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Podiatry is a field of healthcare devoted to the study and treatment of disorders of the foot, ankle, and sometimes knee, leg and hip (collectively known as the lower extremity). The terms podiatry and chiropody are not interchangeable, with the word chiropody being most used in the UK, and podiatry in the US.

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A podiatrist examines the cast of a patient. Casting can correct abnormalities of the foot and ankle.

*Radiography is used by podiatrists as a diagnostic tool to study the foot. Here a phalangeal fracture can be observed.*

History of Podiatry

The professional care of feet was in existence in ancient Egypt as evidenced by bas-relief carvings at the entrance to Ankmahor's tomb where work on hands and feet is depicted. Many Egyptologists believe tending feet probably spanned the whole of Egyptian civilization. The placement of carvings at the entrance of a tomb typically signified the profession of the buried individual and The Tomb of the Physician dates from 2400 BC.

Corns and calluses were described by Hippocrates who recognised the need to physically reduce hard skin, followed by removal of the cause. He invented skin scrapers for this purpose and these were the original scalpels. Celsus, a Roman scientist and philosopher was probably responsible for giving corns their name. Later Paul of Aegina (AD 615-690) defined a corn as "a white circular body like the head of a nail, forming in all parts of the body, but more especially on the soles of the feet and the toes. It may be removed in the course of some time by pairing away the prominent part of it constantly with a scalpel or rubbing it down with pumice. The same thing can be done with a callus."

Until the turn of the 20th century, chiropodists - now known as podiatrists or podiatric physicians - were separate from organized medicine. They are independently licensed physicians who treat the foot, ankle and related leg structures. Lewis Durlacher was one of the first people to recognise the need for a protected profession. He tried to establish the first association of practitioners in 1854, although it would take another century to come to pass.

There are records of the King of France employing a personal podiatrist, as did Napoleon. In the United States of America, President Abraham Lincoln suffered greatly with his feet and chose a chiropodist named Isachar Zacharie, who not only cared for the president’s feet, but also was sent by President Lincoln on confidential missions to confer with leaders of the Confederacy during the U.S. Civil War.

The first society of chiropodists was established in New York in 1895 with the first school opening in 1911. One year later the British established a society at the London Foot Hospital and a school was added in 1919. In Australia professional associations appeared from 1924 onwards. The first American journal appeared in 1907, followed in 1912 by an UK journal. In 1939, the Australians introduced a training centre as well as a professional journal. The number of chiropodists increased markedly after the Great War then again after World War II. Increased numbers of ex-soldiers needing to be gainfully employed gave chiropody a boost and led to the need for registration in all English speaking countries. The study of the foot i.e. podology, brought greater knowledge to the practice of foot care or podiatry.

The Podiatric Physician

A podiatrist or podiatric physician is a podiatric professional, a person devoted to the study and medical treatment of disorders of the foot, ankle and lower extremity. The term originated in North America but has now become the accepted term in the English speaking world for podiatric medical school graduates: Doctors of Podiatric Medicine (D.P.M.).

*A podiatrist makes molds of a child's feet for custom orthotic devices. Such devices are commonly used as a non-surgical means of correcting foot abnormalities.*

Training for podiatrists, podiatric physicians, and podiatric surgeons can only be obtained by first completing advanced study at a Podiatric Medical School. The Doctor of Podiatric Medicine Degree (D.P.M) must be awarded to an individual before they may seek further study & training in podiatric surgery. In the United States the terms chiropodist and podiatrist are not synonymous and are definitely not interchangeable titles.

In the United States and much of Canada, podiatrists have a Doctor of Podiatric Medicine (D.P.M.) degree. To achieve this degree, podiatrists have four years of undergraduate university training with an emphasis in the basic sciences, followed by four years of medical training in a school of podiatric medicine. Hospital rotations in a wide variety of disciplines are conducted in the second through fourth years. In the United States and much of Canada, additional residency training is required for state and provincial licensing. Residency programs are typically two or three years. Some podiatrists also pursue additional fellowship training in a subspecialty.

United States

In the United States, podiatric medicine and surgery is practiced by a licensed Doctor of Podiatric Medicine (D.P.M.). Education consists of a doctoral level four-year program followed by a two- or three-year residency. Like regular Medical School this training follows their college degree. The first four years of podiatric medical school are similar to training that traditional, allopathic (MD) and osteopathic (DO) physicians receive, but with more emphasis on foot and ankle and lower extremity problems and slightly less emphasis on other topics such as pathology and neonatology. Some of the podiatric medical schools are integrating into MD and DO schools for the first year or two. The degree requires a minimum undergraduate educational component of 90 semester hours and/or a bachelor's degree. The D.P.M. degree itself takes a minimum of four years to complete. Dentists likewise, have a separate educational school system and thus there are four medical professions that allow independent diagnosis and medical and surgical treatment: M.D., D.P.M., D.O. and DDS/DMD.

The four-year podiatric medical school is followed by a residency, which is the hands-on post-doctoral training. There are two standard residencies named Podiatric Medicine and Surgery 24 or 36 (PM&S 24 or PM&S 36). These represent the two- or three-year residency training. Podiatric residents rotate through all main areas of medicine such as emergency, pediatric, internal medicine, orthopedic and general surgery and of course podiatry — both clinic and surgery. During these rotations, attending physicians train the resident physicians in medicine and surgery. The surgical training varies from forefoot surgery to more complex foot, ankle and leg reconstruction and salvage as well as trauma.

Podiatric physicians may independently diagnose, treat and prescribe medicine and perform surgery for disorders of the foot and in most states the ankle and leg. Board Certification exists for podiatric physicians in foot and ankle surgery & related structures. First is the Board of Primary Care and Podiatric Orthopedics which is mainly the nonsurgical Board Certification. The surgical Board Certification is divided into foot surgery and rearfoot/ankle reconstruction surgery. The rearfoot and ankle Board Certification requires at least a two- to three-year residency to qualify. All of the Surgical Board Certifications require applicants to submit their surgical cases to the Board committee who heavily scrutinize them. The applicants then take written and oral exams prior to becoming Board Certified. The exams are rigorous and the pass rate reflects the difficulty.

The previous titles used for the Doctor of Podiatric Medicine (D.P.M.) degree were Doctor of Science in Chiropody (D.S.C.) and Doctor of Podiatry (D.Pod.) Although D.P.M. is the modern-day equivalent of the previous degrees, it encompasses a broader spectrum of medical practice for podiatric physicians, whom can now perform medical and surgical procedures in all 50 states, though the specific scope of practice does vary.

The Legacy of Dr. Scholl

William Mathias Scholl began his career in Chicago in 1899 in a small shoe store specializing in comfort and specialist footwear. He became so concerned for customers with painful foot conditions that he enrolled in medical school to study the anatomy and physiology of the foot.

By 1904 he had graduated from the Illinois Medical College as a doctor of medicine (M.D.) and launched his first foot care product, an arch support — The Foot-eazer. Dr. Scholl made it his life-long mission to improve the health, comfort and well-being of people through their feet.

In 1907 the Scholl Manufacturing Co. Inc. was created and in 1912 Dr. Scholl founded the Illinois College of Chiropody and Orthopaedics. By 1913, the company was expanding worldwide and Dr. Scholl’s first Foot Comfort Service shop opened in London. By the 1930s the company expanded its range for the comfort of the legs and began to make a range of compression hosiery for the relief of swollen ankles and varicose veins. Dr. Scholl was a prolific inventor and went on to create a range of remedy and cushioning devices covering the whole spectrum of common foot conditions.

In 1959 the first Scholl Exercise Sandal was created and became an international fashion hit and an icon for the brand.

Today, Dr. Scholl's is a brand of foot-care products manufactured by Schering-Plough and footwear made by Brown Shoe Company. William M. Scholl passed away in 1968 at the age of 86, leaving the company to his nephew, William H. Scholl. The company had an initial public offering in 1971.

Practice characteristics

While the majority of podiatric physicians are in solo practice, there has been a movement toward larger group practices as well as the use of podiatrists in multi-specialty groups including orthopedic groups, treating diabetes or in multi-speciality orthopedic surgical groups. Some podiatrists work within clinic practices such as the Indian Health System (IHS), the Rural Health Centers (RHC) and Community Health Center (FQHC) systems established by the Federal government to provide services to under insured and non-insured patients as well as within the United States Department of Veterans Affairs providing care to veterans of military service.

Scope: The differences in podiatric medical and surgical practice are determined by state law; there are often defined as physicians in most States. Each state allows or limits the practice of podiatric medicine to the foot, ankle or and in many States, includes portions of the leg or related leg structures. This may include surgery above the ankle and leg in at least 18 states. Most states require completion of a residency to practice. Most podiatric surgeons work in surgery centers or hospital settings doing both medical and surgical treatments for patients. As in many other specialties some podiatrists work in nursing homes and some perform house calls for patients. Podiatric patients range from newborns and infants to the geriatric.

Medical and orthopedic practice: Some podiatrists limit their practices to the non-(hospital)surgical treatment of patients. Because much work in podiatric medicine and surgery involves cutting of some kind, many procedures are considered surgical by insurance companies including tasks such as the cutting of nails, removing of corns or callus, which the general public would not ordinarily consider to be surgery. These podiatrists use their skills in handling arthritic, diabetic, and other medical problems associated with the feet and lower extremities. Some use devices fitted in shoes (orthotic devices) or modify the shoe itself to make walking better or easier. Some practices focus on sports medicine and treat many runners, dancers, soccer players, and other athletes.

Surgical Practice: Within the scope of practice, podiatrists are the experts at foot, ankle & related leg structures surgery. Podiatrists have specialized training and interest in the lower extremities as well as one to three year surgical residencies in the United States. Some podiatrists have solely surgical practices and complete an additional one year Fellowship in Reconstruction of the foot, ankle and leg. Most podiatrists mix medical, orthopedic, biomechanics and surgical practices. Indeed surgical podiatric principles rest on a base of orthopedic and kinesthetic knowledge.

Job opportunities and description

The US Department of Labor, Bureau of Labor Statistics expects need for podiatrists to rise but slowly because podiatrists tend to have long practice lives, stopping practice when they retire. Podiatrists need a state license that requires the completion of at least 90 semester hours of undergraduate study, the completion of a four year program at a college of podiatric medicine, and all 50 states now require a residency of two year or three years. In addition podiatric physicians may complete a postdoctoral fellowship in areas such as: podiatric dermatology, orthopaedic surgery, and diabetic wound care. Podiatrists are commissioned officers in all the armed services and serve as department heads in the Veterans Affairs system. Practice income is high for most podiatrists.

Colleges and education

There are eight colleges of podiatric medicine in the United States. These are governed by the American Association of Colleges of Podiatric Medicine (AACPM). The AACPM describes its mission as to enhance academic podiatric medicine.

United Kingdom

The profession of Chiropody has been established in the UK for approaching 100 years. The term "chiropodist" and the profession of chiropody is British in origin and the royal family helped initially to make the profession popular with regular visits to chiropodists.

The Society of Chiropodists and Podiatrists is the largest professional body and trade union for registered chiropodists and students. The Society represents around 8,000 members working in private practice, the NHS, education and the retail sector. The Alliance of Private Sector Practitioners is a representative body for practitioners working in the private sector foot health occupations [1], its membership including HPC registrants[2] and Foot Health Practitioners. In recent years the profession has become more visible.

The scope of practice of podiatrists in the UK has expanded. Podiatrists also deal with biomechanical, rheumatoid and diabetic foot conditions.

The HPC set standards of practice for podiatrists, ensuring regular professional development and good practice. Foot Health Practitioners [3] whilst performing uncomplicated routine procedures, are not at present regulated by the Health Professions Council. The Voluntary Register for Foot Health Practitioners was presented to the HPC on 31st January 2005 and exists for FHPs to indicate that they seek and would welcome appropriate registration.

Canada

In some parts of Canada (Ontario, for example), the situation is legislatively stratified between the U.S. and British systems. For instance, in some provinces like British Columbia and Alberta, the standards is the same Doctor of Podiatric Medicine (D.P.M.) level as in the United States. Quebec, too, has recently changed to the D.P.M. level of training. In the prairie provinces, the standard has been based on the British model of chiropody. The educational standards between the chiropodist and the D.P.M. are overwhelmingly obvious. In the province of Ontario, chiropodists and podiatrists are legislatively distinct occupational designations. As expected, due to vast educational differences, Ontario chiropodists have a narrower scope of permitted practice than Ontario podiatrists (i.e., limitations on surgical practice). Both occupations are governed by the College of Chiropodists of Ontario. Persons licensed after July 1993 in Ontario can only be licensed as a chiropodist and cannot be licensed as a podiatrist, regardless of their training. The motivation behind this legislative change by the large chiropody lobby appears obvious to most DPM's [4]. [5]

Australia

There are seven registration boards and six teaching centres with two levels of awards — unclassified bachelors degree and honours level. Courses vary from three to four years of full-time study.

Australian podiatrists are able to practice abroad with their qualifications recognised in some Commonwealth countries. The scope of practice of the Australian podiatrists includes the full scope of foot and ankle care from including basic care, wound care and orthopedic foot and ankle surgery. Specialisation in fields such as care of children, sports medicine diabetes and foot biomechanics have become established over the last decade.The greatest advances have occured in podiatric foot and ankle surgery which is practised in all states by podiatric surgeons. Podiatrists who have undergone further training (often surgically based)also have prescribing privellges for a range of restricted medicines in most of the country.

Orthopaedic Physicians/Surgeons has opposed and attempted to block the development of podiatric surgery in Australia despite the fact that they are unable to meet the demands for foot and ankle surgery and that podiatric surgeons have a long history of safe and comparable practice to their orthopaedic collegues. The fact that orthopaedic groups will not participate in any comparative study of clinical outcomes raises questions about their claims of reduced standards of care by podiatric surgeons as scare mongering.

USA Podiatric Physicians/Surgeons have developed professional links with podiatric surgeons in Australia and formal training has been occuring in both the US and the UK of Australian podiatric surgeons due to their high level of education in Australia. The Australian Government has recognised podiatric surgery in recent productivity reports and recently changed legislation to ensure that fellows of the Australian college of podiatric surgeons have access to private hospitals. This has helped consumers make their own choice about who to seek for their foot and ankle surgery. Recognition of services provided by podiatrists as a rebatable item by private insurance funds has established a changed emphasis from palliative care to preventative and corrective management. Continuing professional education is recognised as an essential activity for professionals, and here again the public universities have led the way in Australia. In tandem with the profession and to meet their requirements, the universities now offer postgraduate courses leading to postgraduate diplomas and master's degrees.

University of South Australia

Latrobe University

Charles Sturt University

University of Newcastle

Queensland University of Technology

University of Western Australia

New Zealand

Chiropody became a registered profession in New Zealand in 1969 with the requirement all applicants took a recognised three year course of training. The New Zealand School of Podiatry was established in 1970 at Petone under the direction of John Gallocher. Later the school moved to the Central Institute of Technology, Upper Hutt, Wellington. In 1976 the profession gained the legal right to use a local anaesthetic and began to introduce minor surgical ingrown toenail procedures as part of the scope of practice.

New Zealand podiatrists were granted the right of direct referral to radiologists for X-rays in 1984. Acknowledgement of podiatric expertise marked improved services to patients and eventually in 1989 suitably trained podiatrists were able to become licensed to take X-rays within their own practice. Diagnostic radiographic training is incorporated into the degree syllabus and on successful completion of the course, graduates register with the New Zealand National Radiation Laboratory.

In 1986 the profession undertook a needs analysis in conjunction with the Central Institute of Technology to identify competencies for podiatry in 2000. A Bachelor of Health Science was introduced in 1993.

Schools of Podiatric Technicians in New Zealand:

Auckland University of Technology

Disorders of foot and ankle

List of disorders of foot and ankle

Common complicating factors

High heels

External links

Podiatry: Difference between revisions