Podiatry is a branch of medicine devoted to the study, diagnosis and treatment of disorders of the foot, ankle and lower leg.
A student podiatrist treats the foot of a patient at a homeless shelter in Homestead, Florida.

The term "podiatry" came into use first in the early 20th century United States where it now denotes a Doctor of Podiatric Medicine (DPM), also known as a podiatric physician or surgeon 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 also practiced in other countries such as Canada, Ireland, the United Kingdom, Malta, Cyprus, South Africa, Australia and New Zealand. 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[3]" or" "Podólogo" . The level and scope of practice may vary in these countries as compared in the US.

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Australia

In Australia, podiatry is classified as an allied health profession, and is practised by individuals licensed by their representative State Boards of Podiatry. There are seven registration boards and six teaching centres, with two levels of awards — unclassified bachelors degree and honours level. In Australia there exist 2 levels of professional accreditation and professional privilege: Podiatrist and Podiatric Surgeon (Surgical Podiatrist in the state of Queensland). Australian podiatrists are able to practise abroad with their qualifications recognised in some Commonwealth countries.
Registration and regulation

Currently, all podiatrists must be registered with the Podiatrists Registration Board in the state or territory they wish to practise in.

Podiatrists wishing to practise in the Northern Territory (which has no registration board) must be registered in at least one other jurisdiction (eg QLD, SA).

However, as part of proposed reforms to the Australian health system, there are plans to move podiatry (like other registered health professions) to a system of National Registration and Accreditation.

This is likely to occur on the 1st July 2010, and the transition to this major reorganisation of registration and oversight will be facilitated by the Australian & New Zealand Podiatry Accreditation Council (ANZPAC). It is likely there will be ongoing refinement of national policies relating to the practice of podiatry once this process has been completed.
Education and training

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 anatomy, medical chemistry, biochemistry, physiology 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, general medicine, general pathology, local and general anaesthesia, and surgical techniques such as partial and total nail avulsions, wound debridement, and other cutaneous and electrosurgical procedures.

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.[3] 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.
Prescribing and referral rights

There is considerable variation between state laws regarding the prescribing rights of Australian podiatrists.

While all registered podiatrists in each state or territory are able to utilize local anaesthesia for minor surgical techniques, some states allow suitably qualified podiatrists further privileges.

Recent legislative changes, which are expected to come into effect soon, will allow registered podiatrists and podiatric surgeons in Victoria graduates to prescribe relevant schedule 4 poisons.[4] 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.

 

Canada

In some parts of Canada the situation is legislatively stratified between the U.S. and British systems.

For instance, in some provinces like British Columbia and Alberta, the standards are the same Doctor of Podiatric Medicine (DPM) level as in the United States. Quebec, too, has recently changed to the DPM level of training. Also in Quebec, in 2004, Université du Québec à Trois-Rivières started the first program of Podiatric Medicine in Canada. In the prairie provinces, the standard has been based on the British model of chiropody. Recognising this fact, in the province of Ontario, chiropodists and podiatrists are legislatively distinct occupational designations. Ontario chiropodists have a narrower scope of permitted practice than Ontario podiatrists (i.e., limitations on surgical practice).

New Zealand

Chiropody became a registered profession in New Zealand in 1969 with the requirement that all applicants take a recognized three-year course of training. Soon after the professional title was changed from Chiropody to Podiatry and The New Zealand School of Podiatry was established in 1970 at Petone under the direction of John Gallocher. Later the school moved to the Central Institute of Technology, Upper Hutt, Wellington. In 1976 the profession gained the legal right to use a local anaesthetic and began to introduce minor surgical ingrown toenail procedures as part of the scope of practice.

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
United Kingdom

A podiatrist is qualified by their education and training to diagnose and treat conditions affecting the foot, ankle, and related structures of the leg. Podiatrists are uniquely qualified among medical and health professionals to treat the foot and ankle based on their education, training and experience. The scope of practice of UK podiatrists on registration after their degree in podiatric medicine includes the use and supply of some prescription only medicines, injection therapy and non-invasive surgery e.g. performing partial or total nail resection and removal, with chemical destruction of the tissues.

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.

In the United States, podiatric medicine and surgery is practiced by a licensed Doctor of Podiatric Medicine (DPM). Education consists of a professional doctoral degree which is a four-year program followed by a two or three year residency.

This training follows a four-year undergraduate college degree. The first year of podiatry 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. Thus there are five professions in the United States that allow for independent diagnosis and surgical treatment: Doctor of veterinary medicine (DVM), doctors of medicine or osteopathic medicine (MD or DO), podiatric medicine (DPM), dental medicine (DDS and DMD), and optometric medicine (OD).
A podiatry student examines the adduction angle of the hallux.

The four-year podiatry 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.

Podiatric Foot and Ankle Surgeons certified by the American Board of Podiatric Surgery (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. ABPS board certification in Foot Surgery is a prerequisite for board certification in Reconstructive Rearfoot/Ankle Surgery. A candidate must pass both the written, oral, and computer-based patient simulation questions in Foot Surgery as well as the written, oral, and computer-based patient simulation questions in Reconstructive Rearfoot/Ankle Surgery.

In addition, ABPS requires submission of 65 cases for certification in Foot Surgery and an additional 30 cases for certification in Reconstructive Rearfoot/Ankle Surgery, for a total of 95 cases. ABPS requires four years of post-DPM degree clinical experience before taking the certification examination. Additionally, diplomates must re-certify every 10 years to maintain their board-certified status, although some members who were certified prior to 1991 undergo a "self-test" examination, essentially circumventing taking the written exam all others must take in order to become re-certified.

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.
Early educational developments

William Scholl founded the Illinois College of Chiropody and Orthopaedics in 1912. Scholl was a Medical Doctor (MD) who felt the need to focus more on footcare. Just prior to Scholl founding a Chiropody college in Illinois, other innovators and individuals around the United States were founding other institutions of learning for foot care. Among these was M.J. Lewi, MD, who founded what is now the oldest and largest college of podiatric medicine located in New York City. His institution later became the M.J. Lewi School of Podiatric Medicine and ultimately became the New York College of Podiatric Medicine

The New York College of Podiatric Medicine notes that by 1911 the New York School of Chiropody had been created, dedicated to educating and training chiropodists. Maurice J. Lewi, a physician and educator, then serving as Secretary to the New York State Board of Examiners, was named the first president of the school.[9] Lewi assisted in developing the first legislation governing the practice of chiropody. He also developed the curricula and training programs for the first course of study at the school