Amazon Review Says Podiatrists Are Not Experts On Ankle Surgery

Every once in awhile you come across something that makes your blood boil. My trigger was simply reading reviews of the most current edition of McGlamry's Comprehensive Textbook of Foot and Ankle Surgery on Amazon.com. What infuriated me was the following review:

How can any podiatrist write a book on ankle surgery? It is like a blind person writing a book on art appreciation! How many podiatrists do an orthopedic residency, foot and ankle fellowship, (or) take acute trauma on a daily basis at major university trauma centers? At best, maybe 1% of the podiatry profession has any ankle training and usually they are from the military. Podiatry training is very sketchy and they can't handle their own complications for any number of reasons including 50 different scopes of practice in 50 states. How can people who are limited by law in most states from even touching the ankle decide they will teach ankle surgery? The podiatry profession is good at billing and performing procedures they decide are legit without any literature on the subject except what they decide is valid.

Podiatry should stick with bilking the public with their "laser" toenail procedures that are about 30% effective and cutting corns and calluses. If I had an ingrown toenail, I would go to a podiatrist but of course get a bill consistent with cardiac surgery. They are allied health professionals who can't admit without a physician co-admit and in most states can’t even perform a legit H/P. Unfortunately, the public falls victim to their nonsense. Students who had 2.86 GPA in unknown undergraduate schools playing DR and expecting parity. Sorry, ain't gonna happen.” — Ortho1

I am not sure why it is deemed acceptable to be discriminatory, slanderous and defamatory toward a whole group of people in the United States in 2013. I am not naïve. Although I am a Caucasian male, I like to think discrimination is evolving out of our society. Yet it seems very reasonable to some of our “colleagues” to make such comments without any consequence. I wonder if such a person would make discriminatory comments about any other group of people based on their race, religion or sexual orientation, or is it just for those of us with the letters “DPM” after our names?

Let us analyze Ortho1’s review for a second to see just how logical and informed this genius really is. First, this is not a book on ankle surgery. It is a classic text on foot and ankle surgery recognized as such in both the orthopedic and podiatric communities as an authoritative reference. His argument about ankle training being only in military settings is of course outdated and uninformed. This is not the 1960s. Podiatry has well-documented ankle training and recognition in academia. His continued drivel about a lack of evidence-based medicine from our profession makes me want to send him a copy of the Thomson Reuters Healthcare Study showing that podiatry not only saves limbs and lowers hospitalizations, but also saves money.1 I know not every podiatrist can admit a patient to a hospital but many of us can and have been able to do so for years.

Although I am not a Dr. Phil fan, he has a saying, “You have to teach people how to treat you.” For too many years, we allowed ourselves to be treated like Ortho1 is doing in this review. I am mad as hell and will not take it anymore! Stand up and fight back against these types of people. Their stupidity is so easy to use against them.

Reference
1. Available at http://www.reuters.com/article/2010/07/15/idUS181188+15-Jul-2010+MW20100715 .



Ron Raducanu, DPMsays: May 21, 2013 at 1:27 pm

Truly infuriating.

I suggest to anyone who has an Amazon account to log in and report that particular review as inappropriate.

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Patrick A. DeHeer, DPMsays: May 21, 2013 at 3:11 pm

I agree Ron and that is the very first thing I did, but that was not enough. I had to vent some.

Patrick

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Jerraldsays: May 22, 2013 at 2:47 pm

Dr. Raducanu,

You and I last spoke about about fall prevention with bilateral balance braces.

Now this!

Well, let me tell you that "ortho 1" is dead on in all of his comments about the podiatric profession. No question, he is 100% dead on. I only disagree with his comment on the textbook. The textbook is as good as any one published by orthopedic MDs.

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Ron Raducanu, DPMsays: May 24, 2013 at 1:29 pm

You are not genuine. They are no reps that fit the description you provided with your name in the Philadelphia area. What is your real name? I gave mine. You have not provided yours.

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Sheharyar Chaudhrysays: May 22, 2013 at 1:12 am

Two words to Ortho1: "Grow Up!"

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Anonymous, DPMsays: May 23, 2013 at 4:47 pm

Sorry to post as anonymous but I just didn't want to deal with your responses. I have been in practice almost 27 years and I read this comment expecting the worst. What is the big deal? He or she is for the most part 100% correct. This is what the real world and most of the ortho community thinks of us. Get over it.

Did we go to med school, ortho res, foot/ankle fellowship? No, no, no. Ankle trauma at major university trauma center? Nope. Have to work below the malleolus? Yup. Laser nonsense, high bills? Yup, yup. Remember, he who protests to loudly ...

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Anonymous, DPMsays: May 23, 2013 at 10:33 pm

I just have to add folks that it is a cruel world out there. If you have been around since the 1980s, it was almost a hand to hand combat to get hospital privileges, deal with the trash talk, convince the public you weren't a quack, etc. ... and it never ends in DPM world.

Toughen up man. A bad book review gets you all bent out of shape? Are you kidding me? This is nothing compared to what they say about you behind your backs at the hospital. You all and especially the dude who wrote the article in the Hoosier State have to remember, it always was this way and always will be so just roll with the punches bro. That's life in DP-whatsaville?

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Patrick A. DeHeer, DPMsays: May 24, 2013 at 9:19 am

Dear Anonymous DPM,

First and foremost, your anonymous post shows your lack of guts, and you are telling me to toughen up? Please!

The difference is I do not accept being discriminated against and slandered, and I will punch back. To quote Mike Tyson, "Everyone has a plan until they get punched in the face." Someone talks about my family or my profession that I have devoted 23 years of my life to, they are getting punched in the face.

NOBODY says anything like this to me to my face and if they did, it would not be pretty.

You are wrong on many of your original post points. I do ankle surgery. I know several DPMs that work at major university hospitals. I teach at two residency programs that do extensive ankle surgery. Insurance sets all pricing so how are we gouging? I have done over 1,000 laser cases and the literature is emerging but you and Ortho1 are both wrong on outcomes.

I just spoke at the 23rd European Wound Management Association Conference in Copenhagen last week. My topic was the "The role of podiatry in the management of the diabetic foot in the developing world." Prior to my lecture, several MDs from all over the world talked about the vital importance of podiatry in wound care. After I spoke, I had several MDs from all over the world ask me to speak in their countries. I work closely with orthopedics and other specialties at the hospital, and the relationships are of the utmost respect both ways!

There will always be idiots but accepting their idiocy is not the default. I will stand up for what I do and believe in. You should have the guts to do the same.

Best wishes,
Patrick A. DeHeer, DPM

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John Spinasays: May 24, 2013 at 12:04 pm

You do excellent work. I've put some of your techniques to good use!

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Jerraldsays: May 24, 2013 at 2:05 pm

Dear Dr. DeHeer,

I have been following this post. I will stand by my original comment. "Ortho 1" was dead on. And so was "Anonymous" dead on in both comments. Not only were both these people dead on, they were 100% correct.

Dr. DeHeer, you may very well do complex rearfoot and ankle work. I am not questioning your ability at all. I believe what you say.

Here is what you must face up to and realize:
Absolutely no more then 15 to 20% of the DPMs in this country are doing reconstructive rearfoot and ankle work. This is a fact. So this means that at least 80% of the DPMs in this country do not do any of this work. I understand you are in the 15 to 20% but you are a minority.

Also let me tell you that MD/DO orthopedic foot and ankle surgeons do not do wound care work or laser toenail surgery.

I have to imagine that when "Ortho1" discussed "gouging," he was referring to laser toenail surgery that is not covered by insurance. There is no real evidence that this works, however I am quite certain that you will disagree with me. That is fine. Also, orthopedics has no interest in treating fungus toenails.

I will end by asking you why the specialty of dermatology has not bought into treating fungus toenails with lasers. I will answer that for you. MDs and DOs are much more demanding of studies and peer-reviewed literature. There is NONE. Podiatry DOES NOT demand this.

Warm regards,

Jerrald

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Desmond Bellsays: June 9, 2013 at 4:11 pm

Well stated, Pat. Erasmus called it "the arrogance of ignorance." Keep up your great work. Hope to see you soon.

Des

Reply to this comment »
John Spinasays: May 24, 2013 at 11:57 am

The old saying: sticks and stones ...

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Gary Trentsays: May 24, 2013 at 4:20 pm

A few points:

1. Full disclosure: Patrick is a dear friend. That being said, he is an uncommonly experienced and skillful surgeon. He does not represent the rank and file, so to speak, when it comes to ability and training. I would not hesitate to take any foot or ankle pathology to his office but again, he is not common.

2. While Dr D. is a pretty rare bird, he is not as rare as he once was. While surgical residency training has evolved much since 1990 when I graduated, and more students get longer, better training, preceptorships and non-surgical residencies were still taken back then. There is still a lack of consistency and uniformity in podiatric post-grad education as well as board certification. That is a problem. The academic standards for admission to DPM college were, and are, much lower than for M.D. school. Does that mean that all DPM students are below par? Absolutely not. Does that mean a good number of DPM students would not be able to gain entrance to MD school? Absolutely.

3. While I don't necessarily disagree with most of Ortho1's points, there is an angry tone to his post that was not necessary but that is the Internet for you.

4. Overbilling? All professions do that. Just paid $590.00 for 2 routine eye exams by the M.D. Have I seen insane bills from patients that have seen other DPMs? Absolutely.

In closing, I would like to say that the overwhelming number of fellow DPMs with whom I was taught or with whom I trained or under whom I studied and trained are fine people and good, ethical practitioners. It is the lack of consistency in training that is characteristic of the profession since surgery became the focus that has been our undoing with respect to the public's perception and Ortho1's.

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Anonymous, M.D.says: May 24, 2013 at 5:05 pm

Patrick DPM, exemplifies why most people in the medical mainstream echo the post on Amazon. Tough guy podiatrists. There are many reasons why a person's identity is concealed. Among those are: Spiteful, mean, frightening and threatening bursts and reviews, and all sorts of nasty little things folks do to people whose opinion they don't care for. Thanks for pointing that out.

Let's get real here. This review of a book that is solely looked at by podiatrists is simply a review that no one would read unless you brought attention to it. Now that you have, I've got to say, you guys are scary. I did a general surgery residency and retired from clinical medicine a few years ago but at the behest of some friends -- yikes, podiatrists -- checked out what the beef was.

Getting worked up over a book review is unrealistic. The posts by Anonymous were accurate as well. I think you folks ought to leave this to rest.

Tough guy, if you're any indication of the "face of podiatry," it's no wonder the field remains in that funky, freaky, swell technician zone but I wouldn't want to know much more.

Thirty years of a familiarity with the land of podiatry and the same frail egos, hot shot bravado and allusion to Mike Tyson. If you're the voice of podiatry, the states have done wisely via their legislators to limit your scopes of practice.

Anonymously yours.

P.S. I know you'll bash my comments but when all is said and done, you're still the person who wrote a contentious, mean-spirited, in-your-face note that got my attention. I may be just a stranger on the Internet but if you don't have the slightest level of awareness why someone would remain anonymous in light of your post, get a freaking mirror!

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Eddysays: May 24, 2013 at 7:35 pm

Hey folks. If you want to put all this crud where it belongs and show them who's who, do this: Go out and BUY McGlamary's book on Amazon. Show them that you support the profession by putting your money where it will make a difference. A lot of work went into that and all this talk doesn't mount up to much if you're not willing to show the critics there's a market for the authors and editors.

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Anonymous, DPMsays: May 24, 2013 at 10:13 pm

Thank you Jerrald.

I found Dr. DeHeer's post aggressive but mostly hyper-defensive. The response was pretty classic and not unusual for podiatry "lifers". I am glad there are people like him who are experts in ankle surgery, wound care and laser toenail treatment, not to mention all things that are "currently" podiatric this decade or until insurance reimbursement dwindles.

My statements were not meant as an attack but supportive and more "bro-like" based on my own career experiences. As far a being gutless, not really, and if he only knew what I have done for podiatry, hosp privileges, etc ... 30 years since grad, 27 private practice. I just hate to have dudes all over the country contact me or talk about seeing my name especially associated with this profession which in my opinion has taken a wrong turn.

As far as laser toenail treatment, I have colleagues who swear by and naturally do a lot of it but not one derm in my metro area who believes in it? That says something which is similar to why orthos in my area won't inject sclerosing agent for neuromas. No legit literature on the subject which is not unusual for podiatrists as a reason not to do it. I've had the realization our field believes in all which will be reimbursed generously by insurance providers regardless.

I would like to continue posting on this site so I hope they are open to alternative and unpopular views regarding our profession. I noticed quite a bit of corporate sponsorship so I believe most of my opinions will be edited or omitted.

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Allen Jacobssays: May 25, 2013 at 8:19 pm

The above comment is correct in some respects.

Podiatrists will do anything that pays, particularly those procedures which pay well.
So does the rest of medicine. The manipulation of patients for profit is not in any way unique to podiatry.

Look at the literature on the vast over utilization of cardiac and peripheral endovascular work. The over utilization of knee arthroscopy. The overuse of MRI and other diagnostic imaging techniques in facilities owned by MDs and DOs.

The variance in state practice laws suggested by the Amazonian critic of podiatry is due in no small part to the self serving domain preserving interference of orthopedic doctors screaming inaccurate characterization a of podiatry to the state legislators.

As for excessive medical costs, how is podiatry any different than the opthamologist doing 20 cataracts a day (all of them necessary for certain) or the primary care or internist ordering test after test after test?

The Department of Justice recent actions, and the broken American medical system
were the results of the MD and DO misuse of the system for profit, not my profession.
Health care reform is at the forefront because of MD and DO actions, not a few DPMs.

The real center of all this was the suggestion that podiatrists, with a broad brush, are not competent in ankle surgery. Are all orthos competent in spine surgery? Bone oncology?
No. Are all podiatrists competent in or do they do any ankle surgery? No.

The ortho author of the amazon comment has no familiarity with the training or experience of today's podiatry graduate. That fact is inherent in the conclusions expressed in the commentary.

And that is why we ought to dismiss this ortho's comments. They are based in ignorance and self-serving action.

There's an old joke. "Do you know how to keep a secret from an orthopod "?
You publish it.

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Foot Surgeonsays: May 25, 2013 at 11:18 am

Instead of the acerbic comments, why not address the facts? Low caliber students applying, unrealistic expectations (just how many foot and ankle surgeons (depending on the state) are really needed in today's climate? Few NIH studies with PI as a DPM, or a private foundation grant with DPM as the PI?? Few peer-reviewed real studies in MD journals with a DPM as first or last author? 50 states, fifty scopes, and those that think they will be walking into Hopkins with MDs begging for their foot and ANKLE services? Wow. Cognitive dissonance.

Even with the disgraceful repeat of the residency crisis (happened in 90s') 2013--without dismissals/terminations of staff, deans/leaders, etc ... something is awry.

It is time for a real, open/honest discussion about the direction and real change in American podiatry without overly defensive comments which demonstrates inferiority, inadequacy.

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Footman123says: May 27, 2013 at 10:13 am

Either an ignorant undergrad pre-med student whose parent is an orthopedist or an orthopedist wrote that review. Funny thing is, in order for any MD or DO physician to learn foot and ankle surgery, that allopathic or osteopathic physician must apply for a foot and ankle surgery fellowship that is taught by guess who? The DPM podiatrist! Imagine that! A DPM podiatrist is the teacher (and boss) over the student MD or DO physician in the fellowship program!

Talk about an ignorant comment!

Reply to this comment »
Jerraldsays: May 27, 2013 at 3:46 pm

Dear Footman 123,

You do not know what you are talking about. You have absolutely no idea.

An orthopedic resident, once he or she completes the five years of orthopedic residency training can then do an additional one-year fellowship in foot and ankle surgery under an MD or DO. It is NOT a DPM who trains the MD/DO in the foot and ankle fellowship.

You need to get your facts straight before writing.

Nobody is ignorant but you are 100% wrong with your information.

You should be cautious in the future when using the word "ignorant" !

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Ron Raducanu, DPMsays: May 28, 2013 at 1:33 pm

Foot Ankle Int. 2003 Jul;24(7):567-9.
Foot and ankle experience in orthopaedic residency.
Pinzur MS, Mikolyzk D, Aronow MS, DiGiovanni BF, Mizel MS, Pinney SJ, Saltzman CL, Temple HT.

Please review this article.

Reply to this comment »
Footman123says: May 30, 2013 at 9:40 am

Jerrald,

What I am saying is a FACT. As a DPM myself, I know this is a fact!

The MAJORITY of foot and ankle surgery fellowships in the United States are taught by DPMs today. Many of the newly graduated fellowship-trained MD and DO orthopedists in foot and ankle surgery who are practicing for the last 5 years (since the year 2008) had an instructor and BOSS who was a DPM.

In the 21st century, the one-year foot and ankle surgery fellowship programs that MD and DO orthopedists want to pursue after the five-year general orthopedics residency program will most likely (99% chance) have a DPM podiatrist as their boss and teacher.

And if orthopedics departments recently offer foot and ankle surgery fellowships, the instructors in those fellowships will be MD and DO orthopedists who learned foot and ankle surgery from a DPM! But these are only a few for now.

The MAJORITY of these one-year foot and ankle surgery fellowship programs are offered by a podiatry postgraduate education program, NOT an orthopedics postgraduate education program. YES! So that one MD or DO orthopedist will intermingle for the next 12 months with 4th-year podiatry students, podiatry residents and podiatry attendings during his or her surgical fellowship training!

Just peruse websites for every foot and ankle surgery fellowship programs offered in United States teaching hospitals and see for yourself. Or give them a call.

Reply to this comment »
Allen Jacobssays: May 27, 2013 at 11:36 am

This will be my final posting on this subject. I did find it interesting that the posting suggesting that we have too many foot surgeons was signed by " foot surgeon".

As.for the comments of Mr. " foot surgeon", a few points. The JAPMA as well as JFAS contain many excellent studies by podiatric physicians. I fail to understand how publications in "MD journals" is necessary nor required. Our journals represent our profession and to suggest that publication in either JAPMA or JFAS is somehow inferior to publication in an " MD" journal is on its face insulting and reflects your ignorance of medical journal publications. For example, JFAS has a very acceptable impact factor rating, thereby indicating that MANY health care providers throughout the world reference articles in this journal. Have you ever been to a meeting of the council of science editors? I have, Mr. " foot surgeon". They have tremendous respect for Scott Malay, DPM, FACFAS, the Editor of JFAS.

We don't publish in MD journals? Really? Do names like Armstrong, Lavery, Frykberg, Schuberth and Joseph mean anything to you? We can go on and on with this list.

You may not have noticed Mr. " foot surgeon", but increasingly podiatrists are serving as chiefs of surgery and chiefs of staff at many hospitals. Not bad for those students who graduate from inferior schools with inferior grades and inferior training. Some are in major administrative positions in health care provision such as Kaiser, and others elected to major committee chairperson-ships in organizations such as the ADA. Did you know that Mr. " foot surgeon"?

Also, Mr. " foot surgeon", throughout this country, podiatrists are incorporated into orthopedic groups doing much if not all of the foot and ankle surgery. How about that Mr. " foot surgeon"?

Hopkins? I forgot that Hopkins is the end all be all of medicine. Funny, I could have sworn there were podiatrists at Yale, Harvard, Stanford, in fact lots and lots of top medical institutions. Am I mistaken, Mr. " foot surgeon"?

Do we need some definitions and change in our profession? Yes, we do.

We could start with people like you putting a name to their postings. In fact, I wouldn't post anything without a name.

I've got a foot for you, Mr. " foot surgeon". And I think I know just where to put it.

Reply to this comment »
JD, Formerly Anonymoussays: May 27, 2013 at 1:37 pm

Yeah right! Give me a list of major university medical schools that have a DPM teaching foot surgery to the Orthopedic residents! Ha, ha.

Please, no rural community hospitals or DO disasters!

Harvard, Yale, Dartmouth, Stanford, Michigan, Vanderbilt, or wherever! Give me a break. That just tells me you haven't been around much. What they may have though is a 3 year foot and ankle trained podiatrists doing the diabetic nail and wound/ulcer crap real docs don't want to bother with. I read that Ortho 1 comment. It was pretty accurate.

Do you really think MD foot and ankle fellowships around the country are taught by DPMs?

Reply to this comment »
JD, Formerly Anonymoussays: May 27, 2013 at 1:44 pm

How can a DPM teach an Ortho resident ankle surgery when in most states, the DPM can't go above the malleolus? But you think they ask Pods for training around the country? That is hilarious.

Reply to this comment »
Foot Surgeonsays: May 27, 2013 at 4:44 pm

Maybe to help put this ortho book review issue to rest is describing/interviewing all the podiatrists who performed foot and ankle surgery on all the Boston marathon bombing victims who suffered multiple LE trauma. Because podiatrists are the foot and ankle experts, their expertise would have been invaluable in performing surgery on these bombing victims and help showcase podiatry in a positive light.

Perhaps, the podiatric surgeons who operated at Massachusetts General and Brigham and Women's Hospitals could be featured in some of the podiatry periodicals, journals and lay literature. This would showcase the talents of podiatrists in 2013 and educate the public.

Reply to this comment »
David S. Wander, DPM, FACFASsays: May 28, 2013 at 12:06 pm

I certainly can appreciate Dr. Deheer's concerns regarding the comments made by "ortho1". However, I'm afraid that unfortunately this has simply given "ortho1" a greater audience.

I believe that anyone who has any good sense will understand that "ortho1" was simply attacking a profession with many inaccurate comments. His/her credibility was lost in my opinion the moment that he/she went on the attack. His/her agenda was evident, considering the fact that the true intention of the comments were to write a review of the BOOK, not an editorial about an entire profession.

I agree that Amazon should really remove the comments, not because it attacks the profession, but simply because it's not a book review, and therefore inappropriate.

Reply to this comment »
Ron Raducanu, DPMsays: May 28, 2013 at 2:26 pm

Very well said, David.

Reply to this comment »
Jerraldsays: May 28, 2013 at 5:23 pm

Dr. Wander,

Ortho 1 was attacking a profession with true honest comments. Just pick up the phone and call either Dr. Keith Wapner in Philadelphia or Dr. Mark Myerson in Baltimore, Maryland and tell them who you are and you would like their opinion on the issue.

I am not saying it was correct for him to have posted what he did. It was very unprofessional of Ortho 1 to say what he did. But his comments were 100% TRUE, no doubt.

Regards to you and Dr. Raducanu,

Jerrald

P.S. You are very silly to think and or wish Amazon will remove the comments. Move on my friend !

Reply to this comment »
David S. Wander, DPM, FACFASsays: May 29, 2013 at 1:30 pm

Jerrald, I really don't need to pick up the phone to speak with Dr. Wapner. I practice in Philadelphia as I am sure you already know. I don't need to ask their (Dr. Wapner or Dr. Myerson) opinion nor would I ask a vascular surgeon what he/she thinks of an interventional radiologist or cardiologist performing vascular work.

I guess we will simply disagree with what is and isn't true regarding ortho1's comments. I don't have the time or need to debate the issue.

I have no false hope that Amazon will remove the review. I simply stated that since it's NOT a review but an attack on a profession, it it simply inappropriate.

Reply to this comment »
foot doctor 123says: May 30, 2013 at 3:49 pm

A good number of foot surgery techniques were discovered by podiatrists, not by MD orthopedists. Jerrald obviously does not know that.

Reply to this comment »
Jasonsays: June 6, 2013 at 3:54 pm

I will have to respectfully disagree with you Jerrald. Your comments as well as the comments by Ortho 1 are quite outdated and, quite frankly, inaccurate.

The podiatric profession has improved leaps and bounds above what your outdated comments seem to reflect. The fact of the matter is, I routinely perform revision surgeries that were inappropriately performed by orthopedic surgeons and resulted in failure. As a resident, I taught and trained the orthopedic residents about foot and ankle medicine. I trained at one of the top 10 orthopedic hospitals in the country and the only person doing ankle replacements was a podiatric physician. The orthopedic foot and ankle physicians did not.

As a podiatric resident, you perform more ankle surgery than a orthopedic resident does in their residency and fellowship combined. The reason orthopedics have foot and ankle fellowships is because they don't learn about the foot and ankle except for a few months in residency. As a podiatric physician, I have focused my skills on the foot and ankle. That doesn't mean all other areas were neglected. I also managed patients (medicines, diagnostic testing, referrals, etc) in spinal rehab, level I trauma hospitals, and private practice. There are far more than 15% of podiatric physicians doing rearfoot procedures. 100% of podiatric physicians are currently trained in those procedures.

Of course, you can call any foot and ankle orthopedist and they will never respect podiatry. It is a cat vs. dog environment. Two people doing the exact same thing but with different training. Using the "call (fill in the blank) and ask them", is no different than calling an Ohio State football player and asking them if the Michigan running back is as good as theirs.

Step into the modern era of medicine and realize the only difference between a podiatric physician and an orthopedic foot and ankle physician are the letters at the end of their title.

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