Podiatry is a branch of medicine devoted to the study and treatment of disorders of the leg and foot . ‘Podiatrist’ is a reserved title in the UK, meaning that it can only be used by those registered with the Health Professions Council. Within the United Kingdom, the titles “podiatrist” and “chiropodist” are to some extent interchangeable. Although the UK government-appointed regulator acknowledges both titles and makes no distinction between them, they are used differently within the occupation. Inside the profession, chiropody is used to suggest the routine processes of foot care, whilst podiatry is indicative of the higher skills and academic levels. Most United States jurisdictions grant more invasive surgical privileges to podiatrists due to more intensive podiatric medical education in the US. The curriculum of many U.S. podiatric medical schools mirrors the first year of MD medical programs.

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 exists 2 levels of professional accreditation and professional privilege; Podiatrist and Podiatric Surgeon (Surgical Podiatrist in the state of Queensland). Australian podiatrists are able to practice abroad with their qualifications recognised in some Commonwealth countries.

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, and electrosurgical procedures.

Australian podiatric surgeons are specialist podiatrists with further training in basic medicine, basic pharmacology, and training in foot surgery. They first complete a degree of 4 years, 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), and passing oral and written exams, Registrars may qualify for Fellowship status.

Prescribing rights

There is considerable variation between state laws regarding the prescribing rights of Australian podiatrists. While all are able to utilize local anaesthesia for minor surgical techniques, some states allow suitable qualified podiatrists further privileges. Recent legislative changes, which are expected to come into effect soon, will allow Victorian graduates 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. States such as Queensland and New South Wales only grant prescribing privilege to those who are fellows of the Australasian College of Podiatric Surgeons, and thus are Podiatric Surgeons.

United Kingdom

A podiatrist is a specialist professional who studies leg and foot pathology from a structural and functional standpoint and treats conditions of theleg and foot.

In the UK their scope of practice covers:

• Minor foot ailments
• High risk patient management
• Sports injuries and biomechanics
• Foot and nail surgery
• Foot health education

In the UK, podiatrists may continue their studies and qualify as podiatric surgeons. Podiatric surgeons practice more invasive surgery to that of podiatrists. In the UK, individuals may not use the title “podiatrist” or “chiropodist” unless they are registrants of the Health Professions Council (HPC). They are protected titles and their use by non-registrants is unlawful. Such registration is normally only granted to those holding a specialised Bachelors degree or Diploma in Podiatry from one of the 13 recognised schools of podiatry in the UK.

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.

Appropriately qualified podiatrists are licensed to access and supply a limited range of POMs including antibiotics and steroids for injection.

United States

In the United States, podiatric medicine and surgery is practiced by a licensed Doctor of Podiatric Medicine (DPM). Education consists of a second entry degree which is a four-year program followed by a two- or three-year residency. Similar to Medical School, this training follows their four-year undergraduate college degree. The first year of podiatric medical school is similar to training that traditional physicians (either medical doctors or osteopathic doctors) receive, but with more emphasis on foot, ankle and lower extremity problems and less emphasis on other topics such as embryology and pediatrics. Some of the podiatric medical schools are integrating into MD and DO schools for the first year or two. 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. The D.P.M. degree itself takes a minimum of four years to complete. Dentists likewise, have a separate educational school system. Thus there are four medical professions in the United States that allow for independent diagnosis and treatment: allopathic and osteopathic medicine (M.D. and D.O.); podiatric medicine, (D.P.M.); dental medicine (D.D.S. and D.M.D.); and, optometry (O.D.). (In some states, optometrists are permitted to perform chemical dilation to diagnose macular degeneration and other common diseases of the eye; however, only practitioners of the first three professions may perform surgery.)

The four-year podiatric medical school is followed by a residency, which is the 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, orthopedic and general surgery and of course podiatry — both clinic and surgical. During these rotations, attending physicians train the resident physicians in medicine and surgery. The surgical training varies from forefoot surgery to more complex foot, ankle, and leg reconstruction and salvage as well as trauma.

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 passage of the 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.

In the United States, the previous titles used for the Doctor of Podiatric Medicine (D.P.M.) degree were Doctor of Surgical Chiropody (D.S.C.) and Doctor of Podiatry (Pod.D.) Podiatry in the US currently encompasses a broader spectrum of medical practice than it used to. Podiatrists can now perform medical and surgical procedures in all 50 states, though the specific scope of practice does vary slightly in each state.