Volume 22 - Issue 3 - March 2009
Online Exclusive »
Case Study: Working Through The Differential Diagnosis Of Diabetic Neuropathy
Given that neuropathy can have a complex range of manifestations, the diagnosis of the condition is not always as obvious as it initially seems. This author emphasizes the importance of a thorough diagnostic workup and the underappreciated value of communicating with the patient.
When a 62-year-old minister got a referral to see a podiatric physician for neuropathic pain and dystrophic, “dry” changes to his feet, he noted his frustration with previous physicians. He said he felt like “one of those lab rats that has been given one drug and then anoth
Forum »
Understanding The Importance Of Building A Rapport And Trust
I recently started my indentured servitude, also known as third-year clinical rotations, and I have already picked up on some quirky behaviors from a select few patients.
While sitting in one of our examination rooms on a Monday morning, it occurred to me that patients could be fabricating stories for their personal protection. Alternatively, perhaps there is just a glitch in this human interaction.
A lot goes into taking an accurate history and physical. The patient and healthcare provider exchange quite a bit of information. However, the unspoken communication seems to
New Products »
New Products March 2009
Orthotics For Arthritis
New orthotics may offer more options for patients dealing with arthritis.
Footmaxx Orthotics introduces a line of orthotics which targets patients with arthritis-related complaints in the lower extremity. The company says the three orthotics, called Arthritic 1, Arthritic 2 and Arthritic 3, can be beneficial for patients with varying stages of arthritis.
Arthritic 1 is for patients with early stage arthritis and is the most flexible and accommodative orthotic, according to the company. Footmaxx sa
Technology In Practice »
New Implant Offers Viable Alternative For Hammertoe Surgery
For podiatric surgeons looking to reduce complications, improve outcomes and facilitate less postoperative pain for patients, a new implant may prove to be more beneficial than K-wire fixation in correcting hammertoe deformities.
One may use the Smart Toe™ memory implant to help correct hammertoe deformities in toes two through five, according to MMI-USA, the manufacturer of the implant. The Smart Toe offers an implant comprised of a special alloy with shape memory properties called NiTinol. The company notes that these properties resist potential rotat
Treatment Dilemmas »
Has Intraoperative Nerve Testing Reinvented Our Approach To Tarsal Tunnel And Nerve Surgery?
Nerve surgery, especially tarsal tunnel surgery, has been very difficult to perform. More often than not, it is a poorly used treatment in foot and ankle care. Often, the diagnosis is difficult to make and surgical treatment may not result in the best outcomes if physicians have not emphasized careful patient selection.
To date, the most common workup for tarsal tunnel and other peripheral nerve problems has been a nerve conduction test (NCV) with or without an electromyelogram (EMG). Both of these tests have shown moderately good potential in the upper
Surgical Pearls »
Tarsal Tunnel Syndrome: Can A Minimally Invasive Release Be Advantageous?
Compression neuropathies of the posterior tibial nerve and its branches are a fairly common group of disorders, which are often misdiagnosed.1,2 In order to diagnose lesions of these nerves accurately, one must maintain a fairly high index of suspicion of their presentation. Relying on abnormal findings via electromyography and nerve conduction velocity testing is risky because the incidence of false negatives is quite high.2,3
In contrast, pressure specific sensory testing may produce false positive results. Although the classical
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