August 2012

N.Y. Podiatry Scope Of Practice May Include The Ankle

By Brian McCurdy, Senior Editor

Podiatric physicians in New York State may soon be licensed to treat the ankle due to a proposed change in the scope of practice.

   The state legislature recently passed Senate Bill 7800 and Assembly Bill 9293-A, which expand the definition of podiatry to include ankle conditions and all soft tissue structures of the leg below the knee that affect the foot and ankle. The measure now awaits the governor’s signature.

   “New York is a tough state to get any legislation passed, particularly when it comes to professions. From the get-go, we felt that our entire message had merit,” says Vito Rizzo, DPM, the Immediate Past President of the New York State Podiatric Medical Association. He notes that although the bill is not as expansive as hoped, the change in scope of practice has been 10 years in the making.

   Dr. Rizzo notes that the objectives of the scope of practice changes included ensuring that New York podiatrists from residency programs are well trained and keeping them in the state. He says there has been “a real loss of young talent” due to the limited scope of practice. With retirements looming as more doctors reach their 60s, Dr. Rizzo expresses concern about the survival of the profession in New York State.

   Neal Blitz, DPM, praises several aspects of the bill as it allows surgeons the ability “to provide more comprehensive care to the lower extremity.” He cites the potential to perform ankle reconstructions as well as soft tissue procedures above the ankle such as gastrocnemius recessions when performing major foot reconstructions.

   “An expanded scope doesn’t automatically mean that the hospitals will blindly grant these privileges,” cautions Dr. Blitz, the Chief of Foot Surgery and Associate Chairman of Orthopaedics at Bronx-Lebanon Hospital Center in Bronx, N.Y. “I imagine the hospitals will be uber-selective, go slowly and institute a variety of proctoring measures.”

   In regard to future potential changes in scope of practice laws in New York, Dr. Blitz would like to see no restrictions on performing complex ankle fractures (pilon) “because this makes it difficult to be heavily involved in emergency room trauma because the podiatric surgeon couldn’t solely cover all the emergencies. As such, the hospital would still need a back-up or secondary call person.”

   A future goal of scope of practice reform is allowing podiatric surgeons access to perform soft tissue procedures up to the knee, according to Dr. Rizzo.

   “It’s very frustrating when you have people coming in who need care and you can’t do it because of some arbitrary anatomic restriction,” says Dr. Rizzo. “Hopefully, the new scope will allow DPMs the ability to render more comprehensive and complete care.”

   Editor’s note: For further reading, see “Scope Of Practice Update: Where Things Stand” in the December 2011 issue of Podiatry Today.

Podiatry Today Online Poll: DPMs Divided Over Affordable Care Act

By Danielle Chicano, Editorial Associate

Not all DPMs are on board with the Supreme Court’s latest decision to uphold the Affordable Care Act (ACA), according to a recent Podiatry Today online poll (see ). Sixty-four percent disagreed with the outcome as this issue went to press.

   Lee C. Rogers, DPM, is surprised that more doctors do not support the law, stating it is “not perfect, but it is a good building block.” He explains the individual mandate forces citizens to take responsibility for their healthcare by purchasing their own insurance on the private market.


Re: Hybrid method of imaging DFI
As the lead author on the paper entitled, Indexing Severity of Diabetic Foot
Infection With 99mTc-White Blood Cell Single Photon Emission Computed
Tomography/Computed Tomography, published in Diabetes Care 35:1826-1831, 2012, I would like to emphasize the following:

1) Contrary to the statements above, the target to background ratio of Tc WBC is exceptionally high. This has been documented by other investigators quoted in our paper.

2) We performed 2-hour delay imaging specifically to differentiate WBC accumulation in focal infection as opposed to transient reactive hyperemia. This was quite effective and we frequently visualized intense focal uptake in gauze packing within the infected ulcer as well as the ulcer itself.

3) The spatial resolution of this hybrid technique exceeds that of convential MRI for defining cortical surfaces and (by several times) that of convential nuclear medicine infection imaging.

4) Most importantly, although we were clearly able to localize infection to bone or soft tissue, we found that inclusion of other factors, such as grading the intensity of WBC activity, significantly enhanced prediction of successful therapy, thus the superiority of the Composite Severity Index (CSI) over the conventional paradigm.

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