Ankle fight.

[Dr. Gangrene]

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I just had a conversation w/ a gal who graduated from d.o. school. As soon as I said I was going to be a d.p.m., she went off about how pod vs. ortho for the ankle is so huge. Ortho does not care about the foot, but the ankle is theirs etc etc.

So, my questions:
Is there really that much competition for the ankle? From what I have heard, it sounds like most orthos are content to do other joints.

If there is this competition, is it more of a deal in certain states, areas etc.?

Thanks for the replys.

 

[Tired]

Is there really that much competition for the ankle? From what I have heard, it sounds like most orthos are content to do other joints.

Foot and Ankle is a subspecialty of Orthopedics that requires a year of fellowship following Orthopedics. I can assure you that those guys are not "content to do other joints". Doesn't sound like your friend really knows what she's talking about.

 

[Dr_Feelgood]

Foot and Ankle is a subspecialty of Orthopedics that requires a year of fellowship following Orthopedics. I can assure you that those guys are not "content to do other joints". Doesn't sound like your friend really knows what she's talking about.

I will agree that a F&A orthopod will not "be happy with other joints." Even a general orthopod will work on the ankle and rarely the foot. Remember that in an orthopedic group, they generally break into specialties such as hands, feet, hips, spine, ect.

I will agree that podiatry and orthopedics are different specialties. You will not see an orthopod doing diabetic care unless they are cutting something off. So in general, they are content to let pods do foot care. Many places orthopods still fight for the ankle.

Why do they leave the foot? One they hate wound care. Two the ankle is easy, the foot is hard (like hands). Three the foot doesn't pay much (unlike hands). To put into proportion how much "value" a hand has, check of the permanent disability chart, half way down the page(http://www.sternic-law.com/workers_compensation.htm). The hand is the most valuable loss a person can sustain.

 

[funfeet]

Thats interesting Feelgood. Its weird how they label each finger differently. It's really sad how they label each body part and put a value on it, but I guess it has to be done...

 

[krabmas]

Foot and Ankle is a subspecialty of Orthopedics that requires a year of fellowship following Orthopedics. I can assure you that those guys are not "content to do other joints". Doesn't sound like your friend really knows what she's talking about.

Of course foot and ankle orthos will not be content to do other joints but there are not very many foot and ankle orthos out there compared to the total number of general orthos, sports med orthos and others that specialize but still do general ortho. Typically in these threads when we compare orthos and pods we are comparing general orthos and pods. We usually state when we mean F&A. (sorry to speak for others but this is the trend that I have seen)

Just as an example...

I was in the OR with 2 general orthopods in a NYC hospital (2 weeks ago) w/ a podiatry resident on his ortho rotation. They were doing an ankle scope. They started looking for the landmarks for the portal placement. THe foot was plantarflexed and inverted and a structure stuck out on the lateral side. Both orthos decided it had to be the peroneus tertius tendon. THe resident and I corrected them - it was the intermidiate branch of the dorsal cutaneous nerve. The orthos refused to believe us saying that no nerve in the foot is that big or palpable. I'm sorry, but if you do not know the anatomy of an area then do not cut it open. You could see the course of the nerve becoming superficial at the fibula a few cm superior to the lateral malleolus and coursing anterior/inferior/distal to the 4th intermetatarsal space. I do not know any tendon that passes from the lateral compartment to the anterior compartment cutaneously.

I agree with the others who have said this before - general orthos would never touch the hand or wrist why do that want to touch the foot or ankle.

Another fine story comes to mind - I recently saw the orthos scope the knee - pretty cool. But the knee is easy to maintain orientaiton the bones are shaped very differently, there are menisci and ligaments intra-articularly and it is a large joint. The ankle on the other hand is small and difficult to maintain orientation. The orthos repeatedly questioned where in the joint they were looking, did not identify any of the landmark - medial gutter and shoulder, or lateral or ATFL or anything. I have not seen one pod do an ankle scope where they did not identify the landmarks. I do not know if this changes the outcomes of the surgery for the patient but it makes me nervous for them.

 

[jonwill]

I just had a conversation w/ a gal who graduated from d.o. school. As soon as I said I was going to be a d.p.m., she went off about how pod vs. ortho for the ankle is so huge. Ortho does not care about the foot, but the ankle is theirs etc etc.

So, my questions:
Is there really that much competition for the ankle? From what I have heard, it sounds like most orthos are content to do other joints.

If there is this competition, is it more of a deal in certain states, areas etc.?

Thanks for the replys.

This "rivalry" is really played up by those who know little about it. Generally, it is a student fight. It ultimately depends on the hospital and area. I've been to hospitals where podiatry did all of the foot and ortho did the ankle. I've been to hospitals where they rotated foot and ankle call. I've been to hospitals where podiatry takes everything below the knee. It just depends.

There are still a few states where by law, pods cannot do ankles (NY, KS, CT). I've never seen anyone fight about it. Ortho and podiatry are usually extremely busy and if there is any fighting, it is usually trying to give the other more call! So I'm sorry to say that your friend is mistaken. In the last few weeks, I've been in on 3-4 ankles.

 

[Dr_Feelgood]

I do think that there are some skills that many pods and many orthopods don't have when it comes to ankles. An ankle fracture is easy, but ankle scopes, block grafts, OATS procedures, and total ankles are done by a lot few doctors. Maybe these are the procedures that where thinking about. I still don't see a fight it all depends on training.

 

[Northerner]

Of course foot and ankle orthos will not be content to do other joints but there are not very many foot and ankle orthos out there compared to the total number of general orthos, sports med orthos and others that specialize but still do general ortho. Typically in these threads when we compare orthos and pods we are comparing general orthos and pods. We usually state when we mean F&A. (sorry to speak for others but this is the trend that I have seen)

Just as an example...

I was in the OR with 2 general orthopods in a NYC hospital (2 weeks ago) w/ a podiatry resident on his ortho rotation. They were doing an ankle scope. They started looking for the landmarks for the portal placement. THe foot was plantarflexed and inverted and a structure stuck out on the lateral side. Both orthos decided it had to be the peroneus tertius tendon. THe resident and I corrected them - it was the intermidiate branch of the dorsal cutaneous nerve. The orthos refused to believe us saying that no nerve in the foot is that big or palpable. I'm sorry, but if you do not know the anatomy of an area then do not cut it open. You could see the course of the nerve becoming superficial at the fibula a few cm superior to the lateral malleolus and coursing anterior/inferior/distal to the 4th intermetatarsal space. I do not know any tendon that passes from the lateral compartment to the anterior compartment cutaneously.

I agree with the others who have said this before - general orthos would never touch the hand or wrist why do that want to touch the foot or ankle.

Another fine story comes to mind - I recently saw the orthos scope the knee - pretty cool. But the knee is easy to maintain orientaiton the bones are shaped very differently, there are menisci and ligaments intra-articularly and it is a large joint. The ankle on the other hand is small and difficult to maintain orientation. The orthos repeatedly questioned where in the joint they were looking, did not identify any of the landmark - medial gutter and shoulder, or lateral or ATFL or anything. I have not seen one pod do an ankle scope where they did not identify the landmarks. I do not know if this changes the outcomes of the surgery for the patient but it makes me nervous for them.

Could you refrain from making such pompous and inflammatory statements? I'm having a hard time not taking the bait.

 

[Dr_Feelgood]

Could you refrain from making such pompous and inflammatory statements? I'm having a hard time not taking the bait.

You must taken the bait, you posted didn't you?


P.S. Her comments are very common

 

[Northerner]

You must taken the bait, you posted didn't you?

Trying to decipher what "you must taken the bait" means....

P.S. Her comments are very common

Well, it's obvious you're trying to goad me into another debate. Unless I'm wrong, which we MD's always are and you're right, which you DPM's always are.

 

[Podman]

Trying to decipher what "you must taken the bait" means....



Well, it's obvious you're trying to goad me into another debate. Unless I'm wrong, which we MD's always are and you're right, which you DPM's always are.

interesting how you seem to gear things into an MD vs DPM debate. Krabmas simply stated her experience in the OR - unless you scrub for foot and ankle cases regularly then you really have no claim or argument to make.

 

[Northerner]

interesting how you seem to gear things into an MD vs DPM debate. Krabmas simply stated her experience in the OR - unless you scrub for foot and ankle cases regularly then you really have no claim or argument to make.

Yeah, it's really a stretch to say her (anecdotal) comments were disparaging to MDs and exalting DPMs. Especially considering the topic of this thread is whether there is competition for the procedures. She took it in the "we're better at it" direction. And it takes a lot of gall to accuse a person of "gearing things into an MD vs. DPM debate" when my first post in this thread was a respectful request to keep the incendiary comments to a minimum.

 

[OSUDDS]

interesting how you seem to gear things into an MD vs DPM debate. Krabmas simply stated her experience in the OR - unless you scrub for foot and ankle cases regularly then you really have no claim or argument to make.

👍

 

[kelus]

😍 CANT WE ALL JUST GET ALONG😍

 

[dawg44]

These debates end up being nothing but anecdotal. I know a pod that takes 4 hours to do a subtalar fusion because they spend the 1st hour trying to find the subtalar joint god knows what they do the remaining 3. These debates go on and on and we all have our stories back and forth. As far as arthroscopy is concerned I've scoped nearly every joint in the body save the 1st MTP (Don't go there Feelgood ) The ankle arthroscopy case may have some truth in that instance, but again its completely anecdotal.

 

[jonwill]

These debates end up being nothing but anecdotal. I know a pod that takes 4 hours to do a subtalar fusion because they spend the 1st hour trying to find the subtalar joint god knows what they do the remaining 3. These debates go on and on and we all have our stories back and forth. As far as arthroscopy is concerned I've scoped nearly every joint in the body save the 1st MTP (Don't go there Feelgood ) The ankle arthroscopy case may have some truth in that instance, but again its completely anecdotal.

F&A Ortho to the rescue!

I'm sure you DMU'ers are aware of the story about "7 hour sally". If not, ask Dr. S. I'm sure that there are doctors in every surgical sub-specialty that should "never be let into the OR". Podiatry is no different.

 

[Dr_Feelgood]

Trying to decipher what "you must taken the bait" means....



Well, it's obvious you're trying to goad me into another debate. Unless I'm wrong, which we MD's always are and you're right, which you DPM's always are.

I'm sorry I was in a rush b/c I had to be a ACLS at 7:30. Silly huh since pods aren't physicians, right? But at least you are seeing the truth as you have noted, you are always wrong. Thanks, this will save me a lot of time when you post next time. 😱

F&A Ortho to the rescue!

I'm sure you DMU'ers are aware of the story about "7 hour sally". If not, ask Dr. S. I'm sure that there are doctors in every surgical sub-specialty that should "never be let into the OR". Podiatry is no different.

👍 That is the truth. No matter who you are if you can't handle the scalpel or don't know the anatomy, you should be in the OR.

 

[krabmas]

I just wanted to thank everyone who came to my defense.

I was not trying to inflame northerner, that was meerly a benefit (sarcasm).

I was just stating what I had seen.

We've all heard of the 4 hour bunion at Northlake. Do they put a foley in?😕

Like Jonwill stated, in everyprofession there are people who are incompetant. Podaitry and orthopedics are no exception. Even orhtopedics has a worst residency.

 

[Toohotinvegas33]

I will agree that a F&A orthopod will not "be happy with other joints." Even a general orthopod will work on the ankle and rarely the foot. Remember that in an orthopedic group, they generally break into specialties such as hands, feet, hips, spine, ect.

I will agree that podiatry and orthopedics are different specialties. You will not see an orthopod doing diabetic care unless they are cutting something off. So in general, they are content to let pods do foot care. Many places orthopods still fight for the ankle.

Why do they leave the foot? One they hate wound care. Two the ankle is easy, the foot is hard (like hands). Three the foot doesn't pay much (unlike hands). To put into proportion how much "value" a hand has, check of the permanent disability chart, half way down the page(http://www.sternic-law.com/workers_compensation.htm). The hand is the most valuable loss a person can sustain.

I can get 50 weeks of paid disability for loss of one testicle!!! I'm down for it. I think im sterile anyway

 

[Dr_Feelgood]

I can get 50 weeks of paid disability for loss of one testicle!!! I'm down for it. I think im sterile anyway

Before you sign up, think about the pain involved. I would want at least a full year's pay.

 

[diidy]

Before you sign up, think about the pain involved. I would want at least a full year's pay.

I cringe at the thought of the pain involved....and Im a girl!

 

[dawg44]

I just wanted to thank everyone who came to my defense.

I was not trying to inflame northerner, that was meerly a benefit (sarcasm).

I was just stating what I had seen.

We've all heard of the 4 hour bunion at Northlake. Do they put a foley in?😕

Like Jonwill stated, in everyprofession there are people who are incompetant. Podaitry and orthopedics are no exception. Even orhtopedics has a worst residency.

True. I agree. Bad Orthopods look better on paper though with what it takes to even get into an Ortho residency in the first place. But credentials on paper are often no better than the quilted one on a roll in the john.

 

[krabmas]

True. I agree. Bad Orthopods look better on paper though with what it takes to even get into an Ortho residency in the first place. But credentials on paper are often no better than the quilted one on a roll in the john.

Quilted Northern is my favorite. 👍

 

[Dr_Feelgood]

I cringe at the thought of the pain involved....and Im a girl!

One thing that has always stuck with me is when my sister was having contractions. I asked what they felt like and she said, "Imagine someone squeezing your balls every 15 minutes." My brother-in-law looked at me, and I looked at him. Then both of our jaws hit the floor.

 

[Northerner]

I'm sorry I was in a rush b/c I had to be a ACLS at 7:30. Silly huh since pods aren't physicians, right? But at least you are seeing the truth as you have noted, you are always wrong. Thanks, this will save me a lot of time when you post next time. 😱

Your wit is so sharp I should really be wearing green indicator gloves when we argue.

And just so you know, nurses get ACLS certification too.

 

[Dr_Feelgood]

Your wit is so sharp I should really be wearing green indicator gloves when we argue.

And just so you know, nurses get ACLS certification too.

I realize that, remember I am currently attending ACLS. I learned the three professions that are allowed to carry an ACLS card: nurses, paramedics, and physicians. This is according to the AHA, and I know that I've never taken one paramedic or nursing class.

And yes my wit as sharp as your intelligence.

By the way shouldn't you be starting one of your important threads in the lounge such as "Why do you have a lisp?" or "There is nothing more rewarding than waking up next to your sister?"

Since my interaction with you, I have started to doubt the Darwin theory.

 

[AlleghenyPOD]

I realize that, remember I am currently attending ACLS. I learned the three professions that are allowed to carry an ACLS card: nurses, paramedics, and physicians. This is according to the AHA, and I know that I've never taken one paramedic or nursing class.

And yes my wit as sharp as your intelligence.

By the way shouldn't you be starting one of your important threads in the lounge such as "Why do you have a lisp?" or "There is nothing more rewarding than waking up next to your sister?"

Since my interaction with you, I have started to doubt the Darwin theory.

.........

 

[Northerner]

I realize that, remember I am currently attending ACLS. I learned the three professions that are allowed to carry an ACLS card: nurses, paramedics, and physicians. This is according to the AHA, and I know that I've never taken one paramedic or nursing class.

And yes my wit as sharp as your intelligence.

By the way shouldn't you be starting one of your important threads in the lounge such as "Why do you have a lisp?" or "There is nothing more rewarding than waking up next to your sister?"

Since my interaction with you, I have started to doubt the Darwin theory.

How adorable, you're pissed off. I find your insecurity more endearing by the day.

 

[densmore22]

I realize that, remember I am currently attending ACLS. I learned the three professions that are allowed to carry an ACLS card: nurses, paramedics, and physicians. This is according to the AHA, and I know that I've never taken one paramedic or nursing class.

And yes my wit as sharp as your intelligence.

By the way shouldn't you be starting one of your important threads in the lounge such as "Why do you have a lisp?" or "There is nothing more rewarding than waking up next to your sister?"
Since my interaction with you, I have started to doubt the Darwin theory.

This is true. AHHHHHHH!!!!

 

[densmore22]

How adorable, you're pissed off. I find your insecurity more endearing by the day.

You call us pompus? (Krabmas specifically). You're the one that is so freaking close minded to the possibility that there are other professions out there that can and do treat patients equivalently to what an MD does. As stated in previous posts and threads, there are great MD's and horrible ones, there are great DPMs and horrible ones.

 

[Northerner]

You call us pompus? (Krabmas specifically). You're the one that is so freaking close minded to the possibility that there are other professions out there that can and do treat patients equivalently to what an MD does. As stated in previous posts and threads, there are great MD's and horrible ones, there are great DPMs and horrible ones.

Well, one condescending comment deserves another. Could have been worse.

I disagree. I concede points on the debate, just as you all do. Or we should be, at least. We can either keep it professional or let our pettiness drive up the hostility. Your move.

 

[calcaneus]

Well, one condescending comment deserves another. Could have been worse.

I disagree. I concede points on the debate, just as you all do. Or we should be, at least. We can either keep it professional or let our pettiness drive up the hostility. Your move.

How can you chide others on keeping it professional when you make comments such as:
"How adorable, you're pissed off. I find your insecurity more endearing by the day."

You can't get your last snide remark in and then tell everyone to be professional.

 

[justincredible]

Maybe we should close this post? Before even more bridges are burned...

 

[Tired]

You're the one that is so freaking close minded to the possibility that there are other professions out there that can and do treat patients equivalently to what an MD does.

I think they're called "DOs". As in "the other kind of doctor".

 

[Northerner]

How can you chide others on keeping it professional when you make comments such as:
"How adorable, you're pissed off. I find your insecurity more endearing by the day."

You can't get your last snide remark in and then tell everyone to be professional.

Again, one condescending comment deserves another. Luckily, with your post, you now have the "last snide remark" you find so covetous (feel free to post another shot at me following this post if you want to make *extra* sure).

Are you people even reading the posts in this thread or just looking for mine and trying to nag me about what I say regardless of what personal attack it is what it was said in response to? Either way is fine, but you don't come off well.

 

[Dr_Feelgood]

I think they're called "DOs". As in "the other kind of doctor".

Northern got a friend or his other personality to post. You've added as much to this as Northern has.

By the way, I got into an MD program but decided move to FL and party (didn't get in the 2nd time around). What is you excuse? Don't tell me, you just want to do OMM to cure cancer so you went with a DO program? I'm sorry you couldn't get into an MD program but don't pick on DPMs for security.

How adorable, you're pissed off. I find your insecurity more endearing by the day.

Again, one condescending comment deserves another. Luckily, with your post, you now have the "last snide remark" you find so covetous (feel free to post another shot at me following this post if you want to make *extra* sure).

Are you people even reading the posts in this thread or just looking for mine and trying to nag me about what I say regardless of what personal attack it is what it was said in response to? Either way is fine, but you don't come off well.

I have no insecurity. I'm not the one who goes from OD to DPM to DO to PA looking for fights. I've been begging the administrators to get rid of you. You offer nothing to SDN. Your threads show someone who is very insecure. You mock other professions, gays, and females.

Just an FYI about your presence on SDN, if you were the ladies man you claim to be in the Loung,e you wouldn't get a lick of play treating women the way you do. Your homophobic comments seem to point to some sort of hidden insecurity. As for your general tone, I'm sorry you were picked on your whole life.

Since I'm not insecure I'm not even going to respond to your comments. I would be happy to discuss my life and accomplishments if you'd like, but I'm not going to brag to prove who I am.

 

[kelus]

Just shut this post down.
These two will never run out of trash talk
i hope some one decides to be the bigger person and just let it go.
what is so hard about ignoring any ones spiteful comments and continuing the subject with in the original post

 

[Dr_Feelgood]

Just shut this post down.
These two will never run out of trash talk
i hope some one decides to be the bigger person and just let it go.
what is so hard about ignoring any ones spiteful comments and continuing the subject with in the original post

I'm glad you are such a big person that you have time to point out our flaws. I would think that such a "big" person as your self, you wouldn't get involved.

If you think something should get shut down. Hit the little link below a post and it will email a moderator. Posting comments will only flame the fire.

 

[bdaddyjolley]

I have no insecurity. I'm not the one who goes from OD to DPM to DO to PA looking for fights. I've been begging the administrators to get rid of you. You offer nothing to SDN. Your threads show someone who is very insecure.

Not to knock you feelgood, but you seem to get in as many fights as northerner does if not more. I would advise you to think about accusing someone of looking for fights when you have been in a lot of them yourself and have often resorted to name calling. I'm not saying this to annoy you or pick a fight but to bring it to your attention that you act like he does sometimes and it seems no one notices or calls you on it because you are respected here as a valuable source.

 

[jonwill]

Yea, I think this thread has digressed far enough.

Closing...