Podiatrist

Podiatrist

Occupation
Names	Podiatric Physician Doctor of Podiatric Medicine
Occupation type	Specialty
Activity sectors	Medicine, podiatric medicine, sports medicine, endocrinology, orthopedic surgery, dermatology, radiology, biomechanics, rheumatology, neurology
Description
Competencies	The science of medicine, surgical skills, biomechanics, ethics, critical thinking, analytical skills, professionalism, management skills, and communication skills.

A podiatrist, also known as a podiatric physician^[1] (/poʊˈdaɪətrɪst/ poh-dye-eh-trist) or "foot and ankle surgeon", is a medical professional, a physician devoted to the study and medical treatment of disorders of the foot, ankle and lower extremity.^[2] The term originated in North America, but has now become the accepted term in the English-speaking world for all practitioners of podiatric medicine. Podiatrists are the only medical professionals who exclusively specialize in treating the foot and ankle.

In the United States, Doctors of Podiatric Medicine (DPM) are physicians and surgeons who practice on the lower extremities, primarily on feet and ankles.^[3] The preparatory education of most podiatrists includes four years of undergraduate work, followed by four years in an accredited podiatric medical school, followed by a three or four-year hospital-based surgical residency. Podiatrists are licensed in all 50 states.^[4]

Worldwide, in many countries the term podiatrist refers to allied health professionals who specialize in the treatment of the lower extremity, particularly the foot. Podiatrists in these countries are specialists in the diagnosis and treatment of foot pathology, but not through surgical means. In some circumstances these practitioners will further specialise and, following further training, perform reconstructive foot and ankle surgery.

In contrast, American podiatrists who hold a Doctor of Podiatric Medicine (D.P.M.) complete surgical residencies, and thus all practitioners are trained in surgical treatments of the foot and ankle.^[2] Though the title chiropodist was previously used in the United States to designate what is now known as a podiatrist, it is now considered to be an antiquated and etymologically incorrect term. Although podiatrists worldwide do not attend traditional medical school, they are the most qualified doctors to care for the foot/ankle complex.^[1] The median annual Podiatry salary is $188,758, as of March 24, 2016, with a range usually between $154,312-$305,282 which can vary widely depending on a variety of factors.^[5]

Podiatric specialties

Podiatrists treat a wide variety of foot and lower extremity conditions, through nonsurgical and surgical approaches. The American Board of Podiatric Medicine (ABPM) offers a comprehensive board qualification and certification process in podiatric medicine and orthopedics. Podiatric Medicine and Orthopedics is the medical specialty concerned with the comprehensive and continuous foot health care of patients. There are those podiatric physicians who also specialize (i.e., specialists) in such fields of practice of podiatric medical specialties as:

• Reconstructive foot and ankle surgery (Consultant Podiatric Surgeon)^[6]
• General Podiatric Physician
• Podiatric Medical Physician
• Podiatric Orthopedic
• Sports Medicine (Podiatric Sports Physicians)
• High Risk Wound Care^[7]
• Podiatric Rheumatology^[8][9]
• Neuro-podiatrist (Neurology)^[7]
• Onco-podiatrist (Skin Cancers) or Podiatric Oncologist
• Podiatric Vascular Specialist
• Dermatological podiatrist
• Diagnostic Podoradiologist (Radiology)
• Gerontological podiatrist
• Diabetic limb salvage and wound care (Podiatric Diabetologist)^[7]
• Podopaediatrics (the study of children's foot and ankle conditions)^[10]
• 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.^[11] They work as a part of a podiatric medical team in a variety of clinical and non clinical settings. There is currently developing strategies further utilise these skilled workers. Worldwide there are common professional accreditation pathways to be a podiatric assistant. There are many fields such as:

• Podiatric nurse
• Foot carer/nurse
• Podiatry support worker
• Podiatry technician
• Podiatry Hygienists
• Foot Health Professional
• Podiatric Surgical Nurse
• Foot Hygienist
• Foot Health Practitioner
• Podiatric Medical assistant

Podiatric surgery is a specialist field in the podiatry profession in most western countries, including Australia, the United States and the United Kingdom. Podiatric surgery is defined as “the surgical treatment of conditions affecting the foot, ankle and related lower extremity structures by accredited and qualified specialist podiatrists”. Podiatric surgeons are concerned with the diagnosis and treatment of disorders of the foot and ankle. Podiatric surgeons are qualified to care for bone, joint, ligament, muscle and tendon pathology of the foot and ankle, such as:

• Structural deformities, including bunions, hammertoes, painful flat foot and high arch deformity, bone spurs
• Heel pain
• Nerve entrapments
• Degeneration and arthrosis of the joints of the foot and ankle
• Skin and nail conditions
• Congenital deformities
• Trauma-related injuries, including fracture and dislocations and post-traumatic arthrosis

Responsibilities

Podiatrists' roles include dealing with the conditions resulting from bone and joint disorders such as arthritis and soft-tissue and muscular pathologies as well as neurological and circulatory diseases. Podiatrists are also able to diagnose and treat any complications of the above which affect the lower limb, including skin and nail disorders, corns, calluses and ingrown toenails. Foot injuries and infections gained through sport or other activities are also diagnosed and treated by podiatrists.^[12]

Education and training

Australia

Australian podiatrists complete an undergraduate degree of Bachelor of Podiatry or Podiatric Medicine 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, pathophysiology, sociology 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 & prescribing, general medicine, general pathology, local and general anaesthesia, and surgical procedural techniques such as partial and total nail avulsions, matricectomy, cryotherapy, wound debridement and care, enucleation, and other cutaneous and electro-surgical procedures such as electro-desiccation, fulagaration and electrosection. Postgraduate courses in podiatric therapeutics and prescribing are required for having endorsements in scheduled medicines. All podiatrists are required to register with AHPRA prior to be licensed to practice in Australia. Registration is required annually. There is a minimum of continuing professional development (CPD) hours a podiatrist must undertake to maintain said registration. Podiatric surgeons are specialist podiatrists who have completed extensive, post graduate medical and surgical training and perform reconstructive surgery of the foot and ankle. The qualifications of podiatric surgeons are recognised by Australian State and Federal Governments. It is an approved specialty by the Australian Health Practitioners Regulation Agency. Podiatric surgeons are included within both the Health Insurance Act and the National Health Act.

The Podiatry Board of Australia recognizes 3 pathways to attain specialist registration as a Podiatric Surgeon:^[13]

• 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

Podiatric surgical qualifications are a post-graduate speciality of the podiatric profession. Before attaining a podiatric surgical fellowship qualification, a podiatrist must complete an extensive training program, including: 1. Bachelor of Applied Science degree, majoring in Podiatry (4 years) 2. Minimum of 2 years post-graduate clinical practice 3. Master of Podiatry (2 years full-time university degree) 4. A 3-stage surgical fellowship training under supervision of the ACPS (4 to 6 years) 5. International residency training (usually in the UK and USA) 6. Demonstrated mastery of knowledge in foot and ankle surgery by passing oral and written examinations administered by the ACPS

New Zealand

There is only one university that offers the training to become a podiatrist. Podiatrists must have a Bachelor of Health Science majoring in podiatry from Auckland University of Technology (AUT), or an overseas qualification recognised by the Podiatrists Board of New Zealand, be registered with the Podiatrists Board of New Zealand and have a current Annual Practising Certificate.^[14]

Canada

In Canada, the definition and scope of the practice of podiatry varies provincially. For instance, in some provinces like British Columbia and Alberta, the standards are the same as in the United States where the Doctor of Podiatric Medicine (DPM) is the accepted qualification.

Quebec, too, has recently changed to the DPM level of training, although other academic designations may also register. Also in Quebec, in 2004, Université du Québec à Trois-Rivières started the first program of Podiatric Medicine in Canada based on the American definition of podiatry. In the prairie and Atlantic provinces, the standard was originally based on the British model now called podiatry (chiropody). That model of podiatry is currently the accepted model for most of the world including the United Kingdom, Australia and South Africa.

The province of Ontario has been registering Chiropodists since July 1993 (when the Ontario Government imposed a cap on new podiatrists). If a registered podiatrist from outside of Ontario relocates to Ontario they are required to register with the province and practice as a chiropodist. Podiatrists who were practicing in Ontario previous 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 diploma in chiropody, although many also have some university level schooling or a baccalaureate degree in the sciences or in another field. Podiatrists may bill OHIP for their services; chiropodists may not. 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.^[15]

Chiropodists and podiatrists are regulated by the College of Chiropodists of Ontario, which had 594 chiropodists and 65 podiatrists registered as of 29 July 2015.^[16]

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. 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 practicing 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 of 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 practiced independent of medical referral and medical supervision.

United Kingdom

In the UK, podiatrists usually undertake a 3-year undergraduate Bachelor of Science (Podiatry). Podiatric Surgeons have undertaken fellowships and postgraduate training. The scope of practice of a podiatrist falls into four key categories: General clinics, Biomechanics, High risk patient management and Surgery. There are two levels of surgical practice. As part of general podiatric care, podiatrists as HPC (Health Professions Council) registered practitioners are involved with nail and minor soft tissue surgical procedures and qualified to administer local anaesthetics. From 1 August 2012, the HPC is being rebranded to the HCPC (Health & Care Professions Council) as they are expanding their remit to include Social Workers.^[17] The old term of "State Registered" has been defunct for some time and is no longer used since the creation of the HPC. Some podiatrists go on to develop and train as podiatric surgeons, who surgically manage bone and joint disorders within the foot. It is to this latter group (Podiatric Surgeons) that the guidelines apply. Fellowship requires a minimum of six years postgraduate training. This includes a two or three year surgical residency with an approved centre. Podiatric surgeons acquire comprehensive knowledge of related subjects including pharmacology, regional anaesthetic techniques and radiographic interpretation, as well as in-depth knowledge of foot surgery. The surgical faculty of the College of Podiatrists has set the standards for fellowship.

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 Doctors of Medicine (M.D.) or Doctors of Osteopathic Medicine (D.O.) receive, 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 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 (MCAT). The DPM degree itself takes a minimum of four years to complete. To enter a college of podiatric medicine, the student must first complete at least three years or 90 semester hours of college credit at an accredited institution. Biology, Chemistry, Organic Chemistry, Physics (all science courses require a lab) and English are among the required classes. Over 95% of the students who enter a college of podiatric medicine have a bachelor's degree. Many have also completed some graduate study. Before entering a college of podiatric medicine, the student must take the MCAT (Medical College Admissions Test).^[18]

There are nine colleges of podiatric medicine in the United States^[19] . They all receive accreditation from the Council on Podiatric Medical Education, which is recognized by the U.S. Secretary of Education and the Council on Higher Education Accreditation. All of the colleges grant the degree of Doctor of Podiatric Medicine (DPM).^[20]

The four-year podiatric medical school is followed by a surgical based residency, which is hands-on post-doctoral training. There are two standard residencies: Podiatric Medicine & Surgery and Podiatric Medicine & Surgery with Rearfoot Reconstruction and Ankle (PM&SR or PM&SR/RRA).^[21] Podiatric residents rotate through core areas of medicine and surgery. They work alongside their MD and DO counterparts 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 of course podiatric surgery and medicine. Fellowship training is available after residency in such fields such as foot & ankle traumatology or limb salvage.

Upon completion of their residency, podiatrists can decide to become board certified by a number of specialty boards including the more common American Board of Podiatric Orthopedics and Primary Podiatric Medicine and/or the American Board of Podiatric Surgery. The ABPMS or The American Board of Podiatric Medical Specialties has been certifying podiatrists since 1998. 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. Though the ABPS and ABPOPPM are more common, other boards are equally challenging and confer board qualified/certified status. Many hospitals and insurance plans do not require board eligibility or certification to participate.

The DPM superseded the historical DSC (Doctor of Surgical Chiropody) degree in the 1960s.

References