10/27/2025    Robert Kornfeld, DPM

Sacred Myths (Rod Tomczak, DPM, MD, EdD)

I believe Dr. Tomczak has hit more than one nail
on the head here. While a trauma-based fellowship
may make sense for some, and I do believe it is
something that is needed, I do not think it would
be the draw for many and shouldn't be something
that we push our graduates into. One of the things
I have witnessed in my more than 40-year career is
the loss of podiatric medicine from our
residencies. Don't get me wrong. I do believe we
need to be good surgeons. I did thousands of
procedures in my career.

But just look at how things have evolved in our
profession. The better the surgical training for
our residents became and the more we were pushing
well-trained, surgically oriented podiatrists into
society, insurance companies lost their respect
for surgeons and slashed fees to the point of
absurdity. And if that is how a podiatrist is
expecting to earn his or her living, it is going
to be a struggle going forward.

At the same time, I have come up against some very
disturbing experiences in the last 10 or so years.
I happen to specialize in chronic foot and ankle
pain and work from a functional
medicine/regenerative medicine perspective. Many,
if not most, of my patients have already seen a
number of podiatrists before finding me. And the
stories I hear are very upsetting. Patients who
were never touched. No exam. No work-up. Just an
x-ray and a recommendation for surgery. Many of my
patients have had surgery...some have had many
surgeries to correct the same problem by different
podiatrists. Each one failed. Very few had a
legitimate biomechanical evaluation, or any. Many
were never given orthotics, or if they were, they
are OTC devices you can buy from Amazon.

I saw a patient for a second opinion. The first
podiatrist recommended a 5th metatarsal osteotomy
for a painful lesion sub 5th met head. As I
inspected her foot, there was a rather large
lesion in the area. I asked her when she saw the
other podiatrist (thinking it was quite a while
ago because the lesion was quite thick). She said
last week. I asked her if the prior podiatrist
trimmed the lesion. The answer was no. And there
was no biomechanical evaluation. And again, this
doctor did not touch the patient. As is my habit
from my training, I began debriding the lesion. As
I got through the superficial part of the callus,
I felt a clicking under my scalpel. It was a piece
of glass. The patient then remembered breaking a
glass in her kitchen and getting glass in the
foot. She thought she got it all out. I removed
the glass fragment. Problem solved.

I also had a patient (a runner) who was suffering
from pain in the 1st MTP joint. A fusion was
recommended by two other podiatrists. Passive ROM
was restricted to about 45 degrees of
dorsiflexion. The 1st ray was profoundly
hypermobile. No orthotic was recommended to this
patient. Just surgery. I put the patient in a
custom orthotic with a 1st ray cut out. About 75%
of the discomfort was resolved. To work toward
getting him asymptomatic, I gave him an HA
injection followed 2 weeks later by an RPA
injection. He has been asymptomatic since then (7
months now). And is running long distances again.

IMO, we need to return to medical management.
Obviously, if conservative management does not
succeed, surgery can always be done. But podiatry
has fooled itself into thinking we would achieve
more respect from the MD/DO world if we became
super surgeons (sacred myth) and we could achieve
payment parity with MDs and DOs. That definitely
has not happened. And when a surgery fails, it's
imperative that we examine why it failed. Not just
from a procedural failure point of view. But from
an immune system perspective. I understand the
first surgeon. I can even understand the second.
But the third surgeon needs to ask why these prior
surgeries failed. It's usually not a surgical
problem. It's an immune efficiency problem where
repair dynamics are less than desirable.

Finally, I agree (and I never did before) that the
D.P.M. degree needs to be retired. It's time we
merged our specialty into MD and DO programs so
future podiatrists won't be embarrassed to call
themselves podiatrists. And that is obvious when
you go to LinkedIn and see that very few
podiatrists call themselves podiatrists. They are
foot surgeons or foot and ankle surgeons.

I can honestly say I owe a lot to the practice of
podiatric medicine and surgery. It provided me
with a degree to create a beautiful and successful
life. But I do not feel I owe my thanks to a
profession that has chronically mishandled our
challenges. And too many young podiatrists have
shared with me that they were told in residency
that they would never survive without PE
employment. That is totally untrue and unfair.

I graduated in 1980, and in all of my years as a
podiatrist, I do not believe we have solved most
of the problems we faced way back then and sadly,
we have created others that have not served us
well. And now we have come to the point where we
speak about the extinction of podiatry. That would
be a great loss to medicine.

Robert Kornfeld, DPM, New York, NY

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