Uneven Ground: Exploring Socioeconomic and Geographic Differences in Access to Orthopaedic Foot and Ankle Surgeons in the United States

PurposeAcross the United States, there is a well-documented projected shortage of orthopaedic surgeons, including those with foot and ankle subspecialty training. We sought to better understand the current state of patient access to orthopaedic foot and ankle surgeons across region, socioeconomic metrics, and rural areas.MethodsIn this cross-sectional analysis, foot and ankle surgeons identified through the American Academy of Orthopaedic Surgeons (AAOS) website were assigned a county, and distribution trends were contextualized by socioeconomic factors, including insurance coverage rates, unemployment rates, poverty rates, and median household income. Surgeon and location data were sourced from September 2024 to November 2024 via the AAOS "Find a Surgeon" directory, with Doximity and Google searches conducted in the event of partially empty profiles.ResultsDisparities in the presence and availability of orthopaedic foot and ankle surgeons by region were identified, with 4 states having only a single orthopaedic foot and ankle surgeon. While the national average of orthopaedic foot and ankle surgeons per million people was 2.87, with the northeast and midwestern regions above this value, the southern and western regions were below the national average. Counties with at least one orthopaedic foot and ankle surgeon had greater median household incomes ($77 459.24 vs $60 682.49; P < .001) and lower poverty rates (11.67% vs 14.20%; P < .001).ConclusionsInequality in the distribution of orthopaedic foot and ankle surgeons is prevalent at the regional, state, and county levels, as well as by rurality and household income/poverty status. Strategies that implement early exposure and/or focused mentorship for the subspeciality in medical school and/or residency can be combined with targeted programs for those interested in the field who wish to practice in underserved areas.