There are maybe 0.2% of DPM jobs that use those skills
ever. Maybe 0.01% use those skills frequently or semi-frequently. That is the start and the end of it. Those who use the complex cases skills often (limb lengthen, supra-mall osteotomy, TAR, etc) often are tertiary referral centers... of which there are maybe 10 or 20 in the country, most of them F&A ortho (or the best attendings at pod residencies/fellowships).
Even if you go acquire those skills, think how it'll translate into a job. The fellowship DPM likely won't hire you... they've spend many years developing that niche and refers for those cases in that state or an even bigger area. Even if you're their best fellow ever, chances are slim they'd have enough cases to keep you... or pay you well.
In normal PP, you'd starve. Those cases are very inefficient (and poor payers, being disabled doesn't pay well).
In most hospital jobs, you'd starve. Those cases and office visits are very equipment and staff intensive.
In most other hospital jobs, ortho does the recon F&A (podiatry does the DM wound/amp).
If you want to do those case as they come along as an average DPM job, they will be 1/10,000 of your visits in most jobs. Even if you have residents and see 100+ patients per day, only a couple per month will even be candidates for that stuff. Even West Penn or other super busy resident clinics known in their area for F&A recon still see 100x more warts or nail care patients than triple arthrodesis. That is just how it goes.
If you can get an ortho job (chance is probably 1/300 or even 1/500 DPMs who has a true ortho group job with those type of refers for all F&A work), those cases will still be very rare. There will be many more hallux rigidus or Achilles tendonitis as opposed to "needs a Taylor Spatial Frame recon."
Common things occur commonly.
Heel pain and ingrowns and skin/nail issues are super common.
Bunions and hammertoes are pretty common.
Ankle sprains are common, but ortho will take most... and surgery is rare if you're ethical.
Ankle and foot fractures are common, but ortho will take most (esp ankle).
Flat foot is fairly common, but decent surgical candidates are fairly uncommon (unless you like to do surgey on 300 pounders that will fail).
Charcot is somewhat common, but the ppl who do big surgery on it are dumb and/or doing it just for RVUs.
Cavus surgery is pretty uncommon.
Ankle arthritis is uncommon.
Deformity correction is ultra-uncommon. It is non-existent in the vast majority of DPM practices.
...Basically, you are living in resident fantasy land where between all of your reading and attendings, rare things seem common. Look at the attendings of your program... even the good ones probably only do a few cavus foot recons or ankle OA surgeries per year. Would you do a fellowship in de-syndactly surgery and brachymet? Of course not. Advanced deformity is equally rare and hard to get any meaningful amount of refers for.
Everyone thinks they will do way better than average, be different, that rules don't apply. Statistically, you will not... rules and averages
do apply. Again, look at your residency attendings and your program's alumni. See what average is. You are looking at fellowships as much as a way to extend the party and avoid the jobs/loans as for actual practicality. A lot of residents fall into that trap... jobs suck, so I will try to delay and take on more debt to gain some edge with skill that is unnecessary or impractical. That is poor reasoning. Most people won't even use all of the skills they learn in a good podiatry residency - much less a fellowship. In the end, do what you like. It's your career - and your money.
