ACPS Update

The history of podiatric surgery in Australia: Part 1

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10 min. reading time

Mark Gilheany is a highly-experienced foot and ankle surgeon, and a registered specialist who has primarily been in private surgical practice since 1994. Mark uses minimally invasive techniques, as both a standalone approach for a range of foot and ankle problems, alongside traditional open procedures. Mark has been involved in teaching (undergraduate and postgraduate), policy and advocacy throughout his career. Mark has held various leadership and regulatory positions in the profession and developed international education and aid programs.

Simon Smith is a podiatric surgeon and fellow of the Australasian College of Podiatric Surgeons (ACPS). He is an endorsed prescriber and mentor for scheduled medicines endorsement. Simon is also chair of the Selection Committee for the ACPS and sits on the college council. He has published scientific and surgical technique papers in international podiatric and foot and ankle surgery journals and has frequently presented to his peers over zoom, and at state and national conferences. Simon is dedicated to student and peer education. Simon’s major interests are in surgical reconstruction of forefoot pathology. Simon practices in Melbourne and Geelong, Victoria.

The birth of podiatric surgery was inspired by podiatrists who worked hard to see this chapter begin in Australia. Here’s the backstory on how it came to be.

Dr Bill Kutcher (left) and Professor Bob Rutherford (right) and Dr Chris Jerram (background) during the first Australian instructional surgical course in 1978.

In Australia, surgery intervention is a core capability of the podiatry profession, with a registered speciality dedicated to foot and ankle surgical practice. This was not always the case.

In the 1970s forward thinking individuals developed a vision to align podiatric practice in Australia with that seen in the US. The relationship between the Australian and American podiatry professions can be traced back to formal meetings in 1975, and the birth of podiatric surgery in Australia is directly linked to this collaboration.

A chance conversation

The then President of the Australian Podiatry Council Dr John Pickering was attending the American Podiatry Association (APA) annual meeting in San Francisco. During this meeting he was invited to the upcoming Board of Trustees meeting and asked to define podiatry in his home state of South Australia for his American colleagues.

Dr Pickering described the definition of podiatry under the South Australian Chiropodists Act, which included ‘surgery’ as a prescribed treatment for the management of the foot and ankle. Given this definition had been in place since the late 1950s, the APA executive director, Dr Seward Nyman asked, “So, how long have you been doing foot surgery?”

Dr Pickering replied, “Well, we haven’t started operating yet…” and he now reflects on the response prompted by this statement. “The Americans were astounded and could not comprehend that Australian podiatrists were sitting on the best podiatry Act in the world as far as scope of practice was concerned, and no one was cutting tendons or bones.” In contrast, the American podiatry profession had begun to use surgery as a modality in an organised manner during the 1950s.

Examples in practice

While he was in the US, Dr Pickering visited each of the then five Colleges of Podiatric Medicine. He observed podiatrists performing incisional nail surgery, bone spur removal and soft tissue mass excision under local anaesthetic (LA). This was quick and efficient, and it seemed to provide a long-term solution for pathology, which was at the time being treated by podiatrists in Australia with regular debridement, footwear ‘education’ and padding or silicone shields.

Dr John Pickering and Dr Pauline Barry perform foot surgery under local anaesthetic in 1978. Dr John Weir attends to patient notes (foreground).

Podiatry – the emergence of a global community

At this time and into the early 2000s, there was little interest from the orthopaedic community when it came to foot surgery. This lack of interest frustrated Dr Pickering as he wanted to ensure his patients’ need for surgery could be appropriately addressed.

Just like his US colleagues before him, Dr Pickering did not see why podiatrists with adequate training could not undertake surgical practice in Australia. Both Dr Pickering, and another South Australian podiatrist, Dr Bill Kutcher, became increasingly interested in practicing podiatry to the fullest extent.

The impact of American podiatric surgery was significant during the 1970s and 1980s. The American influence was not just limited to surgical techniques, but also included podiatric biomechanics and this influence increasingly drove international links and collaboration in the global podiatric community. With the impetus gained from the biomechanics revolution, both Drs Pickering and Kutcher set themselves the goal to explore surgical training: “It was time to do it”. And so, they set about ensuring that surgical practice would become an accepted domain of the podiatry profession in Australia.

Change can be painful!

While legislation allowed for podiatric surgery, there was no provision for use of drugs like local anaesthesia. Dr Pickering recognised that access to local anaesthetics (LA) was essential to enable the ability to perform foot surgery. In 1975, with the assistance of the late Dr Hans Jordan and with the advice of a member of the South Australian Health Commission (SAHC), a submission for the use of LA by podiatrists was submitted to the SAHC.

Unfortunately, the request for access to LA was turned down and it was not until 1976, when the premier of SA visited Dr Pickering’s office with a painful ingrown toenail, that change came about. The catalyst was that the procedure to fix the premier’s nail problem was extremely painful! The proposition of a meticulous partial nail avulsion without LA was, not surprisingly, most undesirable and extremely painful for patients.

And so it transpired that less than one month later, LA access for podiatrists across South Australia was achieved. Now given the means to provide painless, invasive foot procedures Drs Pickering and Kutcher began performing nail surgery and digital ostectomy procedures in an operating room that Dr Pickering had built within his practice.

John Pickering, the founding father of podiatric surgery in Australia

Early training support from the US

In 1978, Dr Pickering and Dr Kutcher travelled to the US to further their surgical skills. Dr Kutcher recalls the following memory of his time in Pennsylvania:

“[I was] thrown in at the deep end when it came to procedures. We were each handed a surgical case to manage under supervision. John (Dr Pickering) performed a neurectomy and I was handed a second metatarsal head V-osteotomy.”

Both cases proceeded uneventfully, with no postoperative complications and, “to our relief, patients reported little postoperative discomfort.”

Even now, Dr Kutcher reflects on the generosity of their colleagues in the US at that time.

“The American pods were so willing to involve us… and they armed themselves with an osteotome to knock our hands away if we looked like we were making a wrong move.” This peer support and guidance provided the foundation to collaborative training and professional exchange with our US colleagues that has continued through to the current time.

Professor Rutherford

During this same trip, Drs Pickering and Kutcher attended a conference in Atlanta, GA, and met with Dr Robert Rutherford DPM who had retired from the California College of Podiatric Medicine (CCPM) as Emeritus Professor of Foot Surgery.

Following this meeting, Dr Rutherford agreed to help develop and implement a more formal surgical training program for Australian podiatrists. He visited Adelaide in 1978, where he spent three months teaching foot surgical theory and practice. Dr Rutherford provided supervision during surgical procedures, which included nail procedures, digital arthroplasties, and hallux valgus correction.

At this time, seven other South Australian podiatrists, who had completed Dr Rutherford’s Australian course were brought together to form the Australian College of Surgical Podiatrists (ACSP).

The first cohort – the Pod 8

These podiatrists included Bill Kutcher, Valerie Dobie, John Weir, Pauline Barry, Barry Olesen, Max Corsalini and Chris Jerum; with Dr John Pickering as the inaugural president of the college; collectively they were informally referred to as the ‘Pod 8’. In the late 1970s, surgical training included three months of theory and surgical practical training with Dr Rutherford, who returned to Australia periodically for further teaching and instruction. All of the ‘Pod 8’ took opportunities to visit the US at the New York, California and Pennsylvania Colleges of Podiatric Medicine.

The then-termed Australian College of Surgical Podiatrists (ACSP) was registered in 1976 and was incorporated under South Australian corporations law in 1979. Its constitution was modelled on the American College of Foot Surgeons (now American College of Foot and Ankle Surgeons).

In 1985, American podiatric surgeon Dr Paul Wade immigrated to Adelaide from the US. He became a valued educator providing intensive surgical theory courses and practical instruction to a group of young prospective surgical trainees in Adelaide and Victoria. At the same time, a post-graduate diploma in podiatry began in Western Australia and was endorsed by the ACSP as the requisite post graduate qualification for prospective trainees. In 1986 Western Australian surgical podiatrists Allan Bryant, Jenny Bryant and Lee Gray became members of the ACSP.

In the late 1980s, an examining committee was brought together, consisting of Professor Lloyd Sansom (clinical pharmacologist), Dr Sid Adinis (anaesthetist), Dr Pickering, Dr Kutcher, Dr Wade and Dr Hans Jordan. Trainees were now required to pass an oral examination in addition to practical assessment for successful membership with the college.

In 1989, the ACSP became an affiliated body with the Australian Podiatry Council. The SA registration board formally recognised the ACPS qualification in the same year. Other states followed. In the 1990s the ACSP nomenclature was changed to the Australasian College of Podiatric Surgeons.

A final note

This brief historical account has demonstrated the extent to which the birth of podiatric surgery in Australia was championed by individuals whose vision was to align podiatry practice in Australia with that seen in the US. A vision supported by our American colleagues and support that expanded in the coming decades.

Stay tuned for Part 2 of the history of podiatric surgery in Australia, appearing in STRIDE next month.