MSK toolkit
Theme 6: Specialities

The podiatry career framework [Appendix 4] provides descriptors to identify at what stage a podiatrist is at within their career. Within the management of MSK complaints lie several specialities where podiatrists can practice at an advanced and consultant level when their learning, practice, leadership and research go beyond the general care of core patient groups to focus primarily on a subset of pathology. The specialities generally cover Paediatric care, Rheumatology, Sports Medicine, Neurology and Surgical Interventions.

From a snapshot question sent out to 18 NHS MSK services around the UK, team leaders identified the following distribution of specialist services on offer from within their trust (Figure 1). The most frequently available specialist service is a paediatric MSK service which exists in 16 out of 18 areas, the least being neurology. Surgical assessment refers to advanced podiatry services supporting secondary care orthopaedic surgery with pre and post-operation assessment and intervention as well as rehabilitation and conservative management. Other services include specialist skills including joint injections and diagnostic ultrasound which are applicable to many groups of people. 

Figure 1 Survey responses to specialist service availability within NHS trusts.

What needs to be established and defined to create speciality practitioners are suitable pathways of training to equip and support this higher level of practice.  The MSK capabilities framework provides overarching guidance of capabilities for each level of practice with a focus on the key skills are required to provide care within the broad speciality of MSK (Appendix 4). Guidance on development and leading practice in paediatric podiatry can be sought from the Paediatric Podiatry framework (Appendix 4) with applicable guidelines to managing the rheumatoid foot from the Northwest Podiatry Clinical Effectiveness Group (Appendix 4).

These guides could be extended and applied to clinical practice enabling lead podiatrists to develop suitable specialities with appropriate service training. Suggestions of post graduate CPD and qualifications have been created to support practitioners (Appendix 4).