Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences,
St, Pomona, CA

The Question: Should Podiatrists
Provide Free Care?

Recently, I saw a 39 year-old patient in the office. She’d been referred by another physician after a failed ankle arthrodesis. She was one of those patients with a long history of multiple lower extremity surgeries, after being born with an idiopathic clubfoot deformity. She’d reached the point where osteoarthritis set in (a clear complication of the Grice extra-articular subtalar arthrodesis she’d undergone at 13 years-old). She limped in to my office almost unable to walk due to her ankle pain. Without getting too deep into the details, the most recent attempt to help her was made by another physician, a fusion of her ankle, which failed and resulted in an ankle valgus deformity. An interesting patient to help, made all the more “interesting” when I found out she had Medical insurance (California’s version of Medicaid, which only covers podiatric services in emergent situations – currently under debate in the legal system). As such, if I took her on as a patient, I would have to do so without myself being paid.

Tonight's Premier Lecture is
The Basic
Biomechanical Exam
by Robert Phillips, DPM

For the sake of our discussion, I’d like to point out this is a young patient with many years of life ahead of her. She has already attempted various nonsurgical options, including several AFOs, physical therapy, and injections, so we know she’s at the point where she has few if any nonsurgical options. What do you think? Should I send her to vascular surgery for an amputation? Should I perform her reconstruction? What would you do? Share your thoughts on eTalk.