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  • Editorial Correspondence

  • Jeff Hall, Executive Editor/VP-Special Projects, Podiatry Today
  • HMP Communications, 83 General Warren Blvd
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  • March 2007 | Volume 20 - Issue 3
    By Larry Crystal, DPM
    3,186 reads | 0 comments | 09/03/08
          “Good morning, Chief” “Here comes the Chief” and “Good morning, Mr. President” are all greetings that I have heard since I was elected into the position of Medical Staff President of a tri-campus rural hospital with 65 active staff and 45 mid-level providers. So how did the only podiatrist on staff come to serve as Chief of Staff?       Some might say that my election was the result of a fortune of circumstance and those with experience in medical staff leadership might say that I was the victim of circumstance. Regardless, I have had the hono... continue reading
    This X-ray depicts a short first metatarsal caused by prior bunion surgery. This patient’s complaints were pain under the second toe joint.
    By William D. Fishco, DPM, FACFAS
    67,925 reads | 1 comments | 09/03/08
         Metatarsalgia is a diagnostic term used to describe pain in the ball of the foot. Gerard V. Yu, DPM, eloquently described and illustrated predislocation syndrome in 1995. What Dr. Yu described was a clinical syndrome characterized by focal pain under a lesser metatarsophalangeal joint (MPJ), most often affecting the second toe joint.1      Subjective symptoms reported by those afflicted with this syndrome would be described as a “grape-like” swelling under the affected toe joint, and a feeling as if there were a stone bruise on the ball of ... continue reading
    Here one can see a renal failure patient with a problematic lateral foot wound. Note the nonviable tissue and dehiscence.
    By Jessica Kaylor, BA, and John S. Steinberg, DPM
    15,373 reads | 1 comments | 09/03/08
          Although the patient with diabetes and renal failure presents serious challenges to the limb salvage team, there is evidence and argument to support aggressive treatment and attempted limb salvage in a multidisciplinary clinical environment. An abundance of medical literature discusses the separate wound care challenges posed by diabetes and renal failure.       Less work has been done, however, to identify proper treatment and salvage techniques for patients who suffer from both maladies. While many do opt for primary amputation in the patient with diab... continue reading
    One study found that non-compliant patients were over 50 percent more likely to have foot ulcerations and, with increasing underlying neuropathy and deformity, they became more than 20 times more likely than the compliant patients to have an amputation.
    By Kathleen Satterfield, DPM
    5,303 reads | 0 comments | 09/03/08
         The basic question is really “How do you get someone to do something that they do not especially want to do?” The fictional Tom Sawyer was the classic king of this skill but as physicians, we are trying to do something a bit more complicated than getting someone to paint a fence. We are trying to get our patients to adhere to the instructions of given treatment regimens, such as taking a confusing regimen of pharmaceuticals or staying off an injured foot.      Although the word “non-compliance” is not in the title of this article, be assured that... continue reading
    In the photo above, note the presence of an ulcer in a patient with diabetes following a transmetatarsal amputation. (Photo courtesy of Marc Brenner, DPM)
    Clinical Editor: Lawrence Karlock, DPM
    20,636 reads | 0 comments | 09/03/08
         When it comes to patients with ischemic foot ulcers, potential complications can be dire. Accordingly, it is important to have a firm grasp on diagnostic studies as well as current and emerging treatment options that may enhance outcomes for patients.      With this in mind, our expert panelists discuss a range of issues related to the ischemic foot.      Q: How do you approach/work up the ischemic foot ulcer patient?      A: David E. Allie, MD, works up such patients “very, very aggressively.” Of the approxi... continue reading
    By William N. McCann, DPM
    22,829 reads | 0 comments | 09/03/08
          The use of durable medical equipment (DME) has grown to become a part of almost every podiatric practice over the last half-century. In fact, podiatrists have led the field in this important area of patient treatment through our use of orthotic devices.       With our extensive background and training in biomechanics, our understanding of diabetes and its complications in the lower extremities as well as a need to provide patients with immediate immobilization, it is no wonder that DME is one of the more important offerings that we can extend to those we... continue reading
    Surgeons may find success with the Weinert modification of the Akin osteotomy, which the authors believe promotes a more stable fixation with fewer complications and risks.
    By Anthony Weinert, DPM, Ali Elkhalil, DPM, and Ahmad Farah, DPM
    7,507 reads | 0 comments | 09/03/08
          Practitioners have described various osteotomies for the proximal hallux. However, the Akin closing wedge osteotomy is currently the most common procedure. Podiatric surgeons commonly employ the transverse plane closing wedge osteotomy for the correction of hallux abductus interphalangous deformity. One may also use this as an additional procedure for the correction of hallux abductovalgus deformity.       Akin noted that one should perform the closing base wedge osteotomy at the proximal one-third of the proximal hallux and orient it in the transverse p... continue reading
    Note the distal fifth digit eschar, which is dry, stable and well attached with no signs of active infection.
    By Eric H. Espensen, DPM
    25,408 reads | 0 comments | 09/03/08
          Diabetic wounds are a common occurrence in wound care centers and private practice. With the escalating rate of diabetes, more and more patients are developing wounds that require care. Wound care for diabetic wounds routinely includes debridement. The term debridement comes from the French desbrider, meaning “to unbridle,” and was probably first used as a medical term by surgeons working in war zones. The medical personnel and surgeons likely recognized that contaminated wounds had a better chance of healing if one surgically removed the damaged tissue to revea... continue reading
    By Jarrett D. Cain, DPM, and Vickie R. Driver, DPM, MS
    13,262 reads | 0 comments | 09/03/08
          Patients with diabetes can be a quite an undertaking for any physician who manages them on a consistent basis. In the past, this has created reservations when it comes to managing these patients especially from a surgical standpoint. However, over the years, with greater understanding of the disease, improvements in surgical techniques and emerging research, the reservations have diminished and the role of surgical management is a viable option when it comes to successfully treating those with diabetic ulcerations, infections and other related complications that exist in t... continue reading
    Removal of the dorsal hypertrophic bone of the first metatarsal is a commonly used procedure in the treatment of hallux limitus. This photo depicts the pre-cheilectomy range of motion.
    By Justin Franson, DPM, and Babak Baravarian, DPM
    64,343 reads | 0 comments | 09/03/08
          Hallux limitus, by definition, is a decrease in sagittal plane dorsiflexion of the hallux at the first metatarsophalangeal joint (MPJ) when the foot is in a weightbearing or simulated weightbearing position. With this in mind, let us take a closer look at the treatment approaches to this condition.       Normal range of dorsiflexion motion of the first MPJ should be 65 to 75 degrees in order to allow for a normal gait. Near the end of the propulsive phase of gait, the leg has a 45-degree position to the floor and the ankle is in about 20 degrees of plant... continue reading