.... I would go to an orthopod before a podiatrist for any big foot surgeries anyway...& I am a Podiatrist...
There's excellent surgeons trained by either model. It's all about doing your homework on local surgeons. Podfather is 100% correct when he says you can't make blind generalizations. It's just plain naive.
-Ortho = 5yrs general (circa 4-8wk dedicated F&A depending on program, but some F&A on general, trauma, sports, adult, peds, etc rotations)
-F&A Ortho = tack on 6-12mo of dedicated F&A
-Recently trained DPM = 3yr residency (circa 24mo of dedicated F&A depending on program), and possible 12+ month dedicated F&A fellowship
...either way you acquire the training, it's a significant volume of foot and ankle surgery. Those who are interested in the subspecialty of F&A surg and have the talent for it will rise to the top regardless of which model. You always want a dedicated specialist for any surgery IMO, but there will be some excellent F&A surgeons out there who got their skills from either the pod surg residency road, the ortho F&A fellowship road, or even many just the ortho residency + personal F&A interest road.
The main difference is probably just that DPMs have a certification board for F&A surgery, the ABPS. The problem is that there are a ton of current DPMs who were essentially grandfathered into ABPS despite training for and doing very little or no rearfoot, trauma, etc. That will change, but things don't happen overnight. Ultimately, the ABPS cert DPMs who are grandfathered in will wash out. That is a certainty, and at that point, you are pretty safe going with a DPM who is cert by ABPS - esp if they're rearfoot recon and ankle cert (meaning 3+ yr trained and passed additional board exams).
Ortho F&A has a society, AOFAS, but their fellowships are relatively new. For now, their society only requires general ortho board (ABOS) cert and "interested" in foot and ankle to join. An orthopedist who hasn't done any F&A cases besides occasional ER call ankle fractures since he finished residency 20yrs ago could join AOFAS. Similarly to ABPS grandfathered DPMs washing out, the AOFAS fellowships will get more history, and the organization may start requiring completion of an AOFAS-approved fellowship for all members. That is only somewhat likely since it would limit their membership $, but it'd be a good move since then people could feel pretty comfortable picking an AOFAS for F&A surgery since you'd know the ortho F&A did a focused fellowship (even though he still never had to pass a board exam that was focused F&A surgery).
For now, I'd say just do your research if you or a family member needs F&A surgery. Hospitals will generally limit their staff to qualified surgeons to protect their own interests, but you should still do your homework since somebody might have gotten F&A privileges a long time ago (or more recently just out of F&A surgeon rarity) and kept those operating rights despite doing very little volume and/or low quality work in that area. Ask around for recommendations, and then find out about the exact resume of the top recommended docs. They should almost invariably be ABPS qual/cert or an AOFAS member. Then, go and meet with them; don't hesitate to ask the surgeon how many of the proposed procedure he's done,
how many he's done recently, etc. If it's complex elective, then definitely get a 2nd opinion. A second opinion is a good idea any time there's proposed procedure/surgery or a major/lifelong diagnosis (diabetes, cancer, etc), so any good physician welcomes a second opinion. If it's trauma F&A surgery, then you still have a choice of surgeon - contrary to popular belief. There are exceedingly few F&A cases that truly need to have the definitive fix done that night. Sure, you might need an I&D, fasciotomy, or ex fix at 2am for some severe trauma or infections, but you can still pick who will do the definitive surgery, which will probably be the most important to long term outcome.
