Are Podiatrists concentrating more on Foot and avoiding ankle cases!

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I had a conversation today with a local Podiatrist. his family is also indian and he was kind to me. so i got a bit free and started asking questions. i asked him abt his income,types of cases he see, advise for me in college,etc.When i asked abt Rearfoot and ankle surgery, he said rearfoot and ankle surgeries are more of a headache and that his daily bread and butter is from fore foot cases and general diagnosis,etc and he went on to add that many DPMs in country kind of avoid Rearfoot stuff and let the orthos do it. in that way everyone is happy. I had read on SDN also that some DPMs dont do rearfoot even if the state allows.

Iam just curious. Is this like a national trend or few exceptions. Or may be because there are many pods who graduated from those 12 months or 24 montsh residencies,etc. My only sources are SDN , some physicians whom i meet when i go to take x-ray for their cases and ofcourse webpages of Podiatrists on net. So far from SDN Practicing Pods as well as local Pods and online websites iam getting same response when it comes to rearfoot stuff.

Ofcourse at the end of the day all that matters is money and life without extra tensions. and forefoot procedures are very rewarding in that sense. but since many are doing or planning or getting encouraged by seniors to do 3 yr residency . And why not! we all want to have the best education and training before we graduate. But if all we are doing is forefoot and basic rearfoot in real life then whats the point of doing so much hardwork. In clinicals or residency may be we get to do really interesting stuff on ankle or rearfoot reconstruction. But are there really a good number of DPMs out there from PMS-36 programs who are now actively doing these procedures in their present practices?

It will be really awesome if anyone can give names of DPMs or examples where Pods are specializing in these areas apart from forefoot.

 

[bdaddyjolley]

I had a conversation today with a local Podiatrist. his family is also indian and he was kind to me. so i got a bit free and started asking questions. i asked him abt his income,types of cases he see, advise for me in college,etc.When i asked abt Rearfoot and ankle surgery, he said rearfoot and ankle surgeries are more of a headache and that his daily bread and butter is from fore foot cases and general diagnosis,etc and he went on to add that many DPMs in country kind of avoid Rearfoot stuff and let the orthos do it. in that way everyone is happy. I had read on SDN also that some DPMs dont do rearfoot even if the state allows.

Iam just curious. Is this like a national trend or few exceptions. Or may be because there are many pods who graduated from those 12 months or 24 montsh residencies,etc. My only sources are SDN , some physicians whom i meet when i go to take x-ray for their cases and ofcourse webpages of Podiatrists on net. So far from SDN Practicing Pods as well as local Pods and online websites iam getting same response when it comes to rearfoot stuff.

Ofcourse at the end of the day all that matters is money and life without extra tensions. and forefoot procedures are very rewarding in that sense. but since many are doing or planning or getting encouraged by seniors to do 3 yr residency . And why not! we all want to have the best education and training before we graduate. But if all we are doing is forefoot and basic rearfoot in real life then whats the point of doing so much hardwork. In clinicals or residency may be we get to do really interesting stuff on ankle or rearfoot reconstruction. But are there really a good number of DPMs out there from PMS-36 programs who are now actively doing these procedures in their present practices?

It will be really awesome if anyone can give names of DPMs or examples where Pods are specializing in these areas apart from forefoot.

From what I have heard it depends on how many cases you do on a regular basis. If you don't get a lot a ankle stuff then you might be inclined to refer it out since you don't practice it often and then your butt is not on the line. But if you get a lot of ankle cases then you will feel more confident about doing it because you're not rusty in that area. Some DPMs have told me this but I'm sure it's not the rule just what some do.

 

[krabmas]

I had a conversation today with a local Podiatrist and i was asking him what kind of cases he usually see and does he perform lot of rearfoot and ankle stuff. He said rearfoot and ankle surgeries are more of a headache and that his daily bread and butter is from fore foot cases. and he went on to add that many DPMs in country kind of avoid Rearfoot stuff and let the orthos do it. in that way everyone is happy. I had read on SDN also that some DPMs dont do rearfoot even if state allows also.

Iam just curious. Is this like a national trend or few exceptions. My only sources are SDN , some physicians whom i meet when i go to take x-ray for their cases and ofcourse webpages of Podiatrists. So far from SDN Practicing Pods as well as local Pods and online websites iam getting same response when it comes to rearfoot stuff.

Ofcourse at the end of the day all that matters is money and life without extra tensions. and forefoot procedures are very rewarding in that sense. but since many are doing or planning or getting encouraged by seniors to do 3 yr residency . And why not! we all want to have the best education and training before we graduate. But if all we are doing is forefoot and basic rearfoot in real life then whats the point of doing so much hardwork. In clinicals or residency may be we get to do really interesting stuff on ankle or rearfoot reconstruction. But are there really a good number of DPMs out there from PMS-36 programs who are now actively doing these procedures in their present practices?

It will be really awesome if anyone can give names of DPMs or examples where Pods are specializing in these areas apart from forefoot.

In order for the new pods to get trained well in rearfoot and full foot reconstructive surgeries their needs to be someone teaching them. By teaching I mean bringing cases to the OR. We have several attendings that consistently bring cases to the OR that are ankle fractures, flatfoot reconstruction, major joint fusions...

If you are only trained in forefoot then all you know is forefoot. Some patients present with a bunion. You do the exam and realize that it is hypermobile and they have an adult acquired flatfoot. do you then just fix the bunion? Do you tell the patient what is wrong with her foot then give her the option to choose her own treatment (not surgical vs nonsurgical, but which procedure)? Or do you tell the patient that she has a major deformity that can be fixed with some joint sparing procedures and she needs a gastroc recession, lapidus, Evans, and maybe a cotton and repair of her PTT? And if she waits that she will need possibley a triple? and if you trained only in forefoot or are only comfortable doing forefoot do you refer this patient to someone who can give her the best care and the right procedure? Or do you fix the bunion with an austin akin and leave the patient with a foot doomed for failure?

This is what I see as part of the problem with "forefoot" podiatrists. Many bunion failures are due to wrong procedure selection. You cannot fix every bunion with an austin akin.

Many forefoot procedures can have dire consiquences as well. non-unions develope as well as infections, osteomylitis, avascular necrosis... How many re-dos do the forefoot pods do? my guess is not many. The patients go to someone else that is better trained to fix the problem. I don't think that all forefoot pods are bad but they must know their limitations as should all surgeons.

I think after you finish residency you will know if you enjoy doing bigger/longer cases. If you do great. go practice. if you do not enjoy them then do not do them. But you should have all options open to you.

I think many pods choose not to do these cases because they do not enjoy doing them. I do not think that it is all about the bottom line.

 

[NatCh]

I had rearfoot training so my armamentarium includes rearfoot procedures, but honestly I don't care for the prolonged post-operative management and holding my breath hoping nothing goes wrong during recovery. Fortunately one of my Partners enjoys it so I often refer to him. He just got married and is expecting his first child, so I'm curious to see if that changes. A rearfoot case lasts a lot longer than the 60 or 90 minutes it takes to go skin-to-skin. It's like a 2 or 3 month delicate relationship. Being the low-stress, quality-of-life type of guy that I am, I don't have any qualms about referring. I sleep better and can fully enjoy my time off from work without being full of worry.

Right as I finished Residency I was more gung-ho about doing the bigger rearfoot cases, but that changed pretty quickly after a handful of stressful post-ops. I booked the cases thinking to myself, "Hey, I know how to do this. I've done x-number of cases with so-and-so Attending. Piece of cake!' Then came the post-op management...uyyyy.

I still think you guys should seek out the most and best training you can get. Even if at some point you decide you don't want any of the rearfoot or ankle work, the bread and butter stuff will be cake. If you decide you do enjoy the RF/ankle work, the choice will be yours to make and you won't be limited by lack of training.

Nat