Podiatric Medical School Applications Up 9.17 Percent In 2019
Podiatric medical schools across the United States received a total of 964 applications in the 2019 cycle, according to the American Association of College of Podiatric Medicine (AACPM). This is a 9.17 percent increase from 2018 when the prospective student pool was comprised of 883 applicants. The last two years have shown growth in the number of applications after a significant drop of over 25 percent between 2015 and 2016.
Moraith G. North, the Executive Director of the AACPM, is encouraged by the increase in applicants this year. She relates that the AACPM is in the third year of a three-year strategic plan to promote podiatry as a career with “Be Our Guest” events being hosted at state and regional conferences throughout the country. She cites an aggressive increase in the number of events AACPM offers, averaging 2 events per year from 2015 to 2017, and more than 10 events to date in 2019 as of July.
V. Kathleen Satterfield, DPM, FACFAOM, Dean and Professor at the Western University of Health Sciences College of Podiatric Medicine, believes a combination of factors contributes to the increase.
She cites the new television shows that center on podiatry or chiropody, such as “The Foot Fixer” and “The Toe Bro,” as factors that may lead someone to seek out more information on the profession.
“That sends someone to the Internet to search for ‘podiatry’ and from there, it is up to us to make the case,” notes Dr. Satterfield, who cites the American Podiatric Medical Association (APMA), the AACPM, the podiatry colleges and practitioners as teammates in this process.
Strengthening relationships with organizations such as state components of APMA has been crucial, states Ms. North. She cites the ability to connect DPMs from the DPM Mentor Network with college campuses to help initiate on-campus promotions as an example of the benefit of these relationships.
Noting an example of the powerful draw of podiatric medicine, Dr. Satterfield shares the story of a DO student who transferred into podiatric medical school last year. He had discovered his chances of obtaining a surgical residency in his previous program was about four percent. In podiatry, it was nearly 100 percent and with a shorter time frame to completion.
Dr. Satterfield also emphasizes the importance of communicating the economic benefits of podiatric medical education to prospective students. She notes the cost of podiatric medical education can be far less than that of other medical specialties with potential income also being higher.
In order to disseminate messages such as that described by Dr. Satterfield and Ms. North, engaging with prospective students and college advisors in real time at in-person events and virtual online career fairs is another avenue that AACPM continues to pursue. Ms. North also cites new initiatives that connect students in pre-health sciences with DPMs through hands-on workshops and labs to inspire their interest in the field.
Dr. Satterfield relates that more exposure is necessary for the applicant pool to continue to grow. She states Western University has contracted with an educational marketing firm to create a “brand” and educate the public about modern podiatry.
“When I greet applicants each week as they visit our campus, more times than not, when I walk in, they are on YouTube watching videos about podiatry,” she shares. “They enjoy seeing the message there. It is the way of Generation Z!”
“Our goal remains to create more opportunities for students in high school and college to learn about podiatric medicine,” adds Ms. North. “When they learn about the unique opportunity that is a career in podiatric medicine, more students will seek out opportunities to explore the profession.”
Sustained Dynamic Compression Nail Shows Promise In Tibiotalocalcaneal Arthrodesis Study
In a new study, researchers found that the use of a sustained dynamic compression intramedullary nail facilitated a significantly faster time to union for tibiotalocalcaneal (TTC) arthrodesis in comparison to non-dynamized intramedullary nails.
Recently published by Foot and Ankle Specialist, the retrospective study involved 86 patients who had a tibiotalocalcaneal arthrodesis with surgeons employing a sustained dynamic compression nail (DynaNail®, MedShape) in 50 patients and non-dynamized nails in 36 patients. The group with the sustained dynamic compression nail achieved union 3.9 months faster than those patients who received non-dynamized nails, according to the study. The authors also noted that patients in the sustained dynamic compression nail group required less hardware for the arthrodesis procedure.
Study authors also cite research showing less stress shielding and more load transfer to the bone with the DynaNail than with non-dynamized nails.
Alan Catanzariti, DPM, FACFAS, states he would consider the DynaNail in patients undergoing TTC arthrodesis who might be at risk for non-union. He prefers an intramedullary nail in patients at risk for non-union, those who are undergoing revision surgery or patients with severe deformity requiring realignment. In some cases, Dr. Catanzariti relates he will consider supplementation with a neutralization external fixator.
For patients undergoing TTC arthrodesis without the aforementioned concerns, Dr. Catanzariti prefers an anterior locking plate for tibiotalar fixation and compression screws for subtalar fixation.
Dr. Catanzariti, the Director of Residency Training at the Western Pennsylvania Hospital in Pittsburgh, relates his experiences with DynaNail to be positive. He cites successful cases of patients at-risk for non-union including those with uncontrolled diabetes mellitus, previous ankle or hindfoot surgeries, avascular necrosis, previous trauma with periarticular bone loss, Charcot neuroarthropathy and severe deformities.
“The chief benefits of a sustained dynamic compression nail lies in its internal Nitinol element that can respond and adapt to the bone biology during healing,” states Dr. Catanzariti. “This allows the nail to keep the bones closely approximated and maintain compression in response to bone resorption or settling.”
Non-union following TTC arthrodesis often requires significant time, resources and staged procedures that Dr. Catanzariti classifies as a limb salvage endeavor. He stresses the importance of trying to control risk factors for non-union prior to occurrence. Dr. Catanzariti says adequate compression is key in providing mechanical stability and promoting a biological healing response, and that DynaNail could offer these qualities, especially in a more challenging patient population.
Study Evaluates Lateral Oblique Imaging For Haglund’s Deformity
Given the high level of variation in calcaneal anatomy, could the lateral oblique radiograph offer improved diagnosis of Haglund’s deformity?
Study authors assessed this question in a retrospective review involving 75 sets of radiographs in 65 patients with symptomatic Haglund’s deformity. In the study, which was presented as a poster abstract at the APMA National meeting in July, the researchers found that the lateral oblique view demonstrated a Haglund’s deformity on 75 out of 75 radiographs (100 percent) whereas the lateral radiograph view showed the Haglund’s deformity in 62 out of 75 radiographs (82.6 percent). Additionally, in the control group of 30 patients who did not have a symptomatic Haglund’s deformity (as per a clinical exam), the lateral oblique view had a negative predictive
value of 89 percent.
Troy Boffeli, DPM, FACFAS, the lead author of the poster, shares that Haglund’s deformity is somewhat elusive on X-ray due to large clinical lumps that often appear underwhelming on the traditional three view series of radiographs.
“The lateral oblique view images the dorsal lateral aspect of the calcaneal tuberosity, which we refer to as the ‘Haglund’s view.’ Considering that the AP, medial oblique and axial views are minimally useful in posterior heel pathology, a two view X-ray series (lateral oblique and lateral weightbearing heel series) would be appropriate,” states Dr. Boffeli, the Director of the Foot and Ankle Surgical Program at Regions Hospital/Health Partners Institute for Education and Research in St. Paul, Minn.
He continues to cite that the lateral oblique view is useful for multiple pathologies, including tibial sesamoid fracture, dorsal lateral spur formation in early-stage hallux limitus and the accessory navicular.
Dr. Boffeli relates that when a provider is unable to show an obvious deformity on X-ray, the patient loses confidence in the diagnosis and may seek out a second opinion, or question the need for surgery.
“Having to explain that X-rays do not always match clinical findings makes a patient wonder if he or she needs an MRI. Patients also appreciate when the provider gets ‘specialty’ X-rays that clearly show their condition,” adds Dr. Boffeli.
Dr. Boffeli also says intraoperative use of lateral oblique imaging is helpful in assessing the dorsal lateral aspect of the calcaneal tuberosity after surgical resection.