For decades, podiatry has wrestled with a familiar question: Why does the public so often misunderstand what we do?

Many podiatrists have experienced being introduced as the “nail trimmer,” or someone who is excluded from referrals. Yet today’s Doctor of Podiatric Medicine (DPM) completes four years of professional school, a three-year hospital-based surgical residency, and often board certification in foot and ankle surgery or foot and ankle medicine. The profession has evolved dramatically while public perception has lagged behind.

Interestingly, another profession has faced a remarkably similar challenge: osteopathy.

Although the trajectories are different, comparing osteopathy around the world with podiatry provides several valuable lessons for our profession.

One Name, Different Professions

The word osteopath means very different things depending on where you are.

In the United States, a Doctor of Osteopathic Medicine (DO) is a fully licensed physician with the same legal scope of practice as an MD. DOs complete medical school, residency, prescribe medications, perform surgery, and practice every medical specialty.

Outside the United States, however, osteopathy often refers to a manual therapy profession focused primarily on musculoskeletal care. In many countries, osteopaths are not physicians, do not attend medical school, and do not perform surgery.

The same title represents fundamentally different professions.

Podiatry shares a surprisingly similar international identity challenge.

Podiatry Is Also Not the Same Everywhere

Many Americans assume podiatry is a single worldwide profession.

It is not.

Training, surgical privileges, prescribing authority, and scope of practice vary tremendously across countries.

In the United States, podiatric medicine has evolved into a highly specialized physician profession devoted exclusively to diseases and disorders of the foot and ankle. Three-year surgical residencies, hospital privileges, advanced imaging, diabetic limb preservation, sports medicine, reconstructive surgery, wound care, and biomechanics have become routine components of practice.

In many other countries, podiatry (or chiropody) remains primarily focused on conservative care, routine foot care, nail disorders, skin conditions, and biomechanics, with significantly less surgical training.

Neither model is inherently “better.” They simply represent different historical paths.

How does history shape public perception of podiatry and osteopathy?

Both professions illustrate an important principle:

Public perception changes much more slowly than professional education.

Many people still think:

• DOs are “not real doctors.”
• Podiatrists “just trim toenails.”
• Osteopaths everywhere are physicians.
• Foot care is primarily cosmetic.

None of these statements accurately describe modern American practice.

The public often continues to view professions through the lens of decades-old stereotypes.

What is the relevance of osteopathy's evolution to modern podiatry?

The comparison with podiatry is interesting because both professions experienced a gap between historical identity and modern training.

DOs had to overcome the perception that they were something less than physicians. Modern U.S. podiatry faces a different challenge: many people still do not recognize that DPMs are highly trained physicians and surgeons specializing in the foot and ankle.

The DO lesson is that professional perception changes when the profession consistently communicates its education, demonstrates expertise, and establishes itself as indispensable in healthcare.

Lesson 1: Lead With the Physician Role

One of osteopathic medicine’s greatest successes was shifting its messaging.

Instead of constantly explaining how DOs differed from MDs, the profession increasingly emphasized one simple message:

DOs are physicians.

Only after establishing that foundation did discussions about osteopathic philosophy or manipulative treatment become relevant.

Podiatry can adopt a similar strategy.

A profession can evolve while acknowledging its origins.

Medicine has many examples of this:

• Dentistry evolved from barber-surgeons and tradesmen centuries ago, but dentists today do not define themselves by those origins.
• Pharmacy evolved from apothecaries, yet modern pharmacists are not introduced as compounders of herbal remedies.
• Ophthalmology evolved from early eye surgeons, but its identity today is shaped by contemporary medical practice, not its historical roots.

The same principle applies to podiatry. Understanding the history of chiropody is valuable, but it does not necessarily dictate how today’s profession should define itself.

Instead of leading with nail care or diabetic shoes, we should first communicate:

• We diagnose foot and ankle disease.
• We manage complex medical conditions.
• We perform surgery.
• We prevent limb loss.
• We specialize exclusively in the foot and ankle.

Procedures are important.

Professional identity comes first.

Lesson 2: Own the Specialty

Dentists are not constantly explaining that they are not physicians.

Ophthalmologists are not apologizing for treating only the eye.

Hand surgeons do not justify limiting their practice to the upper extremity.

They own their specialty.

Podiatry should do the same.

Our expertise is not diminished because it is anatomically focused.

In fact, specialization is one of healthcare’s greatest strengths.

Lesson 3: Public Education Never Ends

Modern podiatry has changed dramatically over the past several decades.

The public often has not.

Every website, lecture, referral note, community presentation, and patient encounter represents an opportunity to educate.

Patients cannot appreciate expertise they never knew existed.

Lesson 4: Let Training Speak for Itself

The profession has invested enormously in education:

• Four years of doctoral education.
• Three-year surgical residency.
• Hospital training.
• Board certification.
• Continuing medical education.
• Fellowship opportunities.

Rather than arguing for legitimacy, podiatry should simply demonstrate competence through excellent patient care.

Respect follows excellence.

Lesson 5: Build a Practice That Reflects Your Professional Identity

Every podiatrist chooses a different practice model.

Some devote their careers to nursing facilities.

Some focus on sports medicine.

Others specialize in diabetic limb preservation, reconstruction, pediatric care, biomechanics, or office-based medicine.

There is no single correct model.

The important question is whether your daily work reflects the physician you trained to become.

If your practice consistently communicates physician-level specialty care, patients begin to understand the value of that expertise.

How has the internet changed patient referrals and public education for podiatry?

Historically, podiatrists depended heavily on physician referrals.

Today’s patients increasingly search online before contacting any healthcare professional.

That shift creates an enormous opportunity.

A clear website explaining foot and ankle conditions, treatment options, and when specialty evaluation is appropriate allows patients to self-select into the practice because they recognize the need for specialized care.

Public education has become a referral source.

What are the future challenges and lessons for modern American podiatry?

Both osteopathic medicine and podiatry demonstrate that professional evolution takes time.

Education advances faster than public understanding.

Training advances faster than stereotypes disappear.

The lesson from osteopathy is not that podiatry should imitate another profession.

The lesson is that professions succeed when they confidently define themselves, communicate consistently, invest in education, and demonstrate value through excellent patient care.

Modern American podiatry has become one of the most highly trained foot and ankle specialties in the world.

Our challenge is no longer becoming that profession.

Our challenge is helping the public recognize that we already are.

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