Podiatry Today

Podiatry Today






CLINICAL EVENTS CALENDAR

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Non-Accredited Education

Managing the Diabetic Foot: A Clinical and Economic View Complimentary Archived Webcast
Non-Accredited


Understanding Collagen Dressings and their Benefit in Wound Care

Complimentary Archived Webcast
non-accredited

Feature

How To Handle Common Skin Dermatoses

Here is a follow-up view of the same patient. Three weeks later, the eruption had cleared with twice daily application of ciclopirox 0.77% cream.Here is an example of pitted keratolysis. Note the round and oblong pitted-appearing superficial depressions on the plantar surface of the medial heel region. The maceration, which is characteristic of hyperhidrosis, has created a white surface color (“soHere we see juvenile plantar dermatosis. Note the fissuring and scaling of the distal plantar surface in this young patient. There is no erythema or inflammation.Here you can see clearance of the same eruption four weeks after initiating therapy with clocortolone pivalate cream followed by dimeticone 1%- aluminum magnesium hydroxide stearate protectant, applied three times daily.Here is plantar mocassin tinea pedis extending onto the lateral ankle region. Note the sharply demarcated margin of the eruption, with a scaly accentuated border immediately above the lateral malleolus region.Here is a close-up view of localized digital psoriasis involving the left large toe of a 32-year-old female. The eruption had been persistent for several months and was refractory to therapy with topical antifungal agents, a high-potency topical corticos
VOLUME: 15 PUBLICATION DATE: Sep 01 2002
Issue Number: 
9

Dermatoses of the lower extremities are fairly common.1 These conditions include infectious, inflammatory, vascular, neoplastic and traumatic dermatoses. Many dermatologic conditions (i.e. psoriasis, lichen planus) that exhibit the potential for widespread distribution can be prone to occur on the legs, ankles or feet in some patients. Other disorders characteristically involve the lower extremities. For example, dyshidrotic eczema and pitted keratolysis are examples of dermatoses that involve the plantar surface of the foot.

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How To Diagnose And Treat Pressure Ulcers

Here you can see a pressure ulcer of nine months duration with eschar formation on the left heel. The patient has a history of prostate cancer and peripheral vascular disease. Pressure ulcers (as shown above) may develop over any bony prominence or any area of the soft tissue that is subjected to periods of prolonged pressure. To prevent the development of pressure ulcers, the author emphasizes protecting at-risk patients from adverse external forces, friction, shearing and pressure.
VOLUME: 15 PUBLICATION DATE: Jun 01 2002
Issue Number: 
6

Currently, over 34 million Americans are age 65 and over. This figure is expected to double to over 68 million by the year 2030. As a result, there has been a tremendous growth in nursing homes and the related federal regulations that oversee these facilities. Pressure ulcers are particularly problematic in this patient population. According to the Agency for Health Care Policy and Research (AHCPR) guidelines, the incidence of pressure ulcers (often referred to as bedsores) in long-term care facilities was estimated to be as high as 23 percent in 1989.
Pressure ulcers (also called decubitus

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A Comprehensive Review Of Topical Agents

Here you can see a status post open first ray amputation. Panafil treatment has been initiated. Here you can see the same wound five weeks after treatment with Panafil began. Note the healthy red granular base. Here is the same wound approximately eight weeks after the first application of Panafil. As you can see, the wound is close to closing. Here is a plantar forefoot ulceration right at the start of Hyaff dressing therapy. Four weeks later, you can see the healed ulceration site. Several studies have shown that Becaplermin promotes healing in diabetic neuropathic wounds as part of a comprehensive program of debridement, infection control and pressure reduction.
VOLUME: 15 PUBLICATION DATE: Jul 01 2002
Issue Number: 
7

The wound is in constant evolution. Changes arise and you need to be able to respond accordingly in your treatment course. Indeed, understanding the biochemical dynamics of wound healing is vital for proper product selection (see “Understanding The Phases Of Wound Healing” on page 42). The challenge to the practitioner is to have the knowledge base with which to sort through the thousands of topical agents and dressings available today.

Insights On Topical Agents With Collagen
Let’s start out with a discussion of the biologic topical agents that contain collagen. Collagen hastens wou

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Clearing Up The Confusion Over Posterior Tibial Tendon Dysfunction

According to the author, recent evidence suggests that DPMS should be wary of assuming that a ruptured PTT is the primary etiology for adult-acquired flatfooot (shown above). Here you can see an example of positive first metarsal rise. Performing the first metatarsal rise test allows you to check for ligamentous integrity and movement transfer mechanisms in the foot of a patient with Stage II PTTD. When you perform the Hubscher maneuver, be aware that effective ligamentous integrity and movement transfer will cause a one-to-one external rotation of the tibia as you passively dorsiflex the hallux.
VOLUME: 14 PUBLICATION DATE: Dec 01 2001
Issue Number: 
12

Virtually every foot and ankle surgical symposium held in the United States over the past five years has devoted significant sessions to the pathomechanics, surgical and non-surgical treatment of the symptomatic adult flatfoot condition. Unfortunately, the popular name for this condition, posterior tibial tendon dysfunction (PTTD), reinforces a generally accepted notion that a failure of the posterior tibial tendon (PTT) is the primary etiology of the symptomatic adult acquired flatfoot deformity.
However, there has been recent evidence to the contrary that would, at least, caution us about

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Secrets To Motivating Your Staff

You would be surprised at how far a thank you can go. Mustering up a simple thank you for a job well done should become (if it is not already) a daily occurrence.To motivate staff, encourage their development by teaching them new tasks, how to operate new equipment and perform new techniques.Pertinent Pointers On Offering Incentives
VOLUME: 21 PUBLICATION DATE: Jul 01 2008
Issue Number: 
7

Motivation does not always come wrapped in a dollar bill.Yet whenever the topic of “staff incentive” comes up, so does the topic of money. Even though I try to emphasize that it takes more than cold hard cash to incentivize staff, far too many physicians are unable to grasp this notion and keep reverting back to the bankroll in an effort to “buy” their staff ’s enthusiasm.
One survey, conducted by the late Kenneth Kovach, PhD, of the University of Maryland, found a significant disconnect between what employees actually want from a job and what man

Ten Pearls For Treating Difficult Nails

Here is a close-up view of moderate onychomycosis. A close-up of severe onychomycosis. Here you can see severe onychomycosis with onycholysis and subungual debris. Longitudinal streak onychomycosis (as seen above) is one of several presentations of onychomycosis that may be more difficult to treat. Patients with lateral nail involvement (as seen above) may benefit from partial nail avulsion in addition to antifungal therapy.
VOLUME: 15 PUBLICATION DATE: Sep 01 2002
Issue Number: 
9

Onychomycosis is a common nail infection, which is often chronic, difficult to eradicate and tends to recur.1 Current therapeutic approaches include mechanical or chemical avulsion, topical therapy, oral therapy or a combination of one or more of these treatment modalities. Treatment of onychomycosis has improved greatly with the addition of broad-spectrum oral antifungal agents and topical nail lacquers. However, even with the therapeutic advances, onychomycosis continues to increase in prevalence, treatment is not always successful, and relapse and reinfection may occur even after

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Assessing Orthotic Quality

The shape of the orthotic plate should match the shape of the plantar aspect of the foot with the STJ in neutral position and the MTJ(s) pronated and locked. If the patient responds well to low Dye taping and not so well to the orthotics, check the makeup of the orthotic device. Make sure the rearfoot post is properly angled as you requested; is tapered so it doesn’t get malpositioned by the shoe; and has proper height so as to correct for limb length differences when necessary.
VOLUME: 15 PUBLICATION DATE: Jun 01 2002
Issue Number: 
6

Numerous patients use orthotics and have improved foot function as a result of wearing them. Not only do they experience relief from previous pain and symptoms, but wearing orthotics also helps to prevent recurrence of foot, leg and other skeletal pains and conditions. Unfortunately, there are also numbers of patients who are either unable to tolerate their orthotics or are not getting symptomatic relief. We are often asked to evaluate many of these patients and assist them in getting better results from their orthotics.
People may hear about orthotics in different ways, whether it’s throug

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A New Bag Of Innovations

The Promogran Matrix Wound Dressing was recently granted FDA approval for the treatment of exuding wounds, including diabetic, venous and pressure ulcers. Dermagraft, which received FDA approval late last year, facilitates a rapid decrease in wound depth, according to Dr. Armstrong. A 76-year-old insulin-dependent male with diabetes presented with an ulceration under his big toe (see above photo). He has a long-term history of peripheral vascular desease and previously had an amputation of the fifth toe on the same foot. Here we see the same ulcer two weeks after it was treated with debridement, Hyalofill, Aquacel and offloading via a Camwalker boot. With the Pressure Specified Sensory Device (shown above), you can perform quantitative assessments of isolated peripheral nerves. Cleveland Smith, DPM, says the DBX6 orthotic “gives you the best of flexibility and durability in the same compound.”
VOLUME: 15 PUBLICATION DATE: Aug 01 2002
Issue Number: 
8

What products are facilitating quicker wound healing? What are some of the cutting-edge devices that are generating interest among podiatrists? What antibiotics are getting results? Are there new innovations that can provide adjunctive relief in diabetic foot wounds? In an attempt to answer some of these questions, we talked to leading podiatrists in the field. Without further delay, here’s what they had to say.
1. Promogran Matrix Wound Dressing. This chronic wound dressing was recently granted FDA approval for the treatment of exuding wounds, including diabetic, venous and pressure

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How To Manage Difficult Patients

VOLUME: 15 PUBLICATION DATE: May 01 2002
Issue Number: 
5

Is there a particular patient or two you dread seeing in your office? If a vote took place among physicians as to what kind of patient provokes the most distress in healthcare providers, we would bet many providers would answer “patients who fail to comply.” In fact, providers often react with anger and frustration when patients ignore their professional recommendations.
Aside from the potential legal ramifications, a patient’s lack of compliance often triggers feelings that our professional opinion is devalued and may even cause us to begin to question our own self-worth. When our own

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A Guide To Current And Emerging Antibiotics For MRSA

Here one can see MRSA of the heel after wound debridement.The patient received linezolid postoperatively.Here one can see necrosis with MRSA in the Achilles tendon above. While there are antibiotics on the market today that treat MRSA, physicians are reportedly seeing more and more resistance.This post-debridement photo shows an Achilles tendon with MRSA. The patient received daptomycin postoperatively.Here one can see a recurrent ulceration of a transmetatarsal amputation with underlying hypertrophic bone and MRSA.In regard to the aforementioned transmetatarsal amputation with MRSA, here is the same wound after resection of hypertrophic bone and ulcer, and postoperative treatment with daptomycin.
VOLUME: 21 PUBLICATION DATE: Jul 01 2008
Issue Number: 
7

Staphylococcus aureus is a common pathogen that can result in everything from minor skin infections to osteomyelitis, bacteremia, endocarditis and pneumonia.1 In podiatry, infections with Staphylococcus aureus, especially methicillinresistant Staphylococcus aureus (MRSA), are something physicians see on a daily basis.
In a study determining the prevalence of MRSA in infected and uninfected diabetic foot ulcers, 61 percent of infected diabetic foot ulcers were infected with MRSA.2 With the emergence of multi-drug resistant St

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CME Showcase


"Current Concepts In Healing Chronic Diabetic Foot Ulcerations"

A Complimentary On-Demand CE/CME Webcast

This activity is supported by an educational grant from Advanced Biohealing.
This activity is sponsored by the North American Center For Continuing Medical Education (NACCME).

To access this Webcast, visit www.naccme.com/program/n-550/

Current Concepts In Diagnosing And Treating MRSA In The Diabetic Foot

This activity is supported by an education grant from Pfizer.
This activity is sponsored by the North American Center of Continuing Medical Education (NACCME).

To access this activity, visit www.naccme.com/program/n-528/
MRSA And Diabetic Foot Wounds: Where Do We Go From Here?


Archived Accredited Webcast with Q&A

This activity is supported by an educational grant from Pfizer. This activity is sponsored by the North American Center For Continuing Medical Education (NACCME).
PERIPHERAL ARTERIAL DISEASE (PAD) AND CRITICAL LIMB ISCHEMIA (CLI):
Managing Vascular and Wound Healing Challenges with Current and Emerging Technologies

Archived Accredited Webcast with Q&A

This activity is supported by an educational grant from Baxter Healthcare Corporation.

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