What Is a Podiatrist?
A podiatrist diagnoses and treats conditions of the feet, ankles and related structures in the lower legs. They may also treat some conditions related to the lower back. A podiatrist is a doctor of podiatric medicine (DPM), and may also be referred to as a foot doctor, foot and ankle surgeon or podiatric surgeon.
Podiatrists may be employed in private practices, hospitals or clinical centers, or they may choose to work in an academic setting at colleges of podiatric medicine. Others may be involved in hospital administration in addition to their podiatry duties.
What Does a Podiatrist Do?
A podiatrist performs various duties throughout their day, including performing thorough assessment exams and consulting with patients regarding their feet and lower legs.
A diagnosis is made by performing a physical exam, by using laboratory tests such as blood tests or urinalysis, with x-rays, and through other methods. The podiatrist treats common foot troubles such as bunions, as well as complex foot and ankle surgeries such as the removal of bone spurs. They also prescribe medications and provide follow-up care instructions and advice. Podiatrists will also prescribe medical devices such as orthotics and arch supports in order to improve mobility and treat lower leg ailments and pain.
Some common foot and lower leg ailments treated by a podiatrist include ingrown toenails, cysts and tumors, flat feet, warts, corns, calluses, sprains and fractures and skin disorders such as plantar warts. In addition, they also treat foot deformities and walking or foot planting issues, or abnormal posture or gait. Foot deformities may result from birth defects or may be caused by neglect or damage, are also treated by a podiatrist.
Often, larger health issues such as arthritis or diabetes are often diagnosed through symptoms first seen by a podiatrist. Diabetic neuropathy is a condition in which indiscriminate cuts or sores on the feet become infected or cause muscle damage. In such cases, a podiatrist will involve another specialist to provide comprehensive medical treatment to the patient and treat the root cause of the foot, ankle or leg disorder.
Podiatry Sub-Specialty Fields
Podiatry itself is considered a medical specialty, but there are a number of subspecialties within the field of podiatry as well. Primary care podiatry focuses on podiatric conditions as related to the total family healthcare environment, and podiatric sports medicine treats foot and ankle injuries commonly occurring among athletes.
Pediatric care podiatrists treat children and adolescents including those with congenital foot defects. Surgical podiatrists focus on advanced surgical techniques, including foot and ankle reconstruction after injury. They are trained to utilize modern operative procedures to alleviate various foot, ankle and leg problems.
Wound care and management is a podiatry sub-specialty that focuses on the care and prevention of wounds, ulcers and injuries of the lower extremities, particularly as related to diabetes and other chronic diseases. Podiatric orthopedics is also known as biomechanics. These podiatrists offer non-surgical treatment of foot and leg structures and functions through special gear such as foot braces. There are also specialties in geriatrics, dermatology, vascular medicine, diabetes and other areas.
Basics of Foot Health
According to the American Podiatric Medical Association (APMA), most Americans have logged approximately 75,000 miles on their feet by the time they reach the age of 50. Simply walking throughout the day exerts a force on the feet to is equal to several hundred tons. Nearly 50% of all Americans experience issues or disorders with their feet at some point throughout their life. It is not a surprise that many Americans need podiatry services for the prevention and treatment of foot disorders.
Arthritis occurs when the cartilage or lining of the joints become inflamed and begin to swell. The human foot has 33 joints, so arthritis in the foot is a common foot condition seen by podiatrists.
Diabetes and Cardiovascular Disease
Podiatrists are involved in helping patients manage diabetes successfully and help them avoid foot-related diabetic complications. Diabetic wound care is necessary when the disease causes ulcers or open sores on the bottom of the feet. Hypertension (or high blood pressure) and vascular disease are also disorders a podiatrist will be involved in treating.
Other cardiovascular diseases that may involve a podiatrist are peripheral arterial disease (PAD) and peripheral neuropathy. PAD is caused by a blockage or narrowing of the arteries in the legs, and peripheral neuropathy is the damage of peripheral nerves such as in the toes and fingertips. Diabetes can also contribute to peripheral neurology.
Foot and Ankle Injuries
Podiatrists frequently treat sprains, strains and fractures of the feet, ankles and lower legs. A sprain is a soft tissue injury and a fracture is a break in the bone. Because the feet and ankles work together to provide support and mobility to the body, a foot or ankle injury can significantly affect a patient’s mobility.
Muscle and Tendon Problems
Muscle and tendon issues in the feet or ankles may involve deformities or heel pain. The heel bone is the largest bone in the human foot, so heel pain can cause significant discomfort for the patient. Tendonitis occurs when a tendon is inflamed. Achilles tendonitis is one of the most common forms of tendonitis seen by a podiatrist.
A variety of skin disorders are also treated by a podiatrist. Athlete’s foot is a fungal infection commonly found on feet because of the warm, dark environment created by shoes. Corns and calluses and psoriasis are also treated by a podiatrist. Skin cancer can also develop on the feet and ankles, and it may be difficult to notice because most skin cancers on the feet are painless.
Hyperhidrosis refers to excessive sweating of the feet. This can be an indication of a more serious issue, and the hyperhidrosis may occur in the palms as well. Plantar warts are also commonly treated by a podiatrist. They can be extremely painful depending on their location on the foot, although they can be in any location.
Toe Joint and Nerve Disorders
A bunion is when the joint at the base of the big toe is enlarged which can cause the tissue or bone around the joint to move out of place. Hammer toe is when the toe is bent at the top joint of the toe. Some bending can be so severe the toe is in the shape of a “V” when viewed from the side. Neuromas are also referred to as pinched nerves or nerve tumors, and they can be extremely painful.
Ingrown toenails are a common impairment treated by podiatrists. They can often lead to irritation, redness and swelling. A fungal infection underneath the toenails can cause degradation of the nail quality and color.
The History of Podiatry
Transportation by foot is a natural human trait (Pearson, 2017). Humans are unique in that we are bipedic, thus traveling on two feet. Feet take us everywhere, and they are extremely sensitive structures comprised of multiple bones with varying functions. They are sensitive, so much so that the sensory cortex of our brain devotes a disproportionate degree of cells to monitor pain, pressure and sensation (Pearson, 2017). Although not completely recognized, psychology is an important aspect of podiatry.
Ancient Beginnings of Podiatry
Historical evidence recovered in scrolls and tomb paintings suggest that people in Ancient Egypt suffered from various foot conditions. Ankmohor was a celebrated physician to the Egyptian Kings, and the entrance to his tomb contained markings depicting therapies to the hands and feet. He may have been one of the first podiatrists (or chiropodists) in history.
The introduction of footwear in the colder regions of the Northern Hemisphere would have led to an increase in foot disorders such as corns and callouses. This would have been the case as footwear developed as a fashion status and not necessarily for comfort or practicality.
The “father of medicine”, Hippocrates (460BCE – 370BCE), invented scrapers to reduce hard skin and callous, and his original scalpels are much like those used today (Pearson, 2017). Hippocrates is also known for a saying meaning “for those whose feet hurts everything hurts.” Paul of Egina (615-690 AD) defined corns as white circular bodies like the head of the nail, which formed on all parts of the body but were particularly present on the soles of the feet and toes.
The Roman Era
Romans tensed to view disease as spiritual affliction which was susceptible to incantations (Pearson, 2017). During this era, people would offer terracotta models in the shape of a foot to the gods for alleviation of their foot pain. During the reign of Henry VIII the ‘Quacks Act’ was introduced, which prevented the selling and administration of any substance used to alleviate outward sores and wounds (Pearson, 2017). This included conditions associated with the foot and any other body part. Of course, people just made their own homemade treatments for foot ailments and other issues.
Another issue during this time were the beliefs that foot deformities correlated to demonic possession, and many people, including children, were killed because of this belief.
The Emergence of Chiropodists
David Low wrote ‘Chiropodologia or a Scientific Enquiry into the Causes of Corns, Warts, Bunions and Other Painful or Offensive Cutaneous Excrescences’ after translating a 1781 French text by Nicholas-Laurent La Forest entitled ‘L’Art de Soignre les Pieds’ (Pearson, 2017). It was actually identified later that Low plagiarized the French text, so although he was the first to mention the term, he was only the first to do so in the English language.
During the 17th century, many aristocrats and wealthy people received podiatry services, known as chiropodist services at the time. In the 1700s, most of the services involved corn cutting, and the practitioners were referred to as corn cutters by some. These practitioners were highly regarded and were recommended for relieving foot pain.
The 1800s saw even more advances in the profession of chiropody. Textbooks were written and published by practicing chiropodists including Hyman Lion in 1802 with Treatise in Corns and Lewis Durlacher in 1845 with his complete text describing the treatment and care of various foot conditions.
Lewis Durlacher was the practitioner to George IV, William IV and Queen Victoria. He was the first to suggest that chiropodists should be regulated and their title protected. He also attempted to establish ‘a dispensary for diseases incidental to feet … for the gratuitous treatment of the needy’ which, in 1913, would become the London Foot Hospital (Pearson, 2017).
Durlacher wrote multiple texts on disorders and conditions related to the foot. His most significant work, perhaps, was his Treatise on Corns, Bunions, the Diseases of Nails and the General Management of the Feet. This publication was considered a definitive work and was referred to by chiropodists throughout England. By 1880, there were over 40 practicing chiropodists in England.
The practice of chiropody spread throughout Europe and began in the United States with an English settler by the name of Isachar Zacharie, who began practicing his profession in New York and eventually in Washington DC. Zacharie was the chiropodist to President Abraham Lincoln, and President Lincoln wrote in 1862 that Dr. Zacharie successfully operated on Lincoln’s feet and added to his comfort (Pearson, 2017).
At President Lincoln’s request, Zacharie traveled to New Orleans to help stabilize Jewish support for the Union in the Civil War. While in New Orleans, he treated approximately 15,000 soldiers with extremely ravaged foot disorders and conditions. Although he submitted a bill to the War Department after the war, he was never paid for his services.
The United States took the global lead in officially recognizing chiropody as a profession requiring a collective representation when, in 1895, the Society of Chiropodists was founded in New York. Its first official Journal was published in 1907, and the first school podiatry school was opened in 1911. This led to the continuing development of podiatry, and many educational and academic institutions followed suit.
In 1984, the American Podiatry Association became known as the American Podiatric Medical Association (APMA, 2017). The focus of the APMA is to bring awareness to podiatry as a professional medical field, in addition to developing the field as a profession. The APMA is currently headquartered in Bethesda, MD and they are considered the leading resource for foot and ankle health information.
Modern podiatry is focused on education and specialized training, in addition to the treatment of all foot, ankle and lower leg disorders. They treat problems from corns and calluses to foot disorders caused by diabetes or hypertension, in addition to traumatic or sports injuries.
How to Become a Podiatrist
An aspiring podiatrist will have to complete an undergraduate education in addition to a 4-year podiatry program, followed by a residency. A podiatrist must be licensed in order to legally treat patients, and some may receive additional education and training through a fellowship before they begin to practice. A Doctor of Pediatric Medicine (DPM) degree will be rewarded to the students who complete the extensive education and training required.
The required education and training takes approximately 10 years to complete. Undergraduate degrees in pre-medical or other science (biology, chemistry, physics) help the student prepare for the Medical College Admission Test (MCAT) exam, although there are no specific requirements for the undergraduate degree major. Some students choose to major in humanities or social sciences (sociology, psychology, anthropology, foreign language or literature) as well.
It is extremely competitive for medical school acceptance. Volunteering at local hospitals or other medical centers during the undergraduate years is recommended to obtain hands-on experience in the health care profession. Some aspiring proctologists complete a Master’s degree program prior to applying to medical school in order to display additional education and training on their medical school application.
There are currently only 9 programs in the United States that are accredited by the American Association of Colleges of Podiatric Medicine, which makes acceptance incredibly competitive.
The first two years of medical school includes coursework in anatomy, biochemistry, medical law and ethics, microbiology, pathology, pharmacology, physiology and psychology. Additional training may include procedures for physical examinations, examining medical histories and diagnostic testing. The last two years of most medical schools consists of hands-on experience under the supervision of a licensed physician. Rotations allow students to receive training in a variety of areas including internal medicine, family practice, obstetrics and gynecology, pediatrics, psychiatry and surgery.
A podiatry medical program is specialized, and the last two years often consist of podiatry-specific courses such as lower-extremity biomechanics, lower-limb anatomy and podiatric trauma. Clinical rotations in a podiatry program include radiology, podiatric surgery, clinical anatomy, neuroscience, biomechanics, pharmacology and pathology.
Most states require completion of a 1- to 3-year postdoctoral residency program and continuing medical education (CME) for license renewal. Residents receive advanced training in podiatric medicine and surgery and perform clinical rotations in anesthesiology, emergency medicine, internal medicine, orthopedic and general surgery, pathology and radiology. Residency programs also involve biomechanics, orthopedics, wound care, medicine and surgery.
Licensing and Certification
A podiatrist must be licensed in the state they wish to practice in, although some states will accept licensing from other states. To obtain a license, a podiatrist must take and pass a written and oral or clinical examination. The licensing organization for podiatry is the National Board of Podiatric Medical Examiners (NBPME) in most states.
The American Board of Podiatric Medicine and the American Society of Podiatric Surgeons both offer certification to licensed podiatrists. Certification typically requires continuing education, which is available through medical seminars and workshops.
The ABPM is the certifying organization for the profession of podiatry and podiatric orthopedics, and the American Board of Foot and Ankle Surgery (ABFAS) is the certifying board for podiatrists specializing in foot and ankle surgery.
Podiatry Job Prospects
Podiatrists may work in private or group practices, hospitals or outpatient care facilities, while others may work in nursing homes or extended-care facilities. The Bureau of Labor Statistics (BLS) projects a job growth of up to 23% by the year 2022, which is much faster than the average across other occupations. A recent workforce study indicates that the nation’s eight colleges of podiatric medicine would have to triple their graduates between now and 2014 in order to meet growing population demands (IPMA, 2017).
This expected growth is due in part to the increased incidence of diabetes and heart disease in addition to an aging population. The average salary for a podiatrist in the United States is over $137,000, and the median salary is over $116,000. There are currently 15,000 podiatrists licensed in the US. In 2002, podiatrists provided close to 40 percent of all foot care services in the United States, compared to 13 percent for orthopedic physicians and 37 percent for all other physicians, including primary care doctors (IPMA, 2017).
The current podiatry workforce has an average age of 45, which indicates a higher average age than the overall workforce in the US. This is another factor to consider if you are thinking of pursuing a career in podiatry. Podiatrists report a high level of job satisfaction because of flexible schedules and desirable salaries.
In 2007, podiatric medicine placed 15th on Forbes survey of "America’s 25 Best Paying Jobs." In addition, podiatry’s working conditions in comparison to other medical specialties offer more options in practice structure, giving both those seeking an engaging, always-on-call atmosphere in a hospital emergency room and those looking for a more laid-back, family-friendly schedule the opportunity to each thrive in their respective workplaces (IPMA, 2017).
Other Skills for Podiatrists
In addition to extensive education and training, a podiatrist will need additional skills to be successful in their profession. Other skills needed to be a successful podiatrist are an interest in working with people and good interpersonal skills, an aptitude for science, critical thinking skills, academic ability and ambition, comfort with instruments and precision equipment and detail-oriented. A podiatrist must have scientific aptitude as well as the ability to communicate with patients and coordinate with other medical specialists.
APMA – American Podiatric Medical Association. What is a Podiatrist? 2017. Retrieved October 10, 2017 from: http://www.apma.org/Education/content.cfm?ItemNumber=992
Study.com. Podiatry Training Programs and Requirements. 2017. Retrieved October 10, 2017 from: http://study.com/podiatry_training.html
Pearson, John. A Brief History of Chiropody and Podiatry. January 18, 2015. Retrieved October 10, 2017 from: https://johnrpearson.wordpress.com/tag/a-brief-history-of-chiropody-and-podiatry/
IPMA – Illinois Podiatric Medical Association. Careers in Podiatric Medicine, 2008. Retrieved October 10, 2017 from: http://www.ipma.net/?page=A2