrast with those in other specialties. The SE described by podiatrists, in accordance with the parameters of true exostosis, is different from Dupuytren's SE and should be considered as a different pathologic entity. The authors are working on its histologic identification.

The use of prophylactic antibiotics in podiatric foot and ankle surgery

Abstract Objective Infection is a common and serious complication following surgery. Whether antibiotic prophylaxis reduces infection rates in podiatric foot and ankle surgery is unclear. The aim of this prospective cohort study therefore, was to determine the impact of antibiotic use on infection rates following podiatric foot and ankle surgery. Methods Data from 4238 patients who underwent foot and ankle surgery between January 2014 and January 2016 were analysed. Infections within the first 30 days following surgery were recorded according to the Australasian College of Podiatric Surgeons national audit descriptors. Logistic regression analyses were undertaken to determine whether antibiotic prophylaxis decreased the rate of surgical site infection. Results Of the 4238 patient records, 4140 records (98%) provided complete data (aged 2–92 years, mean 48.9 ± SD 19.6, 1124 males, and 3016 females). A total of 79 infections (1.9% infection rate) were reported. More experienced surgeons documented a lower rate of infection (OR 0.36, 95% CI 0.17–0.72, P Conclusion Surgeon experience may influence infection rates in podiatric foot and ankle surgical practice, and the use of perioperative antibiotics may reduce the risk of infection. The use or addition of postoperative antibiotics does not reduce infection rates, and should be used by podiatric surgeons with caution.

Vascular assessment habits in Australian and New Zealand Podiatrists

Background Podiatrists play a central role in conducting non-invasive vascular assessment in the lower extremity. This involves screening for signs and symptoms of peripheral arterial disease (PAD) and ongoing monitoring of the condition. Podiatric vascular assessment practices in Australia and New Zealand are currently unclear. Determining the clinical habits of Podiatrists is essential in identifying if there is a need for further education or support in performing accurate vascular assessments.

Clinical Efficacy and Cost‐Effectiveness of Bespoke and Prefabricated Foot Orthoses for Plantar Heel Pain: A Prospective Cohort Study

Plantar heel pain is a common reason for referral to podiatric practice, and one of the key interventions is the use of orthoses. The aim of the present study was to compare the clinical efficacy of bespoke, casted foot orthoses and prefabricated foot orthoses for plantar heel pain. People with plantar heel pain were included if, following initial assessment, foot orthoses were indicated and participants received either bespoke, casted foot orthoses or prefabricated semi-rigid orthoses (Powerstep™). Clinical efficacy was assessed at eight weeks using the Manchester Foot Pain and Disability Questionnaire (MFPDQ). A total of 67 patients completed the trial and at baseline there were no appreciable differences in the two groups of patients in terms of the MFPDQ score; however, at eight weeks post-treatment both had significantly reduced foot pain and disability (both p < 0.0001). There was no significant difference in effectiveness between the bespoke or prefabricated orthoses. However, prefabricated devices were 38% cheaper per patient compared with the average costs of casted devices. For most patients with plantar heel pain, prefabricated semi-rigid insoles such as the Powerstep™ devices used in the present trial provide short-term benefit equivalent to that of bespoke, casted foot orthoses, but at considerably reduced costs.

SP0071 Biologics Therapies - Changing the Podiatry Needs of People with Inflammatory Arthritis?

Over recent years treatment of inflammatory joint disease has seen dramatic changes with the introduction of ‘biological drugs’. Despite benefits of clinical and radiological outcomes for this group, several potentially...

The practical application of biomechanical theory for patient assessment

Podiatric biomechanical assessment has become a fundamental cornerstone of podiatric practice. However, whilst there are many papers indicating the positive benefits of orthotic intervention, the underlying assessment philosophies remain controversial. The work produced by Root, Orien and Weed still underpins much of the current assessment and management techniques, yet key aspects of their concepts are not supported by scientific scrutiny. For every paper that seems to support aspects of function, there are more which do not support common theory. As a result, several conceptual assessment techniques have been developed and expounded although the evidence base to support these theories remains weak at best. This leaves the clinician who wishes to practice evidenced based medicine in a dilemma when presented with a patient in discomfort. To date, there has been little evidence to guide such an approach and thus replace the disproved theory. This workshop will review common assessment techniques and factors which effect limb function. It will outline an approach which can be taken to integrate these techniques and provide a basis for care utilising the current evidence available. This will include a practical demonstration of assessment techniques.

ACCF/AHA/ACR/SCAI/SIR/SVM/SVN/SVS 2010 performance measures for adults with peripheral artery disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures, the American College of Radiology, the Society for Cardiac Angiography and Interventions, the Society for Interventional Radiology, the Society for Vascular Medicine, the Society for Vascular Nursing, and the Society for Vascular Surgery (Writing

ACCF/AHA/ACR/SCAI/SIR/SVM/SVN/SVS 2010 performance measures for adults with peripheral artery disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures, the American College of Radiology, the Society for Cardiac Angiography and Interventions, the Society for Interventional Radiology, the Society for Vascular Medicine, the Society for Vascular Nursing, and the Society for Vascular Surgery (Writing

Characteristics of diabetic patients visiting a podiatry practice in Germany

To describe the foot characteristics of diabetic patients attending a podiatry practice for their first consultation. The objective was to determine how effectively diabetic foot ulcers are being prevented in primary care. All diabetic patients who presented at a podiatry practice between 2006 and 2008 for their first consultation were analysed. Anonymous data were obtained from the standard patient anamnesis sheet completed by the podiatrist. These included results of patient interviews and examinations. A total of 230 diabetic patients (93.9% had type 2 diabetes mellitus and 6.1% had type 1) were analysed. The mean age was 67.7 years (+/- 10.8). Just under half (47.4%) were female. The mean duration of diabetes was 12.6 years (+/- 10.5) years. 70.4% of the patients had diabetic neuropathy (confidence intervals: 64.5-76.3), of whom 73.2% already had resting foot pain or strain foot pain while walking. 58.3% of the patients had toenail mycosis, and of these 38.1% had the infection in all 10 toenails. Most of the patients had at least one foot deformities (89.6% splayfoot and 37.0% flatfoot). 40.2% had no sensation to microfilament testing on either their right or left foot toes. The overall mean vibration sensation test threshold was 3.7 (+/- 2.3). While there is a structure and strategy for the primary and secondary prevention of the diabetic foot ulcers, its delivery is often ineffective. This audit shows that, in Germany, the detection and prevention of diabetic foot problems in podiatric practices happens far too late.

Clinical audit of core podiatry treatment in the NHS

BackgroundCore podiatry involves treatment of the nails, corns and callus and also giving footwear and foot health advice. Though it is an integral part of current podiatric practice little evidence is available to support its efficacy in terms of research and audit data. This information is important in order to support the current NHS commissioning process where services are expected to provide data on standards including outcomes. This study aimed to increase the evidence base for this area of practice by conducting a multi-centre audit in 8 NHS podiatry departments over a 1-year period.MethodsThe outcome measure used in this audit was the Podiatry Health Questionnaire which is a self completed short measure of foot health including a pain visual analogue scale and a section for the podiatrist to rate an individual's foot health based on their podiatric problems. The patient questionnaire was completed by individuals prior to receiving podiatry care and then 2 weeks after treatment to assess the effect of core podiatry in terms of pain and foot health.Results1047 patients completed both questionnaires, with an age range from 26–95 years and a mean age of 72.9 years. The podiatrists clinical rating at baseline showed 75% of patients had either slight or moderate podiatric problems. The differences in questionnaire and visual analogue scores before and after treatment were determined according to three categories – better, same, worse and 75% of patients' scores either remained the same or improved after core podiatry treatment. A student t-test showed a statistical significant difference in pre and post treatment scores where P < 0.001, though the confidence interval indicated that the improvement was relatively small.ConclusionCore podiatry has been shown to sustain or improve foot health and pain in 75% of the patients taking part in the audit. Simple outcome measures including pain scales should be used routinely in podiatric practice to assess the affect of different aspects of treatments and improve the evidence base for podiatry.

The evidenced-based approach to treating podiatric conditions with Marigold therapy and homeopathy

It is acknowledged that a number of podiatric disorders seen in foot clinics are relieved only in the short term by traditional treatments, necessitating regular attendance every few weeks. Some chronic conditions do not respond to traditional treatments. The chemical and surgical treatments commonly used in podiatric practice are invasive and can cause pain or discomfort, especially in the case of post-operative complications of surgery. Some treatments are contraindicated for patients who are at risk, e.g. diabetics and the elderly. Homeopathic podiatry is a method of treatment for conditions of the skin, bones and nails that were developed by Dr. M. Taufiq Khan, combining homeopathy with podiatric practice. An integral part of the speciality is Marigold therapy, a painless, non-invasive form of topical treatment, which has been researched and developed by combining homeopathic medicinal plants such as Symphytum officinalis, Thuja occidentalis, Ruta graveolens, Rosemary officinalis, Bellis perennis, Hypericum perforatum and Calendula officinalis with different species of Tagetes . Homeopathic and biochemical medicines are prescribed orally when indicated. The topical preparations are in the form of paste, tincture, oil, ointment and cream. Treatment consists of weekly applications of the paste for 2–4 weeks, followed by the use of tincture, oil, ointment or cream applied by the patient as a preventative measure. The effectiveness and safety in the treatment of foot disorders have been demonstrated clinically and in double-blind placebo-controlled trials. Double-blind placebo-controlled studies to investigate hyperkeratotic plantar lesions, hallux valgus and verruca pedis have shown a level of significance giving P