Missouri Ankle Surgery: Certification, Residency and Hospital Approval

Missouri gives podiatrists the ankle in one sentence and then fences it with four conditions in the next few. All of it sits in a single statute, RSMo 330.010, and every condition applies before the first ankle case.

Is the ankle part of a Missouri podiatry license?

Yes. For chapter 330, "the term 'human foot' includes the ankle and the tendons which insert into the foot as well as the foot" (RSMo 330.010.2). The same subsection carves out what podiatry does not include: administering general anesthetics, amputation of the foot, bone surgery on children under one year old, and treatment of systemic diseases. Ankle surgery is then allowed "for surgery of the ankle only" on the conditions below.

What training does ankle surgery require?

The statute offers two tracks and then closes one of them for newer licensees:

• Board certification "in foot and ankle surgery by the American Board of Podiatric Surgery" (the board now called the American Board of Foot and Ankle Surgery), or
• a twenty-four-month postgraduate clinical residency in podiatric surgery.

Any podiatrist "licensed pursuant to this chapter after January 1, 2005" who wants to perform ankle surgery must have the 24-month residency. Certification alone is enough only for those licensed in Missouri on or before that date. For a surgeon moving to Missouri today, the residency certificate is the document that matters, and the program director's verification should show at least 24 months of surgical training. Older training is covered in residencies before 2003.

The statute also allows a podiatrist to perform ankle surgery "under the direct supervision of a doctor who is authorized to perform surgery of the ankle," which is how a surgeon without the qualification can still be in the room.

Where can the surgery happen?

"Surgical treatment of the ankle by a doctor of podiatric medicine shall be performed only in a licensed acute care hospital or a licensed ambulatory surgical clinic." An office procedure room does not qualify, however well equipped.

Who has to approve it?

The podiatrist "shall have obtained approval of the physician's credentialing committee of a licensed acute care hospital or a licensed ambulatory surgical clinic." The state license and the residency are necessary, but the facility's credentialing committee is the final gate. A group placing a surgeon in Missouri should start that facility file at the same time as the license, not after. Our post on hospital privileges and a state license explains the split, and facility credentialing is handled by our sister site, White Glove Credentialing.

Does ankle surgery change Missouri continuing education?

Every Missouri podiatrist renewing must show 24 hours of postgraduate study for each renewal period (RSMo 330.070). Section 330.010 adds that a podiatrist performing ankle surgery must complete "the biennial continuing medical education hourly credit requirements as established by the state board of podiatric medicine," so check the board's current figure for ankle surgeons before renewal. More in CE requirements by state.

How does a podiatrist from another state get the license first?

Missouri's universal recognition law, RSMo 324.009, lets a person who has held a license in another state for at least one year apply at the same practice level. Within six months the board must waive examination, education and experience requirements if the other state verifies you met its minimums. A board that gives a Missouri law exam may still require it. The waiver is not available to anyone whose license was revoked elsewhere, who is under investigation, has a complaint pending or is under discipline, or who does not hold a license in good standing. See universal recognition and podiatry.

Residents are a separate track: RSMo 330.065 provides a two-year temporary license for an internship or residency in a Missouri hospital.

What does a Missouri ankle file look like?

1. The Missouri license, usually through 324.009.
2. Your residency certificate showing at least 24 months of postgraduate clinical residency in podiatric surgery, or, for pre-2005 Missouri licensees, ABFAS certification.
3. Credentialing committee approval at each hospital or ambulatory surgical clinic where you will operate.
4. A plan for the board's CME requirement for ankle surgeons at renewal.

The rest of Missouri's scope, including the ban on foot amputation and general anesthetics, is summarized on the Missouri state page and compared nationally in ankle surgery scope by state.

Where do we fit in?

We prepare the Missouri application (License by Endorsement, $799, covers universal recognition files), gather your residency and board documents for the ankle requirements with the Ankle & Scope Credential Add-On ($499), and track every request. You sign the application and pay the board directly. Prices are on the pricing page.