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A podiatrist (/poʊˈdaɪətrɪst/ poh-dye-eh-trist), also known as a podiatric physician or foot and ankle surgeon, is a medical professional devoted to the treatment of disorders of the foot, ankle, and lower extremity. The term originated in North America, but has now become the accepted term in the English-speaking world for all practitioners of podiatric medicine. In the United States, Doctors of Podiatric Medicine (DPM) are doctors who practice on the lower extremities, primarily on feet and ankles. The preparatory education of most podiatrists includes four years of undergraduate work, followed by four years in an accredited podiatric medical school, followed by a three or four-year hospital-based surgical residency. Podiatrists are licensed in all 50 states, but each state has their own licensing requirements. The scope of practice may vary from state to state and residency training. Worldwide, in many countries the term podiatrist refers to allied health professionals who specialize in the treatment of the lower extremity, particularly the foot. Podiatrists in these countries are specialists in the diagnosis and treatment of foot pathology, but not through surgical means. In some circumstances these practitioners will further specialise and, following further training, perform reconstructive foot and ankle surgery.