drbeesh,
In my humble opinion, a podiatrist who wants to practice Foot and Ankle Reconstructive surgery does not feel a "need" to be in a hospital OR to impress others. Rather, he or she probably feels a calling. Just as many surgeons feel that it was a calling for them to practice the act of surgery. Podiatry is growing in a very positive direction. As time progresses, orthopaedist are beginning to realize the surgical skills of foot and ankle surgeons which may be causing some "insecurity" on their behalf . Many podiatry schools have joined with medical school programs. This allows the entering podiatry and medical students to be very similar in scholastic ability. In our combined anatomy class, there was no significant statistical difference between the means of medical school students and podiatry students. In addition, the detail of our combined clinical anatomy didn't even compare to the detail of our lower extremity anatomy course. If you feel that I am being "insecure" by making such a comparison, I will feel as if I have missed my mark. Rather, it is not called insecurity but it is called a display of confidence with the support of factual data. I hope to use this confidence to educate orthopaedic surgeons about the importance of Foot and Ankle specialist. Especially in the care of patients who have a potential for serious problems (diabetics). In addition, most foot problems, example: mid foot/hind foot equinus, can cause some serious damage to the knee and hip. Equinus will eventually affect the knees of most patients. If the equinus is caught and managed quickly, the damage may be reduced. TPoTa insufficiency can also cause acquired adult flat foot and potential ankle collapse of the elderly. These are conditions that have been overlooked for many years.
You are correct that there are many other means that a podiatrist uses to address a multitude of patient problems. Among them are toe nail trimming, callus removal, orthotics, flat feet management, diabetic management, Hallux Valgus management, charcot foot, neuropathy, PVD, etc..... All of these are important. Not much different than an internal medicine doctor, emergency medicine doctor, family practice doctor, or most other MDs who use lab analysis to diagnose a patient. One difference is the current lack of automated equipment to allow podiatrist to make many of the pathological or traumatic diagnoses that he/she will she when practicing. Instead, the act of trimming the nails, trimming the callus, and etc allows the podiatrist to develop an understanding of the biomechanical nuance that may have caused the abnormal nail growth or callus. The nuance may be a simple as the size of a muscle in proportion to other muscles or the slightly altered angles in the foot, ankle, and tibia. An example of a potential problem: The superficial group of muscles called the soleus and gastrocnemius combine to form the tendocalcaneus from the aponeurosis of insertion of each. Furthermore, it seems that the tendocalcaneus fibers, from origin of insertion, spiral from medial to lateral so that the gastroc fibers insert on the lateral aspect of the upper 1/3 of posterior body of the calcaneus and the soleus fibers insert on the medial aspect of the upper 1/3 of the posterior body of the calcaneus. If the gastroc is disproportionate in size to the soleus, could this cause a biomechanical effect similar to varus equinus? If so, could this be causing that callus on the rigid/lateral portion of the longitudinal arch? How does it affect the required amount of dorsiflexion required when doing certain arthrodesis procedures? Will a lengthening of the tendon be required?
Personally, I think most podiatric students and most practicing podiatric surgeons will ask these questions. Just as other doctors are thinking as they examine a patient. Sorry for the long response. I just enjoy this stuff called podiatric medicine. I am only a PM2 though. 3 more years of school, and 3 years of residency. Maybe some additional education f I am lucky. I would like to learn some tricks from Dr. Paley and his group. A group that includes podiatrist.