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Podiatrist vs. Orthopedic foot speacilist

Posted by Clint M. on 3/03/03 at 04:24 (111549)

My foot surgery was performed by a podiatrist. Needless to say it did not go well. My PCP told me after the surgery that I should have seen an orthopedic specialist for a second opinion. He told me that podiatrist do not have as much training and in general are not as thourough or qualified as orthopedic foot specialist. Is this true or just simply one doctors opinion?

Re: Podiatrist vs. Orthopedic foot speacilist

Jessie W. on 3/03/03 at 14:12 (111609)

Clint - I apologize in advance for not having the answer. I was wondering the same thing though - I've been seeing an Orthopedic Foot and Ankle surgeon and may now need surgery. Someone advised me to see a Podiatric Foot Surgeon for a second opinion - that they're better - I'm puzzeled as to the difference.....

Re: Podiatrist vs. Orthopedic foot speacilist

lara t on 3/03/03 at 15:02 (111621)

My lay impression is that generally, orthopods have more training than podiatrist's. However, that doesn't answer whether any particular podiatrist is more or less trained and skilled in a particular surgery than any particular orthopod (and I would assume that both prefessions have some skilled artists, and some violations of the hippocratic oath). I'd take my podiatrist over most of the orthopod's I've seen (for my feet) because most of the orthopod's I've seen didn't know TTS half as well as my podiatrist (although they were excellent orthopods - no doctor knows everything). If I were to have surgery, the questions I'd ask is how many of the particular kind of surgery they have done, and how much experience they have with whatever ailment you have, and probably a few more questions - like on what basis did the dr. make the Dx & treatment recommendation. Does no good to have a doctor great at 'x'-surgery who doesn't recognize you need 'y'.

I would note that orthopods have the same general training as other doctors, in the same med schools. Podiatrists receive their training somewhere else (podiatric schools I believe). Thus,there would be a natural affinity and trust between doctors of different specialties.

Re: Podiatrist vs. Orthopedic foot speacilist

Jessie W. on 3/03/03 at 15:02 (111622)

P.S. Sorry - I'm new - I didn't realize I was in 'Ask the Foot Doctors' category...

Re: Working with the dr.

lara t on 3/03/03 at 15:07 (111624)

Another consideration is, assuming competence in diagnosis, treatment, and surgery skill, is which doctor can you work with. The patient's participation in understanding and giving good information to the doctor is invaluable. ON that issue, I would note that there are no orthopods (wait, I think maybe there is one I have seen) who post reguarly on this board, while there are at least 3 podiatrists. My own experience is pretty mixed - like the other issues, there is large individual variation.

Re: Podiatrist vs. Orthopedic foot speacilist

Sharon W on 3/03/03 at 18:08 (111650)

Clint,

I am not sure one is better than the other; both podiatrists and foot and ankle specialized orthopedic surgeons are well trained. Podiatrists study medicine as it relates to feet, specifically, during their entire course of study, and therefore they do have more years of study that is focused specifically on feet. They are doctors, with many years of study and experience in providing foot care, but they are not MDs. To become an orthopedic surgeon, you must first become an MD, then go into orthopedic medicine, specializing in foot and ankle surgery. So the ortho surgeon would have the better GENERAL medical background, but less time spent learning specifically about feet.

Of course, and ortho surgeon specialized in foot/anke IS primarily a surgeon, so naturally his approach to foot care usually focuses on surgery. A podiatrist may be more inclined to look at ALL the possible treatments for a patient's condition and to recommend surgery only if other approaches have not been successful. In fact, not all podiatrists do internships in foot surgery; some do not do surgery at all. But there are other podiatrists who specialize in surgery. These podiatrists do several surgeries per week and who are very expert and well-practiced in foot surgery.

So I guess the answer is, you need to find out what your doctor's qualifications are, and put everything on the table with them to find out where both of you are coming from.

Sharon

Re: Podiatrist vs. Orthopedic foot speacilist

Pauline on 3/03/03 at 21:12 (111672)

Sharon,
I would add that any Orthopedic surgeon who is licensed is able to provide treatment to the entire skelton of the human body. A Podiatrist treatment on the skeleton is restricted by the individual state to the lower limb usually below the knee and not including the knee. Others may restrict it even more to the ankle and foot.

I think it's impossible to say that an Orthopedic surgeons primary goal in treating a patient is to perform surgery simply because he has surgeon after his name, but rather that they are equipped to treat the entire skelton, tendons and muscles and surgery is only one type of treatment they are trained to do.

Generally today because of legal libility you will find most doctors looking at every type of conservative treatment before they do surgery.

I believe Orthopediac surgeons however are called upon to do complex reconstructive surgeries especially those involving the harvesting of tissue and bone grafts from other sites needed for repair. They also do complex repairs of the lower limbs which involve the knee.

Today I think it is difficult for a patient to find a 'general' orthopedic surgeon because most of them have gone into specialities. Knees, hips, backs, shoulders, foot and ankle, etc sort of speciality specialist.

They all seem to carry large case loads because it takes time to get an appointment with one of them. I have a feeling there are fewer Orthopedic surgeons than Podiatrist.

Who you see for help often times depends on the type of injury you've sustained.

Re: Podiatrist vs. Orthopedic foot speacilist

Pauline on 3/03/03 at 21:53 (111673)

As an example here is a copy of the Colorado Podiatry Act 2002. Each state provides one which sets forth the scope of practice for Podiatrist. This is only a portion of the entire act. From reading this it appears Colorado only allow treatment from the ankle down, possibly not the lower leg.

As used in this article, unless the context otherwise requires:

(1) 'Podiatric medicine' means the practice of podiatry.

(2) 'Podiatric physician' or 'podiatrist' means any person who practices podiatry.

(3) (a) 'Practice of podiatry' means:

(I) Holding out one's self to the public as being able to treat, prescribe for, palliate, correct, or prevent any disease, ailment, pain, injury, deformity, or physical condition of the human toe, foot, ankle, and tendons that insert into the foot by the use of any medical, surgical, mechanical, manipulative, or electrical treatment, including complications thereof consistent with such scope of practice;

(II) Suggesting, recommending, prescribing, or administering any podiatric form of treatment, operation, or healing for the intended palliation, relief, or cure of any disease, ailment, injury, condition, or defect of the human toe, foot, ankle, and tendons that insert into the foot, including complications thereof consistent with such scope of practice, with the intention of receiving, either directly or indirectly, any fee, gift, or compensation whatsoever; and

(III) Maintaining an office or other place for the purpose of examining and treating persons afflicted with disease, injury, or defect of the human toe, foot, ankle, and tendons that insert into the foot, including the complications thereof consistent with such scope of practice.

(b) The 'practice of podiatry' does not include the amputation of the foot or the administration of an anesthetic other than a local anesthetic.

12-32-101.5. Podiatric surgery.
Statute text
(1) Surgical procedures on the ankle below the level of the dermis may be performed by a podiatrist licensed in this state who is:

(a) Certified by the American board of podiatric surgery; or

(b) Performing surgery under the direct supervision of a licensed podiatrist certified by the American board of podiatric surgery; or

(c) Performing surgery under the direct supervision of a person licensed to practice medicine and certified by the American board of orthopedic surgery or by the American osteopathic board of orthopedic surgery.

History
Source: L. 90: Entire section added, p. 806, 2, effective July 1. 2002

Re: Podiatrist vs. Orthopedic foot speacilist

Dr. David S. Wander on 3/04/03 at 08:35 (111694)

Sharon, I'm a podiatrist and I believe that your answer was accurate and excellent. Some of Pauline's information is not completely accurate, as laws differ from state to state. I practice in Pennsylvania and my scope of practice does include surgery on the foot & ankle as well as the ability to perform amputations. I do not need to be under the supervision of anyone to perform surgery on the foot or ankle, once I have proven that I've been trained in these procedures via surgical logs kept as a resident and in practice. Additionally, there are more orthopedic surgeons than podiatrists, however there are more podiatrists than orthopedic surgeons that specialize in foot and ankle surgery.

A podiatrist that is trained surgically, or a foot and ankle orthopedist are both excellent choices. I would obviously not recommend a podiatrist that has little surgical training, nor would I recommend a general orthopedic surgeon. A well trained podiatric surgeon or foot/ankle orthopedist is certainly a personal decision. You must be comfortable with the individual doctor and his/her demeanor, attitude and reputation.

Once again, Sharon's explanation is excellent, and the decision should be based on the surgeon YOU feel has your confidence.

Re: Podiatrist vs. Orthopedic foot speacilist

Ed Davis, DPM on 3/04/03 at 09:49 (111716)

Paulime:
The law you have stated is for a specific state. Different states have narrower or broader scopes of practice, most somewhat broader than that you have listed.
Ed

Re: Podiatrist vs. Orthopedic foot speacilist

Ed Davis, DPM on 3/04/03 at 09:55 (111717)

Clint:

I believe that the posters here have done a good job answering your question. The fact that your PCP made an inaccurate statement in comparison of qualifications may reveal some inherent biases in his/her perspective. Your PCP is correct in that orthopedists have more training 'in general' as they are trained to perform surgery on the entire body. Podiatrists have more training with respect to the foot and ankle, specifically, and less general training.
Ed

Re: Podiatrist vs. Orthopedic foot speacilist

Jessie W. on 3/04/03 at 14:11 (111767)

Dr. Wander, Do you practice anywhere near the Phila. area? I'm looking for a second opinion regarding Tarsal Tunnel surgery. Thank you.

Re: Podiatrist vs. Orthopedic foot speacilist

Dr Z on 3/04/03 at 16:35 (111785)

Dr. Wander does practice near Philadelphia

Re: Podiatrist vs. Orthopedic foot speacilist

Dr. David S. Wander on 3/04/03 at 19:15 (111809)

Jessie, yes I practice in Philadelphia. My office phone number is 215-725-1092. Call the office, I'd be happy to try to help you.

Re: Podiatrist vs. Orthopedic foot speacilist

Jessie W. on 3/05/03 at 09:15 (111848)

Could you give me the phone number of his office, so I can call about an appointment? Thanks so much.

Re: Podiatrist vs. Orthopedic foot speacilist

Jessie W. on 3/05/03 at 09:18 (111850)

Thanks! I'll call this morning. Please ignore my post asking for your number - I missed your post w/ the info.

Re: Podiatrist vs. Orthopedic foot speacilist

Carrie on 5/14/09 at 23:42 (257499)

In terms of neuroma, which one is better?

Re: Podiatrist vs. Orthopedic foot speacilist

Martin on 5/22/09 at 11:24 (257671)

In the uk, Podiatric surgeons train as podiatrist and are awarded a BSc(Hons)4years in podiatric medicine. They then study at Masters level (3-5 years) before obtaining a placement for up to 3 years.After which they spend another 10yrs gaining surgical completion certificate, the proess is very long and competitive, Podiatrist are specialists in the diagnosis and treatment of the foot and lower limbs. Podiatric surgeons do not pretend to be doctors, they are skilled in what they do.
Final note - the only reason podiatry profession exist = because MDs orthopedics were never interested in feet, more bigger and better fish to fry.And now the podiatry profession has evolved and continues to, they ( orthopedics) have realize we area threat ( less money for them)
It just jealousy.