The Voice of Podiatrists

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June 07, 2007 #2,955 Editor-Barry Block, DPM, JD

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Foot is Window to Body’s Health: FL Podiatrist

"The foot is connected to the rest of the body, and though that sounds trite, it offers a window on your health because of the amount of stress that goes through the foot," says Dr. Robert Duggan, an Orlando foot-and-ankle surgeon. "The foot is often the first place of complaint for little kids with growth issues, for older patients with arthritis and for diabetics."

Dr. Robert Duggan

Eat calcium-rich foods. Osteoporosis shows up in feet, often in the form of stress fractures. But older women aren't the only victims. "We're seeing businessmen who travel a lot and have lousy diets," says Duggan. Consumption of colas, for instance, has been linked to lower bone density in women, though it's not clear that it has the same effect in men.

See a doctor about pain. Foot pain is not normal, though most Americans accept it. If your feet are sore, even after resting, that's a sign that you should change your shoes or behavior. If your feet are sore all the time, you should see a doctor, says Duggan.

Source: Linda Shrieves, Orlando Sentinel [6/5/07]

Payment Cuts Would Hit Medicare Access: AMA

Many physicians plan to limit new or existing Medicare patients and make other practice changes in wake of pending reimbursement cuts, the American Medical Association reported. The sustainable-growth-rate formula, which determines Medicare payments to physicians, ties annual expenditure targets to the economy and has called for negative payment updates over the past several years.

A survey of 8,955 AMA members found that 60% of physician respondents would limit the number of new Medicare patients, and 40% would limit existing patients if a 10% cut goes through in January 2008. More than two-thirds of the respondents may defer investments in their practice, such as the purchase of new equipment and information technology if the cut goes through, and more than half may reduce their practice staff. Fourteen percent said they’d get out of patient care altogether.

If payment rates are cut by nearly 40% by 2015, 77% responded they’d limit new Medicare patients, and 68% said they would limit established patients. Most of the respondents thought overpayments to Medicare Advantage plans should be used to offset physician payment reductions or help low-income patients with out-of-pocket costs.

Source: Jennifer Lubell, Modern Healthcare [6/4/07]

Query: Erythromelalgia with Hyperhydrosis

What are the most effective treatments for erythromelalgia? I have a patient whose feet become itchy and then start to burn for the last few months. There is no evidence of tinea pedis, dermatitis, or allergic reaction. He does have hyperhydrosis and I have tried him on 10% formaldehyde without success. He has minimal/no problems on the weekends when he is wearing tennis shoes. He has tried various types of work shoes but still has the problem. He has been diagnosed "pre-diabetic" by his PCP. I am thinking of starting him on Aspirin 500 mg. qd, and if that is not effective to switch him to Lyrica. Any suggestions?

Birute Balciunas, DPM, Kenosha, WI

RE: Increase in 5th Met Fractures? (Michael DiGiacomo, DPM)
From: Keith Gurnick, DPM , Elliot Udell, DPM

5th metatarsal fractures are of the most common foot injuries that require medical attention due to impairment of function and pain. I believe the longer one is in practice and the more available you are for an "urgent or emergency visit" the more 5th metatarsal fractures you will see. Many of these patients have been seen in our office for non-injury related foot issues and will think of us first for a foot injury, which by the way they often think is a painful ankle sprain when they phone for the appointment. Anyone reading this post who would like to see more foot or ankle trauma patients needs to have spaces available in their daily schedule to add on these acute injuries, or they will go elsewhere.

Keith Gurnick, DPM, Los Angeles, CA, KEITHGRNK@aol.com

Salutations to Dr. DiGiacomo for doing exactly what he should be doing when he noticed an increase in a specific pathology. He put out the question to the entire community of podiatrists. In itself an increase of four cases is not significant. It can be best explained by flipping a coin a number of times. There is a fifty-fifty chance that each time you flip the coin it will land on heads. This does not mean that on each consecutive flip, the quarter it will rotate evenly between heads and tails. It is possible to get four heads in a row. If you flip the coin thousands of times however gradually it should even out giving you fifty percent heads and fifty percent tails.

It is highly likely that the four cases that came into Dr. Digiacomo's office presenting with fifth met head fractures were the equivalent of flipping the coin four times and getting heads each time. on the other hand if four new cases of fifth met head fractures should come in every week for the next sixteen weeks, then a red flag should be raised more inquiry should be done. If a large number of our colleagues respond with information also supporting a sudden increase in this type of fracture that too can be significant.

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

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