Origins, Development, and Global Perspectives

Podiatry, the branch of medicine devoted to the diagnosis, treatment, and prevention of disorders of the feet, has an interesting and varied history. From its origins in ancient civilisations to its modern-day practice, the field has undergone significant evolution, not just in name but in the scope of treatments and the level of medical training involved. The distinction between podiatry and chiropody has often caused confusion, but understanding their historical development helps clarify their differences. Today, podiatry is a well-respected medical profession practiced globally, though its role and recognition vary depending on location.

Origins of Podiatry

The history of podiatry stretches back to ancient times, with early evidence of foot care being practiced in ancient Egypt, Greece, and Rome. These civilisations understood the importance of maintaining foot health, especially for soldiers and labourers whose daily work put immense pressure on their feet.

Podiatry in Ancient Egypt 

Ancient Egypt

The earliest recorded evidence of foot care dates to around 2400 BC where a tomb painting in Egypt depicts an individual working on someone’s feet, which some believe to be an early form of chiropody. While the exact nature of the treatment is unclear, it shows that specialised foot care was an important aspect of health even in ancient times.

Ancient Greece and Rome

In ancient Greece, athletes were particularly concerned with the health of their feet. Foot baths, massage, and ointments were used to treat common foot problems such as calluses and corns. In Rome, foot care became a practice of refinement and status, as wealthy Romans employed specialists, akin to modern-day chiropodists, to maintain their feet. Famous physicians of the time, including Hippocrates, wrote about the treatment of corns, suggesting that scraping them with a specific instrument, followed by a poultice, could be an effective cure. 

The Evolution of the Term "Podiatry"

The word "podiatry" is relatively modern. It comes from the Greek words "podos" (foot) and "iatros" (physician), literally meaning “foot physician.” Prior to the adoption of this term, foot specialists were more commonly known as chiropodists.

The term “chiropody” originates from the Greek words "cheir" (hand) and "pous" (foot), which seems somewhat odd since it refers to the care of the feet alone. The word was first used in the 1700s by a Cornishman named David Low, who introduced the term to the medical lexicon when describing his treatments for foot-related ailments. 

The shift from chiropody to podiatry in the 20th century reflects the growing professionalisation of foot care and its recognition as a medical specialty. The name change was also driven by the desire to distinguish the practice as a science-based medical field, rather than one associated primarily with manual care such as toenail cutting and corn removal.

Podiatry Tool Set from World War 2

Podiatry vs. Chiropody: What’s the Difference?

Historically, the terms podiatry and chiropody were used interchangeably in many regions, including the UK. However, over time, they have developed distinct meanings, largely due to advances in medical training and the broadening scope of foot health services.

Chiropody

In its traditional sense, chiropody refers to the treatment of minor foot problems like nail cutting, callus removal, and corn treatment. It was often seen as a manual trade rather than a medical profession, typically requiring less formal training than podiatry. 

Podiatry

Today, podiatry is seen as a more medically oriented field. It involves diagnosing, treating, and preventing a wide range of conditions affecting the feet, ankles, and lower extremities, including biomechanical issues, sports injuries, and chronic conditions like diabetes. Podiatrists are trained to perform more complex procedures, such as foot surgeries, and to prescribe medications. Podiatrists now require a degree in podiatric medicine, which involves rigorous medical training akin to that of other healthcare professionals. 

In the UK, the transition from chiropody to podiatry occurred during the 20th century, with the term podiatry becoming more widely adopted as the profession became more formalised. However, in many areas, both terms are still in use, and the general public may not always understand the difference.

The Podiatry Industry Today

The podiatry profession has grown significantly over the past century, and podiatrists now play a vital role in healthcare systems around the world. They are crucial in addressing the foot care needs of an aging population, athletes, and individuals with chronic conditions like diabetes, which often leads to foot complications.

Podiatry in the UK

In the UK, podiatrists are highly trained professionals who are regulated by the Health and Care Professions Council (HCPC). To practice as a podiatrist, individuals must complete a three or four-year degree in podiatry from an accredited university. The curriculum covers not just basic foot care, but also anatomy, physiology, pharmacology, and surgery.

Podiatrists in the UK are also able to specialise in various fields, such as diabetic foot care, sports injuries, and paediatric podiatry. Foot health is a critical aspect of care for diabetic patients, as complications like ulcers and infections can lead to amputations if not properly managed. 

The UK healthcare system recognises podiatrists as an essential part of multidisciplinary teams, particularly in hospitals where diabetic and vascular teams rely on their expertise. In private practice, podiatrists offer a range of services, from routine foot care to more advanced treatments like orthotic therapy and minor surgery. 

Podiatry in the United States

In the United States, podiatry is considered a branch of medicine, and podiatrists earn the title Doctor of Podiatric Medicine (DPM). The path to becoming a podiatrist in the US involves completing a four-year podiatric medical degree after obtaining a bachelor’s degree, followed by a residency program that provides specialised training in areas such as surgery, sports medicine, and diabetic foot care. 

American podiatrists are licensed to perform surgery, prescribe medication, and provide a wide array of treatments for foot and ankle conditions. The scope of practice for podiatrists in the US is generally broader than in the UK, with a greater focus on surgical interventions. The American Podiatric Medical Association (APMA) serves as the national professional organisation for podiatrists, advocating for the profession and providing resources for continuous professional development.

Podiatry in Australia and New Zealand

In Australia, podiatry is a well-established profession regulated by the Podiatry Board of Australia. Podiatrists must complete a degree in podiatric medicine, and they can go on to specialise in areas like podiatric surgery, sports podiatry, and paediatrics. 

Australia also recognises the title of podiatric surgeon, a podiatrist who has undergone additional postgraduate training to become qualified in performing reconstructive foot and ankle surgery. This surgical pathway is similar to the one seen in the United States, reflecting the growing recognition of podiatry as a medical specialty that goes beyond routine foot care. 

In New Zealand, podiatry is similarly regulated, and professionals are required to complete a degree in podiatry, which includes extensive clinical training. New Zealand podiatrists work in both the public healthcare system and private practice, addressing a wide range of foot health issues, including diabetes-related complications and sports injuries. 

Podiatry in Europe

Podiatry in Europe varies considerably from country to country. In some nations, podiatry is a well-recognised medical profession, while in others, it is still developing. Spain, for example, has a strong podiatry profession, with podiatrists undergoing rigorous training at the university level. Spanish podiatrists can also specialise in areas like surgery and sports medicine.

In contrast, in countries like France and Germany, the podiatry profession is still emerging, and the scope of practice for podiatrists may be more limited compared to other nations. In these countries, foot care may be provided by other healthcare professionals, such as orthopaedic surgeons or general practitioners, and podiatry is not always recognised as a distinct medical specialty.

Podiatry in Developing Countries

In developing countries, access to specialised foot care can be limited, and the podiatry profession is often underdeveloped. However, with the global rise in conditions like diabetes, there is increasing awareness of the need for podiatric services. Organisations like Footsteps, a charity that provides podiatric care in underserved regions, are helping to improve foot health and prevent complications like amputations by training local healthcare workers and providing essential foot care services. 

College of Podiatry Conference

Conclusion

Podiatry has evolved from the simple foot care practices of ancient civilisations to a sophisticated medical profession. Today, podiatrists are key players in the healthcare system, offering vital services that range from routine foot care to complex surgeries. While the distinction between podiatry and chiropody still exists in some regions, podiatry has become the globally recognised term for medical foot care.

As the profession continues to evolve, especially in response to the global diabetes epidemic, the role of podiatrists will only become more critical in helping individuals maintain their mobility, independence, and quality of life. The differences in how podiatry is practiced around the world reflect varying healthcare systems and levels of recognition, but one thing remains constant: the importance of healthy feet to overall wellbeing.