The Voice of Podiatrists

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June 13, 2013 #4,795 Publisher-Barry Block, DPM, JD

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Amniotic Fluid Saves Feet: AZ Podiatrist

Nerve disease caused by type-2 Diabetes accounts for half of all amputations in the U.S., but a new treatment is helping patients keep their limbs. And it comes from a pregnant woman! Diabetic sores on Rocco LoBosco’s left foot robbed him of his little toe and doctors told him that they could lead to worse. “There’s still a chance that you might lose part of the foot, or the whole foot, or even the leg," said LoBosco. But by harnessing the power of amniotic fluid, Dr. Richard Jacoby, Medical Director at the Scottsdale Neuropathy Institute in Scottsdale, Arizona, says, it’s possible to avoid that.

Dr. Richard Jacoby

“Amniotic fluid seems to meet the criteria to develop new tissue," Dr. Jacoby explained. Amniotic fluid from a pregnant donor is injected into or wrapped around the nerve during decompression surgery. The stem cells in the fluid stimulate the affected area, telling it to heal the wound. “I’ve done 16 nerves with this technique and all of them have restored their sensation," Dr. Jacoby said. The new technique not only helps save limbs, but lives as well. “Your life expectancy is 2 years after an amputation," Dr. Jacoby explained.

Source: KSAT-TV [6/10/13]

IPMA Podiatrists Keep Avon Breast Cancer Walkers "in Step"

“That feels much better,” was a common statement made by a grateful participant after being treated by an Illinois Podiatric Medical Association (IPMA) member at this year’s Avon Walk for Breast Cancer, held June 1 through June 2, in Chicago’s Horner Park. Participants walking in the 39 mile, two-day event raised more than $5.2 million to advance access to care and find a cure for breast cancer.

IPMA Podiatric Volunteers at Avon Breast Cancer Walk

Podiatric volunteers included - Drs. Amanda Brazis, Alice Cisneros, Mitchell Cook, Kathleen Daly (Podiatry Captain/Organizer), Neil Horsley, Jondelle Jenkins,  John Schwab, Carlos Smith, Mansoor Virani, Michael Williams, and David Yeager. Medical students from the Scholl College of Podiatric Medicine also treated walkers, while representatives from the American Society of Podiatric Medical Assistants-Illinois Chapter assisted with triage.

Skin Cancer of the Feet Can be Prevented: APMA President 

Cancer can strike in an area of the body many people don’t think about –the feet. “The most serious, increasingly common type of skin cancer, melanoma, can first emerge on the feet,” says Dr. Matthew Garoufalis, a podiatrist and president of the American Podiatric Medical Association (APMA). “One reason for this may be that many people who are vigilant about using sunscreen on their faces and arms still forget to apply protection to their feet. Exposure to UV rays is a leading cause of skin cancer.”

Dr. Matthew Garoufalis

“Skin cancers on the feet and lower legs can look very different than skin cancers on other areas of the body,” Garoufalis says. “Podiatrists are uniquely trained as lower-extremity specialists, and are best equipped to help patients detect early and treat effectively both benign and malignant skin tumors on the feet and lower legs.”

Source: Coronado News [6/11/13]

Pronation from Flip-Flops Can Damage Feet: MI Podiatrist

Podiatrists say that one of the dangers of flip-flops is abnormal pronation. Pronation creates more movement in the bones, and is a condition that can lead to foot arch collapse, premature arthritis, bunions, and heel spurs, said Dr. Steve Bremer of Mercy Health Center North in Fort Gratiot.

Dr. Steve Bremer

Pronation also applies more stress to the inside of the knee, can lead to an early deterioration of hip cartilage as well as increasing the curvature of the spine. Flip-flops increase stress throughout the lower extremities and clearly accelerate the process leading to knee and hip replacement, Bremer said.

Source: Lance Farrell, Times Herald [6/8/13]

Query: Recurrent Ganglion Cysts

I am wondering what others do to minimize the chance of a ganglion recurring after surgical excision. I seem to have an unacceptably high recurrence rate particularly on midfoot and ankle ganglions. I carefully dissect the margins of the ganglion in an effort to prevent rupture prior to removal. If I identify a stalk (which is rare), I tie it off with non-absorbable suture and heavily cauterize it. More often than not, the ganglions seem to have a diffuse origination from a joint capsule which I will attempt to close and heavily cauterize. 

I'm not sure what other steps I could take to minimize the chance of recurrence short of fusing the offending joint which seems too extreme. I have contemplated the thought of "patching" the area with a GraftJacket or other similar product in an attempt to scarify it and prevent refilling with fluid, but I have yet to try it. Thoughts?

RE: Piezogenic Pedal Papules (Kel Sherkin, DPM) 
From: Steven J. Kaniadakis, DPM

According to my biomechanics instructor at Barry University, these are essentially a herniation of the adjacent fat pad through the tissue containing the adipose. This observation can be a rear foot sign of over-pronation. When present, I would document this in my biomechanical exam notes.

Steven J. Kaniadakis, DPM, St. Petersburg, FL stevenkpm@yahoo.com

RE: How Can American DPMs Get Involved Teaching Podiatry Skills Throughout the World? (Bret Ribotsky, DPM)
From: Leonard A. Levy, DPM, MPH

Bret Ribotsky queries, “How can American DPMs get involved teaching podiatry skills throughout the world?" One international, highly credible way to accomplish this is by becoming a Fulbright Scholar. I was appointed by the Fulbright Commission (a component of the U.S. Department of State) as a Fulbright Scholar in 2009 and assigned to Comenius University Faculty of Medicine in Bratislava, Slovakia. Among the activities that I participated in was the provision of information about podiatric medicine. Like almost all areas in the European community, there may be lesser trained individuals but no equivalent to the podiatric physician.

Among the categories for Fulbright Scholars is a global health listing. Among the areas of eligibility is podiatric medicine. I strongly encourage DPMs, especially those within podiatric medical schools (i.e., students, residents, faculty), to consider applying for one of the highly competitive Fulbright posts. So far as I know, no other podiatric physician has been awarded a Fulbright appointment. I strongly encourage others to apply.

Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL, levyleon@nova.edu

RE: Staff Performing Routine Foot Care (Margie Plon, DPM)
From: Cedric Cooper, DPM

I treat countless patients who have been infected by the practices of some nails shops in my area. Yes, palliative care is important to your practice, and allows a professional to practice the skill of diagnosing and treating a foot problem when that foot problem first arises. Never, I repeat, never are the  sterilization practices of a nail salon better than that of a trained ethical podiatrist. To say so is a loose expression, at best.

I say that palliative foot care is best provided by a trained, dedicated, and ethical podiatrist. I just pray that those who do utilize the services of an unsupervised physician extender do so ethically. Aesthetic foot care has its place in the community. Aesthetic foot care is not a safer economic product  because it is currently more profitable. Look - this whole trend of lower reimbursement for surgery, palliative care, etc. is a cycle, and people know that podiatrists are the best providers of foot care.

Cedric Cooper, DPM, Humboldt, TN, y2kcedric@hotmail.com

RE: CA Podiatrist Uses Minimal Incision with Fixation for Bunion Repair (Hartley Miltchin, DPM)
From: Tip Sullivan, DPM

If Dr. Miltchin is truthful in his post, stating that he has NEVER had a recurrence of a bunion, NEVER had a non-union, NEVER had a hallux varus, and NEVER had a transfer lesion in 31 years of practice doing “a significant number” of MIS weekly, I believe that he should be teaching someone else his secrets. That would be roughly 4,500 cases with NONE of the above complications. Almost unbelievable and certainly deserving of some sort of an award.
 
Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

RE: Unmatched Residency Placement Currently Stands at 92 (Usman Akrum, DPM)
From: Lawrence Kansky, DPM, JD
 
If it is true, as per Dr. Usman Akrum, that there are 92 qualified podiatric graduates unmatched to a 3-year residency program, and if each of these said doctors spent approximately $250,000 to obtain their DPM degrees, then approximately $23,000,000 of earnest money was wasted.
 
A class action lawsuit against those responsible for this epic professional disaster would not be unwarranted. Possible causes of action could be theft by deception, fraud, conspiracy, negligent misrepresentation, unjust enrichment, breach of contract, restraint of trade, and tortious interference with potential future contracts, etc. A large law firm in a major city would be best equipped to handle such a monumental professional legal case.
 
Regardless of any lawsuit, this residency crisis screams to those in podiatric power that our profession would exist best as a specialty of the MD world, where residencies would face less political malfeasance.
 
Lawrence Kansky, DPM, JD, Wilkes-Barre, PA, Larry.Kansky@gmail.com

RE: Professor Killed by Woman with Stiletto Heel, Police Say

It may have been a vicious murder or the unintentional result of a lover's quarrel. Either way, the death of a Texas college professor stands out for the weapon the killer allegedly used: one of her own stilettos. Ana Lilia Trujillo, 44, is charged with murder for striking Alf Stefan Andersson "with a deadly weapon, namely a shoe," Houston police say in the official complaint against her.

Andersson, a research professor from the University of Houston, had 10 puncture wounds on his head -- some as deep as an inch and a half -- and 15 to 20 puncture wounds along his face, arms, and neck, prosecutors say, according to CNN affiliate KTRK. When police arrived at Andersson's apartment on Sunday, Trujillo, who had recently worked as a massage therapist, answered the door with blood on her clothes and hands; Andersson was lying in the hallway face up, with a stiletto by his head, KTRK reported.

Source: Josh Levs, CNN [6/11/13] via Dr. Lee Rogers

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