Volume 16 - Issue 12 - December 2003
Disorders of the posterior heel may present at any age. The multitude of posterior heel problems include retrocalcaneal and pretendinous bursitis, Achilles tendonitis, retrocalcaneal exostosis and Haglund’s deformity. It is essential to consider each of these disorders as a separate entity and, although they often occur in combination, each entity requires a separate course of therapy.
Controlling pain has become a sophisticated, albeit inexact science. Artful pain assessment, integrated care, the titration of medications and the effective use of therapies and modalities are tailored for each patient. Indeed, meticulous clinicians must avoid tunnel vision and take the proper steps in diagnosing and treating chronic pain.
Continuing Education »
When it comes to hallux limitus, there are several circumstances in which one may see this decreased range of motion of the first metatarsophalangeal joint. You may note a limited range in the direction of dorsiflexion, plantarflexion or both. Depending upon the etiology, you may see the restriction during nonweightbearing, static stance or during the propulsive phase of gait.
The etiology may be secondary to direct macrotrauma to the great toe joint, metabolic conditions such as gouty arthritis or, most commonly, first ray hypermobility associated with abnormal pronation. Hypermobility of
Editor's Perspective »
The consumer ads for pain management pharmaceuticals keep coming fast and furious. In one ad, you may see a woman standing at a window grimacing, clutching her painful knee as she watches her children play in the back yard. In the next scene, you see her smiling and pushing her daughter on a swing. You hear the voiceover come in: “Ask your physician about (fill in the name of the medication here).”
Then there’s the obligatory close-up shot of the product with a rosy glow behind it and perhaps a brief hushed warning about possible side effects.
Imagine flipping the script on the voic
In regard to last month’s “Letters” section (see “A Closer Look At Federal Funding For Residencies,” page 14, November), teaching hospitals that have intern and residency training programs and that also treat Medicare patients are currently being reimbursed by the Centers For Medicare And Medicaid Services (CMS) for direct and indirect expenses.
The direct expenses would cover such financial items as intern/resident salaries, health insurance, meals, malpractice insurance and educational expenses. This is usually the smaller of the amounts received by the hospital administration. Th
I have performed more than 300 unnecessary excisional biopsies during the past 28 years. They were unnecessary because the pathology reports were negative. The lesions were not malignant. It’s the five positive biopsies that made all this unnecessary surgery worth doing. I learned early in my career about the risk of neglecting to biopsy a “funny looking lesion.”
A lady in her late 50s came to me the first month I was in private practice. She had a very painful ingrown toenail. The toe seemed normal and there was hardly any incurvation of the nail border. The skin was slightly red and