Dr. Patrick Agnew joins me for a deep dive into paediatric podiatry and the complexities of treating connective tissue disorders like Ehlers-Danlos Syndrome.

10 key takeaways from this episode:

1. Pediatric podiatry is an overlooked niche – Many podiatrists avoid it due to fear, which means less competition and more opportunity.
2. You don't need to specialise 100% – Even 15–20% of your caseload focused on a niche like pediatrics can significantly increase job satisfaction.
3. Children are highly motivated patients – Unlike some adults, kids genuinely want to get better so they can return to sport and activities.
4. Fear in pediatrics often comes from uncertainty – The long-term implications and lack of clear data can intimidate clinicians.
5. Evidence-based data in pediatric podiatry is limited – Many treatment decisions rely on clinical experience and informed opinion rather than definitive research.
6. Ehlers-Danlos Syndrome (EDS) patients almost always have foot issues – Making podiatrists essential in their multidisciplinary care.
7. EDS requires a whole-body understanding – Treating these patients means understanding cardiovascular, neurological, and systemic implications—not just feet.
8. Surgical innovation often comes from necessity – Dr. Agnew developed ligament reconstruction techniques after recognising traditional methods were failing certain patients.
9. Teaching others strengthens your own knowledge – Engaging with students and residents forces you to question and refine your thinking.
10. Humility is critical in healthcare – If a practitioner claims certainty in complex areas like pediatrics, that's a red flag—good clinicians acknowledge uncertainty.

With over 30 years in practice, Dr. Agnew shares how his early mentorship under Dr. James Ganley shaped his path, and why he believes more podiatrists should embrace niche work, especially with children.

"You don't need 90% of your work to be niche—15% can change your career."

Today, Dr. Agnew is on the board of the American College of Foot and Ankle Pediatrics. He continues to write, speak, and advocate for greater understanding in this often-overlooked niche. According to Patrick, pediatric podiatry is an area many practitioners fear unnecessarily; mainly because the stakes seem higher and the data is often sparse.

That fear is valid. But Patrick encourages curiosity over fear. "There's no competition," he says. In fact, many podiatrists shy away from treating children because of perceived risks, parent pressure, or financial concerns. But for Patrick, those young patients are the most rewarding part of his work.

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