日本にはない足の専門分野 ポドロギー
*****************
2009年から2012年にかけてドイツに滞在し、ウルム（ULM）という街でポドロギー（Podologie）を学びました。
その際に書いていたブログをこちらにリライトしていこうと思います。
それに伴い、以前の記事は徐々に削除していきます。
ここで掲載されている情報は、その当時のものですので現在変わっている可能性が高いです。
または私自身の認識が間違っていることも考えられますので、ご自身でも常にご確認下さい。
***************
ドイツのポドロギー（Podologie）について 2011.9.4記事より
今日はポドロギーに関して書いてみたいと思います。
ポドロギーとは？
ポドロギーとは、一言でいえば「足学」です。
くるぶしから下の足に特化しています。
タコ（胼胝）、魚の目などの角質、または巻爪や肥厚爪などの爪の変形をケアします。
また外反母趾などの指の変形、偏平足などの足の変形を予防的にケアする、足全般の治療を行う医療専門職です。
ドイツでは医師ではないので、診断することはできません。
通常、皮膚科、整形外科、外科、糖尿病科のドクターおよび靴職人等、
それぞれ足に関係する分野の方々と協力して治療にあたります。
また、糖尿病の方では足へのリスクが高く、合併症が進行している場合、ちょっとした傷を見過ごすことで壊疽に至ることもあるため、多くの糖尿病患者が自分で爪を切る代わりにポドローゲのところで定期的に予防的フットケアを受けます。
高齢者の方々では目が不自由だったり、体が動かないケースが多く、そういった方々もやはり足検診も兼ねて定期的に治療に来られます。
糖尿病の合併症、糖尿病性足病変の血行障害や神経障害を伴う方々が、ドイツでポドロギーのフットケアを受ける場合には健康保険が使えます（国に健康保険適応可能な施設として認可されているポドロギー施設に限定されます、また例外もあるので必要があれば、施術を受ける前に必ず確認してください）
保存的かつ予防的なケア
ポドロギーでは保存的、予防的なケアを目的とします。
例えば巻爪などの場合、医療機関ではまだ外科的手術で抜爪等を行われることも多いです。
それに対してポドロギーでは、巻爪の場合、例えばシュパンゲと呼ばれるワイヤーの矯正装置
（歯科矯正と似た、てこの原理を利用したもの）を用いて、爪を健康的で自然な爪の形に戻していきます。
またはそれほど重症でない場合、爪の切り方を整えたり、爪と皮膚の間に、摩擦を軽減し巻き爪を予防するためのコットンを詰めて治す場合もあります。
Ross-Fraser シュパンゲ
外反母趾などの足や足指の変形に関しては、オトーゼと呼ばれるそれぞれの足型に合わせた、弾力性のあるシリコンパッドを作成し、それらを変形の進行予防として用います。
またこのオトーゼを特に歩行時に着用することにより、例えば足指の間や足裏にできる魚の目などを予防することができます。
オトーゼ、足に合わせてひとつずつ手作りです。まだ削る前の段階
重要なことは各症状の原因を突き止め、根本から治療していくということです。
そうでなければまた同じことが起こるからです。
足のトラブルの原因は、まず足に合わない靴、姿勢の悪さ、内臓疾患、神経障害、
体重過多、仕事上の問題（立ち仕事座り仕事などいつも同じ姿勢を強いられる、
ハイヒール、冷房から来る冷え、むくみ、ストレスなど）など様々な要因が考えられます。
そのためにポドロギーには足だけでなく身体（内臓機能も含め）全体に関するある程度の知識が求められ、また先に述べた各分野のスペシャリスト達と協力することが必要なのです。
また根本からの治療には患者自身の協力が不可欠で、そのためには各ポドローゲが状況、原因、治療内容などに関してきちんと患者に説明する、啓もうする必要があります。
世界のフットケア事情
ドイツではポドロギー（Podologie）と呼ばれていますが、
靴文化が発達した結果、足に問題を持つ人が多い欧米（実際、ドイツでは国民の半数が
足に問題があると思っているとの調査結果もあるそうです）では多くの国で同様の職業が確立されています。
英語ではPodiatryとかChiropodyと呼ばれています。
国によって、国家資格として制定されているところもあれば、民間資格にとどまる国もあるようです。
そのためその職業に就くまでの必要就学年数や範囲には違いがあり、施術範囲も異なります。
例えばイギリスではPodiatristになるのに、一般的に3年程度掛かり
その資格を取ると医師として部分的な手術もできるそうです。
ドイツではかなり昔からFußpflege（フースフレーゲ、フットケアのこと）に携わる、Fußpfleger*（フースフレーガー、フットケア従事者）がいましたが、2002年にPodologieの資格が法律上確立され、2003年からはMedizinischer Fußpfleger（医学的なフットケア従事者）と従来のフスフレーガーが区別されるようになりました。
それ以前は１カ月などかなり短い期間でフースフレーゲの資格を取ることができました。
今でも医学的なものではなくコスメティック目的であれば短期でフースフレーゲの資格を取ることはできますが、その場合、
“Medizinischer“（医学的）をタイトルに掲げることはできません。
しかし実際にはその辺りはまだまだグレーゾーンで、電話帳なんかでPodologe**（ポドローゲ、ポドロギーに従事する人）の欄に、医学的でない、フースフレーガーの名前が載っていたりします。
残念なことに、日本では需要があるにも関わらず、このポドロギーに関する職業はまだ国家資格として認められていないし、また当然ながら国家資格が取れる学校も日本にはありません。
日本にある全てのポドロギー学校はプライベートで、独自の基準を設けているようです。
フットケアに従事されている方々もかなりの数いらっしゃるようですが、まだまだ色々と制限があるようです。
今後益々増えると予測されている高齢者と糖尿病の方々のことだけを考えても、
ポドロギーが国家資格として認められる日が来ることを期待したいです。
次回はドイツのポドロギー資格取得のための、必須要綱などに
ついて書きたいと思います。
本日もお読み頂き、ありがとうございました！
* Fußpflegerは男性、 Fußpflegerin（フスフレーガリン）が女性。
** Podologeは男性、Podologin（ポドローギン）が女性。
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