Podiatry Today

Podiatry Today






CLINICAL EVENTS CALENDAR

more

Non-Accredited Education

Managing the Diabetic Foot: A Clinical and Economic View Complimentary Archived Webcast
Non-Accredited


Understanding Collagen Dressings and their Benefit in Wound Care

Complimentary Archived Webcast
non-accredited

Can Metformin Use Increase The Risk Of Diabetic Neuropathy?

Allen Jacobs DPM FACFAS's picture
Blog By: Allen Jacobs DPM FACFAS

Metformin (Glucophage, Bristol-Myers Squibb) is a commonly utilized biguanide agent for the treatment of diabetes. Increasingly, it appears that metformin may paradoxically increase the risk of neuropathy in the patient with diabetes. Therefore, when you see a patient with diabetes who is taking metformin, greater surveillance may be necessary for the presence of sensory, autonomic and motor neuropathy.


Why A Post-Op Fatality Is A Wake-Up Call On DVT Prophylaxis

Allen Jacobs DPM FACFAS's picture
Blog By: Allen Jacobs DPM FACFAS

The issue of deep vein thrombosis (DVT) prophylaxis remains controversial with reference to foot and ankle surgery. The limited available studies for review suggest that the incidence of DVT and pulmonary embolism (PE) following foot surgery is acceptably low, and that routine prophylaxis is not required. However, many of these same articles suggest that one should consider prophylaxis when several risk factors for DVT or pulmonary embolism (PE) are present.


Regnault’s HAT Graft Procedure: Can It Have An Impact For Hallux Rigidus And Hallux Valgus?

Allen Jacobs DPM FACFAS's picture
Blog By: Allen Jacobs DPM FACFAS

Figure 1 demonstrates a typical HAT graft fixated with a small Kirschner wire. The remodeled base of the proximal phalanx is demonstrated.Figure 2 demonstrates resection of the base of the proximal phalanx.Figure 3 demonstrates the resected base of the proximal phalanx. This is slightly larger than what you would typically see when performing the Keller procedure.Figure 4 demonstrates the remodeled base of the proximal phalanx. One may use a sagittal saw or other instrument to remove the cortices of the proximal diaphysis of the resected bone.Figure 5 demonstrates preparation of the medullary canal for receipt of the stem of the implant.Figure 6 demonstrates the implanted, remodeled proximal phalanx base. If there is any indication of instability or tendency of the implant to sublux, one may utilize fixation.Figure 7 demonstrates a re-implanted proximal phalanx base with small screw fixation.Figure 8 demonstrates fixation of the implant with an OSStaple.
Figure 1 demonstrates a typical HAT graft fixated with a small Kirschner wire. The remodeled base of the proximal phalanx is demonstrated.
Figure 2 demonstrates resection of the base of the proximal phalanx.
Figure 3 demonstrates the resected base of the proximal phalanx. This is slightly larger than what you would typically see when performing the Keller procedure.
Figure 4 demonstrates the remodeled base of the proximal phalanx. One may use a sagittal saw or other instrument to remove the cortices of the proximal diaphysis of the resected bone.
Figure 5 demonstrates preparation of the medullary canal for receipt of the stem of the implant.
Figure 6 demonstrates the implanted, remodeled proximal phalanx base. If there is any indication of instability or tendency of the implant to sublux, one may utilize fixation.
Figure 7 demonstrates a re-implanted proximal phalanx base with small screw fixation.
Figure 8 demonstrates fixation of the implant with an OSStaple.

Over the years, I have continued to employ the osteochondral graft procedure (HAT graft procedure), described by Bernard Regnault, MD, in selected cases of hallux valgus and hallux rigidus. I find the procedure to be reliable in satisfying the requirements of elderly patients as it offers a viable alternative to arthrodesis, resection arthroplasty or implant arthroplasty.


Are Ethics Getting Shortchanged In Student And Residency Training?

Allen Jacobs DPM FACFAS's picture
Blog By: Allen Jacobs DPM FACFAS

Recently, there was discussion on Podiatry Management online regarding the professional conduct of students and residents. The discussion was centered on what was perceived to have been “unprofessional” conduct, and a discussion of the evaluation of so-called “non-cognitive behaviors” ensued.


A Closer Look At The Modified Hoke Arthrodesis For Flatfoot Deformity

Allen Jacobs DPM FACFAS's picture
Blog By: Allen Jacobs DPM FACFAS

Figure 1Figure 2Figure 3Figure 4Figure 5Figure 6Figure 7Figure 8Figure 9Figure 10Figure 11Figure 12Figure 13Figure 14Figure 15Figure 16Figure 17Figure 18Figure 19
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Figure 10
Figure 11
Figure 12
Figure 13
Figure 14
Figure 15
Figure 16
Figure 17
Figure 18
Figure 19

For many years, I have employed a modification of the traditional Hoke procedure in the management of flatfoot deformity. Surgeons generally employ medial column stabilization in flatfoot deformity to augment other pronation limiting surgical interventions such as arthroereisis, tendo-Achilles lengthening (TAL), calcaneal osteotomy, etc.


Why I Advocate The Medial Incision Approach In Hallux Valgus Correction

Allen Jacobs DPM FACFAS's picture
Blog By: Allen Jacobs DPM FACFAS

   Many years ago (more than I wish to recall), Guido LaPorta, DPM, turned me on to the medial incision for the correction of hallux valgus deformity. Over the years, I have found that the medial incisional approach to hallux valgus correction has been most effective and is associated with less postoperative problems than I have encountered with the traditional dorsal-medial longitudinal incision for hallux valgus surgery.


When ‘Not Guilty’ Does Not Necessarily Mean Innocent

Allen Jacobs DPM FACFAS's picture
Blog By: Allen Jacobs DPM FACFAS

I recently had the opportunity to participate in a malpractice case in which I testified as an expert witness in support of the allegations that a plaintiff brought against her podiatric physician. The case ended with a defense verdict. The famous defense attorney F. Lee Bailey once noted that not guilty does not mean innocent, it means you were able to successfully “beat the rap.”


Advanced Therapies For The Diabetic Foot: Are We Getting Our Money’s Worth?

Allen Jacobs DPM FACFAS's picture
Blog By: Allen Jacobs DPM FACFAS

In a recent issue of Diabetes Care, Kahn and Anderson examine the issue of diabetes care as a model for healthcare reform.1 The authors point out that the prevention of diabetes and the prevention of complications associated with diabetes are seldom cost-saving. This is contrary to many arguments that suggest preventive care is ultimately cost-effective and reduces expenses associated with the management of diabetes.


Bridging The Gap Between Life Lessons And Cornerstones Of A Successful Practice

Allen Jacobs DPM FACFAS's picture
Blog By: Allen Jacobs DPM FACFAS

In 1999, a retired orthopedic surgeon published his perspective on the essentials of success in practice.1 I found his insights and suggestions helpful. I pass these on to our younger colleagues as advice that will stand them well in daily practice. Some older doctors may benefit as well.

1. Maintain humor, humility and humanity.

2. Make only original mistakes.

3. Invest time, thought and energy in interpersonal relationships with patients, colleagues and loved ones.

4. Apologize when causing pain to patients or when you keep them waiting.


Lecture Points To Emerging Bacterial Resistance To Silver

Allen Jacobs DPM FACFAS's picture
Blog By: Allen Jacobs DPM FACFAS

At the recently concluded scientific sessions of the American Professional Wound Care Association (APWCA), Adrianne P.S. Smith, MD, presented evidence of evolving bacterial resistance to silver.

Silver dressings are, of course, frequently utilized in wound care. It has been generally accepted that natural resistance to silver does not occur. However, Dr. Smith noted that silver resistance is being increasingly reported. The origins of this resistance include: plasmids with encoded genes for silver resistance; bacterial chromosomes; and selection when too low a dosage of silver exposure all





CME Showcase

"Current Concepts In Healing Chronic Diabetic Foot Ulcerations"

A Complimentary On-Demand CE/CME Webcast

This activity is supported by an educational grant from Advanced Biohealing.
This activity is sponsored by the North American Center For Continuing Medical Education (NACCME).

To access this Webcast, visit www.naccme.com/program/n-550/





REVIEW OUR OTHER
HMP BRANDS

Check out our other resources for healthcare professionals of all specialties.

  • WOUNDS
  • Todays Wound Clinic
  • Skin and Aging
  • Ostomy Wound Management


HMP Communications LLC (HMP) is the authoritative source for comprehensive information and education servicing healthcare professionals. HMP’s products include peer-reviewed and non-peer-reviewed medical journals, national tradeshows and conferences, online programs and customized clinical programs. HMP is a wholly owned subsidiary of HMP Communications Holdings LLC. ©2010 HMP Communications
# © 2010 HMP Communications, LLC