Podiatry is a branch of medicine devoted to the study, diagnosis and treatment of disorders of the foot, ankle and lower leg.
The term "podiatry" came into use first in the early 20th century United States where it now denotes a Doctor of Podiatric Medicine (DPM) who is qualified by their education and training to diagnose and treat conditions affecting the foot, ankle and related structures of the leg. Within the field of podiatry, practitioners can focus on many different specialty areas, including surgery, sports medicine, biomechanics, geriatrics, pediatrics, orthopedics or primary care.
Podiatry is also practiced in other countries such as Canada, Ireland, the United Kingdom, Malta, Cyprus, South Africa, Australia and New Zealand. In many English-speaking countries, the older title of "chiropodist" may still be used by some clinicians but is gradually falling out of use. In many non-English-speaking countries of Europe, the title used instead of podiatrist may be "podologist" or" "podolog" . The level and scope of practice may vary in these countries as compared in the US.
History
The professional care of feet was in existence in ancient Egypt as evidenced by bas-relief carvings at the entrance to Ankmahor's tomb dating from about 2400 BC where work on hands and feet is depicted.
Corns and calluses were described by Hippocrates who recognised the need to physically reduce hard skin, followed by removal of the cause. He invented skin scrapers for this purpose and these were the original scalpels. Aulus Cornelius Celsus, a Roman scientist and philosopher, was probably responsible for giving corns their name. Later Paul of Aegina (AD 615-690) defined a corn as "a white circular body like the head of a nail, forming in all parts of the body, but more especially on the soles of the feet and the toes. It may be removed in the course of some time by paring away the prominent part of it constantly with a scalpel or rubbing it down with pumice. The same thing can be done with a callus."
Until the turn of the 20th century, chiropodists—now known as podiatrists—were separate from organized medicine. They were independently licensed physicians who treated the feet, ankles and related leg structures. Lewis Durlacher was one of the first people to recognize the need for a protected profession. He tried to establish the first association of practitioners in 1854, although it would take another century to come to pass.
There are records of the King of France employing a personal podiatrist, as did Napoleon. In the United States, President Abraham Lincoln suffered greatly with his feet and chose a chiropodist named Isachar Zacharie, who not only cared for the president’s feet, but also was sent by President Lincoln on confidential missions to confer with leaders of the Confederacy during the U.S. Civil War.
The first society of chiropodists, now known as podiatrists, was established in—and still operates in—New York in 1895 as NYSPMA, with the first school opening in 1911. One year later the British established a society at the London Foot Hospital and a school was added in 1919. In Australia professional associations appeared from 1924 onwards. The first American journal appeared in 1907, followed in 1912 by a UK journal. In 1939, the Australians introduced a training centre as well as a professional journal. The number of chiropodists increased markedly after the Great War then again after World War II.
Increased numbers of ex-soldiers needing to be gainfully employed gave chiropody a boost and led to the need for registration in all English speaking countries. The study of the foot (i.e. podology), brought greater knowledge to the practice of foot care or podiatry.
Specific country practices
Australia
In Australia, podiatry is classified as an allied health profession, and is practised by individuals licensed by their representative State Boards of Podiatry. There are seven registration boards and six teaching centres, with two levels of awards — unclassified bachelors degree and honours level. In Australia there exist 2 levels of professional accreditation and professional privilege: Podiatrist and Podiatric Surgeon (Surgical Podiatrist in the state of Queensland). Australian podiatrists are able to practise abroad with their qualifications recognised in some Commonwealth countries.
Registration and regulation
Currently, all podiatrists must be registered with the Podiatrists Registration Board in the state or territory they wish to practise in. Podiatrists wishing to practise in the Northern Territory (which has no registration board) must be registered in at least one other jurisdiction (eg QLD, SA).
However, as part of proposed reforms to the Australian health system, there are plans to move podiatry (like other registered health professions) to a system of National Registration and Accreditation. This is likely to occur on the 1st July 2010, and the transition to this major reorganisation of registration and oversight will be facilitated by the Australian & New Zealand Podiatry Accreditation Council (ANZPAC). It is likely there will be ongoing refinement of national policies relating to the practice of podiatry once this process has been completed.
Education and training
Australian podiatrists complete an undergraduate degree ranging from 3 to 4 years of education. The first 2 years of this program are generally focused on various biomedical science subjects including anatomy, medical chemistry, biochemistry, physiology and patient psychology, similar to the medical curriculum. The following two years will then be spent focusing on podiatry specific areas such as podiatric biomechanics and human gait, podiatric orthopaedics or the non-surgical management of foot abnormalities, pharmacology, general medicine, general pathology, local and general anaesthesia, and surgical techniques such as partial and total nail avulsions, wound debridement, and other cutaneous and electrosurgical procedures.
Australian podiatric surgeons 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 degree of 4 years, which includes 2 years of didactic study and 2 years of clinical experience. Following this, a masters degree must be completed with focus on biomechanics, medicine, surgery, general surgery, advanced pharmacology, advanced medical imaging and clinical pathology. They then qualify for the status of Registrar with the Australasian College of Podiatric Surgeons. Following surgical training with a podiatric surgeon (3–5 years), 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 given Commonwealth accreditation under the Health Insurance Act to be recognised as providers of professional attention , for the purposes of health insurance rebates.
Prescribing 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 utilize local anaesthesia for minor surgical techniques, some states allow suitably qualified podiatrists further privileges.
Recent legislative changes, which are expected to come into effect soon, will allow registered podiatrists and podiatric surgeons in Victoria graduates to prescribe relevant schedule 4 poisons. In other states, such as Western Australia and South Australia, podiatrists with Masters Degree's in Podiatry, and extensive training in pharmacology are authorised to prescribe S4 poisons. 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.
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 radiology 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 some parts of Canada the situation is legislatively stratified between the U.S. and British systems. For instance, in some provinces like British Columbia and Alberta, the standards are the same Doctor of Podiatric Medicine (DPM) level as in the United States. Quebec, too, has recently changed to the DPM level of training. Also in Quebec, in 2004, Université du Québec à Trois-Rivières started the first program of Podiatric Medicine in Canada. In the prairie provinces, the standard has been based on the British model of chiropody. Recognising this fact, in the province of Ontario, chiropodists and podiatrists are legislatively distinct occupational designations. Ontario chiropodists have a narrower scope of permitted practice than Ontario podiatrists (i.e., limit
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