Residents Rumble In Online Competition

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By Brian McCurdy, Associate Editor

   For a few Tuesday nights out of the year, podiatric residents across the country will compete with fellow residents in other programs to test their knowledge. The game is not Jeopardy but the Residency Challenge, also known as the Residency Rumble, an academic tournament wherein residents from 76 programs draw upon their knowledge to answer questions on all aspects of podiatry.    The brainchild of Podiatric Residency Education Services Network (PRESENT), these Tuesday night Web-based programs will occur four times a year, according to PRESENT CEO Alan Sherman, DPM. The winner of the fall Residency Challenge, sponsored in part by Merz Pharmaceuticals, was St. Joseph’s Hospital Bluemound in Milwaukee, Wis. The prize was a JVC plasma TV/ computer monitor.    Dr. Sherman says the program allows residents to get together and build camaraderie.     “It instilled a sense of pride in the residents for their program and a healthy competitiveness among the programs across the country,” points out Dr. Sherman. “There was also a good deal of David vs. Goliath spirit in these residents. Residents in smaller, lesser-known programs were very excited to have the chance to test their skills against their colleagues in larger, more high-profile programs.”    The Residency Challenge simulates a DPM’s experience in the operating room, according to Dr. Sherman, who notes teams not only had to get the correct answer but had to deduce it quickly before the other team did. He says this type of situation prepares residents for a situation where they would need to remember and quickly apply a skill or technique in order to treat a patient in pain.    Jennifer Suess, DPM, who participated in the fall Residency Challenge, noted the questions ranged from simple anatomy and microbiology to pharmacology and the names of surgical procedures. Dr. Suess, a first-year resident of Inova Fairfax Hospital in Falls Church, Va., says she and a couple of her fellow residents would connect on the phone and answer questions together.     “In that sense, working together as a team was socially enhancing for the residents,” notes Dr. Seuss. “The ‘timing’ of the responses put an interesting spin on the Residency Challenge,” she says, adding that it was fun to anticipate which questions might be asked.    She calls the PRESENT programs a “nice, basic introduction” to podiatric topics.    Dr. Sherman says the next round of the Residency Challenge is in December and adds that PRESENT will also have a “Tournament of Champions” once a year that allows the four season winners to compete for “Champion of the Year” honors.    For more information on PRESENT’s online courses, check out the Web site www.podiatry.com.

Study Emphasizes Safety Of Terbinafine

By Brian McCurdy, Associate Editor    Some patients and practitioners may have the impression that terbinafine (Lamisil, Novartis) causes liver problems. Richard Pollak, DPM, states this misperception is possibly due to experiences with older classes of antifungal drugs, not necessarily terbinafine. However, a new randomized study of over 500 patients confirms that the oral antifungal terbinafine is a safe drug.    The study, “Hepatic Safety with Terbinafine: Reality vs. Perception,” which was presented as a poster at the American Podiatric Medical Association Annual Scientific Meeting in August, tracked 505 outpatients between the ages of 18 and 75. Each patient had moderate to severe dermatophyte-infected great nails and received 250 mg qd of terbinafine for 12 weeks.    After six weeks of treatment, none of the patients in the study experienced clinically significant liver enzyme elevations (with researchers defining “elevated” as twice the upper limit of normal) or adverse hepatic events. According to the study, only 28 patients experienced slight alamine aminotransferase (ALT) or aspartate aminotransferase (AST) elevations. Eight of those patients had additional liver function tests (LFTs) at week 12, the results of which confirmed that all of these elevations were clinically insignificant.     “I was not surprised. These results further confirm my clinical experience with terbinafine as a well-tolerated medication with a well-established safety profile. I am very comfortable using terbinafine in the majority of my onychomycosis patients,” notes Dr. Pollak, the lead author of the study and a Clinical Assistant Professor in the Department of Orthopedics at the University of Texas Health Science Center.    Three years ago, the Food and Drug Administration (FDA) uncharacteristically removed the recommendation for LFT monitoring for patients taking terbinafine, basing its decision on the drug’s well-established safety profile, says Dr. Pollak. He adds that current prescribing information for terbinafine only requires baseline LFTs in all patients to screen for preexisting liver conditions.

Biomechanics Department Strives For Excellence At The California School Of Podiatric Medicine

By Brian McCurdy, Associate Editor    Many educators say having a strong understanding of biomechanics is essential to being a successful podiatrist. While several podiatry schools have biomechanics departments, those who teach in the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt College say the department has a rich history and still has a strong impact on the podiatric profession.    Paul R. Scherer, DPM, the Chairman of the Department of Applied Biomechanics, cites the department’s impressive list of achievements and distinguished alumni. He emphasizes that the department has been able to develop theories that demonstrate the origins of foot pathologies, which include pediatric flat feet, functional hallux limitus and plantar fasciitis.     “While the biomechanics department, as compared to the surgery or podiatry medicine department, is usually considered the eclectic battered child of the college, most of what has been accomplished is done on a shoestring budget,” says Dr. Scherer. “The department has also produced both the majority of the leaders and literature in the field, and the only fellowship program in podiatric biomechanics.”    The biomechanics curriculum consists of six courses. The first three courses are the introductory Biomechanics I; Biomechanics II, which focuses on anatomical variations and recognizing deformities and pathology; and Biomechanics III, which concentrates on treating deformities or pathologies, and emphasizes pathomechanics, orthotic therapy and differential diagnosis.    Biomechanics IV studies sports medicine and focuses on the mechanism of injury, prevention and treatment of the lower extremity in athletes. The department also offers a Clinical Skills course that teaches specific skills in range of motion studies, gait analysis, stance phase measurements, negative casting, orthotic fabrication and orthotic prescription writing. There is also a Biomechanics Clinic which is held at St. Mary’s Medical Center in San Francisco, which applies students’ knowledge of orthotic therapy of lower extremity pathology under clinician supervision.     “The most successful podiatrists in the country — both clinically and professionally — are those who incorporate biomechanics and orthotic therapy effectively into their practices,” asserts Larry Huppin, DPM, an Adjunct Associate Professor in the department.    Dr. Huppin says the biomechanics department at CSPM differs from others in teaching orthotic therapy. He says the professors at CSPM focus on pathology specific orthotic therapy and the tissue stress model of biomechanics rather than the tradition of orthotic prescriptions being based on measurements of the body.     “This approach ensures students understand what they need to accomplish with orthotic therapy to relieve the patient’s symptoms, rather than trying to achieve a predefined ‘neutral’ position of the foot,” explains Dr. Huppin.    As Dr. Scherer notes, other disciplines have embraced the biomechanics field and the majority of work and investigation into human performance of the lower extremity and kinematics is outside the podiatry field. The late Merton Root, DPM, founded the department in 1963 and Dr. Scherer notes the culture that Dr. Root inspired has spread to the University of South Australia, the Joyner Institute at the University of Delaware, the Exercise Science Department of the University of Massachusetts, the University of Calgary Gait Lab and the Research Department of the University of Arizona, all of which study foot and ankle biomechanics. DPMs Mourn Two Podiatric Pioneers By Brian McCurdy, Associate Editor    The podiatric community is mourning the loss of William R. Olson, DPM, who died this summer, a week before his 50th birthday. Sheldon Langer, DPM, the founder of Langer, Inc., died Sept. 15.    Several DPMs cite Dr. Olson’s contributions to the field, including his role as an entrepreneur and teacher. Ronald L. Valmassy, DPM, had worked with Dr. Olson since 1987 at the Center for Sports Medicine in San Francisco, Calif., and had shared regular Tuesday surgical procedures with him. Their relationship goes back to the late 1970s, when Dr. Olson was one of Dr. Valmassy’s students at the California College of Podiatric Medicine (CCPM).     “I was immediately impressed with Dr. Olson’s enthusiasm and dedication to improving both his didactic knowledge and his clinical skills,” recalls Dr. Valmassy. “He demonstrated quite early the attention to detail and professionalism that would ultimately mark him as one of the leaders in podiatry.” After completing his residency, Dr. Olson became Residency Director at Hillside Hospital in San Diego and established a thriving practice in the area. He was a Clinical Assistant Professor at CCPM and a frequent guest lecturer at what is now Des Moines University. In 1980, he entered private practice in La Jolla, Calif. and also was Director of the Podiatric Residency Program at Hillside Hospital in San Diego. In 1988, Dr. Olson joined St. Francis Memorial Hospital’s Center for Sports Medicine, where the staff named him as Physician of the Year earlier this year.    Dr. Olson also founded the Performance Materials Corporation and revolutionized the orthotic industry by developing Melanite, named after his daughter Melanie. The product, widely known as TL-61, is one of the first heat adjustable composite materials used for foot orthotics and is widely used in the industry.    When Robert “Daryl” Phillips, DPM, taught at Des Moines University, he always tried to have his friend Dr. Olson, whom he graduated with from CCPM in 1979, lecture there once a year.     “I felt that he demonstrated both the academic role model as well as the professional and personal role model that I wanted all the students to emulate,” says Dr. Phillips, the Director of Podiatric Residency at the Coatesville Veterans Affairs Medical Center in Coatesville, Pa. “He was confident with his patients but not arrogant, and tried his best to listen to them. He learned as much from them as they did from him. He often talked to me about all the things his patients were teaching him.”    Douglas Richie, Jr., DPM, the President of the American Academy of Podiatric Sports Medicine (AAPSM), recalls Dr. Olson as a “stellar ambassador for podiatric medicine in his professional life.” Dr. Richie says Dr. Olson treated “hundreds of world-class athletes” during his career and was a Past President of the AAPSM.    Dr. Olson is survived by Margaret Olson, his wife of 26 years, and his daughters, Melanie and Lauren. His colleagues remember him as a devoted family man.     “He was a loving husband and father who perfectly balanced his professional and personal lives so that he excelled at both,” says Dr. Valmassy. “We will all miss this individual who exemplified everything that is good in a person both professionally and personally.”    Donations may be sent to: The William R. Olson American Academy of Podiatric Sports Medicine Fellowship and Training Fund, c/o AAPSM, P.O. Box 723, Rockville, MD 20848-0723.

Remembering Dr. Langer

   Dr. Langer, 80, had founded Langer Acrylic Laboratory in 1969 and had hired Jeff Cusack, DPM, as a consultant in 1983 and the two had worked together closely. Dr. Cusack cites Dr. Langer’s “unwavering desire to teach” and says he always emphasized to customers and employees as to how the products would help patients.    Andrew H. Meyers, the President and CEO of Langer, Inc., says Dr. Langer always showed “unwavering respect and admiration” for all of Langer’s employees.     “Not only did I learn a great deal from him about the field of podiatric biomechanics but also the way to run a successful modern orthotic laboratory,” says Meyers.     “One by one, we’re losing the fellows who really put the field of biomechanics where it is on the map,” adds Dr. Cusack. “It is a loss our field is really going to feel for quite some time.”    Dr. Langer is survived by his wife, Marion, sons Paul and Mark, daughter Lisa, eight grandchildren and two great-grandchildren.

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