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), a specialist 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 practiced as a specialty in many countries including Australia, Brunei, Canada, Cyprus, Ireland, Malta,New Zealand, Singapore, South Africa, the United Kingdom, and the United States. In many English-speaking countries, the older title of “chiropodist” may still be used by some clinicians. In many non-English-speaking countries of Europe, the title used instead of podiatrist may be “podologist” or “Podólogo”.The level and scope of the practice of podiatry varies among countries. Podiatry is a very high paying specialty and was listed by Forbes as the 15th best paid profession in the United States.
In the United States, medical and surgical care of the foot and ankle is mainly provided by two groups of physicians:podiatrists (Doctor of Podiatric Medicine or DPM) and orthopedists (MDs or DOs).
The first year of podiatric medical school is similar to training that either medical doctors or osteopathic doctorsreceive, but with an emphasized scope on 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 and/or complete a bachelor’s degree. In addition, potential students are required to take the Medical College Admission Test (MCAT). The DPM degree itself takes a minimum of four years to complete.
The four-year podiatric medical school is followed by a residency, which is hands-on post-doctoral training. There are two standard residencies: Podiatric Medicine & Surgery 24 and Podiatric Medicine & Surgery 36 (PM&S 24 or PM&S 36). These represent the two- or three-year residency training. By July 2013, all residency programs in podiatry will be required to transition to a minimum three-years of post-doctoral training. Podiatric residents rotate through core areas of medicine such as emergency medicine, internal medicine, infectious disease, behavioral medicine, physical medicine & rehabilitation, vascular surgery, general surgery, orthopedic surgery, plastic surgery, dermatology and of course podiatry — both clinic and surgical. During these rotations, surgeons and physicians train the resident podiatrists in medicine and surgery of the foot and ankle. Fellowships are available for further training and experience after residency.
Upon completion of their residency, podiatrists can become board certified by either the American Board of Podiatric Orthopedics and Primary Podiatric Medicine and/or the American Board of Podiatric Surgery. Within the American Board of Podiatric Surgery, PM&S 24 graduates can sit for Board Certification in Foot Surgery and those that complete PM&S 36 can sit for Board Certification in Foot Surgery and Board Certification in Reconstructive Rearfoot & Ankle Surgery. Both boards in ABPS are examined as separate tracks.
Podiatrists certified by the ABPS have successfully completed an intense board certification process comparable to that undertaken by individual MD and DO specialties. There are two surgical certifications under ABPS. 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 ABPS 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 oral examination and computer questions of clinical simulation.
Practice characteristicsWhile 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-specialty 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 US 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.
Some podiatrists have primarily surgical practices. Some specialists complete additional fellowship training in reconstruction of the foot and ankle from the effect of diabetes or physical trauma. Other surgeons practice minimally invasive percutaneous surgery for cosmetic correction of hammer toes and bunions. Podiatrists utilize medical, orthopedic, biomechanical and surgical principles to maintain and correct foot deformities.
Podiatrists treat a wide variety of foot and lower extremity conditions, through nonsurgical and surgical approaches. There are those podiatric physicians who also subspecialize in such fields of practice as: