If so, is this a good thing? What about the nonsurgical aspects of podiatry? Is there still a place for “chiropody” in the podiatry world?

I'm not sure what the answers are. I'm sure the folks in the biomechanics world would argue this part of foot and ankle care is alive and well. They'd point to the highly competitive orthotic and prosthetic market. Just look at all of the advertisements in our journals for over-the-counter inserts as well as the large number of orthotics companies. The wound care experts would similarly argue that a huge market exists for wound healing modalities and off-weighting technologies. There's no shortage of boots, shoes, and cast supplies for our diabetic wound patients, to say nothing of the advanced healing technologies like Apligraf, Oasis and the like. Additionally, there's a large and growing market for in-office dispensed products.

This all may be true, but let’s take a look at the surgical side of podiatry.  I think it would be hard to argue that our residencies are increasingly surgically oriented.  I spent three years in a mixed medicine and surgery program learning almost all aspects of medicine. We spent significant time in clinics learning office medicine and even had a dedicated biomechanics clinic weekly. However, the emphasis was clearly surgical. I spent most of the time in surgery (which is where I wanted to be). When I looked at a patient with pathology my second thought, after diagnosis, was which surgical procedure would be best for that problem. I’ll admit I still think that way even while I’m discussing nonsurgical care. 

So, if I’m part of the new generation of podiatrists, and we’re increasingly surgically oriented, what does that mean for the other aspects of our specialty?  Well, whatever the answer to this question, let me clue in to reality those residents or new practitioners who think they’re going to spend their years in the OR.  The reality is unless you’re in a focused practice like a wound clinic or perhaps a university setting (or just lucky) your “bread and butter” pathology will likely still be onychomycosis, verruca plantaris, plantar fasciitis, corns and calluses, and the like. This is especially true at the beginning of your practice. Is this a bad thing?  I don’t think so.

First, and most importantly, your job as a physician is to help patients. Often that means trimming their toenails or other such ignoble jobs.  If this is your primary goal then I promise you will be very satisfied when your patient tells you how much better she feels after the P&A you just did or the decrease in heel pain of your plantar fasciitis patient after starting orthoses.  You can be a hero without having performed a complex reconstruction.

Second, it’s the “small stuff” that will pay the bills in many cases. I’ve noticed surgery to be cyclical throughout the year with an increase in volume after patients pay their deductibles. Nail trimming will keep your practice running during the lean months.