What is Podiatric Medicine?

Podiatric Medicine is the health care specialty that provides comprehensive medical treatment of the foot.

What is a Podiatrist?

Throughout the United States and Puerto Rico, most people know that a "Podiatrist" is the term for an individual with a Doctor of Podiatric Medicine (D.P.M.) degree. The podiatric physician is a health professional specialist who is involved with examination, prevention, diagnosis and treatment of foot and ankle disorders by the use of physical, medical and surgical means.

The term "podiatrist" means the same thing in most of Canada, too, although there is a little less familiarity with the profession since there are no schools that teach podiatric medicine in Canada, and there are currently only a few post-graduate residency training positions here.

But the term "podiatrist" can be a little confusing to some because in different countries, and even in some parts of Canada, the term may be misused. More on this below.

What kind of foot and ankle conditions do podiatrists treat?

Podiatrists treat virtually any medical abnormality of the foot--including arch pain, heel pain, flat feet, shin splints, sports medicine, bunions, hammertoes, neuromas, nail problems, skin problems, infections, fractures, trauma, corns, calluses, warts, diabetes and complicated surgical problems.

Many podiatrists have areas of specialization, depending upon their individual interests, specialized training, and expertise.

Where do podiatrists work?

Most of North America's 16,000 podiatrists work in private practice, though some have group practices with other podiatrists and/or other medical specialties.

Most podiatrists have some sort of affiliation with one or more hospitals, and according to a 1998 survey of U.S. hospitals, most hospitals (over 80%) have a podiatrist as part of their medical staff. This is more true in the U.S. where there are a lot more podiatrists than in Canada.

What kind of training do Podiatrists (D.P.M.'s) have?

In order to become a Doctor of Podiatric Medicine, one must attend a university to obtain basic undergraduate science training. This typically takes four years of study, and most graduate with a Bachelor of Science (B.S. or B.Sc.) degree.

After undergraduate studies, a prospective podiatrist enters into an additional four-year course of study in podiatric medicine. Like with general medicine, podiatrists study basic medical science, then receive practical training in hospitals all over the country. This training encompasses all areas of medicine, including family practice, surgery, emergency room, anaesthesiology, radiology and so forth, albeit with additional classes and a stronger emphasis on the lower extremity (the foot and leg) than medical doctors receive.

The D.P.M. degree is granted at one of eight specialized schools in the United States--in New York City, Philadelphia, Cleveland, Chicago, Des Moines, Miami, Phoenix and San Francisco. Some podiatric medical schools offer a dual D.P.M.-Ph.D. degree program, in conjunction with studies at affiliated major universities.

Additionally, a program has recently opened up at the University of Quebec's Trois-Rivières campus (in the city of Trois-Rivières, Quebec). This program, affiliated with the New York College of Podiatric Medicine, is the first and only school offering the D.P.M. (Doctor of Podiatric Medicine) degree in Canada, and it is the only program offering the D.P.M. degree program in French.

After obtaining the D.P.M. degree, a podiatrist then does a broad-ranging residency program, with an emphasis in various fields of specialization. Specialties within podiatric residency programs include fields as disparate as: foot and ankle surgery, medicine, geriatrics (the elderly), pediatrics (children), sports medicine, the diabetic foot, trauma, and biomechanics (the study of the mechanical function of the body).

Podiatric residency programs are found all over the United States, in some of the finest medical institutions in the world, including Harvard University's Cambridge and Deaconness Hospitals, Columbia University's New York-Presbyterian Hospital System, Yale University's DVAMC West Haven Hospital, the University of Chicago hospital system, Western Pennsylvania Hospital, the University of Texas Health Science Center in San Antonio, and our own facility, Vancouver Hospital and Health Sciences Centre Hospital / University of British Columbia.

This residency process typically takes two to three more years after graduating school with a doctorate (D.P.M.), depending upon the area of specialty.

Additionally, many podiatrists pursue fellowship training in a sub-specialty field.

So, in total, the typical podiatrist being licensed today has between 10 and 12 years of education after high school.

After undergraduate education, graduate education, and residency, fellowship training in a variety of specialized fields (the diabetic foot, biomechanics, specialized surgery) is also available to podiatric physicians.

Beyond this, many podiatrists choose to pursue board certification.    There are two boards recognized by the American Podiatric Medical Association: The American Board of Podiatric Orthopedics and Primary Podiatric Medicine and the American Board of Podiatric Surgery . In order to become board certified by one of these organizations, specific areas of training are required, and the podiatrist must pass a strenuous written and oral examinations. For more information about board certification and what it means, please visit our web page on board certification.

Does this training mean that a Podiatrist is the same as an Orthopedic Surgeon?

No.

First the similarities:

An orthopedic surgeon would have taken the same basic undergraduate classes in a university that a podiatrist would have taken.   For the most part, these courses are the basic sciences.

An orthopedic surgeon would have taken the same test to get admitted to medical school that a podiatrist would have taken.   This test is the MCAT, the Medical College Aptitude Test. (This is true in the U.S.. In other nations other tests may be used.)

The basic medical training an orthopedic surgeon would have received would be the same length (4 years) that a podiatrist would have received.

The content of each groups training would be similar, though podiatrists take some additional courses specifically relating to the podiatric profession. For example, while both groups take gross anatomy, (anatomy of the whole body), podiatrists take an additional anatomy course specifically devoted to the anatomy of the lower extremity.

In both cases, the orthopedist and the podiatrist graduate from their respective medical training with a post-graduate medical degree.

The residency program for orthopedists and podiatrist both include rotations in most major departments in the hospital--emergency medicine, family medicine, general surgery, anesthesiology, and so forth.

Orthopedic surgeons and podiatrists may both pursue specialized fellowship programs beyond residency training. Some of these orthopedic programs, (and all podiatric programs), are devoted to the foot.

Now some differences:

Orthopedists receive a general Medical Doctor degree. This is the same degree your family physician receives. Podiatrists receive a degree more specific to the foot---the Doctor of Podiatric Medicine, or D.P.M., degree.

Although many rotations through the hospital are the same for both groups, orthopedic residencies usually have differences with podiatric residencies. For example, most orthopedic residency programs run 5 years and encompass training in orthopedic conditions throughout the body. For example, orthopedists would receive more training in knee surgery, hip surgery, back surgery, shoulder surgery, elbow surgery, hand surgery, and so forth. This means relatively less time--usually 3 or 4 months during those 5 years--devoted to the foot. In contrast, podiatric programs usually run 2-4 years, with less time devoted to surgery for other parts of the body, and with the majority of the residency time spent specifically to the foot and ankle.

Some orthopedists choose to specialize in the foot, and they may (or may not) receive additional training through a fellowship program in this area. These foot fellowship programs typically last 1 year, though some are 6 months in length. However, there is no orthopedic board certification program specifically devoted to the foot. The only board certification available to orthopedists is in general orthopedics. In contrast, podiatric physicians may also pursue additional fellowship training, but because the podiatric profession is already dedicated to the foot, these podiatric fellowship programs are usually in sub-specialties in the foot--in fields such as the diabetic foot, the pediatric foot, biomechanics, foot and ankle surgery, and so forth.   Podiatric medicine has board certification in the sub-specialties of foot and ankle surgery, foot and ankle orthopedics and primary podiatric medicine. Podiatric radiology, podiatric dermatology, pediatrics, podiatric sports medicine and other sub-specialties offer other types of professional specialty membership programs.

While both groups may offer the patient similar treatment options, there may be differences in both the philosophies and treatment plans between orthopedists and podiatrists.

Is a Podiatrist the same as a Chiropodist?

A U.S.-trained podiatrist is not a chiropodist, no. But in some parts of Canada, the use of these words is a little more confusing than that, and requires some explanation to fully understand it.

The term "chiropodist" and the profession of chiropody is British in origin. It has been traditionally used to describe an individual who treats feet in various ways, and up until the 1950's and earlier, there were chiropodists in both the U.S. (where Abraham Lincoln had a chiropodist) and Canada based on that British standard.

With the advancements in medicine, however, it gradually became evident in the U.S. that the level of education received by chiropodists was inadequate to allow practitioners to practice in a comprehensive way. Hence, in the 1950's, the profession of chiropody was abandoned in the U.S., and podiatric medicine, with its much lengthier training, developed. This is known as the "Doctor of Podiatric Medicine" standard.

Because of these changes, the term "chiropody" or "chiropodist" has not existed in the United States for about 50 years now. So there is little confusion between the terms "chiropodist" and "podiatrist" in the U.S.

The situation in parts of Canada is not so clear-cut.

Provinces with "Doctors of Podiatric Medicine"
While chiropody was being abandoned and podiatric medicine was being born in the United States, Canada was caught somewhat between the influence of its British heritage and the influence of the United States' changing standard.   As all the schools of podiatric medicine were (and still are) located in the United States, however, provinces like Ontario, British Columbia and Alberta quickly adopted the U.S.-based podiatric standard.   Quebec adopted the U.S. standard sometime later.

In these locations, the term "podiatrist" has the same meaning as in the United States.

In those provinces where chiropodists of one sort or another continue to practice makes things much more confusing.

Chiropodists in Ontario
While Ontario also accepted the U.S. standard, and there are quite a few podiatrists practicing in that province, Ontario has also added a new level of chiropody training into the mix.   While it had been a 2-year program, current licensing requirements for this group in Ontario involves a 3-year course after high school, leading to a "Diploma of Chiropody". The "Diploma of Chiropody" or "DCh" designation is accepted in Ontario, but is not recognized in other locations. Those with a DCh following their name are known as "chiropodists". They are not called "podiatrists" because that would confuse them with the "Doctors of Podiatric Medicine" who already practice in Ontario.

Chiropodists in New Brunswick
Chiropodists also practice in New Brunswick. Because there is no podiatric (meaning "Doctor of Podiatric Medicine") organization in the province, these practitioners use the title "podiatrist" even though they have no degree in the field.

In fact, some chiropodists who practice there may have as little as a 2-year educational program after high school, yet have begun calling themselves "D.P.", or Doctor of Podiatry. This despite the fact that they have earned no doctorate in podiatric medicine. And this despite the fact that there is no "D.P." degree offered anywhere in the world.

British-trained practitioners in Saskatchewan and Manitoba
While U.S.-trained podiatrists are licensed in Saskatchewan and Manitoba, too, these provinces are unique in Canada in that they continuing to follow the British standard as the minimum requirement to practice there.

Influenced by the success of podiatric medicine in the United States, British educational institutions have, over the years, expanded the curriculum of the foot-care education offered. For years the program offered a 3-year chiropody training program after high school. And to emulate U.S. program, the educational institutions began offering what they termed a "D.Pod.M.", a "diploma in podiatric medicine".

This isn't so confusing in places like Britain where there are no DPMs, (Doctors of Podiatric Medicine). But the "D.Pod.M." diploma in podiatric medicine that those trained in Britain have following their name is not the same as a doctorate-level degree that Doctors of Podiatric Medicine have. So in a place like Canada, where Doctors of Podiatric Medicine already existed, the issue of two groups with very different levels of training, yet with very similar sets of letters following their names ("D.Pod.M." versus "D.P.M."), was clearly unnecessarily confusing.

Fortunately, the British have updated the educational system since that time. They now offer a degree called a "B.Sc. (Podiatry). This is also true in British Commonwealth countries such as Australia, New Zealand, and South Africa. The overly-confusing "D.Pod.M." diploma is no longer granted, though there are still quite a few practitioners in Britain, Saskatchewan and Manitoba with the the "D.Pod.M." diploma.

The B.Sc. (Podiatry) program now offered in Britain, (and in British Commonwealth countries like Australia, New Zealand, and South Africa), is similar to the chiropody program in Ontario in that it involves at least a 3-year program following high school.

But the B.Sc. (Podiatry) program differs from the Ontario program in that there is an actual degree offered in lieu of the diploma offered in Ontario. The British system also differs from the Ontario system in that some individuals may choose to pursue additional training programs on top of the basic program. This is unavailable to those who follow the DCh path in Ontario. For example, some British-trained individuals may pursue a Masters or Ph.D. in the field. This is certainly an advance in the education of British-trained individuals, and it's certainly a benefit to patients. However, additional training is not required for licensure in Saskatchewan and Manitoba, and remains the exception more than the rule in those provinces.

What has become confusing is that as the British practitioners adopted the U.S. terminology of using the word "podiatry" in their diploma / bachelor degree name, they also began calling themselves "podiatrists", despite the difference in training with their U.S. counterparts. The practice has carried over to some the provinces where British-trained individuals practice. So while the term "chiropodist" is still used in Britain and Saskatchewan and Manitoba, so, too, is the term "podiatrist", despite the fact that throughout the U.S. and in several provinces the term refers to a doctorate-level of training.

In fact, like the chiropodists of New Brunswick, some British-trained individuals even affix the title "Dr." to their names, despite most not having achieved any sort of doctorate in any field whatsoever.

Unregulated Provinces
Several provinces remain unregulated with regards to the minimum standard of education to practice and the titles those individuals may use. This is true in provinces like Prince Edward Island, Nova Scotia, and Newfoundland and Labrador and in the territories.   In theory, someone in those provinces or territories can practice as he wishes and call himself anything he likes.

Differences With These Groups Compared to "Doctors of Podiatric Medicine"
As described in more detail at the top of this web page, the D.P.M. or "Doctor of Podiatric Medicine" standard as found in the U.S. and in provinces like British Columbia, requires 10-12 years of education. This includes 4 years of undergraduate university education just to get accepted in the podiatric medical school. (In other words, the prerequisites to even get into the program is longer than the entire chiropody program offered in other locations.) From there the podiatrist undertakes 4 years of doctorate-level, professional, graduate-school education, and a minimum of 2 and up to 4 years of hospital residency training. Fellowship programs and Board Certification may be pursued beyond this.

Unlike Ontario-trained practitioners who now have as much as a 3-year diploma, and unlike the British-trained practitioners, the vast majority of whom either have a 3-year diploma (previous requirement) or at least a 3-year bachelor's degree (today's requirement), Doctors of Podiatric Medicine do, in fact, receive a doctorate degree. This is achieved at the end of their first 8 years of training, after which time they are properly called "Doctor".

Minimum licensing standards in British Columbia require 2 years of post-graduate residency training after the 8 years of undergraduate and graduate-level schooling, making the minimum training required for licensure here at least 10 years.

Board Certification in podiatric medical specialties is an additional step. For more information on Board Certification, please follow our link to that web page. There is no such thing as board certification for either Ontario-trained or British-trained practitioners.

With such a difference in training between podiatrists and chiropodists, why are these groups sometimes confused?

In most places in Canada, it doesn't happen so much these days, but there are a few reasons the two groups are still sometimes confused.

First, the two professions may be confused among people who come from British Commonwealth countries and some Canadian provinces where chiropody still exists. And as both groups treat the foot, people may, somewhat naturally perhaps, confuse the two groups.

Second, people in those areas where chiropody has disappeared (like in the U.S. and here in British Columbia) are still old enough to remember their parents or grandparents going to a chiropodist.

Finally, what's particularly confusing, is that some provinces allow those with lesser levels of training sometimes go by the term "podiatrist" just as those with the U.S.-level of training do, and that some provinces allow those without even a college degree--but as little as a 2- or 3-year technical diploma--to use the title "Doctor", just as those have an actual doctorate. This can obviously be very confusing to the public, where the term 'podiatrist' and the term "doctor" already have an understood meaning.

For the sake of clarity, throughout this website, the term "podiatrist" is used in the sense that has been traditional for 50 years now, and in the sense it is used in the entirety of the United States and in the majority of Canada--to describe a Doctor of Podiatric Medicine, or D.P.M..

When should I seek help from a Doctor of Podiatric Medicine?

Any foot or ankle discomfort is abnormal, and warrants professional attention from a podiatric physician. One may also seek professional attention from a podiatrist for concerns which are visible, even if they are not necessarily painful.