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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