Stupid Questions

[alparkeruab]

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Do podiatrists focus on the foot below the ankle, or the foot AND the ankle?

Sorry for the remedial question...

 

[doclm]

Do podiatrists focus on the foot below the ankle, or the foot AND the ankle?

Sorry for the remedial question...

I think the podiatrist focuses on the foot and everything associated with the foot. Such as the ankle, tendons/muscles/bones that play a role in the structure, function, and well being of the foot. As a podiatrist you become a specialist in the whole lower extremity of the body from the legs on down. DPM's have much more knowledge than most MD/DO's.

Also, it should be noted that some states have different regulations on what DPM's can touch. For example, in FL DPM's can touch bone from the knee down and soft tissue from the hip down. Other states say the foot and ankle. However, few say below the ankle line (where ever that may be?).

Although I may be able to give you somewhat of an answer to your question, I am sure that someone knows exactly what is involved, and what DPM's can do/where.

 

[dpmgrad]

Do podiatrists focus on the foot below the ankle, or the foot AND the ankle?

Sorry for the remedial question...

As mentioned in the previous posting, different states have different levels of the lower extremity that the podiatrist can work on. This also applies to level of amputation as well.

As per the APMA website, in 2002, 37 states do allow the podiatrist to operate on both the ankle and foot. How far a podiatrist can go up on the leg will vary from state to state. The following states do NOT allow the podiatrist to operate on the ankle (hence, they may operate on the foot only): Wyoming, South Dakota, Kansas, Louisiana, Mississippi, Alabama, Kentucky, Indiana, South Carolina, Washington DC, Puerto Rico, Connecticut, and New York. State laws are constantly changing and I would recommend you contacting the specific state for the most current laws on the scope of practice for the podiatrist in that state. For example, in 2005, a law was just passed that allowed the podiatrist to operate on both the foot and ankle in the states of Massachusetts and Texas. (Therefore, as of 2005, 39 states now allow podiatrists to operate on both the ankle and foot.)

 

[scpod]

. The following states do NOT allow the podiatrist to operate on the ankle (hence, they may operate on the foot only): Wyoming, South Dakota, Kansas, Louisiana, Mississippi, Alabama, Kentucky, Indiana, South Carolina, Washington DC, Puerto Rico, Connecticut, and New York. State laws are constantly changing...

The law is being re-written in South Carolina and the current version (as it resides in the Senate Medical Committee) says:

"Section 40-51-20. For the purposes of this chapter:

(1) 'Podiatry' means the surgical, medical, or mechanical treatment of all ailments of the human foot, and ankle, and their related soft tissue structures to the level of the myotendinous junction. 'Podiatry' does not include the amputation of the entire foot, the administration of an anesthetic other than local, or the surgical correction of clubfoot of an infant two years of age or less...

"Section 40-51-210. Surgery of the ankle and soft tissue structures governing the ankle must be performed in an accredited hospital or ambulatory surgery center. A podiatrist who performs these surgical procedures must be board certified or eligible for certification by the American Board of Podiatric Surgery to perform ankle procedures and shall satisfy all requirements for credentials as outlined by the facility. In addition to granting or denying privileges, the governing body of each hospital or ambulatory surgery center may suspend, revoke, or modify privileges. All applicants or individuals who have privileges shall comply with all applicable medical staff bylaws, rules, and regulations, including the policies and procedures governing the qualifications of applicants and the scope and delineation of privileges."

 

[dpmgrad]

That is great to see another state allowing podiatrists to operate on the foot and ankle. That would make 40 states allowing podiatrists operating on the foot and ankle in 2006 when that law gets passed in South Carolina. As I said in my post, the laws are constantly being rewritten and privileges will change accordingly. (The states that I listed in the posting were from the APMA website and was accurate to the year of 2002, as stated in my posting.)

The law is being re-written in South Carolina and the current version (as it resides in the Senate Medical Committee) says:

"Section 40-51-20. For the purposes of this chapter:

(1) 'Podiatry' means the surgical, medical, or mechanical treatment of all ailments of the human foot, and ankle, and their related soft tissue structures to the level of the myotendinous junction. 'Podiatry' does not include the amputation of the entire foot, the administration of an anesthetic other than local, or the surgical correction of clubfoot of an infant two years of age or less...

"Section 40-51-210. Surgery of the ankle and soft tissue structures governing the ankle must be performed in an accredited hospital or ambulatory surgery center. A podiatrist who performs these surgical procedures must be board certified or eligible for certification by the American Board of Podiatric Surgery to perform ankle procedures and shall satisfy all requirements for credentials as outlined by the facility. In addition to granting or denying privileges, the governing body of each hospital or ambulatory surgery center may suspend, revoke, or modify privileges. All applicants or individuals who have privileges shall comply with all applicable medical staff bylaws, rules, and regulations, including the policies and procedures governing the qualifications of applicants and the scope and delineation of privileges."

 

[alparkeruab]

Is Florida the only state where a podiatrist can touch bone from the knee down and soft tissue from the hip down?

 

[jonwill]

Is Florida the only state where a podiatrist can touch bone from the knee down and soft tissue from the hip down?

New Mexico (where I am from) is tibial tuberosity down and soft tissue to the thigh, as is Iowa. I know that other states have similar laws. As time goes on, I see most states having these laws.

 

[doclm]

The law is being re-written in South Carolina and the current version (as it resides in the Senate Medical Committee) says:

"Section 40-51-20. For the purposes of this chapter:

(1) 'Podiatry' means the surgical, medical, or mechanical treatment of all ailments of the human foot, and ankle, and their related soft tissue structures to the level of the myotendinous junction. 'Podiatry' does not include the amputation of the entire foot, the administration of an anesthetic other than local, or the surgical correction of clubfoot of an infant two years of age or less...

"Section 40-51-210. Surgery of the ankle and soft tissue structures governing the ankle must be performed in an accredited hospital or ambulatory surgery center. A podiatrist who performs these surgical procedures must be board certified or eligible for certification by the American Board of Podiatric Surgery to perform ankle procedures and shall satisfy all requirements for credentials as outlined by the facility. In addition to granting or denying privileges, the governing body of each hospital or ambulatory surgery center may suspend, revoke, or modify privileges. All applicants or individuals who have privileges shall comply with all applicable medical staff bylaws, rules, and regulations, including the policies and procedures governing the qualifications of applicants and the scope and delineation of privileges."

What states allow full amputation of the foot? What classifications are needed to be met to have an ambulatory surgery center? Is this any POD officine that includes an OR suite with a board certified foot & ankle surgeon? How easy would it be for a DPM graduate to obtain such a business in a private practice?

Finally, under what conditions do patients get referred to a DPM after recieving care from a hospital? Is it possible that patients will make appointments with a DPM before going into the hospital?

Thank you for your replies 👍

 

[dpmgrad]

What states allow full amputation of the foot?

From APMA members only section of the website, as of 2000, there are 36 states (including DC) that have clarified if a podiatrist can do amputation and at what level. The 15 remaining states do not have any reference to amputation in the practice acts for podiatric physicians.

States that do not have any reference to amputation in the practice acts for podiatric physicians include: ME, NH, NY, MD, WV, OH, KY, MS, LA, OK, SD, ND, MT, AK, RI, PR

States that allow amputation of the foot: VT, DE

States that allow amputation of part of the foot: FL, GA, TX, CT

States that prohibit amputation of both the foot and toe: CA, NV, AZ, WY, SC, MA

States that prohibit amputation of the foot but does NOT mention about amputation of toes: OR, ID, UT, CO, NM, NE, MN, IA, MO, AR, IL, MI, TN, AL, NC, DC, VA, PA, NJ

States that prohibit amputation of the foot but are allow to amputate toes: WA, KS, WI, IN, HI

This information is only accurate as of 2000. States are constantly rewriting the laws and the amputation privileges may change accordingly for the podiatrists practicing in that state. This is evident in the posting by SCPOD where SC is introducing a new scope of practice for podiatrist to allow for partial amputation of the foot. Lastly, APMA also states that some states may regulate where an amputation can be performed (ie. hospital or licensed facility). If you know of a state that you wish to practice in, it is best to contact the state podiatric medical board for the exact current privileges of the podiatrist in that state.

 

[dpmgrad]

What classifications are needed to be met to have an ambulatory surgery center? Is this any POD officine that includes an OR suite with a board certified foot & ankle surgeon? How easy would it be for a DPM graduate to obtain such a business in a private practice?

I know of several podiatrists who are involved in starting or investing in ambulatory surgery centers. These can be pretty lucrative and have known several podiatrists who earn quite a bit of money. With all business ventures, there is always a possibility of a loss, where the surgery center ends up closing. There are several private podiatric practices that have a certified OR suite in their offices. The advantage of having a CERTIFIED OR suite is that you can bill a facility fee for all of the surgeries that you do in this certified OR suite. If you are doing procedures that require more than local anesthesia, you may need a board certified Anesthesiologist in your OR suite. I hope that this information had answered some of your questions.

 

[dpmgrad]

Finally, under what conditions do patients get referred to a DPM after recieving care from a hospital? Is it possible that patients will make appointments with a DPM before going into the hospital?

Some of the conditions that a patient from the ER or hospital may be referred to a DPM include diabetic foot infection, ingrown toe nails, foot fractures or ankle fractures that did not require immediate surgical intervention, foot/ankle sprains, arthritis, gout, metatarsalgia, foreign body in foot, routine diabetic foot care. Of course, you will also follow up in the office with patients that you had been consulted on in the hospital.

As for your second question about patient making appt with DPM before going into the hospital, I am not exactly sure what you mean by that. In general, patients that want to see a DPM would make an appt to see the DPM directly without going to the hospital. Of course, if you see a patient in the office with a raging diabetic infection, you can always send the patient to the hospital to be admitted. Podiatric admitting privileges will be delineated by the hospital by-laws.

 

[doclm]

Thank You for your specific replies. You have given me some valuable info that I was trying to find.

🙂

 

[dpmgrad]

Thank You for your specific replies. You have given me some valuable info that I was trying to find.

🙂

You are welcome. If you have any questions, feel free to ask.

 

[scpod]

As for your second question about patient making appt with DPM before going into the hospital, I am not exactly sure what you mean by that. In general, patients that want to see a DPM would make an appt to see the DPM directly without going to the hospital.

I'm not 100% sure what DOCLM wanted with that either, but I did want to reiterate what you said about privileges varying by hospital. One of the two hospitals where I grew up was extrememly podiatry friendly and still is. If you take a look at their website, near the bottom right you'll see a search for physician by specialty. When you click on it, please notice that podiatry is listed and the five podiatrists who have priveleges there are listed along with their pictures and some background information. If you seach for "orthopaedics" you'll find 10 names, but none of them specialize in feet. Pretty much all the work on feet goes to podiatrists locally. The other surgical hospital in town is about the same except only three podiatrists have priveleges there.

In contrast, the level one trauma center I worked in for two years (about 65 miles away) has ZERO podiatrists on staff. They do, strangley enough, have a Geriatrics residency for MD's that has a short block of podiatry. Across town, though, there is a fairly podiatry friendly facility.

I guess my point is that every hospital, even those close together, is very different when it comes to priveleges.

 

[whiskers]

It's less about what a podiatrist wants to "focus" on and more about:

1. their residency and board certs
2. State laws

Both can really restrict a podiatrist's scope of practice.