A Doctor of Podiatric Medicine (DPM) is a specialized medical professional focused on the diagnosis, treatment, and prevention of conditions affecting the foot, ankle, and related structures of the lower leg. These practitioners are physicians who complete rigorous medical education and residency training focused entirely on the lower extremities. Podiatrists are highly trained and licensed to perform a wide range of surgical procedures. These procedures range from minor in-office corrections to complex reconstructive surgeries in a hospital setting. Their scope of practice centers on restoring function, relieving pain, and correcting deformities of the foot and ankle through both medical and surgical means.
The Extent of Podiatric Surgical Practice
The surgical practice of a DPM is defined by the anatomical region of the foot, the ankle, and the distal structures of the leg. This specialized focus allows podiatric surgeons to develop deep expertise in the biomechanics and pathology unique to this area of the body. Podiatric surgical training encompasses procedures on the soft tissues, bone, and joints of the lower extremity. Procedures are often categorized by location, including forefoot surgery, which addresses the toes and ball of the foot, and rearfoot and ankle surgery. Rearfoot and ankle surgery involves the heel, talus, and structures around the ankle joint. Many modern residencies provide extensive training in reconstructive rearfoot and ankle surgery (RRA). The specific boundaries of a podiatrist’s surgical scope vary, as licensing is regulated at the state level. While all states permit DPMs to perform foot surgery, the extent of their authority to operate on the ankle and lower leg differs based on local statutes. Hospitals grant privileges based on a surgeon’s education, residency experience, and board certification, further tailoring their practice to their proven competence.
Educational Pathway and Surgical Training
The journey to becoming a podiatric surgeon is an intensive process mirroring the structure of other surgical specialties. It begins with four years of specialized medical school at an accredited College of Podiatric Medicine, culminating in the Doctor of Podiatric Medicine (DPM) degree. The curriculum covers foundational medical sciences, such as anatomy and physiology, and extensive coursework on the specific pathology of the lower limb. Following medical school, aspiring surgeons must complete a mandatory three-year Podiatric Medicine and Surgery Residency (PMSR). Many programs extend this to a fourth year to include the credential in Reconstructive Rearfoot and Ankle Surgery (PMSR/RRA). This residency takes place in a hospital or academic health center, providing hands-on training across various medical disciplines. Residents rotate through services like internal medicine, emergency medicine, general surgery, and orthopedics to ensure a broad understanding of systemic conditions that affect the lower extremities. Surgical training is comprehensive, involving thousands of supervised cases under experienced attending physicians. After residency, many DPMs pursue board certification through the American Board of Foot and Ankle Surgery (ABFAS). This certification requires a rigorous examination process and documentation of surgical experience, formally recognizing expertise in foot or foot and ankle surgery.
Common Surgical Procedures Performed
Podiatric surgeons routinely address conditions that have failed to respond to non-surgical treatments. They specialize in correcting deformities and repairing traumatic injuries specific to the lower extremity.
Common Procedures
Podiatrists perform a variety of procedures, including:
Bunionectomy, which involves removing the bony prominence at the big toe joint and realigning the metatarsal bone using internal hardware for stabilization.
Hammertoe repair, correcting contracted joints of the lesser toes, often requiring bone removal or joint fusion to achieve straighter alignment.
Fracture fixation, surgically realigning broken foot and ankle bones and securing them with internal hardware like screws or plates to promote proper healing.
Plantar fascia release, cutting a portion of the thick ligament to relieve tension caused by severe plantar fasciitis and persistent heel pain.
Tendon repair, addressing torn or ruptured tendons, such as the Achilles tendon, which connects the calf muscle to the heel bone.
Nerve decompression procedures, such as removing a painful Morton’s neuroma, which is a benign nerve enlargement.
Joint fusions or total ankle replacement surgery for end-stage arthritis or severe joint instability, demonstrating complex reconstructive capability.
Operating Environment and Hospital Privileges
Podiatric surgery is performed in clinical settings determined by the procedure’s complexity and the patient’s condition. Many minor procedures, such as nail surgeries or simple soft tissue biopsies, are often performed safely and efficiently in a specialized podiatry clinic under local anesthesia. More involved outpatient surgeries, like bunion or hammertoe corrections, frequently occur at ambulatory surgery centers (ASCs). For complex procedures, such as reconstructive ankle surgery, severe fracture repair, or limb salvage operations, the surgeon will operate within the sterile environment of a hospital operating room. To operate in these facilities, the DPM must undergo a formal credentialing process to obtain hospital privileges. This process involves the hospital’s medical staff reviewing the surgeon’s training, board certification status, and surgical experience to delineate the specific procedures they are authorized to perform. Podiatric surgeons are integrated members of the medical staff in many hospitals, often collaborating with specialists like orthopedic surgeons, vascular surgeons, and infectious disease physicians. This interdisciplinary approach is important for managing complex cases, such as diabetic foot infections or severe trauma. The granting of privileges ensures the DPM is recognized as a qualified surgical provider meeting institutional standards of care and safety.