Podiatry Today Current Issue

News and Trends

admin — Wed, 03 Sep 2008 17:01:40 -0400

How Effective Is The PTB Test In Diagnosing Osteomyelitis?

There has been some recent debate within the profession about the effectiveness of the probe-to-bone (PTB) test in diagnosing osteomyelitis. A new study in Diabetes Care has found that the PTB test has a relatively low positive predictive value when it is utilized for diabetic patients with foot wounds.

The two-year study tracked 1,666 patients with diabetes who underwent regular foot exams and were instructed to come to the clinic if they developed signs of lower-extremity

Taking An Active Role In Medical Staff Leadership

admin — Wed, 03 Sep 2008 17:01:40 -0400

“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

Is Limb Salvage Practical In Patients With Diabetes And Renal Failure?

admin — Wed, 03 Sep 2008 17:01:40 -0400

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

Current Concepts In Treating Ischemic Foot Ulcers

admin — Wed, 03 Sep 2008 17:01:40 -0400

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

Can Alternative Fixation Foster Better Outcomes With The Akin Osteotomy?

admin — Wed, 03 Sep 2008 17:01:40 -0400

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

Current Concepts In Diabetic Foot Surgery

admin — Wed, 03 Sep 2008 17:01:40 -0400

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

Point-Counterpoint: Should You Cover MRSA?

admin — Wed, 03 Sep 2008 17:01:40 -0400

Yes. By Guy R. Pupp, DPM, FACFAS, and Mark A. Kachan, DPM. Given the increasing incidence of methicillin-resistant Staphylococcus aureus, one should consider empiric coverage against MRSA in high-risk patients with infected ulcerations in the lower extremity.

The most common pathogens in nosocomial skin and skin structure infections in the United States and Canada in 2000 were Staph aureus. Researchers have stated that approximately 30 to 60 percent of all Staph aureus isolates are methicillin-resistant Staph aureus (MR

A Guide To Surgical Offloading In The Neuropathic Foot

admin — Wed, 03 Sep 2008 17:01:40 -0400

The neuropathic foot presents unique challenges when treating and preventing chronic wounds. One of the most difficult challenges is offloading the neuropathic foot without compromising function or causing a transfer of pressure that leads to further ulceration. When performing a limb salvage procedure, the goal is to provide the patient with a stable, plantargrade foot while still allowing for ambulation.¹

In choosing the appropriate procedure to offload the foot, it is important to consider minimal bone resection versus a partial pedal

Honey-Based Dressings: Can They Have An Impact For Diabetic Foot Ulcers?

admin — Wed, 03 Sep 2008 17:01:40 -0400

Honey is an ancient wound remedy that is reappearing in clinical practice in developed countries. The availability of licensed wound care products in Europe, New Zealand and Australia is prompting healthcare practitioners in conventional medicine to consider the use of honey within their treatment armamentarium. Ulcer remedies such as honey are necessary as the prevalence of diabetes rises.

The American Diabetes Association has estimated that about 7 percent of the population had diabetes.¹ It is an increasing problem that has serious impl

How To Address Predislocation Syndrome Of Lesser MPJs

admin — Wed, 03 Sep 2008 17:01:40 -0400

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