08/14/2015    Jeff Root

RE: Pedorthists & Podiatrists Should Work Together: PA Podiatrist

The role and relationship between podiatrists
and pedorthists is anything but clear and
simple. First, the difference in education,
training and licensing between podiatrists and
pedorthists is significant. A podiatrist cannot
practice without a degree in podiatry and a
license. To the best of my knowledge, both
certified and non-certified pedorthists are
able to practice without a license. With no
licensing requirement and authority, who
oversees their conduct to provide a layer of
protection for the public? The difference
between certification and licensure is an
important point of distinction between
podiatrists and pedorthists.

The national, state and local podiatry
associations should not just look at the role
of CPeds working under the direction of
podiatrists, but should consider the role and
function of all pedorthists and CPeds,
including those who function independently.
While having the oversight of a podiatrist
might be beneficial in a collaborative
environment, it is not a requirement to
practice. Although a collaborative effort might
be today’s intent, there is no guarantee of
collaboration now or in the future. Since CPeds
can function independently, this begs the
question as to whether CPeds are qualified to
independently examine the “patient/customer”
and diagnose and treat foot conditions with
orthoses and AFOs.

While some foot conditions are somewhat routine
to treat and can be treated with fairly
standard OTC or custom foot orthoses, other
foot conditions are not so simple and
straightforward. For example, adult acquired
flatfoot, Charcot arthropathy, Charcot Marie
Tooth Disease, tarsal coalitions, clubfoot,
dropfoot, diabetic foot ulcers and pre-ulcers,
etc. can be much more difficult to treat and
the treatment can have potentially harmful side
effects. In addition, these conditions may
require medications and diagnostic tests which
can only be ordered by a licensed medical
practitioner. Even plantar fasciitis may
require imaging, injection or other diagnostic
and treatment procedures that are beyond the
scope of pedorthists and others who sell or
dispense foot orthoses.

If CPeds are expected to examine, diagnose and
treat foot and leg conditions, then they need
the proper education, training and licensing.
If CPeds are to have a more limited scope, then
who defines and enforces their more limited
scope of practice? Just like podiatrists did
with orthopedists, CPeds are working to expand
their scope of practice. This became all the
more evident a few years ago when their
association changed their name from the
Pedorthic Footwear Association to the Pedorthic
Footcare Association (PFA). Since some in
podiatry have turned away from biomechanics and
foot orthotic therapy over the past few
decades, who can blame pedorthists and the PFA
for recognizing the need and opportunity.

While some companies and podiatrists might see
collaboration as an opportunity today, what are
the potential longterm ramifications for
podiatry? Will pedorthic education and training
be improved to support their expanding role? Is
there a need for licensing and regulation for
CPeds? If pedorthic education and training are
improved and their role expands, what might the
economic implications be for podiatry? These
are just a few of the many unanswered questions
that exist.

There are many talented pedorthists providing a
variety of important services to their clients
today. I hope my questions and concerns will
help stimulate much needed dialogue within the
fields of podiatry and pedorthics in the
interest of improving patient care in the
future.

Jeff Root, President, Root Laboratory, Inc.

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