The Voice of Podiatrists

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November 01, 2007 #3,081 Editor-Barry Block, DPM, JD

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Many Running Problems Can Be Corrected With Proper Shoes: NH Podiatrist

Podiatrist Howard Bonenberger of the Ankle and Foot Center in Nashua and Milford, said runners don't appreciate the complexity of foot, ankle and leg mechanics. A runner who repeatedly injures her knee, for example, may believe she has weak knees, although in reality what's at issue is the shape of her foot and structure of her feet and legs. "You don't inherit bad knees," Bonenberger said, explaining that he analyzes gait, flexibility and strength to help runners overcome such predispositions.

Dr. Howard Bonenberger

Many foot problems associated with running can be easily corrected with a comfortable, supportive pair of shoes, the physician added. But Bonenberger said runners often misdiagnose and mistreat their own ailments, spending exorbitant amounts of money on shoes and over-the-counter arch supports, rather than consulting a foot specialist. "Our goal is to help them continue to exercise as long as they are able," the podiatrist said.

Source: Hattie Bernstein, Nashua Telegraph [10/30/07]

CPMA Promotes “Diabetes is a Family Affair” Campaign

Diabetes is the leading cause of non-traumatic, lower-limb amputations in the United States. Nearly 21 million people in the U.S. have diabetes, and of those, 3.2 million are African-Americans. Considered high risk for type 2 diabetes, African-Americans are almost three times more likely to suffer from lower-limb amputations as their Caucasian counterparts. For this reason, the Connecticut Podiatric Medical Association in collaboration with the American Podiatric Medical Association is urging African-Americans to take off their shoes and socks at every doctor’s visit to check the feet for signs and symptoms of the disease as part of its “Diabetes is a Family Affair” (DIAFA) campaign. Focusing on the impact that the disease can have on the entire family, a national effort is being launched to educate consumers that something as simple as a foot exam can reveal the first warning signs of serious diseases, such as diabetes and maybe even save a limb.

Dr. Carol Callahan

“Because diabetes can run in the family, it’s important that families discuss the disease and its warning signs,” said Dr. Christian Robertozzi, APMA President. Connecticut Podiatric Medical Association President Dr. Carol Callahan agrees. Both stress that “Family members can also ensure a person with diabetes maintains a proper diet, increases exercise, performs daily foot inspections and keeps a positive outlook.”

Source: Norwalk Plus [10/30/07]

N.Y. AG, Cigna Reach Agreement on Physician Rankings System

New York state Attorney General Andrew Cuomo (D) on Monday said that Cigna has agreed to provide its members with more information on how it ranks physicians, the AP/Hartford Courant reports. Cuomo said the deal could set a national standard for physician ranking systems (Bauman, AP/Hartford Courant, 10/29).

Under the agreement, Cigna will divide its preferred physician list into three lists -- one that ranks by cost, one that ranks by quality and one that uses a combination of both measures. Cigna said that it always has used both cost and quality measures to rank physicians, but the insurer in the agreement pledged to make its ranking data more transparent to members (AP/Hartford Courant, 10/29).

Medical groups and some state regulators have expressed concerns that doctor rankings can be confusing and could be used to steer patients to the least-expensive health care providers, rather than the highest-quality (Wall Street Journal, 10/30). American Medical Association President-elect Nancy Nielsen supports the agreement, saying that it "will influence other states to implement careful and independent oversight and evaluation of physician performance measurement projects." Nielsen said that the agreement "is important because it establishes a process that seeks to guard against some of the risks inherent in physician performance programs run by health insurers."

Source: American Health Line [10/30/07]

Query: Plantar-Flexed Halluces

My patient is a 25 year old healthy male with foot pain in both first MPJ's. Both halluces are plantar-flexed at the MPJ. Neither the long nor short hallucal extensor work at all (the AT works just fine). The lesser toes have working extensors, but the halluces do not. Both halluces, in non-weight bearing, are maximally plantar-flexed.

Weight-bearing, in stance, the halluces will dorsi-flex sufficiently to reach the longitudinal axis of each first metatarsal, but they will go no further as there are osseous blocks dorsally. This patient has never been able to dorsi-flex each hallux on the first met heads. I suspect that he may have had a sub-clinical case of polio.

His pain is at toe-off, as the halluces are jammed against the first met heads and the associated boney stops. I made orthotics with the first met head cutout which helped him to be a tad more propulsive, walk a little further, stand a bit longer, and has helped his pain, but has done little in gait.

If I put in implants with non-working dorsi-flexors, I am concerned that the halluces will migrate into plantar-flexion again. I could remodel the medial and dorsal eminences of each first met and take a dorsal wedge from the proximal phalanges to allow dorsal excursion in gait, and, hopefully, reduce pain. Any advice would be appreciated.

James Fisher, DPM, Crescent City, CA

RE: Barefoot is Better (Dr. Zipfel - Podiatrist)
From: Robert Scott Steinberg, DPM

Here is the link to more of the article. Of note, is his attack on the APMA !
http://www.pretorianews.co.za/index.php?fArticleId=4097977

I could not find Dr. Zipfel's CV. I was wondering if he is a podiatrist like we are in the USA, or is he a podiatrist like they are in Australia? Is he, or was he ever in private practice? Was he surgically trained?

Boy if we could only convince people to go barefoot. Wow ! But, just as our business would increase, I am sure insurance companies would exclude injuries caused while going bare foot !

Robert Scott Steinberg, DPM, Schaumburg, IL, doc@FootSportsDoc.com

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