Podiatry Management Online


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From: Don Peacock, DPM


I've had the opportunity to perform the Katzen modified version of the MIS Wilson osteotomy. The procedure is very effective in some patients. I use the  procedure in mild to moderate bunion deformities with mild PASA and a relatively small bunion/ "bump".  I do agree with Dr. Greenberg and Kass with respect to head-to-head x-ray evaluations. The excellent surgical result from Dr. Cohen is in the early post-op stages and it is obvious that the patient is guarding in the post-op. Here is a patient whom I performed the procedure on, including a weight-bearing pre-op AP view along with a six week post-op view.  


Pre- and post-op weight-bearing AP views


In these views, we're seeing the deformity correction further out and the patient is not guarding as much in the post-operative views. Secondary bone healing is seen at this stage and good anatomical, clinical, and subjective results were achieved. The pre-op IM angle is 13 and the HA angle is 22. The post-op IM angle is 8 and the HA angle is 11.


Don Peacock, DPM, Whitesville, NC

Other messages in this thread:



From: Scott Carlis, DPM


My many years as a ski boot fitter helped steer me towards my career in podiatry. I wanted to add a few additional thoughts to the in-depth article by Drs. Huppin and Scherer as well as the comments by Dr. Steinberg. 


For those podiatrists who see skiers or who get ski boot-related questions from patients, I want to provide some basic information on the design of ski boots and the most common adjustments made to ski boots by a boot fitter. 


As podiatrists, we are asked to make recommendations about...


Editor's note: Dr. Carlis' extended-length letter can be read here.



From: Steven J. Kavros, DPM


I am writing to clarify the misrepresentation and inaccuracies of James McGuire, DPM in a recent article in Podiatry Management


The American Professional Wound Care Association® (APWCA) is a non-profit medical association welcoming medical providers from all disciplines involved in prevention and treatment of difficult wounds. Through a synergy of disciplines, APWCA has been a worldwide leader in clinician advocacy and education for the prevention and treatment of acute and chronic wounds since 2001. This association provides an informational and educational forum for healthcare providers, while promoting...


Editor's note: Dr. Kavros' extended-length letter can be read here.



From: Robert Scott Steinberg, DPM


I have been fitting ski boots and making ski boot orthotics for 33+ years. I am a certified ski instructor. Dr. Huppin listed many of the reasons skiers call me for ski boot orthotics and custom boot fitting. There is a lot he got right, and went into great detail in doing so, but I caution podiatrists about making ski boot orthotics without being able to check the center of knee mass over the orthotic/ski boot. 


Further, it is most often the compensated forefoot varus that is the cause of foot pain in ski boots, as well as...


Editor's note: Dr. Steinberg's extended-length letter can be read here. 



From: Gwen S. Greenberg, DPM, Jeffrey Kass, DPM


The x-rays that Dr. Cohen provides show interesting results. I was wondering if Dr. Cohen also did a lengthening procedure on the second metatarsal which is longer than the third on the post- op x-ray compared to the pre-operative x-ray. Perhaps showing the entire foot x-ray would be more revealing.


Gwen S. Greenberg, DPM, Allentown, PA


When sending in pre- and post x-rays, it would be nice if the submitted films be the same view. The Katzen Wilson bunionectomy films are hard to evaluate as the post-op foot is in such an oblique position. The metatarsals are all overlapping while the pre-op foot is splayed. It's only fair to evaluate apples to apples.


Jeffrey Kass, DPM, Forest Hills, NY (Similar response by Mark Ellis, DPM)



From: Susan Bartos


I have done considerable research in 3-D printing as it relates to medical applications, and found Dr. Hochstein's article very concise and informative. Its application in custom orthotic fabricating will require the coordinating software to not just replicate the model, but to add the appropriate correction to the device to address the patent's deformity. Software developers will need to adapt their CAD-CAM software to conform to 3-D printers. The two most significant issues in adopting 3-D printing for orthotics in its present technological stage are 1.) having quality software available from established developers such as Sharp Shape, Oretek, and/or Delcam and 2.) reducing the manufacturing time, which is much longer than current machining methods.


Currently, the CAD-CAM software used by many orthotic labs functions by merging prescription information with the negative model to create an electronic, corrected positive model. It is very sophisticated software and requires exacting technical precision, just as the precision required to create a manually-corrected plaster positive. But its patient-specific capacity to balance gait and to integrate and apply patho-mechanical accommodations, goes beyond what can be done manually. Most DPMs who prescribe orthoses have become accustomed to dispensing this type of high-quality device over the last 20 years.  


I think that there is little doubt that 3-D printing has enormous potential in fabrication of medical appliances in the very near future. It will give orthotic laboratories an additional process to offer their customers and give doctors more choices as to how they want their orthotics fabricated. Keep in mind that there is no one right way to make a prescription orthotic, just several alternative options in the processes used to create it. The art lies in the skills of the technician, rather than the process. 


Susan Bartos, President, Earthwalk Orthotics, Inc.



From: Richard M. Maleski DPM


I agree so much with what Drs. Hultman and Rosenblatt have stated in the article and post in response. However, I would make one suggestion. Just like a good attorney, who never asks a question in a courtroom  unless he already knows the answer, I recommend the following. The APMA should work with the colleges of podiatric medicine and have groups of students, or even whole classes take the licensure exams in that particular state. Let's make sure that our education is truly giving our students the ability to pass the exam before we open this up to official scrutiny. I have been involved in residency training for my entire career of 26 years, and I am absolutely certain that our graduates can be competitive in almost all aspects of medicine, but I would like to be absolutely certain that they can compete in ALL aspects of medicine.


Richard M. Maleski, DPM, Pittsburgh, PA



From: Michael M. Rosenblatt, DPM


I always read Dr. Hultman’s articles and letters. But of the hundreds he has written over the last 20 years, the article he wrote on “parity” between MDs and DOs (June/July issue, Podiatry Management Magazine) is his most important and incisive. Paraphrasing his main point, DPMs get “bogged down” in the nomenclature of the DPM degree letters, causing disagreement and in-fighting. Ultimately that has led us away from real parity. 


Dr. Hultman believes the parity issue is really one of licensure and not degree letters. He firmly believes that parity is obtaining a plenary license for DPMs just as it is for...


Editor's note: Dr. Rosenblatt's extended-length letter can be read here.



RE: Valleix’s Sign (Tarsal Tunnel Syndrome, Jan 2014 PM)

From: David Secord, DPM, Kyle Scholnick, DPM


On page 123 of the January 2014 Podiatry Management Magazine, Dr. Scholnick refers to “Apositive Tinel’s or Valleix’s sign is when paraesthesias course along the involved nerve distally or proximately, respectively.” This is my favorite 'medical urban legend' and has been my personal quest to expunge from our schools and usage. 


As opposed to what many of us were taught in medical school, Tinel's sign is both proximal and 

distal tingling upon percussion of a nerve. Valleix’s sign does not exist. There is no such thing. Valleix’s POINTS are as follows: 1. Where the nerve emerges from...


Editor's note: Dr. Secord's extended-length letter and Dr. Scholnick's response can be read here.