International Olympic Committee Seeks DPM's Advice For 2008 Olympics

By Brian McCurdy, Associate Editor

   Officials of the International Olympic Committee (IOC) are already in the midst of planning for the 2008 Olympics in Beijing. In order to facilitate improved treatment for athletic injuries, they recently sought out the suggestions of a United States podiatrist who treated athletes at the Athens Olympiad last year. Nicholas Romansky, DPM, who headed up the U.S. podiatry contingent at the 2004 Olympics, spoke recently to the IOC regarding his clinical experiences and made suggestions for the next games.    Dr. Romansky reviewed injury trends, noted how the clinic functioned in Athens and discussed policies with the IOC. He notes that during 19-hour days, he diagnosed and helped treat 70 to 90 patients a day for 17 days. At the next games, he suggested to the IOC that it should move the physical therapy area closer to the podiatry clinic and have more podiatrists at the event sites. He also recommended using the same equipment as in Athens and continuing to use prosthetists and orthotists as part of the podiatry group.    The polyclinic was a state-of-the-art medical facility in the Olympic village which housed 10,000 athletes. The multidisciplinary clinic ran very efficiently and allowed Dr. Romansky to diagnose and treat as many patients as he did.     “It was a great clinical experience because we saw everything,” says Dr. Romansky, the team physician for the U.S. Olympic and World Cup Men’s and Women’s soccer teams. He notes that it was a tough juggling act as “you had to think quickly and aggressively but you also had to think conservatively.”    While in Athens, Dr. Romansky, a Fellow of the American College of Foot and Ankle Surgeons, says he treated injuries from the upper tibia on down. Common injuries included stress fractures, bunions, sesamoid injuries, plantar fascia ruptures, Achilles problems and Freiberg’s infraction. He says the athletes, on average, ranged between 20 to 29 years in age.    Dr. Romansky notes many athletes had received new equipment from sponsors that was issued specially for the Olympics and they became injured when they were not used to the equipment. Interestingly, Dr. Romansky notes that in some cases, athletes were injured before the games and waited until getting to Athens to seek treatment.     “Making the team in most countries is an honor of their country. They want to hide or conceal the injury until they get to the Olympics and then they come to us,” says Dr. Romansky, a Diplomate of the American Board of Podiatric Surgery. “They don’t want to lose that stature.”    While treating the athletes, Dr. Romansky worked with over 20 Australian podiatrists. Dr. Romansky says they also had the support of 15 pedorthists, who helped in providing shoes, pads and heel lifts. He says the pedorthists were “critical” in that they had to be careful in providing treatment without significantly altering the athletes’ biomechanics as doing so might affect their performance at the events.     “Part of our job was to give them confidence and motivate them to win,” notes Dr. Romansky.

Studies Cite Benefits Of Duloxetine For Painful Diabetic Neuropathy

By Brian McCurdy, Associate Editor    Three studies recently evaluated duloxetine HCl (Cymbalta, Eli Lilly) and concluded the medication may offer improved relief for painful diabetic neuropathy and an improved quality of life. It is the first drug approved by the FDA to treat painful diabetic peripheral neuropathy.    Researchers enrolled a total of over 1,100 patients in three studies, which were presented as a poster at the American Podiatric Medical Association Annual Scientific Meeting in Orlando, Fla. Using various modalities to measure general health, pain and vitality, researchers compared duloxetine to placebo treatment over a 12-week period.    They found that patients taking duloxetine at either 60 mg QD or 60 mg BID showed significantly superior results to those in the placebo group.     “It appears as though the relief of pain with this modality is rather rapid and may be sustained,” says David G. Armstrong, DPM, MSc, PhD, a study co-author and immediate past member of the National Board of Directors of the American Diabetes Association. “The results of the present study suggest that this, coupled with perhaps the behavioral effects of duloxetine, may provide improvement in functional outcomes for what is often a profoundly debilitating problem.”    In addition to facilitating improvements in pain, patients taking duloxetine experienced improvements in several aspects of quality of life, including mood, sleep, social functioning and mental health, according to the study.    Although the study excluded patients with mental health issues such as depression or bipolar disorder, Dr. Armstrong says that exclusion does not signify the drug’s potential efficacy in that patient population. Rather, researchers excluded patients with mental health issues to remove any variables which might confound the study, according to Dr. Armstrong, Professor of Surgery, Chair of Research and Assistant Dean at the William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine.

Court Confirms Ankle Is In Scope Of Practice For Texas DPMs

By Brian McCurdy, Associate Editor    A court has upheld the position of Texas podiatrists that the ankle is in their scope of practice. The Texas Orthopedic Association and Texas Medical Association had sued the Texas State Board of Podiatric Medical Examiners, challenging the latter’s inclusion of ankle in its definition of the foot.    As the upheld definition states, the foot is “the tibia and fibula in their articulation with the talus, and all bones to the toes, inclusive of all soft tissues (muscles, nerves, vascular structures) that insert into the tibia and fibula in their articulation with the talus and all bones to the toes.”     “History has shown that to effectively treat conditions, trauma and deformities of the foot you must treat the bones and soft tissue inserting into the ankle,” says Thomas Zgonis, DPM, an Assistant Professor in the Department of Orthopaedics/Podiatry Division of the University of Texas Health Science Center at San Antonio. “This is not new and podiatrists have been treating ankle sprains, fractures and lower extremity trauma for many years.”    Although Texas DPMs have long treated the ankle, the board of examiners clarified its scope of practice as including the ankle (see News and Trends, September 2002 issue). However, in response to a challenge from the Texas Orthopedic Association, the state attorney general’s office ruled in 2001 the board of examiners had extended its scope of practice. A later ruling determined the attorney general’s opinion did not supersede the board of examiners’ definition of the ankle. Clarification    In regard to the Editor’s Perspective column in last month’s issue (see “Is Sports Medicine Getting Short Shrift At The Schools?” on page 17), the Ohio College of Podiatric Medicine does offer a semester-long course in Sports Medicine during the second semester of the third year for podiatric students.

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