The Hand, Wrist, Forearm

[DPMer]

Podiatrists can treat the foot, ankle and leg below the knee. Question:

What states in America allow podiatrists to treat the hand, wrist, and forearm below the elbow?

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[347932]

Podiatrists can treat the foot, ankle and leg below the knee. Question:

What states in America allow podiatrists to treat the hand, wrist, and forearm below the elbow?

None.

About the only thing you can do on the hand is cut fingernails and that is only in certain states.

 

[Creflo]

I vaguely recall reading a scope of practice summary and think Alaska may have allowed some sort of hand scope, but its been a while since I read this.

 

[FutureCTDoc]

http://www.rosalindfranklin.edu/dnn/portals/17/documents/clerkship/Scope-of-Practice-study.pdf

Actually Alaska allows for superficial lesions of the hand, Michigan, Minnesota and Ohio allow for some scope on the hands.

 

[PADPM]

I think it's only OK if people walk on their hands.

 

[DPMer]

It's funny how podiatrists are limited in some states to perform surgery only on the forefoot (dig met surgery) due to the state law of scope of surgical practice. Yet, there are no such limitations to perform surgery only on the dig met of the hand. There is no such thing as forehand and rearhand surgery! LOL! The politics is nonsense that dictates state laws on forefoot vs rearfoot surgeries for podiatrists from state to state. Foot and ankle ortho surgeons do not have such limitations. And hand ortho surgeons do not have such limitations either. Petty corrupt dirty politics that shape the state laws in the state boards of podiatry when it applies to foot and ankle surgeries! A joke!

 

[skiz knot]

It's funny how podiatrists are limited in some states to perform surgery only on the forefoot (dig met surgery) due to the state law of scope of surgical practice. Yet, there are no such limitations to perform surgery only on the dig met of the hand. There is no such thing as forehand and rearhand surgery! LOL! The politics is nonsense that dictates state laws on forefoot vs rearfoot surgeries for podiatrists from state to state. Foot and ankle ortho surgeons do not have such limitations. And hand ortho surgeons do not have such limitations either. Petty corrupt dirty politics that shape the state laws in the state boards of podiatry when it applies to foot and ankle surgeries! A joke!

It is not all "dirty politics." It is the training model. The reasons Foot and Ankle and Hand ortho surgeons do not have restrictions from operating on the rest of body is because they have had a 5+ year orthopaedic residency learning to do so. Plastic and General surgeons that go into hand ARE limited in their scope of practice. PRS and Gen Surg trained hand surgeons will not be credentialed in elbow/shoulder fracture/tendon/ligament surgery. I do agree the restrictions on podiatrists are inconsistent and somewhat arbitrary from state to state, but that is a different discussion. Hand surgery and Foot surgery are not necessarily analogous. The anatomy may have many similarities but the treatment goals are often astoundingly different.

 

[densmore22]

Why would you, as a podiatrist, want to work on the hand? It makes no sense. The increased liability is astounding. IMO, a lot of Ortho's do F&A fellowships because it's the least amount of post-graduate training to claim "fellowship trained" status, thus, even though a lot of ortho's specialize in F&A, the majority of them don't necessarily want to do it on a day in/day out basis. In contrast to hand fellowships, they are significantly longer and focused. I, personally, would not want to mess with the hand. People can hobble around on a bum foot, but if you can't grip something or have use of fine motor dexterity, then you are f***ed. As stated, the basic anatomy is the same, but the principles and dynamics are much, much different.

 

[PADPM]

Why would you, as a podiatrist, want to work on the hand? It makes no sense. The increased liability is astounding. IMO, a lot of Ortho's do F&A fellowships because it's the least amount of post-graduate training to claim "fellowship trained" status, thus, even though a lot of ortho's specialize in F&A, the majority of them don't necessarily want to do it on a day in/day out basis. In contrast to hand fellowships, they are significantly longer and focused. I, personally, would not want to mess with the hand. People can hobble around on a bum foot, but if you can't grip something or have use of fine motor dexterity, then you are f***ed. As stated, the basic anatomy is the same, but the principles and dynamics are much, much different.

I understand your comments, but you've trivialized the foot just a "bit". Ironically, I know many orthopedic surgeons who hate performing surgery on the foot due to it's intricacy and the fact that unlike a hand, the foot is always in a dependent attitude and unlike a hand, the foot has to put up with the demands of weightbearing.

So there is a distinct trade off. The hand unarguably has more fine motor skills you must deal with, but you have the advantage of being able to tell a patient to keep the hand elevated or up in a sling. The foot, though not used for the same fine motor skills is subject to gravity and weightbearing which can be quite a challenge in the healing process. As you will see/learn if you haven't already, gravity and weightbearing aren't always your friend as a surgeon during the post operative phase.

 

[densmore22]

I understand your comments, but you've trivialized the foot just a "bit". Ironically, I know many orthopedic surgeons who hate performing surgery on the foot due to it's intricacy and the fact that unlike a hand, the foot is always in a dependent attitude and unlike a hand, the foot has to put up with the demands of weightbearing.

So there is a distinct trade off. The hand unarguably has more fine motor skills you must deal with, but you have the advantage of being able to tell a patient to keep the hand elevated or up in a sling. The foot, though not used for the same fine motor skills is subject to gravity and weightbearing which can be quite a challenge in the healing process. As you will see/learn if you haven't already, gravity and weightbearing aren't always your friend as a surgeon during the post operative phase.

I'm not trivalizing the foot. That wasn't my intention. I'm a future foot and ankle surgeon so trivilazing the foot would mean trivilazing my profession and livelihood, which I do not. However, these dumb pod students that come on here and saying "why can't we surgify the hand?" It's just dumb and ignorant. If you wanted to do surgery on the rest of the body, then you should have chosen a different path, plain and simple. My point is that there's a whole profession dedicated to the study of the hand and its surgery, much akin to our great profession, so why would you want to mix the two. I think the intricacy of surgery in the hand is more intense, but the management is much easier than in the foot. (And I've scrubbed in with a ortho hand guy on hand cases in residency thus far).

 

[PADPM]

I'm not trivalizing the foot. That wasn't my intention. I'm a future foot and ankle surgeon so trivilazing the foot would mean trivilazing my profession and livelihood, which I do not. However, these dumb pod students that come on here and saying "why can't we surgify the hand?" It's just dumb and ignorant. If you wanted to do surgery on the rest of the body, then you should have chosen a different path, plain and simple. My point is that there's a whole profession dedicated to the study of the hand and its surgery, much akin to our great profession, so why would you want to mix the two. I think the intricacy of surgery in the hand is more intense, but the management is much easier than in the foot. (And I've scrubbed in with a ortho hand guy on hand cases in residency thus far).

I agree. Students do often ask a lot of questions that boggle my mind. Just look back at many posts on this site and you'll certainly understand. There are students who just got accepted to school who are concerned about the best way to obtain a residency, the details of residency programs, the best way to obtain a job following residency, the residency interview process, etc.

I FULLY understand these students are simply interested in their futures, but those are concerns that are several years down the line, and you would think they would be more concerned with first getting through their first semester, and that they would be asking questions regarding study skills, courses, etc.

You can't drive yourself crazy trying to figure out the thought process of others, that's why I try to answer the questions even though I'm sometimes perplexed as to why the question is asked.

I'm certainly happy and busy enough treating the foot and ankle.