What is a Podiatrist?

This is my first post of (hopefully) many to follow. Don't worry, they won't be as detailed as this one, and I won't be offended if you skim.

First, allow me to introduce myself. I'm Dr. Matthew Stoddard, DPM, AACFAS (Dr. Matt is fine). I'm a surgically trained podiatrist, and I treat pretty much any condition below the knee. I have a wife and 3 beautiful kids, and I love college football, college basketball, and most professional sports. I also have a background playing most competitive sports from childhood, including a season of baseball at a small university in Virginia.

The first topic I'd like to launch into the interwebs is about what a podiatrist is, what we do, and why you should consider visiting a podiatrist when in need of foot and ankle care.

What is a podiatrist?

Well, that answer differs depending on the country you're reading this from. I'm assuming most of my (sparse) readers are from the US. In many countries, foot doctors are referred to as chiropodists and don't have the level of surgical training or scope of practice as a podiatrist in America. If you're one of those people who likes to watch shows where doctors pop pimples, rip toenails off, or do other gross things, there's a chiropodist who practices on television, showing a glimpse into his practice. While that's a small portion of what I do for a living, I treat a broader range of conditions and do far more invasive (and interesting) procedures than ingrown toenail removals or excising a wart.

In America, a podiatrist holds a DPM degree. That stands for Doctor of Podiatric Medicine. We graduate from 4 years of intense medical training from an accredited university. The pre-reqs to apply are the same as other doctors, including studies in biology, chemistry, etc. We take the MCAT and go through a similar application and interview process as any other physician. Most podiatry schools are directly connected to an allopathic (MD) or osteopathic (DO) medical school and we take our basic sciences with the rest of the medical students. A slight deviation happens when the 2nd year rolls around (more on that in a minute). We have clinical rotations and externships to complete during years 3 and 4. We then graduate from a 3 year surgical residency with training either in foot surgery (PMSR certification) or foot surgery with added training in rearfoot and reconstructive ankle surgery (PMSR/RRA certification). We can further specialize with post-graduate fellowships in various areas, including trauma reconstruction, sports medicine, or diabetic limb salvage if we feel the need to do so.

Back to the subtle differences during school. Because we know we're going to focus on the lower extremity, with a heavy emphasis on surgical treatment, there are some tweaks that happen when rehashing the body systems already covered during the first year of school. Typically, you study several heavy science classes such as gross anatomy, biochemistry, physiology, histology, and a number of other classes that make you want to question your decision to become a doctor at all.

The next year, however, you take all these subjects again from a different perspective: that of approaching all of the subjects on a body-systems basis. You study anatomy, physiology, biochemistry, etc from the viewpoint of individual systems (kidneys, lungs, heart, etc). This allows you to make additional mental connections with the material so it is incorporated into your functional knowledge base and long term memory.

Because podiatry students know that they are not going to be attempting to match into a nephrology residency, or pathology, or proctology, for example,  they know that they don't need to know the deep nuances of these specialties. The focus then becomes on paying an appropriate amount of time learning the basics and fundamentals of these areas without needing to know it like the back of your hand. As such, our schools shorten the amount of time it takes to cover some of the systems that are less vital to understanding the lower extremity; this way the focus can be on more pertinent subjects to lower extremity surgery, such as orthopedics, vascular surgery, dermatology, internal medicine, cardiology, pulmonology, and other similar studies that train us in the ability to assess risks for surgery, knowing the overall general health of our patients, and getting a solid overall medical training before we specialize fully.

What we do with the months of 2nd year that have been freed up by focusing on lower-limb-pertinent systems is a deeper study of the lower limb anatomy, lower limb surgery, lower limb clinical diagnosis and biomechanical examinations. This allows us to know on a deeper level the areas we'll be focusing on exclusively. Our clinical rotations and surgical residencies are similarly focused to allow deep specialization and understanding of the lower extremity so that foot and ankle surgery aren't merely something else we do, but rather THE ONLY things we do.

How does that help you as a patient? Well, I'll give a few examples. First, I'll jump all the way back to medical school when taking gross anatomy. During my gross anatomy class (with my DO classmates) we covered from the hip to the toes in 2 days. Yep, you read that correctly--2 days to cover hundreds of structures, dozens of bones, dozens of nerves, etc. Hardly encouraging when you think that some specialists you're going to for treatment only covered the anatomy they're treating in 2 days of lab and lecture. I spent every school day for 4 months during my 2nd year of school covering in tedious detail every small structure from the pelvis to the toes. Believe me, you have no idea how many things there are to learn about the lower limbs until you've had to dissect one inch-by-inch over the course of several months. That doesn't even begin to cover all the other benefits a specialized approach to learning the lower limb provides.

I hope to be able to peel back the curtain on many topics regarding the foot and ankle and hope to include colleagues as contributors to my blog on occasion. My hope is that you can gain knowledge that proves practical, useful, and informative while still being an enjoyable read.