Supporting Podiatry Through Professional Advocacy and Analysis

The American Podiatric Medical Association (APMA) Board of Trustees and staff recently completed our strategic plan, which guides the association’s operational plan and budgetary decisions for the next 3 to 5 years. As part of strategic planning, APMA revised its vision and mission.

“Vision: Improving lives through universal access to patient-centered, comprehensive lower-extremity care.”
 
“Mission: Defend member podiatric physicians' and surgeons' ability to practice to the full extent of their education and training to best serve the public health.”¹

One aspect of the mission regarding defending podiatric physicians' and surgeons' ability to practice to the full extent of their education and training continues to be attacked by the orthopedics community via comparative "research." The article by Chan, et al. in the Journal of Bone and Joint Surgery² in 2019 and, most recently, the publication by Hijji, et al. in Foot and Ankle Specialist³ are excellent examples of a long-term effort to mislead the public about the outcomes of care by podiatrists.
 
Articles like these directly oppose the mission statement above and therefore require action by not only APMA but the profession. However, action without purpose is meaningless. Responding to academic malfeasance is both appropriate and professional. Protecting the profession and all podiatric physicians is a noble endeavor that the APMA Board of Trustees takes seriously.
 
APMA's Research Working Group, cochaired by Rachel Albright, DPM, and me, is working with leading podiatric physicians to publish high-level, evidence-based research demonstrating podiatric medicine and surgery's value to the health care system. APMA’s commitment to this vital matter is evident by the monetary and personnel resources directed toward the issue. In addition, the working group's collective experience and research background are notable, with numerous research projects that I have observed to already be underway utilizing a robust data set.
 
One direct approach individuals representing various professional organizations can take is a letter to the editor.⁴ Recently, the APMA working group requested a redaction of the letter by Hoch, et al. to the Foot and Ankle Orthopedics editor without response as of publication of this blog.⁵ Redaction is entirely at the editor's discretion, whereas a letter to the editor is linked to the article permanently. A well-constructed rebuttal to questionable “research” attacking the profession is appropriate and essential. We all have a role in standing up to baseless attacks, but we must do so in a way that befits our professionalism as physicians.
 
Attacking authors of these types of articles on social media personally is not acceptable or professional. However, if a published article in a peer-reviewed journal attacks the profession, a subgroup of the APMA Working Group will evaluate the research for academic malfeasance and respond accordingly. In addition, other key podiatric stakeholders will be invited to cosign the letter to the editor, as there is strength in numbers. The goal is to make it a well-known fact the profession will not sit idly by and accept baseless attacks. The APMA Board of Trustees will tirelessly promote and defend APMA’s Vision and Mission.
 
“Stand up to hypocrisy. If you don't, the hypocrites will teach. Stand up to ignorance, because if you don't, the ignorant will run free to spread ignorance like a disease. Stand up for truth. If you don't, then there is no truth to your existence. If you don't stand up for all that is right, then understand that you are part of the reason why there is so much wrong in the world.”

—Suzy Kassem, Rise Up and Salute the Sun: The Writings of Suzy Kassem
 
Dr. DeHeer is the Residency Director of the St. Vincent Hospital Podiatry Program in Indianapolis. He is a Fellow of the American College of Foot and Ankle Surgeons, a Fellow of the American Society of Podiatric Surgeons, a Fellow of the American College of Foot and Ankle Pediatrics, a Fellow of the Royal College of Physicians and Surgeons of Glasgow, and a Diplomate of the American Board of Podiatric Surgery. Dr. DeHeer is a Partner with Upperline Health and the Medical Director of Upperline Health Indiana. Dr. DeHeer discloses that he is a speaker for Paragon 28, and that he owns stock in and is employed by Upperline Health.

References
1. American Podiatric Medical Association. APMA Mission Statement.

2. Chan JJ, Chan JC, Poeran J, Zubizaretta N, Mazumdar M, Vulcano E. Surgeon type and outcomes after inpatient ankle arthrodesis and total ankle arthroplasty: a retrospective cohort study using the nationwide premier healthcare claims database. J Bone Joint Surg. 2019; 101(2):127–135.

3. Hijji FY, Goodwin TM, Sich MA, et al. A survey analysis of patient understanding and preferences for podiatrists versus foot and ankle orthopaedic surgeons. Foot Ankle Spec. 2022; 19386400221126209.

4. eLetter exchange between Lee C. Rogers, DPM, director of the American Board of Podiatric Medicine; D. Scot Malay, DPM et al.; and Ettore Vulcano, MD et al., authors of a JBJS study titled “Surgeon Type and Outcomes After Inpatient Ankle Arthrodesis and Total Ankle Arthroplasty”

5. Hoch CP, Scott DJ, Brinton DL, Maldonado L, Gross CE. Increased complication rate associated with podiatric surgery. Foot Ankle Orthopaedics. 2022; 7(1):2473011421S00245.

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