News and Trends

APMA Creates New Surgical Affiliate

By Brian McCurdy, Senior Editor

   Following the American Podiatric Medical Association’s (APMA) parting of ways with the American College of Foot and Ankle Surgeons (ACFAS), the APMA has established its own new surgical affiliate, the American Society of Podiatric Surgeons (ASPS).

   The ASPS has a goal of “promoting the advancement of podiatric surgery through education and research,” according to a recent edition of the APMA e-news. The new surgical affiliate will operate under its own bylaws and will be directed by a yet to be named governing body.

   The APMA decided to seek a new surgical affiliate last year after the ACFAS ruled that renewing ACFAS members did not have to belong to the APMA. (See “ACFAS Changes Dual APMA Membership Policy” in the February 2008 issue and “ACFAS Members Vote Against Dual APMA Membership” in the June 2008 issue.) Last August, the APMA Board of Trustees decided that the best method of establishing a new surgical affiliate would be to look within the APMA itself, according to the APMA e-news.

    “The Board of Trustees also based its rationale on creating ASPS on the great potential to ensure the highest level of communication among leaders of the profession on key issues affecting the future of podiatric medicine and surgery,” says APMA President Ross Taubman, DPM, in the association e-news. “In addition, with the surgical expertise within an organization in such close nexus to APMA, expert testimony can be easily coordinated on issues of mutual interest to ASPS and APMA.”

Promoting Similar Benefits In A United Effort With Lower Costs

   The Board of Trustees feels that the ASPS will be cost-effective and its collaboration with the APMA will allow economies of scale and add more value to the APMA membership. Lloyd Smith, DPM, agrees. He thinks the ASPS will provide the same benefits as the ACFAS at a lower cost.

    “(The ASPS) will also allow for a concerted and united effort on all issues, all committees and all APMA projects. I see no disadvantages to this change,” says Dr. Smith, a Past President of the APMA.

   As far as the goals of the ASPS, Dr. Smith would like to see it “promote and foster surgical education and training” consistent with the stated goals of the APMA House of Delegates.

   However, Alan Catanzariti, DPM, says he is “disappointed” in the APMA’s decision to discontinue using the ACFAS as a surgical affiliate. He feels that the APMA and ACFAS should have compromised in the bylaw dispute.

    “I think (ACFAS) provides a great advantage for podiatrists in terms of representing their interests as foot and ankle surgeons,” says Dr. Catanzariti, the Director of Residency Training within the Division of Foot and Ankle Surgery at the Western Pennsylvania Hospital in Pittsburgh, Pa.

   Dr. Catanzariti, a Fellow of the American College of Foot and Ankle Surgeons, says the establishment of the ASPS would create a competing organization with the ACFAS, and thinks “people are going to be forced to choose.” He also expresses concern as to how the new surgical affiliate may affect board certification.

   Dr. Smith disagrees. He says the board certification process (whether one is achieving board certification through ABPS or ABPOPPM) has “absolutely no relationship” with ASPS, APMA

   The ASPS initially plans to have three membership categories: fellow, associate and member, according to the APMA e-news. The association says it also plans to begin inviting APMA members who are certified by the American Board of Podiatric Surgery to apply to the ASPS. N

Can ESWT Have An Impact In Treating Achilles Tendinosis?

By Brian McCurdy, Senior Editor

   Podiatrists have used extracorporeal shockwave therapy (ESWT) for various conditions, most notably plantar fasciitis. A new study in the Journal of the American Podiatric Medical Association says ESWT holds promise in the treatment of Achilles tendinosis.

   Researchers studied the use of ESWT in 23 patients who suffered from Achilles tendinosis, insertional tendonitis or both. The mean follow-up was 20 months.

   Ninety-one percent of patients told researchers they were either satisfied or very satisfied with ESWT. The study notes that 87 percent of patients said ESWT improved their condition while 13 percent said it did not affect the condition. Four months after treatment, the patients’ mean visual analog score (VAS) for morning pain decreased from 7.0 to 2.3 and activity pain VAS decreased from 8.1 to 3.1, according to the study.

What Advantages Does ESWT Offer?

   Study co-author Robert Fridman, DPM, finds that Achilles tendinopathy is difficult to treat. Since options are limited when the condition does not respond to conservative therapy, ESWT gives physicians another option, according to Dr. Fridman, who practices in the Department of Orthopedic Surgery at Columbia University Medical Center in New York City.

   Lowell Scott Weil Jr., DPM, the lead author of the study, adds that ESWT is noninvasive and does not cause complications or interference in daily activities. He notes that patients do not need to be immobilized but they should reduce the playing of weightbearing sports to permit healing.

   Dr. Weil, the Fellowship Director of the Weil Foot and Ankle Institute in Des Plaines, Ill., says the only absolute contraindications for ESWT are pacemaker use and pregnancy.

Study Cites Benefits Of HBO For Diabetic Foot Ulcers

By Lauren Grant, Editorial Assistant

   A new study found that hyperbaric oxygen (HBO) therapy has adjunctive benefits in healing foot ulcers and reducing the number and degree of amputations in patients with diabetes.

   The study, which was recently published in the Journal of Foot and Ankle Surgery, involved 100 patients with diabetic foot ulcers and researchers compared the use of HBO and standard therapy to standard therapy alone. Researchers found that 48 percent of the standard therapy group underwent distal amputation and 34 percent underwent proximal amputation. In comparison, 8 percent of the HBO group had distal amputations and no patients had proximal amputations.

   While HBO may be perceived as moderately expensive, Caroline Fife, MD, says the use of HBO is cost-effective in the long-term for properly selected patients.

    “The benefits of HBO therapy accrue over time, in part due to savings from averted major amputations,” explains Dr. Fife, an Associate Professor in the Department of Medicine, Division of Cardiology at the University of Texas Health Science Center in Houston. “The cost of a series of HBO is less than the cost of a major amputation if HBO is, in fact, limb-saving.”

   Dr. Fife says therapeutic benefits of HBO include correction of tissue hypoxia, growth factor receptor stimulation and growth factor induction, resulting in fibroblast replication, collagen deposition and angiogenesis.

   In regard to proper patient selection, Dr. Fife says testing methods such as transcutaneous oximetry can be helpful in this regard. She notes that physicians should reserve the use of HBO for patients who would not have healed with conservative care alone. Dr. Fife says HBO should not be utilized for patients who have severe vascular disease because they are incapable of responding to HBO.

In Brief

   • Ethicon annouces the launch of Systagenix Wound Management, which was formerly known as the Professional Wound Care Business of Ethicon. Systagenix will build on its existing wound care products, including Promogran Matrix Wound Dressing, Tielle Hydropolymer Dressing and Regranex Gel, according to the company.

   • Merz Pharmaceuticals announces that Steve Hamm, formerly of Glaxo Dermatology, has become the company’s Senior Director of Marketing for Medical Dermatology. Merz also says Dave Shoup has joined the company as its Vice President of Neurology.

   • XTL Pharmaceuticals recently completed a phase 2b study of bicifadine for the treatment of diabetic neuropathy.


I agree with Dr. Weil that ESWT in the treatment for Achilles tendinosis is an excellent treatment modality. Having performed ESWT for Achilles tendinosis over over 12 years, I have found the results outstanding.

As far as absolute contraindications go, there is no FDA contraindication for ESWT and pacemakers. So long as there is medical clearance and proper medical support, you can consider the use of ESWT in patients with pacemakers.

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