What are the key considerations for a provider starting a new job in podiatry?

Starting a New Job in Podiatry: Essential Clinical Preparation

As a new podiatry provider, your primary focus should be on mastering diabetic foot infection management and wound care protocols, as these conditions account for the largest number of diabetes-related hospitalizations and are the leading cause of non-traumatic amputations. 1

Core Clinical Competencies to Master Immediately

Diabetic Foot Infection Management

Establish a systematic approach to infection severity classification on day one, as this determines your entire treatment algorithm and directly impacts amputation rates and mortality 1, 2:

• Mild infections: Localized cellulitis ≤2 cm around ulcer, no systemic signs 1
• Moderate infections: Cellulitis >2 cm or involving deeper structures 1
• Severe infections: Systemic toxicity, metabolic instability, or limb-threatening presentation 1

Culture and Antibiotic Decision-Making

For mild infections in antibiotic-naive patients, you can initiate empirical oral therapy without cultures 1, 3:

• Use narrow-spectrum agents covering aerobic gram-positive cocci (sufficient for most cases) 1, 3
• Treatment duration: 1-2 weeks for mild infections 1

Obtain tissue cultures (via curettage or biopsy from debrided wound base) for 1, 3:

• All moderate and severe infections 3
• Any patient with recent antibiotic exposure 1, 3
• Infections failing initial therapy 1, 3
• Never swab undebrided ulcers—this yields contaminated specimens 1, 3

Surgical Consultation Triggers

Immediately consult surgery within 24-48 hours for 1, 2:

• Deep abscess or extensive bone/joint involvement 1
• Crepitus, substantial necrosis, or gangrene 1
• Necrotizing fasciitis 1
• Critical limb ischemia requiring revascularization 1

Wound Care Fundamentals

Master sharp debridement techniques immediately, as this is superior to all other debridement methods 2:

• Use scalpel, scissors, or tissue nippers for callus and necrotic tissue removal 1, 2
• Debride before obtaining culture specimens 1, 3
• Off-loading pressure is equally crucial for healing 1

Avoid these common pitfalls 1:

• Never prescribe antibiotics for uninfected ulcerations—this promotes resistance without benefit 1
• Do not continue antibiotics until complete wound healing; stop when infection resolves 1
• Do not rely on clinical vascular assessment alone; obtain objective Doppler measurements 2

Specialized Conditions Requiring Disease-Specific Knowledge

Epidermolysis Bullosa (EB) Foot Care

If you encounter EB patients, recognize this requires specialist training beyond standard podiatry 1:

• Never use highly adhesive tapes, dressings, or felt padding—these cause secondary injury 1
• Handle feet with extreme care; overdebridement increases blistering 1
• Remove adherent dressings only with silicone spray 1
• Lance intact blisters at lowest point with sterile needle to prevent enlargement 1

For EB dystrophic nails 1:

• Apply urea-based keratolytic agents daily to weekly 1
• Trim nails straight across after soaking 1
• Preserve toenails when possible—they protect digit tips 1

Onychomycosis Treatment

For fungal nail infections, prescribe terbinafine 250 mg daily 4:

• 6 weeks for fingernail infections 4
• 12 weeks for toenail infections 4
• Mycological cure rates: 70% for toenails, 79% for fingernails 4
• Warn patients that clinical improvement lags behind mycological cure by months 4

Counsel patients to immediately report 4:

• Persistent nausea, vomiting, right upper abdominal pain, jaundice (hepatotoxicity) 4
• Taste or smell disturbances 4
• Hives, mouth sores, blistering skin (severe hypersensitivity) 4

Building Your Multidisciplinary Network

Establish relationships with these specialists before you need them 1:

• Infectious disease specialists or medical microbiologists for complex infections 1
• Vascular surgeons experienced in limb salvage 1
• Endocrinologists for metabolic optimization 1
• Wound care nurses for dressing management 1

Practice Management During Public Health Crises

Develop telehealth and remote monitoring capabilities now 5, 6:

• Implement digital triage systems for diabetic foot patients 5, 6
• Prioritize high-acuity office visits and in-home care for limb-threatening conditions 5
• Use remote technology to provide self-care guidance and reduce unnecessary exposure 6
• Podiatric care reduces emergency visits, hospitalizations, and amputations—maintaining access is critical 5

Documentation and Follow-Up

Schedule early and frequent follow-up for all infected wounds 1:

• Re-evaluate mild infections in 3-5 days (sooner if worsening) 1
• Reassess daily for hospitalized patients 1
• Monitor for treatment failure and adjust antibiotics based on culture results and clinical response 1

For patients achieving clinical cure, monitor for relapse 4:

• Clinical relapse rate approximately 15% at one year post-treatment for onychomycosis 4
• Long-term surveillance prevents progression to limb-threatening complications 1