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A Doctor of Podiatric Medicine (DPM) is the medical specialist for the foot and ankle. Podiatrists are licensed to diagnose and treat conditions of and relating to the foot and ankle. Treatment can be medical, surgical, or biomechanical. (Biomechanics is the study of how the foot and leg function when the foot contacts the ground.) The podiatrists' extensive knowledge of biomechanics allows them to alleviate many conditions with conservative therapy rather than surgery. However, when necessary surgically trained podiatrists have the capability to fix the most complex foot and ankle conditions.
Education
Candidates for admission to Podiatric Medical Schools are expected to complete baccalaureate degrees before admission. As with institutions granting MD (medical doctor) and DO (doctor of osteopathy) degrees, the colleges will consider candidates who show unusual promise and have completed a minimum of 90 semester hours at accredited undergraduate colleges or universities. About 95 percent of all first-year students entering the colleges of podiatric medicine possess baccalaureate degrees, and about 10 percent have master's degrees.
Applicants for admission are required to complete the Medical College Admission Test (MCAT) as a prerequisite. The course of instruction leading to the DPM degree is four years in length. The first two years are devoted largely to classroom instruction and laboratory work in the basic medical sciences, such as anatomy, physiology, microbiology, biochemistry, pharmacology, and pathology. During the third and fourth years, students concentrate on courses in the clinical sciences, gaining experience in the college clinics, community clinics, and accredited hospitals. Clinical courses include general diagnosis (history taking, physical examination, clinical laboratory procedures, gait analysis, biomechanics, and diagnostic radiology), therapeutics (pharmacology, physical medicine, orthotics, shoes, and prosthetics, surgery, anesthesia, and operative podiatric medicine.
After completing the four-year course and receiving the DPM degree, the graduate is required to complete postdoctoral work before state licensure.
Postdoctoral and Continuing Education
As they near graduation, prospective podiatric physicians seek postdoctoral residency programs. These programs, designed to strengthen and refinethepractitioner's medical, surgical, biomechanical and /or orthopedic skills, are based in hospitals accredited by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) and the American Osteopathic Association (AOA). These programs are at usually two or three years in length and may extend to four years.
Following residency, the podiatric physician may enter practice or continue their education through Fellowships in specialized areas of study.
Practice
Podiatric Physicians are licensed in all 50 states, the District of Columbia, and Puerto Rico to treat the foot and its related or governing structures by medical, surgical, mechanical, or other means. In addition to private practices, they serve on the staffs of hospitals and long-term care facilities, the faculties of schools of medicine and nursing, as commissioned officers in the Armed Forces and US Public Health Service, in the Department of Veterans Affairs, and in municipal health departments. Many podiatrists today are also part of group medical practices.
Special Areas of Practice
In its continuing efforts to protect and improve public health and welfare, APMA has recognized and approved two specialty boards that certify in three areas: podiatric orthopedics, podiatric surgery, and primary podiatric medicine. These boards confer certification on a podiatric practitioner who has satisfactorily passed written and oral examinations and has demonstrated knowledge and experience in his or her chosen specialty.
Those boards are the American Board of Podiatric Orthopedics and Primary Podiatric Medicine and the American Board of Podiatric Surgery.
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The most important criteria to ensure good outcome for your bunion surgery is to choose the right surgeon.
The qualities that make for a good bunion surgeon are:
- Board Certified: Look for an experienced surgeon who is board certified by the American Board of Podiatric Surgery (only board recognized as a surgical board) in Foot Surgery or Foot and Ankle Surgery.
- Understanding of biomechanics: To choose the best procedure, a surgeon must also have the ability to evaluate your biomechanical structure including tightness of leg muscles, foot and leg alignment, motion of the bones around the bunion site, and midfoot and rearfoot alignment.
- Extensive experience: An experienced surgeon usually has a better ability to deal with intraoperative or post operative complications and reduce the chance of complications. Numerous studies have demonstrated that one of the best predictors of surgical outcome is the experience of the surgeon.
- Gentle handling of tissue: A surgeon who handles tissue with a gentle touch will help ensure that pain is minimized and recovery time is reduced.
Be very careful in choosing the right surgeon. It is particularly important to avoid those that make unrealistic claims regarding bunion surgery.
If you see or hear the following statements we suggest you consider another surgeon:
- "90 plus percent of patients have pain free surgery"
Most surgeons could make that claim since surgery is generally performed with a local anesthetic block and the patient is sedated or asleep during surgery. After surgery patients are given a long term anesthetic block to allow them to usually go home pain free. Look for a surgeon who gives realistic expectations and does not make surgery sound too good to be true.
- “I created a better bunion surgery”
There are several problems with this statement. First, all bunion surgery is a variation on several basic types of procedures. There have been substantial evolutionary changes over the years, but if you hear anyone claiming that they have invented a procedure that is far better than anyone else is using, you should have a healthy skepticism. Second, there is no one “best” bunion surgery.
- “My patients never have a bunion return”
It is simply impossible to ethically guarantee that a bunion will not return. The odds of a bunion returning are much less if the surgeon chooses the right procedure and the patient follows all of their post-operative instructions. Also the use of custom foot orthotics (specifically prescribed to enhance normal function of the big toe joint) after surgery can help prevent return of bunions. The reality is a very small percentage of bunions will eventually return regardless. Sometimes the forces leading to bunion formation are just too great.
- "My patients never require crutches”
This often means that the surgeon only knows how to perform a simple type of bunionectomy. More complex bunion procedures may require the use of crutches. In fact, even with a bunion procedure that allows early weight bearing most surgeons will have their patients use crutches for short period of time to reduce swelling and pressure on the surgical site.
- “Surgery is performed in our own surgery center”
Be VERY cautious of a physician who performs bunion surgery in their own office surgery center. Physicians who perform surgery in the hospital must pass a credentialing process and be approved by a committee to perform individual surgical procedures. Physicians in the hospital are re-credentialed/evaluated on a regular basis. This assures you the physician is qualified to perform your surgical procedure and does not have an impairment. An office surgery center must usually be approved, in order for them to bill Medicare, but the physicians are not regulated. A physician may be deemed not qualified to perform a procedure in the hospital but this does not stop him/her from performing procedures in his/her own surgery center. A physician operating in his/her own surgery center has no one evaluating the quality of work. (We tend to see more complications from patients who have had surgery in an office surgery center).
- “I feel your bunion is going to get worse so you should have surgery as soon as possible”
Be cautious of a physician who does not suggest conservative therapy before suggesting surgery.
- “Surgery is virtually pain free, minimally invasive”
Be cautious of a physician who makes the surgery sound too good to be true. “Minimally invasive” bunion surgery was a term used many years ago to describe bunion surgeries performed through a very small incision. Due to significant numbers of complications with minimally invasive bunion surgeries, it is not currently recommended for bunion correction. A responsible surgeon will give you realistic expectations and review possible complications. All surgery, bunion or otherwise may have possible complications.
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