03/29/2018    

RESPONSES/COMMENTS (REVEVANT RESEARCH)

RE: Foot Orthoses Not Superior for Improving Pain and Function in PHP

From: Paul Kesselman, DPM

 

Today, the unfavorable study on orthotics and plantar heel pain (PHP) hit Medscape. I agree that our students and residents are not properly trained in research, nor do we have a sufficient number of  trained clinical or academic podiatrists trained in research. Until such time that this changes, what else can we expect other than more stories and studies which may not accurately reflect the body of knowledge we as clinicians have either been taught and/or have come to believe. 

 

I want to clearly state that podiatrists providing properly peer-reviewed research may not always translate into positive outcomes. And no one would expect all research to be favorable as there of course are more dead ends than not.

 

But podiatrists properly trained in clinical and academic research should, at the very least, be able to provide ample counterpoints to those negative outcomes in poorly written papers. Without either positive outcomes properly researched or properly prepared counterpoints to negatives, the bean counters at the insurance companies can continue to use unfavorable outcomes any way they wish to sway their reimbursement policies in order to favor their profit margins. 

 

Paul Kesselman, DPM, Woodside, NY

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03/09/2021    

RESPONSES/COMMENTS (REVEVANT RESEARCH)

Risk Factors for Melanoma by Anatomic Site

 

The authors analyzed data from 2617 first invasive melanomas (975 controls) from 2 population-based case–control studies in Australia and the UK. They found that the incidence of melanoma was highest on the trunk (35%) and lower limbs (34%) and was lower for the upper extremities (20%) and head and neck sites (11%). Men had a higher frequency of melanoma on the head and neck, whereas women more frequently had disease on the extremities. Melanomas occurred more often on the head and neck than on any other site in patients older than 70 years. Higher density of nevi was associated with higher odds for melanoma of all sites, but a stronger association was seen with many nevi and melanoma on the trunk and extremities. Very fair skin type was associated with melanoma on non-truncal locations.

 

This study sheds light on the factors that affect the risk of developing melanoma and how they vary based on the anatomic site of the melanoma. These data support the dual-pathway hypothesis, which holds that truncal melanomas are more strongly related to nevi and intermittent sun exposure, while head and neck melanomas are more related to chronic sun exposure.

 

Source: Caroline K. Crabtree, MD, Practice Update [3/4/21] via Dr. Allen Jacobs

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03/27/2018    

RESPONSES/COMMENTS (REVEVANT RESEARCH) - PART 1B

RE: Foot Orthoses Not Superior for Improving Pain and Function in PHP  

From: Nicholas A. Ciotola, DPM 

 

What I have found problematic in most studies on the role of various orthotic devices in plantar fasciopathy is that they all treat this disease like it is a homogeneous entity. Future investigations would be more robust by specifying the factors placing the patient at risk for plantar fasciopathy. It seems intuitive to me that plantar fasciopathy secondary to sagittal plane deformities (e.g. equinus) will do fine no matter what you place under the patient's foot, since a heel lift is probably all they needed.

 

On the other hand, I believe heel pain with severe coronal plane deformities will benefit from an appropriately posted customized device. This paper, while limited in its methodology, hints that there may be some substance to this approach.

 

Nicholas A. Ciotola, DPM Methuen, MA