02/25/2025    James H Whelan, DPM

Redefining Roles in Podiatric Care: Exploring the Potential for a Standardized Foot Care Assistant Model

The landscape of foot and ankle care is evolving.
With an aging population, a growing number of
patients with diabetes, and shifts in podiatric
training emphasizing surgical intervention, there
is an increasing need to ensure continued access
to high- quality foot care while reinforcing the
role of podiatric physicians as the foremost
experts in foot and ankle health. A topic of
growing discussion within the profession is the
expansion of routine foot care services provided
by non-podiatric healthcare professionals. While
this raises concerns about scope of practice, it
also presents an opportunity to explore
structured, podiatrist-led models that enhance
patient care and optimize the efficiency of
podiatric practices.

One potential solution is for professional
organizations such as APMA and ACFAS to evaluate
the feasibility of developing a standardized Foot
Care Assistant (FCA) role—a structured position
within podiatric practices that allows trained
professionals to assist with routine, non-complex
foot care under the supervision of a podiatrist.
Similar to the role of dental hygienists within
dentistry, properly trained Foot Care Assistants
could enhance care accessibility, improve workflow
efficiency, and allow podiatrists to focus on the
advanced medical and surgical pathology that
defines our field.

Why This Matters Preserving the Integrity of
Podiatry

Establishing clear education and supervision
requirements ensures that foot care remains within
the domain of podiatric medicine, rather than
being fragmented across independent providers.
Ensuring

Patient Safety & Quality Care – Developing
training and competency standards would help
ensure that patients receive safe, high-quality
care from qualified providers working within a
regulated system.

Addressing Workforce Shortages – As fewer
podiatrists enter the field while patient needs
continue to rise, structured team-based care
models could help bridge this gap without
compromising care standards.

Enhancing Practice Efficiency & Revenue – A
structured assistant role within podiatric
practices could allow for increased efficiency,
while ensuring podiatrists maintain oversight of
patient care.

Encouraging a Collaborative Discussion

Don Blum, DPM, JD, has pointed out that
discussions about scope of practice and delegation
of routine care often involve state regulatory
bodies, including podiatry boards and
organizations such as the Federation of Podiatric
Medical Boards (FPMB). While state-level
considerations vary, it may be beneficial for
national professional organizations to explore
potential models that could be adapted across
different practice settings.

The goal is not to cede control of routine foot
care but to lead the conversation on how podiatric
medicine can evolve to meet the growing demand for
foot health services. If this discussion is not
shaped by podiatric professionals, external forces
may dictate the future of the field in ways that
do not align with our profession’s best interests.

A Call for Professional Dialogue

I encourage my colleagues to engage in this
discussion—whether through professional
organizations, practice-based initiatives, or
collaborative efforts to explore best practices.
How can we structure a Foot Care Assistant role
that enhances patient care, supports podiatric
practices, and reinforces podiatric medicine as
the leader in foot and ankle health? These are the
questions we should be asking, and now is the time
to begin shaping the answers. Let’s be proactive,
not reactive

James H Whelan, DPM, Beloit, WI

Other messages in this thread:

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02/28/2025    Richard M. Maleski, DPM, RPh

Redefining Roles in Podiatric Care: Exploring the Potential for a Standardized Foot Care Assistant Model (James H Whelan, DPM)

I'm glad to see someone else is interested in
seeing the DPMs role go from cutting nails to
overseeing the management and treatment of nail
pathology. I've opined in this forum a few times
now that we should not be spending our time on the
physical practice of cutting nails. About 30 years
ago, I spoke with the Executive Director of our
state society (PPMA), Michael Davis about the
possibility of having podiatric assistants cutting
nails and still being able to bill for that. At
that time, he told me that podiatrists were not
legally able to supervise such activity in
Pennsylvania, let alone bill insurance for it.

When I asked how difficult would it be to change
that,he said that it would probably have to
involve state legislative changes, which would be
very difficult. I did speak with a Board member
also, a DPM, and he felt that there would be very
strong resistance from the podiatric community.
Most DPMs were very content to cut nails on a
routine basis, in his opinion.

Fast forward to about 2005. I went to TUSPM to
give a recruiting talk to the 3rd and 4th year
students about our relatively new residency
program at the University of Pittsburgh. I had an
informal meeting with the Dean, Dr. Mattiacci
basically to introduce myself and the Residency
Program to him. I mentioned the idea of possibly
setting up a formal Podiatry Assistant program at
TUSPM, so that those assistants could greatly
expand their ability to help podiatrists in the
office, including cutting nails. Just like the
hygienist in the dental offices. I would be happy
to help.

He didn't think that would be a good idea, again
because podiatrists wouldn't want to delegate
their main daily activity and source of income.
My thought was that having such assistants in the
office would allow DPMs to focus on the medical
issues of the patients, while still maintaining
control of the patients in the office.

Fast forward another 20 years and we are now
really concerned that we could lose these
patients. Hopefully it's not too late to redefine
the way these patients receive their foot care.

Richard M. Maleski, DPM, RPh, Pittsburgh, PA

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02/28/2025    Richard M. Maleski, DPM, RPh

Redefining Roles in Podiatric Care: Exploring the Potential for a Standardized Foot Care Assistant Model (James H Whelan, DPM)

I'm glad to see someone else is interested in
seeing the DPMs role go from cutting nails to
overseeing the management and treatment of nail
pathology. I've opined in this forum a few times
now that we should not be spending our time on the
physical practice of cutting nails. About 30 years
ago, I spoke with the Executive Director of our
state society (PPMA), Michael Davis about the
possibility of having podiatric assistants cutting
nails and still being able to bill for that. At
that time, he told me that podiatrists were not
legally able to supervise such activity in
Pennsylvania, let alone bill insurance for it.

When I asked how difficult would it be to change
that,he said that it would probably have to
involve state legislative changes, which would be
very difficult. I did speak with a Board member
also, a DPM, and he felt that there would be very
strong resistance from the podiatric community.
Most DPMs were very content to cut nails on a
routine basis, in his opinion.

Fast forward to about 2005. I went to TUSPM to
give a recruiting talk to the 3rd and 4th year
students about our relatively new residency
program at the University of Pittsburgh. I had an
informal meeting with the Dean, Dr. Mattiacci
basically to introduce myself and the Residency
Program to him. I mentioned the idea of possibly
setting up a formal Podiatry Assistant program at
TUSPM, so that those assistants could greatly
expand their ability to help podiatrists in the
office, including cutting nails. Just like the
hygienist in the dental offices. I would be happy
to help.

He didn't think that would be a good idea, again
because podiatrists wouldn't want to delegate
their main daily activity and source of income.
My thought was that having such assistants in the
office would allow DPMs to focus on the medical
issues of the patients, while still maintaining
control of the patients in the office.

Fast forward another 20 years and we are now
really concerned that we could lose these
patients. Hopefully it's not too late to redefine
the way these patients receive their foot care.

Richard M. Maleski, DPM, RPh, Pittsburgh, PA