I recently read the article, “Scope of Practice: Where Things Stand” (see page 36, May issue). I had to refrain from laughing when I compare the problems with scope of practice in the United States to what the situation is in Ontario. Indeed, a brief historical overview of the situation of podiatrists in Ontario is warranted so your American readers can appreciate our frustration.

In July of 1995, the Ontario government imposed a cap on all future podiatrists from entering and practicing in Ontario. Since that time, no new podiatrists have been allowed to practice in the province. The p

Given the increasing use of negative pressure wound therapy (NPWT) to spur wound healing, our expert panelists return for the second part of this Q&A discussion on NPWT (see “Inside Insights On Negative Pressure Wound Therapy,” page 24, May issue). They offer specific pearls on the use of NPWT, how to combine the modality with skin grafts and silver dressings, and tips for avoiding wound maceration.

Q: Do you have any pearls for using negative pressure wound therapy (NPWT)?
A: Eric Travis, DPM, utilizes VAC therapy (KCI) mostly at 125 mmHg of continuous suction. For a fragile w

It is vital to review the “non-surgical revascularization toolbox” for lower extremity treatments for critical limb ischemia (CLI). Consider an analysis of the most recent United States and European data on the number of amputations performed every year. Approximately 160,000 to 180,000 lower extremity amputations are performed every year in the U.S. and a 10 percent yearly increase in these numbers has been projected as well. In Europe, it has been estimated that 40,000 to 50,000 lower extremity amputations occur each year.1-2 It is been estimated that 80 percent of all amputat

It has been estimated that a person with diabetes has a 25 percent lifetime risk of developing a foot ulceration.1 Diabetic foot ulcers commonly become infected, can involve bones and joints and may progress to amputation. Osteomyelitis frequently complicates ulcerations in people with diabetes and may be present in up to 20 percent of mild to moderate and 50 to 60 percent of severely infected wounds.2
Diagnosing osteomyelitis in people with diabetes who present with a foot ulcer is challenging and becomes a clinical conundrum. Misdiagnosis may lead to unnecessary treat

Vacuum Assisted Closure (VAC, KCI) may be the most impressive device for the foot since AO fixation revolutionized elective foot surgery. For large or difficult wounds, VAC therapy can rapidly improve granulation tissue and speed up coverage of exposed tendon and bones. Indeed, this often occurs in days to weeks rather than months. Most clinicians are convinced at the bedside when they see dramatic changes in the characteristics of a wound such as size, depth and exposed structures.

There is a growing body of evidence that supports the clinical observations and animal research that have be