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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 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 "Podólogo". The level and scope of the practice of podiatry varies among countries. Podiatry is a very high paying job and was listed by Forbes magazines as the 15th best paid profession in the US.
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, and assessing foreign trained registrants.
The Podiatry Board of Australia recognizes 3 pathways to attain specialist registration as a Podiatric Surgeon:
1. Fellowship of the Australasian College of Podiatric Surgeons
2. Doctor of Clinical Podiatry, University of Western Australia
3. Eligibility for Fellowship of the Australasian College of Podiatric Surgeons
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.
Recent legislative changes, which are expected to come into effect soon, will allow registered podiatrists and podiatric surgeons in Victoria and New South Wales 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.
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.
In a similar way to podiatrists in Australasia, UK podiatrists may continue their studies and qualify as podiatric surgeons. This training programme has developed over the last 30 years including development of standards in co-operation with the Scottish Royal Surgical Colleges. The training requires a number of years study at postgraduate level including a Masters degree in the Principles of Podiatric Surgery, then a year as a pre-surgical trainee working within a podiatric surgical team, at least 2 years as a surgical trainee working to complete parts C and D of the surgical training and complete pre-Fellowship surgical training. Following this, and having successfully passed a practical surgical assessment, a Podiatric surgeon will work at a specialist registrar (SpR) level for a minimum of three years under a Consultant Podiatric Surgeon. This SpR period must be satisfactorily completed before being eligible to apply for a Consultant National Health Service (NHS) post. These posts are subject to an appointments panel including an assessor from the Faculty of Surgery of the College of Podiatrists (an existing consultant podiatric surgeon). Only if successfully appointed to such an NHS post may he/she then be able to use the title Consultant Podiatric Surgeon.
Podiatric surgery in the UK is not a recent development. The First UK training in podiatric surgery developed over 30 years ago in North London. The original podiatric surgery faculty invited over by UK podiatric surgeons who had trained with them in the USA were leading US podiatric surgeons including; E Dalton McGlamry, Tildern Sockaloff, Guido LaPorta and later Lowell Scott Weil. The First specific podiatric surgery in the NHS was provided via Shropshire Health Authority in 1983 and shortly after in the adjacent English county of Herefordshire. The first specific podiatric surgery service was approved by Herefordshire Health Authority in 1986. Subsequently these NHS services developed with Consultant Podiatric Surgeons being appointed to lead these growing services. The First dedicated NHS Podiatric Daysurgery Unit was officially opened in Hereford in 1993. There are now a number of NHS dedicated NHS Podiatric Daysurgery Units and many NHS Trusts providing podiatric surgery.
Podiatric surgeons specialise in invasive foot surgery. The scope of practice is defined as "surgery of the foot and associated structures". The majority of work reflects the frequency of foot pathology presenting in the UK, most commonly digital and forefoot surgery, as well as mid foot and rearfoot surgery including triple arthrodeses, ankle stabilisations and Achilles tendon lengthenings/repairs. At present these surgeries are not carried out by all Podiatric Surgeons.
In the UK, individuals may not use the title "chiropodist" or “podiatrist” unless they are registrants of the Health Professions Council (HPC). They are protected titles and their use by non-registrants is unlawful. This issue has been debated several times over the last 30 years despite the fact that all podiatric surgeons provide clear information to their patients regarding their training and qualifications as part of the process of informed consent. Despite this much co-operation exists and in many areas podiatric surgeons and orthopaedic surgeons work closely together for the greatest benefit of patients, in multidisciplinary teams while respecting each others' professional independence. Appropriately qualified podiatrists are licensed to access and supply a limited range of POMs including antibiotics, analgesics, and steroids for injection.
Professional bodies recognised by the Health Professions Council are : The Society of Chiropodists and Podiatrists, The Institute of Chiropodists and Podiatrists, The British Chiropody and Podiatry Association and The Alliance of Private Sector Chiropody and Podiatry Practitioners. Foot Health Practitioners: Since the recent statutory regulation/registration of the Chiropody/podiatry sector by the Health Professions Council there has been an increase in the number of former practitioners (of private sector routine chiropody) not being allowed to use their former title – (Chiropodist/Podiatrist) – as a higher degree (or the alternative diploma) in podiatric medicine etc became the required standard for statutory registration. Former practitioners of Chiropody in the UK who did not meet the requirements to be admitted to the HPC register now use the title of Foot Health Practitioner which came in being in 2005. These practitioners provide basic footcare and may refer clients who require more advanced treatments to a Chiropodist/Podiatrist. Clients who have a condition not directly related to the health of the foot, but which is recognised by the Foot Health Practitioner may be referred to a medical doctor for examination (this can be the case especially with elderly clients). It should be noted that it is not only former private sector chiropodists/podiatrists who use the title of Foot Health Practitioner – There are now courses available from well established private training colleges throughout the UK The longest established being The Smae Institute – Founded in 1919) allowing individuals with little or no health care experience to train to become an FHP. Appropriately trained Foot Health Practitioners can become associate members of the following Podiatry/Chiropody bodies: The Institute of Chiropodists and Podiatrists & The Alliance of Private Sector Chiropody and Podiatry Practitioners as well as other professional organizations that are not recognized by the HPC. There is currently no statutory registration/ regulation for practitioners in the private foot health sector – much like the lack of regulation of private sector Chiropody/Podiatry prior to 2003–2005. The title "Foot Health Practitioner" is a title not regulated by statute and can be used by anyone regardless of training levels. The HPC has no plans at present to regulate FHPs despite representations being made by those professional organisation who have FHPs as members.
The first year of podiatric medical school is somewhat similar to training that physicians (either medical doctors or osteopathic doctors) receive, but with a limited scope on foot, ankle, and lower extremity problems. 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.
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The four-year podiatric medical school is followed by a residency, which is 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, and general surgery and of course podiatry — both clinic and surgical. During these rotations, attending podiatrists train the resident physicians in medicine and surgery.
Upon completion of their residency, podiatrists can become board certified by either the American Board of Podiatric Orthopedics and Primary Podiatric Medicine or the American Board of Podiatric Surgery.
Podiatrists certified by the ABPS have successfully completed an intense board certification process comparable to that undertaken by individual MD and DO specialties. Certification by the ABPS involves written, oral, and computer-based patient simulation questions, in addition to submission of surgical case logs. Prerequisites for board qualification in Foot and Reconstructive Rearfoot/Ankle Surgery require successful completion of a three-year podiatric surgical program and passing a written examination.
In the United States, the previous titles used for the Doctor of Podiatric Medicine (DPM) degree were Doctor of Surgical Chiropody (DSC) and Doctor of Podiatry (PodD). Podiatry in the US currently encompasses a broader spectrum of practice than it used to. Podiatrists can now perform medical and surgical procedures in all 50 states, though the specific scope of practice varies slightly in each state.
Some podiatrists have primarily surgical practices. Some specialists complete additional fellowship training in reconstruction of the foot and ankle. Many podiatric surgeons specialize in minimally invasive percutaneous surgery. Most podiatrists utilize medical, orthopedic, biomechanical and surgical practices. Surgical podiatric principles rest on a base of orthopedic and kinesthetic knowledge.
Invasive surgery can be avoided in some limited foot problems, including certain bunion related problems.
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