04/08/2025    Rod Tomczak, DPM, MD, EdD

Defining Podiatry

The last few days, I’ve been thinking about
exactly what this profession we call podiatry is.
It’s important because it’s so much more than a
foot doctor but may not be a foot and ankle
surgeon for everyone who still refers to
themselves as podiatrists. This idea of a
definition becomes important as we explore the
concept of a single board for certification and as
we try to salvage the profession from obscurity as
admissions continue to dwindle under the degree
DPM.

I recalled a Latin term popular in philosophy and
law. The term is sui generis which best translated
for our purposes as “unique unto itself.”
According to Aristotelean logic, it is difficult
to define podiatry with a statement that contains
the essence of the term and an accidental
condition that is descriptive but does not alter
the essence as this accidental term is changed.
Podiatry is in a class alone and we have attempted
to make analogies to dentistry and ophthalmology
which seem to limp. To practitioners of different
generations, the definitions of podiatry are at
best fauxdiatry, a portmanteau of this important
but difficult to classify health care niche.

We all know what podiatry is when we see it, but
we have a problem defining it, similar to the
response of the Supreme Court justice when asked
to define another controversial topic. “I can’t
define it, but I know it when I see it.” The fact
that I can recognize it but not define it
adequately, especially for the public makes what
we call board certification meaningless. This may
be the case for other medical and surgical
disciplines, but I am only interested in the
competency of the practitioners we call simply
podiatrists all the way to the biomechanical,
reconstructive, aesthetic, holistic, foot and
ankle trauma specialists. Orthopedic shoulder
surgeons rarely advertise themselves as aesthetic
plastic surgeons for suprspinatus tears. Where is
Thomas Paine when we need his pamphlet?

I have often pondered the question, “Who decides
that one is a pediatric, aesthetic, hammer toe
surgeon?” Is there propositional logic or
sentential calculus involved in the thought
pattern or have truth tables been constructed and
consulted? “All men are mortal.” “This pediatric,
aesthetic, hammertoe surgeon is a man.”
“Therefore, this pediatric, hammertoe surgeon is
mortal.” What a shame that such a highly
credentialed, accomplished and admired surgeon
must someday die. It must have taken at least half
a lifetime to achieve all these accomplishments.
His peers must be salivating in admiration and
only wish they could take his place inside those
latex-free gloves.

Parents and grandmothers pine with respect at the
knowledge he is readily at hand to treat the
fourth grader that trips over his or her feet when
they run and they stand glossy eyed when this
podiatrist of meager origins casts the child for
the first of serial orthotics that will stimulate
nature’s own correction of femoral anteversion,
especially when the miracle worker shows the
family the alternative to orthotics; the dreaded
Throckmorton Cables.

And we all rejoice, swept up in the bliss of
temporal felicitude as the entourage leaves the
boutique office with the remnants of the lattes
they haven’t had time to finish. What can possibly
be the harm? The child will cease to trip over
their feet, even if the orthotics are worn in the
wrong shoes. Nature over nurture, 99% of the time.

Does all this false self-aggrandizement have any
negative effects on anyone or anything? If
everyone walks away happy is there any harm
effected except on the child who may be ridiculed
if another child sees those magic shovels in the
kid’s shoes? People don’t usually give themselves
titles or in most cases even self-descriptors. I
wasn’t the first person to call myself a
podiatrist. Abe Rubin, DPM who handed out our
diplomas on April 30, 1977 had that distinction. I
received a letter in the mail saying I was a
diplomat of the American Board of Foot Surgery,
and another letter proclaiming me a Fellow. I
never used a descriptor that someone in a position
of authority hadn’t used first.

The child’s family, if ecstatic that you, the
pediatric specialist, cured the child’s in toeing
gait and they don’t trip over their own feet when
running, what’s the harm there? Well, who decided
you were a pediatric specialist. Do you need to be
a pediatric specialist to deliver a pair of
orthotics to a kid? After all, I’ve heard there is
no normal foot that orthotics can’t help, or even
a back or hips or digestion.

Situational ethicists such as Fletcher tell us, in
some circumstances, it may be fine or actually
preferred to lie to a person in order to obtain a
greater good than would be anticipated without the
falsehood. Let’s suppose the orthotics are exactly
what the child needs and without them, there could
or would be a lifetime of problems and you the
pediatric podiatrist astutely perceive this and
communicate it to the family, when the run of the
mill podiatrist may miss the pathology. This is a
great feather in your cap, but the kid may forget
you were partly responsible when they sign that
multi-million dollar NIL contract in college. Or
worse, they may have visited the podiatrist down
the street who does not add the term pediatric to
their website, not reaped the benefit of your
expertise and goes on to JUCO obscurity.

Who exactly gets to decide who exactly gets to add
“pediatric” to the designations describing that
long list of accomplishments? Remember, someone
else usually bestows a title; one does not assume
a level of expertise about oneself. Simply
belonging to a club where the certificate and
title are totally dependent on the $300 check
clearing is not sufficient. It’s like flashing a
fake badge and calling yourself a “police surgeon”
when stopped for speeding. Is there a special
requirement needed to operate on a cop? I was
around when “sports medicine” suddenly became
vogue. I can tell you that no “sports medicine”
guru had special drugs or tricks in their black
bag that the clumsy kid who didn’t get orthotics
but became a regular doctor didn’t have in their
black bag.

There does need to be a way to legitimize and
recognize a special talent. It’s usually based on
training and interest that alerts the public that,
yes I have received additional education and
preparation in a subspecialty and proved both my
efficiency and proficiency in that subspecialty
and am entitled to let the public know it.
However, a plastic surgeon does not advertise that
they are especially adept at skin grafts. That’s
assumed to be part of the board certification
package. Maybe with additional training they may
want to mention on television they have done a
fellowship in burn therapy.

The path analysis for this recognition should
proceed from board certification to fellowship to
a certificate attesting to the accomplishment. For
us, the most reasonable path would be board
certification in podiatry, yes podiatry, then
fellowship in maybe sports medicine or pediatrics
or maybe surgery if that’s what the young
practitioner wants, where a certificate is earned
and a log of patients generated to present to
anyone who needs a look see. We are way past or at
least should be a one size fits all professional
preparation for practice.

If podiatry wants to be more than a shell of
itself in 30 years, it must come to the
recognition it has to evolve and change with the
current generations who simply won’t be interested
in a profession that is afraid of change. Fear of
change can be best exhibited by fear of discussion
of new options. That stubborn and resistant path
analysis constructed by those who know what’s best
for all looks like this:
No change -> no evolution -> die. Requiescat in
pace.

Rod Tomczak, DPM, MD, EdD, Columbus, OH

Other messages in this thread:

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04/14/2025    Rod Tomczak, DPM, MD, EdD

Defining Podiatry (David Secord, DPM)

I really want to thank Dr. Secord for his German
compound word idioms. It plays precisely into the
completion of defining podiatry. When I was 16, I
still was fluent in German, attending a boarding
school near Aachen. I still dream in German once
or twice a month, but nowhere like it used to be.
As a lone monk chants at the burial of as pope,
“Tempus fugit, memoria mortem.” Time flies,
remember death.

For quite some time we have defined ourselves as
the primary care givers of feet, especially what
we identify as sick feet. Let’s be honest, most of
us don’t do reconstructive surgery on feet with
multiple complex deformities and use external
fixation. Orthopedic foot and ankle care givers
don’t have time during their one-year fellowship
to learn what we learn in seven years. If you want
to make it a binary distinction, we take care of
sick feet that have sometimes become deformed. We
care for the diabetic foot that becomes Charcot.
Orthopedic foot and ankle surgeons care for
advanced trauma and fuse the bad Charcot foot that
is a hair shy of amputation.

Historically, the physicians that took care of the
diabetic identified the complex deformities and
osteomyelitic feet and referred these patients to
the orthopedic surgeons because they didn’t know
either we existed and or what we did. This is
changing and now podiatrists are being referred
these complex sick feet. As uncomfortable as these
sick feet may make us feel, we are not saying,
“No!” to them or the referring primary care
physician. Sometimes these feet go really bad and
need more proximal amputations, and rarely are we
involved alone. We call the vascular surgeons and
the endocrinologist, we debride and amputate what
the laws allow us. The diabetic foot has become
our niche and the bad one that comes through the
ED comes to us while the foot that gets caught in
a combine or an outboard propeller goes to the
orthopedic surgeon. Multi-malleolar fractures are
determined by hospital policy and the coin flip
usually comes up MD.

We have gotten extremely adept at what we do. One
might say we are simply the best and that is
extremely important. Given a compliant patient and
with us running point we are very successful at
saving limbs. Some podiatrists don’t want to see
this as their forte and would rather continue as
traumatologists or regenerative medicine
specialists who work on a cash basis. We are
abandoning what brought us to where we are today.
And who can blame the practitioner who wants to
manufacture PRP in their “house lab” and inject it
for $500 at a patient’s home. The thought process
was the same for us multi-year residency graduates
of the late 70’s and early 80’s who were suddenly
too advanced to take care of calluses and nails.
We were surgeons. Orthopedic surgeons don’t want
to trim nails and calluses either. Hence, the
nurse practitioner evolved while we wrung our
hands and lamented, “Out, Damned spot.” There is a
huge chasm separating a young doctor who feels
lucky to have this profession and young doctors
who feel this profession is lucky to have them and
we are the bad guys for standing in the way of
what the younger ones want.

The students who are presently in college and may
be considering a health care profession are smart
and they will research the opportunities and make
an informed decision. If I were in college and
possibly considering podiatry, I’d seek the
opinion of a podiatrist who was born in the 21st
century, or at least close to it rather than a
senior citizen. Don’t get me wrong, podiatry will
always be with us, but what we call or define it
is up for grabs right now. Let’s face it, with
enrollment in the schools declining every year,
there won’t be eleven schools soon. Podiatry
schools are opening and will close as fast as
Caribbean medical schools during Covid. The limb
salvage we accomplish with diabetics mandates a
moral imperative for the profession to continue
and strengthen its position at least in that
realm. We do save limbs and do it better than
anyone else and while saving limbs we save lives
via the amputation prevention path. We should
never diminish that feat, in fact there is a
strong case to place a duty imperative upon the
profession’s leadership to strengthen the bond
between diabetic wound care and the leadership of
the profession under the guise of beneficence, one
of the four pillars of medical ethics.

Diabetic wound care and limb salvage may not be in
the purview of every podiatrist. It certainly
can’t be an occasional diversion from say sports
medicine or biomechanics. That’s not to say it
can’t be part of a person’s practice, but how do
we ensure, and certify that the person trying to
save a limb is fully committed to saving that limb
if front of them? It has to be a team effort and
as I say the podiatrist should be making all the
appropriate referrals and arranging the proper
consultations. But it is the podiatrist who
debrides the wounds and chooses correct
consultations with other experts in their field.
The vascular surgeon may see more than diabetics
but the podiatrist has to be certain that when
seeing the diabetic the vascular surgeon is
completely time devoted to your patient and
possesses the prerequisite expertise. The
expertise factor is supposedly handled with board
certification.

In my last post, I introduced the term “sui
generis” to help define podiatry as “unique unto
itself.” Board certification in danger of losing
the “unique unto itself” descriptor and falling
under a “sui nebulosus or a “vague unto itself”
designation. The residency system should allow
someone to become board certified in podiatry. The
general internist completes a three or four year
medicine residency then may go into practice as a
board certified internist if they pass the exam,
or may elect to spend up to four more years
completing a fellowship in gastroenterology or
spend a different three years becoming a
nephrologist. Allopaths or osteopaths complete
fellowships only under the aegis of the
certification they have achieved.

In other words, gastroenterologists don’t complete
a fellowship in shoulders. But, if someone is
board certified in podiatry could they complete
fellowships in diabetic limb salvage and podiatric
sports medicine? And should they complete approved
fellowships in both of those disciplines before
advertising either subspeciality? Neurosurgeons
complete, often complete a two year fellowship in
spinal surgery and present an impressive log
before a hospital will grant privileges to perform
spinal surgery. Jogging a half mile per day does
not qualify you as a sports medicine specialist
just like training for Boston doesn’t make you a
podiatric sports medicine expert. But can you
mention in your advertisement that you ran Boston
in under three hours? Belonging to a SIG gives
you no special knowledge or technique traction,
and you can list yourself as ACFAS without being
board certified. How do you become an aesthetic
foot and ankle surgeon? Can I call myself that or
has someone else called me that like mentioned
before. Am I putting that in my self-description
to mislead a potential patient into thinking you
had special accredited training and accredited is
the key word?

The hospital I did my residency in was directly
across from PCPM. There was the slogan, “Get Met,
it Pays!” for Metropolitan Hospital. That
residency was supposed to go to the top two
students at PCPM but DEI was born and an OCPM
graduate matched. When we finished the two years
we were the Top Guns and charged with spreading
our knowledge and skills to the profession. A
heady directive for some kids but we all picked up
the gauntlet and became leaders in the education
of the profession. Today, Metropolitan Hospital is
a high-priced condominium complex on a desirable
subway stop. It went from DO royalty to DO
history. The same thing will happen to Ivy League
buildings. After all, there was a hefty profit
involved in filming the opening scenes of Rocky II
at Pennsylvania Hospital and even Dick Rothmann
jumped ship.



Do you need a DPM degree to be a podiatrist? How
will Generation Z feel when the next generation of
medical professionals, still wet behind the ears,
finish training with something generation Z is
clamoring for…an unlimited medical license. Those
of us that graduated between 1975 and 1980 now
grow cobwebs like this generation grows biologics.
We are literally pushing to make ourselves
obsolete for the benefit of future podiatrists.
Most of us have fought a hell of a fight to get
every DPM active staff, medical directorships and
the leadership in foot and ankle surgery. Some of
us look like Rocky at the start of Rocky II as we
pass the torch.

Generation Z has all the tools. The only thing we
have that Generation Z doesn’t have is experience.
It would be a shame if Gen Z doesn’t listen and
equally as bad if we Baby Boomers turned into Baby
Bombers and rejected what the next generations has
to offer the profession, regardless of the
initials after a name. We should be defined by the
essence of podiatry, not by the accidentals of
that definition like the initials after the name.
All this is referenced in the second paragraph of
the first section of “Defining Podiatry” which Dr.
Secord talks about with, I hope, respect for the
profession. It was the generation before us in
podiatry, the generation Tom Brokaw called “The
Greatest Generation,” that paved the way for us as
we are doing for Generation Z. It seems like only
yesterday we were fighting for privileges to
operate on the calcaneus.Time flies…

Rod Tomczak, DPM, MD, EdD, Columbus, OH

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04/19/2006    Office of Gov Jim Doyle

WI Gov Signs Law Redefining Podiatry

WI Gov Signs Law Redefining Podiatry

On April 14, 2006 Governor Doyle signed the
following legislation:
Senate Bill 591 improves patient care by
redefining podiatric
medicine to be the practice of medicine and
surgery that includes
treating the sick, and is limited to conditions
affecting the foot
and ankle. The bill also extends the post-
graduate study requirement
to two years.

Governor Doyle thanked Senators Carol Roessler
and Jon Erpenbach, as
well as Representatives Jean Hundertmark and Jim
Kreuser for their
work on the bill.

Source: Office of Gov Jim Doyle [4/14/06}