Letter to the Editor

Public Health and Podiatry

To the Editor:

The President’s Message from Christian A. Robertozzi, DPM, on “Public Health and Podiatry,” published in the March/April 2008 issue of JAPMA, had a most important theme, emphasizing the nation’s health. Emphasizing the important role of podiatric physicians in preventing disease in our patients and in the community in general, is indeed important, and is certainly a function of the profession that cannot be overstated.

However, our role can and should be considerably broader than what probably is the one most practiced by podiatric physicians. Because we often see patients even more frequently than the patient’s family physician (ie, internist, family medicine physicians, pediatrician), we are in a position to have one of the strongest roles in preventive health care and in the health care of the community. For example, no patient should visit a DPM without having their blood pressure checked. This could be done very quickly by the podiatric physician or by their assistant on a routine basis. So many of our podiatric medical patients may have undiagnosed hypertension or hypertension that is either not being treated adequately or is out of control. Not only would such a finding be useful to the establishment of a podiatric treatment plan but would also be vital to the overall health of the patient. In addition, referring patients with abnormal blood pressure to the physician who is managing their overall health care will not only be a major contribution to their health but will expand relationships with others in the health-care community, increasing the perceived role of podiatric medicine.

Our contribution to cardiovascular health also needs to be articulated. People who are unable to walk comfortably or engage in appropriate physical exercise because of a podiatric disorder are more likely to become overweight or obese, develop life-threatening cardiovascular disease, or become the victim of diabetes and perhaps suffer from its many systemic and podiatric complications. Preventive or definitive podiatric medical care not only will improve their foot health, but can be extremely important to their overall health, perhaps even life saving. Because of the often long-term doctor-to-patient relationship that we develop with our patients, they are considerably more likely to take our advice to refrain from smoking or, if they already are a smoker, to enter into a smoking cessation program. Simply reminding a patient who already smokes to cease doing so prior to foot surgery is not adequate enough.

Too often we focus our role in prevention solely on the lower extremity. This undervalues the very important role that we have in the total health of our patients and in the community. An expanded role in public health and prevention has an impact, not only on the health of the community and on individuals, but on the enormous costs to society that podiatric medical care can save both directly and indirectly. Much more emphasis needs to be given by our profession to this expanded context in public health and to the added value that it will provide to the public. Indeed, making this paradigm shift can even have a major influence on policy makers regarding their perception of podiatric medicine within the health-care community.

Author’s Response

To the Editor:

I agree with Dr. Levy. There is plenty that we can do with regard to public health besides what is in the article. His letter reinforces that there are many things we can do in the office that would benefit the patient and give a greater role in the overall health of our patients.

Christian A. Robertozzi, DPM, Past President, APMA, 222 High St, Newton, NJ 07860