Podiatry () or podiatric medicine () is a branch of
medicine
Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pract ...
devoted to the study, diagnosis, medical and surgical treatment of disorders of the
foot
The foot ( : feet) is an anatomical structure found in many vertebrates. It is the terminal portion of a limb which bears weight and allows locomotion. In many animals with feet, the foot is a separate organ at the terminal part of the leg made ...
,
ankle
The ankle, or the talocrural region, or the jumping bone (informal) is the area where the foot and the leg meet. The ankle includes three joints: the ankle joint proper or talocrural joint, the subtalar joint, and the inferior tibiofibular join ...
, and
leg
A leg is a weight-bearing and animal locomotion, locomotive anatomical structure, usually having a columnar shape. During locomotion, legs function as "extensible struts". The combination of movements at all joints can be modeled as a single ...
.
A Doctor of Podiatric Medicine (DPM), or a
podiatrist
A podiatrist ( ) is a medical professional devoted to the treatment of disorders of the foot, ankle, and related structures of the leg. The term originated in North America but has now become the accepted term in the English-speaking world for ...
, is a healthcare professional who diagnoses and treats conditions affecting the structures of the foot, ankle, and leg. The US podiatric medical school curriculum includes lower extremity anatomy, general human anatomy, physiology, general medicine, physical assessment, biochemistry, neurobiology, pathophysiology, genetics and embryology, microbiology, histology, pharmacology, women's health, physical rehabilitation, sports medicine, research, ethics and jurisprudence, biomechanics, general principles of
orthopedic surgery
Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...
, and
foot and ankle surgery
Foot and ankle surgery is a sub-specialty of orthopedics and podiatry that deals with the treatment, diagnosis and prevention of disorders of the foot and ankle. Orthopaedic surgeons are medically qualified, having been through four years of col ...
.
Podiatry is a high-paying specialization and was listed by ''Forbes'' in 2007 as the 15th-best-paid profession in the United States. The median annual salary of a podiatrist in the US was $124,830 in 2016 according to the US Bureau of Labor and Statistics.
Podiatry is practiced as a
specialty in many countries, while in many English-speaking countries, the older title of chiropodist may be used by some clinicians. In Australia, graduates of recognised academic programs can register through the Podiatry Board of Australia as a "podiatrist", and those with additional recognised training may also receive endorsement to prescribe or administer restricted medications and/or seek specialist registration as a "podiatric surgeon".
History
The professional care of feet existed in
ancient Egypt, as shown by
bas-relief
Relief is a sculptural method in which the sculpted pieces are bonded to a solid background of the same material. The term ''relief'' is from the Latin verb ''relevo'', to raise. To create a sculpture in relief is to give the impression that the ...
carvings at the entrance to Ankmahor's tomb dating from about 2400 BC, where work on hands and feet is depicted.
Corns and
calluses
A callus is an area of thickened and sometimes hardened skin that forms as a response to repeated friction, pressure, or other irritation. Since repeated contact is required, calluses are most often found on the feet and hands, but they may o ...
were described by
Hippocrates
Hippocrates of Kos (; grc-gre, Ἱπποκράτης ὁ Κῷος, Hippokrátēs ho Kôios; ), also known as Hippocrates II, was a Greek physician of the classical period who is considered one of the most outstanding figures in the history of ...
, who recognized 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
A scalpel, lancet, or bistoury is a small and extremely sharp bladed instrument used for surgery, anatomical dissection, podiatry and various arts and crafts (either called a hobby knife or an X-acto knife.). Scalpels may be single-use disposab ...
.
Until the turn of the 20th century, chiropodists—now sometimes known as
podiatrists
A podiatrist ( ) is a medical professional devoted to the treatment of disorders of the foot, ankle, and related structures of the leg. The term originated in North America but has now become the accepted term in the English-speaking world for ...
—were separate from organized medicine. They were independently licensed physicians.
Lewis Durlacher
Lewis Durlacher (1792– 3 March 1864) was a chiropodist who was appointed as surgeon-chiropodist to the royal household in 1823 and served under George IV, William IV and Queen Victoria.
Durlacher was born in Warwickshire (some sources say Birm ...
, who was appointed as surgeon-chiropodist to the British royal household in 1823, was one of the first people to call for a protected profession.
There are records of the King of
France
France (), officially the French Republic ( ), is a country primarily located in Western Europe. It also comprises of Overseas France, overseas regions and territories in the Americas and the Atlantic Ocean, Atlantic, Pacific Ocean, Pac ...
employing a personal
podiatrist
A podiatrist ( ) is a medical professional devoted to the treatment of disorders of the foot, ankle, and related structures of the leg. The term originated in North America but has now become the accepted term in the English-speaking world for ...
, as did
Napoleon
Napoleon Bonaparte ; it, Napoleone Bonaparte, ; co, Napulione Buonaparte. (born Napoleone Buonaparte; 15 August 1769 – 5 May 1821), later known by his regnal name Napoleon I, was a French military commander and political leader who ...
. In the United States, President
Abraham Lincoln
Abraham Lincoln ( ; February 12, 1809 – April 15, 1865) was an American lawyer, politician, and statesman who served as the 16th president of the United States from 1861 until his assassination in 1865. Lincoln led the nation thro ...
suffered greatly with his feet and chose a chiropodist named
Isachar Zacharie
Isachar Zacharie (1825 – September 16, 1900) was a British-American chiropodist (podiatrist), plagiarist, and close confidant and advisor to President of the United States Abraham Lincoln. Born in England, he emigrated to the United States with ...
who not only cared for the president's feet but was also sent by President Lincoln on confidential missions to confer with leaders of the
Confederacy during the
U.S. Civil War
The American Civil War (April 12, 1861 – May 26, 1865; also known by other names) was a civil war in the United States. It was fought between the Union ("the North") and the Confederacy ("the South"), the latter formed by states th ...
.
The first society of chiropodists was established in New York in 1895—and still operates there today as NYSPMA.
[New York State Podiatric Medical Association](_blank)
NYSPMA. Retrieved on 2010-11-27. The first chiropodist school opened in 1911. One year later, the British established a society at the
London Foot Hospital
The London Foot Hospital was founded in 1913 as The Pedic Clinic for Gratuitous Treatment of the Feet. It was the first free clinic for treatment of feet in England, and its School of Podiatric Medicine, which started as evening classes in 1919 ...
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.
Podiatric sports medicine
Sports podiatry covers the following two areas: foot and lower limb chronic overuse injuries and mechanical performance enhancement to minimise injury and maximise efficiency.
Podopaediatrics
Podopaediatrics is a specialty of podiatric medicine that focuses on the treatment of medical lower limb issues in children.
Specific country practices
Australia
In Australia, podiatry is considered an
allied health profession
Allied health professions are health care professions distinct from optometry, dentistry, nursing, medicine, and pharmacy. They provide a range of diagnostic, technical, therapeutic, and support services in connection with health care.
Definitio ...
, and is practised by individuals licensed by the Podiatry Board of Australia.
There are eight teaching centres, as well as Auckland University of Technology in New Zealand, with two levels of awards— bachelor's degree (pass and/or honours) such as the
Bachelor of Podiatric Medicine
Podiatry () or podiatric medicine () is a branch of medicine devoted to the study, diagnosis, medical and surgical treatment of disorders of the foot, ankle, and human leg, leg.
A Doctor of Podiatric Medicine (DPM), or a podiatrist, is a h ...
offered by Charles Sturt University and University of Western Sydney, and the master-level postgraduate
Doctor of Podiatric Medicine
A podiatrist ( ) is a medical professional devoted to the treatment of disorders of the foot, ankle, and related structures of the leg. The term originated in North America but has now become the accepted term in the English-speaking world for ...
offered by the
University of Western Australia
The University of Western Australia (UWA) is a public research university in the Australian state of Western Australia. The university's main campus is in Perth, the state capital, with a secondary campus in Albany, Western Australia, Albany an ...
and the Master of Podiatric Practice by La Trobe University.
In Australia there currently exist two levels of professional accreditation and professional privilege: General Podiatrist and Podiatric Surgeon. There is current lobbying for other specialties to be recognised in Australia, such as podopediatrics, diabetes, high risk, musculoskeletal and sports podiatry. Australian podiatrists are able to practise abroad, with their qualifications recognised in some Commonwealth countries.
Registration and regulation
Australian podiatrists must register with the Podiatry Board of Australia. The Podiatry Board of Australia is responsible for regulation and recognition of podiatrists and podiatric surgeons, and assessing foreign trained registrants in conjunction with the Australian & New Zealand Podiatry Accreditation Council (ANZPAC).
The Podiatry Board of Australia recognizes 3 pathways to attain specialist registration as a podiatric surgeon:
# Fellowship of the Australasian College of Podiatric Surgeons
# Doctor of Podiatric Surgery, University of Western Australia
# Eligibility for Fellowship of the Australasian College of Podiatric Surgeons
Until 21 November 2019, ANZPAC approved the Doctor of Podiatric Surgery program of study offered by the University of Western Australia as providing a qualification for the purpose of specialist registration as a podiatric surgeon.
Education and training
Entry into undergraduate
Podiatric Medicine
Podiatry () or podiatric medicine () is a branch of medicine devoted to the study, diagnosis, medical and surgical treatment of disorders of the foot, ankle, and leg.
A Doctor of Podiatric Medicine (DPM), or a podiatrist, is a healthcare p ...
degrees can be done after the completion of a Year 12 Certificate with an Australian Tertiary Admissions Rank (
ATAR
Atar, Atash, or Azar ( ae, 𐬁𐬙𐬀𐬭, translit=ātar) is the Zoroastrian concept of holy fire, sometimes described in abstract terms as "burning and unburning fire" or "visible and invisible fire" (Mirza, 1987:389). It is considered to b ...
). The cut-off scores from the
Universities Admissions Centre
The Universities Admissions Centre (UAC, pronounced ) is an organisation that processes applications for admission to tertiary education courses, mainly at institutions in New South Wales and the Australian Capital Territory. A not-for-profit com ...
(UAC) generally range from 70.00 to 95.00, dependent on the popularity and intake of each podiatric medical school. Prospective students can also be of mature age (21 and over) and they apply directly to the university instead of going through UAC. The
UWA
The University of Western Australia (UWA) is a public research university in the Australian state of Western Australia. The university's main campus is in Perth, the state capital, with a secondary campus in Albany, Western Australia, Albany an ...
DPM program has admission requirements of: completion of a UWA bachelor's degree or equivalent, a minimum GPA of 5.0 from the most recent three years (FTE) of valid study, suitable GAMSAT score, and English language competency. There is no interview requirement for the DPM at UWA (applications are handled via the university).
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 functional anatomy, microbiology, biochemistry,
physiology
Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology, physiology focuses on how organisms, organ systems, individual organs, cells, and biomolecules carry out the chemical ...
,
pathophysiology
Pathophysiology ( physiopathology) – a convergence of pathology with physiology – is the study of the disordered physiological processes that cause, result from, or are otherwise associated with a disease or injury. Pathology is the ...
,
pharmacology
Pharmacology is a branch of medicine, biology and pharmaceutical sciences concerned with drug or medication action, where a drug may be defined as any artificial, natural, or endogenous (from within the body) molecule which exerts a biochemica ...
,
evidence-based medicine
Evidence-based medicine (EBM) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients". The aim of EBM is to integrate the experience of the clinician, the values of t ...
, sociology, and patient psychology, similar to the medical curriculum. The following one year will then be spent focusing on podiatry specific areas such as podiatric anatomy & biomechanics, human gait, podiatric orthopaedics or the non-surgical management of foot abnormalities, podopaediatrics,
sports medicine
Sports medicine is a branch of medicine that deals with physical fitness and the treatment and prevention of injuries related to sports and exercise. Although most sports teams have employed team physicians for many years, it is only since the ...
,
rheumatology
Rheumatology (Greek ''ῥεῦμα'', ''rheûma'', flowing current) is a branch of medicine devoted to the diagnosis and management of disorders whose common feature is inflammation in the bones, muscles, joints, and internal organs. Rheumatolog ...
,
diabetes
Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...
,
vascular medicine
Angiology (from Greek , ''angeīon'', "vessel"; and , '' -logia'') is the medical specialty dedicated to studying the circulatory system and of the lymphatic system, i.e., arteries, veins and lymphatic vessels.
In the UK, this field is more of ...
,
mental health
Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. It likewise determines how an individual handles stress, interpersonal relationships, and decision-making. Mental health ...
,
wound care
The history of wound care spans from prehistory to modern medicine. Wounds naturally heal by themselves, but hunter-gatherers would have noticed several factors and certain herbal remedies would speed up or assist the process, especially if it was ...
,
neuroscience
Neuroscience is the scientific study of the nervous system (the brain, spinal cord, and peripheral nervous system), its functions and disorders. It is a multidisciplinary science that combines physiology, anatomy, molecular biology, development ...
&
neurology
Neurology (from el, wikt:νεῦρον, νεῦρον (neûron), "string, nerve" and the suffix wikt:-logia, -logia, "study of") is the branch of specialty (medicine), medicine dealing with the diagnosis and treatment of all categories of co ...
,
pharmacology
Pharmacology is a branch of medicine, biology and pharmaceutical sciences concerned with drug or medication action, where a drug may be defined as any artificial, natural, or endogenous (from within the body) molecule which exerts a biochemica ...
, general medicine, general pathology, local and general
anaesthesia
Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), am ...
, minor and major podiatric surgical procedural techniques such as
partial
Partial may refer to:
Mathematics
* Partial derivative, derivative with respect to one of several variables of a function, with the other variables held constant
** ∂, a symbol that can denote a partial derivative, sometimes pronounced "partial ...
and
total nail avulsions, matricectomy,
cryotherapy
Cryotherapy, sometimes known as cold therapy, is the local or general use of low temperatures in medical therapy. Cryotherapy may be used to treat a variety of tissue lesions. The most prominent use of the term refers to the surgical treatment, s ...
, wound debridement,
enucleation,
suturing
A surgical suture, also known as a stitch or stitches, is a medical device used to hold body tissues together and approximate wound edges after an injury or surgery. Application generally involves using a needle with an attached length of threa ...
, other cutaneous and electro-surgical procedures and theoretical understanding of procedures performed by orthopaedic and podiatric surgeons.
Australian
podiatric surgeons
Podiatry () or podiatric medicine () is a branch of medicine devoted to the study, diagnosis, medical and surgical treatment of disorders of the foot, ankle, and leg.
A Doctor of Podiatric Medicine (DPM), or a podiatrist, is a healthcare p ...
are
specialist podiatrists with further training in advanced medicine, advanced pharmacology, and training in foot surgery. Podiatrists wishing to pursue specialisation in podiatric surgery must meet the requirements for Fellowship with the Australasian College of Podiatric Surgeons. They first complete a 4-year degree, which includes 2 years of didactic study and 2 years of clinical experience. Following this, a master's degree must be completed with a 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), rotations within other medical and surgeons' disciplines, overseas clinical rotations, and passing oral and written exams, Registrars may qualify for Fellowship status. Fellows are then give
Commonwealth accreditationunder the Health Insurance Act to be recognised as providers of professional attention for the purposes of health insurance rebates.
Australian podiatric medical schools
There are currently nine universities in Australia (plus one in New Zealand) offering varying degrees of podiatric medicine, from a Bachelor of Podiatry/Podiatric Medicine (BPod), a Masters of Podiatric Medicine (MPod), and a Doctor of Podiatric Medicine (DPM) (DPM is a master-level degree). All podiatry schools are accredited by the Australian and New Zealand Podiatry Accreditation Council (
ANZPAC). ANZPAC is an independent body comprising members consisting of the Podiatry Registration Boards in Australia and New Zealand. The Board of Management comprises registered podiatrists (nominated by the Registration Boards), nominees from the professional associations (
Australasian Podiatry Council
Australasian is the adjectival form of Australasia, a geographical region including Australia, New Zealand, and New Guinea.
Australasian may also refer to:
Institutions Commercial
* Australasian Correctional Management, private company running ...
and Podiatry New Zealand), nominees from the educational institutions offering podiatry programs and community representation. ANZPAC has been assigned the accreditation functions for the
Podiatry Board of Australia
Podiatry () or podiatric medicine () is a branch of medicine devoted to the study, diagnosis, medical and surgical treatment of disorders of the foot, ankle, and leg.
A Doctor of Podiatric Medicine (DPM), or a podiatrist, is a healthcare p ...
under the National Registration and Accreditation Scheme for Health Professions. There are also two more podiatry schools currently being developed at the Australian Catholic University and the University of Ballarat. The following universities offering podiatry are
University of Western Australia
The University of Western Australia (UWA) is a public research university in the Australian state of Western Australia. The university's main campus is in Perth, the state capital, with a secondary campus in Albany, Western Australia, Albany an ...
,
Charles Sturt University
Charles Sturt University is an Australian multi-campus public university located in New South Wales, Australian Capital Territory and Victoria. Established in 1989, it was named in honour of Captain Charles Napier Sturt, a British explorer w ...
,
La Trobe University
La Trobe University is a public research university based in Melbourne, Victoria, Australia. Its main campus is located in the suburb of Bundoora. The university was established in 1964, becoming the third university in the state of Victoria an ...
,
University of Western Sydney
Western Sydney University, formerly the University of Western Sydney, is an Australian multi-campus university in the Greater Western region of Sydney, Australia. The university in its current form was founded in 1989 as a federated network u ...
,
University of South Australia
The University of South Australia (UniSA) is a public research university in the Australian state of South Australia. It is a founding member of the Australian Technology Network of universities, and is the largest university in South Australi ...
,
University of Newcastle (Australia)
The University of Newcastle (UON), informally known as Newcastle University, is a public university in Newcastle, New South Wales, Australia. Established in 1965, it has a primary campus in the Newcastle suburb of Callaghan. The university als ...
,
Queensland University of Technology
Queensland University of Technology (QUT) is a public research university located in the urban coastal city of Brisbane, Queensland, Australia. QUT is located on two campuses in the Brisbane area viz. Gardens Point and Kelvin Grove. The univ ...
,
Central Queensland University
Central Queensland University (alternatively known as CQUniversity) is an Australian public university based in central Queensland. CQUniversity is the only Australian university with a campus presence in every mainland state. Its main campus ...
,
Southern Cross University
Southern Cross University (SCU) is an Australian public university, with campuses at Lismore and Coffs Harbour in northern New South Wales, and at Coolangatta, the most southern suburb of the Gold Coast in Queensland.
It is ranked in the top ...
, and
Auckland University of Technology
Auckland University of Technology (AUT) ( mi, Te Wānanga Aronui o Tāmaki Makau Rau) is a university in New Zealand, formed on 1 January 2000 when a former technical college (originally established in 1895) was granted university status. AUT ...
(New Zealand).
Prescribing of scheduled medicines and referral rights
There is considerable variation between state laws regarding the prescribing rights of Australian podiatrists. While all registered podiatrists in each state or territory are able to use local anaesthesia for minor surgical techniques, some states allow suitably qualified podiatrists further privileges.
Recent legislative changes allow registered podiatrists and podiatric surgeons with an endorsement of scheduled medicines in Victoria, Western Australia, Queensland, South Australia, and New South Wales to prescribe relevant
schedule 4 poisons. In states such as Western Australia and South Australia, podiatrists with
Master's degree
A master's degree (from Latin ) is an academic degree awarded by universities or colleges upon completion of a course of study demonstrating mastery or a high-order overview of a specific field of study or area of professional practice. s in Podiatry, and extensive training in pharmacology are authorised to prescribe Schedule 2, 3, 4, or 8 medicines (
Australian Health Practitioner Regulation Agency
The Australian Health Practitioner Regulation Agency (AHPRA), infrequently spelt as the Australian Health Practitioners Regulation Agency is a statutory authority founded in 2010 which is responsible, in collaboration with the ''Medical Board of ...
). In Queensland, Fellows of the Australasian College of Podiatric Surgeons are authorised to prescribe a range of Schedule 4 and one Schedule 8 drug for the treatment of podiatric conditions. Currently endorsed podiatrists who have the ability to write prescriptions do not have those prescriptions qualify for the
Pharmaceutical Benefits Scheme
The Pharmaceutical Benefits Scheme (PBS) is a program of the Australian Government that subsidises prescription medication for Australian citizens and permanent residents, as well as international visitors covered by a reciprocal health care ag ...
. There is also political lobbying for more Chronic Disease Management places from 5 to 12 visits a year to a podiatrist for chronic diseases such as diabetes and for
PBS
The Public Broadcasting Service (PBS) is an American public broadcasting, public broadcaster and Non-commercial activity, non-commercial, Terrestrial television, free-to-air television network based in Arlington, Virginia. PBS is a publicly fu ...
rights.
All podiatrists may refer patients for Medicare rebatable plain x-rays of the foot, leg, knee, and femur, as well as ultrasound examination of soft tissue conditions of the foot. Podiatrists may refer patients for other radiologic investigations such as CT, MRI, or bone scans, however Medicare rebates do not currently exist for these examinations. Similarly, podiatrists may refer patients when needed to specialist medical practitioners, or for pathology testing, however similar exclusions in the Medicare Benefits Schedule prevent rebates being available to patients for these referrals.
Canada
In Canada, the definition and scope of the practice of podiatry varies by province. For instance, in some provinces like
British Columbia
British Columbia (commonly abbreviated as BC) is the westernmost province of Canada, situated between the Pacific Ocean and the Rocky Mountains. It has a diverse geography, with rugged landscapes that include rocky coastlines, sandy beaches, ...
and
Alberta
Alberta ( ) is one of the thirteen provinces and territories of Canada. It is part of Western Canada and is one of the three prairie provinces. Alberta is bordered by British Columbia to the west, Saskatchewan to the east, the Northwest Ter ...
, the standards are the same as in the United States, where the Doctor of Podiatric Medicine (DPM) is the accepted qualification.
Quebec
Quebec ( ; )According to the Canadian government, ''Québec'' (with the acute accent) is the official name in Canadian French and ''Quebec'' (without the accent) is the province's official name in Canadian English is one of the thirtee ...
has also adopted the DPM level of training, although other academic designations may register. Also, in 2004,
Université du Québec à Trois-Rivières
The Université du Québec à Trois-Rivières (UQTR) (''English: University of Quebec in Trois-Rivières''), also known as "l'université du peuple", established in 1969 and mainly located in Trois-Rivières, Quebec, Canada, is a public universi ...
started the first and only program of Podiatric Medicine in Canada based on the American definition of podiatry. This program enlists 25 students yearly across
Canada
Canada is a country in North America. Its ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, covering over , making it the world's second-largest country by tot ...
and leads to a DPM upon obtaining 195 credits. In the prairie and Atlantic provinces, the standard was originally based on the British model, now called podiatry (chiropody).
The province of
Ontario
Ontario ( ; ) is one of the thirteen provinces and territories of Canada.Ontario is located in the geographic eastern half of Canada, but it has historically and politically been considered to be part of Central Canada. Located in Central Ca ...
has been registering chiropodists since 1944, then introduced new legislation in 1991 (when the Ontario government imposed a cap on Ontario-trained chiropodists becoming podiatrists). If a registered podiatrist from outside of Ontario relocates to Ontario, they are required to register with the province and practise as a chiropodist. Podiatrists who were practising in Ontario prior to the imposed provincial cap were 'grandfathered' and allowed to keep the title of podiatrist as a subclass of chiropody. The scope of these 'grandfathered' (mostly American-trained) podiatrists includes boney procedures of the forefoot and the ordering of x-rays in addition to the scope of the chiropodist.
In Ontario, podiatrists are required to have a "Doctor of Podiatric Medicine/DPM" degree (a post-baccalaureate, four-year degree), where the majority of chiropodists currently practicing hold a post-secondary advanced diploma in chiropody, requiring a baccalaureate degree in the sciences or in another field as a prerequisite before entering chiropody. Podiatrists may bill
OHIP
The Ontario Health Insurance Plan (Canadian French, French: ''Assurance-Santé de l'Ontario''), commonly known in both official languages by the acronym OHIP (pronounced ), is the Government of Ontario, government-Government-owned corporation, ...
for their services; chiropodists were restricted in 1991 from billing OHIP. Podiatrists may "communicate a diagnosis" to their patients (or to their patients' representatives) and perform surgical procedures on the bones of the forefoot; chiropodists may do neither.
Chiropodists and podiatrists are regulated by the College of Chiropodists of Ontario, which had 701 chiropodists and 54 podiatrists registered as of December 31, 2019.
The only English-speaking chiropody program in Canada, in which also has a working chiropody clinic on campus for students to treat patients under the supervision of licensed chiropodists is
The Michener Institute
The Michener Institute of Education at UHN, or simply Michener, is a specialist post-secondary institution in Toronto, Ontario, Canada. Based in Downtown Toronto and governed by the University Health Network (UHN), Canada's largest funded health c ...
– affiliated with University Health Network, Toronto. According to The Michener Institute website, chiropody is a branch of medical science that involves the assessment and management of foot and lower limb disorders. This includes the management of a wide variety of disorders, injuries, foot deformities, infections, and local manifestations of systemic conditions. A chiropodist is a primary care professional practising in podiatric medicine in Ontario that specializes in assessment, management and prevention of diseases and disorders of the foot. An essential member of the inter professional healthcare team, the chiropodist is skilled in assessing the needs of their patients and in managing both chronic and acute conditions affecting foot and lower limb function. As a primary care provider capable of independent clinical practice, these skills are often practised independent of medical referral and medical supervision.
Iran
There are no podiatric medical schools in Iran. The
Ministry of Health and Medical Education (MoHME) reviews the dossier of podiatric applicants for medical registration according to the "Regulations on the Evaluation of the Educational Credentials of Foreign Graduates", updated on 12
Mordad
Mordad ( fa, Mordād, ) is the fifth month of the Solar Hijri calendar, the official calendar of Iran and Afghanistan. Mordad has thirty-one days, beginning in July and ending in August of the Gregorian calendar. It is the second month of summer ...
1388
AHS (3 August 2009
CE). Section 12-5: "The specific requirements for evaluation of education degrees in podiatry" stipulates that the podiatric degree from the United States will be registered as a professional doctorate in podiatric medicine, provided that the following are met: possession of a
bachelor's degree
A bachelor's degree (from Middle Latin ''baccalaureus'') or baccalaureate (from Modern Latin ''baccalaureatus'') is an undergraduate academic degree awarded by colleges and universities upon completion of a course of study lasting three to six ...
, Successfully passing the
MCAT
The Medical College Admission Test (MCAT; ) is a computer-based standardized examination for prospective medical students (both Allopathic M.D. and Ostepathic D.O.) in the United States, Australia, Canada, and Caribbean Islands. It is designed ...
, completion of the podiatric curriculum and obtaining the
Doctor of Podiatric Medicine
A podiatrist ( ) is a medical professional devoted to the treatment of disorders of the foot, ankle, and related structures of the leg. The term originated in North America but has now become the accepted term in the English-speaking world for ...
(DPM) from an accredited school, if required by the home jurisdiction, completion of a one-year postgraduate training, successfully passing of the relevant board examinations, an exception is made for those holding the (3-year undergraduate)
Bachelor of Science (Podiatry) degree from accredited schools in the United Kingdom. After successful evaluation by the relevant commission, these degrees will be accepted at the bachelor's level.
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. Auckland University of Technology is now the only provider of podiatry training in New Zealand.
United Kingdom
![Mobile chiropodist in Chorley 2011](https://upload.wikimedia.org/wikipedia/commons/a/a8/Mobile_chiropodist_in_Chorley_2011.jpg)
The scope of practice of UK podiatrists includes the use of some prescription-only medicines, injection therapy and non-invasive surgery e.g. performing partial or total nail resection and removal, with chemical destruction of the tissues. Podiatrists complete about 1,000 supervised clinical hours in the course of training which enables them to recognise systemic disease as it manifests in the foot and will refer on to the appropriate health care professional. Those in the NHS interface between the patients and multidisciplinary teams. The scope of practice of a podiatrist is varied ranging from simple skin care to invasive bone and joint surgery depending on education and training. In order to perform invasive foot surgery a UK podiatrist must undertake extensive postgraduate education and training, usually taking a minimum of 10 years to complete.
In a similar way to podiatrists in Australasia, UK podiatrists may continue their studies and qualify as podiatric surgeons. Due to recent changes in legislation, the professional titles 'chiropodist' and 'podiatrist' are now protected by law. In the UK there is no difference between the terms chiropodist and podiatrist. Those using protected titles must be registered with the
Health and Care Professions Council
The Health and Care Professions Council (HCPC, formerly the Health Professions Council, HPC) is a statutory regulator of over 280,000 professionals from 15 health and care professions in the United Kingdom. The Council reports its main purpose i ...
(HCPC). Registration is normally only granted to those holding a bachelor's degree from one of 13 recognized schools of podiatry in the UK. Professional bodies recognised by the Health Professions Council are:
The Society of Chiropodists and Podiatrists, The Alliance of Private Sector Practitioners,
The Institute of Chiropodists and Podiatrists and
The British Chiropody and Podiatry Association.
The
Royal Commission on the National Health Service
The Royal Commission on the National Health Service was set up by the Wilson government in 1975. It was to consider the "best use and management of the financial and manpower resources of the NHS".
The Royal Commission reported in June 1979, by ...
in 1979 reported that about six and a half million NHS chiropody treatments were provided to just over one and a half million people in
Great Britain
Great Britain is an island in the North Atlantic Ocean off the northwest coast of continental Europe. With an area of , it is the largest of the British Isles, the largest European island and the ninth-largest island in the world. It is ...
in 1977, 19% more than three years earlier. Over 90% of patients receiving these treatments were aged 65 or over. At that time there were about 5,000 state registered chiropodists but only about two-thirds worked for the NHS. The Commission agreed with the suggestion of the Association of Chief Chiropody Officers for the introduction of more foot hygienists to undertake, under the direction of a registered chiropodist, "nail cutting and such simple foot-care and hygiene as a fit person should normally carry out for himself."
United States
In the United States, medical and surgical care of the foot and ankle is mainly provided by two groups: ''podiatrists'' (who hold the degree of Doctor of Podiatric Medicine or DPM) and ''orthopedic surgeons'' (MD or DO).
The first two years of podiatric medical school are similar to training that
M.D.
Doctor of Medicine (abbreviated M.D., from the Latin ''Medicinae Doctor'') is a medical degree, the meaning of which varies between different jurisdictions. In the United States, and some other countries, the M.D. denotes a professional degree. T ...
and
D.O.
Doctor of Osteopathic Medicine (DO or D.O., or in Australia DO USA) is a medical degree conferred by the 38 osteopathic medical schools in the United States. DO and Doctor of Medicine (MD) degrees are equivalent: a DO graduate may become licens ...
students receive, but with an emphasized scope on the foot, ankle, and lower extremity. Being classified as a second entry degree, in order to be considered for admission, an applicant must first complete a minimum of 90 semester hours at the university level or more commonly, complete a bachelor's degree with emphasis on general/organic chemistry, biochemistry, biology, etc. In addition, potential students are required to take the
Medical College Admission Test
The Medical College Admission Test (MCAT; ) is a computer-based standardized examination for prospective medical students (both Allopathic M.D. and Ostepathic D.O.) in the United States, Australia, Canada, and Caribbean Islands. It is designed ...
(MCAT). In 2019, the average MCAT for matriculants was 494.6 and 3.3 average undergraduate cGPA. The DPM degree itself takes a minimum of four years to complete.
The four-year podiatric medical school is followed by a surgical-based residency, which is hands-on post-doctoral training. As of July 2013, all residency programs in podiatry were required to transition to a minimum of three years of post-doctoral training. This upgrading of training was spearheaded in California by the state Board of Podiatric Medicine (BPM) and its California Liaison Committee (CLC). BPM’s Executive Officer James H. Rathlesberger included it in the Federation of Podiatric Medical Boards’ Model Law, which he wrote before becoming FPMB president in 2000.
Podiatric residents rotate through core areas of medicine and surgery. They work in such rotations as emergency medicine, internal medicine, infectious disease, behavioral medicine, physical medicine & rehabilitation, vascular surgery, general surgery, orthopedic surgery, plastic surgery, dermatology, and podiatric surgery and medicine. Fellowship training is available after residency in such fields such as geriatrics, foot and ankle traumatology, infectious disease, etc. In reality, the residency training of most podiatry residencies today are already highly inclusive of these medical areas. In most states, their scope is limited to areas at the ankle joint, however, some states (16 as of 2021) include the leg, and some, the hand as within the scope of podiatry.
![Wyckoff](https://upload.wikimedia.org/wikipedia/commons/3/35/Wyckoff.jpg)
Upon completion of their residency, they are eligible to sit for examinations for board certification, in a similar process as their MD/DO colleagues, by one of two specialty boards: American Board of Podiatric Medicine (ABPM) and/or the American Board of Foot and Ankle Surgery (ABFAS). ABPM certification leads to fellowship in either the American Society of Podiatric Surgeons (ASPS) or the American College of Podiatric Medicine (ACPM). ABFAS certification leads to fellowship in the ASPS or the American College of Foot and Ankle Surgeons (ACFAS). ABPM is recognized by CPME as certification in primary podiatric medicine and orthopaedics
and the ABFAS as recognized in podiatric surgery,
hospital credentialing committees oftentimes do not distinguish between the two due to professional guidance, opinion, or possibly due to local or federal
restraint of trade laws. There are several other boards that have arisen over the past several decades issuing certifications to podiatrists, however, no other board is certified and legally recognized by the podiatric accrediting agency: the Council on Podiatric Medical Education (CPME), which is overseen and approved by the
Department of Education
An education ministry is a national or subnational government agency politically responsible for education. Various other names are commonly used to identify such agencies, such as Ministry of Education, Department of Education, and Ministry of Pub ...
.
There are two surgical certifications under ABFAS.
[US Podiatry](_blank)
K12 Academics Retrieved on 2012-08-24. They are foot surgery and reconstructive rearfoot/ankle (RRA) surgery. In order to be board certified in RRA, the sitting candidate has to have already achieved board certification in foot surgery. Certification by ABFAS requires initial successful passing of the written examination. Then the candidate is required to submit surgical logs indicating experience and variety. Once accepted, the candidate has to successfully pass an oral examination and computer questions of clinical simulation.
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
Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...
, or in multi-specialty orthopedic surgical groups. Some podiatrists work within clinic practices such as the
Indian Health Service
The Indian Health Service (IHS) is an operating division (OPDIV) within the U.S. Department of Health and Human Services (HHS). IHS is responsible for providing direct medical and public health services to members of federally-recognized Nativ ...
(IHS), the
Rural Health Centers (RHC) and Community Health Center (
FQHC
A Federally Qualified Health Center (FQHC) is a reimbursement designation from the Bureau of Primary Health Care and the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services. This designation is si ...
) systems established by the US government to provide services to under-insured and non-insured patients as well as within the
United States Department of Veterans Affairs
The United States Department of Veterans Affairs (VA) is a Cabinet-level executive branch department of the federal government charged with providing life-long healthcare services to eligible military veterans at the 170 VA medical centers a ...
to provide care to veterans of military service.
Some podiatrists have primarily surgical practices. Some specialists complete additional fellowship training in reconstruction of the foot and ankle from the effects of diabetes or physical trauma. Other surgeons practice minimally invasive percutaneous surgery for cosmetic correction of
hammer toe
A hammer toe or contracted toe is a deformity of the muscles and ligaments of the proximal interphalangeal joint of the second, third, fourth, or fifth toe causing it to be bent, resembling a hammer. In the early stage a flexible hammertoe is m ...
s and
bunion
A bunion, also known as hallux valgus, is a deformity of the joint connecting the big toe to the foot. The big toe often bends towards the other toes and the joint becomes red and painful. The onset of bunions is typically gradual. Complicatio ...
s. Podiatrists use medical, orthopedic, biomechanical, and surgical principles to stabilize and correct foot deformities.
Colleges and education
There are 11 colleges/schools of podiatric medicine in the United States. These are governed by the
American Association of Colleges of Podiatric Medicine
The American Podiatric Medical Association (APMA) is a professional medical organization representing Doctors of Podiatric Medicine (podiatrists) within the United States. The organization was founded in 1912 and is headquartered in Bethesda, Mar ...
(AACPM). The AACPM describes its mission as to enhance academic podiatric medicine. All podiatric medical schools in the United States are accredited by the Council on Podiatric Medical Education.
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Arizona School of Podiatric Medicine at Midwestern University
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Barry University School of Podiatric Medicine
The Barry University School of Podiatric Medicine is one of the nine podiatric medical schools in the United States. It is located in Miami Shores, Florida. The school was founded in 1985 as the first podiatric medical college to be part of a univ ...
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California School of Podiatric Medicine
California School of Podiatric Medicine at Samuel Merritt University is a podiatric medical school based in Oakland, California. It is one of nine podiatric medical schools in the United States. The college is accredited by the American Podiatri ...
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New York College of Podiatric Medicine
The New York College of Podiatric Medicine (NYCPM) is a private podiatric medical college in Manhattan, New York. It is the oldest and second largest podiatric medical school in the United States.
History
Founded in 1911, NYCPM was the first pod ...
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Kent State University College of Podiatric Medicine
Kent State University College of Podiatric Medicine (KSUCPM), is the graduate podiatric medical school of Kent State University (KSU). As of 2022, it is the only fully public podiatry medical school in the U.S. The college is located in Independenc ...
Lake Erie College of Osteopathic Medicine School of Podiatric Medicine*
Dr. William M. Scholl College of Podiatric Medicine
Rosalind Franklin University of Medicine and Science (RFU) is a private graduate school in North Chicago, Illinois. It has more than 2,000 students in five schools: Chicago Medical School, College of Health Professions, College of Pharmacy, Dr. W ...
at
Rosalind Franklin University of Medicine and Science
Rosalind Franklin University of Medicine and Science (RFU) is a private graduate school in North Chicago, Illinois. It has more than 2,000 students in five schools: Chicago Medical School, College of Health Professions, College of Pharmacy, Dr. W ...
*
Temple University School of Podiatric Medicine
The Temple University School of Podiatric Medicine is a podiatric medical school associated with Temple University in Philadelphia, Pennsylvania. The school is located at 8th and Race Streets in downtown Philadelphia. The school was founded in 19 ...
University of Texas Rio Grande Valley School of Podiatric Medicine
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College of Podiatric Medicine at
Western University of Health Sciences
Western University of Health Sciences (WesternU) is a private medical school and health sciences university with its main campus in Pomona, California, with an additional osteopathic medical school in Lebanon, Oregon. With an enrollment of 3,81 ...
Podiatric subspecialties
Podiatrists treat a wide variety of foot and lower extremity conditions through both non-surgical and surgical approaches. While the terminology of subspecialties differ around the world, they generally fall into these categories:
* Podiatric surgery
* Podiatric sports medicine
American Academy of Podiatric Sports Medicine
* Dermatological podiatrist
* Gerentological podiatrist
* Diabetic limb salvage and wound care
* Podopediatrics
American College of Foot and Ankle Pediatrics
* Forensic Podiatry (the study of footprints, footwear, shoeprints and feet associated with crime scene investigations)
In Australia there is now an option to be a podiatric assistant. The qualification is a Certificate IV in Allied Health Assistance specialising in podiatry.
They work as a part of a podiatric medical team in a variety of clinical and non clinical settings. There are currently developing strategies to further use these skilled workers. Worldwide, there are common professional accreditation pathways to be a podiatric assistant. There are many fields such as:
* Podiatric
nurse
Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health c ...
* Podiatric surgical nurse
* Foot carer
* Podiatry support worker
* Podiatry technician
* Podiatry hygienists
* Foot hygienist
* Podiatric medical assistant
Professional societies and organizations
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Academy of Ambulatory Foot and Ankle Surgery (AAFAS)
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Alberta Podiatry Association
Alberta ( ) is one of the thirteen provinces and territories of Canada. It is part of Western Canada and is one of the three prairie provinces. Alberta is bordered by British Columbia to the west, Saskatchewan to the east, the Northwest Terri ...
(APA)
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Alpha Gamma Kappa
Alpha Gamma Kappa ( or AGK) is the oldest and largest professional fraternal organization for students and practitioners of podiatric medicine in the United States. The fraternity was founded in 1939 at the Dr. William M. Scholl College of Podia ...
fraternity
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Alliance of Private Sector Practitioners
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American Podiatric Medical Association
The American Podiatric Medical Association (APMA) is a professional medical organization representing Doctors of Podiatric Medicine (podiatrists) within the United States. The organization was founded in 1912 and is headquartered in Bethesda, Mar ...
(APMA)
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American Society of Podiatric Surgeons
American(s) may refer to:
* American, something of, from, or related to the United States of America, commonly known as the "United States" or "America"
** Americans, citizens and nationals of the United States of America
** American ancestry, pe ...
(ASPS)
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American Society of Forensic Podiatry
American(s) may refer to:
* American, something of, from, or related to the United States of America, commonly known as the "United States" or "America"
** Americans, citizens and nationals of the United States of America
** American ancestry, pe ...
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American College of Foot and Ankle Surgeons
The American College of Foot and Ankle Surgeons (ACFAS) is a professional medical society of foot and ankle surgeons in the United States (US). Each of the over 7,700 members have graduated from one of nine podiatric medical schools in the US w ...
(ACFAS)
*American Board of Foot and Ankle Surgery (ABFAS)
American College of Podiatric Medicine(ACPM)
American Board of Podiatric Medicine(ABPM
*American Board of Multiple Specialties in Podiatric Medicine
*American Board of Multiple Specialties in Podiatric Surgery
*American Academy of Podiatric Sports Medicine (AAPSM)
*American Society of Podiatric Dermatology (ASPD)
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Australian Podiatry Association
Australian(s) may refer to:
Australia
* Australia, a country
* Australians, citizens of the Commonwealth of Australia
** European Australians
** Anglo-Celtic Australians, Australians descended principally from British colonists
** Aboriginal Au ...
(APODA)
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Association Belge des Podologues
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Canadian Podiatric Medical Association (CPMA)
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American Academy of Podiatric Practice Management
American(s) may refer to:
* American, something of, from, or related to the United States of America, commonly known as the "United States" or "America"
** Americans, citizens and nationals of the United States of America
** American ancestry, pe ...
(AAPPM)
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International Federation of Podiatrists – Fédération Internationale des Podologues (FIP-IFP)
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International Foot and Ankle Biomechanics Community (i-FAB)
International is an adjective (also used as a noun) meaning "between nations".
International may also refer to:
Music Albums
* ''International'' (Kevin Michael album), 2011
* ''International'' (New Order album), 2002
* ''International'' (The T ...
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Student National Podiatric Medical Association (SNPMA)
*American Podiatric Medical Students' Association (APMSA)
*Australian College of Podiatric Surgeons (ACPS)
*Australian Podiatry Association (APodA)
*Australian Podiatry Council (APodC)
*Australasian Academy of Podiatric Sports Medicine (AAPSM)
*Australasian Podiatric Rheumatology Specialist Interest Group (APRSIG)
*Federation of Podiatric Medical Boards (FPMB)
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Institute of Chiropodists and Podiatrists (IOCP)
*Canadian Federation of Podiatric Medicine
*Royal College of Podiatry (RCoP)
References
External links
*
The Kederminster Pharmacopolium
* {{Portalbar, Medicine