I appreciate your input and wanted to clarify that I would not plan to do anything outside of qualifications but it’s hard to know that is considered foot qualification vs RRA....
There is no line in the sand (foot) for foot vs RRA.
ACFAS privileging guidelines just recommend ABFAS cert for procedures... and appropriate case logs, volume, competency monitored, etc. I think they suggest course training cert for scopes or TARs, but I haven't looked at it in awhile. It's a good read... doesn't really delineate Foot vs RRA. A lot of hospitals and Chiefs of Podiatry follow that (because it's good... and so they can't be accused of being subjective).
Regardless, as was said, get all the certs you can, pass the tests, have the logs, bring your 'A' game for anything you do. You won't go wrong that way (even if you are not allowed to use your full training in most places).
At the end of the day, in any surgery field, there are lions and foxes...
-The lions are the young ones who are hungry and aggressive and getting numbers for boards and will put a plate and screws on 98% of fractures they see, do recon on obese people, salvage obvious osteomyelitis in the cunieforms, etc. They are often talented and well trained and meaning well. Results can be good, bad, or often even good on xray yet disastrous in the pt eye. A lot comes down to communication.
-The foxes are your surgeons who have been there and done that (or at least read and watch enough to see the train wrecks of others). They learn to spot the ones that will do fine with non-op, the ones who should not have any op, the 'CRPS-prone,' etc. They usually do good work (or refer it appropriate), but they might ORIF 60% of fractures. Most still do a fair amount of surgery - and not all even have gray hair, but they pick their spots and spend as much time talking to patients as they do talking to reps and drooling over fixation and implant options. The sooner you can graduate to fox, the better for your sleep and sanity and weekends... and usually better for your pts also.
So, example from yesterday: ER sends me early 50s guy with splinted calc fx intra-articular. He is a laborer who fell off a ladder, not overweight, light smoker, former EtOH but now under control, ipsi ankle ORIF many years ago, DVT from a few years ago (etiology unclear since he had spotty care with pandemic) and still on Xeralto, lives alone without much help available. Exam is ecchymotic edema heel and palpable pulses and WNL temp and cap refill. Xray shows calc fx with height and length ok, clinically pretty rectus. He has CD of ER CT from yesterday, and it's a blown up calc body with lateral blowout with some anterior facet trouble but very minimal posterior facet damage. We talk for 20mins while I put a Jones and show XR on about how the Achilles will shorten if he walks, he feels he can use the crutches ok, fit him a CAM boot, risk of DVT, risk of surgery, risk of not fixating, etc. I explain how he has a 500% chance of arthrosis due to the injury (and prior ankle bimall), possible future hindfoot brace or injects or recon (whether or not we did ORIF now or not). He was cool with it and thanked me.
...so, 30 year old me would've been on the phone figuring out Xeralto and an OR time next week without much thought.
...current ~10yrs later me is going to leave it, even though he's a fair surgical candidate with significant injury, and I would like the case for RRA boards. I think the balance is in favor of non-op (I would've done ORIF for him if it was in any significant varus or shortened, though). I did the same non-op treatment for at least a couple waifish 20s girls at my last IHS job who had worse fx on CT (no terrible varus or shorten, but pretty bad post facet), but I chose to cast since they had really sketchy domestic/transportation situations or drug issues. I also ORIFed a few of the same injuries in other patients with better social support and less issues, but I just try to pick my spots to the best of my ability and training... you can almost always kick the can down the road and do re-align or STJ or triple later on. In a lot of surgery, the soft skills are as important as the suture and bone skills. Maybe I'm getting old
