Research Is At The Forefront At Scholl College
Podiatrists like David G. Armstrong, DPM, know the value of research in podiatric medical schools. A Professor of Surgery, Assistant Dean and Chair for Research at Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, Dr. Armstrong says research is part of a “triad of care” along with teaching and patient care. To that end, the podiatric medical program of Scholl College is looking toward the future with its establishment of a new research focus. Dean Terence Albright, DPM, says the school’s merger with the Rosalind Franklin University of Medicine and Science has “opened new avenues of research” and is building collaborative professional relationships with the larger university. “The university’s strategic plan encourages collaborations and partnership within the university as well as the establishment of centers of excellence,” says Dr. Albright. “The ultimate goal is to emphasize biomedical and clinical research in selected disciplines that encourage the bridging of departments, engage students and build synergies.” Dr. Albright says the podiatric medical college is focusing on establishing a research department that will be aligned with the Chicago Medical School’s basic science and school of graduate and postdoctoral studies. In cooperation with those programs, Scholl College is starting a DPM/PhD program for selected second-year students. The faculty of Scholl has received secondary academic appointments to promote research, according to Dr. Albright, who says the integration of curriculum and research over the next three years will correspond with hiring research faculty assigned to the Chicago Medical School’s departments of biochemistry, microbiology and pharmacology. Emphasizing Diabetes And Wound Healing Research The Scholl College is also at the forefront of establishing the University Center of Excellence in Diabetes, which has been dubbed the Rosalind Franklin Diabetes Center. Dr. Armstrong, a member of the National Board of Directors of the American Diabetes Association, will represent the college at the diabetes center and will incorporate his clinical research programs. Dr. Albright notes the program’s goal is translating science to clinical trials. Dr. Armstrong is continuing his work with the Center for Lower Extremity Ambulatory Research (CLEAR), which publishes on average about 20 peer-reviewed manuscripts a year and has received numerous federal and industry grants. Collaborative wound healing projects are in the works at Scholl and the Southern Arizona Veterans Affairs Medical Center in Tucson, Ariz., where Dr. Armstrong was based until accepting the Scholl position a few months ago. He says the research continues to explore areas of the diabetic foot with an emphasis on healing and preventing ulcers and amputation. Dr. Armstrong’s research team is also exploring the use of intelligent insoles, which can identify areas of high pressure and temperature, and notify both the patient and caregiver. Another research group, the Diabetic Foot Resistant Organism Surveillance Team (D-FROST), is identifying resistant organisms in the diabetic foot in major metropolitan areas, according to Dr. Armstrong. He says this group is also trying to develop a sophisticated activity monitor that can dose activity like a drug. Offering Research Opportunities For Students The strategic plan of Scholl College includes disseminating its podiatric medical research to the community, the profession and prospective students. Dr. Albright says current students may participate in summer research opportunities in the Chicago area or serve as research assistants at the Chicago Medical School’s Science Department. He adds that Scholl’s Swanson Independent Scholar Program permits selected students to participate in research activities while obtaining their DPM degree. Students mentored by faculty have participated in national scientific poster contests conducted by renowned medical and science organizations, according to Dr. Albright. While every student and faculty member does not have to participate in research, Dr. Armstrong says having research at schools is important in increasing school pride, fostering what he calls “true advances” in care and continuing to bring podiatric medical programs into the collaborative medical mainstream. Is Early Weightbearing Effective After First MPJ Arthrodesis? Brian McCurdy, Associate Editor Nonunion and delayed union have been cited as complications when surgeons allow patients to bear weight early after a first metatarsophalangeal joint arthrodesis. However, a recent study in The Journal of Foot and Ankle Surgery reveals a union rate of 100 percent in a group of patients who underwent this procedure and post-op protocol. Researchers conducted a retrospective observational study on 42 patients who had undergone 47 fusions, all of whom bore weight immediately after surgery on the heel or lateral aspect of the foot. They found that patients achieved a 100 percent rate of both clinical and radiographic union. Patients achieved clinical healing at an average of 5.6 weeks, showed signs of radiographic union at an average of 6.1 weeks and the mean time for return to athletic shoes was 6.23 weeks, according to the study. Lawrence Ford, DPM, says he had not typically allowed immediate weightbearing after performing a first MPJ arthrodesis, preferring to allow four to six weeks of post-op nonweightbearing. However, Dr. Ford says this study may change his approach. “Based on the results of this study, there is evidence to support early weightbearing,” says Dr. Ford, a Fellow of the American College of Foot and Ankle Surgeons. “I am now having my patients bear weight immediately in a short leg cast or removable walking boot.” Why was the healing rate so high in the study? In their study, authors Paul Dayton, DPM, FACFAS, and Andrew McCall, DPM, say the most important factor was having the patients maintain a flatfoot gait postoperatively. They note that this allowed the fusion’s position to resist the transfer of force to the fusion site from the hallux. They note that surgeons typically position the first MPJ arthrodesis with the hallux dorsiflexed 15 to 20 degrees from the weightbearing surface, a position that prevents the toe from purchasing the ground until heel lift and the initiation of propulsion. Researchers also attribute the success to the stability of internal fixation, which promotes primary bone healing. They also note in the study that making a dorsomedial incision of skin and the joint capsule facilitates a minimal dissection technique. Drs. Dayton and McCall also say preparing the joint surfaces in a cup-and-cone fashion creates a relatively large surface area for fusion, which promotes healing and stability, according to the study. However, as Dr. Ford points out, most of the patients in the study were at low risk for nonunion. “For higher risk patients, it is still prudent to keep them non-weightbearing unless future studies prove otherwise,” notes Dr. Ford. PFOLA Meeting Emphasizes Biomechanics And Orthotic Therapy By Brian McCurdy, Associate Editor The country’s leading biomechanics and orthotics experts will gather next month for the Seventh Annual International Conference on Foot Mechanics and Orthotic Therapy. Sponsored by the Prescription Foot Orthotic Laboratory Association (PFOLA), the conference workshops focus on both new research and practical topics of interest to DPMs. Speaker Lawrence Huppin, DPM, calls the conference “the one essential seminar for any podiatrist who wishes to learn the most effective techniques of biomechanical treatment.” Dr. Huppin is presenting a workshop on troubleshooting in orthotic therapy and says he will emphasize to podiatrists the importance of being able to diagnose, correct and prevent problems patients might have with their orthotics. Dr. Huppin says there are many other topics DPMs will find interesting. These include a lecture by Kevin Kirby, DPM, on the “Use of Modern Biomechanical Theory in Orthotic Prescription Writing,” and “Orthotic Prescription Writing in Complex Cases” by Howard Dananberg, DPM. Dr. Dananberg says his lecture will focus on observational tips that one can use in orthotic design and will probably discuss how in-shoe pressure analysis can be of benefit in the more difficult cases. Dr. Dananberg is also moderating two 90-minute workshops on using the F-Scan (Tekscan) in clinical practice. “I believe that this will be extremely valuable for those looking to take the biomechanics portion of their practice to another level,” he states. As Dr. Dananberg notes, the workshops will be particularly useful for attendees as the 90-minute sessions permit “hands-on experiential learning.” The International Conference on Foot Biomechanics and Orthotic Therapy will be Oct. 29 to 31 at the Boston Marriott Copley Place in Boston, Mass. For more info, see www.pfola.org. Clarification In regard to the article, “Assessing The Role And Impact Of Enzymatic Debridement,” which appeared in the July issue of Podiatry Today, the manufacturer of Collagenase Santyl is Ross Products.