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Podiatric Sugergy
- Thread starter Dr. Agape
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Depends by state. Look for the thread about scope of podiatry. Coolvkb found one, its fairly recent under the Podiatry Forums (not pre-pod forum).
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Agape,
thank you for the inquiry. To answer your question, no podiatrists do not and probably should not operate on the knees. We typically operate on the foot and ankle but during residency, we get exposure to other areas of orthopoedic surgeries including the hip and the knee. However, in practice we are guided by state-legislated scopes. Some states will allow you to operate on the foot - majority will allow the foot and ankle - and some will include operating on soft tissue structures that include the leg and/or the thigh/hip region.
good luck
D
Dr_Feelgood
But no state allows knee surgery. That would be a orthopedic surgeon's area of expertise.
Podiatrists in several state are able to perform surgeries on hands, as well. This can only be done if the podiatrist has received the proper training, of course.
Thanks,
AZPOD Rocks
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Are you sure about that AZPOD? I haven't seen many residency programs that would give us proper certification to operate on hands. As a matter of fact, the only states that maintain the old "chiropody" act (Ohio included) stress superficial lesions - i.e. warts and maybe a superficial ulcer at most - but nothing surgical, to my understanding at least.
The study of Podiatry includes the primary treatment of the foot and related structures attached to the foot. The beauty of podiatry is, it is multi faceted. I've performed skin grafting from the thigh and applied these grafts to the foot. (plastic surgery), I regularly take biopsies and perform excisional biopsies on the foot or lower leg (dermatologist). I regularly prescribe arthritic medications (rheumatologist) . . . Our scope of practice is dictated by the state board of Podiatric Medical Examiners from state to state. I regularly perform knee, hip and back evaluations to determine its effects on gait (ie measurements, leg raising tests and other examinations to check for scoliosis, for example). I believe that primary treatment of the knee should only be done by an orthopod who is trained in that area of expertise. In fact, most orthopedic surgeons will go through general orthopedic residency and then begin to focus on other structures (like the shoulder, knee, hip, etc). Usually this is because they find that they like treating one particular area better than others. Some orthopods hate treating patients with back pain, etc. So , how does an orthopod become a knee specialist, because he chooses to be. The entire premise of podiatry is treatment of the foot and ankle and its related structures (Texas law).
Al Kline DPM
THE FOOT BLOG
We have a list of states which show the states allowing for the treatment of hands. I'm too lazy to search through my stuff to find it... but I believe 6 or 8 states allow for hands. According to Dr. Page, Director of AZPOD, these states allow us to "work on hands." It was said right after talking about surgeries we are allowed to do. I can't say for certain that the scope in these states includes hand SURGERY but that's what it sounded like (I didn't investigate further because none of the states were appealing for me to practice in).
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I'm pretty sure hand treatment does not include surgery - usually the superficial lesions per the definition of the old and outdated chiropody acts. However, I can say from my experience in Ohio (one of the 6 or 8 states) that not too many DPM's want to advertise hand treatments because they'll get themselves into problems that they wouldnt be able to handle because like i said - our residencies are great, we learn a bit of everything and emphasize on the lower extremity - but including hands in our specialties? I think thats a big no no.
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Some commentary on the "Hand Surgery" remarks:
As part of our residency training in our third year we spend 2 months with a well known Harvard-trained hand surgeon who operates on adults and pediatrics taking primary hand trauma call at HUP(Hosp of the University of PA) and CHOP(Children's Hosp of Philadelphia). He is a plastic surgeon by training with a ortho/hand fellowship and we are primary assist on all his cases so we get to do a lot of hand/forearm cases. HOWEVER, I would never attempt to operate on any hands in the private sector. Your malpractice will not cover you, your state association will not protect you, and you are not practicing under an acceptable standard of care. I am very aggressive surgically but you need to know your limitations. The more you learn/advance, the more you realize what you can do safely. If you can rotate with a hand service this will greatly help your hand skills especially if you have/use loupes and they allow you to do microsurgical procedures with them. This will give you a new respect for this difficult skill. I feel if you have a question whether you should be performing a procedure or not, ask yourself the question, "Am I prepared to deal with ALL complications from this procedure?" This also relates to a more podiatric question - If you aren't prepared to treat tibial fractures, should you be doing supramalleolar ostetomies or harvesting bone graft from the tibia? Just my perspective.
As part of our residency training in our third year we spend 2 months with a well known Harvard-trained hand surgeon who operates on adults and pediatrics taking primary hand trauma call at HUP(Hosp of the University of PA) and CHOP(Children's Hosp of Philadelphia). He is a plastic surgeon by training with a ortho/hand fellowship and we are primary assist on all his cases so we get to do a lot of hand/forearm cases. HOWEVER, I would never attempt to operate on any hands in the private sector. Your malpractice will not cover you, your state association will not protect you, and you are not practicing under an acceptable standard of care. I am very aggressive surgically but you need to know your limitations. The more you learn/advance, the more you realize what you can do safely. If you can rotate with a hand service this will greatly help your hand skills especially if you have/use loupes and they allow you to do microsurgical procedures with them. This will give you a new respect for this difficult skill. I feel if you have a question whether you should be performing a procedure or not, ask yourself the question, "Am I prepared to deal with ALL complications from this procedure?" This also relates to a more podiatric question - If you aren't prepared to treat tibial fractures, should you be doing supramalleolar ostetomies or harvesting bone graft from the tibia? Just my perspective.
Great response! Thanks for your insight. I never intend on operating on the hand but so many rumors regarding podiatrists treating hands are floating around that I have often wondered about the semantics of it all just out of curiosity. You solved my case of curiosity and didn't even need to kill the cat.🙂
AZPOD Rocks
