07/22/2013    Jon Purdy, DPM

Setting the Record Straight on Debridment of Calluses in Diabetics (Alan Sherman, DPM)

Here is the letter I sent to Dr. Bernstein. I
would think others may want to use it as a
template and possibly send it to The journal’s
Editor in Chief, William T. Cefalu, MD. I am
amazed that he would let such slander be printed.

Dr. Bernstein,

I have read your unscientific and misleading
observations as you presented them in your ADA
Diabetes Care piece. I challenge you to show me
statistically where podiatrist’s paring of
calluses are the leading cause of ulcerations and
morbidity in the diabetic population.

You make some valid points in advising the
offloading of pressure areas. This is not
always “readily accomplished” in patients with
significant or rigid deformities. It is a non-
covered service by Medicare absent a diagnosis of
diabetes, and for patients with diabetes and only
Medicare is only covered at 80%. Most other
insurances do not cover it at all.

Have you ever stopped to consider that any out of
pocket treatments that would prevent future
ulceration are routinely declined by the patient?
Or, that these prescribed treatments are commonly
not adhered to by the non-compliant patient?

I see many insensate patients that come to my
clinic with what they think is just a callus
which ultimately turns out to be a callus
covering an existing ulcerative site.

I can’t tell you how many times I have seen
surgeons and other physicians debride non-
infected ulcerations in avascular patients
leading to larger ulcerative areas, infections,
and amputation.

Your statement of diabetic ulcerations caused by
podiatrists in “every case” no doubt undermines
your credibility, as this is an impossible
scenario. For you to publically write something
defamatory about an entire profession without any
data, and only basing it on a patient’s side of
the story, is at the very least unprofessional.

Jon Purdy, DPM, New Iberia, LA,
jpurdy@mindspring.com

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