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From: Doug Richie, DPM


Dr. Udell suggests that orthotic labs should subsidize lectures at podiatry meetings and at the podiatry schools. This proposal underscores exactly why teaching the science of biomechanics has disappeared from all of the major educational symposia available to the podiatry profession. The content and speakers at these meetings have become heavily dependent upon corporate sponsorship and most of this comes from the wound care and surgical technologies industries.   


Foot orthotic labs with their meager profits and budgets cannot and should not be called upon to fund the teaching of an essential element of the podiatric curriculum. To assume that foot orthotic therapy represents the major delivery of skill and knowledge of biomechanics of the lower extremity is a sad conclusion. No student or resident should enter the operating room and be allowed to make an incision before mastering this subject. Biomechanics is an essential pillar of podiatric medicine AND surgery and should not rely on funding from commercial interests in order to maintain priority in our educational process.


Doug Richie, DPM, Long Beach, CA

Other messages in this thread:



RE: Shortage of PMSR/RRA Programs (Daniel Chaskin, DPM)

From: Charles M Lombardi, DPM, Alan A. MacGill, DPM


First, Dr. Chaskin is in error on several fronts. Most programs are PMSR/RRA. Second, it is only select states (that used the unified residency training model) in which one cannot do leg soft tissue procedures. 


Charles M Lombardi, DPM, Flushing, NY


According to the 2020 CASPR Directory, nearly all of the podiatric residency programs in the country are PMSR/RRA with the exception of only 9 programs.


Alan A. MacGill, DPM, Boynton Beach, FL



RE: Time for The New Generation of Podiatrists to Speak Up

From: Dale Feinberg, DPM


I’ve followed PM News for quite some time and noticed that there are only a limited number of practicing podiatrists who are either proactive or reactive to the many subjects brought up on the open forums. If you read their current posts, it appears that many are about to hang up their white coats. I can’t believe that out of over 18,000 daily subscribers, the new generation is not stepping up to let us know what they think. 


When I was editor of the First Amendment at the California College of Podiatric Medicine, I was tasked with editing, writing, layout, and publishing 95% of each issue. I guess things haven’t changed much in the last 40 years. Please step up and help Barry keep this blog going. He needs new blood and he needs our help. To post a comment or respond to one, simply reply to PM News or send an email to


Dale Feinberg, DPM, Yuma, AZ



From: Robert Kornfeld, DPM


This discussion is a critically important one, especially because my professional path brought me to a deep understanding of human physiology, the foundations for health and healing, and a never-ending focus on understanding mechanisms of pathology BEFORE symptoms are treated. I pursued a path in functional medicine for foot and ankle pathology because it provides a means to heal pedal pathology AND improve the health of the patient. This has been my path and my passion since 1987 (I am a 1980 graduate of NYCPM). My career has been extraordinarily satisfying because the healing is in medicine, not surgery. Of course there’s a place for surgery, but without a true mechanistic approach to healing, we correct one issue but leave our patients open to future pathology.


Podiatry has always struggled with itself. In our zeal to be accepted as ”real doctors”, we focused on pushing ourselves into hospital operating rooms. Unfortunately, that...


Editor's note: Dr. Kornfeld's extended-length letter can be read here.



From: Brent D. Haverstock, DPM


It would seem that if podiatry is to become a branch of medicine (MD/DO), the APMA would have to meet with the American Medical Association (AMA) and the American Osteopathic Association (AOA) to see if there is a desire to see this happen. If there were an agreement, the schools of podiatric medicine would have to close. The APMA and AMA/AOA along with the Accreditation Council for Graduate Medical Education (ACGME) would establish appropriate training programs.


I suggest a 5-year commitment to become a podiatric surgeon and 3-years to become a podiatric physician. Podiatric medicine and surgery would have a single certification board with specialist certificates granted as either a podiatrist or podiatric surgeons. Medical students (MD/DO) could consider podiatry or podiatric surgery as their career path. This is the only way to...


Editor's note: Dr. Haverstock's extended-length letter can be read here.



From: Leonard A. Levy, DPM, MPH


In the ongoing discussions about the highly controversial proposal to have two specialty boards in the podiatric medical profession (i.e., podiatric surgery and podiatric medicine), Ira Baum, DPM remarks, “Unfortunately, it is the grassroots podiatrists who will suffer for their inaction. I strongly recommend those in leadership positions to consider these points and begin to explore options and opportunities for change”. 


James J DiResta, DPM, MPH further states that, “Many graduating podiatric medical students would benefit from an Intensive Podiatric Medicine Residency option. Providing this option for our graduates who do not want to be surgeons can have real value IF done correctly. That would work if we were able to engage Dr. Levy in this process in creating such a program.” 


I suggest that the best way to address these and related matters is to engage in major strategic planning and include leaders in the profession to once and for all determine the direction of this growing, exciting profession. As said in Alice and Wonderland, “If you don’t know where you are going, how will you know when you get there?” Certainly if it was thought I could help, as Dr. DiResta hints, I would be glad to do so at any level.


Leonard A. Levy, DPM, MPH, Ft.Lauderdale, FL



From: Jon Purdy, DPM


There is no need to compare dentistry to podiatry in this debate. Dentists are not defined as physicians nor do they have any competition among the medical community. Our closest colleague and competitor, orthopedics, has gone through its own transitions over the years. Originally a specialty in addressing pediatric deformities (the Greek derivation meaning “straight babies”) has transitioned to anything bone related in all age groups.


I find it a difficult argument to claim three years of residency isn’t a sufficient amount of time to learn the surgical and medical conditions related to the lower extremity. Orthopedics learns the surgical and medically related treatments of the entire body in four years. The first of five years concentrates on general surgery and medicine. Once an orthopedist’s standardized residency is completed, they may choose to do additional training in specialized areas or concentrate their practice on specific areas of their basic training.


Change is inevitable and our profession has not kept up. It should be obvious at this point, an MD degree will be our only acceptance into the medical world, fair or not. Aside from that, not having standardized training in ALL aspects of lower extremity care, and one single certifying board, is foolish, to say the least.


Jon Purdy, DPM, New Iberia, LA



From: Leonard A. Levy, DPM, MPH


Elliot Udell, DPM, asks a great question, namely, “Could you offer us some insight into why podiatry has not generated the types of limited specialty practices that we see in dentistry and medicine?” I served a total of 14 years as dean and then president of the then California College of Podiatric Medicine. For another 14 years, I was founding dean of the College of Podiatric Medicine and Surgery of the then University of Osteopathic Medicine and Health Sciences (Des Moines, Iowa). I just spent 17 years as associate dean of the Nova Southeastern University (NSU) College of Osteopathic Medicine learning in detail the intricacies of a DO curriculum. I just completed a year serving of the curriculum committee of NSU’s new allopathic medical school and currently serve as an interviewer of applicants to that school.


I was successful in modifying the pre-clinical aspect of podiatric medical education at the California and Des Moines podiatric medical schools and led the way in California to a podiatric medical residency that was 2 years in duration, virtually unheard of at that time. But the profession for years kept focusing on preparing DPMs who were qualified podiatric surgeons. While vital, it is time to expand that narrow perspective and provide graduate medical education that leads to the production of highly qualified podiatric physicians comprehensively training, experienced, and certified in the relatively neglected area of medicine related to the pedal extremity.


Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL



From: Elliot Udell, DPM


I’m questioning why podiatry does not have specialties as dentistry does. This ignores a rather large elephant sitting in our living room. Dentistry has true specialties. There are periodontists, oral surgeons, endodontists, pediatric dentists, etc. The one difference between dentistry and podiatry is that dental specialists limit their practices to their specialties. 


If one goes to an endodontist for a root canal, or an oral surgeon for an extraction, those dental specialists would never be caught filling a cavity or making a crown for that patient. If he or she did, they could kiss their referral base goodbye. Podiatry is different. There are those who have greater training in surgery, biomechanics, pediatrics, or dermatology but I have yet to hear of any of my colleagues, outside of the academic arena, who limit their practices to any one area of specialization. Perhaps Dr. Levy could offer us some insight into why podiatry has not generated the types of limited specialty practices that we see in dentistry and medicine.


Elliot Udell, DPM, Hicksville, NY



From: Doug Richie, DPM


I applaud Dr. Richie’s comments about the tragic devolution of our podiatry education away from the core discipline of biomechanics. The knowledge of biomechanics and foot function lies at the heart of our profession and must never be neglected.


Robert Frykberg, DPM



From: Jeffrey Root


Dr. Udell states he has no idea why orthotic labs stopped sponsoring biomechanics at conferences and podiatry schools. As the owner of a prescription foot orthotic laboratory I can shed some light on the subject. The short answer is that there is no/inadequate return on investment. Sponsorships are essentially a marketing expense for most businesses. If an orthotic lab can’t benefit from a sponsorship or if it can’t afford to fund one for altruistic purposes, then they are unlikely to do so.


The economics of the custom foot orthotic manufacturing industry have changed over the years. There was a time when the exhibit halls at podiatry conferences had many foot orthotic labs in attendance. That is no longer the case. In fact, exhibitors at podiatry conferences are down in general. It's extremely expensive to exhibit, sponsor speakers, or to otherwise financially support educational content. As Dr. Richie indicated, foot orthotic labs have relatively meager budgets and have watched their profit margins shrink for many years, in part, because podiatry has become more of a surgical specialty. Unless that trend changes, you are not likely to see orthotic labs support biomechanics like they once did.


Jeffrey Root, President, Root Laboratory, Inc.



From: Alan Sherman, DPM


The always erudite Elliot Udell’s call to orthotic companies to support biomechanics education is currently being generously met by Scott and his son Robert Marshal of KLM, Michael Friedman of Redi-thotics, and Pavel Repisky of 8Sole, all of whom sponsor podiatric education. 


Doug Richie, DPM shared an important point: for podiatrists, there is so much more to biomechanics than orthotics. While all corporate entities working in the podiatry space should do their share, I would add that while we all appreciate corporate sponsorship, we can’t and shouldn’t ever rely on it to choose what is taught at the colleges or at the post-graduate level.


Alan Sherman, DPM, Boca Raton, FL



From: Dale Feinberg, DPM


Dr. Borreggine’s excellent analysis of the future of podiatry hit the nail right on the head. He had been prognosticating that the demise of private practice was coming and now he has put out the word that private practice is dead. 


I started reading the tea leaves about seven years ago when the implementation of Obamacare started affecting my practice. Denial of payment for the medically necessary diabetic shoes was the opening shot in the war with...


Editor's note: Dr. Feinberg's extended-length letter can be read here.



From: Elliot Udell, DPM


Doug, in an ideal world, corporate entities would have no say in what is presented at medical conferences. We do not live in an ideal world. When I lecture at podiatry conferences, I don't always get paid and I have sometimes paid for my own room, board, and transportation, and given multiple lectures. Why do I do this? To be of service to my profession and the public it serves. There are others like me.


Unfortunately, this model is not sustainable even for me. Many conferences including ones that I have chaired cannot afford to subsidize all of its speakers or depend on all of its speakers to lecture for gratis. Hence, they have to turn to the corporate world for help or scrap the seminar. As for podiatry labs, when I started practice back in the 70's, Langer labs, Schuster labs, and other labs did sponsor biomechanics at conferences and at the schools. Why did they stop? I have no idea. 


Elliot Udell, DPM, Hicksville, NY 



From: Ira Baum, DPM


I couldn’t agree more with Dr. Ritchie. Without mastering the fundamentals; one can never become a master. Techniques to cure a deformity develop from understanding the root causes. With the exception of congenital deformities, abnormal lower extremity mechanics play a primary factor. John Wooden, the immortal UCLA basketball coach and philosopher, once said “If you only try to learn the tricks of the trade, you will never learn the trade.” The trade of being an expert podiatrist/foot and ankle surgeon is understanding the cause of the pathology and applying the solution. 


Regarding foot/ankle surgery - without understanding the biomechanical fault causing the deformity, even the surgeon with the greatest hands will fail most of the time. I say most of the time because in golf lingo, "Even a blind squirrel finds an acorn once in a while." Learn what our masters in biomechanics have uncovered and you’re on your way to becoming an expert. Regarding who sponsors lectures at symposiums is an issue, but whatever the solution, lower extremity biomechanics should be an integral part of most conferences, and all surgical conferences.


Ira Baum, DPM, Naples, FL



RE: Welcome to the Future of Podiatry

From: Joseph Borreggine, DPM


Who needs a podiatrist when you can just buy a pair of custom orthotics on your own? Soon not one insurance will pay for orthotics, but what does it matter anyway? A new class of DPMs are now entering the profession with the mindset that they are only “foot and ankle” surgeons.


They opine that general podiatry is truly passe’and is beneath the DPM degree. All the time and money invested in their degree that was earned along with the required 3-year surgical residency is far beyond the... 


Editor's note: Dr. Borreggine's extended-length letter can be read here.



From: Paul Busman, DPM, RN


I too had some human bones left over when I closed my practice, including an entire leg and half pelvis, and a nylon threaded disarticulated foot. I gave them to a local podiatry group where I was working part-time to use as I did in my office, for patient education. 


Paul Busman, DPM, RN, Frederick, MD



RE: The Problem With the American Healthcare System

From: Jill Hagen, DPM


I received a refund request from Humana yesterday. I checked the patient’s account and saw I was overpaid, and in fact, the refund was legit. I then decided to call Humana insurance today to pay the refund.  After 20 minutes on the call, I finally got the representative whom I told I was calling to pay the refund. She asked me these questions: name of the patient, insurance ID number, claim number, and date of service. I answered all these questions. Then she asked, “What is the patient’s date of birth”? I did not have the answer in front of me.  


She then said, sorry, I cannot help you if you don’t know the patient’s DOB. I told her that I wanted to speak to her supervisor. She said the supervisor was not available and she was sorry but there was no more she could do for me. I then told her, “if you see your supervisor, tell her a doctor called to pay a refund due, and that you could not process this refund without the patient’s DOB. If this insurance rep worked for me, she would be fired on the spot! This can only happen in the American healthcare system.   


Jill Hagen, DPM, Englewood, NJ 



From: Martin M Pressman, DPM


I agree with Dr. Allen Jacobs completely. The use of graded pulses (+1 thru +4), capillary filling time, and hair growth as the standard podiatric documentation, while necessary, is simply not enough. Hand-held Doppler evaluation is an inexpensive method of determining the quality of pulses: monophasic, biphasic, or triphasic. Documenting the presence and quality of the three foot pulses with a Doppler and referring to a vascular consult or ordering vascular ultrasound imaging/ABI for absent or monophasic sounds would save limbs and time spent in depositions for a missed diagnosis of PAD.


Martin M Pressman, DPM, Milford, CT



From: Richard M. Maleski, DPM


Dr. Udell's post reminded me of an incident about 4 or 5 years ago at our community hospital. The wound care nurse at the hospital, who also worked part-time for a home nursing service, apparently took some training course for routine foot care and started advertising, with the hospital's blessing, her availability for nail care and corn/callus care. My understanding was that she could not bill any insurance, cash only. 


I became familiar with her since I worked closely with her on some wound cases, and therefore felt comfortable talking to her about her new "business". She told me that she stopped after a few patients because she didn't realize how difficult it was to adequately provide... 


Editor's note: Dr. Maleski's extended-length letter can be read here.



From: Daniel Chaskin, DPM


Consolidating podiatric medical boards with foot and ankle surgical boards would be a positive first step to prevent what I believe is discrimination by hospitals, against podiatrists who are board certified in podiatric medicine.


Unfortunately, some hospitals require board certification in surgery. If podiatrists lack these credentials, they can be excluded from a hospital's operating room. 


Daniel Chaskin, DPM, Ridgewood, NY



From: Andrew Levy, DPM 


I feel a need to add another voice of support to Doctor DeHeer's concerns and important consideration for finding ways to prevent suicide among our residents and our peers. We too have suffered the sadness of this tragedy in our community, in our professional ranks, and with our professional colleagues in other fields. I discussed this today with a patient who is director of a post-doc program in our community, and they also have that problem as well. This is, unfortunately, ubiquitous to all of our societies. 


While we search for the appropriate tools to study the phenomenon and assess different tools to help fight the problems through mentorship, referral to physician services, or the importance of enlightening our fellow colleagues, the important work must...


Editor's note: Dr. Levy's extended-length letter can be read here.



From: Norman Rubin, DPM, David E Gurvis, DPM


My partner of thirty years tragically committed suicide just as we had sold our practice and were about to retire. He was financially secure and was looking forward to his retirement. In addition to being my partner, he was my best friend. You would have thought that if anyone should have seen the warning signs early on, I would have seen them.


About a month before he committed suicide, however, I noticed a significant change in his personality. I spoke with my partner about my observations, but he insisted that he was doing fine. Nevertheless, I was concerned and...


Editor's note: Dr. Rubin's extended-length letter can be read here.


I was also at the memorial service for one of my oldest friends. I have known him for over 30 years. I am also a colleague of Dr. DeHeer and know he is prone to action, not simply talk. When he speaks of suicide prevention in doctors, he is speaking from a position of knowledge and caring. I personally know he cares about others. I don’t know Dr. Bellezza, but I find his comments very offensive and lacking any care or understanding of human psychology.  


Were we able to weed out those who might become depressed later, I would support giving them the ability to accept counseling or medication as necessary, just as I would anyone suffering. However, to prevent someone from entering podiatry school simply because they may have depression is untenable. To simply say we should weed them out, besides being impossible, shows no ability, in my opinion, to exhibit sympathy for those suffering from depression.


David E Gurvis, DPM, Avon, IN



From: Jessica Tabatt, DPM


Thank you, Dr. Bellezza, for showing us that there is still an unfortunate stigma surrounding mental health that prevents people from seeking the care they need. If a person is stressed, you cannot tell them that they are not, nor should they not be stressed. This would be like telling me that I am not hungry because you are not hungry.  


I took my residency and now my current career seriously. Even though my patients are not dying, I still have their health and well-being under my care, which can be very stressful at times.


Jessica Tabatt, DPM, Brainerd, MN



From: Robert Scott Steinberg, DPM, Irwin B. Malament, DPM


Dr. Bellezza's comments underscore the need for all the colleges of podiatric medicine to immediately add a full year course on mental health (psychology/psychiatry). So far, the Scholl College of Podiatric Medicine has refused. The Illinois Podiatric Medical Association has reported they have had multiple meetings with the college, and all the college does is kick-the-can-down-the-road.  


Robert Scott Steinberg, DPM, Schaumburg, IL


I applaud Dr. Deheer's survey regarding suicide prevention in podiatric residents. This should be extended to all physicians in practice as well. I recently lost a good friend and former class-mate who committed suicide last week. We talked 4 days before he did this and never attempted to reach out that there was a problem I could help him with or talk about.


We are all under a lot of stress these days with practice and family. A lot of issues are under the surface and if we are proactive, possibly we could avoid these tragedies.


Irwin B. Malament, DPM, Indianapolis, IN



From: Peter Bellezza, DPM


Dr. DeHeer, my original message was to point out that if you want to design a research tool to predict behavior/suicidal ideation in the podiatric residency training model, you have to consider the disparity of training between the individual podiatry residency programs, the training disparity between podiatry residency training vs other med/surgery specialties and the disparity in student preparedness for residency training when comparing the DPM vs. the MD/DO medical education system. If you think there is no disparity in any of the above, then that’s an entirely different debate.


Residents who work longer hours are going to have social factors that can come into play that could increase the potential suicidal ideation. That’s obvious. For residents that have succumbed to suicide, was it really because medicine (the work) drove them to it? Or are we dealing with individuals with extensive histories of anxiety, depression, substance abuse, etc. that entered the field of medicine? These are important questions to ask. 


Understanding the medical and social history of residents may be important screening tools to better identify residents who are at risk during residency training. I look forward to reading the data you produce. I apologize if I offended you and others with my initial response. 


Peter Bellezza, DPM, Bristol, CT

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