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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). In this regard, the range of disorders of the lower extremity which podiatry can address is largely dependent on the scope of practice as per national, state, and/or provincial jurisdiction.

Contents

History

Podiatrists

Speciality branches of podiatry

United States

Early educational developments

Practice characteristics

Job opportunities and Salary

Colleges and education

Podiatry in the United Kingdom

Podiatry in Australia

Podiatry in New Zealand

See also

External links

History

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 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 or podiatric physicians - were separate from organized medicine. They were independently licensed physicians who treated 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.

Podiatrists

A "podiatrist" is a podiatric physician; a person devoted to the study and medical treatment of disorders of the foot, ankle and lower extremity.
Although 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 an antiquated and etymologically incorrect term. The term "podiatrist" originated in North America but has now become the accepted term in the English-speaking world for graduates in podiatric medicine.
In other countries such as the United Kingdom, and certain provinces of Canada, the old-fashioned title "Chiropodist" has been kept (in the UK for public-relations purposes) and is considered synonymous with “podiatrist.”
Although podiatrists worldwide do not attend traditional allopathic medical school, in many countries such as the US, UK, and Australia, they are granted privileges to perform surgical procedures of the foot and ankle. In the US, podiatry graduates are Doctors of Podiatric Medicine (D.P.M.).

Speciality branches of podiatry

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:

★ Podopaediatrics (the study of children's foot and ankle conditions)

★ Sports Medicine

★ Diabetic foot and wound care

★ Rheumatology

★ Gerontology

★ Reconstructive foot and ankle surgery

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. As with other Medical Schools this training follows an undergraduate college degree. The prerequisites are a minimum undergraduate educational component of 90 semester hours and/or a bachelor's degree. Completing the D.P.M. degree takes a minimum of four years.
The first four years of podiatric medical school are similar to traditional allopathic (MD) and osteopathic (DO) education, but with more emphasis on foot, ankle and lower extremity; and less emphasis on other topics such as embryology and pediatrics. Some podiatric medical schools integrate MD and DO curriculum for the first year or two.
The four-year podiatric medical school is followed by hands-on post-doctoral residency training. Standard residencies include two- or three-year programs named ''Podiatric Medicine and Surgery 24'' (PM&S 24) and ''Podiatric Medicine and Surgery 36'' (PM&S 36). Podiatric residents rotate through both clinic and surgical areas of main medicine including emergency, pediatric, internal medicine, orthopedic, general surgery and of course, podiatry. During these rotations, attending physicians train the resident physicians in medicine and surgery. The surgical training varies from forefoot surgery to complex foot, ankle, and leg reconstruction caused by trauma.
Podiatric physicians may independently diagnose, treat and prescribe medicine. They perform surgery for disorders of the foot, and in most states, the ankle and leg. There are a few Board Certification for podiatric physicians. First is the Board of Primary Care and Podiatric Orthopedics, primarily the nonsurgical Board Certification. Next is the surgical Board Certification that is divided into foot surgery and rearfoot/ankle reconstruction surgery. The rearfoot and ankle Board Certification requires at least a three-year residency to qualify.
A Board committee scrutinizes the surgical cases that are required with the application. The applicants then must pass 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 Surgical Chiropody (D.S.C.) and Doctor of Podiatry (Pod.D.) The D.P.M. is the modern equivalent of the previous degrees. The D.P.M encompasses a broader spectrum of medical practice for podiatric physicians, who can now perform medical and surgical procedures in all 50 states. The specific scope of practice various by state. [1]

Early educational developments

William Mathias Scholl began his career in Chicago, 1899, in a small shoe store specializing in comfort and specialist footwear. His concern for customers with painful foot conditions motivated him to enroll 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 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 to include the comfort of the legs, making 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, becoming an international fashion hit and an icon for the brand.
Dr. Scholl's is a brand of foot-care products manufactured by Schering-Plough and footwear made by Brown Shoe Company. William M. Scholl died 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.

Immediately prior to Scholl founding a Chiropody College in Illinois, other innovators around the United States were founding other institutions of learning for foot care. Among these was M.J. Lewi, M.D. who founded what is now the oldest and largest college of podiatric medicine located in New York City. His institution later became the M.J. Lewis School of Podiatric Medicine and ultimately became the New York College of Podiatric Medicine.

The New York College of Podiatric Medicine notes that the New York School of Chiropody was created in 1911, dedicated to educating and training chiropodists. Dr. Maurice J. Lewi, a physician and educator, then serving as Secretary to the New York State Board of Examiners was named the first president of the school.
Dr. Lewi was a true leader in educational reforms. He assisted in developing the first legislation governing the practice of chiropody. He also developed the curricula and training programs for the first course of study at the school.
Dr. Lewi was the first to suggest changing the term "chiropody" to "podiatry" because the term "chiropody" was etymologically incorrect. Some years later, the term "podiatry" was adopted by all other colleges of podiatric medicine and by the National Association of Chiropodists (NAC), now known as the American Podiatric Medical Association.

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.
Podiatry practice in the USA:

★ 'Scope:' The differences in podiatric medical and surgical practice are determined by state law. Podiatrists are often defined as physicians in most States. Each state allows or limits the practice of podiatric medicine to the foot, ankle, and in many States, 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 hospitals performing 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. Some podiatrists have solely surgical practices and complete an additional one-year fellowship in reconstruction of the foot, ankle and leg. Most podiatrists utilize medical, orthopedic, biomechanical and surgical practices. Indeed, surgical podiatric principles rest on a base of orthopedic and kinesthetic knowledge.

Job opportunities and Salary

The US Department of Labor, Bureau of Labor Statistics expects the need for podiatrists to rise, but slowly because podiatrists tend to have long careers before retirement. The Journal of the American Podiatric Medical Association (JAPMA) reported in 2006, the average salary for a practicing podiatrist in the United States in 2005 was approximately $127,000.

Colleges and education

There are eight colleges of podiatric medicine in the United States with a ninth school being added in 2009 at Western University of Health Sciences. These are governed by the American Association of Colleges of Podiatric Medicine (AACPM). The AACPM describes its mission as to enhance academic podiatric medicine.

★ Arizona Podiatric Medicine Program at Midwestern University

★ Barry University School of Podiatric Medicine

★ California School of Podiatric Medicine at Samuel Merritt College

★ College of Podiatric Medicine and Surgery at Des Moines University

★ New York College of Podiatric Medicine

★ Ohio College of Podiatric Medicine

★ Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science

★ Temple University School of Podiatric Medicine
See also Podiatric medical school

Podiatry in the United Kingdom

In the UK, podiatric medicine is practiced by practitioners registered with the Health Professions Council (HPC). Only HPC registrants may legally use the title "podiatrist". You can check if a practitioner is registered with the HPC by going to: http://www.hpcheck.org.
Education in podiatry consists of a three- or four-year B.Sc.(Hons) program, followed by a two- or three-year surgical pupilage (residency) that usually takes place at one of the many hospital based departments of podiatric surgery. Surgically qualified UK podiatrists are Fellows of the College of Podiatric Surgery and carry the designatory letters FCPodS.
UK podiatrists may independently diagnose, treat, and perform the full scope of surgery for disorders of the foot and ankle.
Following appropriate training, UK podiatrists may use prescription only medicines (POMs), including antibiotics, analgesics, non-steroidal anti-inflammatory drugs, injectable steroids, and a number of topical preparations.
The Society of Chiropodists and Podiatrists [2] is the largest professional body and trade union for registered 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 Chiropody and Podiatry Practitioners[3] represents Podiatrists and Foot Health Practitioners who can be consulted directly by the public for early attention. Details of their practices can be found in the 'phone book under the 'Chiropodists & Podiatrists' or 'Foot Health' categories.

Podiatry in 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 occurred 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 privileges for a range of restricted medicines in most of the country.

Orthopaedic surgeons have 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 colleagues.
USA podiatric physicians/surgeons have developed professional links with podiatric surgeons in Australia and formal training has been occurring 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

★ University of Western Australia

Podiatry in New Zealand

Chiropody became a registered profession in New Zealand in 1969 with the requirement that all applicants take a recognised 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.
Podiatrists in New Zealand began to expand their scopes of practice into Podiatric Surgery in the mid 1980's following similar trends in the United Kingdom and Australia. This led to the development of the New Zealand College of Podiatric Surgery in 1990 which is responsible for the post-graduate training of podiatric surgeons in New Zealand. The New Zealand College of Podiatric Surgery (NZCPS) delivers its syllabus of training in collaboration with the Ohio College of Podiatric Medicine (USA). Graduates of the NZCPS are registered under the scope of Podiatric Surgeon by the Podiatrists Registration Board of New Zealand which is the New Zealand Ministry of Health's Registration Authority for podiatry.
Schools of Podiatric Medicine in New Zealand:

★ Auckland University of Technology

See also

★ List of disorders of foot and ankle

External links

★ Australasian College of Podiatric Surgeons

★ American Podiatric Medical Association

★ Australasian Podiatry Council

★ American Association of Colleges of Podiatric Medicine

★ Council on Podiatric Medical Education

★ American Academy of Podiatric Sports Medicine

★ American College of Foot and Ankle Surgeons

★ American College of Foot and Ankle Orthopedics and Medicine

★ American Board of Podiatric Surgery

★ American Board of Podiatic Orthopedics and Primary Podiatric Medicine

★ American Academy of Podiatric Practice Management

★ Journal of the American Podiatric Medical Association

★ Comfort Zone Orthotics

★ Podiatry Today Magazine

★ www.podiatryonline.com

★ www.foot-health.info

★ www.epodiatry.com

★ University of Québec in Trois-Rivières, Podiatric Medicine in Canada