20171023 The Best Practices of Foot Care in Denmark by Prof. Mette Modler

THE BEST PRACTICE OF
FOOTCARE IN DENMARK
Global Health Forum
Taiwan 2017
Podiatrist and specialist teacher Mette Modler

What is podiatry?
 Treatment of the feet, nails, nail diseases, hard skin,
skin diseases and corns
 Nailbraces for ingrown toenails
 Insoles for different kinds of jointdeformities

Podiatry in Denmark
You will find podiatrists working in
 Private clinics
 Nursing home/homecare
 Hospital and Diabetes Centers
 Cooperation with physioterapist, chiropractor,
handshoemakers and other healthcare workers

Private clinics
 Private clinic

Private clinic
 Patients who ”just” needs pedicure
 Patients with different diseases or medicin
 Patients with high risk for ulcers
Treatments of feet, nailbraces and insoles

Private clinics
 In the private clinics the National Health Service
provides financial grants/support to patients with
 Diabetes
 Rheumatoid Arthritis
 Ingrowened toenails
 Scar tissue from treatment with x-ray on footwarts

Podiatry in Denmark
Nursing home

Nursing home/homecare
Nursing home
 Elderly who are not able to take care of themselves
 Younger people with psykiatric diagnoses or psysical
limitations who can’t take care of themselves
Homecare
 Elderly or young people in their own home who are
not able to leave the home, the podiatrist will see
them in their home.

Hospital
Mainly treatments of footulcers and
prevention of footulcers

Podiatry in Denmark
Who needs podiatry/footcare?
 Most people with feet 
 Young people with nailproblems or problems with joint
deformities
 People who from different reasons can’t reach their feet
 Older people who can’t take care of themselves
 People with different kind of diseases like diabetes,
psoriasis and arteriosclerosis

Podiatryschool Copenhagen
 We got 110-120 students
 The average age is 32 years old (19-53 years old)
 Different backgrounds
- nurses
- nurse assistents
- pharmacists
- teachers
- people working at offices, shops, constructers etc..

Students
 Age difference gives a good diversity of
supporting one another
 Different backgrounds = great diversity
 Students have days with integrated teaching.
3. semster supervises 1. semester or 1. semester
follows 3. semester in their work, mainly at the clinic
and at our workshop

Training
 All teaching, both theory and the practicaltraining,
are taught at the podiatryschool
 After 4 weeks of study, the students see their first
patients
 From here theory and practice goes hand by hand
We focus on the benefits of connecting the theory
and the work at the clinic - plus
the other way around

Training

Microbiology
Practical work
Knowledge that is needed in the work
Treatment of feet
Work in the sterilization room
Interruption/
prevention
Infections
Microorga-
nismsTheory

Training
3’ semester
Cooperation with Bispebjerg Hospital
 Patients with diabetic footulcers
 Patients with footulcers generally
 Patients with different skin diseases
Cooperation with detentioncenter for homeless
Citizens addicted to alcohol and drugs

Training, focus and aims
 High quality of their work
 - treatments of feet
 - ortonyxi (nailbraces)
 - insoles
 Not just treatments of symptoms of footproblems,
but to look at what causes the footproblems.
 How can the patient possibly get the best
treatment, what does it take/need?
 Supervisning/guidance of the patients.

Teaching
For teaching to be succesful!
Keywords are
Motivation, commitment and
engagement

What makes teaching succesful?
 Learning styles
 Hands on & learning by doing
 CL cooperativ learning
 Gamification

Training at the clinic

Teaching at the clinic
 Connecting the theory to the patient
- Informations from the patient’s record
- Informations from the patient
- What do they see - colours of skin, pressure marks, hard skin,
wounds, nails etc.
- What diseases and medicin are we dealing with
- Their (the students) thoughts and reflections
- Plans for today/future
- Supervising/guidance of the patient

Reflection
Keyword in teaching is also reflection!
 How can we train the students to reflect on their
work?
Studies shows that the more students are involved
in the teaching the better they learn

Teaching - lectures

Studygroups

Student to student

Ortonyxi/nailbraces
 Unguis incarnatus, ingrown toenails

Ortonyxi/nailbraces
Nailbraces on feet
with ischimia where
surgery isn’t
possible.

Gait - analysis

Examination of the feet

Workshop
Shoes and insoles

Insoles for jointdeformities

Insoles
 Simple and easy basic knowledge about insoles,
that can be made with
very few resources…
but can make a world
of difference!
Make basis for further
developement for other
ways to do insoles

Insoles
 Insoles using IT-equipment

Off - loading
Foot ulcer caused by neuropathy

Practical training
Students are always supervised by a teacher.

Patients
 From ”normal” feet that just needs pedicure
 To complicated feet that needs podiatry

Patients
 Patients who ”just” needs pedicure, no diseases or
medicin that ”influence on the feet”
 Patients with different diseases or medicin, that does
that the feet need extra care
 Patients with high risk for ulcers
Our patients are categorized in 3 groups, one for each semester

Patients

Patients
 Rheumatoid arthritis

Patients
Foot ulcer caused by Diabetes
and Neuropathy
Onychomycosis/
Fungusinfection in nails

Patients
Ichthyosis – ”Fishskin” Eczema

Trainee experience for patients with speciel needs

Podiatry in Denmark
How can 1½-2 years of training
do a difference and
be important, when it is not
a University degree?

Teamwork
Podiatristt
Surgical/
vascukar doctor
Medical doctor
Nurse/
nurse assistent
Dietitian
Secretary
Physiotherapist
Holistic

Facts
 Treatments of ulcers cost from
152.800- 252.800 Dkr *
754555 – 1248374 TWD
 Amputations cost from 252.800 – 407.900 Dkr *
1248374 – 2014287 TWD
 Shoes and insoles cost 2.500 Dkr
12345 TWD
* Referral source:
* Tennvall GR, Apelqvist J, Eneroth M, Costs of deep foot infections in patients with diabetes mellitus. Pharmacoeconomics 2000;18: 225-8PubMed
* Diabetiske fodsår – en medicinsk teknologivurdering. Sundhedsstyrelsen. 2011; 13(2) (Diabetic footulcers –technology assessment. Health Board.
201;13(2)

Thank you for your interest

20171023 The Best Practices of Foot Care in Denmark by Prof. Mette Modler

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20171023 The Best Practices of Foot Care in Denmark by Prof. Mette Modler