For much of its history, podiatry has developed along different paths in different countries. In the United States, the profession evolved toward a physician-based model with increasingly sophisticated medical and surgical training. In the United Kingdom, Australia, New Zealand and other countries, podiatry developed within different healthcare and educational systems, often placing greater emphasis on biomechanics, musculoskeletal medicine, sports medicine, orthoses, rehabilitation and management of the high-risk foot. Today, these traditions increasingly overlap—and the international profession offers an important perspective on what comprehensive foot-and-ankle care can look like.
From Chiropody to Modern Podiatry
The roots of British podiatry extend back to the 19th century, when the profession was generally known as chiropody. The Royal College of Podiatry’s historical archives document practitioners such as Fanny Potter, who practiced in Victorian London and treated members of the royal family. Her son, Ernest Runting, became one of the founders of the National Society of Chiropodists in 1912. Runting was interested in elevating chiropody into a recognized profession and helped establish clinical education and the London Foot Hospital. (College of Podiatry)
Professional education continued to develop. In Edinburgh, Catherine Norrie and Margaret McKenzie Swanson established the Edinburgh Foot Clinic in 1924. Its success led to a School of Chiropody developed in collaboration with the university medical school and the Royal Colleges, with a two-year academic curriculum. Norrie worked extensively to gain recognition of chiropody by the medical profession and British Royal Colleges. (College of Podiatry)
The British profession subsequently developed within the National Health Service and gradually evolved from chiropody toward modern podiatry. Over time, its clinical scope expanded beyond traditional foot care into areas such as biomechanics, musculoskeletal medicine, sports medicine, diabetes, wound care, rheumatology, paediatrics and prescribing.
The Royal College of Podiatry’s historical archive preserves this development through journals, correspondence, textbooks, organizational records and biographies of important practitioners. (College of Podiatry)
Australia Took a Different—and Fascinating—Path
Australian podiatry provides an especially interesting example because it incorporated substantial American influence while retaining a broader podiatric foundation.
In the 1970s, Australian podiatrists began looking to the United States for development of podiatric surgery. Formal professional contact between Australian and American podiatry began in 1975, and American podiatrists subsequently helped Australian practitioners develop surgical skills and training programs. (Stride)
This eventually produced a formal Australian podiatric surgical specialty. Australian podiatric surgery subsequently developed sophisticated reconstructive capabilities, including bone and joint procedures and tendon and ligament surgery. (Stride)
But Australia did not simply become a smaller version of American podiatry. Its podiatric profession continued to encompass biomechanics, sports medicine, rehabilitation, orthoses, high-risk foot care and other areas.
The Australian Podiatry Association currently describes graduate podiatric education as including anatomy, physiology, biomechanics, rheumatology, pharmacology, medicine, surgery, dermatology, radiology and pathology. Qualified podiatrists may assess and diagnose foot and lower-limb conditions, treat sports injuries, set fractures, prescribe orthoses, order imaging and, where appropriately endorsed, prescribe medications. Podiatrists may also order and perform physical therapy. (Australian Podiatry Association)
That is important: international podiatry did not simply choose rehabilitation instead of surgery. In some countries, it developed both.
The American and International Models Developed Different Emphases
It is tempting to describe the distinction as:
American podiatry = surgery
International podiatry = conservative care
That is too simplistic.
A better description is that different healthcare systems encouraged different centers of gravity.
American podiatry developed a particularly strong physician and surgical identity. Podiatric medical education, residency training, hospital practice and surgical specialization became major components of the profession.
Meanwhile, British, Australian and other international podiatric systems developed strong traditions in:
- biomechanics and gait
- orthoses and footwear
- musculoskeletal medicine
- sports medicine
- exercise and rehabilitation
- diabetic and high-risk foot care
- wound management
- rheumatology
- paediatrics
- and, in some countries, podiatric surgery
The result is not necessarily a difference in what podiatrists can do. It is often a difference in what podiatrists are expected to do and what their healthcare systems expect them to provide.
| 🇺🇸 U.S. | 🇬🇧 UK | 🇦🇺 Australia | |
|---|---|---|---|
| Formal podiatric scope | Broad | Broad | Broad |
| Surgery | Highly developed; major part of professional identity | Limited/niche compared with U.S.; podiatric surgery exists as a recognized specialist pathway | Developed but specialist |
| High-risk foot | Well developed, but often fragmented among wound care, vascular, diabetes and podiatry | Strong; major NHS podiatric role in diabetic/high-risk foot | Strongly embedded in podiatric practice |
| MSK / sports | Established but unevenly distributed | Well established within podiatry | Very prominent |
| Biomechanics / orthoses | Historically very strong, particularly CCPM tradition | Strong, with gait/biomechanics integrated into podiatric practice | Strong |
| Rehabilitation / exercise therapy | Within scope but not a mainstream identity; PT frequently receives the rehabilitation referral | More integrated into podiatric MSK practice | Especially explicit/integrated |
| Routine foot care | Major identifiable practice segment | Common, particularly community/NHS podiatry | Common, but not as defining of the profession |
| Public-sector role | Relatively limited compared with UK/Australia | Very important; podiatrists are integrated into NHS multidisciplinary services | Significant public and community health role |
| Professional identity | Often perceived as polarized: surgery ↔ routine care | More clinical/MSK/high-risk/community oriented | More broad/generalist/MSK/high-risk oriented |
| Rehabilitation culture | Developing niche | More established | Particularly developed |
Musculoskeletal Medicine: A Major International Strength
One of the most interesting differences is the prominence of musculoskeletal podiatry internationally.
A contemporary MSK podiatrist may manage conditions such as:
- plantar heel pain
- Achilles tendinopathy
- metatarsalgia
- tendon disorders
- ankle instability
- stress injuries
- osteoarthritis
- running injuries
- biomechanical disorders
- activity-related foot and ankle pain
The treatment may include orthoses and footwear, but increasingly also includes exercise prescription, progressive loading, strength development, neuromuscular control, movement retraining and return to activity.
This creates a different relationship with physical therapy.
Rather than assuming:
Podiatrist diagnoses → PT rehabilitates
the model may be:
Podiatrist diagnoses → podiatrist manages biomechanics and rehabilitation → PT collaborates when additional rehabilitation expertise or intensity is needed.
Australia’s professional scope is particularly explicit about this, identifying rehabilitation and sports-related care within podiatric practice while also emphasizing collaboration with physiotherapists and other health professionals. (Australian Podiatry Association)
Sports Podiatry Is More Than Treating Athletes
International sports podiatry has also evolved beyond simply treating an injured athlete.
Modern sports/MSK practice considers:
tissue capacity + training load + biomechanics + strength + movement + recovery + return to activity.
That approach is increasingly relevant even to patients who would never call themselves athletes.
A person with Achilles tendinopathy who wants to walk three miles a day is still an MSK patient.
A recreational runner with plantar heel pain is an MSK and sports patient.
A middle-aged patient who wants to return to hiking after an ankle injury needs rehabilitation even though they aren’t a competitive athlete.
This is why MSK podiatry is arguably the broader category, with sports podiatry representing an important application within active and athletic populations.
Rehabilitation Changes the Model
The greatest opportunity may be the development of podiatric rehabilitation.
Traditional podiatric biomechanics often emphasized changing the mechanical environment:
orthoses → footwear → padding → activity modification.
Contemporary rehabilitation adds another dimension:
change the patient’s physical capacity.
That means learning how to prescribe and progress:
- calf strengthening
- tendon loading
- intrinsic foot strengthening
- balance and proprioception
- neuromuscular control
- mobility
- progressive resistance training
- kinetic-chain strengthening
- running progression
- return-to-activity programs
This doesn’t mean podiatrists become physical therapists.
Rather, it means that rehabilitation becomes another clinical tool available to the foot-and-ankle specialist.
PT remains an important collaborator, particularly when patients require intensive rehabilitation, broader whole-body rehabilitation, specialized sports performance training or services outside the podiatrist’s expertise.
The U.S. Has a Different Challenge: Fragmentation
The United States has developed tremendous podiatric medical and surgical capabilities. But the American healthcare system can also fragment the foot and ankle among multiple specialties.
A patient with a foot-and-ankle problem may be directed to:
PT for rehabilitation
orthopedics for fracture or surgery
wound care for an ulcer
vascular surgery for arterial disease
dermatology for a skin lesion
podiatry for other aspects of foot care.
In some cases this is exactly appropriate.
But fragmentation can also mean that no single clinician remains responsible for understanding the entire foot-and-ankle problem.
The patient may never see a podiatrist at all.
This is particularly important for musculoskeletal conditions. A patient with Achilles tendinopathy may be referred directly to PT. A patient with an ankle injury may be directed to orthopedics. A patient with a stress injury may enter an orthopedic or sports medicine pathway.
The result is that podiatry can lose part of its natural role as the comprehensive foot-and-ankle clinician.
The Answer Isn’t to Become a “Super Surgeon”
There is an important lesson here for American podiatry.
The response to fragmentation does not necessarily have to be:
“We need to do more surgery.”
Surgical competence is extremely valuable, but surgery is only one part of foot-and-ankle medicine.
A comprehensive podiatrist can potentially provide:
Diagnosis
↓
Musculoskeletal medicine
↓
Biomechanics and gait
↓
Orthoses and footwear
↓
Exercise and rehabilitation
↓
Shockwave and other appropriate procedures
↓
Sports and activity medicine
↓
Wound and limb preservation
↓
Fracture and trauma care
↓
Surgery when indicated
Not every podiatrist needs to personally provide every component. But maintaining knowledge across the continuum allows the podiatrist to determine what the patient actually needs and when collaboration or referral is appropriate.
What the International Perspective Offers American Podiatry
The international profession provides an important counterbalance to the tendency to equate professional sophistication with surgical complexity.
A podiatrist can be highly sophisticated because they are excellent at:
- diagnosing MSK disorders
- understanding biomechanics
- prescribing orthoses
- prescribing exercise
- managing tissue loading
- conducting rehabilitation
- treating sports injuries
- managing diabetic and high-risk feet
- coordinating multidisciplinary care
- and knowing when surgery is appropriate.
Surgery remains an important part of the profession—but it doesn’t have to be the sole measure of professional identity.
At the same time, international podiatry has learned from American podiatry. Australia’s development of podiatric surgery is a particularly clear example: American podiatrists helped Australian colleagues establish surgical education, and subsequent Australian surgical training incorporated American residency and fellowship models. (Stride)
The exchange has therefore gone in both directions.
A More Complete Vision of Podiatry
The history of international podiatry suggests that there is no single correct model.
American podiatry has developed extraordinary strengths in medical education, residency training, surgery and hospital-based care.
British and Australian podiatry have developed particularly visible strengths in MSK medicine, biomechanics, sports medicine, rehabilitation and multidisciplinary practice.
The future doesn’t require choosing between them.
A genuinely comprehensive podiatrist can understand:
the disease, the mechanics, the tissue, the patient’s function, the rehabilitation, the medical issues, and the surgical options.
That is perhaps the most valuable lesson from looking beyond the American professional model.
The foot and ankle do not stop being one interconnected anatomical and functional system simply because healthcare divides them among different professions.
Podiatry’s opportunity is not to claim that it should replace every other profession. It is to remain capable of seeing and managing the whole patient—and to collaborate intelligently when another professional can add something valuable.
For American podiatry, the international experience offers an important reminder: being a comprehensive foot-and-ankle clinician means more than being a surgeon, and it certainly means more than routine foot care.
Royal College of Podiatry — Centre for the History of Podiatric Medicine
Australian Podiatry Association — Scope of Practice
Australian history of podiatric surgery — Part 1
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