The human foot is a complex structure. It contains 26 bones plus muscles, nerves, ligaments, and blood vessels and is designed for balance and mobility. Podiatrists, also known as doctors of podiatric medicine (DPM's), diagnose and treat disorders, diseases and injuries of the foot and lower leg to keep this part of the body working properly.
Podiatrists treat corns, calluses, ingrown toenails, bunions, heel spurs, and arch problems; ankle and foot injuries, deformities, and infections; and foot complaints associated with diseases such as diabetes. To treat these problems, podiatrists prescribe drugs, order physical therapy, set fractures, and perform surgery. They also fit corrective inserts called orthotics, design plaster casts and strappings to correct deformities, and design custom-made shoes. Podiatrists may use a force plate to help design the orthotics and shoes. Patients walk across a plate connected to a computer that reads the patients' feet. From the computer readout, podiatrists may order the correct design.
To diagnose a foot problem, podiatrists may order x rays and laboratory tests. Podiatrists consult with and refer patients to other health practitioners when they spot systemic diseases, such as arthritis, diabetes, and heart disease, of which first symtoms may appear in the foot. For example, diabetics are prone to foot ulcers and infections due to their poor circulation.
Most podiatrists have a general practice. Some specialize in surgery, orthopedics, or public health. Besides these certified specialties, podiatrists may practice a subspecialty such as sports medicine, pediatrics, dermatology, radiology, geriatrics, and diabetic foot care. Podiatrists generally are in private practice, which means that they run a small business. They may hire employees, order supplies, and keep records.
Most podiatrists are solo practitioners.
Podiatrists usually work independently in their own offices. They may also spend time visiting patients or performing surgery at a hospital. Those with private practices set their own hours, but to meet the needs of their patients, they may have some evening and weekend hours.
Podiatrists held about 14,700 jobs in 1992. Most podiatrists are solo practitioners, although more are entering partnerships and group practices. Others are employed in hospitals, nursing homes, and offices and clinics of physicians. Public health departments employ podiatrists, too.
Geographic imbalances are pronounced in podiatric medicine. Most podiatry graduates establish their practices in or near one of the seven States that have colleges of podatric medicine California, Florida, Illinois, Iowa, New York, Pennsylvania, and Ohio. Large areas of the country particularly the South, the Southwest, and nonmetropolitan areas have few podiatrists. In these areas, foot care is typically provided by primary care physicians and orthopedists.
All States and the District of Columbia require a license for the practice of podiatric medicine. Each defines its own licensing requirements. Generally, the applicant must be a graduate of an accredited college of podiatric medicine and pass written and oral examinations. Twenty-five States also require completion of an accredited residency program. Some States permit applicants to substitute the examination of the National Board of Podiatric Examiners, given in the second and fourth years of podiatric medical college, for part or all of the written State examination. Certain States grant reciprocity to podiatrists who are licensed in another State. Thirty-one States require continuing education for licensure renewal.
Prerequisites for admission to a college of podiatric medicine include the completion of at least 90 semester hours of undergraduate study, an acceptable grade point average, and suitable scores on the Medical College Admission Test (MCAT). All require 8 semester hours each of biology, inorganic chemistry, organic chemistry, and physics and 6 hours of English. Over 90 percent of podiatric students have a bachelor's degree.
Colleges of podiatric medicine offer a 4-year program whose core curriculum is similar to that in other schools of medicine. Classroom instruction in basic sciences, including anatomy, chemistry, pathology, and pharmacology, is given during the first 2 years. Third- and fourth-year students have clinical rotations in private practices, hospitals, and clinics. During these rotations, they learn how to take general and podiatric histories, perform routine physical examinations, interpret tests and findings, make diagnoses, and perform therapeutic procedures. Graduates are awarded the doctor of podiatric medicine (DPM) degree.
Most graduates complete a hospital residency program after receiving a DPM. Residency programs usually last 1 year. Residents receive advanced training in podiatric medicine and surgery and serve clinical rotations in anesthesiology, internal medicine, pathology, radiology, emergency medicine, and orthopedic and general surgery. Residencies lasting more than 1 year provide more extensive training in specialty areas.
There are three recognized certifying boards for four specialty areas: The American Board of Podiatric Surgery, the American Board of Podiatric Orthopedic and Primary Podiatric Medicine, and the American Board of Podiatric Public Health. Certification means that the DPM meets higher standards than those required for licensure. Each board requires advanced training, completion of written and oral examinations, and experience as a practicing podiatrist.
People planning a career in podiatry should have scientific aptitude, manual dexterity, interpersonal skills, and good business sense.
Podiatrists may advance to become professors at colleges of podiatric medicine, department chiefs of hospitals, or general health administrators. They may also enter a higher degree program.
Employment of podiatrists is expected to grow faster than the average for all occupations through the year 2005. More people will turn to podiatrists for foot care as the elderly population grows. The elderly have more years of wear and tear on their feet and lower legs than most younger people, so they are more prone to foot ailments.
Like dental services, podiatric care is more dependent on disposable income than other medical services. Medicare and most private health insurance programs cover acute medical and surgical foot services, as well as diagnostic x rays and leg braces. However, routine foot care including the removal of corns and calluses is ordinarily not covered. Because disposable income is expected to rise, more people are expected to pay for podiatric care out-of-pocket.
Establishing a new podiatric practice will be most difficult in the areas surrounding the seven colleges of podiatric medicine and in the Northeast since podiatrists are concentrated in these locations.
Because replacement needs result mainly from retirements and deaths, they are low. Most podiatrists continue to practice until they retire; few transfer to other occupations.
According to a 1993 survey by the American Association of Colleges of Podiatric Medicine, average net income of podiatrists was $100,287, but it varied greatly with years of experience. Podiatrists with 1 to 2 years of experience netted $35,578; those with 10 to 15 years of experience, $119,674.
Workers in other occupations who apply scientific knowledge to prevent, diagnose, and treat disorders and injuries are chiropractors, dentists, optometrists, physicians, and veterinarians.
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Reprinted with Permission of U. S. Department of Labor