Why Podiatric Surgery? – Part One
Why Consult with a Podiatric Surgeon?
Many conditions of the foot and lower limb do not respond to non-surgical methods of care. This is when the option of surgery has to be seriously considered.
Podiatric surgeons are specialist podiatrists, who undergo extensive training in podiatric medicine, surgery and general medicine, including pharmacology. This enables them to be able to surgically treat disorders of the foot, ankle and lower limb. A copy of the ACPS (Australasian College of Podiatric Surgeons) training program, outlining the objectives, criteria and requirements to complete fellowship to become a podiatric surgeon, can be found here.
Podiatric Surgeons in Australia are approved by the Australian Health Professions Regulatory Authority (AHPRA) and are considered as specialists, analogous with specialists within the fields of dentistry and medicine. Podiatric surgeons in Australia currently operate within the private hospital system. With time, it is hoped the specialty will become integrated within the public health sector, similar to what has happened in the United Kingdom. Podiatric surgeons in the United States operate within the private sector, a structure which is in many ways equivalent to the Australian public health sector.
Integration of podiatric surgery in the Australian public system will be of great benefit to the community, as foot and ankle complaints are common and can be debilitating, sometimes life threatening. It is hoped this can occur in the near term, once certain political obstacles can be overcome.
Characteristics of podiatric surgery
Podiatric surgeons are able to treat conditions affecting the foot and ankle. These include bunions, arthritis, hammer toes, nerve entrapments, soft tissue masses, in-growing toenails, ganglions, tendinopathies, flat feet and high arch feet. Other disorders such as recalcitrant triceps surae inflexibility and joints affected by gout/inflammatory arthritis can also be treated. Podiatric surgeons are trained to manage the diabetic foot and can play a major role in reconstructive surgery associated with the diabetic foot, including prophylactic (preventative) foot surgery.
Podiatric surgeons are the only surgical specialty fully dedicated to the non-surgical and surgical management of disorders of the foot, ankle and related structures. As their focus is on the foot and ankle, podiatric surgeons are well trained in performing surgery on small and tight, closely packed joints. Podiatric surgeons use the principles of plastic surgery combined with orthopaedic surgery. Tissue handling and precise tissue dissection are very important.
An understanding of general medicine and the ability to take a detailed medical history are also characteristics of training emphasised in podiatric surgery. I undertook medical rotations in plastic surgery, anaesthetics, pathology, rheumatology, vascular surgery, orthopaedics and the ‘high risk’ foot, amongst other fields, to augment my podiatric medical training. In my clinical assessments I place a great deal of emphasis on the medical history of my patients.
Pain associated with the foot has many origins. It is important to be able to differentiate these. For example, pain and disability associated with the foot can be caused by infection, systemic disease (ie- inflammatory joint conditions, gout, diabetes), trauma, overuse as in sports injuries, hereditary factors and even congenital (birth) disorders. Nerve injury at the level of the back can cause neuropathic foot pain… and the list continues.
Podiatric surgeons are able to marry the nonsurgical forms of treatment with the surgical and are well trained in post-operative management. It is one thing to do the surgery, but after care is critical to achieve an optimum result for the patient.
Podiatric surgeons are well trained to recognise and manage potential complications, should they occur. They work closely with anaesthetists and a surgical team to achieve the best in patient care. Referral to the general medical practitioner or other specialist fields, is sometimes is necessary for an opinion or additional management and podiatric surgeons do this, if and when required.
To complete a fellowship program of training, podiatric surgeons in Australia have to publish research, complete overseas rotations to obtain exposure to other health care models and sit both practical and oral examinations, throughout the training program.
In conclusion, podiatric surgeons are highly training and skilled in treating disorders of the foot and ankle (and associated structures).