Podiatry Today Current Issue

Case Studies In Cryosurgery For Heel Pain

admin — Wed, 03 Sep 2008 17:01:39 -0400

Cryosurgery is an effective pain relief modality that uses freezing temperatures for ablation of the nerves that provide sensation to the heel. While this treatment is relatively new for foot pain, physicians have utilized cryosurgery for pain relief for decades. This modality has proven to be a viable treatment and is an excellent choice for appropriate patients prior to considering more invasive procedures.

Heel pain has become an epidemic in our society. Diabetes, arthritis, weight gain, injuries, previous heel surgery and other medical conditions are known contributing factors.

How To Maximize Outcomes In Tarsal Tunnel Surgery

admin — Wed, 03 Sep 2008 17:01:39 -0400

As with any peripheral nerve surgery, tarsal tunnel surgery is demanding and can sometimes be excessively difficult. Additionally, one may not have a full appreciation of the outcome until some point in the postoperative period — if at all — when the nerve has had adequate time for recovery and/or regeneration.

Sadly, there are many misnomers in podiatric medicine and surgery. For example, the nomenclature of “tarsal tunnel syndrome” implies that the site of chronic nerve entrapment is at the level of the tarsal tunnel,

A Guide To Conservative Care For Heel Pain

admin — Wed, 03 Sep 2008 17:01:39 -0400

Over the years, podiatrists have become the primary health care providers for all forefoot conditions and most rearfoot conditions. With greater public awareness and increased referrals from primary care doctors, heel pain pathology is perhaps the most common foot pathology we treat in our offices. As a result, many new devices and surgical techniques have emerged in recent years to help improve our outcomes.

Unfortunately, some of these newer methods and techniques are not always necessary and may not demonstrate the same outcomes that some of the research states.

Do Prefab Orthoses Have A Place In Treating Plantar Fasciitis?

admin — Wed, 03 Sep 2008 17:01:39 -0400

The world of orthotic therapy and foot biomechanics was somewhat shaken in 2006 when a randomized study found that “customized and prefabricated orthoses used in the trial (had) similar effectiveness in the treatment of plantar fasciitis.”¹ Of course, there was a great deal more to this study than the one sentence but it sure stimulated discussion within podiatry and orthopedic surgery concerning the value of custom orthoses in comparison to prefabricated devices.

There are actually four relatively recent trials that compare prefabricated and custom orthoses relativ

A Guide To The Differential Diagnosis Of Plantar Fasciitis

admin — Wed, 03 Sep 2008 17:01:39 -0400

Please click here for the full Continuing Medical Education article:

http://www.naccme.com/program/n-216/

There may be a tendency to leap to a plantar fasciitis diagnosis when patients present with heel pain. However, this author emphasizes the importance of a thorough differential diagnosis. accordingly, he offers diagnostic insights on a variety of potential causes ranging from calcaneal spur fractures and neurogenic heel pain to systemic etiologies.

How Does Quality Of Life Affect Diabetes Treatment Compliance?

admin — Wed, 03 Sep 2008 17:01:39 -0400

Given that patients with diabetes can face extensive treatments due to the risk of complications, adherence to treatment regimens may be a problem due to a perceived decline in their quality of life.

A new study finds that although end-stage complications have the greatest effect on quality of life, comprehensive treatments affect quality of life to the degree that some patients were willing to forego years of healthy living to avoid treatments.

In the study, which was recently published in Diabetes Care, researchers interviewed 701 patients with diabetes a

Tendo-Achilles Lengthening: Friend Or Foe In The Diabetic Foot?

admin — Wed, 03 Sep 2008 17:01:39 -0400

While various researchers have implicated the equinus deformity as a major deforming force in a host of foot and ankle pathologies, the exact definition of equinus remains unclear.^1-4 However, Root states that “the minimal range of ankle joint dorsiflexion that is necessary for normal locomotion is 10 degrees.”⁵ Subsequent studies report that the ankle joint range of motion for asymptomatic patients ranges from 0 to 13.1 degrees with the knee extended and from 5 to 22.3 degrees with the knee flexed.^6-9

The implication from these studies and

Expert Insights On Managing Traumatic Wounds

admin — Wed, 03 Sep 2008 17:01:39 -0400

Important questions arise when traumatic wounds occur in the lower extremity. Accordingly, our expert panelists address key considerations in the initial evaluation and when one should consider an amputation. They also explore the use of soft tissue coverage, skin substitutes and topical dressings with traumatic wounds.

Q: What protocol/triage steps do you utilize in the initial evaluation of a traumatic wound?
A: For a patient with extreme pain and a traumatic wound that requires immediate surgical debridement, Molly Judge, DPM, says pain management and a

Can A New Nail Trephination Device Help Treat Nail Conditions?

admin — Wed, 03 Sep 2008 17:01:39 -0400

The fully keratinized, thick multilayered structure of the nail plate presents a formidable barrier to nail bed access. This limits the options for treatment of nail diseases such as onychomycosis and subungual hematoma from nail trauma. Until recently, clinicians considered nail removal as an option for formal repair of the nail bed for subungual hematomas involving large regions of the nail bed.¹

Penetration enhancing formulations have aided the delivery of molecules to the nail bed through the impermeable nail plate.² Researchers have used a carbon diox

A Closer Look At A New Algorithm For Treating Plantar Fasciitis

admin — Wed, 03 Sep 2008 17:01:39 -0400

In the United States, at least 10 percent of the population experiences heel pain secondary to plantar fasciitis. Reportedly, 600,000 outpatient visits to medical professionals a year are due to plantar fasciitis.¹ According to a 2003 study, plantar fasciitis frequently occurs in people who are on their feet most of the day, those who are obese and those who have limited ankle dorsiflexion.²

However, it is important to recognize that all heel pain symptoms do not stem from plantar fasciitis. There are many different etiologies for heel pain and making the