- THIS MATERIAL IS PUBLISHED AND PROTECTED BY U.S. COPYRIGHT LAW - REPRODUCTION PROHIBITED UNLESS FOR PERSONAL USE, EXCEPTING AUTHOR PERMISSION - Peter F. Kelly, D.P.M., F.A.C.F.A.S. Diplomate, American Board of Podiatric Surgery Fellow, American College of Foot and Ankle Surgeons INTRODUCTION TO PODIATRY, AND HOW DID LASERS GET HERE? THE HISTORY AND ESTABLISHMENT OF PODIATRY Podiatry had its start as a different profession - Chiropody. For this reason it was a difficult beginning. It was formally introduced by law in New York by the Senate bill no. 195 on June 3, 1895. Since then, advances within the profession can be compared to the advances in other medical professions. With the concommitant advances in Podiatry education this has enabled the profession to expand into medical and surgical subspecialties providers deliver today. The "Chiropodist" of the early 1900's was licensed to treat both the hands and the feet, but was limited to treating only nails, corns, warts, and other skin disorders. They could treat bunion problems using pads and splints, but no incisions could be made below skin level. The first Chiropody school was established in 1915 at Temple University in Philadelphia. However these limitations were unappealing to students pursuing careers in medicine, so Chiropody schools found themselves in financial distress, and needed an intensive change in education to survive. There was also confusion with the similar sounding name of "Chiropractors". In 1957 the professional designation was changed to "Podiatry". CHANGES AND ADVANCEMENTS IN THE FIELD The Council on Podiatry Education was established in 1965, and set regimented standards for improving the Podiatry schools and residencies to meet accreditation standards. The formal education program was lengthened from three to four years, incorporating a standard two-year basic science curriculum identical to that of the Allopathic (M.D.) medical schools. The second two years were spent in clinical practice and surgical education. After completion of this education the graduate was then termed "Podiatrist". The first residency program was established at St. Luke's and Children's Medical Center in Philadelphia. Requirements for continuing education were established in most states by 1979. Further evolution after residency added board certification following the guidelines similar to the Allopathic (M.D.) and Osteopathic (D.O.) specialties. Now specialty residencies are available, such as surgery, infectious disease, Podiatric Medicine, Orthopedics, etc., and the residency varies from 1 to 4 years in length. The most important contribution the Podiatric profession introduced into the medical field was "ambulatory" surgery in the early 1970's, which is of course popularly known now as outpatient surgery. At the time it was known as the "walkaway operation". Currently Podiatry is one of the three medical professions acknowledged by all medical boards as practitioners who can treat systemic diseases manifested within their scope of anatomical practice. The other two mainstream medical professions are the M.D. and D.O. (Doctorate of Osteopathic Medicine). WHEN AND HOW LASERS WERE INTRODUCED INTO PODIATRY The first laser procedure was pioneered into surgery with the CO2 laser used by Bruce A. Carlson, D.P.M., in February, 1976, with the treatment of cutaneous verrucoid lesions at the Wenske Laser Center in Chicago. The first laser procedure for major reconstructive surgery was introduced with the Nd:YAG contact-tip by Peter F. Kelly, D.P.M., at the Western Virginia Laser Center, in Roanoke, VA. Laser applications have diversified to the use of incisionless Argon laser surgery for cutaneous verrucoid lesions, and small endoscopic-type incisions using the KTP laser for heel spur surgery. The protocol for applications of other lasers, such as the Ho:YAG and the Copper-Vapor type are being developed currently. Procedures frequently performed with the laser in Podiatry are cutaneous diseases of skin and nails, for which the CO2 and Argon are used. For invasive and major procedures, the Nd:YAG contact-tip and KTP lasers are applied to the soft tissue component of Bunionectomy, Metatarsal, Ganglion, Neuroma, and Heel Spur surgery. New methods continue to be added and those currently performed continue to be refined and modified. The American Society of Lasers in Medicine and Surgery has incorporated a Podiatry subsection into its annual meetings, and national laser training courses are provided by various organizations which are imperative for certification of Podiatric Surgeons to be qualified to use a variety of hospital lasers. THE FUTURE OF PODIATRY As a specialty, Podiatry has established a reputation of expertise in foot and ankle medical and surgical treatments, and has invented and promoted the concept of "same day surgery". Microsurgical and endoscopic procedures are being added to the field. Laser applications have decreased the magnitude of the invasiveness of the major surgical procedures, and have resulted in faster patient recovery with reduced physician utilization and thus overall cost, popular with insurance carriers. Recently there has been a sharp division of Podiatrists into two components: certified Podiatric Surgeons and general Podiatrists. The certification is further categorized into those operating on the front of the foot and those trained also for ankle surgery. As long as there are patients who need to get back on their feet fast, or present with foot pathologies requiring specialty care, there will always be a need for Podiatrists in either category. Today's evolution in medical technology continues to narrow the difference between today's technology and that of television's science fiction taking place several hundred years in the future. It is feasable that these future procedures may become available in the next one or two decades. The revolution in medical technology and Podiatrists applying these advancements to their medicine and surgery will continue to improve the quality of life of their patients.