Podiatry

Podiatry, podiatric medicine or chiropody is a field of healthcare devoted to the study and treatment of disorders of the foot, ankle, and the knee, leg and hip (collectively known as the lower extremity). The range of disorders podiatry can address largely depends on the scope of practice laid down in national, state, and/or provincial jurisdiction. It is practiced by podiatrists (Template:PronEng, "poh-DYE-eh-trist"), chiropodists (Template:PronEng) and podiatric surgeons.

A podiatrist or foot doctor is a medical or allied professional, a person devoted to the study and medical treatment of disorders of the foot, ankle and lower extremity. The term originated in the United States but has now become the accepted term in the English speaking world for all graduates of podiatric medical schools who have earned one of the following degrees: (D.P.M., D.P., B.Pod., Pod.B, or Pod.D. or BSc(Hons)).

In other countries, such as the United Kingdom, Germany, New Zealand, and certain provinces of Canada, the title “chiropodist” (Template:PronEng) is often used. The titles “podiatrist” and “chiropodist”, in these countries, are now interchangeable, with the term “podiatrist” becoming more favoured within the profession. In these countries they usually only treat the foot through non-invasive procedures, they can however perform minor surgical procedures such as nail surgery using local anaesthetics. In the UK, individuals may not use the title “podiatrist” or “chiropodist” unless they are registrants of the Health Professions Council (HPC). They are protected titles and their use by non-registrants is unlawful. Such registration is normally only granted to those holding a specialised Bachelors degree or Diploma in Podiatry from one of the 13 recognised schools of podiatry in the UK.

The United States is one of the few countries that grants more invasive surgical privileges to podiatrists. This is due to the fact that podiatric medical education in the US trains podiatric physicians to heal the body attached to the feet, as the curriculum of said schools are mirrored after allopathic medical programs. The programs stress nearly the same basic medical science courses in the first two years as their allopathic counterparts, but with more emphasis on lower leg anatomy/pathology than ob/gyn, psychiatry etc. This followed by 3 year surgical residencies enables the podiatric surgeon to sit for surgical board certification thus making them the preeminent authority on foot and ankle surgery.

Though the title "chiropodist" was previously used in the United States to designate what is now known as a "podiatrist," the title "chiropodist" is now considered to be an antiquated and etymologically incorrect term.

History

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. Aulus Cornelius 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 paring 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 - were separate from organized medicine. They were independently licensed physicians who treated the feet, ankle and related leg structures. Lewis Durlacher was one of the first people to recognize 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, 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 a 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.

Australia

In Australia, podiatry is classified as an allied health profession, and is practised by individuals licensed by their represpective State Boards of Podiatry. There are seven registration boards and six teaching centres, with two levels of awards — unclassified bachelors degree and honours level. In Australia there exists 2 levels of professional accreditation and professional privilege; Podiatrist and Podiatric Surgeon (Surgical Podiatrist in the state of Queensland). Australian podiatrists are be able to practice abroad with their qualifications recognised in some Commonwealth countries.

Education and training

Australian podiatrists complete an undergraduate degree ranging from 3 to 4 years of education. The first 2 years of this program are generally focused on various biomedical science subjects including anatomy, medical chemistry, biochemistry, physiology and patient psychology, similar to the medical curriculum. The following two years will then be spent focusing on podiatry specific areas such as podiatric biomechanics and human gait, podiatric orthopaedics or the non-surgical management of foot abnormalities, pharmacology, general medicine, general pathology, local and general anaesthesia, and surgical techniques such as Partial and Total Nail Avulsions, and electrosurgical procedures.

Australian podiatric surgeons are specialist podiatrists with further training in basic medicine, basic pharmacology, and training in foot surgery. They first complete a degree of 4 years, 2 years of clinical experience. Following this, a masters degree must be completed with focus on biomechanics, medicine, surgery, general surgery, advanced pharmacology, advanced medical imaging and clinical pathology. They then qualify for the status of Registrar with the Australasian College of Podiatric Surgeons. Following surgical training with a podiatric surgeon (3-5 years), and passing oral and written exams, Registrars may qualify for Fellowship status.

Prescribing rights

There is considerable variation between state laws regarding the prescribing rights of Australian podiatrists. While all are able to utilize local anaesthesia for minor surgical techniques, some states allow suitable qualified podiatrists further privileges. Recent legislative changes, which are expected to come into effect soon, will allow Victorian graduates to prescribe relevant schedule 4 poisons. In other states such as Western Australia and South Australia, podiatrists with Masters Degree's in Podiatry, and extensive training in pharmacology are authorised to prescribe S4 poisons. States such as Queensland and New South Wales only grant prescribing privilege to those who are fellows of the Australasian College of Podiatric Surgeons, and thus are Podiatric Surgeons.

Canada

In some parts of Canada 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. Also in Quebec, in 2004, Université du Québec de Trois-Rivières started the first program of Podiatric Medicine in Canada. In the prairie provinces, the standard has been based on the British model of chiropody. Recognising this fact, in the province of Ontario, chiropodists and podiatrists are legislatively distinct occupational designations. 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.

New Zealand

Chiropody became a registered profession in New Zealand in 1969 with the requirement that all applicants take a recognized three-year course of training. Soon after the professional title was changed from Chiropody to Podiatry and 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.

United Kingdom

A podiatrist is a specialist professional who studies foot pathology from a structural and functional standpoint and treats conditions of the foot.

In the UK their scope of practice covers:

• Minor foot ailments
• High risk patient management
• Sports injuries and biomechanics
• Foot and nail surgery
• Foot health education

Foot surgery, if necessary, may be performed by Podiatrists who have undertaken appropriate training to become Podiatric Surgeons.

In the UK any practitioner using the reserved title 'Podiatrist' must be registered with the Health Professions Council (HPC).

The Society of Chiropodists and Podiatrists is the largest professional body and trade union for chiropodists and students. The Society represents over 11,000 members working in private practice, the NHS, education, and the retail sector.

The Alliance of Private Sector Practitioners represents private sector Podiatrists. They are directly approachable and offer rapid attention - see your telephone directory. [1]

Since 2006, appropriately qualified podiatrists are licensed to use some prescription-only medications (POMs) and to access and supply a limited range of POMs including antibiotics and steroids for injection.

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Speciality branches

Podiatrists worldwide, regardless of educational pathways, treat a wide variety of foot and lower extremity conditions, through conservative or surgical approaches.

Amongst those subspecialties are such fields of practice as:

• General Podiatry Practice
• Podopaediatrics (the study of children's foot and ankle conditions)
• Sports Medicine
• Diabetic foot and wound care
• Forensic Podiatry (the study of footprints, footwear, shoeprints and feet associated with crime scene investigations)
• Rheumatology
• Gerontology
• Reconstructive foot and ankle surgery
• Minimally invasive percutaneous surgery

Professional societies and organizations

• Alpha Gamma Kappa
• Kappa Tau Epsilon
• Pi Delta National Honor Society
• Student National Podiatric Medical Association (SNPMA)
• American Podiatric Medical Students' Association (APMSA)

See also

• List of disorders of foot and ankle
• American Association of Colleges of Podiatric Medicine
• American Podiatric Medical Association
• Podiatric medical school

External links

• Podiatry at Curlie
• American Association of Colleges of Podiatric Medicine
• American Podiatric Medical Association
• The American Society of Forensic Podiatry
• The Society of Chiropodists and Podiatrists (UK)
• Health Professions Council (UK)