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Evo Terra (Host): What is a Podiatrist? And do your feet really need their own doctor? Let's find out with Dr. Eric Powell, a Podiatrist in the foot and ankle department at Skagit Regional Health. This is Be Well with Skagit Regional Health. I'm Evo Terra. Thanks for joining me, Dr. Powell.

Eric Powell, DPM: Pleasure to be here. Thanks for having me today.

Evo Terra (Host): I want to restate the question that I posted at the top of this episode. What is a Podiatrist, and do my feet really need their own doctor?

Eric Powell, DPM: Those are all very valid questions. What is a podiatrist? The plain and simple is we medically and surgically manage conditions associated with the feet and the ankle. I did do some research on the history of podiatry through the ages. I can just do a brief overview because I think it's interesting to see where we were and where we've come and where we are and where we're going to go. There are references to foot ailments that go all the way back and carved on the Egyptian tombs. There's also obviously biblical references to foot ailments. Jesus washing people's feet, et cetera, et cetera, stuff like that. Hypocrisy is actually described what a certain condition called clubfoot is and associated treatments that they used to do back in those times. So, obviously, foot ailments have been around through antiquity. We fast forward through time, we kind of have two influences. We have a European influence. We have an American influence. 

Back in 1768, there was gentleman named David Lowe. And he actually published in a medical record about chiropodalgia, which is a fancy term for foot pain. In 1774, Chiropody, which is the old school term for what we used to be called. And what we called ourselves uh, that term was coined. Going into 1816, Louis Durlocker, he was actually the surgeon Chiropodist to Queen Victoria.

And he actually wrote a treatise on how to treat corns, bunions, and ailments of the feet. So we have published literature all the way back into the mid-1700s about treatments for foot and ankle ailments. If you fast forward a little bit, 1913, a gentleman called F. V. Runting kind of considered the modern Chiropodist founder.

He was the president of the National Society of Chiropodist. This was all in London. And actually founded a school of Chiropody at the London Foot Hospital in 1919. Then we go to the American influence. Nehemiah Kenneson was actually a ward in our profession and named after him, 1846, he was the first American Chiropodist. 

Louris Louis, who was actually medical doctor, he actually founded the New York School of Chiropody in 1911. And he actually suggested the term podiatry, and he actually was the kind of guy that spurned off us being our own sort of thing after all these years of being blended together.

And his thought was that the foot was complicated enough and was unique enough from other parts of the body that he felt it required its own dedication to schooling and profession similar to dentistry or now pharmacology or, even going into the surgical subspecialties like ear, nose and throat.

Evo Terra (Host): Interesting. I feel a little bit sad that, I mean, here we are a hundred and some odd years later and we don't call you a chiropodist. 

Eric Powell, DPM: No. 

Evo Terra (Host): I like that chiropodist. 

Eric Powell, DPM: Well, it's interesting. Uh, there's an old Seinfeld episode that George Costanza runs out and says, I have to take my mom to the chiropodist. That was in the late eighties. Gained some fame there, but yeah, it's just an antiquated term. We just don't use it anymore. Much like podiatry is starting to turn to more of an antiquated term. We're starting to refer to ourselves as foot and ankle specialists or foot and ankle surgeons. So going back to the broader question of what is podiatry, so there are 13 or 14 podiatry schools in the country right now.

To get into school, it's the same requirements as any other professional school. It's at least 90 semester hours of undergraduate work with focused, dedicated prerequisite courses, sciences, and then we take the MCAT, which is the Medical College Admissions Test, which is what allopathic and osteopathic schools also utilize. So, kind of similar baseline coursework that we take with any of the other professional schools to apply. School is four years. 

Residency is now three years. Most programs are heavily surgical, three years of surgery. Of course, you do off rotations. So, you know, you month on podiatry service, a month off doing other things, vascular surgery, general surgery, internal medicine, those types of things. And then after you graduate from residency, you can either start practice and get a job or you can apply to do a fellowship, which is usually another year of specialized training, typically in more heavy duty reconstructive, more complex surgical, but there's also sports medicine fellowships, there's wound care fellowships, there's pediatrics fellowships, there's all different things that you can do. And then when you're done with all that, you go find a job and start working. As with any specialty, you want to find somebody that is board certified in what they do. We have a board certifying body called the American Board of Foot and Ankle Surgery. And that just means that you've been vetted and you've gone through a higher level of scrutiny and testing to confirm that you have the knowledge and skills to practice. 

For patients, if you're looking to find out if somebody is board certified, you want to look for FACFAS or DABFAS behind their initials. So that tells you that they're board certified.

Evo Terra (Host): And to me it makes sense that we have foot and ankle doctors, podiatrists, chiropodists, whatever we want to call them, because of all of the things on the human body, feet take a pounding, literally, so I'm curious, what conditions do you and your fellow podiatrists see most often? What do you treat?

Eric Powell, DPM: That's a good question. We see pretty much everything. We are the people to go to for anything below the knee, foot and ankle wise. We do simple soft tissue conditions if it's ulcers or bumps and bruises, we do broken bones, we do everything from toenails to tibias as I say. I personally do total ankle replacements, I do bigger surgery, trauma surgery of the lower extremity what we call pilon fractures, calcaneal heel bone fractures, ankle bone fractures. All that kind of stuff. And then we just treat kind of chronic conditions as well. People that come in with deformities, like bunions or flat feet or high arches or tendon tears, Achilles issues you know, anything that is bugging you, basically on your foot or your ankle, we take care of whatever it is.

Evo Terra (Host): Earlier you mentioned orthopedic physicians, and I have had ankle issues, and by issues I mean I broke my foot twice, not really the ankle, the foot itself, and I went to see orthopedic physician who helped me with that. But can you kind of break down the difference between what a podiatrist does as opposed to specialties like orthopedic physicians?

Eric Powell, DPM: So orthopedic surgeons are doctors that specialize in that orthopedics, which is just bones and joints and musculoskeletal disorders, mostly surgically related the conditions, arthritis, tendons, sprains and strains, broken bones. 

We spend, I think a bit more time dedicated on just focusing on the foot and ankle conditions. We definitely don't take as much focus on the whole body, but we do get our training in that and are competent in that.

We have a limited license, which means I can only work on the foot and ankle, where an orthopedic surgeon can technically work on any part of the body. So that's the main difference. I don't think necessarily one's better or worse. I do think that podiatry probably focuses a little bit more on conservative management of issues before we jump to surgery. Statistics say we tend to do surgery on more complicated and more sicker patients just because of kind of the nature of what we deal with.

We deal with a lot more diabetes and stuff like that than probably the average foot and ankle orthopedic surgeon. I'm well trained for what I need to take care of and what I'm able to do.

Evo Terra (Host): Absolutely. Let's talk about what it's like from the other side, from the patient's point of view. Someone who's never seen a podiatrist, is walking into their first podiatry visit with a physician like yourself. What can that patient expect?

Eric Powell, DPM: Hopefully, at least for me, they can expect me to listen to what's going on.. I try to take my time. Make sure we understand and explain why the condition they have is what they have. I really want to educate patients on not just what they have, but why they have it. What's the mechanics, what's the structure behind their foot that's driving this. And then I think that really helps us decide what we can do to get you better and feel better. And just making sure that we're all on the same page and we want to understand and I like to be collaborative. I want to have a team approach with patients. A lot of it is homework for them. They got to go home and do stretches or get insoles or stuff like that. And so really making sure that they understand the reason why. And then of course, if we have to offer surgery, then we certainly have those discussions.

Evo Terra (Host): This may sound like a very basic question, but I think it's probably a good way for us to get close to the end of this conversation. And that is, why is it important we take care of our feet?

Eric Powell, DPM: Well, your feet carry you for the rest of your life, right? If your feet aren't feeling good, you're generally not feeling good. That can affect your mood. It can affect your livelihood. It can affect your personal life, everything. If your feet hurt, you're not a happy person. So I think it's important to pay attention to when things aren't feeling good and take care of them and don't ignore it. Now, certain things, you don't have to rush off and see us right away. Try the simple things first, rest it a bit, ice and anti inflammatories or Tylenol. If you can take those medications, that's great. But if something's not getting better and not working, and it's starting to affect what you do, then of course, we need to see you and take a look at things and see if we can do something to get you better. 

Evo Terra (Host): I think that's a great sentiment to have. Is there anything else you wanted to add before we wrap the conversation?

Eric Powell, DPM: Podiatry has taken me all over the world. I've been able to go through training and go to Eastern Europe and do surgery with people over there and travel all over the country at conferences. And it's been a great opportunity and it's a real honor and a privilege that patients trust you to come in and see them and take care of them. I hope they choose to come see myself or my partners, because we are good at what we do and, we want to help people get better.

Evo Terra (Host): Dr. Powell, thank you very much for your time today.

Eric Powell, DPM: I appreciate the opportunity. Thank you very much.

Evo Terra (Host): Once again, that was Dr. Eric Powell, a podiatrist in the foot and ankle department at Skagit Regional Health. For more information, visit skagitregionalhealth.org. That's S-K-A-G-I-T regionalhealth.org.

If you found this podcast episode helpful, please share it on your social channels and check the full podcast library for topics of interest to you. I'm Evo Terra, and this is Be Well with Skagit Regional Health. Thanks for listening.