Scope of practice
Podiatric practice spans the assessment and management of:
- Skin and nail conditions of the foot — corns, calluses, verrucae, fungal and other nail disorders, ingrown toenails;
- Mechanical and structural problems — plantar heel pain, bunions and hammertoes, flatfoot and arch problems, tendon disorders;
- Sports and overuse injuries of the foot and ankle;
- Biomechanical assessment and the prescription of foot orthoses and therapeutic footwear;
- Diabetic foot care, including risk assessment, preventive care and the management of ulceration;
- Nerve and circulatory problems as they present in the foot, including screening for peripheral arterial disease and neuropathy;
- Foot surgery, in jurisdictions and at levels of qualification where that is within scope.
Much of the work is preventive and long-term rather than episodic, particularly in diabetes, rheumatology and older people's care, where regular foot assessment is a routine part of managing the underlying condition rather than a response to a complaint.
Training and regulation
The details vary by country, and this is where confusion usually arises.
In the United States, a podiatrist holds the degree of Doctor of Podiatric Medicine, awarded after a four-year programme at an accredited college of podiatric medicine, which itself follows an undergraduate degree. That is normally followed by a hospital-based surgical residency lasting three years. Practitioners are licensed by individual states, and additional board certification in areas such as foot surgery or reconstructive rearfoot and ankle surgery is available through recognised certifying boards. Surgical scope is broad. The American Podiatric Medical Association is the profession's national body there.
In the United Kingdom, podiatry is a three-year degree, and the title "podiatrist" — along with the older term "chiropodist" — is protected by law, with practitioners required to be registered with the statutory regulator. Surgical practice is a specialist route pursued after registration by a minority of the profession. In Australia and New Zealand the structure is similar, with a separate surgical fellowship pathway.
The practical implication for a patient is that "podiatrist" describes a regulated profession with a verifiable registration, and that checking the register is straightforward and worth doing.
Podiatrist, chiropodist, foot health practitioner
"Chiropodist" is the historical term for the same profession, still used interchangeably in some countries and by many older patients. It is not a lesser qualification; it is an older word.
Titles such as "foot health practitioner" or "foot care assistant" generally denote a shorter, non-degree training, often focused on routine nail and skin care. That can be entirely appropriate for straightforward maintenance in a low-risk foot. It is not equivalent to a registered podiatrist, and the distinction becomes important in anyone with diabetes, neuropathy or circulatory disease, where routine foot care is a higher-risk activity than it looks.
How the roles fit together
Orthopaedic surgeons specialising in foot and ankle come from a general surgical and orthopaedic training route and handle the full range of bone, joint and trauma surgery of the region. There is genuine overlap with podiatric surgery, and which route a person takes often reflects local service organisation as much as the condition. The patient-education material at OrthoInfo comes from the orthopaedic side of that overlap.
Vascular specialists assess and treat the arterial supply, and are involved wherever a foot wound is failing to heal or where walking is limited by circulatory pain.
Diabetes teams, rheumatologists, dermatologists, physiotherapists and orthotists all intersect with foot care, and the more complex problems — the diabetic foot in particular — are usually managed by a team rather than any single profession. Multidisciplinary management of the at-risk foot is standard practice precisely because no one discipline covers all of it.
Choosing and checking
Verify registration with the relevant national regulator — this is public information and takes a minute. Ask what the practitioner's particular interest is, since foot and ankle practice is broad and most clinicians have a focus. If surgery is proposed, ask about their specific training and volume in that procedure. And if you have diabetes or a high-risk foot, make sure whoever is providing your routine foot care knows that and is appropriately qualified for it.
For what an assessment involves in practice, see preparing for a foot and ankle appointment. For the scope of conditions treated, see what foot and ankle care covers.