My Top Ten Podiatric Pet Peeves

Patrick DeHeer DPM FACFAS

10. Podiatrists instructing patients to cut their toenails straight across. Where did this originate? Where is the evidence-based medicine for this approach? If everyone’s nails are shaped differently, why would everyone cut them the same? I have always told patients to follow the shape of the nail when trimming.

9. The heads of screws not using a universal screwdriver. This is especially annoying when you are trying to remove hardware and the right screwdriver is not available. Although it helps to get the prior operative report, sometimes that is not possible. Not having the correct screwdriver transforms a simple case into a nightmare. If the Food and Drug Administration wants to do something useful, it should mandate that all orthopedic companies use the same screwdriver.

8. Midtarsal fusions. I love the Lapidus procedure and I am not including it in this pet peeve. I am talking about the second and third metatarsal-cuneiform joint arthrodesis. Any articles on this procedure discuss fixation of the fusion, healing rates, complications, etc. The articles never provide detailed descriptions for the dissection or joint debridement portions of the procedure. Why? I think it is because this procedure is such a hassle to do.

7. Patients who argue about a podiatrist’s treatment recommendations. I know it is not a paternalistic relationship between doctors and patients. I treat my patients the same as I would treat any of my family. It is alright if they do not want to heed my recommendations but patients do not need to be rude, confrontational and argumentative.

6. Podiatrists who complain about the American Podiatric Medical Association (APMA) or state Political Action Committees (PACs) but do not contribute to these associations. Am I missing something here? How can someone expect these organizations to help if they do not contribute anything? Should contributing podiatrists pay for non-contributors? If podiatrists want their profession to be strong and vibrant, they need to provide it with the money to protect their professional interest in state and national legislation.

5. Those who do not participate in their state associations or the APMA. How can someone not give back to the profession that has done so much for them? The podiatric profession has probably helped in providing food, clothes and shelter for their family. Is it too much to ask that one be on a state committee and give something back?

4. Negativity at any conference. I often stay at a different hotel from where a conference is located since I cannot handle all the negative talk about the podiatric profession. I know things are more challenging and laborious than ever but if someone is that unhappy in podiatry, he or she should go work at Sears selling appliances.

3. Plaintiff malpractice professional experts. I was going to use a much more derogatory word than professional experts but I refrained. These “colleagues” are the slime at the bottom of the barrel. If we find them to be fraudulent in their testimony, our professional associations should censor them. My feeling is: do not let the door hit you on your way out of the podiatric profession.

2. Not understanding the difference between a bad outcome and an outcome that is below the standard of care. I do understand why patients do not see the difference. They have a personal involvement in their own case. However, we should hold lawyers who take bogus cases and physicians who instigate an unwarranted malpractice case as equally accountable as those who do commit malpractice.

And my number one podiatric pet peeve is …

1. Discrimination based on the letters behind my name. This goes for insurance companies, government agencies, lawyers and other physicians who discriminate against podiatrists based solely on the letters behind their name. In all other walks of life, people do not tolerate discrimination nor should they. However, more people accept discrimination in medicine. This is something that makes my head want to explode and angers me more than I can express without vulgarity. We will fight for equality and we will not quit until we have it.

Happy holidays to you and your loved ones. Here is wishing you peace and prosperity in the new year. Stay diligent.


Patrick, I am so very lucky to have a friend and colleague in you. I am constantly confronted in my travels (as are you) with disgruntled colleagues who are very negative but fail to contribute via their state components and the APMA to our cause.

Why not be a member? Those who aren't very happy to make use of the strides these organizations make but are very quick to downplay the very important role they play in these advances. I just don't get it.

I also agree with you in that tort reform is what we need to curtail the current flood of malpractice cases. Make the plaintiffs and their lawyers personally responsible for the frivolous cases they bring, and watch the malpractice crisis in this great nation virtually disappear.


I agree with all of your points. Some of us tend to get caught up in everyday stresses and business, and don't take the time to state their thoughts.

From an individual who really loves his chosen field and educates residents, I want to thank you for all you do and stand for.

A little negativity may be a good thing as long as it leads to solutions.

I love podiatry but it is becoming more of a hobby rather than a way to make a living.
In a world of $200 bunions, you have to be insane to think that you are treated fairly.
What is my solution? Start respecting yourself, stop doing elective cases for nothing and tell patients that their HMOs are a scam. When a patient goes around the area and finds 10 podiatrists willing to do a bunion for $200, why would an HMO pay more?

Let us learn some self-respect from dentists. They know how to run a business.


Your words make absolute sense. The "slime" that give sleepless nights to us because of their "expert" opinion will one day get theirs. Karma sees to that. I have NEVER seen an absolute below standard of care and have talked 4 patients out of lawsuits because that is what was needed and secondly, we don't need frivolous lawsuits to continue to damage our profession. I wish the same could be said for some of our colleagues.

Kudos to you!

Great summary of very common problems.

I wonder how the order would change by the day of the week (surgery versus office).

Standardizing screw heads was my favorite. When I had the honor of being in surgery as a sales rep, this was one of my biggest frustrations. Even within the same company, they use different types. Snap-On tools once made a universal nail extraction system that had every type of large screwdriver tip and the fittings for IM nails. Hospitals would laugh at the $20k price tag until someone got stuck in a room for hours. Someone should make such a set for small screws.

Happy New Year

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