Podiatrist


A podiatrist is a medical professional devoted to the treatment of disorders of the foot, ankle, and related structures of the leg. The term originated in North America but has now become the accepted term in the English-speaking world for all practitioners of podiatric medicine. The term chiropodist was previously used in the United States, but it is now regarded in that country as antiquated.
In the United States, podiatrists are educated and licensed as Doctors of Podiatric Medicine. The preparatory education of most podiatric physicians—similar to the paths of traditional physicians —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 podiatry residency. Optional one- to two-year fellowship in foot and ankle reconstruction, surgical limb salvage, sports medicine, plastic surgery, pediatric foot and ankle surgery, and wound care is also available. Podiatric medical residencies and fellowships are accredited by the Council on Podiatric Medical Education. The overall scope of podiatric practice varies from state to state with a common focus on foot and ankle surgery.
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 nonsurgical treatment of foot pathology. In some circumstances, these practitioners will further specialise and, following further training, perform reconstructive foot and ankle surgery. In the United States, a podiatrist or podiatric surgeon shares the same model of medical education as osteopathic physicians and doctors of medicine with 4 years of medical school and 3-4 years of surgical residency focusing on the lower extremity.
Medical Group Management Association data shows that a general podiatrist with a single specialty earns a median salary of $230,357, while one with a multi-specialty practice type earns $270,263. However, a podiatric surgeon is reported to earn with a single specialty, with the median at $304,474 compared to that of multi-specialty podiatric surgeons of $286,201. First-year salaries around $150,000 with performance and productivity incentives are common if working as an associate. Private practice revenues for solo podiatrists vary widely, with the majority of solo practices grossing between $200,000 and $600,000 before overhead.

Podiatric specialties

Podiatrists treat a wide variety of foot and lower extremity conditions through nonsurgical and surgical approaches. The American Board of Podiatric Medicine offers a comprehensive board qualification and certification process in podiatric medicine and orthopedics. Subspecialties of podiatry include:
In Australia, Certificate IV in Allied Health Assistance is the required qualification to work as a podiatry assistant. The podiatry assistant can work as a part of a podiatric medical team in either clinical or non-clinical settings. Common professional accreditation pathways include:
Podiatric surgery is concerned with the diagnosis and surgical treatment of disorders of the foot and ankle:
  • Structural deformities, including bunions, hammertoes, flat feet, high arches, and bone spurs
  • Heel pain
  • Nerve entrapment
  • Joint degeneration and arthrosis
  • Skin and nail conditions
  • Congenital deformities such as clubfoot and polydactyly
  • Trauma, including fractures and dislocations
  • Ankle fractures
  • Deformity correction/reconstruction for things like malunion, limb length discrepancy, Charcot neuroarthropathy
  • Joint fusions for arthritis and other painful joint destructive conditions in the foot and ankle
  • Total ankle replacements
  • Total or hemi-joint replacements

    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.
Podiatrists scope of practice within Australia allows them to;
- Refer for a range of diagnostic imaging: x-ray, ultrasound, MRI etc.
- Assess a range of special patient groups including, paediatric patients, older patients, high-risk patients, sporting patients.
- Assess and treat a wide range of musculoskeletal injuries, including, fractures , tendon pathologies , plantar heel pain , ankle sprains, chronic ankle instability, foot/ankle/knee arthritis, medial tibial stress syndroms .
- Utilise a range of therapeutic modalities including, exercise prescription, electrotherapies , orthoses, footwear prescriptions, pharmacological prescriptions .
- Perform partial nail avulsion surgeries.
- Inject local anaesthetics.
- Perform routine & general nail care treatments.
- Assess & manage pediatric pathologies.
- Assess & manage high-risk patient groups in both private and hospital settings, including; perform neurovascular assessments, diabetic wound care.

Education and training

United States

In the United States, medical and surgical care of the foot and ankle is mainly provided by two groups of professionals: podiatrists and orthopedists.
The first two years of podiatric medical school is similar to training that either Doctors of Medicine or Doctors of Osteopathic Medicine receive, but with an emphasized scope on foot, ankle, and lower extremity. 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 and English are among the required subjects. 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. In 2019, the average MCAT score for matriculants was 499.6 and the average undergraduate cGPA was 3.3.
There are 11 colleges of podiatric medicine in the United States. 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.
The four-year podiatric medical school is followed by a hospital based residency, which is hands-on post-doctoral training. Their residency model was standardized to 3-years of post-graduate training in 2011, and the residency is now known as the Podiatric Medicine and Surgery Residency with almost all now having an added Reconstructive Rearfoot and Ankle credential. 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 and rehabilitation, vascular surgery, general surgery, orthopedic surgery, plastic surgery, dermatology and podiatric surgery and medicine. Fellowship training is available after residency in such fields such as foot and ankle traumatology, lower extremity reconstruction, or limb salvage.
Upon completion of their residency, podiatrists can decide to become board certified by a number of specialty boards including the and/or the American Board of Foot and Ankle Surgery, which are both approved by the profession's accrediting agency, the CPME, and both have been certifying podiatrists since the 1970s. Though the ABPM and ABFAS are more common, other boards not recognized by CPME are challenging the status quo confer board qualified/certified status. The American Board of Multiple Specialties in Podiatry is one additional option and has been certifying podiatrists since 1998.
The DPM superseded the historical DSC degree in the 1960s.

Australia

Australian podiatrists complete an undergraduate degree of Bachelor of Podiatry or Bachelor of 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 and that of other allied health disciplines.
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 and 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.
During the initial two years of study, podiatry students begin clinical placements, practicals and skills labs which give them exposure to a wide range of patients and treatment modalities.
For example; diabetic foot assessments, gait & biomechanical assessments, orthoses manufacture, clinical history taking, diagnostic imaging and general podiatry care.
Other topics studied in the final years of the degree include, podiatric sports medicine, exercise prescription & rehabilitation, advanced wound care and paediatric podiatry.
Postgraduate courses in podiatric therapeutics and prescribing are required for having endorsements in scheduled medicines.
The Australian Podiatry Association supports Career Framework credentials, that recognise advanced competencies and clinical skills of podiatrists in Australia.
The purpose is to provide an enhanced career progression beyond initial training that is both clear and transparent to consumers and the profession.
In awarding the credential, the APodA can verify podiatrists have demonstrated and provided evidence of competency in their clinical interest area and undergone a rigorous assessment process.
The APodA currently awards credentials in two clinical interest areas:
- Paediatrics
- Sports/Biomechanics
The curriculum and assessment of The APodA Career Framework has been structured around the CanMEDS framework. CanMEDS is a universally recognised and adopted physician competency framework. A credentialled podiatrist will therefore personify and seamlessly integrate the competencies of all seven CanMEDS Roles:
  1. Medical Expert
  2. Communicator
  3. Collaborator
  4. Leader
  5. Health Advocate
  6. Scholar
  7. Professional
Only current APodA members are eligible to promote their credentialling. That is, the title is only available to be used by active members of the Australian Podiatry Association.
All podiatrists are required to register with Australian Health Practitioner Regulation Agency prior to be licensed to practice in Australia.
Registration is required annually and there is a minimum registration standard that includes;
- Completing 20 hours of continuing professional development hours.
- Having current professional indemnity insurance.
- Having current CPR, First Aid & Anaphylaxis training.