Volume 15 - Issue 3 - March 2002
Surgical Pearls »
Distal posterior heel pain is a deformity we see quite often. It masquerades as chronic Achilles tendinitis, when in fact a calcaneal step (aka retrocalcaneal exostoses) is present at the Achilles insertion. You must also clinically differentiate it from adjacent problems, such as Haglund’s deformity, retrocalcaneal bursitis and intra-Achilles tendon tear. Often, these problems may be concurrent, however, you must treat the calcaneal exostoses for complete cessation of pain. Keep in mind that retrocalcaneal exostoses are most symptomatic in active individuals over 30.
On inspection, you w
Type 2 diabetes is one of the fastest growing diseases in the United States, with 15.7 million Americans afflicted with the disease, according to the American Diabetes Association. Diabetes is one of the leading causes of death in the United States, and the primary cause of blindness in people (due to diabetic retinopathy) between the ages of 20 and 70.1
Diabetes is considered one of the most psychologically and behaviorally demanding of the chronic medical illnesses. Patients with diabetes are particularly vulnerable to depression. Indeed, up to one in every three diabetics has depression at a level that impairs functioning and quality of life, and lowers adherence to glucose monitoring, exercise, diet, medication regimes and glycemic control. As a result, depression increases the risk of long-term diabetic complications.
When you use self-reporting surveys as a gauge, you’ll find an even broader spectrum of depressive illness in diabetic
The prevalence of diabetic ulceration is alarmingly high and increasing. Currently, it is between 4 and 10 percent, depending on a host of factors including ethnicity, geographic region and duration of disease. Wounds are clearly associated with infection and a high risk of future amputation. The economic implications are overwhelming to the health care system. As clinicians, we must be able to rapidly identify, access and manipulate the factors necessary for wound healing.
Indeed, it is vital to approach the wound healing process as a whole body process when you’re treating a patient who
Is it an infection or an inflammation? That’s just one of the questions about the paronychia that came up during a roundtable discussion among DPMs. They also addressed the debate over doing a P&A for a paronychia, whether soaking is the ideal treatment and what you should do differently when treating a diabetic who has a paronychia. Here are their comments.
Warren Joseph, DPM: Any of us who have had a paronychia know they hurt. These patients will come into your office and they are in pain. They’ve all been to their family doctor, their primary doctor if they’re HMO patients a
Wound Care Q&A »
There have been many technological advances in wound care over the past decade, ranging from research into the wound healing model to the role of growth factors and the use of living skin constructs in clinical practice. With this in mind, our expert panelists take a closer look at Apligraf and their experiences in using this product.
Q: Do you use Apligraf much in your practice? If so, when do you use it in the course of treatment?
A: Both Robert Snyder, DPM, and Sheldon Ross, DPM, use Apligraf frequently in their practices. David Armstrong, DPM, says he uses Apligraf if he does no