Podiatry


Podiatry, also known as podiatric medicine and surgery, is a branch of medicine devoted to the study, diagnosis, and treatment of disorders of the foot, ankle and lower limb. The healthcare professional is known as a podiatrist. 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, plastic surgery, and foot and ankle surgery.
Podiatry is practiced as a specialty in many countries. 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 depicted by bas-relief carvings at the entrance to Ankmahor's tomb from about 2400 BC.
Until the turn of the 20th century, podiatrists were independently licensed physicians, separate from the rest of organized medicine. Lewis Durlacher, appointed as surgeon-podiatrist to the British royal household in 1823, called for podiatry to be a protected profession.
Prominent figures including Napoleon and French kings employed personal podiatrists. President Abraham Lincoln sent his personal podiatrist, Isachar Zachrie, on confidential missions to confer with leaders of the Confederacy during the U.S. Civil War.
The first podiatric society was established in New York in 1895, and still operates there today as NYSPMA. The first podiatric school opened in 1911. One year later, the British established a podiatric society at the London Foot Hospital; a school was added in 1919. The first American podiatric journal appeared in 1907, followed in 1912 by a UK journal. In Australia, professional podiatric associations were organized as early as 1924, followed by a podiatric training center and professional podiatric journal in 1939.

Specific country practices

Australia

In Australia, podiatry is considered an allied health profession and is practised by individuals licensed by the Podiatry Board of Australia.
Australia recognizes two levels of professional accreditation, with ongoing lobbying for the recognition of other subspecialties. Some Commonwealth countries recognize Australian qualifications, allowing Australian podiatrists to practise abroad.

Registration and regulation

Australian podiatrists must register with the Podiatry Board of Australia, which regulates podiatrists and podiatric surgeons. The board also assesses foreign-trained registrants in conjunction with the Australian & New Zealand Podiatry Accreditation Council. It recognizes three pathways to attain specialist registration as a podiatric surgeon:
  1. Fellowship of the Australasian College of Podiatric Surgeons
  2. Doctor of Podiatric Surgery, University of Western Australia
  3. 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

To enter an undergraduate Podiatric Medicine program, applicants must have completed a Year 12 Certificate with an Australian Tertiary Admission Rank. Cut-off scores from the Universities Admissions Centre generally range from 70.00 to 95.00; prospective students who are 21 or older can instead apply directly to the university. The UWA 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 of valid study, suitable GAMSAT score, and English language competency. There is no interview requirement for the DPM at UWA.
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, pathophysiology, pharmacology, evidence-based medicine, sociology, and patient psychology, similar to the medical curriculum. The following year focuses on podiatry-specific areas such as podiatric anatomy & biomechanics, human gait, podiatric orthopaedics, podopaediatrics, sports medicine, rheumatology, diabetes, vascular medicine, mental health, wound care, neuroscience & neurology, pharmacology, general medicine, general pathology, local and general anaesthesia, minor and major podiatric surgical procedural techniques such as partial and total nail avulsions, matricectomy, cryotherapy, wound debridement, enucleation, suturing, other cutaneous and electro-surgical procedures and theoretical understanding of procedures performed by orthopaedic and podiatric surgeons.
Australian podiatric surgeons are specialist podiatrists with further advanced training in medicine and 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 must complete a 4-year degree, including 2 years of didactic study and 2 years of clinical experience, followed by a master's degree 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, 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 under the Health Insurance Act, recognising them as providers of professional attention for the purposes of health insurance rebates.

Australian podiatric medical schools

The following podiatric teaching centres are accredited by the Australian and New Zealand Podiatry Accreditation Council :
Some, including Charles Sturt University and University of Western Sydney, offer the degree Bachelor of Podiatric Medicine; others offer postgraduate degrees, such as the University of Western Australia's Doctor of Podiatric Medicine, and La Trobe University's Master of Podiatric Practice.
Two more podiatric schools are being developed, at the Australian Catholic University and the University of Ballarat.

Prescribing of scheduled medicines and referral rights

The prescribing rights of Australian podiatrists vary by state. All states allow registered podiatrists to use local anaesthesia for minor surgeries.
In Victoria, Western Australia, Queensland, South Australia, New South Wales: registered podiatrists and podiatric surgeons with an endorsement of scheduled medicines may prescribe relevant schedule 4 poisons.
In Western Australia and South Australia, podiatrists with Master's degrees in Podiatry and extensive training in pharmacology are authorised to prescribe Schedule 2, 3, 4, or 8 medicines.
In Queensland, Fellows of the Australasian College of Podiatric Surgeons are authorised to prescribe a range of Schedule 4 drugs and one Schedule 8 drug.
Prescriptions written by podiatrists do not qualify for the Pharmaceutical Benefits Scheme, despite lobbying to change this.
Some referrals from podiatrists are rebated by Medicare, while others are not eligible for Medicare rebates.

Canada

In Canada, the definition and scope of the practice of podiatry varies by province. A number of provinces, including British Columbia, Alberta, and Quebec, accept the qualification of Doctor of Podiatric Medicine ; in Quebec, other academic designations may also register.
In 2004, Université du Québec à Trois-Rivières 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 and leads to a DPM upon obtaining 195 credits.
The province of Ontario has been registering chiropodists since 1944, with 701 chiropodists and 54 podiatrists registered by the College of Chiropodists of Ontario as of December 31, 2019. Ontario makes a distinction between podiatrists and chiropodists. Podiatrists are required to have a DPM, whereas chiropodists need to obtain a 3-year graduate diploma in chiropody offered by Michener Institute of Education at University health Network. Podiatrists, unlike chiropodists, may bill OHIP, "communicate a diagnosis" to their patients, and perform surgical procedures on the bones of the forefoot. Registered podiatrists who relocate to Ontario are required to register with the province and practice as a chiropodist. Ontario legislation in 1991 imposed a cap on Ontario-trained chiropodists becoming podiatrists, while grandfathering in already-practising podiatrists.

Iran

There are no podiatric medical schools in Iran. The Ministry of Health and Medical Education reviews the dossier of podiatric applicants for medical registration according to the "Regulations on the Evaluation of the Educational Credentials of Foreign Graduates".
Applicants with podiatric degrees from the United States qualify for registration in Iran if they meet the following criteria:
  • possession of a bachelor's degree
  • passing score on the MCAT
  • completion of the podiatric curriculum of an accredited school, thereby obtaining the degree of Doctor of Podiatric Medicine
  • completion of a one-year postgraduate training
  • passing score on relevant board examinations