Doctor of Podiatric Medicine
Podiatry, podiatric medicine/surgery or chiropody is a field of healthcare devoted to the study and treatment of disorders of the foot, ankle, and the “anatomical leg” (i.e. below, and not including, the knee).
A podiatrist or foot doctor is a medical professional devoted to the study and 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 the degree of Doctor of Podiatric Medicine.
The United States is one of the few countries that grants more invasive surgical privileges to podiatrists. This is due to the fact that the US podiatric medical education system trains podiatric physicians to treat the entire body, as the curriculum of said schools is mirrored after allopathic medical programs (MD’s/DO’s).
To be considered for admission to podiatry school, an applicant must first complete a minimum of 90 semester hours at the university level and/or complete a bachelor’s degree with prerequisite courses including the same courses required for admission to MD/DO programs (biology, chemistry, physics etc). The MCAT (Medical College Admission Test) is required for admission to Podiatry school.
Podiatry programs stress nearly the same basic medical science courses in the first two years as their allopathic counterparts. In fact, 3 of the 9 podiatry schools in the US share the same classroom as D.O. (doctor of osteopathic medicine) programs during the first 2 years of school. However, during the four years comprising podiatry medical school, more emphasis is placed on lower leg anatomy/pathology than OB/GYN and psychiatry.
Podiatry school is followed by a manditory 3-4 year podiatry surgical residency that incorporates a general internship year and podiatry specific 2nd and 3rd year rotations. Podiatric residents rotate through all main areas of medicine such as: emergency, vascular, pediatric, internal medicine, orthopedic and general surgery and podiatry (both clinic and surgical aspects). During these rotations, attending physicians train the resident physicians in medicine and surgery. The podiatry surgical training varies from forefoot surgery to more complex foot, ankle, and leg reconstruction and salvage as well as trauma.
Completion of the mandatory 3 year podiatric surgery residency enables the podiatric surgeon to sit for surgical board certification. The A.B.P.S (Amercan Board for Podiatric Surgery) certifies podiatric surgeons. The surgical board certification is divided into foot surgery and rearfoot/ankle reconstruction surgery. A three-year residency is required in order to apply.
Podiatrists may independently diagnose, treat and prescribe medicine and perform surgery for disorders of the foot and in most states the ankle and leg.
Dentists, like podiatrists have a separate educational school system. Thus there are three medical professions that allow for independent diagnosis and medical/surgical treatment of the human body: medicine- M.D., D.O.; podiatric medicine D.P.M.; and dental medicine DDS/DMD.
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 or multi-specialty 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 of practice
The differences in podiatric medical and surgical practice are determined by state law. Podiatrists are often defined as podiatric physicians in many 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 44 states. Most states require completion of a residency or a post-graduate training 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- surgical treatment of patient such as the cutting of nails, removing of corns or callus. 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 (orthotics) 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.
Radiography is commonly used by all podiatrists to diagnose ailments in the foot and ankle.
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.
Distinction from orthopedic foot and ankle surgery
Orthopedic foot and ankle specialists first must complete a medical degree either (MD, MBBS, MBChB, etc) or Osteopathic D.O. degree. After completion of medical school orthopedic surgeons complete a 5-6 year residency program. A majority of orthopedic residency programs dedicate 12 weeks or less to foot and ankle surgery. To compensate for this, some orthopedic surgeons may complete a foot and ankle fellowship that varies from 3 – 12 months. This contrasts with podiatric surgeons who undergo podiatry school training with a focus on foot and ankle medicine and surgery followed by a residency of 3+ years dedicated to foot and ankle surgery. Foot and ankle orthopedic surgeons often work in the same practices as podiatrists, and will refer patients to one another.
Podiatrists worldwide, regardless of educational pathways, treat a wide variety of foot and lower extremity conditions, through conservative or surgical approaches.
Amongst those sub-specialties are such fields of practice as:
- General Podiatry Practice
- Podopediatrics (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)
- Reconstructive foot and ankle surgery
- Minimally invasive percutaneous surgery
History of Podiatry:
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.
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 center 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.
In the United States, 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.) Podiatry in the US currently encompasses a broader spectrum of medical practice than it used to. Podiatrists can now perform medical and surgical procedures in all 50 states, though the specific scope of practice does vary slightly in each state.
This article was adapted from information found on Wikipedia.