Over the last few weeks, I have been exposed to a variety of podiatric colleagues, many of whom I had not known previously. About two weeks ago, I participated in an ongoing project to edit part of the AACPM’s Curriculum Guide. This guide has been created to assist our podiatry colleges by giving them a reference of objectives that are necessary for students to acquire before they enter residency. Additionally, this large document gives our colleagues of other professions an understanding of the requirements necessary to become a podiatric physician and surgeon. As part of a committee editing a portion of this document, I have been privileged to work with some of the best educators in our profession.

Additionally, this past weekend, I was lucky enough to participate in the APMA’s House of Delegates as a board member of the American College of Foot and Ankle Orthopedics and Medicine (ACFAOM), the college that represents the nonsurgical arm of podiatry. After a podiatrist becomes board certified through ABPM (the American Board of Podiatric Medicine), he or she has the opportunity to become a fellow with ACFAOM. I would urge all of us to become members of ACFAOM. Why you ask? Because considering the nonsurgical side of podiatry is incredibly important.

To be clear where I stand, I will remind readers that I am board certified through both the ABFAS and ABPM and I am a fellow of both ACFAS and ACFAOM. I identify myself as a podiatric physician and surgeon. I spend part of my time taking care of patients surgically and a larger part of my time taking care of patients nonsurgically. I consider myself a well-trained modern podiatric specialist who is able to take care of most problems relating to the lower extremity. I am willing to bet a very large amount of money that most of you reading this are the same.

Here, though, is where I seem to diverge from some of the rest of our profession. Although I love surgery, I recognize the importance of the nonsurgical side of the profession. In fact, I feel this has been a highly neglected aspect. If you speak with our students, you will hear a strong desire for most of them to become surgeons. They see surgery as glamorous and exciting and think almost nothing about clinic. They can recite classifications of ankle fractures, but if I ask them to describe how a medial heel skive functions, they are clueless. Give them an intermetatarsal angle, and they will recite five surgical options to fix a bunion. Ask them to treat a bunion nonsurgically and the answer will be something vague like “NSAIDS and orthotics.”

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“Although I love surgery, I recognize the importance of the nonsurgical side of the profession. Nonsurgical podiatry has become a highly neglected aspect of podiatric practice.”

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What I find ironic is that the vast majority of podiatrists do relatively little surgery. In fact, I have heard statistics that quote somewhere between 10 to 25% of a podiatrist’s practice is surgical. I’m not certain what the real number is, but I am sure it is much less than 50%. Given those low numbers, most of us should be more concerned with the nonsurgical than the surgical side of our practices.

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“The vast majority of podiatrists do relatively little surgery – generally 10-25%”

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Here are a few things to consider.

We spend so much time focused on becoming better surgeons, yet for perhaps 80% of our practice, we really should be focused on the nonsurgical side. In fact, this aspect of our practice can in many cases be more intellectually challenging than surgery. Converting a deformed foot to a rectus one has its challenges but trying to treat that patient with recalcitrant heel pain or a diabetic foot ulcer that no one has been able to heal can be an even more challenging issue. Sometimes successfully avoiding the surgery is harder to accomplish than doing the surgery.

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“Sometimes successfully avoiding the surgery is harder to accomplish than doing the surgery.”

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Surgery and nonsurgical care should have equal billing in the podiatry world. Our conferences should reflect this, reimbursements should reflect this, and our practice interests should as well. For that reason, it seems most logical to me that we should be members of both ACFAS and ACFAOM. We should take advantage of the powerful education both organizations provide and develop ourselves to be the true comprehensive specialists of the foot and ankle. It’s not surgery or medicine. It’s surgery AND medicine. If we’re just surgeons, then how are we any different from our orthopedic colleagues? When we embrace equally both sides of our podiatrist nature, then we’re truly the experts of the foot and ankle.

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“Surgery and nonsurgical care should receive equal attention by podiatrists”

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