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December 04, 2008 #3,416 Editor-Barry Block, DPM, JD

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IL Podiatrist Discusses Prevention and Treatment of Plantar Fasciitis

Whether you are a regular runner, a weekend warrior, or someone knocking around the yard, foot problems can easily cause you pain. Most pain associated with the heel can be tied to one disorder: plantar fasciitis. "There is a ligament called the plantar fascia which attaches at the heel bone and then runs through the arch and into the toes," explains Lowell Scott Weil, Jr., DPM, team podiatrist for the Chicago White Sox. "Its function is to support the arch. If you bend your toes back, you can feel a tight band in your arch. That is the plantar fascia."

Dr. Lowell Scott Weil, Jr.

A good preventive measure is stretching exercises two or three times a day. "I don't think the importance of stretching can be over-emphasized," stresses Dr. Weil. "Even if you don't have heel pain, you want to maintain some kind of daily stretching routine. These should be done before exercise and absolutely afterwards."

While custom-made orthotics provide the most accurate way to direct the foot into the correct position for walking or running, they are often not necessary as a first-line treatment. "I would say about 80% of my patients respond favorably to over-the-counter inserts," notes Dr. Weil.

Source: Kurt Ullman, Third Age [12/2/08]

Two NYCPM Faculty Members Lecture in Spain

Michael J. Trepal, DPM, Dean and Vice President for Academic Affairs, and Professor of Surgical Sciences, at the New York College of Podiatric Medicine, and Kevin T. Jules, DPM, Professor and Chair, Department of Surgical Sciences at the College, traveled to Madrid, Spain in mid-November and delivered two days of lectures on bunion surgery to nearly 130 European podologists from Spain, Italy, France and Portugal at the Universidad Complutense de Madrid.

(Front L-R): Luca Avagnina, DPM, President of the Society of Italian Podologists; Dr. Michael Trepal, DPM; Marta Losa Iglesias, Ph.D.; Dr. Ricardo Becerro de Bengoa Vallejo; and Dr. Kevin Jules.

Held in the impressive lecture hall of the University’s Faculty of Medicine, the lectures were co-sponsored by NYCPM and the University, and were coordinated by Dr. Trepal and Dr. Ricardo Becerro de Bengoa Vallejo, a professor at the Universidad Complutense de Madrid and a 1995 graduate of NYCPM who is the only podologist in Spain and in Europe with the earned D.P.M. degree. Dr. Trepal and Dr. Becerro de Bengoa Vallejo also coordinate a semi-annual, week-long visit to NYCPM by Spanish podologists, who study podiatric medicine and surgery in a program begun in 1991.

RE: Flu Shots and Podiatrists
From: Elliot Udell, DPM

I just received an announcement in the mail from Health Insurance Plan (HIP) saying that the governor of NY just signed legislation allowing pharmacists to give flu vaccinations. The note said that every state with (the exception of Maine) allows this. The note said that this legislation could give increase the number of elderly people who get flu shots by 50,000.

Pharmacists are, by and large, not trained in giving injections. Podiatrists are among the best-trained in giving injections. Is there any movement either nationally or in any local region to allow podiatrists to give annual flu injections? It certainly would make it more available. We could save lives by preventing flu and we are all trained in giving far more complicated injections than flu shots.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

Query: Online Backup

I am looking for input on using a HIPAA-compliant online backup for my office notes and billing software.

Arthur Lukoff, DPM, Ellenville NY

RE: Efficacy of Alternate Treatment for Heel Pain
From: Michael Turlik, DPM

It is my impression, after reading recent postings, that a number of podiatrists do not understand the difference between studies which generate hypotheses (descriptive studies) and studies which test hypotheses (randomized controlled trials).

Descriptive studies, even if large, still do not have the methodological safeguards to limit bias. The best conclusion one could reach reading a descriptive study is that a treatment may be effective. In order to determine efficacy or effectiveness a more rigorous study design which employs randomization, blinding, concealment allocation, intention to treat, and analysis are required for therapeutic interventions. It is very common that descriptive studies exaggerate the magnitude and sometimes the direction of the treatment effect.

The references regarding cryotherapy and mechanically-induced heel pain provided by Steven H. Goldstein, DPM appear to be descriptive studies. Performing a MEDLINE search using the keywords cryotherapy AND heel pain OR plantar fasciitis (while restricting the articles returned to randomized controlled trials) fails to generate any studies. As result, there does not appear to be any valid evidence that cryotherapy is effective in the treatment of mechanically-induced heel pain. That does not mean that cryotherapy may not be effective - just that the proper studies have not been performed as of this date.

With limited financial resources, and campaign promises to extend healthcare to the uninsured and under-insured Americans, it is conceivable that healthcare payments in the future may be restricted to those treatment and diagnostic procedures which have a demonstrated beneficial effect.

Michael Turlik DPM, Cleveland OH, mmturlik@aol.com

RE: Sources for AO Fixation Techniques (Paul Gabriel Scullion, FCPodS)
From: Multiple Respondents

We just finished a reconstructive surgery course here at TUSPM and found these websites to be very helpful: aovideo.ch/catalog/ and
aofoundation.org/www/elearning/modules/intro/index.html

Jeff Merrill, TUSPM 10’, teflon@temple.edu

Manual of Internal Fixation: Techniques Recommended by the AO-ASIF Group by Maurice E. Muller, et al.

Thomas A. Graziano, DPM, MD, Clifton, NJ, TGrazi6236@aol.com

McGlamry's "Comprehensive Textbook of Foot Surgery" is excellent.

Dwight L. Bates, DPM, Dallas, TX, dlbates04@yahoo.com

RE: Practice in England (Jay Wenig, DPM)
From: Simon Fay, FCPodS, Martin Harvey BSc (Hons)

Just to add to Dr Wenig's comments, things have moved along a little in the UK since he left in '93. Podiatric surgery has become pretty widespread and most areas have a public funded service (Wales and Scotland are not so well served). In all facilities, there is good access to surgery-based medicines although podiatrists still do not have specific prescribing rights. Injection therapies are widely available and not just from surgically trained practitioners. Many surgical units have access to general anesthetic services. The range of surgical procedures is now essentially all foot and ankle procedures, up to and including comprehensive flat foot repair. In other areas of specialty, diabetic foot services are pretty well served in the public system, often well integrated with the medical team.

To Dr. Miller (who made the original post), you may find that contacting the Society of Chiropodiists and Podiatrists (London) would be helpful for you: (website) feetforlife.org

Thanks must be offered to Dr. Wenig and his colleagues from RAF Lakenheath; their contribution to UK Podiatric surgery cannot be over-estimated.

Simon Fay, FCPodS, Winnipeg, MB, Canada, simon_fay@mac.com

The situation in the UK is currently different to that recounted by Dr Wenig. With suitable training, many podiatrists can supply directly to patients certain medicines, including amoxicillin, erythromycin, and flucloxacillin antibiotics, from an approved list published by the Government’s regulatory body, the MHRA. This training is now standard in all new podiatry degrees and available as a standalone add-on postgraduate qualification to those with older qualifications. Additionally, since 2005 it has become possible with further training for UK podiatrists of a certain seniority to become supplementary prescribers, which means working in a prescribing partnership with a doctor (or dentist) to prescribe any drug for any condition within their scope of knowledge and an agreed clinical management plan, including conditions outside the foot.

There has been a slow take-up for such training, as when I started studying for my supplementary prescribers course, which finishes next year, I discovered that only 61 out of some 13,500 UK registered podiatrists were supplementary prescribers, however, this number will undoubtedly grow and hopefully lead to full independent prescriber status (this is now possible for suitably trained UK Nurses). Also, suitably-trained, we can and do inject the likes of neuromas with steroids, etc., although my personal preference is to initially try dextrose prolotherapy before considering other treatments. UK podiatry has its politics, like any other profession, but I agree that on the whole we are a friendly lot. Another important change for American visitors since Dr Wenig’s time is that now most UK beer is served chilled.

Martin Harvey BSc (Hons), Tamworth, Staffordshire, UK. martin@podmed.info

ASSOCIATE POSITION- BALTIMORE, MARYLAND

Busy practice in the Pikesville/Owings Mills area located in 1st class medical building seeks motivated individual to work PART-TIME. Must be surgically trained. Must have a great personality and a good sense of humor. State-of-the-art office with hospital-grade ASC. Good mix of general podiatry, sports medicine and surgery. Competitive salary. Benefits for malpractice and health insurance allowances are available and negotiable. Please forward your CV by fax to 410-602-9781 or by email at mwaiken@comcast.net

PODIATRISTS NEEDED - CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC

ASSOCIATE - METRO NEW YORK--LONG ISLAND & NEW YORK CITY

Excellent Opportunity for immediate partnership with established practice. Excellent Salary arrangement, serious inquiries only. Send CV along with response. E-mail: rrranch7@yahoo.com

ASSOCIATE POSITION – MASSACHUSETTS

Excellent opportunity for a highly-motivated, entrepreneurial individual to join a very successful, rapidly growing multi-office practice, North of Boston. Seeking a PSR-24/36 trained podiatrist to join our group. We offer a competitive salary/benefit package with the opportunity of partnership after one year, for the right individual. Send CV and letter of interest to drfleishman@nefootankle.com

PODIATRIST NEEDED—SEATTLE, WA

Established podiatric practice in Seattle, WA is looking for licensed podiatrist for part-time leading to full-time position. Need help with Adult Family Homes and Nursing Homes as well as in the office. Flexible schedule and attractive compensation. For all details please call 206-661-9644.

ASSOCIATE POSITION –GEORGIA

A well-established practice in South Georgia seeks a full time PSR-24/36 trained podiatrist. Excellent benefit package. Please send CV to agriffin@southernpodiatry.com. For more information, visit our website

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for part-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

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