As diabetic foot complications become common in India, experts highlight the lack of specialised doctors: ‘Podiatrics is often confused with paediatrics’

With over 101 million diabetics [according to a study by the Indian Council of Medical Research–India Diabetes (ICMR-INDIAB)], India is often dubiously called the diabetes capital of the world. Characterised by increased blood sugar levels, the lifestyle condition — which can be managed by following a healthy diet and fitness regimen — can lead to kidney problems, heart ailments, and even vision-related issues. However, did you know that one out of 10 diabetic patients develop diabetic foot complications?

“Out of these, 90 percent of cases are neuropathic and painless, hence patients are reluctant to see a specialist,” noted Dr KVNN Santosh Murthy, podiatrist and diabetic foot surgeon, Malakpet, Hyderabad. He cautioned that when a complication sets in, a non-healing ulcer turns into gangrene — with amputation being the only treatment option, a surgery best performed by podiatrists.

However, experts quickly point out that despite the rise in foot complications — from diabetes or otherwise — many people are still not widely aware of podiatrists, and often reach out to general practitioners, orthopedic surgeons, or physiotherapists for treatment.

But, what do podiatrists do?

In simple words, podiatrists, also known as doctors of podiatric medicine (DPMs), play a crucial role in maintaining and improving foot health through non-surgical as well as surgical means, said Dr Parmila Sharma, HOD, physiotherapy and rehabilitation, Paras Health, Gurugram. Adding, Dr Indramani Upadhyay, MPT (ortho), HOD, The Center for Knee and Hip Care, Vaishali, Ghaziabad said that these foot doctors or chiropodists are specialists in treating a broad spectrum of foot-related diseases, such as infections, injuries, deformities, and biomechanical problems caused by diabetes or other health issues. Their specialty includes prevention, diagnosis, and treatment of disorders of the foot, ankle, and lower extremities.

They added that, unlike orthopedics and physiotherapists, podiatrists can identify early signs of systemic conditions such as diabetes, arthritis, and cardiovascular disease through foot examinations. “Their expertise involves a proper foot examination with the pieces of machinery available, detecting neuropathies, vasculopathy, conducting gait analysis, and giving customised footwear – for prevention, during treatment, and when the wounds are healed to prevent a recurrence,” explained Dr Murthy.

How is it different from the scope of physiotherapy and orthopedics?

Physiotherapy (or physical therapy) is a broader field focused on restoring, maintaining, and promoting overall physical function and mobility. Dr Sharma explained that physiotherapists develop and implement rehabilitation programs for patients recovering from injuries, surgeries, or chronic illnesses. They use exercises, manual therapy, and other modalities to improve movement, strength, and function.

Although they both treat conditions of the lower limbs, podiatrists and physiotherapists have different specialties and methods. “Podiatrists are generally trained to diagnose and treat problems of the foot and ankle, including ingrown toenails, heel discomfort, bunions, and consequences from diabetic foot disease. They might offer advice on foot care, recommend orthotic (custom-made) devices, and carry out surgical procedures,” Dr Upadhyay shared.

For instance, a podiatrist might treat a patient with a foot injury surgically and then refer them to a physiotherapist for post-operative rehabilitation to restore function and mobility, said Dr Sharma.

Here’s what to understand about podiatry (Source: Freepik)

Physiotherapists, on the other hand, treat disorders of the musculoskeletal, neurological, and cardiovascular systems that impact the body as a whole. “Although they might also handle issues with the feet and ankles, their treatments usually center on regaining general mobility and function via manual therapy, exercises, and other techniques,” shared Dr Upadhyay.

Contrarily, orthopaedics treats a wider variety of musculoskeletal issues, including issues with the body’s bones, joints, ligaments, tendons, and muscles. “Podiatrists specialise in less intrusive interventions and foot-specific surgeries, while orthopaedics generally entails more extensive surgical procedures on major bones and joints, such as hip replacements or spinal surgery. Both areas treat injuries and deformities,” said Dr Upadhyay.

So, despite the important role they play, why do we not see as many podiatrists in India?

Painting a grim picture, Dr Murthy said that many doctors do not even realise the urgent need and scope of podiatry, “which is an upcoming branch in medical science”. “People with foot problems mostly approach a general practitioner or a physiotherapist. In fact, podiatrics is often pronounced as and confused with paediatrics by most doctors. However, despite this lack of awareness — among people and the medical community — the need for podiatrists cannot be stressed enough, and is only increasing by the day,” expressed Dr Murthy.

Dr Sharma rued that foot problems are “sometimes viewed as minor or non-specialised issues that do not require a dedicated specialist, leading to underutilisation of podiatric services”.

Concluding, Dr Sharma said that healthcare priorities in India often focus on more critical areas such as infectious diseases, maternal and child health, and major non-communicable diseases, which may overshadow the development of specialised fields like podiatry. “Not all doctors are podiatrists. A doctor must have a degree in Doctor of Podiatric Medicine (DPM) and undergo specialised residency training in podiatry,” he informed.

Agreed Dr Murthy, stating that “diabetic foot wounds must be treated through a multi-modality approach. So, India requires dedicated centers and dedicated doctors who exclusively practice podiatry.”

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