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Podiatric Ankle Surgery Privileges for Podiatry

Chapter 438 of the Laws of 2012 amended the Education Law section 7001 and added new Education Law sections 7009 and 7010 to expand the scope of practice of podiatry and to establish requirements for the issuance of ankle surgery privileges which will enable podiatrists holding the privileges to perform certain procedures they had not previously been authorized to perform. The new law took effect on February 17, 2014, together with implementing regulations. An explanatory presentation concerning the new law is available here.

Types and Scope

Chapter 438 of the Laws of 2012 established two new credentials, the holders of which are authorized to perform podiatric ankle surgery. The two new credentials are:

  • Podiatric Standard Ankle Surgery Privilege – Podiatrists who hold a privilege to perform podiatric standard ankle surgery may perform surgery on the ankle1 which may include soft tissue and osseous procedures, except those procedures specifically authorized for podiatrists holding a podiatric advanced ankle surgery privilege.
     
  • Podiatric Advanced Ankle Surgery Privilege – Podiatrists who hold a privilege to perform podiatric advanced ankle surgery may perform surgery on the ankle1 which may include:
    • ankle fracture fixation,
    • ankle fusion,
    • ankle arthroscopy,
    • insertion or removal of external fixation pins into or from the tibial diaphysis at or below the level of the myotendinous junction of the triceps surae, but does not include the surgical treatment of complications within the tibial diaphysis related to the use of such external fixation pins, and
    • insertion and removal of retrograde tibiotalocalcaneal intramedullary rods and locking screws up to the level of the myotendinous junction of the triceps surae.

Possession of a podiatric ankle surgery privilege does not authorize:

  • the surgical treatment of complications within the tibial diaphysis related to the use of external fixation pins;
  • partial or total ankle replacements; or
  • the treatment of pilon fractures.

1For purposes of the podiatric ankle surgery privileges, the term “ankle” is defined as “the distal metaphysis and epiphysis of the tibia and fibula, the articular cartilage of the distal tibia and distal fibula, the ligaments that connect the distal metaphysis and epiphysis of the tibia and fibula and talus, and the portions of skin, subcutaneous tissue, facia, muscles, tendons, ligaments and nerves at or below the level of the myotendinous junction of the triceps surae.”

Podiatric Ankle Surgery Requirements

An applicant for the podiatric standard or advanced ankle surgery privilege must:

  • be licensed as a podiatrist in New York State;
  • file an application with the Department (Form 1PODPR); and
  • pay the licensure and first registration fee of $430.

Standard Ankle Surgery Requirements

An applicant must satisfy one of the following training and certification options to qualify for a podiatric standard ankle surgery privilege.

  • Option 1
    • Residency – The applicant must have graduated on or after June 1, 2006 from a 3-year residency program in podiatric medicine and surgery accredited by the Council on Podiatric Medical Education; and
    • Board certification – The applicant must be board certified in reconstructive rearfoot and ankle surgery by a national certifying board having certification standards acceptable to the State Education Department. The American Board of Foot and Ankle Surgery (formerly the American Board of Podiatric Surgery) has been determined to have certification standards acceptable to the Department.
  • Option 2
    • Residency – The applicant must have graduated on or after June 1, 2006 from a 3-year residency program in podiatric medicine and surgery accredited by the Council on Podiatric Medical Education;
    • Board qualification – The applicant must be board qualified, but not yet certified, in reconstructive rearfoot and ankle surgery by a national certifying board having certification standards acceptable to the State Education Department. The American Board of Foot and Ankle Surgery (formerly the American Board of Podiatric Surgery) has been determined to have certification standards acceptable to the Department; and
    • Additional training and experience – The applicant must submit acceptable documentation that he or she has acceptable training and experience that consists of not less than 10 ankle procedures in the five years immediately preceding application, provided that:
      • not less than 5 procedures shall be osseous procedures, and
      • not less than 5 procedures shall be soft tissue procedures.
  • Option 3
    • Residency – The applicant must have graduated before June 1, 2006 from a 2-year residency program in podiatric medicine and surgery accredited by the Council on Podiatric Medical Education;
    • Board certification – The applicant must be board certified in reconstructive rearfoot and ankle surgery by a national certifying board having certification standards acceptable to the State Education Department. The American Board of Foot and Ankle Surgery (formerly the American Board of Podiatric Surgery) has been determined to have certification standards acceptable to the Department; and
    • Additional training and experience – The applicant must submit acceptable documentation that he or she has acceptable training and experience that consists of not less than 20 ankle procedures in the five years immediately preceding application, provided that:
      • not less than 10 procedures shall be osseous procedures, and
      • not less than 10 procedures shall be soft tissue procedures.

Advanced Ankle Surgery Requirements

An applicant must satisfy one of the following training and certification options to qualify for a podiatric advanced ankle surgery privilege.

  • Option 1
    • Residency – The applicant must have graduated on or after June 1, 2006 from a 3-year residency program in podiatric medicine and surgery accredited by the Council on Podiatric Medical Education; and
    • Board certification – The applicant must be board certified in reconstructive rearfoot and ankle surgery by a national certifying board having certification standards acceptable to the State Education Department. The American Board of Foot and Ankle Surgery (formerly the American Board of Podiatric Surgery) has been determined to have certification standards acceptable to the Department; and
    • Additional training and experience – The applicant must submit acceptable documentation that he or she has acceptable training and experience that consists of:
      • not less than 10 ankle procedures in the five years immediately preceding application, provided that:
        • not less than 5 procedures shall be osseous procedures, and
        • not less than 5 procedures shall be soft tissue procedures; and
      • in the 10 years immediately preceding application, not less than 15 ankle fracture fixation, ankle fusion, and ankle arthroscopy procedures that include:
        • not less than 3 ankle fracture fixation procedures which may, but need not, include:
          • the insertion or removal of external fixation pins into or from the tibial diaphysis at or below the level of the myotendinous junction of the triceps surae, but does not include the surgical treatment of complications within the tibial diaphysis related to the use of such external fixation pins, and/or
          • the insertion and removal of retrograde tibiotalocalcaneal intramedullary rods and locking screws up to the level of the myotendinous junction of the triceps surae;
        • not less than 3 ankle fusion procedures; and
        • not less than 1 ankle arthroscopy procedure.
  • Option 2
    • Residency – The applicant must have graduated before June 1, 2006 from a 2-year residency program in podiatric medicine and surgery accredited by the Council on Podiatric Medical Education;
    • Board certification – The applicant must be board certified in reconstructive rearfoot and ankle surgery by a national certifying board having certification standards acceptable to the State Education Department. The American Board of Foot and Ankle Surgery (formerly the American Board of Podiatric Surgery) has been determined to have certification standards acceptable to the Department; and
    • Additional training and experience – The applicant must submit acceptable documentation that he or she has acceptable training and experience that consists of:
      • not less than 20 ankle procedures in the five years immediately preceding application, provided that:
        • not less than 10 procedures shall be osseous procedures, and
        • not less than 10 procedures shall be soft tissue procedures; and
      • in the 10 years immediately preceding application, not less than 15 ankle fracture fixation, ankle fusion, and ankle arthroscopy procedures that include:
        • not less than 3 ankle fracture fixation procedures which may, but need not, include:
          • the insertion or removal of external fixation pins into or from the tibial diaphysis at or below the level of the myotendinous junction of the triceps surae, but does not include the surgical treatment of complications within the tibial diaphysis related to the use of such external fixation pins, and/or
          • the insertion and removal of retrograde tibiotalocalcaneal intramedullary rods and locking screws up to the level of the myotendinous junction of the triceps surae;
        • not less than 3 ankle fusion procedures; and
        • not less than 1 ankle arthroscopy procedure.

Documentation of Residency Completion

Each of the 5 options for obtaining a podiatric ankle surgery privilege requires graduation from a residency program in podiatric medicine and surgery. (See above for the specific residency requirement for each option.) To document graduation from the required residency program, the applicant must complete Section I of Form 4PODPR and then send it to the Program Director of the residency program from which the applicant graduated. The form must be received directly from the residency program; the Department cannot accept the form if it comes directly from the applicant.

Documentation of Board Status

Four of the 5 options for obtaining a podiatric ankle surgery privilege require that the applicant be board certified in reconstructive rearfoot and ankle surgery by a national certifying board having standards acceptable to the State Education Department. The fifth option requires board qualification status from such a certifying board. To document the required board certification or board qualification status, the applicant must have verification of such status submitted directly from the certifying board to the State Education Department. The verification should be sent to New York State Education Department, Office of the Professions, Division of Professional Licensing Services, Podiatry Unit, 89 Washington Avenue, Albany, NY 12234-1000. The Department cannot accept verification from the applicant.

Documentation of Additional Training and Experience

The documentation required of the additional training and experience required for issuance of a podiatric ankle surgery privilege will depend on the setting in which the procedures are performed. The applicant must complete Form 4PODPRA and send it to the Department at the address indicated on the form. The applicant must also complete Section I of Form 4PODPRB and then send it to the appropriate individuals, as indicated below, for verification of the completion of the required procedures. The form must be received by the Department directly from the individual verifying the completion of the procedures; the Department cannot accept the form if it comes directly from the applicant. The applicant should complete Section I of as many Form 4PODPRBs as are necessary to document all of the required procedures and then send them to appropriate individuals.

  • Procedures completed during residency – The Form 4PODPRB must be received by the Department from the Program Director.
  • Procedures completed under ankle surgery limited permit – The Form 4PODPRB must be received by the Department from the podiatrist or orthopedic surgeon who provided the supervision required for procedures performed under the applicant’s ankle surgery limited permit.
  • Procedures completed in other circumstances – In some circumstances, an applicant may have completed the required procedures in another setting in which he or she is authorized to perform those procedures (e.g., in another jurisdiction in which the applicant is licensed and the scope of practice includes the performance of such procedures). In such circumstances, the Form 4PODPRB must be received by the Department from an individual who serves as chief of service of the appropriate department of the facility or facilities in which the procedures are performed or from an individual who performs a comparable function if there is no appropriate chief of service.
  • Note 1: The procedures to be used toward either of the ankle surgery privileges must have been performed within a specified time period preceding the application for the privilege. Procedures performed outside of that time period will not be counted.
  • Note 2: Procedures performed in a residency program in podiatric medicine and surgery may be used to satisfy the osseous/soft tissue requirements for option 2 for the standard ankle surgery privilege and for option 1 for the advanced ankle surgery privilege, if those procedures are performed within the 5 years immediately preceding application.
  • Note 3: Both procedures performed in a residency program in podiatric medicine and surgery and procedures used to satisfy the osseous/soft tissue requirements for the advanced ankle surgery privilege may be used to satisfy the ankle fixation, ankle fusion, and ankle arthroscopy requirements for that privilege, if those procedures are performed within the 10 years immediately preceding application.

Acceptable Procedures to Qualify for an Ankle Surgery Privilege

In choosing procedures to include on Forms 4PODPRA (Applicant Training and Experience Record) and 4PODPRB (Certification of Training and Experience), the submitted procedures must be ones that the podiatrist was legally authorized to perform (e.g., under a limited residency permit, under a limited ankle surgery permit, or in a jurisdiction that permitted such procedures). The general rule is that procedures that were in former scope of practice of podiatry (those that a podiatrist could perform prior to February 17, 2014 if competent to do so) are not acceptable toward the procedures required for an ankle surgery privilege. There are, however, certain procedures that were in the former scope that are acceptable. These include:

  1. Ankle fusion – Under the former scope, a podiatrist could perform that part of the fusion that involves the talus but not that part of the procedure that involved the tibia or fibula. To the extent that the knowledge and skills needed to perform the portion of the procedure that was in the former scope are the same as the knowledge and skills to perform those parts of the procedure that are in the expanded scope, ankle fusion procedures in which the podiatrist acted within the former scope are acceptable.
  2. Ankle arthroscopy – Under the former scope, a podiatrist could perform an arthroscopic procedure on that part of the ankle that was below the ankle mortise but could not do so to treat above that level. Because the mechanics of inserting the arthroscope are the same for procedures under the new scope of practice as they are for procedures that fall under the former scope, arthroscopies performed under the former scope are acceptable toward the arthroscopy requirement. However, they would not be acceptable toward the osseous or soft tissue requirements. On the other hand, ankle arthroscopies for procedures beyond the former scope could be used toward the osseous and soft tissue requirements, provided that the podiatrist was legally authorized to perform the procedure (e.g., under a limited residency permit, under a limited ankle surgery permit, or in a jurisdiction that permitted such procedures).
  3. Procedures on soft tissue structures that connect to both the foot and the leg – To the extent that the procedure is performed proximal to the ankle mortise, it is acceptable. Procedures performed below that level are not acceptable.
Acceptability of Procedures  
Brostrom procedures Basic Brostrom procedures are not acceptable. Modified Brostrom procedures, which involve surgical repair, enhancement or revision of soft tissues attaching to the fibula and for which the operative record clearly indicates the surgeon working with the fibula, are acceptable.
Repair of Achilles tendon midsubstance tear Acceptable
Gastrocnemius recession Acceptable
Repair peroneal subluxation If the procedure involves cutting the fibula or using soft tissue structures proximal to the ankle mortise, yes. Otherwise, no.
Achilles lengthening Acceptable if proximal to the ankle mortise.

Ankle Surgery Limited Permits

In order to obtain the additional training and experience that is required for four of the five options for obtaining a podiatric ankle surgery privilege, it may be necessary for the applicant to obtain authorization to perform the required procedures. In the absence of any other authority to do so (e.g., a limited residency permit), the applicant may apply for an ankle surgery limited permit. There are separate permits for those seeking the standard ankle surgery privilege and those seeking the advanced ankle surgery privilege.

  • An ankle surgery limited permit may be issued to an individual who:
    • is licensed as a podiatrist in New York State;
    • meets the residency requirements for issuance of an ankle surgery privilege; and
    • meets the board qualification/certification requirements for issuance of the ankle surgery privilege for which the ankle surgery limited permit is sought.
  • Supervisor – Procedures performed under an ankle surgery limited permit must be performed under the direct personal supervision of either:
    • a podiatrist holding a podiatric standard ankle surgery privilege or a podiatrist holding a podiatric advanced ankle surgery privilege, provided a podiatrist supervising procedures performed under a limited permit to perform advanced ankle surgery must hold a podiatric advanced ankle surgery privilege; or
    • a physician licensed in New York State who is certified in orthopedic surgery by a national certifying board having certification standards acceptable to the State Education Department.
    • Direct personal supervision means supervision of procedures based on instructions given directly by the supervising podiatrist or physician who:
      • remains in the immediate area where the procedures are being performed;
      • authorizes the procedures; and
      • evaluates the procedures performed by the holder of the limited permit.
  • Setting for services provided under an ankle surgery limited permit – All surgery performed under an ankle surgery limited permit must be provided in a hospital or health care facility licensed under Article 28 of the Public Health Law and authorized to provide such surgery.
  • Duration of ankle surgery limited permit – The permit is valid for one year and may be renewed up to four times, when necessary to enable the applicant to complete the required training and experience. If a podiatrist first seeks the standard ankle surgery privilege and, after obtaining that privilege, later seeks the advanced ankle surgery privilege, he or she would be eligible for a standard ankle surgery limited permit to perform procedures for the standard ankle surgery privilege and later for an advanced ankle surgery limited permit to perform the procedures for that privilege. Each would be renewable up to four times, if necessary.
  • To obtain or renew an ankle surgery limited permit, complete Section I of Form 5PODPR and send it to your prospective supervisor, who must complete Section II. Either you or your prospective supervisor must return the form to the address listed on the form. If you have more than one supervisor or change supervisors, submit a Form 5PODPR for each one and check the appropriate box in Item 8.

Fees

  • Podiatric ankle surgery privileges – The fee for each privilege is $430 (which includes the $210 first triennial registration fee).
  • Triennial registration – The triennial registration fee for each privilege is $210, and the registration period is the same as the registration period of the privilege holder’s podiatry license. Once a podiatrist holding a standard ankle surgery privilege has obtained the advanced ankle surgery privilege, it will not be necessary to continue to register the standard ankle surgery privilege.
  • Ankle surgery limited permit – The fee for a permit is $105. The fee for each annual renewal is $50.

    Fees are subject to change. The fee due is the one in law when your application is received (unless fees are increased retroactively). You will be billed for the difference if fees have been increased.

    • Do not send cash.
    • Make your personal check or money order payable to the New York State Education Department. Your cancelled check is your receipt.
    • Mail your application and fee to:

      New York State Education Department
      Office of the Professions
      PO Box 22063
      Albany, NY 12201

    NOTE: Payment submitted from outside the United States should be made by check or draft on a United States bank and in United States currency; payments submitted in any other form will not be accepted and will be returned.

What and When to Submit

  • o For issuance of a standard ankle surgery privilege or an advanced ankle surgery privilege:
    • Form 1PODPR
    • Form 4PODPR (The form must be received directly from the residency program; the Department cannot accept the form if it comes directly from the applicant.)
    • Verification of board certification/qualification status (Verification of such status must be received directly from the certifying board to the State Education Department; the Department cannot accept verification from the applicant.)
    • Form 4PODPRA (for all options except Standard Ankle Surgery Option 1)
    • Form 4PODPRB (for all options except Standard Ankle Surgery Option 1) (The form must be received by the Department directly from the individual verifying the completion of the procedures; the Department cannot accept the form if it comes directly from the applicant.)
    • Fee payable to New York State Education Department
    • Do not submit (or arrange to have submitted) the items listed above until you have completed all requirements for the privilege for which you are applying, including the additional training and experience procedures.
  • For issuance of a standard ankle surgery limited permit or an advanced ankle surgery limited permit:
    • Form 5PODPR
    • Form 4PODPR (The form must be received directly from the residency program; the Department cannot accept the form if it comes directly from the applicant.)
    • Verification of board certification/qualification status (Verification of such status must be received directly from the certifying board to the State Education Department; the Department cannot accept verification from the applicant.)
    • Fee payable to New York State Education Department
    • Either the applicant or the prospective supervisor may submit Form 5PODPR, together with the required fee, to the Department.
    • Do not submit (or arrange to have submitted) an Application for Ankle Surgery Limited Permit until you have completed all of the requirements of the privilege for which you are seeking a permit, except for the additional training and experience procedures.