From: Steven Kravitz, DPM
The ability for podiatrists to treat systemic disease affecting the lower extremity, especially the leg and foot is generally accepted in the medical community based on our current level of training. The question pertains more to the point of the amount of systemic treatment required by the specific case.
Generally speaking, good quality practice requires podiatrists to have good general knowledge of systemic disease affecting the lower extremity. This does not mean that we have to independently treat these conditions. I generally referred neuropathy, vascular disease, and similar cases to appropriate specialists, and generally, cases requiring relatively simple treatment such as various medication, etc. were referred back to me to monitor and follow up. Podiatrists, as all practicing physicians, are not necessarily required to fully treat everything...
Editor's note: Dr. Kravitz's extended-length letter can be read here.
From: Elliot Udell, DPM
The question of whether podiatrists should be allowed to treat any systemic condition that affects the foot is not clear cut. On one hand, would anyone question our right to prescribe antibiotics even though they are either orally or intravenously administered? On the other hand, if a patient presents with neuropathy caused by complicated diabetes, should a podiatrist be allowed to manage the patient's diabetes? What if the neuropathy is caused by a spinal lesion, would we be expected or allowed to operate on the patient's back?
The answer lies in the complexity of the systemic condition and the training to manage it. It takes an internist or endocrinologist many years to master the management of diabetes. I would not allow that same internist or endocrinologist to operate on my back. To sum it up, it’s not the practitioner's title which should govern whether he or she should be allowed to treat a systemic condition with pedal manifestations, but the training to treat such a condition.
Elliot Udell, DPM, Hicksville, NY