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Leaders take us from where we are to where weve never been.
Henry Kissinger
The greatest leaders are the ones with vision. The interesting thing about their
vision is that often only they are able to clearly see what is in front of them.
Others cannot, and many times are fearful or doubtful of their leaders decisions.
There is once again a push within the profession to change the DPM degree
to MD, or to designate a dual degree of DPM/MD. This is much like the
oralmaxillofacial surgeons who dual degree as DDS/MD and are clearly recognized
as the dental surgical subspecialists. I certainly can appreciate the desire for
this degree change. It would make our lives much simpler, recognition much
quicker, and appointments to hospital staffs less cumbersome.
Others argue that a loss of professional identity would occur. But I wonder
about that. Exactly what professional identity are we talking about? Surely it
cannot be chiropody; we wanted that moniker gone a long time ago. James Burke
said, There are many institutions in history that have simply winked out of
existence because there was no need for them anymore. Where is the nearest
watermill? I have heard the argument that if we, as a profession, do not continue
to perform all of the services that we have in the past, someone else will do it.
If those services were all that we did, then yes, that would be a problem. But
as we progress as a profession, as we understand the science and pathophysiology
0891-8422/04/$ see front matter D 2004 Elsevier Inc. All rights reserved.
doi:10.1016/j.cpm.2004.04.005
Vincent J. Mandracchia, DPM, MS
Consulting Editor
Clin Podiatr Med Surg
21 (2004) xi xiiof the conditions we treat, our sophistication should open new avenues of
treatment that may indeed put the old ways to rest or safely in the hands of
others. Hasnt this happened with our allopathic and osteopathic comrades?
Hasnt the role of the physician assistant increased, and at the request and
insistence of MD and DOs, freeing the doctor to do more, research more, and
exercise more diagnostic abilities?
I was at a recent meeting of our society when the topic of sterilization of nailcutting
instruments came up. Nurses who were caring for nonambulatory patients
in nursing homes in rural areas (where no podiatrist coverage is available) wanted
to know how to clean their nail instruments satisfactorily between patients. One
of the members of our group brought up the issue of whether nurses should be
cutting toenails at all. My answer is yes, they should. We as the podiatric
physicians should be diagnosing the pathologic nail, determining if the patient is
a candidate for antifungal treatment, recommending treatment options, and not
fixating on who is physically cutting the toenail.
The students at the Iowa College were upset because a physical therapist,
while lecturing on muscle testing and treatment, mentioned that the therapists
were debriding foot ulcers in their department. So what . . . do they understand
the science of wound healing, the role of growth factors? Do they understand
when exogenous growth factor therapy is warranted, who is a candidate for
surgical off-loading, the role of vascular perfusion in the healing process? Or are
they merely mechanically removing dead tissue because someone told them to or
showed them how.
We dont need to hold onto the entire identity of our profession. We just need
to be recognized as the true foot and ankle specialists, and that is done by our
ability to diagnose and treat lower extremity problems with predictable outcomes.
That is accomplished by first being a physician in our approach to patient
concerns. Do we need an MD degree to do that? I doubt it. Would it be nice?
Absolutely! I support the efforts of our leaders who continue to push for better
recognition, better education at the colleges, better and longer residency training.
These are the visionaries who will lead us into a bright and secure future. The
question remains, Will we be ready to release the baggage of the profession and
step up to the plate?
One of the ways that we grow up as a profession is to look at our surgical
results with a critical eye, allowing us to confirm or alter our procedures as needed.
This issue of the Clinics is dedicated to the recognition and treatment of the lessthan-
desirable surgical outcome, and Dr. Wally Strash has done an excellent job
of coordinating authors and articles that will, hopefully, stimulate self-evaluation,
critical thinking, and discussion that will ultimately benefit our patients.
Vincent J. Mandracchia, DPM, MS
Broadlawns Medical Center
1801 Hickman Road
Des Moines, IA 50314, USA
E-mail address: [email protected]
xii V.J. Mandracchia / Clin Podiatr Med Surg 21 (2004) xixii
Henry Kissinger
The greatest leaders are the ones with vision. The interesting thing about their
vision is that often only they are able to clearly see what is in front of them.
Others cannot, and many times are fearful or doubtful of their leaders decisions.
There is once again a push within the profession to change the DPM degree
to MD, or to designate a dual degree of DPM/MD. This is much like the
oralmaxillofacial surgeons who dual degree as DDS/MD and are clearly recognized
as the dental surgical subspecialists. I certainly can appreciate the desire for
this degree change. It would make our lives much simpler, recognition much
quicker, and appointments to hospital staffs less cumbersome.
Others argue that a loss of professional identity would occur. But I wonder
about that. Exactly what professional identity are we talking about? Surely it
cannot be chiropody; we wanted that moniker gone a long time ago. James Burke
said, There are many institutions in history that have simply winked out of
existence because there was no need for them anymore. Where is the nearest
watermill? I have heard the argument that if we, as a profession, do not continue
to perform all of the services that we have in the past, someone else will do it.
If those services were all that we did, then yes, that would be a problem. But
as we progress as a profession, as we understand the science and pathophysiology
0891-8422/04/$ see front matter D 2004 Elsevier Inc. All rights reserved.
doi:10.1016/j.cpm.2004.04.005
Vincent J. Mandracchia, DPM, MS
Consulting Editor
Clin Podiatr Med Surg
21 (2004) xi xiiof the conditions we treat, our sophistication should open new avenues of
treatment that may indeed put the old ways to rest or safely in the hands of
others. Hasnt this happened with our allopathic and osteopathic comrades?
Hasnt the role of the physician assistant increased, and at the request and
insistence of MD and DOs, freeing the doctor to do more, research more, and
exercise more diagnostic abilities?
I was at a recent meeting of our society when the topic of sterilization of nailcutting
instruments came up. Nurses who were caring for nonambulatory patients
in nursing homes in rural areas (where no podiatrist coverage is available) wanted
to know how to clean their nail instruments satisfactorily between patients. One
of the members of our group brought up the issue of whether nurses should be
cutting toenails at all. My answer is yes, they should. We as the podiatric
physicians should be diagnosing the pathologic nail, determining if the patient is
a candidate for antifungal treatment, recommending treatment options, and not
fixating on who is physically cutting the toenail.
The students at the Iowa College were upset because a physical therapist,
while lecturing on muscle testing and treatment, mentioned that the therapists
were debriding foot ulcers in their department. So what . . . do they understand
the science of wound healing, the role of growth factors? Do they understand
when exogenous growth factor therapy is warranted, who is a candidate for
surgical off-loading, the role of vascular perfusion in the healing process? Or are
they merely mechanically removing dead tissue because someone told them to or
showed them how.
We dont need to hold onto the entire identity of our profession. We just need
to be recognized as the true foot and ankle specialists, and that is done by our
ability to diagnose and treat lower extremity problems with predictable outcomes.
That is accomplished by first being a physician in our approach to patient
concerns. Do we need an MD degree to do that? I doubt it. Would it be nice?
Absolutely! I support the efforts of our leaders who continue to push for better
recognition, better education at the colleges, better and longer residency training.
These are the visionaries who will lead us into a bright and secure future. The
question remains, Will we be ready to release the baggage of the profession and
step up to the plate?
One of the ways that we grow up as a profession is to look at our surgical
results with a critical eye, allowing us to confirm or alter our procedures as needed.
This issue of the Clinics is dedicated to the recognition and treatment of the lessthan-
desirable surgical outcome, and Dr. Wally Strash has done an excellent job
of coordinating authors and articles that will, hopefully, stimulate self-evaluation,
critical thinking, and discussion that will ultimately benefit our patients.
Vincent J. Mandracchia, DPM, MS
Broadlawns Medical Center
1801 Hickman Road
Des Moines, IA 50314, USA
E-mail address: [email protected]
xii V.J. Mandracchia / Clin Podiatr Med Surg 21 (2004) xixii