Volume 15 - Issue 9 - September 2002

Feature »

Restoring Sensation In Diabetic Patients

By Stephen L. Barrett, DPM | 8544 reads | 0 comments

Statistics from the American Diabetes Association (ADA) reveal there were 86,000 amputations due to complications from diabetes mellitus in 2000. The ADA also points out that 50 to 70 percent of these patients will develop peripheral neuropathy sometime in the course of their disease.1
The most widely believed paradigm in mainstream medicine today is that loss of sensation in diabetic peripheral neuropathy is irreversible and the only treatment available is the achievement of euglycemic control and the ancillary use of medicines such as Elavil and Neurontin.2 Sadly, this



Editor's Perspective »

PSSD: Assessing Its Value And Potential

By Jeff Hall, Editor-in-Chief | 4801 reads | 0 comments

The pursuit of a better testing method for diabetic peripheral neuropathy has spurred the re-emergence of the Pressure Specified Sensory Device (PSSD) and accompanying debate over its potential utility.
Yes, the NCV test and the Semmes-Weinstein monofilament allow you to test for the presence of neuropathy. However, in his article, “Restoring Sensation In Diabetic Patients” (see page 38), Stephen Barrett, DPM, says the monofilament does not “quantify or stage the level of peripheral neuropathy” and neither test enables you to assess “early stages of isolated peripheral nerve compres



Forum »

When It's Time To Put Up The 'Gone Fishing' Sign

By John McCord, DPM | 1886 reads | 0 comments

I usually enjoy my work. My office is efficient. The patients appreciate our help. My staff is like family. Most weeks go by fast and end upbeat. Last week was an exception. The efficient office self-destructed when the computer medical billing program died. Something corrupted all the financial data and it vanished. The backup tapes were disabled. Neither the software support guy nor the hardware technician could bring it back to life.
The vascular surgeon with whom I have shared space for the past four years suffered a major bout of burnout and left practice last week. He is 44 and looks 60



Letters »

Debating The Merits Of The EPF Procedure

5194 reads | 0 comments

It was with great incredulity that I read the article by Dr. Barrett entitled “A Closer Look At Endoscopic Plantar Fasciotomy” (see the May issue, pg. 38). He writes: “Prior to the development of endoscopic foot surgery, there was a strong desire not only to find a better, less invasive method to treat … plantar fasciitis surgically … Indeed, the standard of care … has changed radically since the … EPF.”
The inference here, of course, is that after EPF, that desire has been fulfilled and it is now the standard of care. The truth is that in the facilities where I perform surger



Diabetes Watch »

Educating Your Patients On Nutrition And Exercise

By Pamela M. Jensen, DPM | 6200 reads | 0 comments

Diet and exercise are essential for blood sugar management and are subject of much frustration for the diabetic patient and the physician. With each visit to the physician’s office, the patient has to anticipate the stern lecture about exercising, controlling his or her diet, abstaining from sweets, and testing his or her sugars regularly or face the multitude of complications from diabetes. In addition, physicians may also give a patient a handout with the recommendations from the American Diabetes Association.
But does this method work? King and Armstrong studied the effectiveness of thi



Diagnostic Dilemmas »

Pinpointing The Cause Of Posterior Ankle Pain

By Babak Baravarian, DPM | 20506 reads | 0 comments

Chronic posterior ankle pain is a very difficult problem for foot and ankle surgeons. Given the multiple potential tendinous and osseous causes of pain, doing a proper diagnostic workup is essential for proper care. With this in mind, let’s consider the following case of a 52-year-old Caucasian male who presents with chronic pain and weakness of the posterior ankle.
A computer salesman with an avid love for golf and tennis, the patient plays tennis on the weekends and golf at least once a week for business. Approximately two months ago, while playing tennis, he began to feel pain in the



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