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Monday, December 22, 2008

A potted history of podiatry




Whilst other groups have contributed to the care of feet; podiatry (aka chiropody) and orthopaedics, historically seem to be the two main professions dedicated to pedal care (Tollafield & Dagnall, 1997). The professional care of feet has been in existence since the time of the Egyptians and was evidenced by bas-relief carvings at the entrance to Ankmahor's tomb. Work on hands and feet are clearly depicted and many Egyptologists believe tending, feet both medically and personally, probably spanned the whole of ancient Egyptian civilisation. The placement of carvings at the entrance of a tomb typically signified the profession of the buried individual and The Tomb of the Physician dates from 2400 BC. No one can be sure, of course, whether podiatry was practised continuously throughout the two millennium.



Corns and calluses were described by Hippocrates who recognised the need to physically reduce hard skin, followed by removal of the cause. He invented skin scrapers for this purpose and these were the original scalpels. Celsus, a Roman scientist and philosopher was probably responsible for giving corns their name. Later Paul of Aegina (AD 615 -690) defined a corn as "a white circular body like the head of a nail, forming in all parts of the body, but more especially on the soles of the feet and the toes. It may be removed in the course of some time by pairing away the prominent part of it constantly with a scalpel or rubbing it down with pumice. The same thing can be done with a callus."

Chiropody or Podiatry?
The word appears in the English language in the 18th century, when a London corn cutter by the name of David Low wanted to write the definitive text on care of the feet. Unfortunately Low was a plagiarist and translated the thesis entitled L'Art de Soigner les Pieds (1781), previously written by Frenchman, Nicholas-Laurent LaForest. To avoid detection Low renamed the works Chiropodologia. By combining both Greek and Latin prefixes. "Chiro" Greek meaning hand and foot; and Pod Latin for foot. No one was really sure whether the new study chiropody was treatment of the hand by the foot, or visa versa. Most scholars have accepted Low intended to promote care of the foot by the hand. 'Ch', in Greek is written as an 'x' and pronounced with a silent 'h.' "X" when translated into English becomes a harsh sounding 'k'. The proper and correct pronunciation is therefore 'kir-opodist'. We see the same phonetic translation in the word Xmas. Contrary to popular belief the abbreviation for was not for the convenience of greetings card manufacturers but instead a celebration of "K" or Christmas mass. During the depression years of the 1930's, chiropody and chiropody services became very popular within the United Kingdom and were patronised by the Royal Family. On a visit to the Edinburgh School of Chiropody and Foot Clinic, the Royal researchers were concerned at the origins of the word chiropody and set to out find an alternative derivation. Chiron was a Greek God, a centaur, half man half horse. He was a tutor to many Greek heroes and taught Asclepius his medical arts. Chiron lived as recluse at the bottom of Mount Pelion, and dedicated his life to caring for the crippled. After his half-brother Pholus was killed by Heracles, a stray arrow wounded Chiron. His wounds were painful and he agreed to exchange his immortality with Prometheus so he could die, peacefully. Zeus immortalised the centaur, who became a bright light for many with the constellation (Sagittarius). Alternatively according to Runting (1932), Lewi the US podiatrists considered the word chiropody was originally written 'Chirurgpodist" or surgeon of the foot. He believed for the sake of euphony the word "chiropodist" was coined. Whatever its origin US chiropodists changed their name to podiatrists in the 1950s. The term podiatry came to be used in Australasia about thirty years ago and more recently the term has been adopted by many UK, practitioners. However chiropodist still exhausts and can be found in State Acts in Australia as well as the UK e.g. The Society of Chiropodists and Podiatrists. Practitioners. Europeans refer to themselves as podologs. The term podology means the study of feet (in health and disease) and may be considered a specialised branch of zoology. According to Harper Davis (1932) the term podogeny is used to describe the science or the serial phenomena of foot history and the origin and modification of foot types. Podogeny may refer to the individual or to the racial development of feet. Podometry relates to the measurement of feet.

Foot Orthopaedics
Surgery is the practice of treating injuries, deformities and other disorders by manual operation or other appliances. The origins of the word surgery come from the Greek, cheirourgein i.e. to work with the hand. Throughout history surgery has been associated with war, but the addition of operating theatres to hospitals did not come to pass until relatively recently. Barber surgeons worked in the field of battle with no special facilities. No one understood the need for cleanliness during the operation and many patients died as a result of infection. Not until the discovery of antiseptics by Joseph Lister (1827-1912) was the need for special premises for surgery recognised. Prior to this surgeons worked in clothes stiffened with coagulated blood of former operations and on wooden tables in which bacteria could grow on old blood and pus. Rooms in which operations and dissections took place were called theatres because they had tiers of seats round them from which students could watch. These started to appear in the 16th century. The term orthopaedics first appeared in the English language around 1743. Taken from 'orthos' the Greek word meaning straight, and 'paedics', the Greek for child. The term s thought to have been first used by Nicholas Andry. In his book he described conservative care for childhood deformities using bandages and braces. Orthopaedic contributions for the next two hundred years were dominated by splinting message and manipulation (Tollafield & Dagnall, 1997). Surgical management of the foot was initially restricted to dealing with injury and removing foreign objects from the foot. Although amputation was commonplace especially in time of war it was not until Lister (1827-1912) and the discovery of antisepsis the number of surgical procedures increased. Evidence of orthopaedic surgery dates back to 10,000 BC although it took to the Renaissance (14-16th century) and the rebirth of science before it became accepted. Only after the French Revolution did the discipline of orthopaedics become recognised as we understand it today. Progress in surgery was delayed by the beliefs of the church in Europe during the Middle Ages. Excessive modesty was fashionable and it was considered indecent to expose the body for surgery. Dissection was forbidden and research was frowned upon. The works of Galen, who dissected animals, was regarded as sacred until Andreas Vesalius (1514-1564) a Flemish anatomist started to query conventional wisdom. Dissection rights were finally given to barber surgeons in 1540 and gradually great strides were made. The loss of blood was soon identified as a reason for high fatalities. Barber surgeons in the seventeenth century experimented with blood transfusions from dogs, however blood form one animal clots with the serum of another. Sadly it took to the Second World War before the science of transfusion could be completely understood. Anaesthetic gases were first described in the 18th century and ether was first used in 1847. Freiderrich Serturner discovered morphine in 1806 and local anaesthetic were first used in 1812. The introduction of anaesthetics made the shock to patients much less. Subsequent developments in operative techniques have stemmed from the Second World War, where major orthopaedic advancement comes from. Paradoxically most advances in orthopaedic care have originated from human conflict. Throughout people died from the infection of their wounds and not the actual wounds themselves. From the invention of the microscope by Leeuwenhoek in 1675 many pioneered the study of disease. From the works of Pasteur to Liston the basics of antisepsis were developed and further reduced post surgical fatalities. Today operations are performed in an atmosphere completely absent of microscopic organisms. Up until the French Revolution medicine had relied on the authority of printed books. Post revolution with the introduction of the teaching hospitals observation of patients became important. Described by French philosopher Michael Foucalt who called this novel approach "le regard" or 'the gaze'. Observation techniques lend themselves to breaking down or analysing what was seen; never totally content the analysis was complete. This approach developed continuously and with new scientific evidence and invention orthopaedics became progressively more penetrating in ever more varied ways. The discovery of x-rays by Willhelm Roentgen in 1895 made further progress. The influence of computers has lead to tomputerised axial tomography, which was introduced in 1975. Magnetic resonance imaging became available a decade later and the combined screening is used to show soft tissue injuries as well as bones and joints. Diagnostic ultrasound is frequently used to examine soft tissues. New technologies continue to reveal new ways of seeing analysing and judging the human body. During the 1900s new foot orthopaedic procedures were developed. Operations for hallux valgus appeared from about 1881. Up until this time conservative treatment of the foot had been recommended. These involved techniques which might now be considered as closed surgical procedures such as lifting, tilting or wedging the foot, especially in children. Clubfoot deformities attracted the attention of early surgeons who were constrained because of the risks of infection. Hence the reason why most orthopaedic procedures were manipulative. With many of the techniques been in existence since the time of Hippocrates. Later application of animal fats with strapping and manipulation were popular. Traction was often used to help rectify bends or malformed bones to various levels of success. Digital amputation was described from the 17th century, with metatarsal amputations and mid tarsal amputations recorded a century later. Trans-tarsal amputations were introduced in the nineteenth century. The Great War and World War II meant greater strides were made in amputation techniques. Seldom now are these undertaken unless a radical separation is required. The introduction of soft tissue surgery such as tenotomies did much to encourage surgical technique of the foot. One critic of forefoot surgery was Hans Rudolph Mayer, a Swiss medic, he believed many procedures were designed principally to alter the female foot but not for functional reasons, instead to fit stereotypical female shaped shoes. He called this the Cinderella Principle. In the film Cinderella (Walt Disney) the glass slipper was broken by the grotesque ugly sister. However in the original version of the fairytale, the wicked mother cut her daughter's feet to fit the shoe.

Corn Cutters and Corn Operators
Although corn cutting was known to exist from the time of antiquity it is not clear whose specific role this was and may have been part of a general hygiene and caring process which could be practised by many. According to Tollafield and Dagnall (1997) physicians and surgeons regarded treatment of corns as undignified and therefore the window of opportunity was filled by persons willing to cut corns. By the seventeenth century corn cutting had become an acknowledged means of living albeit it was not considered a respectable profession. Corn cutting services were popular and hence, could be considered essential. The corn cutter of the early part of the seventeenth century was poor and earned little from his trade. (Seelig, 1953). This may explain why many provided other services such tooth pulling. To the modern gaze this would give the appearance of a 'Jack of All Trades" and charlatan. The earliest references to corn cutter and corn cutting are in the Oxford Dictionary (1893) and the entries indicate these were abusive terms. Corn cutters plied their trade in the streets of towns in the company of many other street traders. Prior to the Great Fire of London (1666) it was common place to advertise personal services such as the removal of corns through the medium of street cries. The lyrics were crude by modern jingle standards but often-celebrated musicians composed the tunes. Orlando Gibbons was a prolific jingle writer. Best known for his madrigals and music for the Anglican Church he most certainly wrote music to accompany jingles to sell corn cutting. Gibbons eventually became the organist of the Chapel Royal, and was named virginalist to the king, before becoming organist of Westminster Abbey. Gibbons never forgot his humble beginnings and composed a poignant fantasia for voices and viols based on the traditional cries of London street peddlers (Runting, 1932). One of the rare occasions a corn cutter featured in a seventeenth century play was seen in Ben Johnson's (1563 -1637) "Bartholomew Fair" (1614). The character appears in the second act and enters the fair ground with his cry. The Roxburghe Ballads were a collection of ancient songs and ballads written on various subjects and published between 1560 and 1700. Under the title of The Cries of London, the fourth verse read as follows.

"Here's fine herrings, eight a groat;
Hot codlines pies and tarts.
New mackerel I have to sell.
Come buy my Wellfeat & Oysters, ho!
Come buy my whitings fine and new.
Wives, shall I mend your husband's horns?
I'll grind your knives to please your wives,
and very nicely cut your corns.
Maids, have you any hair to sell,
Either flaxen, black or brown?
Let none despise the merry, merry cries
Of famous London town."
(quoted from Hindley C 1884 A History of the Cries of London, London 113.)

It is well established corn cutters were in existence at this time and even Shakespeare included reference to the humble corn.

"Cap: Welcome , gentlemen ! Ladies that have their toes Unplagued with corns, will have a bout with you. Ah ah my mistresses! which of you all Will now deny to dance? She that makes dainty, she I'll swear hath corns! Am I come near you now?"
Romeo & Juliet Act 1 Sc5 William Shakespeare (1564-1616)

Towards the end of the seventeenth century, corn cutting had become more respectable with the numbers of practitioners increasing in England. This was thought in part to be due to an influx of Dutchmen after the accession of King William of Orange, to the English throne. Many corn cutters frequented the popular coffee and bathhouses, advertising their skills with grandiose claims of cure and infallible remedies. Most professed to be the world's greatest authority on feet and foot related problems and their eccentric behaviour soon brought them to the attention of high society. Their individualism and notable personalities meant some became celebrities in their own right such as Thomas Smith and Thomas Shadwells. But by far the best known corn cutter of the time was John Hardman posthumously remembered for having a portrait painted of himself (Caufield, 1819). Hardman was reported to be the corn cutter to King William of Orange (1650-1702), a monarch of delicate health. Royal recognition brought respectability and rather like today's endorsement of products, every respectable effort was made to broadcast the association. In Reed's Weekly Journal (or British Gazetteer) in March 16th, 1734. The following announcement was made.
"Mr March a famous corn cutter had became the nail cutter to his Royal Highness the Prince of Wales with an annual salary of 50 guineas."
It took to the eighteenth century and "La Gaze" before corn cutting became a recognised discipline. The application of scientific method to medicine began in France after the Revolution with the establishment of teaching hospitals. Nicholas Laurent La Forest was thought to be corn cutter to Louis XVI and well placed to write a respectable thesis on corns and callus. The book entitled " L'Art de Soigner les Pieds" was published in 1781. La Forest took the title Chirurgien-Pedicure inferring he was a surgeon and pedicurist albeit his name did not appear in the Academie Royale de Chirugie. This may well be another example of the corn cutter taking on another speciality to increase their meagre remuneration. Suffice to say after the Revolution La Forest gave up corn cutting and made his living as a fruit merchant. In the same year as the first book on foot care was published a Dutch anatomist called Petrus Camper published his treatise on shoes in 1781. La Forest's work was later plagiarised by London corn cutter, David Low. Toa avoid detection he retitled the works Chiropodoligia and hence the term chiropody. The first original UK contribution to footcare literature came from an Edinburgh corn cutter by the name of Heyman Lion, who in 1802 wrote a treatise on corns. This was followed in 1845 by the first medical text on footcare authored by Lewis Durlacher.
By the eighteenth century the trade of corn cutting or corn operators as they preferred to be known had become very respectable. Charging approximately a guinea for their services practitioners became quite prosperous (Lion, 1802 cited in Seelig). Funney (circa 1750) captured the image of a London corn operator in one of his engravings. The gentleman appeared well presented with wig and spectacles which would infer affluence. He also displayed a set of small surgical tools, the first time these had been seen. By the end of the eighteenth century, the street corn cutters had started to disappear and with them went the fashion for outlandish claims and expertise. Instead the more discerning corn operator preferred simple business cards with the address of their practice. Clients could expect to find premises well appointed reflecting the standard of the occupier. In 1800 according to Kelly's London Directory there was only one chiropodist registered in London, by 1840 there were another two ; and by 1880 there were forty (Runting ,1914). Whilst respectable chiropodists were on the increase at this time there were many itinerant corn cutters some of dubious quality. In 1774 corn operating was not a recognised trade with any entry recorded for chiropody in Campbell's, The London Tradesman (1747). The absence of a formal apprenticeship meant many practitioners encouraged their offspring to take up the calling and trained them appropriately. Abraham Durlacher's son, Lewis Durlacher (1792-1864) was surgeon-chiropodist to three successive British sovereigns, as well as author of a chiropody text. After Heyman Lion there appeared Robert Lion corn cutter in the Edinburgh Directories of 1805. Dr Wolff was a founder of the firm of Wolf and Son, chiropodists, which flourished in London. Mrs Seymour Hill was a well-respected corn cutter in London and inherited her fashionable practice from her father. She was described as one of the greatest London characters and proved an inspiration for Mrs Moucher (Mowcher) in Charles Dicken's David Copperfield. Many of the early corn operators in Europe had aspirations as dentists. The town archives of Frankfort, Germany, for example contains records have repeated licence application from Jacob Hirsh from Saxony to practise chiropody and dentistry. Eventually he was given permission to trade as a chiropodist but refused a licence to practice as a dentist. Dr. Wolf in London described himself as operator on the teeth and corns; Durlacher was registered as a Surgeon-Dentist and corn operator; Lion registered in the Edinburgh Directories (1790-1803) as dentist and corn operator. The same dualism was seen in North America and possibly the other colonies too. Continuation would be necessitated by the absence of sufficiently qualified people. Only with the development of specialisation would separation become apparent. Meantime the scope of podiatry would appear to be based on history and practice.

As a footnote, Hyman Lion whilst practising as corn operator undertook studies for a medical degree at Edinburgh and Aberdeen University. Despite passing with distinction Lion was prevented from practising medicine because the medical faculty did not consider his first calling of corn cutting a reputable occupation. This mind set does not appear to have shifted much in two hundred years.

Corn Cures
During the sixteenth century an epidemic of syphilis devastated the known world. In the absence of a cure physicians were ill prepared and many refused to treat patients with the complaint. Hence it became fashionable to seek alternative treatments usually from charlatans. During the reign of Henry VIII (1457-1509), an act entitled the Quack's Act was passed which gave licence to sell and administer almost anything to alleviate outward sores or wounds. Many topical corn cures date from this time. In 1714 Daniel Turner published a dermatological text with reference to corns, warts, kibes and whitlaws. (Tollafield and Dagnall, 1997) Many of the common remedies referred to came from the sixteenth century. It is unlikely corns were considered a medical ailment and hence provided no interest to medical practitioners whatsoever. In factual terms at those times in history when tight fitting shoes was fashionable it was often thought, especially for women, that baring discomfort and pain associated with the shoe was a mark of piety. Mountbanks demonstrating foot remedies were a common site and in one instance the inspiration for a painting entitled "The Charlatan " by Jan Victoor (1620-1676). The corn cure panaceas of the seventeenth century were followed with more specific claims in the eighteenth century and by the nineteenth century their advertisements filled the pages of the newspapers.
Possibly the largest corn ever reported was in 1677 when Dr Robert Plot measured an excrescence belonging to a wheelright by the name of Sarney (National History of Oxfordshire). It was two inches long. Many corn cures have originate from antiquity, some so bizarre you cannot help wonder, under what circumstances they were first discovered. Looking at the range of activities a pattern emerges, which is not that, different from today's self-treatment. Whilst materials chosen may seem odd, by today's standards, to the poor peasant these would have the advantage of being cheap and available. Throughout history popular corn cures involved the application of pastes to the skin surface. Two regularly recommended treatments in the sixteenth century involved pastes made from swine dung or the ashes of charred willow. Highly recommended in the nineteenth century were pastes made from common garden leeks or common soda of the oil-shops. These were placed on buff leather sticking plaster and were to become the forerunner of medicated plasters. It was also common for people to soak their painful corns in the gastric juices of animals including calf. In 1622 the Safonya stone was reported to be very good for treating corns. By the late nineteenth century periodicals and newspapers were full of advertisements for preparations to undo the damage caused by ill-fitting footwear. The magnitude of the problem could be gauged from the masses of cures for corns, which promised to obviate the necessity for the knife. C& J Clark Somerset shoemakers came up with a novel idea, in 1833, by advertising boots and shoes manufactured on anatomical principles and the promise that “these boots do not deform the feet or cause corns and bunions but were comfortable to wear and make walking a pleasure. Country folk continued to rub their hard skin nightly with castor oil. Others soaked their feet in vinegar or kerosene, using lemon juice as a skin astringent. Onion in vinegar was also a popular cocktail. These remedies would undoubtedly increase the water content of the skin, which would make the hardened skin layers, softer and easier to remove. However there remained no panacea. It is well documented both skin and leather and leather were softened by urinating on the corn or into the shoes. This was commonly reported during the Great War. Not perhaps as bizarre as you might think however since the protective layer which surrounds the skin has high uric acid content. Increased concentration of uric acid would help the scaling process of the skin. By the 1930s and North Americas pre-occupation with marathons such the Bunion Derby, meant a trade opportunity few could miss. Sore toes with painful corns responded to salves of salicylic acid. Soon all manner of patent medicines appeared with wondrous claims of cure. A little more circumspect today the industries of self care for corns and callus remains buoyant with little change since the Middle Ages.

Professionalism
Until the turn of the 20th century, chiropodists worked independently of others. and Durlacher was one of the first people to recognise the need for a protected profession and tried to establish the first association of practitioners. He wrote the following in 1854.

'From such men the public unable of themselves to distinguish between the competent practitioner and the empiric, ought to be protected either by legislation enactments, or by the licensing medical bodies, making diseases of the feet a part of the regulation medical education, and also by examining those persons who wish to practise as chiropodists and to whom , if found to possess the surgical information, a kind of diploma or certificate of qualification for its practice as a special branch of science , might be granted. I hope the time will soon arrive when the chiropodist will rank with all other members of the profession, and that any infirmity, however trivial it may seem, may not be considered beneath the attention of the surgeon, because although corns and other disorders of the feet may not be regarded as properly coming under his notice, the operations for their relief require as much skill and dexterity as are necessary for the performance of those of greater importance.'

The author was clearly describing the beginnings of what would become a registered medical auxiliary service. Albeit it would take another century to come to pass.
The first society of chiropodists was established in New York in 1895 with the first school opening in 1911. One year later the British established a society at the London Foot Hospital and a school was added in 1919. In Australia professional associations appeared from 1924 onwards. With professionalisation came the written culture and the first American journal appeared in 1907, followed in 1912 by an UK journal and in 1939, the Australians introduced a training centre as well as a professional journal. The number of chiropodists increased markedly after the Great War then again after World War II, increased numbers of soldiers needing to be gainfully employed in Civvy Street gave chiropody a much required boost and led to the need for registration in all English speaking countries. The respectable study of the foot i.e. podology brought greater critical thought to the practice of foot care or podiatry. Many basic skills practised today had their beginnings during the first half of the twentieth century.

Biomechanics
Once the care of ordinary people became the focus of La Gaze and the establishment of public teaching hospitals meant acknowledged experts could practice medicine as well as teach. Medical specialisation became possible. Until this time hospitals were glorified brothels where poor people were sent to die, usually in great pain and distress. During this time the workings of body systems became known as biomechanics. Modern interpretation takes rather a narrower meaning and relates this to human movement only, but originally it meant the complete biological system. Throughout history many researchers have tried to analyse walking but it took to the introduction of cinematography before real insights were made. Perhaps, with surprise, it is worthy of note that an early pioneer of kinematics was Sir Charles Chaplin. He acknowledged walking as a basic human trait, which the filmmaker fully exploited on celluloid to the delight of millions around the world. Chaplin filmed many of his sequences backwards then ran them forward to accentuate the movement and expression. Frame by frame analysis now helps researchers and clinicians make sense of the human condition but started off as an amusement for the masses. When the wounded veterans returned from Korean and Vietnam Wars, many North American people were appalled at the apparent lack of research and development in the science of rehabilitation of amputees and those physically and mentally afflicted by combat. Greater political pressures resulted in the introduction of a national rehabilitation initiative. Coincidentally at the same time, North Americans were concerned about the threat of Russia dominating space, and began to throw zillions of dollars into and aerospace development. This happy coincidence brought physics and medicine together in the 1950s, and biomechanics was born through research. At first greatest concentration was given to the analysis of the major weight bearing joints but later in the early 1970s researchers at the California School of Podiatry began to apply the same principles to the biomechanical behaviour of the sub talar and mid tarsal joints. The Root Paradigm provided a worthy description of gait events and has become the preferred model for allopathic care of the foot. Paradoxically the criteria of normalcy lack validity and reliability, but this fact is often ignored by foot biomechanists who simply accept it in the absence of other credible alternatives to describe foot function. Closer professional ties between practitioners across the globe during the 1970 and 80s meant podiatric mechanics were accepted in the UK, Australasia, Canada and South Africa.

Focus on Flat Feet
From medieval times it was commonly believed a flat feet were unlucky and a sign of evil. The devil was thought to appear with cloven hoof (like the goat) but his disciples were flatfooted. Even shoes were viewed with considerable suspicion because it could hide a flatfoot (under the cover of a shoe). Shoemakers throughout history have been portrayed as people with ulterior motives. Ironically in Roman times several early Christian saints made meagre living by day as sandal makers, then, by night, preached the subversive gospel. In the Middle Ages shoemakers pandered to popular demand by making shoes with attitude i.e. shoes which reflected a resurgence of pagan worship. Gothic folklore often depicts shoemakers as puckarian, often as hobgoblins. The reason why flat feet were chosen, as a mark of evil is unclear but it may have been because they were the opposite to the Christian ideal of perfection i.e. the arched foot. Since all Judo-Christians believed they were made in the image of god, then artistic depiction of perfection, as seen from contemporary paintings and statues etc. indicate ached feet were the image of perfection.

Flat feet were considered iconoclastic or 'unchristian'. People in the Middle Ages with marked flat feet were especially vulnerable even although they were congenitally challenged or suffering crippling disorders including leprosy and rheumatoid disease. The church did not discourage peasant mentality which associated disease with demonic possession. Many supposed witches were put to death on the accusation they had flat feet or other disfiguring features considered, unnatural. As centuries passed and the medical profession developed "La Gaze", devils were replaced by disease in Western Medicine. During the eighteenth and nineteenth centuries scientists believed in Darwinism with the pseudo - scientific belief there were some races inherently weaker than others. Lowest on the scale were the aboriginal races, next in the pecking order of frailty, were the white ghetto dwellers of European cities i.e. Jewish people. After many years of so called research the medical profession came to the conclusion, the main factor which linked the Jewish population was they all had flat feet. This meantime was used to explain why they were physically incapable of contributing to the society in which they lived. The condition of flat feet was given the medical term "Jewish foot" and anyone so diagnosed was considered lazy and useless. This referred particularly to men and maybe the deep rooted reason why men, even to this day, men are not keen to admit to foot problems. By the twentieth century however the atrocious logic based on anti-semiticsm had become a medical fact and the condition was now known as a weak feet. Continued anatomical studies gave plausible reasons why they were present and the myth was complete when medics began to select recruits for armed services, on the basis of the arch of their feet. Men with well formed arches were automatically selected to serve, whereas the cruel paradox was many had structural weakness which ensured thousands of enlisted men suffered needlessly. The cost to the governments of releasing recruits from service due to foot fatigue was costly and hence the task of medical officers was to decide whether the presenting feet were likely to collapse during the early months of preparing the soldier. This proved quite impossible and much of the resulting injury had little to do with weak feet per se and more to do with cruel military regimes. It took till the 1970s before the pronated foot was discovered and this remains a euphemism for weak feet. The preferred treatment for the medical condition, weak feet was exercise with external arch support. These treatments fell into the professional remit of orthopaedic surgeons and chiropodist/ podiatrists. Pioneers like Franklin Charlesworth from Manchester, England bridged the gap by specialising in foot appliance work (foot orthoses) and through his published works forged valuable links between professions as well as bringing UK chiropody and US podiatry closer together in the 1960s.

History of Podiatry in Australia
The earliest mention of chiropody in Australia was in the 1840's with chiropodists in Sydney (NSW) and Geelong (Victoria) advertising their services. Full time practices were established within the more populated areas of Sydney (1862), Melbourne (1857) and Brisbane (1899). Gradually new and second practices sprung up until by the end of the century there were nine chiropodists working in Sydney; two in Melbourne and Brisbane. The cessation of the Great War (1914-18) saw the number of practitioners swell because many who served in the Australian Army Medical Corps took chiropody as a living. New associations were formed in each state and these had both familiar names as well some exotic combinations. The Society of Chiropodists and Practipedists was formed in Sydney, 1924 with ten members. The association had a short life and were soon replaced with the Australian Institute of Podology in New South Wales, three years later. The Institute established a foot clinic which provided free foot treatment to citizens in need. Later this became the College of Podiatry of New South Wales and continued for another twenty years. A rival group was the Incorporated Institute of Chiropodists of New South Wales, formed in 1939, it had seventy members. They also sponsored a training centre and clinic and introduced the first Australian professional journal. Other states e.g. Victoria and South Australia had independent but mirrored developments. In 1934 Victorians formed the Australian Institute of Surgical Chiropodists, but later the word surgical was deleted from the title. The first attempt to draft a Chiropody Bill was in 1936 in South Australia, This took to 1944 before it became law and other states followed the established pattern. In 1940 the National Society of Chiropodists (Victoria) was formed and like their counterparts in New South Wales, provided training facilities in many of the larger metropolitan hospitals. Queensland, South and West Australia had similar metamorphoses. During the forties, there were three main organisations in the most populated state of Australia i.e. Incorporated Institute, College of Podiatry, and the Pharmaceutical-Chiropodists Society. Eventually there was a New South Wales Chiropody Council which was formed to uplift the profession and act as an advisory body. The Chiropody council had out of state representatives in neighbouring Queensland, Victoria and Tasmania which formed the beginning of a true national body. The Australian Journal of Chiropody was first published in 1940 and although publication was suspended during the war years it did reappear in 1947. New groups formed and reformed as the profession spread throughout the populated areas. Many soldiers returning from the Second World War took the opportunity to train as chiropodists under the government's rehabilitation scheme. Full time courses were twelve months in duration with an option for two years part-time. By 1949 there were two associations claiming to represent the profession. Each had their own training
and code of ethics however there was so little differences between them; they merged in 1954 to form the Australian Chiropody Association. During this time the vast majority of practitioners in Australia were from overseas and immigration brought chiropodists from the UK and a decade later, podiatrists from the US. The average fee was 17/6d (18 pence). The establishment of a Chiropodists/Podiatrists Registration Act for each state assured a closed profession and this took place between 1957 and 1962 across the country. At the National Convention in Adelaide (SA) in 1963 delegates moved to incorporate Australian Chiropody Association and two years later, rival association amalgamated. The first three year full time course of training was started by Australian Podiatry Association (NSW) in 1965, Victoria followed in 1968 This brought Australian and UK training into alignment. The Western Australian Institute of Technology was the first to offer a full time diploma in 1972, by 1975, the Sydney Technical College was offering and Associate Diploma in Podiatry. Queensland Institute of Technology followed in 1977 with a diploma; and Lincoln Institute of Technology, Melbourne, a year later with the South Australian Institute of Technology offering its diploma in 1980. Later these institutes were absorbed into universities*. Eventually the state associations formed the Australian Podiatry Council (the national body for the State Associations) with its administrative offices in Melbourne. There are now six Registration Boards and six teaching centres with two levels of awards i.e. unclassified bachelors degree and honours level. Courses vary from three to four years of full time study. The Australian universities offering podiatry are: Charles Sturt University; Curtin University of Technology (WA); La Trobe University (Victoria); Queensland University of Technology; University of South Australia; & University of Western Sydney (NSW). Australian podiatrists are able to practice abroad with their qualifications recognised in all Commonwealth countries. The scope of practice of the Australian podiatrist ranges from pedicure to bone surgery. Specialisation in fields such as care of children, sports medicine and foot biomechanics have become established over the last decade. Most podiatrists remain general practitioners but will have other specialist interests. Growth in demand for podiatry services has increased over the years and is now related to the increasing ageing population. However the Australian way of life which places so much emphasis on outdoors and physical fitness has really made care of the feet very much an Australian phenomenon. Recognition of podiatry as a debatable item by private insurance funds has also established a changed emphasis from palliative care to preventative and corrective management. Continuing professional education is recognised as an essential activity for professionals and here again the public universities have led the way in Australia. In tandem with the profession and to meet their requirements, the universities now offer post graduate courses spanning post-graduate diplomas, masters and now doctorates. Curtin University of Technology WA launched a new distance education program designed to help Australian practitioners unable to physically get to a centre of education. Thanks to the technical expertise and distance education experience the new program will be based on the internet. Collaboration between professions and other universities have made this possible.
* The University of Western Sydney took over the podiatry program from Sydney Technical College in 1997.

History of Podiatry in New Zealand
Podiatry became a registered profession in New Zealand in 1969 with the requirement all applicants took a recognised three year course of training. The New Zealand School of Podiatry was established in 1970 at Petone under the direction of John Gallocher. Later the school moved to the Central Institute of Technology, Upper Hutt, Wellington. In 1976 the profession gained the legal right to use local anaesthetics and began to introduce minor surgical procedures as part of the scope of practice. New Zealand podiatrists were granted the right of direct referral to radiologists for x-rays in 1984. Acknowledgement of podiatric expertise marked improved services to patients and eventually in 1989 suitably trained podiatrists were able to become licensed to take x-rays within their own practice. Diagnostic radiographic training is incorporated into the degree syllabus and on successful completion of the course, graduates register with the New Zealand National Radiation Laboratory. By 1987, the CIT recognised the need and began to develop plans to build a surgical training facility on campus. The self-contained twin theatre and radiology facility was completed in 1991 and serves the podiatric surgical needs of the population of the Hutt Valley. Surgical training is overseen by the New Zealand College of Podiatric Surgery and post graduate programs have been run in conjunction with the Ohio College of Podiatric Medicine. Over the past three decades, podiatry educators from all over the world has made valuable contributions to the developing curriculum which makes the department of podiatry rather a unique centre of podiatric excellence in the world. In 1986 the profession undertook a needs analysis in conjunction with the Central Institute of Technology to identify competencies for podiatry in 2000. A Bachelor of Health Science was introduced in 1993.

Modern History of European Podiatry
I am grateful to Alex Bots for the following summary of the history of the Federation internationale des podologues (F.I.P.). The international association was founded circa 1947, by French-speaking associations from France, Switzerland and Belgium. It was agreed to hold a congress every two years. Between 1963-1969 the Association grew incorporating: Spain, United Kingdom, Italy, Denmark, Germany, Austria, Sweden, Norway, Finland and the Netherlands. F.I.P. commissioned, the CLPUE (Comite de liaison de la Communaute Europenne) to defend the interests of the Association within the European Union. In 1979 a slinter group broke away from F.I.P.and formed a new Association, named Association European des Podologues (AEP). Later another new crisis arose when in 1975 Spanish and French members wanted to break away from the F.I.P. Growing differences of opinion concerning the future of the profession were eventually ratified and both countries rejoined forces with the F.I.P. Four years later history repeated itself, this time the delegates from the United Kingdom raised concerns regarding the function of FIP. The ICTPM (International College of Teachers of Podiatric medicine) was founded in 1982. Recently the title of the college changed into ICDP and new ties were made with America and Canada. As a result of these changes the title of the Association changed and a "P" was added, which stood for "Podiatrists", later the addition was dropped again and the old name (F.I.P.) has been used ever since.

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3 comments:

Aaron Carter said...

This is quite the history. I have always enjoyed learning about the history about things. I didn't know the history of foot clinics was so deep. I will have to share this with my podiatrist.

Aaron | http://www.physiomobility.com/orthotics-footcare.html

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