David Thordarson, MD, president of the American Orthopaedic Foot and Ankle Society (AOFAS) recently published an editorial to the members of the American Academy of Orthopaedic Surgeons (AAOS) titled “Protecting musculoskeletal care: Perspective of the president of the American Orthopaedic Foot and Ankle Society.” In this article, Dr. Thordarson exhorts his colleagues to engage with hospital credentialing committees as well as lawmakers and health-care leaders about the differences between orthopedic and podiatric training “to prevent scope creep.”
Dr. Thordarson’s article is riddled with misleading messages, exaggerations, and outright falsehoods. He references decades-old studies to support his argument. In an era in which science itself is under attack, physicians must hold themselves to an even higher standard for truth and accuracy.
APMA addresses individual inaccuracies in “Protecting musculoskeletal care” below. On behalf of our member podiatric physicians and surgeons, APMA demands that AAOS and AOFAS rescind this deceptive article.
Podiatry’s Proven Value
Dr. Thordarson notes that a 2024 analysis showed that orthopedic surgeons provide foot and ankle care with lower costs and fewer complications. The cost differences noted in the study Dr. Thordarson quoted were marginal, and the research had methodological flaws that impact the author’s findings, as detailed in a letter to the editor published in May in Foot and Ankle International.
Regardless of cost, value in health care is defined by outcomes and patient safety. A nationwide Pearl Diver analysis of 130,982 older adults with ankle osteoarthritis found that patients undergoing total ankle arthroplasty (TAA) were 51-percent less likely to fall over an 11+ year follow-up than those managed non-surgically. This reinforces that ankle surgery, such as that performed by podiatrists, improves long-term health and reduces downstream costs.
Another Pearl Diver study covering 2010–2023 demonstrated that TAA outcomes did not differ by surgeon specialty: The risk of revision, 90-day readmission, infection, and venous thromboembolism did not differ between podiatric and orthopedic surgeons. TAA survivorship is not associated with surgeon specialty; thus, care provided by podiatrists is just as safe and effective as TAA performed by other surgeons.
The current evidence is clear—podiatric surgeons deliver care that is safe and effective.
Specialized Training = Unmatched Expertise
Dr. Thordarson diminishes podiatric training for its concentration on the foot and ankle. Podiatrists, just like other physicians and surgeons, undergo three years of mandatory, hospital-based residency training, with optional fellowships for further specialization. Podiatric education also, by necessity, covers systemic health care. In fact, podiatric medical students often learn alongside MD and DO students.
Podiatric residency training is uniquely focused on the foot and ankle compared to the broader training orthopedic surgeons receive. This concentrated training produces experts from day one, with foot and ankle surgical case volumes often exceeding those of non–fellowship-trained orthopedists.
The latest outcomes research proves that this training translates into clinical equivalence between DPMs and MDs and DOs, and, in certain areas such as limb preservation, superiority for DPMs.
It is no wonder, then, that so many orthopedic practices employ podiatric surgeons to manage foot and ankle cases, or that the federal government recognizes podiatrists as physicians. Podiatrists manage patients and develop strong patient-centered relationships with our vascular surgery, internal medicine, endocrinology, rheumatology, and orthopedic colleagues.
Scope Modernization Reflects Trust, Not Turf
State legislatures modernize podiatric scope of practice because of decades of demonstrated safety and quality care. These expansions improve patient access in communities underserved by fellowship-trained orthopedists.
Recent evidence confirms no increase in complications when podiatrists perform certain ankle procedures, directly rebutting claims that scope expansion endangers patients.
Legislatures and hospitals modernize scope of practice laws and privileges for podiatrists consistent with the advancements in podiatrists’ education and training: four years of medical education, national boards, three years of residency, and lifelong CME. Podiatrists’ education and training mirrors the rigor of MD and DO training.
It is problematic to suggest that not only legislators but also hospital medical staff would advance scope of practice laws or hospital privileges without sound evidence of patient safety and quality outcomes.
Dr. Thordarson reverts to scare tactics, suggesting that podiatric scope may soon include the knee or hip. As noted by Dr. Thordarson, in a few limited states, podiatrists can treat the hands, but contrary to his assertion, podiatrists are not authorized to perform invasive surgical treatments of the hand. Treatment of the hand is limited to superficial lesions, such as warts.
Residency Growth = Access for Patients
Dr. Thordarson bemoans the fact that podiatry residency training positions are uncapped by CMS. While orthopedic residency slots are capped, podiatric residencies are not—allowing the profession to meet urgent workforce needs. With nearly 40 million Americans projected to have diabetes by 2030, the demand for limb salvage and reconstructive surgery will rise sharply.
Each year, millions of older people—those 65 and older—fall, making podiatrists vital resources to assess fall risk and implement life-saving measures to protect patients from falls.
Podiatric residency expansion ensures patient access to surgical care in both urban and rural settings. More podiatric residents mean more innovation, scholarship, and patient care capacity—critical for addressing the national physician shortage.
Collaboration Over Competition
Patients benefit most when specialties work together, not compete. Podiatrists bring unmatched expertise in diabetic limb salvage, biomechanics, minimally invasive surgery, and reconstructive foot and ankle care.
Orthopedists bring broad musculoskeletal training.
Together, we can partner on CME, collaborate on high-quality research, and develop co-management and referral pathways that elevate musculoskeletal care for all patients.
Conclusion: Standing Proud as Podiatric Physicians
The latest evidence confirms what patients and payers already know: Podiatrists deliver safe, effective, cost-saving care.
Our outcomes in total ankle arthroplasty are equivalent across specialties. Our surgeries and services reduce long-term risks such as falls in older adults. Our residency growth ensures that patients will not be left behind in a time of national physician shortages.
APMA stands firmly behind the care our members provide: Podiatry is not just protecting musculoskeletal care—it is advancing it.
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