Does Stress During Walking Occur During Foot ‘Takeoff’ And ‘Landing’ Rather Than ‘Midflight’?

David G. Armstrong DPM MD PhD
7/27/10 | 2470 reads | 1 comments
At this year's American Podiatric Medical Association (APMA) meeting in Seattle, Bijan Najafi, PhD, presented some very compelling data that may force us to rethink what we know about repetitive stress in walking. For many years, we have posited that plantar pressure x cycles of stress = ulcer. More recently, this has been refined to theoretically include shear stress along with normal stress. This begs the question: where does damage occur? Read More.

Can Doxycycline Have An Impact As An Agent For ‘Wound Chemotherapy’?

David G. Armstrong DPM MD PhD
7/2/10 | 3065 reads | 0 comments
Editor’s note: This blog is co-authored by Nicholas A. Giovinco, DPM, and Julia Bernardini, DPM. Read More.

Can 'Chemovac' Dressings Be A Valuable Addition To Wound Care?

David G. Armstrong DPM MD PhD
4/27/10 | 3371 reads | 1 comments
Editor's note: This blog entry is co-authored by Nicholas Giovinco, BS. As one might imagine, the use of chemotherapeutic modalities is generally easy. Topical applications and traditional dressing modifications are, in many instances, technically unchanged from standard practice. Our experience with the application of “chemovac” dressings (combining chemotherapeutic dressings with negative pressure wound therapy (NPWT)). Read More.

Experts At DFCon 2010 To Combat ‘Amputation Tsunami’

David G. Armstrong DPM MD PhD
3/16/10 | 2987 reads | 0 comments
With an amputation performed every 30 seconds due to diabetes-related complications we are dealing with a worldwide amputation tsunami. The Diabetic Foot Global Conference (DFCon 2010) serves as something of an early warning system for doctors worldwide. Read More.

Can An Electrical Stimulation Device Be Part Of A ‘Pacemaker’ In Neuropathic Patients?

David G. Armstrong DPM MD PhD
2/16/10 | 2907 reads | 0 comments
For patients with diabetic and motor neuropathy, an electrical stimulation device, combined with pressure monitoring and thermometry, may be able to act as a “pacemaker” to stimulate the foot. At the Southern Arizona Limb Salvage Alliance (SALSA), we have become increasingly interested in the Walkaide system (Hanger Orthopaedics) and its potential future as a delivery system for extracorporeal nerve and muscle stimulation. The device uses electrical stimulation to improve walking in patients with post-stroke footdrop, according to the company. Read More.

Can Walking Sensors Help Predict The Outcome Of Diabetic Limb Salvage Surgery?

David G. Armstrong DPM MD PhD
1/25/10 | 2648 reads | 0 comments
In the past, surgery designed to heal wounds or reduce the risk for development of wounds in people with diabetes has been haphazard. A recently published pilot study in Gait & Posture suggests strongly that we can work toward predicting success preoperatively.1 See Read More.

A Closer Look At The Plantar Fat Pad In People With Diabetes

David G. Armstrong DPM MD PhD
12/21/09 | 4009 reads | 0 comments
At the Southern Arizona Limb Salvage Alliance (SALSA), we have been fascinated with a recent paper by our colleagues Hsu and co-workers from the Chang Gung Memorial Hospital and National Taiwan University Hospital. These authors suggest that the plantar fat pad -- that specialized fat that exists on the sole of every one of us -- may undergo changes in people with diabetes. To make a long story short, fewer small “microchambers” of fat make it less cushy and more susceptible to ulceration. We invite you to give the work a read. See Read More.

A Closer Look At The Roles Of Advanced Therapies Within The Wound Healing Spectrum

David G. Armstrong DPM MD PhD
11/24/09 | 2610 reads | 0 comments
There has been a consistent request for some clarity on where various classes of wound healing modalities may fit along a timeline. Rather than adhere to a "one size fits all" concept, more clinicians have moved toward a multimodal approach. However, there is a variety of questions when it comes to optimal use of these modalities to help ensure optimal outcomes. Read More.

Can Teams Trump Technology When It Comes To Optimal Care For High-Risk Patients?

David G. Armstrong DPM MD PhD
11/3/09 | 2493 reads | 0 comments
Can teams trump technology in the new healthcare debate? I ask this question because I continuously see many patients referred to the Southern Arizona Limb Salvage Alliance (SALSA) who have been relegated to amputation. This is not because they have not had access to technology. In fact, most have had extensive work done by well-intentioned clinicians. What frustrates me, and I know my SALSA partners agree as well, is the lack of access to a team. Read More.