Campaigning For The HELLPP Act To Clarify Gray Areas In Podiatric Medicine And Surgery

Patrick DeHeer DPM FACFAS

There are many gray areas in podiatric medicine and surgery. I tend to lean much more to the conservative side on those gray podiatric issues. However, last week I ran into something that really made me think outside of my normally conservative approach.

I had a patient who needed a below-the-knee amputation and I could not find anyone to do it at the small hospital I primarily work out of. Neither orthopedic surgeon with whom I have outstanding relationships would do it. The general surgeons at the hospital, one of whom works in the wound care center with me, would not do it. The patient finally had to go to the VA hospital in Indianapolis to have the amputation.

This experience got me thinking about why podiatric surgeons could not do below-knee amputations. Is it really that far of a stretch? The more I ponder the question, the more I am convinced it is not out of the realm of possibilities for a podiatrist certified in reconstructive rearfoot and ankle surgery by the American Board of Podiatric Surgery.

Is a below-knee amputation really that more difficult of a surgery than a complex ankle fracture repair or a total ankle replacement? My experience with assisting on below-knee amputations in the United States and outside of the U.S. — with the procedure often supervised by an orthopedic surgeon or general surgeon — is that is not more difficult than many of the complex surgeries many podiatric surgeons do already.

Obviously, this is something that we must address at the state level and there is significant variance in state laws that make this discussion more realistic for some states than others. I believe a significant initial factor in getting some of these gray areas in podiatric medicine and surgery rectified is getting the HELLPP Act (S1318/HR1761) passed into law. This is such an important bill for the profession and you have got to do your part.

H.R. 1761 / S. 1318, the Helping Ensure Life- and Limb-Saving Access to Podiatric Physicians (HELLPP) Act, would recognize podiatrists as physicians in Medicaid at the federal level. This would be on par with our classification in Medicare at the federal level. This is a critical bill that will have significant impact on the future of podiatry.

There are three actions every podiatrist should be doing right now to do their part. Use the American Podiatric Medical Association (APMA) eAdvocacy site to contact your senators and members of Congress, and ask them to support the bill. Even more importantly, call their offices and ask about co-sponsorship of the bill. The more cosponsors the bill has in the House and Senate, the better the chance it has to become law.

I recently have worked closely with Congresswoman Susan Brooks, my representative from Indiana, and through phone calls and follow-up e-mails, she has recently signed on as a co-sponsor. She is the first Congress member from Indiana to support the bill and our Indiana Podiatric Medical Association Board is dedicated to getting the remaining Congress members to sign on co-sponsors. The final thing everyone needs to do is to contribute to the APMA political action committee, which is critical to allowing our voice to be heard on Capitol Hill.

Whether or not you think podiatrists should do below-knee amputations is not what is important here. What is important is equality and continued growth for the podiatric profession. Membership comes with responsibility and now is the time for you to do your part.

Expecting others to carry the load while you sit on the sideline is selfish. For those of you who are not APMA members, the bottom line is we are a small group and we must stick together in unity for the betterment of the profession.


Podiatry residency is a combination of podiatric medicine AND podiatric surgery with more emphasis on podiatric surgery. It is important for podiatry residency to be EITHER purely podiatric medicine OR purely podiatric surgery. The reality is after podiatry residency, licensed practicing podiatrists will be doing more podiatric medicine in the clinic and in the hospital. Physicians perform medicine first, surgery second. If a podiatrist wants to do more surgery, there should be a podiatry residency that focuses only on podiatric surgery. If a podiatrist wants to focus more on pure medicine in his or her practice, their residency should be focused only on medicine. APMA and podiatry residency directors need to focus their priorities on this issue of post-graduate podiatry training in teaching hospitals.

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