The Voice of Podiatrists

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June 22, 2007 #2,968 Editor-Barry Block, DPM, JD

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IL Podiatrist Uses HemiCap for Toe-Joint Replacement

While knee and hip replacements get most of the attention (close to a million are done each year in the United States), arthritis also attacks cartilage in other joints, causing excruciating pain. "Patients with degenerative arthritis in the toe bones live with debilitating pain for many years," said podiatrist John Fleischli of Foot and Ankle Associates in Springfield, adding that after hips and knees, arthritis most often attacks the toe bones. Add to that the 13.7 million Americans who see a doctor every year for shoulder injuries, and it is no wonder that shoulder and toe-joint replacement are booming medical specialties.

Dr. John Fleischli

My feet hurt for 15 years," said Shirley Coville of Springfield and a patient of Fleischli's. "One day it hurt so bad I knew I had to have the surgery." Coville had her left toe joint replaced in 2005 and the right toe joint a few months later. She now is able to work out on a treadmill and play golf. Her surgery involved a HemiCap, a metal cap that is attached to the long tendon and gives patients good motion. "HemiCap caps the metatarsal, or source of the arthritis, providing a smooth surface that doesn't cause as much irritation after the connective tissue is reattached," Fleischli said, adding that previous toe-joint replacements did not offer as good a range of motion.

Source: Marla Krause, Chicago Tribune, [6/19/07]

Wrong Sandal Can Cause Heel Pain, Achilles Tendonitis, Other Ailments: ACFAS

Footwear has come a long way since Roman armies conquered an empire wearing only sandals on their feet. But what's old is new again. The market research firm NPD Group reports that sales of men's sandals grew 20 percent between 2005 and 2007.

Along with the growing popularity of men's sandals come more aches and pains for male feet. Doctors with the American College of Foot and Ankle Surgeons (ACFAS) say the wrong sandal could cause problems including heel pain, Achilles tendonitis, pain in the big toe and even breaks and stress fractures in some of the foot's 26 bones.

The surgeons group recommends men shopping for a man sandal – or "mandal” as some people call it – look for a sturdy, cushioned, supportive sole and padded straps. Men with diabetes should consult their foot and ankle surgeon before wearing sandals. Despite what many men may tell themselves, foot pain is not normal.

No Quality Benefit Seen in Medicare Pay Pilot

Medicare's largest pay-for-performance pilot project has not produced any better quality gains than a private initiative that used no financial incentives, a recent study said.

Researchers from Duke University in Durham, NC, analyzed quality scores for the treatment of acute myocardial infarction at 54 hospitals participating in both Medicare's Hospital Quality Incentive Demonstration and a joint American College of Cardiology/American Heart Assn. quality improvement initiative. They then compared these figures with those from 446 hospitals that participated only in the latter project, which unlike Medicare did not offer monetary bonuses to top performers.

The investigation revealed that when it came to treating heart attack patients, the hospitals enrolled in the ACC/AHA quality improvement project did not make any statistically significant gains in quality of care, patient outcomes or mortality by also participating in the Medicare pay-for-performance program. The Medicare project hospitals as a whole made improvements on all of the quality measures they reported to the government, but so did the facilities that participated in only the cardiac associations' initiative. The study appeared in the June 6 Journal of the American Medical Association.

Source: David Glendinning, AMNews [6/25/07]

Query: Differential Diagnosis for Mycotic Nails

Lately, I have been receiving many neagative PAS stains and cultures of mycotic appearing nails. What should I be considering in the differential, and what treatments have been successful?

Mark Gresser DPM, Mt. Sinai, NY

RE: Forefoot Pain (Cynthia Ferrelli, DPM)
From: Greg Cohen, DPM

I have a fair number of patients in my practice who present with forefoot pain which does not respond to conventional therapy. Upon further investigation, I have found lumbar radiculopathy to be a common underlying etiology, even in the absence of lower back symptomotolgy. I would recommend an MRI of the LS spine to rule this out as a potential cause.

Also consider a rheumatologic work up, as well as EMG/NCVs to rule out tarsal tunnel syndrome, which can also produce forefoot pain.

Greg Cohen, DPM, Brooklyn, NY, gcohen428@yahoo.com

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