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02/15/2022
RESPONSES/COMMENTS (PODIATRISTS AND DIABETES)
From: Steven Kravitz, DPM
It's not just DFUs; it is all non-healing wounds. I applaud any effort to attract more attention to the importance of nutrition for the medical community. This is especially true for my specialty of dealing with non-healing wounds. The report endorsed by the American Limb Preservation Society and cited by Dr. Armstrong makes important points but is focused on the diabetic foot ulcer.
Podiatry has paid much attention to the diabetic foot, and for good reason. But the question I bring to the floor is: has this been at the expense of being more articulate and informed as we should be on other chronic wounds? An example is the venous leg ulcer (VLE). These ulcers have a published recurrence rate of 75-80% within six months. A better understanding, and coordinated care, has been shown to bring this down to 25%. Nutrition is one aspect out of several to be addressed.
To the point regarding this article cited by Dr. Armstrong - All non-healing wounds require a nutritional assessment. It's not just diabetes.
Steven Kravitz DPM, Winston Salem, NC
Other messages in this thread:
12/13/2025
RESPONSES/COMMENTS (PODIATRISTS AND DIABETES)
RE: -25 Modifier and RFC
From: Allen M. Jacobs, DPM
The -25 modifier appended to “routine care“ visits is a subject about which I am now passionate. For the last several years, Michael Warsaw and I have spoken on this subject in detail at the St. Louis Podiatry Seminar and will do so again this year.
Why? My job as a podiatrist is in no small part the evaluation of the diabetic patient for risk factors which increase the likelihood of skin breakdown, infection, ulceration, and ischemia. When such risk factors are present, my job is to either treat or refer, or both. My job is also to improve the patient’s quality of life.
As a profession, we have accepted the role of diabetic foot care. This is wide-reaching. Yes, Charcot’s joint reconstruction and stabilization...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
07/06/2023
RESPONSES/COMMENTS (PODIATRISTS AND DIABETES)
From: Tilden H Sokoloff, MD, DPM
Kudos to David Armstrong, DPM, MD, PhD for getting his paper published in JAMA. As a member and Committee member of the AMA Section of Foreign Medical School Graduates, this represents a monumental step in the ability of JAMA editors to recognize not only the importance of this topic but to offer this paper for CME Credit to all AMA members.
David, your Pop is smiling from high above, you have done yourself and the American Podiatric Medical Association a huge step to creating the parity. You are a gift to this profession. A very proud “Uncle T”.
Tilden H Sokoloff, MD, DPM, Ketchum, ID
02/16/2022
RESPONSES/COMMENTS (PODIATRISTS AND DIABETES) -PART 1B
From: Robert Kornfeld, DPM
I began my journey into nutritional medicine in 1987. I started a teaching institute in 2000, after 13 years of experience treating thousands of patients holistically at the mechanistic level before treating symptoms. I self-hosted seminars because I could not get any support from the colleges. I wrote often in this forum back then. I wrote articles to assist other DPMs that were interested in becoming more comprehensive in their approach to podiatric medicine. Very few were interested in learning. Those that did, did not stick with it. I’m sorry to say I was unsuccessful at getting our profession to embrace what I had to offer. My practice is a functional medicine/regenerative medicine paradigm.
After 35 years of experience, it’s amazing to me to see a post on DFUs that includes nutrition, as if this is new information. With 3/4 of your immune system in the gut, I should not have been an army of one all these years. Podiatry is so far behind in the practice of health-promoting protocols that manage mechanisms and stimulate reparative pathways. I gave up on you guys a long time ago out of frustration. I fielded criticism, attack, and incredible ignorance from some in this profession until I just walked away. I have enjoyed an incredible journey in MY chosen field of foot and ankle care and at 67 years old, still love what I do and help people in a way my traditional training could not come close to. Is nutrition important in healing DFUs? How could it not be?
Robert Kornfeld, DPM, NY, NY
02/16/2022
RESPONSES/COMMENTS (PODIATRISTS AND DIABETES) - PART 1A
From: Elliot Udell, DPM
As Yogi Berra said, “It’s like déjà vu all over again." When I first got into practice, there was an outspoken Brooklyn podiatrist named Ike Tereno who devoted his entire practice to treating wounds with nutrition. He even started a society to teach his findings and he lectured to whoever would listen to him. Ike was laughed at, called a quack, and I don't know if the society he founded still exists. Now in 2022, Ike can look down from heaven and get the last laugh.
Elliot Udell, DPM, Hicksville, NY
12/01/2021
RESPONSES/COMMENTS (PODIATRISTS AND DIABETES)
From: Steven Kravitz, DPM
Congratulations to both David Armstrong, DPM and Larry Lavery, DPM. Dr. Armstrong was listed as the top-rated expert in diabetic foot in the world during the years 2011-2021. However, also outstanding is that this Medscape article acknowledges Larry Lavery, DPM as the number three rated expert in diabetic foot in the entire USA during the years 2011-2021.
The worldwide analysis is "based on 6,449 eligible articles published since 2011." Medscape is a biographical database that uses primarily MEDLINE published articles. It is produced by the National Center for Biotechnology Information (NCBI). This achievement is remarkable for both of these doctors and at the same time is the very best way the podiatric community, on a worldwide scale, can be recognized for our expertise and knowledge in the treatment of the diabetic foot. Their accomplishments cannot be understated.
Publishing scientific articles in podiatric publications is indeed important. But also equally as important is to publish in other sources for other fields of medicine to broaden our reach to inform other providers of the skills and knowledge offered by the podiatric physician. Many thanks for their hard work and effort.
Steven Kravitz, DPM, Winston-Salem, NC
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