APMA Response:
David Thordarson, MD, president of the American Orthopaedic Foot and Ankle Society (AOFAS) recently published an editorial to the members of the American Academy of Orthopaedic Surgeons (AAOS) titled “Protecting musculo
www.apma.org
A Statement from President Brooke Bisbee, DPM, Regarding AAOS Editorial
David Thordarson, MD, president of the American Orthopaedic Foot and Ankle Society (AOFAS) recently published an editorial to the members of the American Academy of Orthopaedic Surgeons (AAOS) titled “Protecting musculoskeletal care: Perspective of the president of the American Orthopaedic Foot and Ankle Society.” In this article, Dr. Thordarson exhorts his colleagues to engage with hospital credentialing committees as well as lawmakers and health-care leaders about the differences between orthopedic and podiatric training “to prevent scope creep.”
Dr. Thordarson’s article is riddled with misleading messages, exaggerations, and outright falsehoods. He references decades-old studies to support his argument. In an era in which science itself is under attack, physicians must hold themselves to an even higher standard for truth and accuracy.
APMA addresses individual inaccuracies in “Protecting musculoskeletal care” below. On behalf of our member podiatric physicians and surgeons, APMA demands that AAOS and AOFAS rescind this deceptive article.
Podiatry’s Proven Value
Dr. Thordarson notes that a 2024 analysis showed that orthopedic surgeons provide foot and ankle care with lower costs and fewer complications. The cost differences noted in the study Dr. Thordarson quoted were marginal, and the research had methodological flaws that impact the author’s findings, as detailed in a letter to the editor published in May in
Foot and Ankle International.
Regardless of cost,
value in health care is defined by outcomes and patient safety. A nationwide Pearl Diver analysis of
130,982 older adults with ankle osteoarthritis found that patients undergoing total ankle arthroplasty (TAA) were
51-percent less likely to fall over an 11+ year follow-up than those managed non-surgically. This reinforces that ankle surgery, such as that performed by podiatrists, improves long-term health and reduces downstream costs.
Another Pearl Diver study covering
2010–2023 demonstrated that
TAA outcomes did not differ by surgeon specialty: The risk of revision, 90-day readmission, infection, and venous thromboembolism did not differ
between podiatric and orthopedic surgeons. TAA survivorship is not associated with surgeon specialty; thus, care provided by podiatrists is just as safe and effective as TAA performed by other surgeons.
The current evidence is clear—podiatric surgeons deliver care that is safe and effective.
Specialized Training = Unmatched Expertise
Dr. Thordarson diminishes podiatric training for its concentration on the foot and ankle. Podiatrists, just like other physicians and surgeons, undergo
three years of mandatory, hospital-based residency training, with optional fellowships for further specialization. Podiatric education also, by necessity, covers systemic health care. In fact, podiatric medical students often learn alongside MD and DO students.
Podiatric residency training is uniquely focused on the foot and ankle compared to the broader training orthopedic surgeons receive. This concentrated training produces
experts from day one, with foot and ankle surgical case volumes often exceeding those of non–fellowship-trained orthopedists.
The latest outcomes research proves that this training translates into
clinical equivalence between DPMs and MDs and DOs, and, in certain areas such as limb preservation, superiority for DPMs.
It is no wonder, then, that so many orthopedic practices employ podiatric surgeons to manage foot and ankle cases, or that the federal government recognizes podiatrists as physicians. Podiatrists manage patients and develop strong patient-centered relationships with our vascular surgery, internal medicine, endocrinology, rheumatology, and orthopedic colleagues.
Scope Modernization Reflects Trust, Not Turf
State legislatures modernize podiatric scope of practice because of
decades of demonstrated safety and quality care. These expansions
improve patient access in communities underserved by fellowship-trained orthopedists.
Recent evidence confirms
no increase in complications when podiatrists perform certain ankle procedures, directly rebutting claims that scope expansion endangers patients.
Legislatures and hospitals modernize scope of practice laws and privileges for podiatrists consistent with the advancements in podiatrists’ education and training: four years of medical education, national boards, three years of residency, and lifelong CME. Podiatrists’ education and training
mirrors the rigor of MD and DO training.
It is problematic to suggest that not only legislators but also hospital medical staff would advance scope of practice laws or hospital privileges without sound evidence of patient safety and quality outcomes.
Dr. Thordarson reverts to scare tactics, suggesting that podiatric scope may soon include the knee or hip. As noted by Dr. Thordarson, in a few limited states, podiatrists
can treat the hands, but contrary to his assertion, podiatrists are
not authorized to perform invasive surgical treatments of the hand. Treatment of the hand is limited to superficial lesions, such as warts.
Residency Growth = Access for Patients
Dr. Thordarson bemoans the fact that podiatry residency training positions are uncapped by CMS. While orthopedic residency slots are capped, podiatric residencies are not—allowing the profession to meet urgent workforce needs. With nearly
40 million Americans projected to have diabetes by 2030, the demand for limb salvage and reconstructive surgery will rise sharply.
Each year, millions of older people—those 65 and older—fall, making podiatrists vital resources to assess fall risk and implement life-saving measures to protect patients from falls.
Podiatric residency expansion ensures patient access to surgical care in both urban and rural settings. More podiatric residents mean more
innovation, scholarship, and patient care capacity—critical for addressing the national physician shortage.
Collaboration Over Competition
Patients benefit most when specialties
work together, not compete. Podiatrists bring unmatched expertise in
diabetic limb salvage, biomechanics, minimally invasive surgery, and reconstructive foot and ankle care.
Orthopedists bring broad musculoskeletal training.
Together, we can partner on
CME, collaborate on high-quality research, and develop co-management and referral pathways that elevate musculoskeletal care for all patients.
Conclusion: Standing Proud as Podiatric Physicians
The latest evidence confirms what patients and payers already know:
Podiatrists deliver safe, effective, cost-saving care.
Our outcomes in total ankle arthroplasty are
equivalent across specialties. Our surgeries and services reduce long-term risks such as falls in older adults. Our residency growth ensures that patients will not be left behind in a time of national physician shortages.
APMA stands firmly behind the care our members provide:
Podiatry is not just protecting musculoskeletal care—it is advancing it.
References
- Fleischer A, Albright R, Jetty I, Tower D, Hook J, Weil L Jr. How Does Total Ankle Arthroplasty Affect Fall Risk?: A Nationwide Database Study of 130,982 Older Adults with Ankle Osteoarthritis. J Foot Ankle Surg. 2025; Epub ahead of print. PMID: 40588119 .
- Fleischer AE, Albright RH, Patel K, Santiago H, Hook J, Tower D, Weil L Jr. Risk of revision and other complications in total ankle arthroplasty do not differ by surgeon specialty: Analysis of the Pearl Diver healthcare claims database from 2010 to 2023. J Foot Ankle Surg. 2025; Epub ahead of print. PMID: 40639434 .
- Chan JJ, Chan JC, Poeran J, Zubizarreta N, Mazumdar M, Vulcano E. Surgeon Type and Outcomes After Inpatient Ankle Arthrodesis and Total Ankle Arthroplasty. J Bone Joint Surg Am. 2019;101(2):127-135. PMID: 30653042.
- Reeves CL. American College of Foot and Ankle Surgeons Commentary on Surgeon Type and Outcomes After Inpatient Ankle Arthrodesis and Total Ankle Arthroplasty: Chan et al, J Bone Joint Surg 2019;101:127-135. J Foot Ankle Surg. 2019 Sep;58(5):1051. doi: 10.1053/j.jfas.2019.07.006. PMID: 31474394.
- Nixon D, Ko H, Martin B. Impact of Surgeon Type on Total Ankle Arthroplasty Readmission, Complication, and Infection Rates. Foot Ankle Orthop. 2024;9(2):2473011424S00075. PMCID: PMC11015809.
- Albright R, DeHeer P, Tower D. Letter Regarding: A Retrospective Cohort Analysis Comparing the Costs of Ankle Fracture Fixation in Orthopaedics and Podiatry in a U.S. Medicare Limited Data Set. Foot & Ankle International. 2025;46(5):571-572. doi:10.1177/10711007251330603
- Rosenblatt NJ, Girgis C, Avalos M, Fleischer AE, Crews RT. The Role of the Podiatrist in Assessing and Reducing Fall Risk: An Updated Review. Clin Podiatr Med Surg. 2020 Apr;37(2):327-369. doi: 10.1016/j.cpm.2019.12.005. Epub 2020 Jan 30. PMID: 32146988.
- Sadra S, Fleischer A, Klein E, Grewal GS, Knight J, Weil LS Sr, Weil L Jr, Najafi B. Hallux valgus surgery may produce early improvements in balance control: results of a cross-sectional pilot study. J Am Podiatr Med Assoc. 2013 Nov-Dec;103(6):489-97. doi: 10.7547/1030489. PMID: 24297985; PMCID: PMC4815263.
- Yalla SV, Crews RT, Fleischer AE, Grewal G, Ortiz J, Najafi B. An immediate effect of custom-made ankle foot orthoses on postural stability in older adults. Clin Biomech (Bristol). 2014 Dec;29(10):1081-8. doi: 10.1016/j.clinbiomech.2014.10.007. Epub 2014 Oct 30. PMID: 25467809.
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