01/14/2025
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
From: Bruce I Kaczander, DPM
When I was in practice, I would, daily, advise my elderly patients that walking barefoot at home, increases their fall risk tenfold. That has been proven multiple times in a variety of studies, too numerous to mention here. Keeping a shoe on at home is critical, reminding them that a slipper is not a shoe!
Bruce I Kaczander, DPM (retired), Southfield, MI
01/13/2025
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
From: Ivar E. Roth DPM, MPH
I agree with Dr. Musser. Going barefoot in theory may be a great idea but in reality, it is not practical for the general population due to the increased incidence of injuries, etc. which we all see from going barefoot. The cons far outweigh the pros of going barefoot.
Ivar E. Roth DPM, MPH, Newport Beach, CA
01/09/2025
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
From: Stephen Musser, DPM
I could not disagree more. The only time (except for in the shower or bathtub) I advise my patients to go barefoot at home is when they are sitting down. Too many times, I see patients with foreign bodies, puncture wounds due to going barefoot or just wearing socks around the house. And yes, 70+% of the time they're diabetic.
Stephen Musser, DPM, Cleveland, OH
01/02/2025
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
RE: CA Podiatrist Cautions Against Wearing Sneakers Without Socks
From: Joel Lang, DPM
I think everyone can agree with Dr. Vincent-Sleet's opinion and recommendation. In practice, I always presented the issue to the patient as, "Would you ever take a shower, get all cleaned up, and then put the same old underwear back on?"
This was almost always followed by a response like, "Ewww!, no, of course not." To which I would reply, "That's exactly what you are doing when you wear shoes without socks." Some would see the comparison and some probably would not.
Joel Lang, DPM, Cheverly, MD (retired)
12/13/2024
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
From: Joseph Borreggine, DPM
Unfortunately, this will never stop or change, but rather it will get worse and not better. The largest and most influential lobby in the U.S. is the American Hospital Association (AHA). They control healthcare... period, and there is no question about it.
Most hospital systems are considered non-for-profit oligarchies. This is so they do not have to pay taxes. Most take their profits and put them into foundations, but that is minor in comparison to where else they put their money. They usually reinvest in physical plants, but they also invest in real estate including farm land (usually the largest land owner in the community), and then taking all the other funds and investing it in the stock market. Hospitals are corporate conglomerates and are there to make money and provide healthcare in that order. They make money from...
Editor's note: Dr. Borreggine's extended-length letter can be read here.
12/03/2024
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
From: Elliot Udell, DPM
Perhaps Dr. Clayton could further explain what he saw in a mycotic nail that made him suspicious that he was dealing with skin cancer as opposed to the "run of the mill" mycotic nails that we all see, every day of the week. Should we do nailbed biopsies on all mycotic nails or was there something that made Dr. Clayton's case appear clinically unusual that called for further pathological evaluation?
Elliot Udell, DPM, Hicksville, NY
12/02/2024
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
From: Charles D Clayton, DPM
I read with interest the story of Dr. Markinson diagnosing acral melanoma. Many years ago, I covered a hospital clinic when a patient presented with what they thought was a mycotic hallux nail. The patient had been treating it for several months and I expected it to look better than it did. With a high index of suspicion, I biopsied the nail bed. The next week the chief pathologist was waiting to tell me the patient had amelanotic melanoma. Proof that if we don't see what we expect, we need to look closer.
Charles D Clayton, DPM, Mastic, NY
10/24/2024
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
From: Ivar E. Roth, DPM, MPH
With 40 plus years of experience, the simple procedure using phenol is 99% effective in my hands for nail removal. Having said that, I see so many poor results and failures from other podiatrists doing this procedure. The explanation for me is simple... these doctors could care less and do sloppy work. While I am sure there will be doubters to what I have written, I stand firmly on my opinion. If you want excellent results, take your time, be careful, and have pride in your work.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
10/21/2024
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS) - PART 1B
From: Pete Harvey, DPM
Thank you, Dr. Gurnick. During my 55 years of practice, I too have used almost every procedure for onychocryptosis, including radio ablation. But, in the ‘70s, I settled on the phenol procedure; not the PA or phenol/alcohol procedure. Following removal of the offending nail portion, I apply 88% phenol for 30 seconds and then dry the groove. Then I repeat this one time. I don’t apply alcohol at that time. I instruct the patient to remove the dressing (4 snug 1” Band-Aids) one hour before bedtime, pour alcohol on the snug dressing, and wait 5-10 minute to loosen the adhesive; then clean the toe with isopropyl alcohol. Then apply a fresh BandAid but fairly loose and not tight; then remove that dressing the next morning and shower without the dressing. Then clean the toe with alcohol again and apply the Band-Aid dressing. The third day should require no further dressing.
I instruct the patient to allow air to the toe as much as possible by wearing a cut-out shoe or a sandal. Then apply alcohol directly to the toe twice a day (drying agent). Apply no ointments or creams and only alcohol. I allow no soaks unless there is pain which is rare. Constant air exposure allows the toe to heal faster. Shower only with no tub baths, etc. Most toes heal in 3-4 weeks some longer. People required to wear closed shoes or steel toes will take longer to heal so I recommend doing the procedure on vacation time. I do not routinely Rx antibiotics unless the patient is compromised with brittle diabetes or poor circulation. Operating on a compromised patient is a judgment call and I will not operate on many of these cases.
Pete Harvey, DPM, Wichita Falls, TX
10/21/2024
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS) - PART 1A
From: Gary S Smith, DPM
I have been in practice 33 years. I have used the CO2 laser and the radio wave frequency machines many times for matrixectomies. I tried NaOH as well. I have never found anything with less re-occurrence rates or side-effects than phenol.
Gary S Smith, DPM, Bradford, PA
10/19/2024
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS) - PART 2
From: Paul Kesselman, DPM
I’ve been a Costco member for years and admired their optometry and hearing aid departments for years. When my local Costco opened about 7 years ago, I had a long conversation with their Northern Hemisphere chief of operations of their optometry department. He provided me with a significant amount of information on how cost-effective they were and the scope of operation. I was amazed that he was so free to divulge this amount of information.
What I’ve learned as an observer and consumer is that Costco is very ethical, cost-effective, and stand behind their products and services, and is very sensitive to consumer sentiment. That being said, the issue here with all orthotics for them may be within each state‘s regulations for providing foot orthotics. There are many states which have no licensure requirements regarding who...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
10/19/2024
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS) - PART 1
From: Keith L. Gurnick, DPM
I have 42+ years of practice experience doing phenol matrixectomies. This is probably the most common in-office surgical procedure that I do. I have done 1000s+ of these. The complication and recurrence rate is low, exactly how low I cannot say, but it remains an excellent procedure done for the prevention of recurring painful or infected ingrowing toenails and a procedure that our profession does well, thus providing great benefits to our patients to help them to enjoy the activities of daily living without painful ingrown toenails.
There are many procedures available to eliminate the toenail matrix including phenol, curettage, sharp frost, Winograd, plastic lip, CO2 laser, and yes also radio wave ablation. Each has its own set of risks, and potential complications including regrowth. In his post, Dr. McLean states, “The upshot is faster healing (also resulting in reduced bandaging time). Even better, the rate of recurrence is much lower, meaning the edge treated regrows less often."
Show me the proof of what you have written about the benefits of radio wave technique for toenail matrixectomy. Is this your own practice experience, or do you have journal articles or comparative studies you can provide? These are the same identical claims that were made by some podiatrists all across the country with the introduction of the CO2 lasers from the late 1980’s and early 1990’s, and most would agree that they were merely advertising gimmicks to attract new patients?
Keith L. Gurnick, DPM, Los Angeles, CA
10/17/2024
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
From: Keith L. Gurnick, DPM
I was equally surprised, a few weeks ago, when I went in person to shop at a local Costco near Los Angeles and came across a non-doctor vendor on premises making on-site custom 3D printed orthotics for Costco shoppers. I stood by and watched him do his thing. They even had a display sign stating the customer could use an FSA or HSA card for payment.
Keith L. Gurnick, DPM, Los Angeles, CA
10/16/2024
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
From: Michael Loshigian, DPM
I was pleasantly surprised to see an article in the October issue of Costco Connection that featured podiatrists as experts on plantar fasciitis with no mention of foot specialists holding any other degree. I was equally surprised to learn that the distribution of this monthly magazine is about 15 million to Costco Executive members per month and has a readership of over 30 million.
Michael Loshigian, DPM, NY, NY
10/14/2024
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
From: Rod Tomczak, DPM, MD, EdD
I just heard an NPR piece about kids and Crocs footwear. The narrator called upon an APMA spokesperson who said that wearing Crocs could lead to every possible foot malady except for a gun shot wound (GSW). This is an example of how the APMA works for us.
I looked up the APMA spokesperson in PubMed to see if they had authored any publications that may translate to Crocs, let alone on Crocs. This person has no publications listed on PubMed. So it appears this APMA authority is subtly preaching her own value judgment as the APMA's position. Not to be deterred, I searched Crocs on PubMed and there are no articles referred to or not that the APMA spokesperson could have consulted before formulating an opinion. To state emphatically there could be a cause and effect relationship between this footgear, and anything else is anathema. I personally don't like Crocs, but I will never try to impose my feelings on anyone else by stating they are dangerous for everyday wear. Try telling your OR team to quit wearing Crocs. However, if Crocs start making hockey skates, I will make an existential leap and advise players not to wear them.
In this spokesperson's defense, there was also an opinion by an orthopedic surgeon stating that wearing Crocs could lead to other musculoskeletal maladies. I expect as much from that cohort.
Rod Tomczak, DPM, Columbus, OH
09/16/2024
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
From: Howard Dananberg, DPM
There is no doubt in my mind that the 1st MTP joint serves a crucial role in human ambulation. The question to ask is why such a small, and most distal anatomical site can have such a profound impact on postural form and function. The answer lies in how humans power each step. While there must be a “ground push” to advance, it is far more passive than directly muscular. The swing limb is an essential part of this puzzle, PULLING the body OVER the standing limb as it kicks forward.
Try walking without stepping forward. It doesn’t work! To facilitate this “pull”, the foot is RESPONSIVE via MTP joint dorsiflexion. This permits heel lift (ankle plantarflexion) while simultaneously maintaining ground contact, re-supinating the foot with the non-muscular windlass effect. And once the MTP joint commences dorsiflexion, the hallux portion REMAINS STATIONARY. It is the remaining proximal foot structures which move over the immobile great toe. Therefore, the impact of hallux limitus, functional or structural, is about ALL the proximal anatomy, with flexion replacing extension as a method to accommodation. Over the millions upon millions of steps humans take in a lifetime, hunched over posture is the result. Form follows function. My life’s goal has been to explore the foot’s role in chronic postural issues and to highlight the importance of podiatric medicine in the treatment process.
Howard Dananberg, DPM, Stowe, VT
09/14/2024
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
From: Jeffrey Trantalis, DPM
Conway McLean, DPM’s assessment of the importance of the first MPJ is correct. Years ago, in the early 1980s, a professional football receiver came into my office complaining of 1st MPJ pain. At that time, he had orthotics with an extension to limit 1st MPJ motion. I felt this was not the answer for a receiver in the NFL. He came back into my office not happy. I could not blame him.
So, I modified his orthotic, removing the hallux extension and changed the support of the orthotic to support the 1st MPJ - cuneiform joint, allowing plantarflexion of the first ray upon weight-bearing. This was a total success. From that point on, I used this modification, instructing orthotic labs to incorporate this modification into the orthotic. I would mark the joint on my casts. A low-Dye taping plantarflexing the first ray reproduces this correction and can be tried prior to having expensive orthotics made.
Jeffrey Trantalis, DPM, Delray Beach, FL
06/19/2024
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
From: Doug Richie, DPM
The advice given by Dr. Botek for prevention of friction blisters on the feet has some value but unfortunately also propagates several myths regarding the pathomechanics of this common skin injury. In short, ill-fitting shoes are not the primary cause of friction blisters on the feet as any active athlete can attest after changing or modifying their own footwear and still suffering from blisters.
Shoes do not "rub against the foot", rather the foot rubs against the shoe. Friction blisters are not an abrasion or external rubbing injury against the skin of the foot. Instead the friction blister is the result of shear distortion of the deeper layers of the epidermis in response to...
Editor's note: Dr. Richie's extended-length letter can be read here.
04/22/2024
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
From: PM News Subscriber
The feet can provide a window to one’s health if you look. A 48 year old female patient came to me for an issue with her feet... bunions. Upon examination of her feet, she presented mottling, with black and blue discolorations to a few digits. There was no pain or history related to the discoloration.
I referred her to a vascular specialist and told her to go the next day. The vascular surgeon called me to ask how I knew to refer this patient. The patient had 98% blockage to her carotid arteries and he did not know how she survived. She was throwing clots to her extremities. Sometimes you have to think "outside the box.”
PM News Subscriber
04/15/2024
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
From: Paul Betschart, DPM
Surgeons should also check with their malpractice policy to make sure they are covered for cosmetic procedures as some policies do not.
Paul Betschart, DPM, Danbury, CT
04/12/2024
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
From: Steven Mazer, DPM
Dr. Jill Berkowitz-Berliner is confused about not being allowed to treat bunions cosmetically with possibly not being reimbursed by an insurance company. A podiatrist may, with informed consent of the patient, perform a bunionectomy for cosmetic reasons in the state of New York. The patient would need to be made aware of the fact that his or her insurance may not pay for the procedure and that the patient would be responsible for any fees associated with that procedure.
Steven Mazer, DPM (retired), Woodbury, NY
04/11/2024
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
From: Jill Berkowitz-Berliner, DPM
I thought NY podiatrists are only allowed to surgically treat PAINFUL bunions, not just for aesthetic reasons.
Jill Berkowitz-Berliner, DPM, Mount Kisco, NY
03/20/2024
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
From: Ivar E. Roth DPM, MPH
I read Dr. Kelly John’s explanation for toe cramps. It seems she missed the mark by not mentioning the number 1 reason why patients get toe cramps or see podiatrists for toe cramps which is a neuroma.
This was an opportunity to inform the public about this common problem. Remember, we are podiatrists first and should inform the public from our specialty’s perspective.
Ivar E. Roth DPM, MPH, Newport Beach, CA
02/22/2024
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
From: Jeffrey Trantalis, DPM
“Ice cup massage” to the heel for plantar fasciitis is not the only location to utilize this method. It is very effective for sports medicine injuries. Muscle and tendon injuries respond to this method prior to stretching. Achilles tendinitis comes to mind as an ideal place for this method of treatment. At the end of the day, after stretching, an ice pack is utilized to calm daily inflammation. Having used this method for over 40 years, I have made it a must in my practice.
Jeffrey Trantalis, DPM, Delray Beach, FL
01/25/2024
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS) - PART 2
From: Jeff Root
I appreciate the points presented by Drs. Stess, Steinberg, and Radovic. Unfortunately, I’m not aware of any reliable, scientific method for comparing the contour of slipper casts to that of direct foot scans. I’m also not aware of any good outcome studies that support one method over the other clinically. In the lab, we have made orthoses of the same subject using multiple techniques and then we compare the shape of the finished orthotic shells to the positive models produced using other techniques. This is the only way I’m aware of to compare the contours of orthoses made from a fully manual process (slipper cast to corrected, positive plaster cast), a partially manual process (a scanned slipper cast to computer generated positive wood mold), and a fully digital process (direct foot scan to a computer generated...
Editor's note: Jeff Root's extended-length letter can be read here.
