The Voice of Podiatrists

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July 17, 2012 #4,516 Publisher-Barry Block, DPM, JD

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Correction

In the PM News dated 7/16/12, Dr. Robert Wunderlich's note was in response to Dr. Arnold Ross, not Dr. Chuck Ross.    

CA Podiatrist Cautions Diabetics Not to Go Barefoot

The effects of diabetes on the skin are many and require attention before they become serious medical problems. Women pay more attention to their feet as they try to keep them looking well groomed and beautiful, especially during summer months. But feet are vulnerable year round and for diabetics especially, it is very important to check the skin on the feet frequently for sores and open cracks.

Dr. David Sabet

David Sabet, DPM in Laguna Beach, CA advises: “Do not go barefoot. Plantar warts are caused by a virus, which may invade the sole of the foot through cuts and breaks in the skin. Walking barefoot on dirty pavements or littered ground can expose feet to this sometimes painful skin condition."

Source: Gabriele Monson, Examiner.com [7/14/12]

Long-Term Use of Flip-Flops May lead to Needed Surgery: IL Podiatrist

Injuries resulting from long-term flip-flop wear can mean injury to your feet, knees, and even back, doctors warn. In worse-case scenarios, these injuries can lead to expensive surgeries to repair the damage.

Dr. Marlene Reid

“If a problem develops and it goes neglected for a long time, it can result in a surgery,” says Dr. Marlene Reid, a Chicago-based podiatrist with the American Podiatric Medical Association (APMA). “These are the most extreme cases, but we do see it happen.”

Source: Kathryn Tuggle, Fox Business News [7/13/12]

Barefoot Runners Gain Mechanical Advatage at a Price: NE Podiatrist

A small but dedicated group has turned to barefoot running since the book Born to Run kicked off the movement a few years ago. Author Christopher McDougall and other advocates say it alleviates the pain associated with the sport. Our shoeless ancestors, they say, had it right. But doctors caution to take barefoot running slow. Some worry it could do more harm than good by causing other injuries.

Dr. Robert Greenhagen

Dr. Robert Greenhagen, a podiatrist at the Foot and Ankle Center of Nebraska, over a year has treated half a dozen people who moved toward minimalist running. Barefoot runners are more susceptible to stress fractures, tendonitis, tight calves, and puncture wounds from jagged shards stuck in the cement or uneven gravel. “Mechanically, it's more efficient, but it has significant risks because most people overdo it,” he said.

Source: Katy Healey, World-Herald [7/16/12]

Royal College of Surgeons Opposes Use of Title "Surgeon" by UK Podiatrists

A poll published by the Royal College of Surgeons (RCS) has revealed that 92% of people are in favor of the use of the title ‘surgeon’ to be legally protected. There are currently no restrictions on who can use the title, and according to the poll, only 27% of people would check a surgeon’s qualifications before having an operation. The RCS is particularly adamant that podiatrists and ‘aesthetic surgeons’ who have not undertaken the required sixteen years of training should be denied the title. The British Association of Aesthetic Plastic Surgeons (BAAPS) has openly supported them.

However, the Department of Health has countered claims that no podiatrists should be able to use the job title of ‘surgeon’. A representative of the department says that they are "fully supportive of podiatrists who have undergone the appropriate training performing surgery of the foot and ankle. These professionals are regulated by the Health Professions Council (HPC)."

Source: The Information Daily [7/16/12]

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky: What changes have you noticed in podiatric residents over the last decade?

Dr. Glenn Weinraub

Glenn Weinraub: The change I’ve noticed is that new residents coming through now are seeking more of a balance in their life, whereas the residents who I first started dealing with back in the late ‘90s were much more uniformly focused on what they were trying to get out of the residency training program. I don’t know if that’s a good or a bad thing. I think you can be overly focused and tunnel-visioned in what you’re looking for, and by missing out on other life experiences, maybe that’s going to play a role in you being a good or a bad physician. Maybe the residents who come in now and have a better life balance outlook will become better physicians because of it.

Dr. James Stavosky

Meet the Masters is  broadcast each Tuesday night at 9 PM (EST). This week's guest is podiatric surgeon and educator Dr. James Stavosky. You can register for future events by clicking here

RE: Failed Phenol Procedures (Charles F. Ross, DPM)
From: George Jacobson, DPM

I also use 3 applications of 89% phenol but for 45 seconds. If there is granulation tissue, I use a 15-second application of the phenol after removal. I don't know why one would not use a tourniquet for such a short procedure, when we know the bloodless field yields the greatest results. Over the years, there have been cases reported of digital amputation because patients went home with the tourniquet still on under the bandage. Don't tie a Penrose, elastic band, or use a donut that can not be defended if accidentally left on the toe. If you always use a clamp like a Kelley or small hemostat to clamp the Penrose or 1/4 inch elastic band, it will be nearly impossible to have anyone, including the patient, miss it!

I track recurrences by telling patients that if they feel or notice anything hard like callus or nail at the site over the next year, they shouldn't remove it. They should return to the office, so I can advise whether it is callus or nail. If the phenol was still 89% and you used 3 applications and a tourniquet, you should not be seeing recurrences.
 
George Jacobson, DPM, Hollywood, FL, fl1sun@msn.com

RE: Failed Phenol Procedures (Charles F. Ross, DPM)
From: Jack A. Reingold, DPM

It is interesting to see so much discussion regarding phenol nail procedures next to all the comments on ankle privileges and 3-year surgical residences. For most of us, treating ingrown nails is still a big part of our podiatry practice. About 25 years ago, I stopped using phenol and started utilizing a "radio surgical generator" for my nail and other soft tissue procedures. I utilize one from Ellman International. It generates and directs AM radio waves, which are a slightly higher frequency than light waves. All energy travels in wave formation and the biological effects are similar to ones with a laser.

With this technique, I have had about 98% success on matrisectomies.  There are no questions about dilution or concerns about phenol burns. There is less drainage and a very quick recovery time. More information can be attained on the web or from the manufacturer. 

Jack A. Reingold, DPM, Solana Beach, CA, footdoc@san.rr.com

RE: Dr. Markinson's Commencement Speech at the NW Podiatric Residency Graduation
From: Michael M. Rosenblatt, DPM
 
Please publish Dr. Markinson's commencement address on PM News for all of us to read. Reading his letters and articles is "not enough."
 
Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

Editor's note: We agree. His speech appears here.

RE: NY Podiatrist Does Not Support Cosmetic Foot Surgery
From: Paul J Betschart, DPM, MS

There has been a lot of debate in the podiatry community as to the ethical concerns with performing cosmetic foot surgery. Some believe that foot surgery should only be performed to treat painful conditions. Many of the surgeries we regularly perform do improve the appearance of the feet as a “side-effect” of correcting a painful condition, like hammertoes or bunions. No one can argue the important role shoes play in the way people, especially women, feel about their appearance. Many of the worst foot deformities can be rendered pain-free with the appropriate footwear, such as athletic or orthopedic shoes. Custom-molded shoes can even be employed. So, what is to be said of the woman who insists upon wearing stylish shoes? Should we refuse to correct her deformity because she could just as easily wear orthopedic shoes to that important meeting or night out? Here is where the controversy lies. 

My opinion as an experienced foot surgeon is that appearance, shoe choice, and emotional concerns, as well as pain are all part of treating the whole person. We are not treating “the bunion in room 1”. We are treating Ms. Jones, the busy executive, who needs to look sharp in her negotiations and is self-conscious about taking her shoes off at the beach. The debate will likely continue. One thing is certain, cosmetic procedures are here to stay.

Paul J Betschart, DPM, MS, NY, NY, drbetschart@aol.com

RE: NY Podiatrist Performs Cosmetic Surgery on Fat Toes
From: Frank Lattarulo, DPM

"Toe-besity" really? And we wonder why podiatry is frowned upon by some.

Frank Lattarulo, DPM, NY, NY, doclatt@aol.com

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