‘It’s Just A Foot:’ Contemplating Perceptions Of Our Work Among Fellow Physicians

How many times have I heard “it’s just a foot” from general surgeons, internists, traumatologists and other specialists over the course of my career? Unfortunately, too many times to count. I have even heard it and continue to hear it at the Level I trauma center where I have been practicing, along with two other full-time attendings and six residents, for 25 years. We spend numerous hours in the classroom, going through residency, attending conferences, reading the literature, and you’re telling me it is just a foot? Maybe I have wasted my time. However, my wife and mortgage company know the value of all of the feet I have seen and still see to this day!

Do I ever tell another physician that it is just a heart, an appendix or a cranium? Unfortunately, the foot is often maligned and undervalued. But why? Maybe it is not the foot but the associated practitioner (a podiatrist) who is the recipient of the scorn? Does that same physician tell the foot and ankle orthopedist “it is just a foot” or is the foot viewed as more important when an orthopedist is involved?

I refuse to ask so I will never know. The answer I may receive would prompt harsh words on my part. Boy can those doctors find us, though, if they have their own foot problems or when they consult us for nail care. Then we are the experts!

Why is it then that my elderly patients always tell me, “Doc, when your feet hurt, you hurt all over?” Do they know something all those doctors do not?

Maybe the health care community fails to realize that in every case that we work on, the patient walks on the result. This is very challenging in and of itself. Couple that with ground reaction forces, shoe gear and ambulation, and one can hopefully recognize the obstacles we face every day helping someone with a foot or ankle malady. Is all of this easy? I truly believe they think it is.

How many times have you been called in for a consult, only to have your recommendations ignored? Later, when that separate treatment pathway did not work, don’t you receive another call? Oh, how I would like to tell the whole bunch off but that would not be professional. It would possibly remind them who the foot and ankle experts are or it possibly would alienate them even more. What makes them think they know everything there is to know about the foot? I cannot make this claim after 30-plus years of practice. Maybe I am a slow learner.

In spite of this tirade, there are some colleagues who will defer everything to us when it comes to our scope of practice. Bless them! Fortunately, those who downgrade the importance of the foot are a small number. They just stay in your mind a little longer than necessary.

We teach and harp on the residents, no pun intended, to always put their best foot forward. How does one best accomplish this? First, act professional, ethical and empathetic. Second, know your stuff and be able to present it eloquently in written and verbal formats using scientific jargon. In other words, blow them away with what you know. Third, be in command wherever you practice, whether it is the office, operating room, emergency department or any other venue. All eyes are on you so give them all you have!

Finally, let me give you an example. We were called in to literally clean up a mess after a general surgeon’s debridement of a foot. Slash and burn would be the closest verbiage to describe what we found. Our chief resident called it perfectly: “If you are going to resect, do it with respect.” The surgeon even kept calling the resected bones ‘metacarpals’ when giving me a rundown of the surgery. I asked him whether the peroneals were intact and the silence was deafening.

Why couldn’t we have been called in at the beginning of this case? Is it a financial issue? Don’t get me started on that but perhaps that is a topic for a future column. Next time, call us in from the start. The general surgeon agreed to do just this but I am not holding my breath. Then again, it is just a foot.

Maybe I am just showing my age in being tired with all of this. Yes, we have made great strides but please don’t tell me “It’s just a foot.” You never know when it may bark at you. What will you do then? 

Dr. Wallace is the Director of the Podiatry Service and the Medical Director of Ambulatory Care Services at University Hospital in Newark, N.J.