The Final Frontier for the Podiatric Surgeon-Scientist: Multidisciplinary Research Teams

 

The concept of a multidisciplinary team is not new. Multidisciplinary teams have been around for decades, and perhaps are most successful in limb preservation;^1–5 however, many podiatric surgeons do not collaborate with DOs and MDs when it comes to research. You can look no further than to our own academic journals; most of our publications will not include a single osteopathic or allopathic physician. While it is true that podiatric surgeons take a backseat to no other specialty when it comes to foot and ankle surgery, we feel too many of us fail to consider the perspectives of our nonsurgical colleagues, as well as other specialties, to a fault.

In the discipline of surgery, there is a need for more high-level evidence studies focused on long term outcomes.^6,7 When podiatric surgeon-scientists are developing the parameters of these much-needed studies and preparing to go through the institutional review Board (IRB) process, it may be pertinent and beneficial to reach out to a colleague of another specialty. Adding an additional perspective can potentially bolster your research project. It also opens up a two-way street of connection between you and a colleague. When conducting a study that mirrors a previous published project, perhaps a study previously done in another specialty, reaching out to the corresponding author with an invitation may be beneficial to your own study; many researchers, if given the opportunity to “redo” a study, may do certain things differently based on the knowledge gained. For example, in survey research, this concept is often why a “pilot survey” is done.^8,9 Through multidisciplinary collaboration, we advance not only podiatry but other specialties as well. Sometimes these teams are MD-led, sometimes DO-led, and sometimes they can be DPM-led.

An example of a DPM-led multidisciplinary research team, is that of Brooks and colleagues when a collaboration between podiatry, psychiatry, and addiction medicine developed the “Diabetic Foot – Pain – Depression Cycle.”¹⁰ This team highlighted the importance of all surgeons screening the diabetic population for depression both pre- and postoperatively when performing forefoot amputations (ie, toe, ray, or transmetatarsal).¹⁰  Brooks and team concluded that patients treated for depression had significantly reduced odds of using opioids beyond the first week following surgery.¹⁰ It is well-documented that depression is underdiagnosed in the diabetic population.^11–15 This is the same population that tends to have altered epicritic and protopathic sensation.¹⁰ Many don’t feel pain the same way a patient undergoing an elective first metatarsal osteotomy would. These authors also concluded that the pain felt by this population undergoing any forefoot amputation may be related to depression more so than the actual surgery.¹⁰ Ultimately, this multidisciplinary research team demonstrated the need for DPMs to  screen certain patients for depression.¹⁰

As podiatry becomes increasingly specialized, we should not forget about the input and insight of our allopathic and osteopathic colleagues. In the same way that we can benefit their studies, they can benefit ours. As podiatry continues to flourish as a profession, we should pay homage to the giants that built our profession by continuing to advance it forward rather than being stagnant.^16–21 We are experts on foot and ankle medicine and surgery, but if we are only hyper-focused on competing, then we may lose sight of the forest from the trees. The podiatric surgeon-scientist that advances our profession is the one who is open to collaborating with those both inside and outside of our profession. This is the final frontier for the podiatric-surgeon scientist.

Dr. Johnson is the Chairman of the American Society of Podiatric Surgeons and a Clinical Assistant Professor at the University of Michigan.

Dr. Brooks is the Chief of Podiatry at the Columbia VA Health System.

Disclaimer: The views and opinions expressed are those of the author(s) and do not necessarily reflect the official policy or position of Podiatry Today or HMP Global, their employees and affiliates. Any content provided by our bloggers or authors are of their opinion and are not intended to malign any religion, ethnic group, club, association, organization, company, individual, anyone or anything.

References

1.             Sanders LJ, Robbins JM, Edmonds ME. History of the team approach to amputation prevention: pioneers and milestones. J Am Podiatr Med Assoc. 2010;100(5):317-334. doi:10.7547/1000317
2.             Van Acker K, Garoufalis M, Wilson P. POINT: podiatry for international diabetic foot teams. J Wound Care. 2018;27(Sup11):1-32. doi:10.12968/JOWC.2018.27.SUP11.1
3.             Crowell DM. Building spirited multidisciplinary teams. J Perianesth Nurs. 2000;15(2):108-114. doi:10.1053/PA.2000.5785
4.             Driver VR, Fabbi M, Lavery LA, Gibbons G. The costs of diabetic foot: The economic case for the limb salvage team. J Vasc Surg. 2010;52(3 SUPPL.):17S-22S. doi:10.1016/j.jvs.2010.06.003
5.             Musuuza J, Sutherland BL, Kurter S, Balasubramanian P, Bartels CM, Brennan MB. A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers. J Vasc Surg. 2020;71(4):1433-1446.e3. doi:10.1016/J.JVS.2019.08.244
6.             Diener MK, Simon T, Büchler MW, Seiler CM. Surgical evaluation and knowledge transfer--methods of clinical research in surgery. Langenbecks Arch Surg. 2012;397(8):1193-1199. doi:10.1007/S00423-011-0775-X
7.             Søreide K, Alderson D, Bergenfelz A, et al. Strategies to improve clinical research in surgery through international collaboration. Lancet. 2013;382(9898):1140-1151. doi:10.1016/S0140-6736(13)61455-5
8.             Woodland J, Foster K, Robertshaw D. Nursing in the 21st century: results of a pilot survey on attitudes towards nurses and nursing. Br J Nurs. 2022;31(4):230-238. doi:10.12968/BJON.2022.31.4.230
9.             Barthold D, Brah AT, Graham SM, Simoni JM, Hauber B. Improvements to Survey Design from Pilot Testing a Discrete-Choice Experiment of the Preferences of Persons Living with HIV for Long-Acting Antiretroviral Therapies. Patient. 2022;15(5):513-520. doi:10.1007/S40271-022-00581-Z
10.            Brooks BM, Shih CD, Brooks BM, Tower DE, Tran TT, Simon JE, Armstrong DG. The Diabetic Foot-Pain-Depression Cycle. J Am Podiatr Med Assoc. 2023 May-Jun;113(3):22-126. doi: 10.7547/22-126. PMID: 37463195.
11.            Wagner JA, Tennen H, Osborn CY. Lifetime Depression and Diabetes Self-management in Women with Type 2 Diabetes: A Case Control Study. Diabet Med. 2010;27(6):713. doi:10.1111/J.1464-5491.2010.02996.X
12.            Roy T, Lloyd CE. Epidemiology of depression and diabetes: A systematic review. J Affect Disord. 2012;142(SUPPL.):S8-S21. doi:10.1016/S0165-0327(12)70004-6
13.            Bădescu S V., Tătaru C, Kobylinska L, et al. The association between Diabetes mellitus and Depression. J Med Life. 2016;9(2):120-125. Accessed February 23, 2022. https://pubmed.ncbi.nlm.nih.gov/27453739/
14.            Semenkovich K, Brown ME, Svrakic DM, Lustman PJ. Depression in type 2 diabetes mellitus: prevalence, impact, and treatment. Drugs. 2015;75(6):577-587. doi:10.1007/S40265-015-0347-4
15.             De Groot M, Anderson R, Freedland KE, Clouse RE, Lustman PJ. Association of depression and diabetes complications: a meta-analysis. Psychosom Med. 2001;63(4):619-630. doi:10.1097/00006842-200107000-00015
16.             Schuster RO. A history of orthopedics in podiatry. J Am Podiatry Assoc. 1974;64(5):332-345. doi:10.7547/87507315-64-5-332
17.             Root ML. An approach to foot orthopedics. 1964. J Am Podiatr Med Assoc. 2003;93(1):63-65. doi:10.7547/87507315-93-1-63
18.             Helfand AE. Podogeriatrics: an historical review. J Am Podiatry Assoc. 1974;64(5):357-363. doi:10.7547/87507315-64-5-357
19.             Payne CB. The past, present, and future of podiatric biomechanics. J Am Podiatr Med Assoc. 1998;88(2):53-63. doi:10.7547/87507315-88-2-53
20.             Hymes L. History of modern operative podiatry. J Am Podiatry Assoc. 1974;64(5):364-372. doi:10.7547/87507315-64-5-364
21.             Dagnall JC. The history of podiatry. J Am Podiatry Assoc. 1976;66(12):944-947. doi:10.7547/87507315-66-12-944