Podiatry Today Current Issue

Leading Authors Criticize Surgical Decompression For Diabetic Neuropathy

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

While some have touted surgical decompression as a possible treatment option for diabetic sensorimotor polyneuropathy (DPN), authors of a recent Diabetes Care commentary have challenged the validity of this procedure, calling it an unproven modality based on flawed hypotheses. The authors of the commentary note that the use of surgical decompression for DPN is based on several hypotheses including: signs and symptoms being caused by multiple nerve entrapments; that such entrapments can be diagnosed solely with the Tinel sign; that surgical release of the nerves corrects DPN; and that s

Physical Therapy: Ancillary Service For Patients Or Referral For Profit?

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

I am writing in response to the recent feature article, “How To Provide Physical Therapy As An Ancillary Service,” written by Jonathan Moore, DPM (see pg. 36, February issue). Unfortunately, the article may lead some readers to believe that adding physical therapist services to a physician/medical practice is not without potential harm or controversy. Dr. Moore stresses that providing such services can improve your “bottom line” and that the profit potential is mostly dependent on the number of referrals the investor directs to his or her physical therapy program. This describes a pra

Islet Cell Transplantation: Can It Facilitate Insulin Independence?

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

Do islet cells hold promise in treating diabetes? Islet cells are groupings of hormone-secreting cells in the pancreas that are responsible for several endocrine functions including the production of insulin. Pancreatic islets contain four different types of cells including: insulin-producing beta cells, glucagon-releasing alpha cells, somatostatin-producing delta cells and cells that contain polypeptides (PP cells). Each individual islet contains approximately 1,000 of these four types of cells. In islet cell transplantation procedures, surgeons use enzymes to extract islet cells, typically

How A Retrospective Analysis Can Bolster Practice Profitability

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

Podiatrists in private practice really have two jobs: taking care of foot and ankle problems, and running a business that makes a profit. While the science and art of solving various pedal problems are described elsewhere in this publication, we will offer a closer look at the second component of being a podiatrist, namely running the business. Owners of a well managed business will periodically review results with the goal of improving the operation. This article depicts the process of a Retrospective Analysis for Practice Improvement. In order to illustrate this process, we will incorporat

Treating A Child With Multiple, Mildly Pruritic Papules

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

An 11-year-old boy presents to the clinic with a chief complaint of multiple bumps on his right leg and foot. He reports the lesions have been present for almost two months and appear to be increasing in number and size. The boy did not see his pediatrician or family physician for this condition. The patient says the lesions started as very small bumps and they itched but not too badly. After scratching one of the bumps, the boy says the bump got bigger and new bumps occurred around the area in a few days or so. After further questioning, the patient and his mother stated that he had no know

How To Manage Isolated Lateral Column Pain

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

The lateral column of the foot includes the calcaneus, the cuboid, the fourth and fifth metatarsals as well as the calcaneocuboid (CC), cuboido-metatarsal and intermetatarsal joints. Injuries to the midtarsal joints are relatively uncommon. However, when these injuries do occur, there is a debate on the best way to approach the treatment.¹ Traditionally, patients with CC joint arthrosis in combination with midtarsal or subtalar joint pain have undergone a triple arthrodesis. The notion of performing isolated fusions has previously been disregarded since the general belief is the s

A Guide To Pathology Specific Orthoses For RA

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

As the population ages, the impact of chronic disease is challenging the world of medicine. Rheumatoid arthritis (RA) is a chronic disease that affects more than 2.1 million Americans and, unlike osteoarthritis, the impact of RA typically starts much earlier in life.¹ There is a wide range of pathology in the musculoskeletal system that may occur as RA progresses and in more advanced disease, more than 85 percent of patients have foot involvement.² As RA progresses or in severe cases, deformity occurs earlier and patients struggle with disabling pain and functional limita

How To Diagnose Peripheral Arterial Disease

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

Peripheral arterial disease (PAD) affects 10 to 20 percent of the United States senior citizen population, approximately 8 million people. These PAD patients experience significant and costly morbidity such as leg amputation and death.¹ There is a 20 percent incidence rate of PAD in patients 75 years of age and older. Despite the prevalence of the disease and associated cardiovascular risk, only 25 percent of these patients with PAD undergo treatment.² Early diagnosis and treatment of PAD not only improves one’s quality of life, it can save lives. According to the REA

Essential Insights On Flexor Tendon Transfers

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

It would be safe to say that among foot deformities, lesser digital deformities are one of the most common and one of the most complicated problems. The etiology and mechanism of action of the deformities have been well established. In order to best fix the deformity, the surgeon must have a good knowledge of the specific anatomy as well as the intricate biomechanics within the digits. The mechanism of action for the development of hammertoes, mallet toes and clawtoes has been established in the literature. It is beyond the scope of this article to expound on the anatomy and the etiology of

What You Should Do If You Get A Summons

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

A sheriff comes to your office, asks to see you and hands you a summons and complaint. You have been served with a lawsuit. Welcome to my world. This world is not about the medicine. You will not be judged by your peers. There is no search for the truth. In this world, it is about perception, credibility and spin.