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07/12/2022
RESPONSES/COMMENTS (PODIATRY MANAGEMENT ARTICLES)
From: Allen Jacobs, DPM
As much as I respect legitimate practice management, the article by Mr. Horr borders on questionable care recommendations. With regard to onychomycosis, topical therapies dispensed in the office have little proven efficacy as isolated treatment. Systemic therapy, perhaps supplemented by topical therapy and concurrent treatment of tinea pedis, may be appropriate in some cases. However, laser treatment does not provide a cure for onychomycosis. Nor do office dispensed topical antifungal therapies as isolated treatment for advanced disease. Where is the literature to support these recommendations? Why do dermatologists or podiatric physicians as a profession not employ laser therapy for onychomycosis?
Similarly, the suggestion that a “subtalar joint stent "be utilized for the management of plantar fasciitis. Generally, with few exceptions, subtalar joint arthroereisis is not a covered service. The procedure is frequently and fraudulently billed as “open reduction and internal fixation of a peritalar dislocation." Worse yet, "modified subtalar joint arthrodesis." If one looks at the recommendations for the treatment of plantar fasciitis by ACFAS or AOFAS, where are the recommendations for pronation limiting surgery or the injection of agents other that corticosteroids?
Of course, there are occasional articles of variable quality published which support almost anything. However, if these therapies were indeed predictably helpful, why are they not standard of care? It is reasonable to posture that our therapies should not be restricted to those paid for by a third party. However, non-covered services endorsed to a patient should have a reasonable basis upon which that recommendation is made.
Allen Jacobs, DPM, St. Louis, MO
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09/19/2022
RESPONSES/COMMENTS (PODIATRY MANAGEMENT ARTICLES)
From: Paul Kesselman, DPM
Over the past several years, there have been many letters regarding the lack of biomechanical leadership, fellowships, and research led by podiatrists. It is quite refreshing that there has been an uptick in this by academia but, in my opinion, it still falls far too short of what is needed (at least as what I see from other professions), but at least there are some rumblings in the correct direction.
What continues to baffle me is the link between biomechanical leadership/research and orthotic reimbursement, regardless of who is performing the studies. Here are some questions to think about: 1) Has your reimbursement for anything gone up since...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
09/16/2022
RESPONSES/COMMENTS (PODIATRY MANAGEMENT ARTICLES) -PART 1
From: V. Kathleen Satterfield, DPM
All is not lost, indeed! As I read your editorial “Biomechanics and the Survival of Podiatry”, I realized there is growing evidence that we are actually entering a new era of biomechanics and this is a welcome sign. But it is not necessarily the biomechanics of my teachers, as research expands our knowledge. Western University College of Podiatric Medicine is contributing to this renaissance. A modern biomechanics lab opened this fall, with instruments that evaluate both kinesthetics and kinematics.
The mainstay of traditional orthotic production is taught by Dr. Arnold Ross, and through a gift from KevinRoot Medical, our students will learn creation of orthotics through scanning technology. The late Paul Scherer, DPM and Dr. Aaron Meltzer established a Biomechanics Fellowship at WesternU with the intent of educating podiatric physicians who have an interest in teaching...
Editor's note: Dr. Satterfield's extended-length letter can be read here.
07/14/2022
RESPONSES/COMMENTS (PODIATRY MANAGEMENT ARTICLES)
From: Elliot Udell, DPM
Dr. Jacobs is touching on a gray area when he asks, "Why do dermatologists or podiatric physicians as a profession not employ laser therapy for onychomycosis?" The gray area applies to many products that are not officially endorsed by our profession but the endorsement may be implied. If a young podiatrist or podiatric medical student attends one of our conventions sponsored by our national organization or regional societies and sees booths manned by suave salespeople and even colleagues, what is he or she to think about whether our profession endorses that product or not?
The sponsors of our conferences even encourage people to visit the booth areas and even have sponsored speakers tout a product from the podium in the lecture hall. Perhaps a solution would be to have signs all over the exhibitors' halls stating that the sponsors of the convention do not endorse any of the products and that buyers should use them at their own risk.
Elliot Udell, DPM, Hicksville, NY
07/01/2022
RESPONSES/COMMENTS (PODIATRY MANAGEMENT ARTICLES)
From: Doug Richie, DPM
Yesterday, I was quoted by Dr. DiPaolo in a post on PM News referring to a recent roundtable published in Podiatry Management (June/July 2022). He stated that, according to Dr. D. Richie, "in the literature, steroid injections are always cited as the most effective treatment of plantar heel pain.” This quote did not include my complete statement and fails to recognize that I was specifically comparing the effectiveness of NSAIDs to corticosteroids.
My actual statement reads: "That is why in the literature, steroid injections, not NSAIDs, are always cited as the most effective treatment of plantar heel pain." My response in the roundtable was to a question specific to the use of NSAIDs in treating plantar heel pain. In retrospect, it would have been more appropriate for me to clarify that corticosteroids are more effective than NSAIDs, but are not the single most effective treatment overall for plantar heel pain compared to other options.
Doug Richie, DPM, Long Beach, CA
06/30/2022
RESPONSES/COMMENTS (PODIATRY MANAGEMENT ARTICLES)
From: Vincent T. DiPaolo, DPM
I really enjoyed the article on heel pain in the June/July 2022 issue, but please note these two conflicting statements: Dr. D. Richie: “…in the literature, steroid injections are always cited as the most effective treatment of plantar heel pain.” Dr. L. Weil, Jr: “There are virtually no studies validating the benefits of cortisone injections for heel pain.” Personally, I find them very helpful in most cases. Any comments?
Vincent T. DiPaolo, DPM, Plainview, TX
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