Path to podiatry

Conway McLEAN, DPM

I have been interested in medicine and science for as long as I can remember. From day one, my goal was to have a career in the medical arena, in some capacity or other. Strange when you think about it, considering no one in my immediate family was involved in medicine, or biology, in any capacity whatsoever. Still, that is my earliest memory, knowing that was what I wanted to do when I grew up. My father was an artist, which remains a devoted passion of mine, but who wants to be another starving artist? And my mother, a psychologist. Talk about a “soft science,” this is a field that can’t realistically be called a science, dealing, as it does, with the fallibility and vagaries of the human mind.

How then did I come to the rather odd profession of podiatry? It is true that my grandmother, of all people, counseled me long ago to pursue this path. She proclaimed grandly that her podiatrist was always busy, his waiting room packed with people. I can’t say this had a tremendous impact on me, although, naturally, I loved her dearly. In my mind, a full waiting room was not exactly a scientific study into the desirability of this career path.

The age of specialization in medicine has brought about an explosion of options for a chosen career into which a young person might be drawn, from medical research, to teaching, to all the myriad possibilities of medical practice. Having been involved in research in several capacities, at several different institutions, I can say I have had experience at true, pure research. During one particular stint, we were investigating the effects of benzodiazepine drugs, a popular class of drugs with Valium being the best-known representative, looking at its effects on peri-natal brain development. Naturally, we weren’t using an animal model. (Humans don’t generally like being the subject of such experiments, and the time required for gestation would make this study excessively time-consuming.)

Rats were used for our study, as they were for much of the research I have been involved in. Now I can say, when raised from birth in the close company of humans, rats actually make very good pets. I know many reading this will likely be disgusted by the thought, but they are fairly intelligent, and quite trainable. But one problem I have with research is the lack of communication and interaction with your subjects. There is a certain empathy or connection generally lacking with your average lab rat. I speak in jest, but there lies a nugget of truth; scientific research tends to be cold and sterile, greatly lacking in human interaction.

It was during this particular study that a former co-worker at this institution returned for a visit. She had left our establishment a year or so earlier to pursue a career in podiatric medicine. I had not seriously considered it until then (despite my grandmother’s admonitions), but she spoke highly of it, the multitude of options for practice, the variety seen on a daily basis. The more I investigated, the better it sounded.

I’ve tried teaching. This is a direction I hadn’t thought of as a youth (despite the fact my father earned his “daily bread” this way…is that why?) But given the opportunity, I took it, and ended up teaching at two different podiatric medical school programs, one as a full-time professor in surgery. Could this be why education, especially for diabetics, has become such a passion of mine? Perhaps you didn’t know that the root of the word doctor is educator. As we all know, that component of good medical care is sorely lacking in this era of corporate quotas and doctors “punching the clock”.

One aspect of modern podiatric medicine I found especially appealing was the variety, as mentioned. Unlike most other specialties, we deal with a part of the body rather than an organ system. A neurologist deals with problems of the nerves. A dermatologist treats skin conditions, and an orthopedist bones and joints. But because a podiatrist treats the foot, ankle and lower leg, he or she is part orthopedist, part neurologist, and so on. This lends a great deal of diversity to the practice of podiatry. I see a plethora of problems, of different organ systems in the human body, from skin problems, to blood flow conditions, maladies of the nerves, bones, and so on.

Podiatry has changed radically since its inception. Our roots were in the barber-surgeons of the 1700’s, when an individual would go to have their hair cut, and their calluses shaved. During the early 1900’s, the practitioners of chiropody, as podiatrists were once called, endeavored to better themselves and their profession, primarily by improving their education. Whereas a chiropodist completed three years of a “technical school-type” education prior to opening a practice, true four-year medical schools were developed. The name change to podiatry followed shortly. This evolution has continued to the point that a podiatric physician’s education is of the same duration as a family practice doctor, with four years of medical school education, followed by three years of residency. It is also possible to obtain fellowship training in various sub-specialties after your residency.

Nowadays podiatric physicians routinely perform ankle replacement surgery, foot and ankle reconstruction, and a whole host of procedures, simple to complex. Then again, many conservative measures are utilized by the average podiatrist. That is one of the best aspects of this specialty. Generally speaking, a patient walks out of the office with significant relief of the pain they walked in with.

These days, podiatric physicians are able to provide a whole host of amazing, new treatments and techniques. Wound care is one field I find fascinating. The use of placental tissue as a source of stem cells has proven quite effective at helping to close chronic wounds. Cold lasers provide obvious relief of muscle and tendon pain, but are proving to also aid in healing these problematic wounds. Also, new forms of electrical stimulation have allowed us to improve blood flow into tissues that won’t heal. And that’s just wound care.

Our surgical “know-how” has advanced exponentially as well. Pioneered by podiatric surgeons, the use of minimally invasive surgical techniques is now world-wide. These methods allow correction of all manner of deformities, with reduced pain and swelling, with obvious cosmetic benefits. A commonly used surgical implant, with a long and successful track record, allows us to prevent the foot collapse seen in many suffering from flat feet. It’s performed with a minimally invasive technique, with a simple recovery. Because of our use of specialized, metal frames around the foot, we can correct foot deformities never thought reparable.

The mechanical and physical stresses place upon the foot and ankle are unique to the rest of the body. Because of the job the human foot and ankle must perform, carrying us around as they do, the maladies suffered by this part of the body are unique. Podiatrists train in general medicine, but concentrate on the foot and ankle throughout their education, making us particularly attuned to the problems experienced. We are not generalists, but specialists in this body part so critical to the health and well-being of the human body, be it socially, psychologically, or medically. And by the way, foot pain is not normal!

Editor’s note: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.