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'Podiatry', a field of healthcare, is 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 range of disorders podiatry can address largely depends on the scope of practice laid down in national, state, and/or provincial jurisdiction.

Contents

History of podiatry

Podiatric physician

United States

Early educational developments

Practice characteristics

Job opportunities and Salary

Colleges and education

Podiatry in the United Kingdom

Chiropody and Podiatry in Canada

Podiatry in Australia

Chiropody in New Zealand

Disorders of foot and ankle

Common complicating factors

Speciality Branches of Podiatry

External links

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 - 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 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.

Podiatric physician

A 'podiatrist' or 'foot doctor' 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.).
In other countries, such as the United Kingdom, New Zealand, and certain provinces of Canada, the title "Chiropodist" is used. It should be noted that the titles "podiatrist" and "chiropodist" are not interchangeable or synonymous. In these countries a chiropodist is a medical professional (not a physician), who generally can only treat the foot, ankle, and lower extremity through non-invasive procedures. The United States is one of the few countries, which grants surgical privileges to podiatric physicians.
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.

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 embryology and pediatrics. 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 for 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 surgical. 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 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 Surgical Chiropody (D.S.C.) and Doctor of Podiatry (Pod.D.) Although the D.P.M. is the modern-day equivalent of the previous degrees, it encompasses a broader spectrum of medical practice for podiatric physicians, who can now perform medical and surgical procedures in all 50 states, though the specific scope of practice does vary.

Early educational developments

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.
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.

Just prior to Scholl founding a Chiropody College in Illinois, other innovators and individuals 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 historically by 1911, the New York School of Chiropody had been created, 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.
He was the first to suggest that the term "chiropody" be changed to "podiatry" since 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.

★ '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 primarily surgical practices. Some specialists complete additional fellowship training in reconstruction of the foot, ankle and leg. Many podiatric surgeons specialize in minimally invasive percutaneous surgery. 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

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 scope of practice of podiatrists in the UK has recently expanded to encompass prescription of certain drugs and delivery of steroid injections following appropriate training. The HPC sets standards of practice for podiatrists, ensuring regular professional development and good practice.
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 registrant Podiatrists [2] and Foot Health Practitioners.
Foot Health Practitioners [3], whilst performing routine procedures and undertaking regular professional development, are not currently regulated by the Health Professions Council but have their own independant register. The Voluntary Register for Foot Health Practitioners was presented to the HPC on 31st January 2005 and exists to allow FHPs to indicate that they are not opposed to appropriate registration. Foot Health Practitioners refer onwards to GPs or Podiatrists where necessary.They can be contacted directly for early attention. Look under Foot Health in the telephone directory.

Chiropody and Podiatry in 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. 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. 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]

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. They are not permitted and, in fact, are ineligible to apply for licensure in the USA (unless they graduate from a USA Podiatric Medical School). This decison is strictly based upon a good faith thorough review of UK/Commonwealth chiropodial/podiatric technical academic training. The scope of practice of the Australian "podiatrists" should include a limited scope of foot care which may include basic and chiropodial wound care but definitely should not include orthopaedic foot and ankle surgery. Australian foot health care individuals do provide essential services within the communities they serve. Specialisation in fields such as care of children, sports medicine, diabetes and foot biomechanics have been attempted over the last decade and some organisations have been created to promote this.
Some orthopaedic surgeons and USA DPM's have commenced a good faith, due diligence inquiry into the notion of UK/Commonwealth so called "podiatrists" performing "surgery". Presently in the UK, Australia, New Zealand, and Canada (Ontario) there is no "Podiatry/Podiatrist" professional title academic training congruency with the USA's Doctor of Podiatric Medicine (DPM) Model of education. The case is well summarised by the obvious facts:
1) The average age for UK/Commonwealth individuals at the time of "earning" the title of "podiatrist" is circa 21 years old.
2) The average age for USA DPM individuals at the time of EARNING the title of podiatric physician is circa 26 years old. USA DPM podiatric surgeons then (after obtaining the DPM degree) receive additional years of fully transparent, accountable, and formally accredited hospital based surgical training.
These notable and obvious differences apparently remain yet unexplained by the UK/Australian "Podiatry" leadership, despite opportunities available (such as on this web page).

★ University of South Australia

★ Latrobe University

★ Charles Sturt University

★ University of Newcastle

★ Queensland University of Technology

★ University of Western Australia

Chiropody 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. 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 Podiatry in New Zealand:

★ Auckland University of Technology

Disorders of foot and ankle

★ List of disorders of foot and ankle

Common complicating factors

★ High heels

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 childrens foot and ankle conditions)

★ Sports Medicine

★ Diabetic foot and wound care

★ Rheumatology

★ Gerontology

★ Reconstructive foot and ankle surgery

★ Minimally invasive percutaneous surgery

External links

★ Academy of Ambulatory Foot and Ankle Surgery

★ American Podiatric Medical Association

★ 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

★ Podiatry Today Magazine

★ www.podiatryonline.com

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