Podiatry as a medical specialty has advanced greatly over the last fifty years. However, in certain areas, recognition and understanding of that advance by the general public and even the medical community has not followed. No longer a trade that simply treats toenails, corns, and calluses, podiatry has become the branch of medicine with the most expertise in foot and ankle medicine and surgery. This article will discuss common myths about podiatry, and the nature of this specialty in 2010.
Myth #1: Podiatrists only go to school for two years
After graduating from a four year undergraduate university, podiatrists go to school just as long as a medical doctor (MD), or doctor of osteopathy (DO). In fact, much of the first two years of podiatry school academic study are identical to those degrees. The difference begins in the third year, where podiatry students begin to develop experience in foot and ankle medicine. While podiatry students serve in many of the same hospital departments learning general medicine during the third and fourth year as MD and DO students, more of that time is spent in the field where they have already decided on specializing, as opposed to MD and DO students who are undecided on a specialty. Upon graduating, new podiatrists become hospital-based resident physicians for two to three years, learning advanced medical and surgical techniques, and usually are tasked with the same responsibilities as MD and DO interns and residents in those institutions. Only after that do podiatrists enter practice.
Myth #2: Podiatrist mainly treat nails and calluses
There was a time in the former half of the last century that podiatrists (then known as chiropodists) strictly treated nails, calluses, and simple foot pain. That time has long since passed. For the last forty years, podiatrists have treated every condition that could possibly affect the foot and ankle, from bunions and hammertoes, to serious infections and fractures, and even severe birth deformities. Podiatrists treat skin disorders, bone disorders, nerve disorders, injuries, and even have a role in circulation disorders. And yes, they even still treat toe nail disease and corns and calluses.
Myth #3: Podiatrists do not perform surgery
The specialty of podiatry is generally a surgical one, since many treatments performed by a podiatrist in or out of the office involve some hands-on procedure. While some of this is not surgery in the sense of involving an operating room and general anesthesia (like the in-office treatment of ingrown toenails, for example), much of what podiatrists do does involve traditional surgery. Nearly all podiatrists perform hospital or surgery center-based surgery. They become board certified in foot surgery, and American podiatrists are recognized world-wide as the experts in foot and ankle surgery. Podiatrists employ traditional orthopedic surgical techniques, and also pioneer procedures unique to the specialty to advance modern foot and ankle surgical knowledge. Podiatrists perform routine corrective surgery, but also serve on trauma teams and save lives with aggressive surgical intervention in diabetic foot infections. Some sub-specialize in pediatric surgery, while others concentrate on sports medicine.
Myth #4: Podiatrists use expensive shoe inserts to treat everything.
Part of the unique advantages of a podiatrist over another specialist who has cross-treatment of foot problems is the podiatrist’s education and understanding of the field of biomechanics. The foot has a unique structural, physiological, and engineering relationship with the ground as it pertains to body movement. Biomechanics involves the study of that relationship. Part of a podiatrist’s education is understanding this relationship, how it factors into foot disease and injury, and how it can be manipulated to prevent injury and disease. One of the greatest advances in this field in the last fifty years has been the development of the orthotic. Although any store-bought insert is now called an orthotic, the traditional and more accurate description of an orthotic is a molded plastic or composite insert that was formed over a model of one’s foot. This foot is manipulated during the modeling process such that the foot joint that controls flattening and excessive arching is held in an accepted zero degree position, thus ensuring the resulting orthotic will hold the arch in a biomechanically ideal position. Since many common foot injuries are related to excessive foot flattening, or less commonly a high arch, orthotics have a role in stabilizing and preventing that disease process. Orthotics are used as part of a treatment plan for many foot conditions, but are not a panacea for everything, and therefore use is limited to conditions for which they will be of benefit. As a prescription device, they unfortunately are expensive (comparable with many high quality eyeglasses). However, they are durable, and should last many years as long as one’s foot structure does not change much over time.
Myth #5: “Bone doctors” are better trained to treat foot injuries than podiatrists.
Orthopedic surgeons share with podiatrists treatment of many of the same conditions that involve the foot and ankle. However, most general orthopedic surgeons are not as specially trained in foot and ankle medicine and surgery as modern podiatrists, with most of their experience lying within the scope of trauma and fracture care. While orthopedic surgeons are highly trained specialists who excel in treating all other areas of the body, they have less training in elective foot reconstruction, non-surgical treatment of the foot, and foot biomechanics. There are orthopedic surgeons who specialize in the foot and ankle, with more fellowship training and experience. However, these fellowships are short compared with a typical podiatry residency, and emphasize surgical treatment over non-surgical treatment. By contrast, most podiatrists practice a mix of non-surgical medical therapy and surgical intervention, and have established themselves as the first line specialist for foot and ankle conditions due to their comprehensive training and breadth of treatment capabilities.
By understanding the role that podiatrists play in modern medicine, old myths about who provides foot care can be dispelled, and patients seeking expert care of the foot and ankle can find the appropriate physician to provide that treatment.