HEALTH HORIZONS : MEDICINE : Podiatry Takes a Giant Step Forward
When Patsy Reynolds went to see a foot doctor several years ago about a crippling pain in her feet, the Anacortes, Wash., woman hardly expected her condition to require arterial bypass surgery. But thanks to her alert podiatrist, Reynolds soon learned that she had a serious blockage of an artery in her abdomen that was preventing adequate circulation to her lower extremities.
“If he hadn’t found that and another month went by, I wouldn’t have any legs today--that’s what the vascular surgeon told me,” Reynolds, 49, recalled. “Now I’m great. I walk. I swim. I can even run. I’m ecstatic.”
Bertha Brooks of Elmira, N.Y., had a similar experience. She consulted a podiatrist about severe heel pain last year and was told that she suffers from diabetes.
Santa Ana podiatrist Richard Viehe has had patients who turned out to have multiple sclerosis, tuberculosis, high blood pressure, even a brain tumor. “Podiatrists often function as family practitioners by default because many people believe they are healthy and therefore have no regular doctor,” Viehe says. “Then they develop a foot problem and come to us, and we discover a medical problem.”
To be sure, bunions, calluses, corns and ingrown toenails remain the mainstays of any podiatrist’s practice. Podiatrists also fit corrective shoe inserts (orthotics), prescribe medication, order physical therapy and perform corrective foot surgery.
But, luckily for their patients, podiatrists are spotting other, systemic problems unrelated to the foot. This is so in part because of the more sophisticated education that aspiring podiatrists now receive. But it can also be traced to America’s aging population and because many of the conditions associated with old age--arthritis, high blood pressure, tuberculosis and multiple sclerosis--manifest themselves in the lower extremities. At the same time, an increasingly active, sports-oriented populace is experiencing foot injuries as never before.
As more people turn to foot doctors, whether the problem is a sports-related injury or simply the ravages of time, the nation’s 12,000 podiatrists (more than 10% of whom are in California) are finally beginning to emerge from the backwaters of the healing profession.
“People are becoming aware that it’s not a normal thing for their feet and legs to hurt,” says Burbank podiatrist Franklin Kase. “It used to be that people were told they had to live with it. Now they are learning that there are reasons for these things, and we can treat them.”
Adds Long Beach podiatrist Eric R. Hubbard, who refers as many as 20 people a week to physicians, primarily general practitioners or orthopedic surgeons: “Podiatry has always been a great profession. It’s also been one of the best-kept secrets around.”
But not any more. Podiatry is one of the fastest-growing fields in medicine. American Demographics magazine projects a 77.2% increase in the number of podiatrists by the year 2000. Already, the number of new practitioners has caused a startling drop in the median age of podiatrists--from 51 in the mid-1970s to well below 40. At the same time, income has risen sharply--from an average of $10,000 a year in 1960 to almost $100,000 today.
“Either we podiatrists are sleeping giants or we are mighty midgets,” quips Barry H. Block, a New York podiatrist and editor of Podiatry Management magazine.
Most podiatric medical problems are not directly life-threatening, but foot ailments can deter people from exercise--with all the adverse consequences that accompany a sedentary lifestyle. “If you can’t walk, you can’t do much,” says Stephen J. Miller, the podiatrist who initially saw Patsy Reynolds.
Podiatry has a colorful past. As far back as 3,500 years ago, foot treatments were depicted on the walls of Pharaohs’ tombs. Over the centuries, arsenic, swine manure and cow fat have been recommended as treatments for various foot disorders. In the 15th Century, “barber-surgeons” extracted foot corns as well as teeth.
By the early 19th Century there were many podiatrists who roamed the United States, knocking on doors and staying in a community as long as they could drum up business. Some of these itinerant “corn doctors” sought to establish their credibility by claiming an ability to pull out corns by their roots. They did so by perpetrating a well-known trick. With a flourish, “the doctors” would brandish an extracted corn--the roots of which were small pieces of previously concealed fish bone.
The first known practice dedicated solely to foot care was inaugurated in Philadelphia in 1841. In those days, podiatric skills were passed from one generation to another largely through informal apprenticeships. But by the turn of the century, podiatric colleges were established, offering what amounted to one-year courses. By 1948, four years of study were required.
During the 1940s, only 14% of podiatrists had hospital privileges. But in 1953, the Joint Commission on Accreditation of Hospitals began allowing podiatrists to admit patients to hospitals as long as it was done jointly with a physician. And three years later, podiatrists abandoned the term chiropodist , changing the name of their professional organization to the American Podiatry Assn.--emphasizing treatment of the entire foot instead of just corns and calluses. Some podiatrists also believed that the public might confuse a chiropodist with a chiropractor.
Along with their growing numbers and political influence, podiatrists continued to see their medical privileges expand. During the Korean War, podiatrists won the right to become commissioned officers in the armed forces--another landmark breakthrough. During the Great Society, the Medicare Act was amended to include the services of podiatrists. And at the height of the Vietnam War, deferment from the Selective Service Act was granted to podiatric medicine students.
Today there are seven American colleges of podiatric medicine, including the California College of Podiatric Medicine in San Francisco. The others are in Miami, Des Moines, Chicago, New York, Cleveland and Philadelphia. Together, the schools graduate more than 600 students each year.
The rapidly growing demand for podiatrists is stirring debate within the profession about ways to improve further podiatric education and research. Because the podiatric colleges are free-standing, autonomous institutions, there has been little coordination or standardization of curriculum--a shortcoming that podiatric medicine educators are redressing. Within the past two years, the seven colleges have agreed on a single curriculum for biomechanics, an experiment that may be adopted in other areas as well, says Richard H. Lanham Jr., a Bay Area podiatrist and president of the California College of Podiatric Medicine.
“That way, the graduates would be less diverse in their knowledge base than currently,” Lanham says. “That would be a great help. A standardized national curriculum would be wonderful.”
In their first two years, podiatric students take the same courses as medical school students--biochemistry, pharmacology, microbiology, physiology and pathology. The final two years of podiatric schooling include internships at clinics and hospitals that stress medical, orthopedic and surgical treatment of foot disorders. Though podiatrists are not MDs, they are permitted to perform certain limited surgeries.
Lanham and others would also like to see more podiatric research. Toward that end, Lanham has worked to triple the research funds available to faculty members at the San Francisco institution. “All the colleges have been strictly training students to be clinical practitioners. It’s been very service-oriented. But as we strive for excellence in education, we must increase the amount of research going on in our colleges,” Lanham says.
Among the many people who are learning to appreciate podiatrists is Ronald Zweig, a semi-retired handyman from Riverside who now lives near Seattle.
Suffering last year from foot pain so severe that he was unable to climb a ladder, Zweig, 55, was told by a physician that he needed an operation to correct a nerve condition caused by repetitive motion.
Before having such surgery, Zweig went to see podiatrist Stephen Miller, who, after learning of Zweig’s symptoms, suspected that his otherwise healthy patient probably had some nerve disorder of the extremities.
Sure enough, a test showed that Zweig had a blood sugar level four times above normal. He had diabetes, a condition that was quickly brought under control by an internist.
“I have good days and bad days,” Zweig says. “But at least I’m much more mobile now than I was before.”
“One of the real pleasures of this line of work,” Miller says, “is that 95% of your patients go home feeling better than when they came in.”
Eric Hubbard agrees. “Picking podiatry is the best thing I ever did. There’s nothing more satisfying than to see a person who limps into your office walk out without pain.”
