Friday, January 19, 2018

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Why Podiatric Surgeons?

The Podiatric Foot and Ankle Surgeon

Podiatric SurgeonBoard Certified in Foot Surgery and Reconstructive Rearfoot and Ankle Surgery

The question is often raised: “Who is the most appropriate specialist to promptly diagnose and treat patients with foot and ankle injuries in a caring, cost effective and time sensitive fashion?” Traditionally these injuries have been referred to Orthopedists, but with the evolution of a new generation of highly trained surgical Podiatrists, now a choice exists.

Education of the Podiatric Foot and Ankle Surgeon

After graduating from college, four years of medical school are required by both the Podiatrist and the Orthopedist. The Podiatrist graduates from Podiatric Medical School as a Doctor of Podiatric Medicine (DPM) while the Orthopedist becomes either a Medical Doctor (MD) or a Doctor of Osteopathic Medicine (DO). The curricula for these programs are extremely similar with a few very important differences. In fact, in many cases, allopathic, osteopathic and podiatric medical students actually share the classroom for didactic lectures and complete the same clinical rotations side by side.

The first two years in each of the above programs consist of didactic classes and labs in the basic medical sciences including subjects such as gross anatomy, biochemistry, physiology, histology, pathology, pharmacology, microbiology, etc. The last two years consist of lectures and rotations in the clinical sciences and include the major medical specialties such as internal medicine, emergency medicine, general surgery, anesthesia, radiology, etc.

However, differences in the curricula allow the Podiatrist to begin to focus on their future area of expertise. During the first two years of school, Podiatric medical students take two courses in Lower Extremity Anatomy (in addition to gross anatomy) and two in human functional biomechanics. This time is allowed in their schedule by requiring the student to attend summer classes. The Podiatric medical student also receives and is expected to keep current with the major peer reviewed journals of the field including the Journal of the American Podiatric Medical Association and the Journal of Foot and Ankle Surgery. Even at this early stage of their career, these students begin to develop a thirst for knowledge in the field of foot and ankle surgery.

During the second two years, the curricula differ in that the Podiatric student also completes classes, rotations and “externships” in clinical Podiatric Medicine and Surgery in place of less related specialties such as, OB/GYN, Psychiatry, etc. The externships, which focus on specific areas of interest in Podiatric Medicine and Surgery such as Sports Medicine, Trauma, Reconstructive Surgery, Office Podiatry, etc. are selected by the student and located around the country. It is during this time that the student chooses the area of Podiatry in which he or she would like to focus. In the case of the Podiatric Foot and Ankle Surgeon, by the completion of the fourth year of school, the student is extremely familiar with foot and ankle surgery, related diseases and conditions, as he or she has now, externed, interviewed and been selected for a foot and ankle surgical residency program.

The Orthopedic Surgeon completes four years of medical school with no initial focused lower extremity training. After graduation, he/she will enter into a five year general orthopedic residency. Current orthopedic residency training guidelines are vague and do not require specific experience or proficiency in foot and ankle surgery. A study in 2003 found that 35% of all orthopedic residencies had no dedicated foot and ankle training. Of the rest that did, 40% had an average of 12 weeks of dedicated foot and ankle training, 27% had less than 12 weeks, and 32% had 16 to 24 weeks of training. Orthopedic surgeons wishing to specialize in foot and ankle surgery would then complete a one year fellowship.

The vast majority of Podiatric Medicine and Surgery residency programs are 3 years. The resident is exposed to various aspects of hands on clinical and hospital based training including an emphasis on foot and ankle surgery. The resident will also have dedicated rotations with internal medicine, infectious disease, orthopedics, emergency medicine, radiology, pathology, anesthesiology, vascular surgery, general surgery. They are also able to have elective rotations that they so choose to gain additional training. During this time, the resident will also take the Board Qualification exam for Foot and Reconstructive Rearfoot and Ankle Surgery as offered by the American Board of Podiatric Surgery (ABPS).

Once board qualified surgeons have successfully passed the rigorous oral and written examinations, they will become board certified. This process usually takes 3 to 5 years, but applicants have up to 7 years before board qualification status expires.

ABPS certification ensures that podiatric surgeons have completed appropriate training, successfully performed a diverse range of foot and ankle surgical procedures, and passed extensive written and oral examinations. The importance of board qualification and certification is reflected in trends by hospitals, surgery centers, managed care organizations, and insurance carriers to require specialty board certification.


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