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August 09, 2011 #4,228 Publisher-Barry Block, DPM, JD

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WesternU Foot & Ankle Center Sponsors Claremont AYSO

The WesternU Foot & Ankle Center is now a proud sponsor of Claremont AYSO (American Youth Soccer Organization), which opens its fall season this week. “We felt it would provide good visibility for the center and good support of community athletics,” said Jonathan Labovitz, DPM, Medical Director of the Foot & Ankle Center and associate professor and chair of the Department of Podiatric Medicine, Surgery & Biomechanics in the College of Podiatric Medicine.

Dr. Jonathan Labovitz

The WesternU Foot & Ankle Center is a featured sponsor on Claremont AYSO’s website, and will also appear on soccer field banners throughout the season. WesternU is working with Claremont AYSO to develop safety education courses for its coaches and referees. WesternU will offer lessons in proper stretching, injury prevention, first aid, preventing head injuries, and more.

UofA's SALSA-led Team Wins National Research Award in Wound Healing

Dr. David G. Armstrong, Professor of Surgery and Director of the University of Arizona's Southern Arizona Limb Salvage Alliance (SALSA) led a nationwide team of investigators who were awarded the top prize for clinical research to be held at the Fall meeting of the Symposium for Advanced Wound Care (SAWC). The first-ever study of its kind in wound healing compared two different types of so-called "negative pressure wound therapies", which apply highly specialized vacuums to wounds to speed blood vessel growth and healing.

Dr. David Armstrong, Robert Kirsner, and Alex Reyzelman

"These types of comparative efficacy studies are increasingly critical to the health of our patients and to the viability of our healthcare system," noted Dr. Armstrong. "They will help drive innovation and help identify where we can improve." The results of the studies will be presented at the SAWC in October in Las Vegas. They are authored by Armstrong along with Drs. Robert Kirsner (University of Miami), Alex Reyzelman (Samuel Merritt University) and William Marston (University of North Carolina).

FL Podiatrist Plays Sax to Relieve Daily Stress

On July 28, Dr. Melvin Price found himself putting down his stethoscope and picking up his saxophone to play to a packed house at The Loft Ristobar in Sarasota. The restaurant/night club puts on a jazz and dinner night every Thursday with Katt Hefner and featured guests. Project SRQ is a local Sarasota Jazz group that has an energetic sound. Dr. Melvin Price plays tenor, alto, and soprano sax - incorporating the same passion he uses while practicing podiatry – which is to say, the doc can get down! According to him, “Music is the release from the stress of the day.” 

Dr. Melvin Price (Photo Brian David Braun)

Dr. Price is the Chief of Medicine and Surgery at Manatee County Rural Health Services, Inc. and continues to play music in the local Sarasota Area. He has previously served as Chair of the Florida Department of Health Medical Quality Assurance Board of Podiatric Medicine. In 2010, Charlie Crist appointed Dr. Price to the Bradenton Diabetes Advisory Council. He has hospital privileges at Manatee Memorial Hospital, Sarasota Memorial Hospital, and the Lakewood Ranch Medical Center.

Source: Marcile Powers, The Bradenton Times [8/6/11]

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

Bret Ribotsky: How are podiatrists as compared to MDs treated in the military ?

Dr. Brad Wenstrup

Brad Wenstrup: I think I was treated very well. I was given a great opportunity, but there is definitely some disparity, and that has changed since the war. I think podiatry has shown itself very well. I saw a large number of patients, probably more so than the other providers. We were able to provide such a service that it became realized that we do have a combat mission and a go to war mission which has really helped. The army has a residency in podiatry, but we don’t always get the same benefits as the other doctors which is somewhat interesting. Bonuses are not the same, if they even exist at all, and the pay is different from that regard.

Dr. Jeffrey Page

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's guest is Dean of the Arizona School of Podiatric Medicine at Midwestern University, Jeffrey Page, DPM. You can register for future events by clicking here

RE: Recalcitrant Wound  (Samuel Rosenwald, DCh)
From: Robert Thiele, DPM

Something is not allowing the wound to heal. Assuming all medical and nutritional reasons including cessation of smoking have been addressed, remove the hardware. Biopsy and culture the bone to rule out osteo.  Also biopsy and culture the soft tissue.  If biopsies are clean, then a delayed primary closure should not be a problem with reported size of this wound. Non-weight-bear the foot until it heals. If osteo, treat accordingly. You either have an osteo or possibly a reaction to the hardware, assuming also that you have a healed fracture. You did not mention anything about a non-union. Update us on the outcome.   

Robert Thiele, DPM, Hillsborough, NJ, drthiele@comcast.net

RE: Recalcitrant Wound  (Samuel Rosenwald, DCh)
From: Thomas Graziano, DPM, MD

You can assume your 42 y/o patient with a chronic open calcaneal wound that probes to bone has osteomyelitis. These patients are very difficult to manage and resistant to closure for a number of reasons. The first is that the local soft tissue and osseous structures (the nidus) are relatively avascular. Because of this low vascular perfusion, antibiotics, intravenous or otherwise, cannot adequately penetrate the tissue, let alone any topical treatments. The second reason has to do with the lack of soft tissue coverage over the bone. The patient continues to ambulate on an unprotected area and therefore continues to exacerbate the problem.

If you review the literature, you will find numerous articles on the subject. A partial calcanectomy is one option. This can be combined with a local muscle transposition which addresses the issues mentioned above. Applying a well-vascularized muscle flap over a well debrided osseous and soft tissue structure accomplishes two things. It allows for improved perfusion, thereby increasing antibiotic penetration, and at the same time provides well needed soft tissue coverage over the defect. The abductor digiti minimi muscle is an excellent choice by virtue of its wide base of origin and proximal neurovascular supply, as well as other intrinsic muscles depending on the location of the defect. I recommend that you search the literature for a more complete description and philosophy behind the technique.
 
Thomas Graziano, DPM, MD, Clifton, NJ, TGrazi6236@aol.com

RE: Medial Malleolus Screw Removal (Gary Bjarnason, DPM)
From: Neil A Burrell,  DPM

All the comments on removing a screw from the medial malleolus reminds of the time a well respected orthopedist in our community went in to remove a screw from a patient's hip. The patient had her original surgery in another state. When he got to the screw head, he realized that he had never seen anything like it before. He called maintenance  and had them bring up every screw driver they could lay their hands on. He found the correct screw driver, had it sterilized, and successfully removed the screw with no complications, short-term or long-term.  

Neil A Burrell,  DPM,  Beaumont , TX, nburrell@gt.rr.com

RE: Prescription Data and HIPAA (Elliot Udell, DPM) 
From: Jeffrey Kass, DPM

I agree with Dr. Udell and find this to be a gross invasion of privacy. There was some form of challenge of this injustice, but in a recent Supreme Court case about data mining in Vermont, the court sided with the pharmaceutical companies. The reasoning supplied to Dr. Udell makes no sense to me. If someone is already a high prescriber for a drug - I would think it would be smart to pay visits to a non-prescriber to drum up new business.
 
Jeffrey Kass, DPM, Forest Hills, NY Jeffckass@aol.com

RE: Effectiveness of a Multi-faceted Podiatry Intervention to Prevent Falls in Older People
From: Doug Richie, DPM

It was a privilege to present this newly published research in the Biomechanics Section of the recent APMA National Meeting in Boston.  One of the co-authors of this research, Hylton Menz was extremely helpful in providing background data and related studies that his team has published over the past 10 years. This group of Australian podiatrists have published pioneering research in muti-disciplinary journals which have provided significant insight into the cause and prevention of falls in the elderly.  

This recent prospective, randomized trial demonstrated that a mutifaceted program, implemented by podiatrists in Australia reduced the rate of falls in elderly patients with foot pain by 36% during a 12 month period.  The main components of the program were patient education, regular podiatric care, a pair of custom foot orthoses, and a pair of proper shoes. This program can be easily adapted and implemented in the United States, and the APMA is going to focus on this initiative in the next few months.
 
Doug Richie, DPM, Seal Beach, CA, DRichieJr@aol.com

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