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Can External Fixation Have An Impact For Pediatric Patients?

Ron Raducanu DPM FACFAS — Wed, 17 Mar 2010 08:32:58 -0400

In the last several years, there has been a large push toward the use of external fixation for complex surgeries such as Charcot reconstruction and foot and ankle trauma. A little known application for external fixation is podopediatric surgery.

Podopediatric surgery can be stressful in general. This is not because of a lack confidence in one’s skills nor is it a lack of successful outcomes. It is the nature of performing surgery in this patient population.

Experts At DFCon 2010 To Combat ‘Amputation Tsunami’

David G. Armstrong DPM PhD — Tue, 16 Mar 2010 15:53:58 -0400

With an amputation performed every 30 seconds due to diabetes-related complications we are dealing with a worldwide amputation tsunami. The Diabetic Foot Global Conference (DFCon 2010) serves as something of an early warning system for doctors worldwide.

Fixation Of The Medial Malleolus Fracture: What You Should Know

Neal Blitz DPM FACFAS — Mon, 08 Mar 2010 11:58:32 -0500

Those with experience in the surgical treatment of ankle fractures often consider the medial malleolus fracture a relatively straightforward fracture to repair. Most commonly, surgeons use two screws to fixate the fracture and it is a short procedure in terms of operative time.

The surgery is often so predictable that the surgeon may go into “auto pilot” mode (more appropriately termed “auto surgeon” mode). However, there is some fracture variability that occurs and it is important for the surgeon to slow down and choose the best fixation for the fracture pattern.

Striving To Stay At The Top Of Your Surgical Game

William Fishco DPM FACFAS — Thu, 04 Mar 2010 10:45:43 -0500

I have been practicing for 12 years now and some things have not changed. I still worry about my patients. I often wake up in the middle of the night feeling flushed when the stress of a recent surgery or an upcoming surgery is on my mind.

You run the surgery over and over in your head questioning whether the fixation is strong enough. Will the patient be adherent? Did I get enough correction? Will the correction hold over time? Did I do the best procedure for that given circumstance?

Why Did DPMs Miss The Boat On Therapeutic Diabetic Hosiery?

Doug Richie Jr. DPM FACFAS — Wed, 03 Mar 2010 08:28:58 -0500

While the incidence of diabetes and foot-related complications continues to spiral out of control in this country, medical professionals need to step back and evaluate their role in preventive medicine.

Most of my podiatric colleagues are unaware of the significant role that the Internet and direct-to-consumer businesses have in the care of the patient with diabetes. Today, millions of patients with diabetes turn to the Internet and commercial companies to provide information and products to prevent the complications of diabetes.

Why Shoe Fit Matters Even For Non-Deformed Feet

Jenny L Sanders DPM — Mon, 01 Mar 2010 10:11:23 -0500

Every podiatrist understands the relationship between poorly fitting shoes and foot deformity. Many of us routinely order diabetic shoes, extra-depth shoes and sometimes even casts for custom molded shoes for the deformed foot. For the non-deformed foot, we simply rely on an “approved shoe list” or a “specialty running shoe store” to which we send our patients.

Will CPME 320 Changes Jeopardize Dr. Jolly’s ‘Foot Function’ Goals For Surgical Outcomes?

Kathleen Satterfield DPM FACFAOM — Mon, 01 Mar 2010 08:20:55 -0500

If you have been involved in a really good grand rounds, you know what it means to prepare well for a surgery, a care plan or a discharge.

As a first-year resident in Connecticut a long time ago, I remember facing Gary Jolly, DPM, and proposing a surgical procedure for one of his patients. I gave him a typical “NLDOCAT” breakdown of the patient’s problem. After describing the nature, location, duration, onset, course, aggravation and treatment for the patient, I was proud of my presentation to this brilliant surgeon.

Can Metformin Use Increase The Risk Of Diabetic Neuropathy?

Allen Jacobs DPM FACFAS — Mon, 01 Mar 2010 08:18:26 -0500

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.

Recognizing The Potential Impact Of Stress With Skin Conditions

Tracey Vlahovic DPM — Thu, 25 Feb 2010 08:39:35 -0500

How many times has a new or established patient presented to you with a new onset skin rash that was acute and angry in nature? As you are digging deeper with your patient interview, you find that a large stress (or stressors) has occurred in that person’s life. Sources of stress may include unemployment, divorce, a new baby, etc.

Is The Closing Base Wedge Osteotomy Extinct?

Patrick DeHeer DPM FACFAS — Mon, 22 Feb 2010 08:03:21 -0500

The closing base wedge osteotomy (CBWO) has long been a favorite for the severe bunion deformity in podiatric surgical history, especially throughout the 1970s and 1980s. Has the once sacred procedure become extinct? Is this procedure still a viable option for the severe bunion deformity? Do the potential complications move this procedure to the back of the bus when it comes to treating the severe bunion deformity?

In my opinion, the answer to all of these questions is yes.

Can An Electrical Stimulation Device Be Part Of A ‘Pacemaker’ In Neuropathic Patients?

David G. Armstrong DPM PhD — Tue, 16 Feb 2010 15:33:12 -0500

For patients with diabetic and motor neuropathy, an electrical stimulation device, combined with pressure monitoring and thermometry, may be able to act as a “pacemaker” to stimulate the foot.

At the Southern Arizona Limb Salvage Alliance (SALSA), we have become increasingly interested in the Walkaide system (Hanger Orthopaedics) and its potential future as a delivery system for extracorporeal nerve and muscle stimulation. The device uses electrical stimulation to improve walking in patients with post-stroke footdrop, according to the company.

When a Child Presents With An Underlapping Toe

Ron Raducanu DPM FACFAS — Tue, 16 Feb 2010 10:26:42 -0500

Sometimes you have to think outside of the box. This is especially the case when it comes to possible surgical intervention in the pediatric population. Even the simplest procedure can test your skills and experience.

Recently, a very pleasant family brought in their two and a half year-old daughter so she could be evaluated for “walking problems.“ I eventually diagnosed these walking problems as a severe metatarsus adductus. I decided to attempt conservative management with a custom-molded orthotic with a medial flange. This initially helped the toddler.

Where Can The Foot And Ankle Surgeon Go For Continuing Education On Biomechanics?

Doug Richie Jr. DPM FACFAS — Mon, 08 Feb 2010 16:11:12 -0500

The last time I checked, there were no lectures devoted to biomechanics at the upcoming American College of Foot and Ankle Surgeons (ACFAS) Scientific Conference in Las Vegas (Feb. 22 to 26).

I continue to be amazed that our profession would stage a conference that advertises “cutting edge clinical and practice management topics,” and ignores the vital role that biomechanics plays in foot and ankle surgery. Our counterparts at the American Orthopaedic Foot and Ankle Society (AOFAS) devote almost one-third of the lectures at its annual meeting to biomechanics topics.

Failure To Biopsy: When Alleged ‘Wound Care Specialists’ Fall Short Of The Standard Of Care

Molly Judge DPM FACFAS — Mon, 08 Feb 2010 10:59:58 -0500

I do not know about you but I continue to find myself wondering who are these so-called wound care specialists who undertake management of wounds but are nowhere to be found when bad wounds take a turn for the worse.

A Closer Look At The Three-Knot Layered Krackow Achilles Repair

Neal Blitz DPM FACFAS — Fri, 05 Feb 2010 08:40:14 -0500

When it comes to repairing the ruptured Achilles tendon, there are a variety of methods ranging from wide-open exposures with grafting to percutaneous approaches. All of these options have their advantages and disadvantages. However, the most common is a straightforward open approach in which the surgeon re-approximates the tendon in an end-to-end fashion.

Does Saying ‘I Am Sorry’ Make Malpractice Lawsuits Go Away?

Kathleen Satterfield DPM FACFAOM — Wed, 03 Feb 2010 07:02:31 -0500

Does making a medical mistake mean never having to say you are sorry?

No, it is just the opposite. Apparently, it is all about saying you are sorry. That is what my surgical mentor taught me and it definitely worked. One time I made a serious mistake and I approached the patient and his family and said those simple words, “I am sorry.” They found no fault. We worked through the problem together and solved it. All was forgiven and they appreciated my sincere efforts.

The Art Of Dealing With The Challenges Of Hammertoe Surgery

William Fishco DPM FACFAS — Fri, 29 Jan 2010 08:46:31 -0500

Hammertoe surgery is a mainstay in every podiatrist’s office. I have personally found that hammertoe surgery is among the most challenging surgery we perform. Although the surgery is seemingly simple, the results are not as predictable as other surgeries that we do. When we look at each toe individually, there are inherent challenges that each one possesses.

Can Walking Sensors Help Predict The Outcome Of Diabetic Limb Salvage Surgery?

David G. Armstrong DPM PhD — Mon, 25 Jan 2010 09:45:07 -0500

In the past, surgery designed to heal wounds or reduce the risk for development of wounds in people with diabetes has been haphazard. A recently published pilot study in Gait & Posture suggests strongly that we can work toward predicting success preoperatively.1 See http://tinyurl.com/yzbkt96

New Year’s Resolution: Get Involved In Your State Association

Patrick DeHeer DPM FACFAS — Mon, 25 Jan 2010 08:52:30 -0500

Well, it is that time of year again. It is the time for New Year’s resolutions. Lose weight, stop smoking, read more, exercise more, etc. We have all made resolutions and sometimes keep them. Here is one I would ask you to consider for this upcoming year: become involved with your state podiatric medical association.

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

Allen Jacobs DPM FACFAS — Wed, 20 Jan 2010 10:39:52 -0500

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.