Podiatry Today Current Issue

Harkless Heads Up New Podiatry School

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

The podiatry profession will welcome its ninth college under the leadership of a DPM with decades of experience in education. Western University of Health Sciences School of Podiatric Medicine will start classes in 2009 under the helm of Lawrence Harkless, DPM. Dr. Harkless became the college’s first Dean on July 1 and has begun planning the school’s curriculum. He recently retired from the University of Texas Health Sciences Center at San Antonio after serving as a Professor in the Department of Orthopaedics and as the Louis T. Bogy Professor of Podiatric Medicine and Surgery. Dr.

Another View On Scope Of Practice Challenges

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

I recently read the article, “Scope of Practice: Where Things Stand” (see page 36, May issue). I had to refrain from laughing when I compare the problems with scope of practice in the United States to what the situation is in Ontario. Indeed, a brief historical overview of the situation of podiatrists in Ontario is warranted so your American readers can appreciate our frustration. In July of 1995, the Ontario government imposed a cap on all future podiatrists from entering and practicing in Ontario. Since that time, no new podiatrists have been allowed to practice in the province. The p

A Closer Look At The Research Behind MIRE Therapy

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

Monochromatic infrared light energy (MIRE) therapy is controversial. Do you prescribe this therapy? How can infrared light reverse sensory neuropathy or heal ulcers? Some reports indicate that just two weeks of therapy is enough to show significant improvement. Some patients rave about its benefits. Patients may say they no longer have numbness and/or pain. They may say they sleep better. It sounds too good to be true. Aside from the anecdotal claims, here are just a handful of published studies that have been used to evaluate MIRE therapy to improve sensory neuropathy, painful neuropathy an

Expert Pointers On Negative Pressure Wound Therapy

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

Given the increasing use of negative pressure wound therapy (NPWT) to spur wound healing, our expert panelists return for the second part of this Q&A discussion on NPWT (see “Inside Insights On Negative Pressure Wound Therapy,” page 24, May issue). They offer specific pearls on the use of NPWT, how to combine the modality with skin grafts and silver dressings, and tips for avoiding wound maceration. Q: Do you have any pearls for using negative pressure wound therapy (NPWT)? A: Eric Travis, DPM, utilizes VAC therapy (KCI) mostly at 125 mmHg of continuous suction. For a fragile w

How To Achieve Improved Results With The Chopart Amputation

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

When it becomes apparent that the current treatment is not proving effective for a debilitating disease or a trauma induced by accident or warfare, amputation is generally considered the medical intervention of last resort. Indeed, one would exhaustively consider any and all other medical alternatives to save a limb before deeming it necessary to amputate. However, once the physician has made the decision to amputate, then one has to decide on the level of the amputation. Recent advances such as newer generation antibiotics and endovascular approaches to revascularization have aided in the ab

Emerging Vascular Approaches For Healing Diabetic Ulcers

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

It is vital to review the “non-surgical revascularization toolbox” for lower extremity treatments for critical limb ischemia (CLI). Consider an analysis of the most recent United States and European data on the number of amputations performed every year. Approximately 160,000 to 180,000 lower extremity amputations are performed every year in the U.S. and a 10 percent yearly increase in these numbers has been projected as well. In Europe, it has been estimated that 40,000 to 50,000 lower extremity amputations occur each year.^1-2 It is been estimated that 80 percent of all amputat

New Advances In Predicting Wound Healing

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

Chronic lower extremity skin ulcerations affect millions of people in the United States alone. These ulcerations are defined by the Wound Healing Society as wounds that have “failed to proceed through an orderly and timely process to produce anatomic and functional integrity, or proceeded through the repair process without establishing a sustained anatomic and functional result.”¹ The relapsing course of wound healing poses a significant management challenge to healthcare professionals and imposes an astounding economic burden on healthcare.² The total direct cost o

Current Concepts In Treating Osteomyelitis

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

It has been estimated that a person with diabetes has a 25 percent lifetime risk of developing a foot ulceration.¹ Diabetic foot ulcers commonly become infected, can involve bones and joints and may progress to amputation. Osteomyelitis frequently complicates ulcerations in people with diabetes and may be present in up to 20 percent of mild to moderate and 50 to 60 percent of severely infected wounds.² Diagnosing osteomyelitis in people with diabetes who present with a foot ulcer is challenging and becomes a clinical conundrum. Misdiagnosis may lead to unnecessary treat

Understanding The Impact Of MRSA On Limb Preservation

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

To say that methicillin-resistant Staphylococcus aureus (MRSA) is a growing problem in the healthcare setting is an understatement. Indeed, healthcare providers are diagnosing this organism at an alarming rate in severe infections of both healthy people and the immunocompromised. In 1973, the Centers for Disease Control and Prevention (CDC) reported that MRSA accounted for 2 percent of all Staphylococcus infections. In 2004, it accounted for 63 percent.1
In both the nondiabetic and diabetic populations, Staphylococcus aureus is the most frequently isolated or

Emerging Concepts With VAC Therapy

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

Vacuum Assisted Closure (VAC, KCI) may be the most impressive device for the foot since AO fixation revolutionized elective foot surgery. For large or difficult wounds, VAC therapy can rapidly improve granulation tissue and speed up coverage of exposed tendon and bones. Indeed, this often occurs in days to weeks rather than months. Most clinicians are convinced at the bedside when they see dramatic changes in the characteristics of a wound such as size, depth and exposed structures. There is a growing body of evidence that supports the clinical observations and animal research that have be