Suggestions For Improvement
Proposed changes in the CPME 320 residency requirements would mean residents would be exposed to fewer clinical encounters in biomechanics in favor of more rearfoot surgical procedures, according to Dr. Richie.
“Nearly all rearfoot surgical procedures must have a biomechanical rationale and this would be a perfect opportunity to integrate biomechanics into surgical residency training,” says Dr. Richie. “A simple protocol which requires a biomechanical assessment of each and every rearfoot surgical case should be mandated if the proposed changes are approved.”
Dr. Richie also suggests that residency programs require residents to be exposed to a gait lab sometime during the program. Residency programs should require a valid clinical rotation, which involves hands-on application of foot orthotic therapy, ankle foot orthoses, footwear modification and physical rehabilitation, according to Dr. Richie. He also advocates mandating some type of research that focuses on one of the many subject areas of lower extremity biomechanics, such as kinetics, kinematics, neuromuscular control, foot orthotic therapy or gait training.
Dr. Frankel offers similar sentiments.
“Biomechanics must be more than one or two courses in podiatry schools,” says Dr. Frankel, a Fellow of the American College of Foot and Ankle Surgeons.
In addition to a need for increased course curriculum in this area, Dr. Frankel says biomechanics training must also encompass and encourage investigative research.
What should one say to a young student/resident who believes he or she can practice podiatry without understanding biomechanics? Dr. Richie would ask such students to open any issue of Foot and Ankle International. He says there is an emphasis on original biomechanical research in this journal with quality articles that have “direct relevance to foot and ankle surgery.”
Dr. Richie also offers an analogy: “How can a mechanic fix a car when he does not even know how the car works?”
Study Assesses Impact Of Surgical Preparation In Patients With Diabetes
By Brian McCurdy, Senior Editor
Removing bacteria via sound preoperative preparation is vitally important to help prevent postoperative infections, particularly in immunocompromised patients such as those with diabetes. A recent study in the Journal of Foot and Ankle Surgery investigates the potential of a “best evidence available” surgical preparation in this patient population.
The prospective study, the recipient of a 2006 American College of Foot and Ankle Surgeons Research Grant, involved 15 patients with diabetes undergoing elective foot and ankle surgery, and 15 patients with diabetic foot ulcerations. All patients had surgical preparation consisting of a chlorhexidine gluconate 4% scrub followed by painting with a topical solution of ethyl alcohol and 1% iodine. Researchers obtained qualitative aerobic cultures from the hallux nail fold; the second, third and fourth toe web spaces (as one culture); and the distal anterior tibia.
Prior to employing this surgical preparation, the study author cultured a total of 120 organisms. The most commonly isolated organism was methicillin-resistant Staphylococcus epidermidis (MRSE), which the study identified in 46 pre-preparation cultures (38.3 percent). The next most common organisms were methicillin-sensitive S. epidermidis (16.7 percent) and ‘‘other’’ organisms (10 percent), according
to the study.
The study noted a “signiﬁcant reduction” in both the numbers of organisms identiﬁed and positive cultures for the most commonly isolated organisms after surgical preparation. The study also noted that the surgical preparation appears to be effective for eradicating aerobic bacterial pathogens from the foot in patients with diabetes both with and without ulceration.
Thomas S. Roukis, DPM, PhD, the author of the study, notes that the study only evaluated patients with diabetes and either an intact or ulcerated/infected skin envelope. He also notes that the study only evaluated aerobic bacteria and not anaerobic bacteria, fungus, yeast or mold. Dr. Roukis says further research is required to determine if the preparation would be as efficacious in those without diabetes and for other pathogens.