June 2012

Study: U.S. Obesity Rate To Increase 33 Percent By 2030

By Brian McCurdy, Senior Editor

By the year 2030, the rate of obesity in the United States will increase by an estimated 33 percent while the prevalence of severe obesity will rise by 130 percent, according to a recent study.

   The study, published in the American Journal of Preventive Medicine, used data from the Behavioral Risk Factor Surveillance System gathered between 1990 and 2008. By 2030, the study’s non-linear regression model projects that 42 percent of Americans will be obese.

   “I’m actually quite alarmed at how many more obese children I see now,” says Ron Raducanu, DPM, the President and a Fellow of the American College of Foot and Ankle Pediatrics. “Most (parents) haven’t a clue about how obesity can affect their children over the year.”

   Marc A. Brenner, DPM, says obesity is a “major problem” for podiatrists and emphasizes its link with diabetes. In addition, he calls the fact that kids are becoming obese at a rapid rate a “dangerous sign.” Dr. Brenner advocates having a better diet and Russell Volpe, DPM, cites “fighting the convenience of fast food and sugary sodas.”
“The problem is when (kids) go home to their houses, they eat fast food,” says Dr. Brenner, who is in private practice in Glendale, N.Y.

   Raising awareness of the dangers of obesity starts at home and in the schools, according to Dr. Raducanu. He advises teaching parents about healthy alternatives to what they give their children for school lunches as well as getting vending machines and McDonald’s out of the schools.

   Tracey Vlahovic, DPM, concurs. “We have to really focus on pediatric obesity and the quality of school lunches, increasing activity levels and decreasing TV and video game time, and encouraging family meals instead of takeout,” notes Dr. Vlahovic, an Associate Professor at the Temple University School of Podiatric Medicine.

   Dr. Raducanu and Dr. Volpe also advise getting patients off the couch and outside playing. Dr. Brenner suggests more physical education in classrooms and walking every day.

   The study researchers did note several factors that could slow the growth of obesity, such as access to recreational facilities, obesity education programs and urban design improvements.

   To stem the tide of obesity, Dr. Vlahovic advocates having workplace programs, whether it is a gym on site or a Weight Watchers-like program that is available to employees.

   As for solutions in podiatric practice, Dr. Vlahovic also says DPMs can measure body mass index in the office and have a discussion with patients about the impact that extra weight has on the lower extremity as well as the risk of developing diabetes. Likewise, Dr. Raducanu emphasizes the importance of educating kids on the diabetic foot.

   Dr. Volpe says podiatrists should also treat children with foot imbalances and abnormalities so that a weak or poorly functioning foot is not an additional excuse for lethargy and inaction.

   “Many kids ‘self-select’ out of being active because they have lax, pronated feet that function poorly in sustained weight-bearing and athletic activities,” says Dr. Volpe, a Professor in the Department of Orthopedics and Pediatrics at the New York College of Podiatric Medicine. “Improve foot function and you will improve the chances of these kids being able to move comfortably and enthusiastically and, in so doing, help fight the growing obesity epidemic in children.”

Can PRP Promote Healing In Chronic Diabetic And Ischemic Wounds?

By Danielle Chicano

Platelet-rich plasma (PRP) gel treatment may promote good healing outcomes and low amputation rates in patients with long-standing chronic wounds and a history of diabetes and ischemic disease, according to a recent study published in Ostomy Wound Management.

   Researchers focused on 39 patients with 40 chronic, lower extremity wounds. Study authors note after initial evaluation, researchers administered standard treatment for a period of approximately 75 days followed by a treatment period of PRP gel.

   Authors note that following the 75 days of standard treatment, none of the wounds were healed and the average wound area, depth and volume actually increased. However, following the topical PRP gel treatment, 83 percent of wounds healed within approximately 145 days with one patient requiring amputation, according to the study.

   David Armstrong, DPM, MD, PhD, notes, on the aggregate, his experience with PRP gel and similar treatment modalities has been positive.

   “We think that, when taken as a whole, the data for this technology and other cell-based therapies may show a positive signal. At the Southern Arizona Limb Salvage Alliance (SALSA), we have begun a specific cell therapy clinic to work to harness this potential promise and better understand this modality,” notes Dr. Armstrong, a Professor of Surgery at the University of Arizona and the Director of SALSA.

   The authors say their findings warrant prospective, controlled studies comparing the use of this PRP gel to other advanced treatments. Dr. Armstrong notes that although he and his clinic do not currently know definitively where this technology would be advantageous over other therapies, his cell therapy clinic is currently scheduling patients to gather such insights.

   “Presently, in our cell therapy clinic, we are scheduling patients that have failed many previous therapies in order to both give these patients increased interdisciplinary attention as well as offer them another adjunctive technique,” states Dr. Armstrong.

   Editor’s note: To read the full Ostomy Wound Management study, visit http://bit.ly/Kg3GSt .

In Brief

Cytomedix announced that the Centers for Medicare and Medicaid Services (CMS) issued a proposed National Coverage Determination memo for autologous blood-derived products for chronic non-healing wounds. In its decision memo, CMS has proposed coverage for three wound categories: diabetic, venous and pressure wounds, according to Cytomedix. Cytomedix notes the AutoloGel System is the only PRP device cleared by the FDA for use in wound management. The complete decision memo is available on the CMS website at http://go.cms.gov/KmIwEp .

What Is The Most Effective First MPJ Fusion Method?

By Brian McCurdy, Senior Editor

A study recently published in the Journal of Foot and Ankle Surgery notes no significant statistical difference in union rates when fusing first metatarsophalangeal joints (MPJ) with static or locked plates either with or without lag screws.

   The authors performed a retrospective review of 138 first MPJ fusions in 132 patients. The mean time to union and rate of fusion were 59 days and 95 percent with a static plate; 56 days and 86 percent with a static plate and lag screw; 66 days and 92 percent with a locked plate; and 53 days and 96 percent with a locked plate and lag screw.

   As study author Christopher Hyer, DPM, notes, although his study reported a high fusion rate with all constructs, having a lag screw under a plate is the most certain way to provide compression across the site. Dr. Hyer comments that there is a risk of plating without the lag screw in that one could potentially plate the fusion under slight distraction rather than compression, making nonunion or delayed union more likely.

   Dr. Hyer says screws can be useful to maintain intraoperative correction while one applies the plate. He prefers to dictate the position of the toe, fix it there with the lag screw and then make the plate fit that position.

   Dr. Hyer adds that he prefers using locked plates in poor quality bone, in revision cases with bone graft use and in patients at risk for nonunion like smokers and those with diabetes. He has used low profile locked plates in most situations.

   “I still may use a static/non-locked plate when I want the plate construct to compress the fusion site using (an) eccentrically loaded screw technique,” says Dr. Hyer, a Fellow of the American College of Foot and Ankle Surgeons.

In Brief

BioMedix has joined with the Western University of Health Sciences to promote amputation prevention through awareness and early detection of peripheral artery disease (PAD). Through an educational grant from BioMedix, the company says the college will have access to PADnet, a non-invasive test for PAD that can identify obstructive disease and determine whether medical or surgical treatment is necessary.

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