Podiatry

Podiatry is a branch of medicine devoted to the study, diagnosis, and treatment of disorders of the foot, ankle, and lower leg. The term podiatry came into use first in the early 20th century United States, where it now denotes a Doctor of Podiatric Medicine (DPM), a specialist 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 practiced as a specialty in many countries including Australia, Brunei, Canada, Cyprus, Ireland, Malta, New Zealand, Singapore, South Africa, the United Kingdom, and the United States. In many English-speaking countries, the older title of "chiropodist" may still be used by some clinicians. In many non-English-speaking countries of Europe, the title used instead of podiatrist may be "podologist" or "Podólogo". The level and scope of the practice of podiatry varies among countries. Podiatry is a very high paying specialty and was listed by Forbes as the 15th best paid profession in the United States.

History
The professional care of feet was in existence in ancient Egypt as evidenced by bas-relief carvings at the entrance to Ankmahor's tomb dating from about 2400 BC where work on hands and feet is depicted.

Corns and calluses were described by Hippocrates who recognised the need to physically reduce hard skin, followed by removal of the cause. He invented skin scrapers for this purpose and these were the original scalpels. Aulus Cornelius Celsus, a Roman scientist and philosopher, was probably responsible for giving corns their name. Later Paul of Aegina (AD 615–690) defined a corn as "a white circular body like the head of a nail, forming in all parts of the body, but more especially on the soles of the feet and the toes. It may be removed in the course of some time by paring away the prominent part of it constantly with a scalpel or rubbing it down with pumice. The same thing can be done with a callus."

Until the turn of the 20th century, chiropodists—now known as podiatrists—were separate from organized medicine. They were independently licensed physicians who treated the feet, ankles and related leg structures. Lewis Durlacher was one of the first people to call for a protected profession. He held the appointment of Surgeon-Chiropodist successivley to King George IV, King William IV and eventually also to Queen Victoria. He tried to establish the first association of practitioners in 1854, although it would take another century to come to pass.

There are records of the King of France employing a personal podiatrist, as did Napoleon. In the United States, President Abraham Lincoln suffered greatly with his feet and chose a chiropodist named Isachar Zacharie, who not only cared for the president’s feet, but also was sent by President Lincoln on confidential missions to confer with leaders of the Confederacy during the U.S. Civil War.

The first society of chiropodists, now known as podiatrists, was established in—and still operates in—New York in 1895 as NYSPMA, with the first school opening in 1911. One year later the British established a society at the London Foot Hospital and a school was added in 1919. In Australia professional associations appeared from 1924 onwards. The first American journal appeared in 1907, followed in 1912 by a UK journal. In 1939, the Australians introduced a training centre as well as a professional journal. The number of chiropodists increased markedly after the Great War then again after World War II.

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 medical doctors or osteopathic doctors 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 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.

The four-year podiatric medical school is followed by a residency, which is hands-on post-doctoral training. There are two standard residencies: Podiatric Medicine & Surgery 24 and Podiatric Medicine & Surgery 36 (PM&S 24 or PM&S 36). These represent the two- or three-year residency training. By July 2013, all residency programs in podiatry will be required to transition to a minimum three-years of post-doctoral training. Podiatric residents rotate through core areas of medicine such as emergency medicine, internal medicine, infectious disease, behavioral medicine, physical medicine & rehabilitation, vascular surgery, general surgery, orthopedic surgery, plastic surgery, dermatology and of course podiatry — both clinic and surgical. During these rotations, surgeons and physicians train the resident podiatrists in medicine and surgery of the foot and ankle. Fellowships are available for further training and experience after residency.

Podiatric Surgical Training
Upon completion of their residency, podiatrists can become board certified by either the American Board of Podiatric Orthopedics and Primary Podiatric Medicine and/or the American Board of Podiatric Surgery. 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.

Podiatrists certified by the ABPS have successfully completed an intense board certification process comparable to that undertaken by individual MD and DO specialties. There are two surgical certifications under ABPS. They are Foot Surgery and Reconstructive Rearfoot/Ankle (RRA) Surgery. In order to be Board Certified in RRA, the sitting candidate has to have already achieved board certification in Foot Surgery. Certification by ABPS requires initial successful passing of the written examination. Then the candidate is required to submit surgical logs indicating experience and variety. Once accepted, the candidate has to successfully pass oral examination and computer questions of clinical simulation.

Practice characteristics
While the majority of podiatric physicians are in solo practice, there has been a movement toward larger group practices as well as the use of podiatrists in multi-specialty groups including orthopedic groups, treating diabetes, or in multi-specialty orthopedic surgical groups. Some podiatrists work within clinic practices such as the Indian Health System (IHS), the Rural Health Centers (RHC) and Community Health Center (FQHC) systems established by the US government to provide services to under-insured and non-insured patients as well as within the United States Department of Veterans Affairs providing care to veterans of military service.

Some podiatrists have primarily surgical practices. Some specialists complete additional fellowship training in reconstruction of the foot and ankle from the effect of diabetes or physical trauma. Other surgeons practice minimally invasive percutaneous surgery for cosmetic correction of hammer toes and bunions. Podiatrists utilize medical, orthopedic, biomechanical and surgical principles to maintain and correct foot deformities.

Podiatric Medical School is the term used to designate the institutions which educate students and train them to be podiatric physicians. In the United States, only schools which are accredited by the Council on Podiatric Medical Education (CPME) may earn the status of being a "Podiatric Medical School". The Doctor of Podiatric Medicine degree is commonly abbreviated D.P.M. degree. The D.P.M. degree is in fact a pre-requisite for an individual to be accepted into a CPME accredited surgical residency.

Podiatric medical education in the United States consists of four (4) years of graduate education with the first two focusing primarily upon the sciences and the last two focusing upon didactic, clinical, and hospital externship experience. After successful completion of these four (4) years of professional education, students are granted a Doctor of Podiatric Medicine (D.P.M.) degree.

Residency
In order to enhance the progression from student doctor to competent podiatric physician and podiatric surgeon status, graduates are required to complete a two or three year residency program before practicing podiatric medicine. Each individual residency program must be approved by the Council on Podiatric Medical Education of the American Podiatric Medical Association. The American Association of Colleges of Podiatric Medicine provides a complete list of approved Podiatric Residency Programs.

Accreditation and Governing Bodies
All podiatric medical schools in the United States are accredited by the Council on Podiatric Medical Education.The American Association of Colleges of Podiatric Medicine is in charge of governing many aspects of Podiatric Medical Education including a mentor network, a centralized application service for prospective students, the Central Application Service for Podiatric Residencies (CASPR), and the Centralized Residency Interview Program (CRIP). In addition, students are represented by the American Podiatric Medical Student's Association. Each school is also accredited by their respective state and/or regional accrediting association.

Schools in USA
There are nine acredited podiatric medical schools in the United States.

All nine podiatric medical schools in the United States are affiliated with colleges or universities, while the remaining two continue to exist as independent academic institutions.

The nine podiatric medical schools (all are accredited by the rigorous standards established by the CPME) in the U.S. are:

    Arizona Podiatric Medicine Program at Midwestern University AZPOD
    Barry University School of Podiatric Medicine BUSPM
    California School of Podiatric Medicine at Samuel Merritt University CSPM
    Des Moines University College of Podiatric Medicine and Surgery DMU
    New York College of Podiatric Medicine NYCPM
    Ohio College of Podiatric Medicine OCPM
    Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University SCPM
    Temple University School of Podiatric Medicine TUSPM
    College of Podiatric Medicine at Western University of Health Sciences

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