04/14/2025 Arden Smith, DPM
Podiatry’s Identity Crisis
Background: this is my third winter since retiring
and snow-birding. Both my former partner and I are
both double boarded and we we’re lucky enough to
develop a very early niche in the medical and
surgical treatment of the high risk, diabetic foot
and limb salvage through having a satellite office
within a large endocrine practice beginning in the
mid 1980s. This was something that we had very
little training for and learned by the seat of our
pants and attending diabetic foot conferences. We
started out asking a friendly vascular surgeon if
we could assist on referred cases and over a
relatively short period of time, started asking
him if he wanted to assist us; and then eventually
stopped asking, other than the vascular consult.
We also had a large volume general podiatry
practice that was somewhat surgically oriented. We
would see multiple generations in families.
Our general practice was a neighborhood practice
in a middle class area, and our diabetic practice
was a referral hub between two teaching hospitals
and in a more affluent area. My former partner and
I met the very first day of podiatry school and
ended up randomly sitting next to one another in
seats that became our official assigned seats. Our
podiatric marriage lasted approximately 40 years.
Enough background.
While wintering and snow-birding in a new age 55+
community this winter in Florida, I decided to do
my own very unofficial survey.
When meeting new people, the conversation
generally goes to what we did in our previous
lives. Approximately half the people I told That I
was a foot surgeon and specialized in high risk
diabetic foot problems. The other half of the
people I said that I was a podiatrist. The people
who were told that I was a foot surgeon gave me a
pleasant smile and a nod and generally started
calling me doc. The people who I told that I was a
podiatrist would constantly pepper me with foot
related questions about every possible condition,
every time that they saw me; and of course also
started calling me doc.
My take on my unofficial survey is: if you want to
be a legend in your own mind (Unless it is truly
mostly all that you do) Call yourself a foot and
ankle surgeon. My advice to a young doctor is, if
you would like to live in a nice neighborhood,
with a good school district, take nice vacations,
send your kids to the best summer programs, pay
for their college education without taking out
loans, call yourself a podiatrist.
My own observations on paradigm shifts through the
years:
By the later 1980s through the mid 1990s, I
thought that we had maxed out surgically. We were
able to move a bone up, down, sideways, and
backwards. There was nothing in the foot that we
couldn’t do; and our future would turn to the
total medical management of our patients.
Background: I came from a generation that learned
AO and we made round holes square to fit implants
and used saws at least in the very beginning, that
we could barely get our hands around. Now, the
instrumentation and the technology has improved so
much and continues to. There are instrument kits
for every possible procedure. These kits make
procedures and results much more reproducible,
with a goal to practically idiot proof, the
technical aspect of surgery. Please don’t get me
wrong, I think this is a great thing; and we
definitely did not max out surgery, but I believe
we are still heading to greater medical management
of our patients.
Another major paradigm shift over the last 40
years: when I trained, and when I began private
practice, my goal was to have a good surgically
oriented, general podiatry practice. This was nice
and stood my partner, and I well, but would you
want to have for yourself, or your parent to have,
heart surgery from someone who is a cardiac
surgery oriented surgeon? Numbers and volume
create muscle memory, judgment and experience,
especially dealing with complications. I think the
future lies in podiatric surgeons whose practice
consists of almost all foot surgery and its
associated management and management of its
complications and generalists who do everything
else. I believe that with all of the new
diagnostic and treatment technology, there will be
a lot very lucrative everything else.
God forbid the foot surgeon who tries making
orthotics, or does maintenance care on a
generalist’s patient. They may get their fingers
broken!
Because of where I see podiatry going, I believe
that there really should be two boards, but the
surgical board for a surgical podiatrist, not a
surgically oriented podiatrist, a term that will
become a term of the past.
If you ask me what I miss most about my 40+ years
in practice, I would have to say that it’s not the
surgery, been there done that, not the hospital
rounds, and trying to find the patient that was
taken down to radiology, not my difficult or
challenging case; it would be schmoozing with my
patient that I’ve seen for more than 20 years
about kids, grandkids, and vacations; while doing
podiatric maintenance care, otherwise known as
nails, and C and C. I would never give that up! I
loved doing it!! And it also paid for a very happy
family life!
Additional musings:
My partner and I accepted every possible insurance
plan that we could get into and were believers
that if we were busy enough, it would all work out
in the end. Even with “mangled care”!!!
Although being just literally a few years older
than us, Allen Jacobs was our professor and our
guru and still had the ability to be friends with
us and hang out.
I also remember Rodney Tomzcak, as a resident at
Metropolitan Hospital, while I was a student; and
he always had the time to share his knowledge,
answer any question, and was never at all
condescending to a student.
My final advice: be the best and most
knowledgeable Podiatrist you can be, and never
stop learning, all the way to the bank!!! And
enjoy what you do!!! Very few people have the
ability to actually help people and earn a good
living at the same time! It is a blessing!
Arden Smith, DPM, Great Neck, NY
