A podiatric surgeon is a doctor who specializes in surgical treatment of the foot and ankle. Unlike orthopedic surgeons, who operate across the entire musculoskeletal system, podiatric surgeons focus exclusively on the structures below the lower leg. They hold a Doctor of Podiatric Medicine (DPM) degree rather than an MD or DO, and they complete a dedicated surgical residency focused on foot and ankle procedures.
Training and Education
Becoming a podiatric surgeon requires four years of podiatric medical school followed by a three-year surgical residency. During medical school, students study the vascular, neurological, dermatological, and musculoskeletal systems of the foot and ankle in depth. The residency then provides hands-on training in both inpatient and outpatient surgical management.
This path differs significantly from an orthopedic surgeon’s training. Orthopedic surgeons complete four years of general medical school (earning an MD), then a five-year residency covering the entire musculoskeletal system, including the spine, hand, hip, and knee. A podiatric surgeon’s training is narrower but deeper within its focus area.
After residency, podiatric surgeons can pursue board certification through the American Board of Foot and Ankle Surgery (ABFAS). Certification involves passing both written and case-review exams in two categories: foot surgery and reconstructive rearfoot/ankle (RRA) surgery. Candidates must hold an unrestricted podiatric license and maintain active surgical privileges at a hospital or surgery center. If they don’t achieve full certification within seven years of qualifying, they lose eligibility.
Scope of Practice
A podiatric surgeon’s core territory is the forefoot and the soft tissues of the foot. With additional RRA certification, their scope expands to include the bones of the hindfoot, the ankle joint, and part of the lower leg. They do not operate on the knee or any structures above the lower leg.
State laws play a significant role in what a podiatric surgeon can actually do. In Kansas, for example, podiatrists cannot perform ankle surgery unless they’ve completed a three-year residency in reconstructive rearfoot/ankle surgery and are board certified or actively progressing toward certification. Kansas also requires that any ankle surgery be performed in a licensed medical care facility, not an office-based setting. Other states have their own restrictions and requirements, so the practical scope of a podiatric surgeon varies depending on where they practice.
There are also limits outside of surgery. In some states, podiatrists cannot perform a full preoperative physical examination that covers areas beyond the foot and ankle. They can assess what’s relevant to the planned procedure, but a broader medical workup falls outside their scope.
Conditions They Treat
Podiatric surgeons handle a wide range of foot and ankle problems when conservative treatments like orthotics, physical therapy, or medication haven’t worked. Common conditions include bunions, hammertoes, arthritis of the big toe or midfoot, plantar fasciitis, neuromas, tendon injuries, and fractures. They also treat complications of diabetes, which can cause severe foot wounds, infections, and structural breakdown that sometimes require reconstructive surgery to save the limb.
Limb salvage is one of the more high-stakes areas of podiatric surgery. For patients with diabetes, the goal is preserving a foot that can bear weight, remain stable, and stay free of ulcers. When reconstructive surgery succeeds, it can prevent major amputation. Research has found that patients who’ve undergone successful limb salvage fear amputation more than death, which underscores how critical this work is for quality of life. In cases where the damage is too extensive, though, amputation becomes necessary.
Common Surgical Procedures
The procedures podiatric surgeons perform range from relatively minor corrections to complex reconstructions:
- Bunion correction: Reshaping or removing bone, realigning tendons and ligaments, and using screws or plates to hold the new joint position. The approach depends on how severe the deformity is.
- Hammertoe repair: For flexible toes, a minimally invasive release may be enough. Rigid deformities often require tendon transfer or joint fusion, with pins or wires to stabilize bones during healing.
- Total ankle replacement: Replacing a damaged ankle joint with a prosthetic implant to preserve motion while reducing pain from arthritis or trauma.
- Big toe joint fusion: Fusing the bones of a severely arthritic big toe joint to eliminate pain, though at the cost of some movement.
- Midfoot fusion: Removing damaged cartilage, realigning the midfoot bones, and stabilizing them with metal plates or screws. This is typically done for midfoot arthritis that hasn’t responded to other treatments.
Diagnostic Tools Before Surgery
Before operating, podiatric surgeons use imaging to understand exactly what’s happening inside the foot or ankle. Standard X-rays are the starting point for evaluating fractures, joint alignment, arthritis, and bone abnormalities. They’re also used to rule out bone changes from conditions like Achilles tendon rupture or ligament injuries.
For soft tissue problems, ultrasound can identify bursitis, tendon tears, neuromas, and plantar fasciitis without radiation. MRI produces high-resolution images of soft tissue and is particularly useful for chronic foot pain or complex injuries that X-rays can’t fully explain. CT scans, including weight-bearing versions, allow precise measurement of bone position and deformities, making them especially valuable for planning surgeries involving the ankle joint or hindfoot alignment.
Podiatric Surgeon vs. Orthopedic Surgeon
The practical overlap between these two specialties is the foot and ankle. An orthopedic surgeon who subspecializes in foot and ankle work performs many of the same procedures a podiatric surgeon does, but they arrive there through a broader training path that covers the entire skeleton. A podiatric surgeon’s training is concentrated on the foot and ankle from the start.
For patients, the choice often comes down to the specific problem and the surgeon’s individual experience. If you have an isolated foot or ankle issue, a podiatric surgeon’s focused expertise is well suited to it. If your problem involves the knee, hip, or other joints in addition to the foot, an orthopedic surgeon can address the full picture. In many hospitals and surgical centers, the two specialties work alongside each other, and referrals between them are common.