The Voice of Podiatrists

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February 19, 2007 #2,813 Editor-Barry Block, DPM, JD

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Shoe Makers More Sensitive to Foot Health: IL Podiatrist

While you may think "no pain, no gain," doctors warn wearing shoes that are too pointy or too high can lead to serious health problems like arthritis, stress fractures and bunions. Some of those problems might actually require surgery.

Dr. Marlene Reid

"Once you have a structural bone deformity, it needs to be corrected," explained Dr. Marlene Reid, American Podiatric Medical Association. Reid added, "You don't have to suffer for beauty anymore. The manufacturers are developing more sensitive shoe products." Doctor Reid said these products are actually better for your feet.

But if you still can't think of giving up those sky-high pumps, there's a shoe insert Doctor Reid says can actually change the pitch of your foot to make high heels feel not so high. Comfort is key, but when it comes to shoes, many women say style is still king.

Source: Karen Borta, CBS 11- TV [2/15/07]

DC Podiatrist Offers Advice on Pre-Race Planning

Stephen M. Pribut, a doctor of podiatric medicine in Washington, D.C., and past president of the American Academy of Podiatric Sports Medicine, has run everything from 200 meters to the marathon.

Dr. Stephen Pribut

Pribut, 55, says to start planning your recovery before the race.

•Don't wear anything new on race day, including underwear and socks, to avoid blisters and chafing. Have 75 miles on your running shoes.
•Don't eat anything new on race day. Replace your fluids, but don't overhydrate.
•If it's cool outside, bring an extra shirt or pair of sweatpants that you can toss as you warm up.
•Pay attention to your body. If something doesn't feel right, readjust, even if it's something as simple as your shoelace.

Source: Patti Kim, Tampa Tribune [2/17/07]

PM News will be posting selected resolutions scheduled for the upcoming APMA House of Delegates (HOD) to be held March 23-26 in Washington, DC. Readers are encouraged to comment on these important issues.

Resolution No. 11-07 (Directive) Ethics Presentations in CME Programs

RESOLVED, That the Annual Scientific Meeting of American Podiatric Medical Association (APMA), officially designated regions of APMA, component societies and their divisions, APMA affiliated and related organizations, and other podiatric educational seminars, be encouraged to include at least one (1) continuing medical education (CME) credit annually on the subject of “Ethics in the Delivery of Health Care Services,” based on the APMA Code of Ethics;

RESOLVED, That the APMA annually survey the sponsoring organizations of such meetings utilizing a report form documenting the efforts that each such organization had undertaken on this subject during the previous year; and

RESOLVED, That a report of this annual survey be provided to the House of Delegates for at least a five-year period, beginning at the 2008 House of Delegates of APMA, so that the profession and the public can be aware and informed of the efforts being extended to support and encourage the goals set forth in the APMA Code of Ethics, and to also serve to remind all concerned program sponsors to include this important subject in their continuing education efforts.

Sponsors: Multiple APMA State Components

A complete list of current Resolutions can be found at:
http://www.apma.org/s_apma/bin.asp?CID=995&DID=20934&DOC=FILE.PDF

Query: APMA State Leader as an Expert Witness

I’m involved in a malpractice case based on a rather insignificant post-op infection in which my patient was neither hospitalized nor suffered osteomyelitis or any permanent disability. The most disturbing part to me is that the plaintiff’s expert is a board member of my state association, who will one day be president. What action, if any can I take?

Name Withheld

Editor’s comment: PM News does not provide legal advice. The situation you describe is very problematic because it represents a conflict of interest for the expert, who unfairly carriers the imprimatur (countenance) of the state association into the courtroom. In June, the New York State Podiatric Medical Association (NYSPMA) will be dealing with this issue when it considers a resolution banning present or past board members from serving in the capacity of expert witnesses. We hope that this resolution passes, and that this trend will spread nationwide.

In the meantime, we suggest that you present this information to your state president and the other board members. Most expert witnesses prefer to operate in the background and do not like their identities revealed.

RE: Formula 3 Topical Antifungal (Philbert Kuo, DPM)
From: Elliot Udell, DPM

The essential ingredient in Formula 3 appears to be tolfonate, which is a time-honored over-the-counter antifungal. Tinactin is the trade name for this product. There are other companies that are advertising similar tolfonate compounds on the Internet and people can go online and order them without consulting with a doctor.

There is no problem from a medical perspective in mixing an older antifungal with a vehicle to aid nail penetration. Dermik labs have been doing this by mixing the time-honored ciclopirox (Loprox) with a vehicle that enables nail penetration. The difference however with products such as Formula 3 and Penlac is that the latter can now only be obtained via a prescription. The other products can bought with a click of the mouse and probably in some health food stores as well.

In our office our policy is to dispense over-the-counter creams and other products that are not readily available by either a trip to a supermarket, health food store or over the internet. This way we are providing a good service that the patient cannot obtain from a non-professional source. In my professional judgment, if there is a product available in a local store that can be of greater help to a patient, we will simply send the patient there.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Compression Neuropathy while Skiing (Alex Dellinger, DPM)
From: Walter Roth, DPM

I have two recommendations for ski boot issues. First, DaleBootUSA, out of Salt Lake City, manufactures a fairly customizable ski boot. Second, Jim Lindsay of Bootech at Aspen Highlands is a phenomenal boot-fitter. He is quite active with the US ski team. My wife and I purchased our boots and insoles from him years ago, and we know
several upper level skiers who are quite pleased with his service and results.

Walter Roth, DPM, Lake Mary, FL, weroth3@mindspring.com

RE: Post-op Allergic Reaction? (David Gutierrez, DPM)
From: Paul Kesselman, DPM

I recently had a similar, less serious reaction never-the-less persistent problem with a Statak anchor. The patient currently has a similar presentation to a spitting suture typically seen a few weeks post op. This presentation however is almost 9 months after repair of a ruptured anterior tibial tendon. On sonography, the suture appears as a spiraling tail of a comet with a surrounding hypoechogenic area. Standard wound care for a few months has failed to resolve the problem and it does not appear infected.

I am planning to remove the suture, but would like to leave the buried anchor, which on x-ray appears well below the cortical structures and not posing any problems. Surely removing the anchor would be quite more invasive for this not very well controlled diabetic. Any thoughts or suggestions would be appreciated.

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

Editor's note: This topic is now closed

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