|
|
|
Search
04/18/2018 Robert D. Phillips, DPM,
The Importance of Examining Legs:
I would like to commend the thoughtful letters written by Dr. Forman (4/14/18), Dr. Silver (4/18/18) and Dr. Jacobs (4/16/18). All bring to the fore the important facts that diabetes not only has a negative effect on all the systems in the foot, but that decrease in the utilization of the foot also accelerates the impact of the disease on the other body systems.
Certainly, the main goal of any podiatrist treating the diabetic patient is to increase the activity level of the patient. Many years ago, I heard Dr. Root talk about no longer thinking of geriatric foot care as trimming calluses and nails and moisturizing the skin. Instead he stated that a major focus should be the prevention of falls.
This concept needs to be updated to include diabetic foot care. A required journal read of all medical students who rotate in our wound care externship is “Cavanagh, Peter R., Guy G. Simoneau, and Jan S. Ulbrecht. ‘Ulceration, Unsteadiness, and Uncertainty: the Biomechanical Consequences of Diabetes Mellitus.’ Journal of Biomechanics 26 (1993): 23-40.” This now classic article (cited now 254 times since) should create no doubt in the physician’s mind that diabetes is as much a biomechanical disease as an endocrine disease.
The fact that any diabetic would have a callous should point to a biomechanical issue that needs to be addressed by the podiatric physician, and it is unconscionable in my opinion that a significant amount of E/M time isn’t spent in identifying the etiologies of the callous.
I recently contributed to another podiatric magazine, a brief overview on the biomechanical issues that the diabetic faces, from changes in the biomechanics of every body tissue, to the changes in muscle mass(which changes start long before any detection of deficit using a 10g monofilament), to changes in proprioception and changes in muscle firing patterns, all of which markedly impairs normal walking and increases the risk of falls.
I agree totally with Dr. Jacob’s statements that a 33% E/M use should be the norm for podiatry. Let us hope that this time next year we will have a consensus in the profession that less than 33% E/M use is definitely below the norm. Robert D. Phillips, DPM, Orlando, FL
There are no more messages in this thread.
|
|
|
|