An Open Letter To Foot And Ankle Orthopedic Surgeons

Patrick DeHeer DPM FACFAS

Dear Fellow Foot and Ankle Specialist,

I am writing this letter to your group to bring to light a worsening problem between our two groups that is being perpetuated by a handful of members from your group. We are never going to agree on which group is best qualified to take care of foot and ankle pathologies. In reality, though, there is more than enough work for all of us to be very busy. We should try to concentrate on what we have in common: the medical and surgical management of the foot and ankle, and our dedication to healing those placed in our care.

The problem is that some members of your group are instigating unsubstantiated and unfounded lawsuits against members of our group. This is driving up our malpractice premiums and running podiatrists out of practice, solely for financial gain on the part of those instigating the claims and out of pure spite and bigotry. The latter is the most egregious offense of them all. I know there are many more of your group who provide balanced, fair evaluation of individual cases but there are a few bad apples in your group.

I am asking you to police your group. Otherwise, we will see an escalating war that neither group will win. The only winners will be the lawyers and the insurance companies. Do we really need to help these two anymore? Do they not make enough money already?

I do not know how many more of us there are compared to your group but my guess is it is substantial. My colleagues and I are tired of getting punched in the face by these members of your group who insist that every complication that one of our patients have or do not have is malpractice.

We are going to have to start fighting back. I am suggesting to my colleagues that they start compiling a list of those in their area who are in your group. Then when one of your patients presents to one of our offices, we are going to punch back and make it hurt. I am suggesting to my colleagues that they serve as expert witnesses against those who are unethical towards us. Unlike the cowards from your group in my own personal experiences, we will face your lawyers head-on in depositions and court. We will see the process through until this nonsense stops.

When an injustice occurs, ideally the two parties can sit down and discuss the circumstances. When one group is persecuted unfairly, there comes a time for that group to stand and fight. I am not sure there is ever a winner in any fight like this if both sides do not find common ground and establish fair and equitable means to resolve the conflict. I would ask those of you with a sense of the “Golden Rule” to start policing those unethical, immoral clinicians in your group.

For my colleagues, if you find yourself victim to this type of attack from a foot and ankle orthopedic surgeon in your area and need someone to provide some assistance, I am willing to help in any way I can. If you need someone to review your case, act as an expert on your behalf or just provide another point of view, e-mail me at .


This is an ongoing problem with certain orthopedic surgeons. Generally, it is interesting that those orthopedists least respected by their own colleagues create so much of the chaos.

When I have the dissatisfied patient from them, I do as they do. I refer to the surgery as "failed orthopedic foot surgery" just as they refer to "failed podiatry surgery" in their notes. I refer to them as "an orthopedic doctor" just as they refer to us in their notes as "a podiatrist." I detail the transgressions and negligence in detail. I have testified against these people on multiple occasions.

It is interesting that you are only now reacting to a problem which has been longstanding and ongoing. Unlike the orthopedic doctor, however, my concern for patient well-being prevents me from mutilating the patient with additional surgery and blaming "the podiatrist" for the poor outcome.

I agree this a huge problem but I must caution those who think we can fight back by promoting the same tactics. The legal system is neither cheap nor fair toward us.

Just maybe if we spent a little more time working together and standing up for one another, then we would eliminate the need for referrals outside our community. Just like the foot and ankle ortho community, they are just as unfriendly to us as they are to themselves. They have just as much rivalries as we do. Promoting such behavior as Dr. DeHeer suggests will only band them together and encourage their colleagues to join in on the fight.

For those of us who have good relationships with orthopedists, the key to keeping the relationship civil is too simply have open lines of communication, occasionally stroke their ego and thank them for their advice whether you needed it or not. And when they have a poor outcome, you send the patient back to them. Stay professional. Don't bash them in the records. We all have poor outcomes, we all do things that someone else may question, and far too often, surgeons of both professions jump too fast into criticizing an outcome especially during a first visit or second opinion.

That is all we would want them to do for us. See someone's mess, let them know and send the patient back to them. If that surgeon wants you to re-do it or send somewhere else, then it is on them. We have allowed patients to doctor shop and frankly it is the doctor shoppers who seem to be one comment away from seeking out a lawyer. Let them get second, third or even fourth opinions, but stay away from those patients.

Too often, we forget to remember that a second opinion is NOT a referral. It is to provide that patient or provider an opinion. It is not an invitation to steal a patient. It is not an invitation to bash the other provider. Second opinions are a great opportunity to gain the respect of both patients and referring surgeons.

When a former surgery patient, especially within the same calendar year, comes to your office, don't be afraid to ask the patient permission to contact the other surgeon. I would remember to not take on a surgical patient without written communication from the previous surgeon when you are dealing with a surgeon in the same state or region. Keep those cross town lines of communication open. Some surgeons like foot and ankle orthopedists can often become territorial and possessive when their patients walk to another provider.

Sounds like us? Just as I would want to know, they want to know. Do the right thing. Contact our colleagues. Ask for their permission to take over care and if they won't, then send the patient back. In time, they will do the same for us.

I completely agree with your analysis of the situation and your methods of managing these difficult patients and circumstances. Having worked in orthopedic groups who have had little knowledge or desire to treat foot and ankle conditions, outside of ORIF of ankle fxs, they have come to respect podiatry and podiatry training as good, if not better than ortho foot/ankle docs. They are also aware of the ortho docs who present the most problems and oftentimes speak negatively of them since their reputations are known throughout the ortho community.

Bravo to a wonderful letter by Dr. DeHeer! This problem in some areas has gone on too, too long. The other disturbing trend is foot and ankle orthopaedic surgeons, many of them young, making videos, giving testimony that misrepresents our training, experience and knowledge. Dr. DeHeer clearly points out that this is a small group of foot and ankle orthopaedic surgeons. However, they are creating damage to our profession.

Despite what others may think, you can not reason with some people. Being nice to them will not work. Been there, done that. Being nice to bullies does not work. Sometimes you have to punch them in the mouth. It does not have to be public but it can work.

A famous (or infamous) foot and ankle orthopaedic surgeon in Ohio used to routinely trash our profession and try to entice patients to sue the podiatrist. He even had lawyers' names handy to give to the patients. Finally, someone called him and told him that they had seen many of his complications. If he was going to continue to play that game, so would we. Guess what? He backed off!

Again, thanks Dr. DeHeer for having the guts to bring this out in an open letter.

"Everyone has a plan until they are punched in the mouth" - Mike Tyson

Well said, Dr. DeHeer! Treat others as you would want to be treated. Tough words to put out there but very admirable.

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