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The number of older individuals living in the United States is projected to increase significantly over the next few decades. To help meet the health-care needs of this growing population, podiatric medicine must assure the public of the availability of specially educated teachers and practitioners who can not only provide direct patient care, but also participate in establishing national policies and priorities pertaining to foot health. Fellowship training, the traditional educational model beyond the first professional degree and residency education, is one means of accomplishing this goal. This article proposes a model for a geriatric fellowship in podiatric medicine. Implementation of such fellowship training in geriatrics can help the podiatric medical profession pursue its mission and fulfill its responsibility to the public.
Because the majority of practicing podiatrists' received their professional training when less emphasis was placed on geriatrics, future continuing education activities should be expanded to upgrade a practitioners' understanding of elderly patients and the diagnosis and treatment of their foot problems, particularly among the frail elderly living at home or in nursing homes or other institutional settings. Efforts should also include special emphasis on the current publications in the profession on the subject of aging, including patient care, health care delivery, and other related topics. The podiatric medical profession stands ready, as it has always done, to care for the elderly with dignity and quality. The elderly should not be allowed to waste away because of their inability to help themselves. As we strive to meet these objectives and needs, there is no doubt that they will be met, as long as there is a national recognition of the needs and appropriate changes take place in the total health care delivery system to provide the mechanism for action.
The inclusion of appropriate podiatric services in long-term care programs often will produce dramatic effects. Immobility can be replaced by activity. Quality of care translates into quality of life. Support and encouragement can be directed to independence and a strong sense of personal identity and worth. Isolation can be replaced by interaction. When the quality of life decreases as a result of disease, disability, or age, those precious aspects of dignity must be restored to a maximum level by caring staff and people. Because walking is a catalyst for life, podiatric care can help restore some of the lost dignity by keeping patients walking and moving about, so that they can accept and participate in the social activities provided by the facility.
Podiatric physicians play an important role in the field of public health. In 1975, the Podiatric Health Section of the American Public Health Association (APHA) formulated an official statement of the roles and responsibilities of podiatrists in the public health field. Entitled Functions and Educational Qualifications of Podiatrists in Public Health, the document was published in the September 1975 issue of the American Journal of Public Health. For more than 2 decades, it remained the primary document defining and delineating the activities of the specialist in podiatric public health. Recently, it was recognized that in this time of rapid change in health-care delivery, a revision of this important statement was needed. A mini-grant from the APHA in 1996-1997 supported the formation of a special commission to update the formal position of the APHA and its Podiatric Health Section with respect to podiatric public health and to provide direction for the future. This article is a shortened version of the report issued by the special commission of the APHA.
Changes in the health-care system will continue to modify the delivery of podiatric medical care and podiatric medical education. Podiatric medicine and its educational programs will need to focus on the management of care, special populations, and disease prevention. Future providers will need to participate as team members and respond to new patterns of care, including the special needs of the older population. This article explores methodologies for professional activities, administration, incentives for change, academic issues, innovation, implementation, outcome measures, and health policy development. Podiatric medicine must be prepared to establish standards, protocols, and guidelines to serve as the benchmark for foot health.
In 1989, the Board of Directors of the Professional Diabetes Academy, Pennsylvania Diabetes Academy endorsed the concept to revise Feet First, published in 1970, and gained the permission of the US Public Health Service to use the initial document as a base. With marked expansion, added color, nonreflective paper, and larger print, Feet First was published in 1991, and introduced to the podiatric profession during the Annual Meeting of the American Podiatric Medical Association in New York. The concept of need expressed by the late Glen W. McDonald, MD, and the late Seward P. Nyman, DPM, to see a melding of public health education and podiatric medicine has brought new meaning to the subject and provided an interdisciplinary approach to foot health education for the diabetic patient.
