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Do pods working in private practice always give there patients a foot massage at the end of the treatment? Is this what a patient paying for treatment expects?

I come from a public environment and my patients dont expect me to do this. I have very small hands that get tired from just giving my boyfriend a shoulder rub (no jokes please ) so I'm not sure i could handle giving a foot massage to 15 sets of feet each day!

I'd be interested to hear if many of my colleagues working in private practices give each patient a foor massage (ie longer than 5 minutes) or is this not considered a routine component of our treatment regime.

Good job you don't practice in China where foot washing/massage is an essential part of daily life. Frequently undertaken by specialist physicians, the massage can take up to 90 minutes. Want to learn how?

http://www.youtube.com/watch?v=yIeSzKv0PZ8

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Hi Cinderalla,

No, it isn't mandatory by any stretch. You don't have to at all!
I would massage in creme on particularly dry feet for 1-2 mins, but not on someone with hyperhidrosis etc., and that's only if time permits. If for example a complicated case takes all of your time (20-25-30 mins whatever), then no you don't have to run overtime just for massage.

In 1997 I worked (1 day only!) for a colleague who had his receptionist (a lady in her 50's no less) on all fours washing the patients feet in a bath prior to Tx, then had her carefully massage their Feet for quite a time. I was appalled and decided there and then, Pod's (and our staff) are first and foremost professionals whose time is valuable and we as a profession should not be going down the beautician road too much. Personally it is a rod for your back to go down this road.

Having said that...I would say around 50% of patients expect at least a quick application of creme, but 100% appreciate it. If a patient said "you didn't massage long enough!" just say politely, your hands aren't able to!

Don't forget, a beautician will charge $50-$60 for pedicure!

So my advice, when time permits, only on appropriate cases, slap on a bit of light creme from time to time, or, not at all if your hands are giving trouble. Remember, the patients won't care in 5 or 10 years when you have osteoarthritic hands........just dazzle them with your excellent treatment!

I suppose these are the aspects of private practice that you aren't told about and, you are right to query them. I know some patients attend us just for the "feel-good" factor and they also get a rebate from Health Insurance as well.

Hope this helps!

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Julian
Podiatrist-at-large

I always apply an emollient of some sort at the end of a routine treatment. I usually find that I benefit from this as it gives my hands a stretch, I settle into a more relaxed posture and make eye contact maybe for the first time during the treatment.
It is useful for a quick assessment of foot mobility and some muscle tone, and feel that it helps improve my tactile senses.
Many patients don't relax until this point in time because they have seen most of the tools of torture and sit there quite tense most of the time without being aware of it.
I haven't had one person that told me that they didn't appreciate it in the 10 years of practice, so I figure the one minute or so I spend doing this is extremely valuable all round.

Hi, I also apply a quick rub of emmollient if time permits, they love it and express so. I then suggest why not go and have a foot massage, ( I am not a massueur) and pamper yourself. That reinforces that I am not massaging their feet but applying emollient ( if they need this I will have recommended they should be doing daily) and that podiatry is not so much pampering but preventing foot complications. cheers hb

Well said hj--ray?, in 22 years i have never applied any emollient to any one's feet. I was never trained in massage techniques. I am not a massueur! I certainly recommend pts apply a suitable emollient with the usual spiel but i'm not in the pedicure business!
I had a 'browned-off' patient this morning having a rant about not getting a 'foot massage'. Ungrateful old bag!

I have to say, if I am in good form I will put cream on a patients feet. They love it, and whats more they come back for more which is the name of the game in private practice (maybe noone else sees it like this). I know if I get a service and think I am getting a little extra, I always go back to that person.
For the sake of 20 secs rubbing cream in someones feet, you shouldn't get sore hands. And the patient will thank you for it, and come back again!!!!

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pd6crai, good on you, if it doesn't bother you, do it; if i was private again and for a select FEW I'd even given them a smacka on da lips if it got them to come back to me. They tell me my bottom lip is what fantasies are made of!

I'm with MJ on this one.

I was never taught this at Uni-although i do encourage pts to apply reguarly.

I can understand a private practitioner trying to get pts to keep coming back etc. If thats is the case why not learn how to do it properly and charge them accordingly for the service.

Just a thaught

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MON THE HOOPS

Brian Kelly

Dear All,

I had never come across this in 20 years of NHS practice nor in 10 years p/t private practice. So had never done this in all that time.

I believe that if you worked for Scholl and previously Boot's then this is part of the service provided.

On arrival here in Aus i found myself having to give pts this application of emolient on completion of the tt.

many pts appreciated this when one was reinforcing the daily use of emolients by showing the immediate improvement in skin condition.

However many saw this as a FOOT MASSAGE which i do not consider this to be and ask for the MASSAGE to be more vigorous and of longer duration. This i feel starts to become borderline sexual and allows a change in the pt clinician relationship .

So sometimes there is a therapeutic benefit other times it can be creepy with some pts.

I personally would like to discontinue this practice , but it is part of the deal in the practice.

I personally see no therapeutic benefit to this practice other than to do it once to reinforce the benefits of daily application of an emolient.

regards david

I apply an emolient at the end of treatment, in conjunction with discussion about various creams. Sometimes it even encourages patients to continue with this themselves

BOYS!! You make it sound like you actually have to learn how to massage. All you do is slap some cream on their feet and rub it in like you would do on your own (If you actually apply cream, which prob none of us do, its more a do as I say not as I do senario!!).
Its not a science, or even an art!!!!! Different if you are doing it for an hour, but for 30 seconds..........honestly!!!

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I dont see this as "pampering". I use the last few minutes of the consult not only to apply emollient but to feel for ROM, abnormalities , relationships and muscle tone. The tips of your fingers are quite sensitive, why not use them?....They can feel what the eye cant see

At the end of the day if the public percieve this as a "massage" thats fine with me....

.......something they didnt teach at uni was to actually "use" your hands.

Being in private practice I sometimes rub a bit of cream on my patients feet after a treatment. It depends what mood I'm in and depends on the patient, and if I want to show them the benefits of using emollients on their feet. I always let the patients know that I am not a qualified masseuse and that they shouldn't just expect a "foot massage" at the end of a treatment. Most of them get this and don't ask for it, if they get it that's just a bonus. :)

I totally agree with you especially in a private practice setting. I usually spend about 20 secs after each primary care treatment rubbing in some cream. The old girls love it!!! I usually spend the time chatting to the patient and setting up their next appt time and date.

Patients feel like you are taking more time and more of an interest in them. After treatment it gives the feet a more professional look after debridement of HK and disc.

Happy patients are patients who are most likely to return to your clinic!!! :

This thread seems to be drifting all over the place between a theraputic application of emollient to foot massage and marketing strategy to DAVOhorn feeling boarderline sexual. Such a simple discussion thread exposing so many different view points.

We apply an application of emollient which takes a couple of minutes, when appropriate, at the end of each treatment; at times as a theraputic benefit, sometimes as a preventative measure and other times to help patients save money! Apply emollient and your problems will resolve! But most important of all we never take it for granted that our patients know how to apply an emollient appropriately, demonstrate and get over the stigma between beauty and health care.

I am 43 years of age and have been attending a dentist since I got teeth. Last year an advertisment on TV showed me how floss properly. For years my dentist had been criticising the amount of tartar between my teeth, encourage me to floss but never showed me how. After seeing that advert, I changed my style and last month got a gold star from the dentist.

Makes you think. How many fissured heels have you prevented by demonstrating the use of emollient and reinforced the application at every visit? How many potential cellulitic episodes have you prevented by getting your diabetes patients to examine their own feet during an application of emollient or involving a partner in helping? I could go on...

Interesting thread and well done to Cinderella for bringing it up.

GB

Hi Brian,
re doing it properly,
pt would pay and often ask for a massage
BUT my thumbs can't manage and I choose not to offer this.
There is an item/code number is there not?
So we can use it if we choose.
Cheers

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Heather J Bassett
137 Wheatsheaf Road
Glenroy 3046
Victoria
Australia

Goodaye George, (note: I'm public nowadays and don't need to 'make' the pt happy), I always demonstrate 'how and where' to apply the emollient at all new and review assessments and at general treatments when their use is indicated. I use either my hand or a foot skeleton, as a model, to demonstrate. I advise the pt to apply, whilst sitting after their shower, on their heels with an a motion parallel to the fissures. I advise against applying to the forefoot, except with a single digit to the shearing callus sub 1st mpj's. I warn them to put hosiery on immediately and retain for at least 1/2 hour post application.
Voila, no need to apply it to the pt's feet at all. And noting the advertisement didn't floss your teeth just demonstrated the technique.
Got me there, haven't got the time to pamper just treat.
I wouldn't be surprised how many episodes the advice has prevented, not just those with d/m. I always advise the pt to have their feet inspected whenever possible, preferably by someone who can get their eyes a bit closer than the pt can. All the best, mark c

To Cinderalla, I perform massges to many of paitents if there is truely a need. In fact, here in the states, massage therapy is actually covered by the elderly and disabled health plan, medicare for certain diagnoses eg. edema, pain in limb and cramps. Somethimes if time allows I will do a short version to those who don't need it but just a way to help me stand out from others who have the advantage of being allowed on hospitals just because they can bring surgical cases.
Dr Brooks

Good day to you too Mark,

Now why on earth do you demonstrate in this fashion when you have a perfectly good model in front of you?

But wouldn't it have been better for the dentist to have observed my technique then put right what I was doing wrong so much sooner?

This is the same philosophy we apply to our practice of emollient application.

GB

You got me George, and excellent and obvious point. It does sound strange me using a model instead of the 'real thing'. My aversion to hands on with emollient stems from, when i was completing the pod course (~87'ish), a pod in Melbourne (Aus) was taken to tort after one of his pts slipping, fracturing neck of a femur (methinks) after the pod had applied emollient. But I do find it just as simple to demonstrate on a model.
Can't argue that one either George, you're doing very well mate, yes it would be better if I observed, and corrected / reinforced, the pts technique.
Thanks George, it's been nice (and rewarding) talking to you, Mark

Is this not a crucial part of patient education in skin care on patients with dry skin and diabetics (reinforcement and enpowering the patient!!! most patients will cream their bodies and stop at the ankle) eg advise on creams and how to apply them which only needs a min or two, if you have time!. There is no time for any longer if you are writing patient notes doing bio/vasc assessments and treatments. But be aware of the patients who are wearing sandles and high heels with no socks or stockings don't want them falling over.

Cinderalla refer them on if they want more massage to Reflexologist ect, the best foot massage I ever had was from an English girl who specialised in Thia massage.

Jude

Dear Betafeet,

Best massage here is to be found care of loverly Thai girls who leave no stone unturned. Yes brothels are legal here and are found in every suburb if local suburb magazines are to be believed.

We recommend a shoe shop in a local suburb and it will be aurrounded by 3 Brothels if local planning applications are approved.

The Massage section here in papers is even more impressive than Spanish news papers.

I seem to be in the wrong service industry.

Cream on feet leads to cream on floor and potential falls.

But here if you do not do it PATIENT FEELS ROBBED!

So we do it.

I still do not like doing it though.

It has no therapeutic value unless patient follows the advice given on applying emolient daily.

DAVOhorn, socks stockings put on feet before leaviong chair, stop cream on floor, shoes situated beside chair allow for feet to slide straight into shoes.

NEVER NEVER cream on feet without socks or stockings?

Just another thought

Hope to one day here how much you are enjoying down under?

Cheers

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Heather J Bassett
137 Wheatsheaf Road
Glenroy 3046
Victoria
Australia

Ouch! Guess you are always mindful after an experience such as this.

We seem to have had a year of filling the accident book following patient falls, I just hope you haven't cursed me with another from down under!

GB

PS None of the falls have been emollient related!

Hi All

Dave oh

And the stimulation of the circulation and to reduce odaema has nothing to do with it then ??

I do give a short massage ( as short as is humanly possible using the quickest absorbable cream I can find) and making sure it HAS absorbed BEFORE the patient gets off the couch

In reality I do one foot and then ask the patient to look at the difference in the two feet ( brings the point home) do the other one and say goodbye.

Takes about 3 minutes if you use the right cream.

It does work not only for the emollient side of it but to get a relative ( yes they get p****d off about it. But do I care ? ) to rub some cream in twice daily.

The only problem you may get is ( apart from the relative) is the patient complains their shoes are suddenly too big.

Simple really

Cheers
Derek

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