By Dr. Brian K. Bailey, Podiatric Physician & Surgeon
A podiatrist is a physician who specializes in medicine and surgery of the foot and ankle. It is a specialty that is often misunderstood as to what exactly is their scope of practice, what they are capable of as far as the amount of education and training is required, and their abilities in treating patients. In this issue we will try to explain the podiatrist’s role and shed some light on the profession, as well as clear up some “myths” about podiatry and the treatment of feet in general.
Today’s podiatrist typically completes a Bachelor’s Degree or equivalent from an undergraduate college or university. Then they matriculate into one of several specialized medical schools that focuses not just on feet, but also on general medical studies for about the first two years, usually alongside other students enrolled in MD or DO programs. The following two years of medical school focus more on medicine and surgery of the foot, ankle, and lower leg. During these years, students complete several month-long externship rotations at hospitals and physician offices to learn and gain clinical experience. Nationwide student board exams are completed during these years as well.
Upon completion of podiatric medical school, graduates earn a degree of Doctorate in Podiatric Medicine, or a “DPM” degree. Sometimes it is thought that podiatrists are MD’s that specialize in the feet. Others do not even know that podiatrists are considered “doctors” or physicians in this country. MD’s or DO’s that specialize in feet are usually orthopedic surgeons who have completed a general orthopedic residency and then a 1-year fellowship specifically for foot and ankle surgery. That is basically the only MD or DO specialty where physicians with those degrees deal specifically with the foot and ankle. This may be the reason why foot heath is typically neglected, and has led to the fact that podiatrists have been able to gain such a “foothold” in their profession over the years, no pun intended of course.
Today, podiatry graduates typically attend a 3-year foot and ankle surgical residency after podiatry school, with many rotations in other specialties, including orthopedic surgery, general surgery, vascular surgery, plastic surgery, dermatology, rheumatology, radiology, internal medicine, family practice, neurology, pathology, and behavioral medicine. During these outside rotations, resident podiatrists receive training in performing complete history and physical exams, ordering diagnostic tests, prescribing medications, performing surgery, and treating patients in hospitals, clinics, and offices alongside other DPM, MD, and DO residents of other specialties. Again, nationwide examinations are held to establish residents as Board Eligible or Board Qualified. After residency, podiatric physicians generally require up to 7 years to become Board Certified.
After residency, some podiatrists further their training at fellowship programs that last from 1 month to 1 year. They usually consist of foot and ankle orthopedic surgery, many of which are completed at the same programs with MD and DO orthopedic surgery residents.
In the past, some podiatrists may have had a variety of different amounts of training. Basically, the number of years of residency completed and the amount of surgery performed during these years has increased over time. This may be why the profession is a bit misunderstood, where one podiatrist may not do surgery, and another in the same area may be doing total ankle replacement surgery. A movement to bring uniformity to the amount and length of residency training of podiatric physicians is in place, which may help alleviate any ambiguity among the profession.
Once in practice, podiatrist can treat the foot, ankle, and lower leg, dependent on the scope of practice in the state in which they are treating patients. Again, this causes confusion as to what they are able to treat, where one state may allow foot surgery but not ankle surgery.
Many podiatric physicians perform general podiatry, where some may sub-specialize in areas such as dermatology, geriatrics, diabetic foot care, wound care, sports medicine, biomechanics, trauma, and orthopedic surgery. Most practice as solo practitioners or in small group practices, larger multi-specialty group practices, orthopedic group practices, and some are employed by hospitals. Several DPM’s also hold faculty positions at allopathic, osteopathic, and podiatric medical schools.
Today’s podiatrist diagnoses and treats a wide variety of conditions, employs a multitude of surgical and non-surgical treatment modalities, and plays a key role in foot health, which is imperative for the complete healthcare of an individual. They treat patients of all ages, from infants to seniors. They are essential for the comprehensive and preventive care for many people who suffer from diabetes, neuropathy, and peripheral vascular disease, and save our country millions of dollars in healthcare each year for this reason.
Body Mind Spirit Podiatric Center
500 14th Street, Ashland, Kentucky, 41101
Phone (606) 324-FOOT