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Across the Middle East, India and Africa, podiatry remains one of the most underdeveloped professions in the rehabilitation and musculoskeletal healthcare ecosystem. This shortage is becoming increasingly difficult to ignore. Diabetes, obesity, ageing populations, road injuries, sports participation, paediatric foot disorders and demand for mobility services are all increasing, yet many countries still have few formally trained podiatrists, no clear professional pathway, and limited public understanding of what podiatry actually does.
In many IMEA health systems, the word “podiatry” is still associated almost entirely with wound care or diabetic foot ulcers. That is part of the profession, but it is not the whole profession. Podiatrists are not only wound-care clinicians. They are lower-limb specialists who assess, diagnose and manage foot, ankle and lower-limb conditions across prevention, biomechanics, skin and nail care, footwear, orthotic therapy, sports medicine, paediatrics, diabetes, ageing and rehabilitation.
This distinction matters because the region does not only need more diabetic foot clinics. It needs a much wider foot-health workforce.
A Global Workforce Gap with IMEA Consequences
The global podiatry workforce has long been unevenly distributed. A diabetic-foot training paper noted that podiatry services are largely absent in many developing countries and reported that only a limited number of countries had licensed schools of podiatry, with trained podiatrists operating in a relatively small number of countries worldwide. The article also noted that the International Working Group on the Diabetic Foot encouraged countries without podiatry services to employ podiatrists, train podiatrists at recognised universities and establish university-level podiatry courses.
That observation remains highly relevant across IMEA. Some Gulf markets now have podiatry clinics and diabetic foot services, particularly in private healthcare. India has growing diabetic foot and foot-care awareness, but podiatry is still not established at the scale required for its population. In many African countries, podiatry as a regulated profession is extremely limited or absent, with foot care often delivered by nurses, orthotists, physiotherapists, wound-care teams, surgeons or general practitioners.
The International Federation of Podiatrists describes its mission as advancing podiatry worldwide through education, advocacy and strategic alliances for people with foot and ankle conditions. This type of global professional advocacy is important, but IMEA needs local education pipelines, regulatory recognition and career structures if the profession is to grow sustainably.
Why the Shortage Matters
The consequences of limited podiatry access are visible across the region.
For people with diabetes, lack of routine foot screening, footwear advice, offloading, nail and skin care, pressure redistribution and early intervention can allow minor problems to become ulcers, infections and amputations. Multidisciplinary diabetic foot care is widely recognised as central to reducing major lower-limb amputation risk, especially when podiatry works alongside vascular surgery, endocrinology, orthopaedics, infectious disease, wound care, orthotics and rehabilitation.
For children, limited podiatry access means delayed assessment of flat feet, gait concerns, heel pain, in-toeing, toe walking, neuromuscular conditions and footwear problems. For adults, it means untreated plantar heel pain, metatarsalgia, bunions, tendon problems, occupational foot pain and walking limitation. For athletes, it means fewer clinicians trained to connect footwear, training load, biomechanics, orthoses and injury prevention. For older adults, it means avoidable falls risk, pain, nail problems, skin breakdown and reduced mobility.
The result is a system that often reacts late. Patients reach specialist care when pain, deformity, ulceration or mobility loss has already progressed.
Podiatry Is Not Just Wound Care
Diabetic foot and wound care are essential parts of podiatry, but defining podiatry only through wounds narrows the profession and limits its value.
A full podiatry service can include:
- Diabetic foot screening and risk stratification
- Preventive foot care and patient education
- Nail, skin and callus management
- Footwear assessment and prescription advice
- Biomechanical assessment and gait analysis
- Custom and prefabricated foot orthoses
- Sports injury assessment and return-to-activity support
- Paediatric foot and gait assessment
- Management of heel pain, forefoot pain and tendon problems
- Lower-limb musculoskeletal triage
- Offloading for ulcers and high-pressure areas
- Charcot foot monitoring and referral
- Falls-risk support in older adults
- Post-amputation foot and contralateral-limb protection
- Collaboration with orthotists, prosthetists, physiotherapists and surgeons
This is why podiatry should be seen as a mobility and prevention profession, not only a wound-care profession.
The Link Between Podiatry and O&P
For the prosthetics and orthotics sector, podiatry is a natural partner. Podiatrists identify pressure, pain, deformity, alignment problems and footwear-related issues that often require orthotic or prosthetic input. Orthotists and prosthetists, in turn, provide the device solutions needed to protect tissue, improve alignment, redistribute load and maintain function.
The overlap is especially important in:
- Diabetic foot offloading
- Custom insoles and footwear
- AFOs and ankle-foot control
- Partial-foot amputations
- Charcot foot management
- Paediatric orthoses
- Adult acquired flatfoot and posterior tibial tendon dysfunction
- Sports orthoses
- Gait analysis and pressure mapping
- Contralateral-limb protection for amputees
In stronger systems, podiatrists and O&P professionals work together. The podiatrist may identify risk, manage skin and nail care, assess pressure and prescribe or recommend footwear strategies. The orthotist or prosthetist may design and fabricate the orthosis, insole, brace or prosthetic interface. The physiotherapist may support gait, strengthening and function. The surgeon or physician may manage medical or operative needs.
In weaker systems, these roles are fragmented, duplicated or missing.
The Diabetes Pressure Across IMEA
The need for podiatry is particularly urgent because diabetes is growing across the region. The Middle East and North Africa have high diabetes prevalence in many countries, while India has one of the world’s largest diabetes populations. African countries are also experiencing rising diabetes rates, often with late diagnosis and limited access to preventive care.
A 2025 review on diabetic foot care in the Middle East and North Africa reflects growing regional attention to diabetic foot services and the need to improve prevention, care pathways and outcomes.
Diabetes-related foot disease is one of the clearest examples of why podiatry matters. A preventable blister can become a non-healing ulcer. A non-healing ulcer can become an infection. An infection can become sepsis, hospitalisation or amputation. After amputation, the patient may require prosthetic rehabilitation, but prevention would have been better for the patient, family and health system.
Podiatry should therefore be positioned as a limb-preservation profession as much as a wound-care profession.
Why IMEA Has Too Few Podiatrists
The shortage of podiatrists across IMEA is not caused by one factor. It reflects several linked problems.
First, podiatry is not formally recognised or regulated in many countries. Without a clear professional title, scope of practice or licensing category, it is difficult to build university programmes, recruit students or employ podiatrists in hospitals.
Second, there are limited local education pathways. Countries without recognised podiatry degrees depend on foreign-trained clinicians or short-course upskilling of other professions. That may help in the short term, but it does not create a full profession.
Third, foot health is often undervalued until a crisis occurs. Health systems may fund surgery and wound care but underinvest in prevention, footwear, orthoses, education and routine screening.
Fourth, public awareness is low. Many patients do not know what a podiatrist is or when they should see one. They may seek help only after severe pain, infection or mobility loss.
Fifth, reimbursement is weak. If podiatry is not covered by insurance, public funding or employer health systems, it remains a private-pay service for those who can afford it.
Sixth, podiatry is often incorrectly viewed as cosmetic or low-level care. In reality, it is a clinically important profession that can prevent serious complications, reduce pressure on hospitals and improve mobility.
What Is Needed to Grow the Podiatry Workforce
The IMEA region needs a deliberate podiatry workforce strategy. This should not be left to market forces alone.
1. Formal recognition of podiatry
Governments and health regulators should define podiatry as a recognised healthcare profession with a clear scope of practice. This should include preventive care, diabetic foot screening, lower-limb assessment, nail and skin management, orthotic therapy, footwear advice, wound prevention and referral responsibilities.
Without recognition, the profession cannot grow.
2. University-level education programmes
Countries with large populations and high diabetes burden should develop accredited podiatry degree programmes. These should be locally relevant, clinically rigorous and aligned with international standards.
Where full degree programmes are not immediately possible, countries can start with transitional models:
- Postgraduate podiatry conversion routes for physiotherapists, nurses or O&P professionals
- Diabetic foot practitioner certificates
- Foot health assistant programmes
- University diplomas in lower-limb and foot health
- Regional training partnerships with established podiatry schools
However, short courses should not become a substitute for building a true profession.
3. Multidisciplinary diabetic foot teams
Every major diabetes centre and hospital should have access to a multidisciplinary foot team. This should include podiatry, vascular surgery, endocrinology, infectious disease, wound care, orthotics, prosthetics, physiotherapy and nursing.
Evidence from multidisciplinary diabetic foot care models shows that team-based approaches can reduce major amputation rates and improve care coordination.
4. Podiatry in primary care
Foot care should not be available only at tertiary hospitals. Many problems can be prevented or managed earlier in primary care, community clinics and local rehabilitation centres.
Primary-care podiatry could provide:
- Annual diabetic foot checks
- Nail and callus care for high-risk patients
- Footwear advice
- Referral for orthoses and specialist care
- Education for patients and families
- Early identification of vascular or neurological risk
This would reduce hospital burden and catch problems before they become emergencies.
5. Stronger links with O&P and footwear services
Podiatry workforce development should be linked to orthotics, prosthetics and therapeutic footwear. A diabetic foot screening programme without access to offloading, insoles and footwear is incomplete.
Hospitals and clinics need integrated pathways for:
- Pressure assessment
- Custom insoles
- Footwear modification
- Total contact casting or removable offloading devices
- AFOs and bracing
- Partial-foot prostheses
- Charcot restraint orthotic walkers
- Diabetic footwear
- Prosthetic rehabilitation after amputation
This is where O&P providers can become essential partners in podiatry expansion.
6. Public awareness campaigns
Patients need to understand that foot pain, numbness, callus, ulcers, footwear problems and walking difficulty are not minor issues. In diabetes especially, numb feet are dangerous feet.
Public campaigns should explain:
- What podiatrists do
- Why diabetic foot screening matters
- When to seek care
- How footwear affects mobility
- Why children’s gait issues should be assessed
- How early care can prevent amputation
7. Career pathways and professional bodies
A profession grows when clinicians can see a future in it. IMEA countries need podiatry associations, professional standards, continuing education, mentorship, conferences and leadership roles.
Regional collaboration could help smaller countries develop shared standards, cross-border training, visiting faculty and common competency frameworks.
8. Data and workforce planning
Most IMEA countries lack clear data on podiatry numbers, diabetic foot service coverage, orthotic access, ulcer prevalence and amputation pathways. Without data, workforce planning becomes guesswork.
Health systems should track:
- Number of podiatrists or foot-health clinicians
- Diabetic foot screening coverage
- Ulcer incidence and recurrence
- Amputation rates
- Access to offloading and therapeutic footwear
- Availability of O&P services
- Geographic distribution of foot-care providers
- Patient waiting times
This data would help governments justify investment.
Why Podiatry Matters for Universal Health Coverage
Podiatry supports Universal Health Coverage because it keeps people mobile, independent and out of hospital. It prevents complications, reduces avoidable amputations, supports rehabilitation and improves quality of life.
For a region facing rising diabetes and ageing populations, foot health is not a niche service. It is a core part of non-communicable disease care, rehabilitation, musculoskeletal health and disability prevention.
The WHO Rehabilitation 2030 agenda calls for rehabilitation to be integrated into health systems and made available closer to communities. Podiatry fits naturally within this agenda because foot health directly affects mobility, function and participation.
The Opportunity for IMEA
The shortage of podiatrists across IMEA is a challenge, but it is also an opportunity. Countries can build modern podiatry systems from the ground up, learning from international experience while adapting to local needs.
The region does not need to copy one model exactly. Gulf countries may develop hospital-led podiatry and private specialist clinics. India may need large-scale education, diabetic foot networks and community screening. African countries may need hybrid models combining podiatrists, trained foot-care assistants, nurses, O&P professionals and rehabilitation teams.
What matters is that foot health is no longer ignored.
Outlook
IMEA needs more podiatrists, but it also needs a broader understanding of what podiatry is. The profession should not be reduced to wound care. Podiatrists are central to prevention, biomechanics, orthotic therapy, footwear, paediatrics, sports medicine, diabetes care, ageing, rehabilitation and limb preservation.
For the O&P and rehabilitation community, the message is clear: podiatry should be seen as a partner profession. Together, podiatrists, orthotists, prosthetists, physiotherapists, nurses, surgeons and physicians can build stronger lower-limb care systems.
The future of podiatry in IMEA will depend on formal recognition, education, workforce planning, multidisciplinary clinics, public awareness and investment in prevention. Without this, the region will continue to treat foot complications too late. With it, IMEA can reduce avoidable amputations, improve mobility and build a more complete rehabilitation ecosystem.
- International Federation of Podiatrists
- International Working Group on the Diabetic Foot
- WHO Rehabilitation 2030 Initiative
- WHO and UNICEF Global Report on Assistive Technology
- International Society for Prosthetics and Orthotics
- Multidisciplinary diabetic foot care and amputation prevention
- Diabetic foot care training in developing countries
- Current situation and progress of diabetic foot care in the MENA region
