Saturday, October 25, 2014
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Scope of Practice - Notes for the referring clinician

Muscular skeletal injuries and conditions
While the focus is on foot function all lower limb joints and structures are considered in diagnosis and treatment. Chronic and ‘over use’ injuries for example plantar fasciitis or patella-femoral pains usually have poor foot function as the major aetiology. At times patients will be referred by NCP to other paramedical clinicians for complimentary diagnosis of spine, pelvic and hip pathology.
Paediatric conditions
Conditions from continuing complications of congenital dislocated hips to the various osteochondroses in lower limbs can be diagnosed and treated. Sever’s disease, pes planus as well as intoed gait (pigeon toe) respond to podiatric intervention. Early detection and palliative podiatric intervention for hallux valgus (bunions) can reduce associated pain or future need for surgery.
Nail/skin care
NCP diagnose all epidermal manifestations of pressure in the foot including corns, callous and ulceration with treatment including enucleation debridement and prevention advice. Onychocryptosis (ingrown toe nails) are managed with continual palliative care or by nail wedge resection and cauterisation of the respective germinal nail matrix. Fungal and other infections including verucca pedis will be accurately diagnosed and treated.{mospagebreak}
Diagnostics
NCP use a full clinical range of skills to develop a differential diagnosis, for example evaluation of functional radiographs and video gait analysis for biomechanical afflictions. Doppler ultrasound and photoplethysmography are also used ‘in office’ to generate segmental systolic pressures to measure even the most distal vascular segment – the feet, of patients with suspected peripheral vascular disease.
Management
The presenting complaint and your accompanying referral information/opinion form the starting point for formulation of a differential diagnosis. In the case of muscular/skeletal pain following examination and testing of gait and biomechanics, initial treatment may consist of diagnostic temporary insoles, taping, footwear prescription, with advice to return for review. In the review a definitive diagnosis is decided upon or your diagnosis confirmed. Often if the patient has responded to initial management, prescription thermoplastic foot orthoses made from neutral position casts of patient’s feet form part of a continuing comprehensive therapeutic plan.
Treatment
It is the sincere aim of the NCP team to administer effective treatment to the patient’s you refer. We will also endeavour to keep you informed about your patient’s foot health.

In a Nut Shel

Referring clinicians can be confident in NCP management of their patients with prompt report returns informing clinicians of further diagnostic input and progress of their patients.

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