There has been an exciting surge in advanced treatments in podiatry, from diagnostic ultrasound and shockwave therapy to microwave and laser technology and dermal fillers. 

But alongside that innovation, a misleading idea has begun to creep in: that ‘core podiatry’ – routine care such as nail management, callus debridement and corn removal – is somehow basic. 

Nothing could be further from the truth. 

In the hands of a highly trained podiatrist, core podiatry is not simply maintenance. It is an opportunity to assess, diagnose, prevent deterioration and sometimes identify signs of much more serious disease. 

To the untrained eye, treating a stubborn corn or debriding hyperkeratosis might look straightforward. To the podiatrist, however, the lower limb can provide important clues about what is happening elsewhere in the body. 

From the moment a patient walks into the clinic, the practitioner is drawing on their knowledge of pathology, biomechanics, pharmacology and the patient's wider medical history. 

Core podiatry can therefore provide an important opportunity for early intervention in long-term and debilitating lower-limb problems. It is also one of the ways our profession can contribute to the wider challenges facing the NHS. 

When a routine appointment reveals something more 

One of the most underappreciated parts of a core podiatry appointment is the clinical history. 

During one routine assessment, a patient mentioned severe colour changes in their toes when they were cold – Raynaud's phenomenon. They also presented with bilateral plantar fibromas and shiny skin. 

Further conversation revealed a history of heartburn, gastrointestinal problems and contracture of the hand. 

Taken together, these features could indicate an underlying connective tissue disease such as systemic sclerosis, or scleroderma. 

Recognising that possibility allows the podiatrist to refer the patient for appropriate medical investigation rather than treating the presenting foot problem in isolation. 

The podiatrist as detective 

A podiatrist carrying out core treatment is not simply looking at skin and nails. The consultation provides opportunities to assess vascular, neurological and wider health. 

Sometimes that can reveal signs that warrant further investigation. 

Atrial fibrillation: While checking pedal pulses, a podiatrist may detect an irregular pulse. This can prompt onward referral for investigation of possible atrial fibrillation.  

Peripheral arterial disease: Vascular assessment can identify signs of compromised arterial circulation and enable appropriate management or onward referral. Early identification is particularly important because advanced PAD can be associated with ulceration, tissue loss and amputation.  

Diabetes: Routine assessment can identify neurological and vascular changes associated with diabetes. Callus and other areas of increased pressure can also require particular attention in people at risk of diabetic foot ulceration. 

Sepsis: A podiatrist who recognises signs of serious or rapidly progressing infection can identify when a patient requires urgent medical assessment. 

The power of prevention 

The primary goal of core podiatry is to prevent foot problems from developing or becoming more serious. 

Much of what happens during a routine appointment has a preventative purpose. 

Callus debridement 

Removing callus can reduce areas of high pressure and the risk of skin breakdown. This is particularly important for people with neuropathy who may be at greater risk of ulceration. 

Nail management 

Good nail care can reduce trauma to the surrounding skin and the risk of problems including paronychia, cellulitis and infection. 

Skin assessment 

Assessing the skin gives the podiatrist an opportunity to identify and manage problems such as fissures, tinea pedis and maceration, which can compromise the skin's integrity and create routes for infection. 

Taking a clinical history 

The conversation with the patient is just as important as the treatment itself. A thorough clinical history can connect apparently local symptoms with wider patterns and identify signs that warrant further investigation or referral. 

The clinical mind of the practitioner 

When we champion advanced treatments such as dermal fillers or diagnostic scanning while allowing core podiatry to slide down the priority list, we risk missing the bigger picture. 

An ultrasound scan may help diagnose a plantar fascial tear. A core podiatry appointment can reveal something the patient – and sometimes the wider healthcare system – did not yet know was there. 

Advanced podiatry is not defined by the tools we use, but by the clinical mind of the practitioner. 

In my view, core podiatry is advanced podiatry. 

It requires knowledge of anatomy, pathology, systemic disease and preventive medicine, but also the clinical judgement to bring those things together in front of an individual patient. 

New technologies have an important place in our profession. But we should not allow excitement about what is new to diminish the value of what podiatrists have always done – look, listen, assess, think and act. 

Sometimes the most advanced thing we can do is get the fundamentals right. 

Links and references 

Royal College of Podiatry: Podiatric detection of atrial fibrillation: Policy position statement 

Diabetic medicine: The cost of diabetic foot ulcers and amputations to the National Health Service in England 

National Institute for Health and Care Excellence (NICE): Peripheral arterial disease: diagnosis and management (Clinical Guideline CG147).  

The Journal of Foot and Ankle Research: How can podiatrists and other healthcare professionals support the detection of atrial fibrillation.