Diabetic heel ulcers are particularly challenging to treat as a wide range of factors can affect potential healing. With this in mind, this author discusses the challenges of wound bed preparation, key considerations with offloading and the possible impact of peripheral arterial disease.

   Despite a better understanding and the advent of preventive measures that have been developed to address heel ulcers, the problems we encounter due to complications of diabetes make treating this specific patient population more challenging.

Given the potential complications of Charcot foot in the diabetic population, these authors review the pathophysiology of the disease, discuss key diagnostic considerations and offer their perspectives on possible surgical treatments.

   The Charcot foot poses quite a challenge in even the most organized centers. The outcomes are often poor and can lead to osteomyelitis, amputation and permanent disability. The diagnostic delay averages 29 weeks.¹ Even when appropriate diagnosis occurs early, there is no agreement on the best treatment approach.

Poorly managed diabetes can have devastating consequences and there are challenges in getting patients to do their part in following treatment regimens. With these things in mind, this author offers key insights into the psychology of non-adherent behavior and how to get patients back on the right path.

CPME May Extend Residency Requirement To Three Years

By Brian McCurdy, Senior Editor

   The Council on Podiatric Medical Education (CPME) is proposing longer residency requirements for podiatrists to qualify for advanced certification. The council advocates lengthening the residency duration from two years to three, according to CPME 320 documents posted on www.cpme.org/

   Surgical revision of a failed silicone prosthesis in the first metatarsophalangeal joint (MPJ) is a difficult dilemma that many foot and ankle surgeons increasingly encounter. While advocates of silicone and similar implants have alluded to their preliminary benefits, there is a scarcity of literature on how to salvage these failures, especially when they occur in younger, active patients.