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July 12, 2012 #4,512 Publisher-Barry Block, DPM, JD

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NY Podiatrist Discusses Cold Feet in Diabetics

For some, the thought of walking down the aisle causes cold feet; for those with diabetes, the issue isn't as quaint. "In most cases of patients with diabetes that complain of 'cold feet', it can be attributed to one of two causes, vascular insufficiency or diabetic neuropathy," said Gary F. Stones, DPM, President of the New York State Podiatric Medical Association. "I have found in my experience that it is often the latter, but may have a component of small vessel disease often seen in diabetics."

Dr. Gary Stones

Though it can be tempting to simply dunk your feet in warm or hot water, that's the last thing you should do. "Never soak your feet in hot water," Dr. Stones cautioned. "This can lead to thermal injury, and in some cases have disastrous consequences, especially in someone with DPN and underlying vascular insufficiency." You should also avoid heating pads or hot water bottles, as these can cause burns.

Source: Shannon Dauphin, Diabetes Monitor [7/9/12]

Flip-Flops Not Meant to Be Worn as Normal Shoes: TX Podiatrist

There's little doubt that for some, flip-flops have become "sort of the go-to shoe," said Abilene podiatrist Dr. Shelley Bruton. "It became a big trend three or four years ago," Bruton said of the current love affair with the footwear. "All of a sudden, everyone started wearing flip-flops like they were normal shoes."

Dr. Shelley Bruton

But the popular, usually inexpensive sandals aren't generally designed for long-term wear, she said. "They shouldn't be worn for walking long distances," Bruton said. Those who insist on wearing flip-flops for yardwork, for example, can leave themselves vulnerable to toe or foot injury — mowers, weed trimmers, and the like, all providing potential hazards. "We can see pretty horrible toe injuries and lacerations" from such accidents, Bruton said.

Source: Joy Lewis, Abilene Reporter News [7/10/12]

IFAF Presents Awards

The 2012-13 IFAF Annual Awards were presented by Dr. G Dock Dockery, Chairman of the Board and Director, at the 42nd Annual Residency Graduation Program held at the World Trade Center, Seattle on Thursday evening, June 28th.

(L-R) Drs. Kaj Johansen and Byron Hutchinson

This year's award winners were Kaj Johansen, MD, PhD, for Outstanding Teacher of the Year and to Byron Hutchinson, DPM, who received the National Service Award.

OH Podiatrist Facing 8 Malpractice Lawsuits

Eight patients have active medical-malpractice lawsuits against Dr. Leonard Janis, a Hilliard podiatrist, in Franklin County Common Pleas Court. Four of the patients had complications from ankle surgeries that led to amputations. Janis also is a defendant in a wrongful-death action.

Five of the lawsuits also name Grant Medical Center or its parent company, OhioHealth, where Janis performed surgery for nearly 26 years until he resigned his privileges in February. Janis also resigned his privileges at Doctors Hospital, an OhioHealth facility with which he had been affiliated since 1979. Robin Yocum, a spokesman for the doctor, said Janis performs about 600 surgeries a year and “takes on a lot of high-risk cases that other physicians aren’t willing to take on."

Source: John Futty, The Columbus Dispatch [7/9/12]

Primary Care Docs See Pay Rise 5%: MGMA Survey

New payment methodologies may be driving compensation increases of around 5% or higher for primary-care physicians, according to the new MGMA publication "Physician Compensation and Production Survey: 2012 Report Based on 2011 Data."

Median earnings for primary-care doctors increased around 5.2%, with internists seeing a 5% compensation boost to $215,689. The median compensation for pediatric/adolescent medicine physicians was $203,948, according to the report; for family medicine physicians, it was $200,114. The report also includes information on non-physician providers, such as primary-care and surgical physician assistants, whose median compensation was $92,635 and $111,246, respectively.

Source: Andis Robeznieks, Modern Physician [7/10/12]

Query: Failed Phenol Procedures

Over the past few years, I have transitioned from liquid phenol to utilizing phenol sticks, and unfortunately have encountered more recurrences when using the sticks. I do not utilize a tourniquet, and have utilized more than one stick if I believe there is excessive bleeding. I would appreciate any pearls on how to improve my results and also save the environment from phenol concentrate.

Charles F. Ross, DPM, Pittsfield, MA

RE: Recovery Time for Bunionectomy for Karate Artist
From: Wenjay Sung, DPM

Dr. Jaffe, I am pleased that our international brethren are making headway into foot and ankle care overseas. For this patient, I would explain to her that it would depend on how bad her "bunion" or deformity is. If her deformity is severe, she may need to take a long time off before she can return to her sport. If her deformity is minor, she may take less time, but typically 3-4 months before returning to her sport.

Martial arts (breaking boards) is a high impact sport and, as with other professional athletes, I would only allow them to return to their sport after they can jump in a figure of eight on the post-operated foot comfortably and convincingly.

Wenjay Sung, DPM, Chicago, IL, wenjay.sung@gmail.com

RE: Recovery Time for Bunionectomy for Karate Artist (Richard Jaffe, DPM)
From: Joseph Menn, DPM

Enroute to my own black belt in Tae Kwon Do, I broke many boards with both my hands and my feet. The foot can be used to break boards with various types of kicks. The one I believe that your patient would be concerned with would be a kick to break the board or strike her target with the ball of the foot. Although this can be performed with different kinds of kicks, the most common one would be a front kick where the foot is basically whipped forward from a raised knee, striking the board or target with the ball of the foot. 

This requires the toes to be fully dorsiflexed, and the foot slightly supinated (for midfoot stability) in order to strike with the force necessary to break the wood and not your foot. Although the force necessary to break a single board is not that much, multiple boards certainly increase the difficulty. I'm assuming that an osteotomy would be used to correct the bunion. Assuming the bone heals at a "normal" rate, it would probably be strong enough to perform "easy" breaks in about 8-10 weeks. Basically, you would have to be comfortable that the bone was healed solidly enough to withstand a sudden sharp impact. The patient would definitely need full dorsiflexory range of motion for this activity. 

As we all know, sometimes a "perfect" bunion surgery still has ROM issues for many months following surgery. Of course, all of the above depends on the type of surgery performed, stability of fixation, overall strength, quality of the patient's bone, and her recovery course. That said, you should know that board breaking is not typically used in the day-to-day training in martial arts, but rather, more often used during demonstrations or competitions. 

Joseph Menn, DPM, Myrtle Beach, SC,jmenn@coastalpodiatry.com

RE: OCPM is Now the Kent State University College of Podiatric Medicine
From: Robert K Hall, DPM

I am pleased to hear of OCPM's association with Kent State University. My alma mater, PCPM (class of '75) is now Temple University affiliated (TUSPM). We have Barry here in South Florida. While training improves, affiliation with a University setting appears to heighten podiatry's credibility to some measure with other allopathic physicians (MD/DO). Perception is an intangible.

Robert K Hall, DPM, Ft Lauderdale, FL, robertkhalldpm@bellsouth.net

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