Volume 18 - Issue 7 - July 2005
Editor's Perspective »
In a recent position statement, “Third-Party Reimbursement For Diabetes Care, Self-Management Education and Supplies,” the American Diabetes Association (ADA) doesn’t exactly mince words. “To reach diabetes treatment goals, practitioners should have access to all classes of antidiabetic medications, equipment and supplies without undue controls. Without appropriate safeguards, these controls could constitute an obstruction of effective care.”
What about patients who do not have pain or cannot feel pain due to neuropathy? One of the often-cited s
The use of plastic surgery techniques has increased dramatically among podiatric surgeons over the past few years. The most useful techniques involve the use of skin grafts and local flaps, which can help solve some difficult wound closure problems. The increased usage of these techniques is partially due to the fact that some are relatively easy to learn and one can learn the basics at weekend workshops. However, as one might expect with any surgical procedure, complications can arise.
Fortunately, severe complications are infrequent but one must handle
Diabetic foot infections arising from ulcerations are the largest non-traumatic cause of lower extremity amputations. Contributing factors include peripheral neuropathy and vascular disease, rigid pedal deformities, local trauma and pressure, extensive soft tissue loss, multi-system failure, non-compliance and severe infection.
Over the decades, there have been a number of shifts in the way clinicians approach diabetic foot infections (DFIs). Throughout the ‘60s and into the ‘70s, clinicians felt most DFIs were, like other skin and skin structure inf
Diabetes Watch »
Approximately 3 percent of the United States population has diagnosed diabetes mellitus.1 Diabetic foot problems, however, are the leading cause of amputation.2,3 The risk of amputation is 15 times greater in patients with diabetes than in other people.2 Up to 15 percent of patients with diabetes will require amputation.1,3 Over 50,000 amputations in patients with diabetes occur annually in the U.S.4 In one study of patients with diabetes mellitus, 84 percent of lower extremity amputations were preceded by foot ulcers.
Diagnostic Dilemmas »
Forefoot issues related to rheumatoid arthritis (RA) are well noted with fusion of the great toe being a standard procedure in association with relocation or resection of the lesser metatarsophalangeal joints, and fusion of the proximal interphalangeal joints. Surgeons have also been successful in treating the rearfoot with fusion procedures once the arthritis is not tolerable with bracing and medication.
As a patient grows older, it is easier to address the issues of RA in the ankle. In the thin and fairly sedentary patient, ankle replacement is a good
This is the time of my professional life when I planned to slow down with fewer clinic hours, less surgery and maybe a few more nursing home visits. It has not worked out that way. Three years ago, I hired an associate who had just completed a quality PSR-24 in a university hospital. The place was an advanced trauma center with a lot of emergency room activity to stimulate young podiatric residents.
He asked about my referral experience from our local emergency room. I received a handful of referrals and consults over the years, and just accepted that tr
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