PODIATRY

 

1.           Introduction

2.           The Current Role of Podiatry in America

3.           American Podiatry and Public Health

4.           A Brief History of American Podiatry

5.           Conclusion

6.           Bibliography

7.           Sources for Further Information

 

 

 

 

 

 

 

 

 

 

 

 

INTRODUCTION

 

 

 

The following is a brief chapter on podiatry, that branch of medicine which deals with the care of the human foot. Although podiatry, or chiropody as it is sometimes known, is quite international in scope, the following account in focused on podiatry in the United States of America. To the extent possible, this author has attempted to sketch out a profile of American podiatry which he could directly corroborate by his 25 plus years as a practicing podiatric physician and surgeon. At the end of this chapter, there are listed a number of addresses and URLs which will provide the reader with other sources of information.

 

 

 

 

 

 

 

 

 

 

 

 

THE CURRENT ROLE OF PODIATRY IN AMERICA

 

            In the United States of America, a podiatrist is a doctor licensed to practice podiatric medicine and surgery. This branch of medicine specializes in the art and science of treating disorders and injuries of the human foot, ankle, and leg, and in preventive health measures for the public, with a goal of maintaining active ambulation, even in an aging society. “Doctors of Podiatric Medicine are licensed in all 50 states, the District of Columbia, and Puerto Rico, to treat the foot and its related or governing structures by medical, surgical, or other means. The vast majority of states also include ankle care as part of podiatric physicians’ scope of practice”.1 Since this author has 20+ years of experience practicing in the state of Ohio, it seems appropriate to use this state’s law as a fairly representative example. The Ohio Revised Code, Paragraph 4731.51 states: “The practice of podiatric medicine and surgery consists of the medical, mechanical, and surgical treatments of the foot , the muscles and tendons of the leg governing the foot; and superficial lesions of the hand other than those associated with trauma.”.

            It is interesting to note the inclusion of the hand which recalls the days when the profession was known as chiropody, before its official name change in 1958. The word chiropody derives from two Greek word roots meaning ‘hand’ and ‘foot’. The name chiropody is still in common use internationally along with podiatry. The title of podiatrist derives from Greek words combining  ‘foot’ with ‘healer, or physician’, and is considered more etymologically correct, since there is very little treatment of the hand rendered by the profession.2 The State of Ohio in paragraph 4731.56 O.R.C., authorizes a podiatrist to use the title “physician” or the use of the term “surgeon” “...when the title is qualified by letters or words showing that the holder of the certificate is a practitioner of podiatric medicine and surgery.”.

            The scope of modern podiatric surgical practice is very broad and includes all the procedures and techniques which are also employed by the specialty of orthopedic surgery, in so far as they are applied to the foot and ankle. For example, such procedures would include: treatment of open and closed fractures of the foot and ankle using both internal and external fixation; similar pediatric trauma surgery; major arthrodesis of the joints of the foot and ankle; the use of implanted bone stimulators; the reconstruction of pediatric and adult congenital deformities; treatment of  feet crippled by arthritis; emergency incision and drainage of significant diabetic foot and ankle infections; amputations of the foot; plastic surgical techniques such as rotational skin flaps and skin grafting; surgery on the major nerves of the foot and leg;  and excision of many kinds of tumors from the foot or leg. All of the above procedures are ones which this author has performed and also taught to second and third year podiatric surgical residents over his career of 25 years.

             Because these services might be rendered by either an orthopedic surgeon or a podiatrist there is a potential for friction not unlike that which exists where many other surgical specialties overlap. Such types of unhealthy competition may exist where economic considerations prevail, but seem less consequential where all practitioners are simply “trying to get the job done”, and are equally salaried from sources such as the military, the Veterans’ Administration, or large HMOs.

            In fairness to orthopedic surgeons it must be pointed out that orthopedic surgeons have postgraduate education and training, i.e. surgical residencies in hospitals, which is more extensive than that required for podiatrists. Orthopedic surgeons frequently spend five to seven years in such residencies and may take additional fellowship specialization in foot and ankle surgery for an additional year.3 The orthopedist has an unlimited license which means that he or she may operate on any bone of the human body, not just the foot and ankle. However, in practice most do specialize in certain areas of orthopedic surgery such as shoulder and hand surgery, back surgery, large joint replacement,  sports medicine and surgery, or foot and ankle surgery. Podiatrists, on the other hand, are more likely to have two to three years of surgical residency, although some programs do offer an additional fellowship year, sometimes providing an opportunity to study in Europe with famous orthopedic surgeons on the Continent.4 Most states require at least one year of postgraduate education for a podiatrist, and all podiatric residency programs are designed so that the first year is a rotating medical internship, in which the podiatrist performs in exactly the same capacity as other first-year medical residents.5

            While podiatric medicine has matured as a sophisticated medical and surgical discipline, it is nevertheless, a tiny profession. The United States Bureau of Labor Statistics reports that “...podiatrists held about 13,000 jobs in 2002.”.6 By comparison, there are 700,000 physicians in the United States.

            The following profile of the American podiatrist of today is abstracted from the 2002 Podiatric Practice Survey as reported to the American Podiatric Medical

 

 Association by Al Fisher Associates, Inc.7 There were 9,392 members of APMA , of which 2,955 (31.5%) responded to a two-page, 30-question survey similar to surveys that were conducted in 1995 and again in 1997.(In which this author participated.) Most (56.6%) podiatrists were still in solo private practice, although the trend compared to 1995 and 1997 is toward more group practices of podiatrists and also participation in multi-specialty groups. The average age of the respondents was 44.9 years of age, reporting 16 years of practice experience. Most were male (86.6%), and white (90.2%), although the trend among younger podiatrists did include many more women and minorities. Most podiatrists had completed a residency program (90.2%), generally in surgery (66.3%). Fully 84.5% reported still having some student loan indebtedness despite being in practice for 16 years. The average student loan debt owed by podiatrists with fewer than three years of practice was $119,773. Most podiatrists were board certified by the American Board of Podiatric Surgery, ABPS, (51.6%) or the American Board of Podiatric Orthopedics and Primary Podiatric Medicine, ABPOPPM, (22%), and 10.7% were certified by both boards.

            In 2001, the average podiatrist worked 41.8 hours per week, averaging 101.4 patient visits per week. On average, 77% of their working day was devoted to treating patients, and 23% was required for administration. The foot problems that these doctors were treating divided as follows: 44.8% heel pain, 23.9 fungal nails, 8.9% ingrown nails, other nail problems accounted for 9.9%, and 4.4% of their treatments were devoted to diabetic foot care. It is interesting with regard to this last percentage that 4.4% is the exact figure that the Center for Disease Control and Prevention8 reports as the prevalence of diabetes in the United States.

            It is gratifying to this author to note that in 2001 nearly 22% of podiatrists were independently performing their own History and Physical exams for patients whom they admitted to the hospital. This capability was certainly not always the case, and represents the beginning of a fundamental change which the author has very strongly advocated.

            In terms of earnings, podiatrists reported a gross income of $276,680 with a net income of  $134,415. At least ten percent of podiatrists were earning a net income of more than $250,000. Podiatrists employed in multi-specialty groups received an average salary of $148,786. In order to compensate for declining reimbursements from third party payers, podiatrists increased their patient volume. The sources of this income were Medicare (38.6%), HMOs (21.6%), and fee for service (18.8%). Only a small fraction of the reporting members of the American Podiatric Medical Association were in military service or employed in the Veterans Administration (1.2%).

            The above statistics would accurately reflect this author’s practice experience of 20 years in an Ohio city of 80,000 population which was closely bounded by other suburban cities creating a population base of 250,000. ‘Sources of Referral’ was not a survey question, however, this author would expect that the more successful podiatry practices enjoyed a significant physician referral base. In his experience of a practice that grew from the first patient seen in 1985 to well over 12,000 persons served by 2001, this practice benefited by referrals from many (more than 50) primary care physicians and from emergency departments as well.

 

 

 

AMERICAN PODIATRY AND PUBLIC HEALTH

 

            Every branch of medicine has been blessed by certain far-sighted individuals who possessed both the wisdom and the energy to move their discipline into a positive future. Podiatric Medicine was fortunate to be moved toward public health by Marvin W. Shapiro, D.P.M., who believed that “...podiatric medicine’s greatest contribution could come in the field of public health.”.9 In the 1950s and 1960s, Dr. Shapiro and a select few other podiatrists put together exhibits at the American Public Health Association’s annual meetings. Eventually, Dr. Shapiro became the first podiatrist to be awarded fellowship status in the APHA. Several physician members of APHA took notice of foot health as a separate topic of health concern. Foot health was seen as especially critical for older persons. Eventually, Arthur E. Helfand became the second podiatrist to receive the honor of fellowship in the APHA. In 1962, the APHA funded Dr. Helfand’s project, entitled “Keep Them Walking”. This was aimed at the older population, and this three-year study provided important justification for the inclusion of podiatric medicine as a necessary service under Medicare.Ibid,9 In 1970, the American Podiatric Medical Association established a Council on Public Health, bringing together all APMA-related committees, coordinating a public health policy, and helping to foster a growing relationship with the American Public Health Association. All these years of cultivation bore fruit in 1972, at the 100th annual meeting of the American Public Health Association, the Podiatric Health Section was formally created. The section was granted three seats in the APHA’s Governing Council. Podiatric medicine has been an active, contributing part of APHA

since that date.  Within the first year, this Podiatry Section was able to formulate and guide

through the Governing Council of APHA a resolution titled “Foot Health and Public Policy”. The Podiatric Section immediately began developing interdisciplinary scientific programs that infused podiatrists’ expertise into major programs of the APHA.Ibid,9

            It must be said that the APHA benefited too, from the dynamic leadership of several podiatrists. Dr. Helfand became the chairman of APHA’s task force on malpractice. It was under his guidance that a resolution was adopted by the Governing Council and submitted as the APHA’a policy statement to the National Academy of Sciences hearings on medical injury compensation.10 Association-wide activity by podiatrists did not end there. Podiatrists also took a lead role in representing the APHA in its efforts with the National League of Nursing to accredit home health agencies and community nursing services.

            While podiatrists were eagerly contributing their services to APHA, podiatry as a profession was benefiting by the association. Dr. Helfand has said: “No other external organization has opened so many doors for podiatric medicine and made it an equal partner in the development of health policy than has APHA.”.11

            In 1975, APHA adopted a statement on the Functional and Educational Qualifications of Podiatrists in Public Health, but it was not until 1983 that the American Podiatric Medical Association formally approved public health as a special area of podiatric medical practice. Although the  Podiatric Medical Section of APHA had made great initial strides during the 1970s, and could boast of a membership of over 700, this involvement declined and membership dropped significantly during the next dozen years.

            Jeffery M. Robbins, D.P.M. was moved to write in his “Chair’s Message” for the Podiatric Health Section Newsletter, Winter 1998-1999 that: “The Podiatric Health Section has lacked a dynamic agenda in the past.”. There is some evidence that certain presidents of the American Podiatric Medical Association, and their administrations, did not fully understand the role that should be played by podiatrists in improving the Nation’s foot health, and consequently they did not provide an adequate level of support for activities in APHA.12 Fortunately, the APMA presidencies of Dr.Marc Lenet and later Dr. Terence Albright provided excellent support and the Podiatric Health Section increased its membership by over 100 members. Dr.Jeffery M. Robbins was (and remains) director of the entire department of podiatry services for the Veteran’s Administration, and he brought this considerable administrative skill to his chairmanship of the Podiatric Health Section. He worked hard to ensure that foot health, particularly that of diabetics, was included in the goals advocated and published in Healthy People 2010. As podiatry enters the 21st century it appears that it has rediscovered its mandate to improve the Nation’s foot health. In a telephone interview which this author conducted recently with the incoming Chair-Elect of the Podiatric Health Section of the APHA, Patricia Moore, D.P.M., there are exciting plans being made now to create a textbook of podiatric health directed toward an audience of other health professionals, and greater emphasis will be placed on podiatrists participation in other sections of APHA.

 

 

 

 

A BRIEF HISTORY OF PODIATRY IN AMERICA

 

            Bates has pointed out that although podiatry may have a new name (see elsewhere in this chapter), “...and the recognition of podiatric medicine as a primary care profession is fairly recent,...podiatry, itself, is as old as any other branch of medicine.”. 13 Humans have undoubtedly always suffered from foot problems since evolving to bipedal gait. Indeed, there is written documentation in an Egyptian papyrus of 1500 B.C.A., outlining a treatment for corns. Hippocrates advocated a sensible approach to corns (thick, hard skin which usually forms on the knuckles of the toes). He recommended a simple operative technique and getting rid of the cause (probably tight sandals or boots). There are records of the King of France employing a personal podiatrist, as did Napoleon. In the United States of America, President Abraham Lincoln suffered greatly with his feet and chose a podiatrist named Isachar Zacharie, who not only cared for the president’s feet, but also was sent by President Lincoln on confidential missions to confer with leaders of the Confederacy during the U.S. Civil War.

            According to Bates history14, the licensing of podiatrists began in 1895 in New York, and in that year, America’s first association of podiatrists was formed. In 1907 the association began publishing Pedic Items, the first professional journal on podiatry. The American Podiatric Medical Association was formed in 1912, and boasts the highest membership percentage of current medical associations.15

            Both traditional allopathic medicine and podiatric medicine required the wake-up call of a formal report to begin moving into the modern era. For medicine this came in the form of the Flexner Report published in 1910 which was initiated by the American Medical Association. The Flexner Report had major impact. Sub-standard medical schools closed, and those that remained became affiliated with universities, admission standards were raised, full-time faculty became the norm, and teaching included work in laboratories and hospitals instead of lectures only. Podiatric medicine had to wait until 1961 for an analogous phenomena with publication of the Selden Commission Report.16 By 1978 all the colleges of podiatric medicine agreed to adopt the exact same requirements as U. S. schools of medicine.

            These were watershed events in the history of podiatric medicine because in the words of Leonard Levy, D.P.M., M.P.H., “...they began providing the basis for establishing legitimacy to the call by the profession for parity with medicine.”.17 In 1967 two separate national changes in policy had a significant impact on the development of podiatric medicine. In 1967 Congress amended the Medicare Act of 1965 to include podiatry. This permitted podiatrists to qualify for payment as did the other physician categories: M.D., D.O., D.D.S. This same year, “...the then Joint Commission on Acreditation of Hospitals issued a bulletin permitting hospitals accredited by the Joint Commission on Accreditation of Hospitals to allow qualified podiatric physicians to perform surgery without having a scrubbed-in ‘physician-surgeon’ in the operating room who was a member of the active medical staff.”Ibid,17

            The growth of post-graduate training programs for podiatrists was slow. The first residency program was opened in 1958 in Philedelphia at St.Luke’s and Children’s Medical Center.Ibid,17 However, it required another thirty years before all graduating  podiatric medical students received residencies.18

            Given that podiatry began as chiropody with ‘knife-in-hand’ cutting corns and

calluses, it should not be surprising that most board certified podiatrists are, in fact, board                                                             

 certified in foot surgery.Op.Cit. The road to a place alongside orthopedic surgery, establishing podiatric surgery as a legitimate specialty area was a long, slow road. One significant step along this road took place in 1942 when the American College of Foot Surgeons was organized. Almost immediately, rigid requirements for membership included both a written and an oral examination.19 A corps of competent podiatric surgeons ( still called Doctors of Surgical Chiropody) lectured throughout the U.S. and trained other surgeons. A State Supreme Court decision in Michigan (Fowler vs. State Board of Pharmacy) gained the right for podiatrists (chiropodists) to prescribe narcotics to relieve the pain of their postoperative patients, thus allowing more extensive surgical operations.

            “The renaissance of podiatric surgery occurred with the opening on June 4, 1956 of Civic Hospital in Detroit, Michigan which was the first podiatry hospital in the United States.”Ibid,19 This hospital had 18 beds and a fully equipped operating room. It quickly became a center for postgraduate education and training in the science and art of podiatric surgery, providing alumni who greatly advanced the state of podiatric surgery, often establishing residencies in their hospitals around the country.

            Fortunately for podiatric medicine and surgery, two podiatrists at the California College of Podiatric Medicine, Drs. Merton L. Root, and Thomas E. Sgarlato, became intrigued with the pioneering research of Verne T. Inman, M.D., who was unraveling the mysteries of human gait. Both Dr. Root and Dr. Sgarlato began to study the biomechanics and kinesiology of the human gait cycle, including pathological conditions that appeared

in the foot. Both began to lecture widely in this country, greatly helping podiatrists to base both their conservative and their surgical treatments on scientific understandings of the complex patterns of human locomotion.

            Podiatric surgeons learned early the great importance of intense postoperative                                                                 

care, and since many of their surgeries were performed in outpatient settings, an early emphasis was placed on ambulatory care. By 1974, Kaplan could claim in his historical review of podiatric surgery that “...the majority of foot surgery is now being performed by podiatrists.”Ibid,19 

            Most developed counties have professions of chiropody or podiatry. Many countries have several colleges of podiatric medicine which have welcomed guest lecturers from America podiatrists whose surgical experience has had a leavening effect on the evolution of the profession in these countries. For example the city of Perth in Western Australia is permitting a rapid growth of surgical skills among its podiatrists. This author had the privilege of participating in the surgical training of one Australian podiatrist who came to Cleveland, Ohio through a fellowship program of the Ohio College of Podiatric Medicine. For six months this author guided his surgical fellow through of all the surgeries which were scheduled through his office. Correspondence with the Australian surgical fellow told a story of considerable development of his surgical practice after he returned to his home. However, at that time in the provinces of New South Wales and Victoria, podiatrists still had not achieved the right to prescribe narcotics, relying entirely on their anesthesiologists for this necessary postoperative

service to their patients. And so, step by step, podiatry grows internationally by a winding path not unlike that followed by American podiatry.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONCLUSION

 

An ancient healing art has evolved in America to become a highly complex surgical subspecialty. The advances that podiatry has made in the 20th century are unquestionable. Modern American podiatrists with advanced postgraduate training are some of the finest foot and ankle surgeons in the world. However, despite these advances there are some questions that remain.

            Some skilled podiatric surgeons wonder if it makes any sense to have a separate branch of medicine for the care of the foot. Such a division has worked well for dentistry, but, perhaps, not so well for podiatry. Podiatry does not stand side by side with medicine as dentistry does. Even a cursory look at medical literature, or medical research, or medical schools will confirm this. These podiatrists can often be found advocating that podiatric medicine be subsumed under the allopathic umbrella. They argue that podiatrists should attend standard allopathic medical schools and then specialize in podiatric surgery , podiatric orthopedics, podiatric primary care, or podiatric public health. This would, they believe, eliminate the confusion that sometimes surfaces regarding a podiatrist’s education and training, and podiatrists’ role in the developing healthcare complex.

            Other podiatrists counter that such an abdication would wipe out entirely the special affection which so many patients feel for their ‘foot doctor’. They claim that such a change would lose that body of knowledge which excels at treating human foot problems without surgery! These doctors and educators, including surgeons as well as non-surgeons, lament their impression that as young podiatrists gain more and more years of postgraduate education, and master increasing complex surgical skills, they grow farther and farther away from the core techniques (and values?) that created the enduring and beneficial profession of podiatry. Only time will answer this.

 

John D. Waddell, D.P.M.

Diplomate, American Board of Podiatric Surgery

Board Certified in Foot and Ankle Surgery

Fellow, American College of Foot and Ankle Surgeons

Board Certified, American Board of Quality Assurance

 

Please contact me at:     john.waddell@case.edu

to offer criticism and corrections which will be incorporated in future chapter revisions. Thank you.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BIBLIOGRAPHY

 

 

1. Viehe RB, Diabetic Foot Care: podiatric physicians are the experts.

     J Am Podiatr Med Assn. 2002 Sep; 92 (8) : 477

2.  This author does have a colleague practicing in the same city who routinely removes

     warts from patients’ hands by laser surgery, in addition to his foot surgical practice.

3.  American Orthopedic Foot and Ankle Society

     2517 Eastlake Avenue East, Suite 200

      Seattle, WA 98102         www://aofas@aofas.org

4.  For example, the three year podiatric surgical residency at the University of Chicago

     offers a fellowship year in Europe with the orthopedic surgeons who originated the

     modern concepts and techniques of using metal screws and plates to fixate fractures.

5.  Viehe RB, How Else Have We Arrived

     J Am Podiatr Med Assn.  2002 Oct; 92 (9) : 528-9

6.  United States Department of Labor, Bureau of Labor Statistics

     Occupational Outlook Handbook       www.bls.gov

7.  Allan H. Fisher, Jr., Ph.D.

     Al Fisher Associates, Inc.

     406 New Mark Esplanade

     Rockville, MD  20850-2735

8.  Centers for Disease Control and Prevention

     1600 Clifton Rd.

      Atlanta, GA 30333       www.cdc.gov

9.  Helfand AE, Hausman AJ, A Conceptual Model for Public Health Education in     

     Podiatric Medicne, J Am Podiatr Assn. 2001 Oct; 91 (9): 488-95

10. Rowena A. Wilson, R.N., M.P.H. J Am Podiatr Assn. 1977 Jul; 67 (7) 463-4

11. Helfand AE, History of the Podiatric Health Section of APHA as recorded by

      the American Podiatric Medical Association on their website: www.apma.org/phshis

12. Personal Correspondence

13. Dagnall JC, The History of Podiatry; J Am Podiatr Assn. 1976 Dec; 66 (12) 944-5

14.  Bates JE, Podiatric Medicine: History and Education; J Am Podiatr Assn. 1975 Nov;

      65 (11) 1076-7

15.  Viehe RB, The Effectiveness of Organized Podiatric Medicine. J Am Podiatr Assn.

       2003 Mar-Apr; 93 (2): 165-6

 

 

 

 

 

 

 

 

 

 

 

Sources for Further Information

 

 

American Podiatric Medical Association                                   Tel:  1 301 571 9200   

9312 Old Georgetown Road                                                    Fax:  1 301 530 2752

Bethesda, Maryland   20814                                                     Email:  askapma@apma.org

USA                                                                                        Website: www.apma.org

 

 

Affiliated and Related Organizations

 

 

American Academy of Podiatric Sports Medicine                      Tel:  (301) 845-9887

P.O. Box 723                                                                           Fax: (301) 845-9888

Rockville, MD  20848-0723  USA                                           Website: www.aapsm.org

 

 

American College of Foot and Ankle Orthopedics and Medicine          

3525 Ellicott Mills Drive, Suite N                                              Tel:  (206) 682-8741

Ellicott City, MD  21043-4547  USA                                       Website:  www.acfaom.org

 

American College of Foot and Ankle Pediatrics             Tel:  (410) 772-9245

P.O. Box 33                                                                

Burtonsville, MD  20866  USA

 

American College of Foot and Ankle Surgeons             Tel:  (847) 292-2237

515 Busse Highway                                                                  Fax:  (847) 292-2022

Park Ridge, IL  60068-3262    USA                                        Website: www.acfas.org

 

 

International Directory

 

Sociedad Científica de Podología de la República Argentina     

Libertad 174 2º - 3º Piso                                                          Tel:  54 4382 9173

Capital Federal (C.P.:  1012)                                                    Fax:  54 4381 7342

Republica Argentina, America Del Sur

 

Australasian Podiatry Council                                        Tel:  03 9416 3111

41 Derby Street                                                                        Fax:  03 9416 3188

Collingwood, Victoria 3066                                                      Website: www.apodc.com.au

Australia

 

Associação Brasileira De Podólogos-ABP                                Tel: 55 22 4422.7500

Av. Prestes Maia, 241 - 21º Conj. 2111                                   Fax: 55 11 3311.7557

São Paulo – SP – Brazil                                                           

 

Canadian Podiatric Medical Association                                    Tel:  1 416 927 9111

900-45 Sheppard Avenue East                                     Fax:  1 416 733 2491

North York, Ontario

Canada, M2N  5W9

 

Fédération Nationale des Podologues                                       Tel:  33 1 44 79 90 91

17 rue de l’Echiquier                                                                 Fax:  33 1 44 79 08 02

75010 Paris, France

 

Zentralverband Der Medizinischen Fußpfleger Deitschlands E.V. (ZFD)

Johannisstr. 12                                                              Tel:  49 02302 83781

D 58452 Witten, Germany                                                        Fax:  49 02302 88537

 

The Society of Chiropodists and Podiatrists                               Tel:  44 020 7234 8620

1 Fellmongers Path, Tower Bridge Road                                   Fax:  44 020 7234 8621

London SE1 3 LY, England                                                     

 

 

Israelic Podiaric Medical Association                            Tel:  972 2 625 4162

P.O. Box 37166                                                                       Fax:  972 2 625 9282

Jerusalem, Israel

 

Associazione Italiana Podologi-A.I.P.                           Tel/Fax:  39 06 228 20 23

Via dei Berio 91

00144 Roma, Italy

 

Nederlandse Vereniging van Podotherapeuten               Tel:  31 033 465 55 51

P.O. Box 1161                                                                         Fax:  31 033 465 05 01

3800 BD Amersfoort

Netherlands

 

The New Zealand Society of Podiatrists Incorporated   Tel: 64 4 9142000

P.O. Box 24-139                                                                    

Royal Oak, Auckand  New Zealand                                        

 

Singapore Podiatry Association                                     Fax:  65 6259 3175

Orchard Post Office

P.O. Box 410              

Singapore  912314

 

The South African Podiatry Association                                    Tel:  27 11 406 2233

P.O. Box 29139                                                                       Fax:  27 11 401 0675

Johannesburg 2131, South Africa

 

 

 

Federación Espaňola de Podólogus                                           Tel:  34 1 531 50 44

San Bernardo, 74, bajo dcha                                                    Fax:  34 1 523 31 49

28015 Madrid, Spain