A dilemma of modern medicine is that reimbursement has become procedurally based. Clinicians are paid for what they do for patients, not for what they refrain from doing. Accordingly, the system, by its very nature, encourages intervention. Indeed, when one considers the combination of high patient expectations, the availability of technology, the economic pressures to generate revenue for economic survival and the litigious nature of society, the result is a higher probability of medical interventions. For this reason, Medicare and other payors are experimenting with pay for performance and

Despite the success rate one may have with orthotic devices, sometimes patients may not tolerate the devices. These expert panelists discuss treating patients who do not tolerate orthoses, when orthoses need to be replaced, which orthotic materials may lead to success and how shoes affect orthotic function. Q: How do you handle patients who do not tolerate or find comfort from the orthotic devices that you fabricate regardless of the adjustments made? A: As David Levine, DPM, CPed, notes, one can use a variety of approaches with patients who have trouble tolerating orthotic devices

Lichen planus (LP), one of the so-called “papulosquamous diseases,” is a form of dermatitis which produces a characteristic skin lesion that is classically papular in configuration. This very distinctive eruption is often described with six Ps: pruritic, polygonal, planar, purple, papules and plaques. Individual lesions of lichen planus classically possess a fine scaly surface that exhibits lacey white striations, aptly called “Wickham’s striae,” or small gray or white pinpoint spots or puncta. Such lesions range from very discrete, individual lesions of 1 to 3 mm in diameter to

Yes, this author says technological advances with internal fixation may reduce the need for external fixation. He notes that ex-fix may not be as cost-effective as AO techniques in facilitating early weightbearing, and also cites the anesthesia risks associated with external fixation. By Lawrence DiDomenico, DPM In recent years, there has been an increase in the use of external fixation in lower extremity care. In the midst of the increased use of this modality, some surgeons have acquired “frame disease” and some patients have developed “cage rage.” This means the surgeo

Aside from calcaneal fractures, adult-acquired flatfoot (AAF) may be the most difficult foot pathology to treat successfully. The complexity surrounding this pathology originates in the continued confusion about etiology, pathology, classification, pathomechanics and surgical and non-surgical treatment. Accordingly, let us take a closer look at the various classifications of AAF, which has previously been referred to as posterior tibial tendon dysfunction (PTTD), and discuss the pathomechanics, prognosis and treatment options for non-surgical care. The loss of the active and passive pull