|
|
|
|
|
Search
08/28/2025
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
From: Gary S Smith, DPM
Years ago, I saw a 35-year-old farmer as a patient who had never worn shoes in his life. The effects were truly remarkable. His skin was like leather with the fat pad bulging up around the sides of his feet. His feet were so wide from not wearing shoes that in the winter he wore galoshes, rubber boots that are designed to fit over shoes. He drove the tractor and walked in the hay fields with no shoes.
Phillip Tome was one of the first settlers to NE PA in the late 1700s. He wrote about his encounter with Indian Chief Cornplanter, who was said to be 100 years old at the time. He was shocked at the state of his bare feet by how wide and deformed they were.
Gary S Smith, DPM, Kane, PA
Other messages in this thread:
09/01/2025
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS) - PART 1A
From: Howard E. Friedman, DPM
Regarding the recent posts about the benefits of barefoot walking, I revisited my letter to this forum in 2020 in which I cited two studies that documented either improved intrinsic muscle size or improved balance and posture in barefoot walkers. Since then, there have been further studies that have returned the same results in addition to previous research.
However, many things are clinically true about barefoot walking at the same time. Yes, people can get puncture wounds and fungal or bacterial infections. But, it is incontrovertible that a program of barefoot walking in a safe environment for appropriate people can result in larger, i.e. stronger, intrinsic foot muscles. It is also true that barefoot walking does not result in a zero-injury rate in feet and legs and in fact can lead to...
Editor's note: Dr. Friedman's extended-length letter can be read here.
09/01/2025
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS) - PART 1B
From: Robert Scott Steinberg, DPM
I find it interesting that a number of my colleagues who promote running around barefoot did not experience treating patients presenting with "COVID-19" feet during the shutdown and after, among those who continue working from home barefoot.
Has anyone studied whether people with excessive pronation who take up walking barefoot rebuild their arches? Does walking or running in stability shoes, with prescription functional orthotics, cause all the intrinsic muscles in the foot to relax and not get a workout?
Robert Scott Steinberg, DPM, Schaumburg, IL
08/29/2025
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS) - PART 1C
From: Herbert Abbott, DPM
Thank you to Drs. Dananberg and Smith for your interesting and unique anecdotal stories. However, I would be willing to bet for each one of those stories, the thousands of PM News readers could share scores, hundreds, or even thousands of examples of patients suffering from the previously mentioned risks of barefoot walking. Again, is the juice really worth the squeeze?
And now, Dr. Langer: You assume that just because this disparager is “retired,” that he has not bothered to keep up with research. Not only have I kept up with research, but I even know how to use the Internet.
Feel free to review:
• Kelsey JL, Procter-Gray E, Nguyen U-DT, et al. Footwear and Falls in the Home Among Older...
Editor's note: Dr. Abbott's extended-length letter can be read here.
08/29/2025
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS) - PART 1B
From: Amol Saxena, DPM, MPH
My colleague Rob Conenello was quoted in a publication about walking barefoot indoors as a good way to strengthen feet. This apparently is controversial among colleagues. One thing to remember is that writers often look for “sound bites” and not all responses are complete. For instance, I am sure Rob did not want to encourage those with current conditions such as plantar fasciitis, plantar wounds, or neuropathy to go unshod.
Barefoot exercises and even a small amount of running on grass are great ways of strengthening feet. Many top track and field coaches including Golden Foot winner Brooks Johnson U.S. Olympic Coach (RIP) encouraged this. Some more research is needed on what is the optimum amount of time, and perhaps why some cultures have less foot issues if they spend a lot of time barefoot. Another thing to consider is that we use boots or casts for a period of time, and then through rehab we progress people out of them. Using devices such as a Blackboard and techniques like Spiral dynamics are helpful in the rehab process for many of my elite athletes.
Amol Saxena, DPM, MPH, Palo Alto, CA
08/29/2025
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS) - PART 1A
From: Michael Chin, DPM
Dr. Conenello makes compelling points for the benefits of barefoot activity, particularly regarding the strengthening of intrinsic foot muscles and their impact on mobility as we age. It’s old dogma of everyone needing to be “supported” at all times with orthotics and stability shoes in order to be properly treated by our profession. In the changing landscape of podiatry, it is important to read the current literature and think before you speak. Dr. Langer provided a great study in his commentary and I suggest those who haven’t read it should.
As Dr. Conenello’s clinical perspective raises good and valid points, we do need to consider the idea that humans have a hard time “doing things in moderation.” It is not an all or nothing approach to going barefoot.
Of course, there are populations that are more at risk for foot pathologies like diabetics with neuropathy or patients with fat pad atrophy who maybe are not the best candidates to go without footwear. You still have to use your best medical decision judgment to determine what’s best for your patient. Just be open to the possibility that there is something gleaned from the ones leading positive change in our great profession.
Michael Chin, DPM, Chicago, IL
08/28/2025
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS) - PART 1A
From: Paul Langer, DPM
I'd like to respond to the criticisms of Dr. Conenello's quotes on barefoot walking. My response is as follows: It is disappointing that within our profession, we have people who would publicly disparage a well-informed colleague simply because the disparagers have not bothered to keep up with the research.
The evidence for the benefits of foot intrinsic strengthening and barefoot/minimalist shoe ambulation to increase the foot’s capacity to support the body gets better every year since McKeon and colleagues first introduced the concept of the “foot core” in 2015. It would be better for our profession if we spent less time criticizing concepts we do not understand and more time working to understand them.
Paul Langer, DPM, Minneapolis MN
08/28/2025
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS) - PART 1B
From: Howard Dananberg, DPM
Many years ago, a patient came in who was injured in a rock-climbing accident. He only required an ankle manipulation and the problem was resolved. But what was remarkable about him was that he was a barefoot hiker, and climbed Mt. Washington in the New Hampshire White Mountains BAREFOOT! Twice!
Upon examination, the intrinsic muscles in his feet were bulging out of the inferior surface of his arch. Two things immediately occurred to me. The first was that this was the way the inferior foot was supposed to look, and second that the vast majority of patients I saw had moderate to severe muscle atrophy of their inferior feet. It was startling. Since that time, prescribing foot strengthening exercises has become a staple in my treatment process.
Howard Dananberg, DPM, Stowe, VT
08/27/2025
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
From: Neil Barney, DPM, Herbert Abbott, DPM
I had to chuckle a bit when I read the Dr. Conenello article about the great advantages of walking barefoot when so many other articles stated a significant increase in plantar fasciitis while walking barefoot or in slippers with no support at home during the pandemic, especially on this site. Which is it? Do we really know?
Neil Barney, DPM, Mashpee, MA
With all due respect to Dr. Conenello, there are several other ways in order to safely (without risk) reinforce the muscles of the feet other than walking barefoot at home. As a retired podiatrist who became extremely comfortable from treating fungal and bacterial infections caught from barefoot walking, broken toes, metatarsals, ankle sprains, foreign objects, and plantar fasciitis, his advice is archaic. The majority of our population is obese; this is not an opinion, it is fact. With this obesity comes biomechanical pathology, quite often including pronation, which adds to instability. I have not even mentioned the risks of diabetes and PVD. A good, supportive “house” shoe is the safest option for ambulating in one’s home.
Herbert Abbott, DPM, (retired), NY, NY
05/23/2025
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
From: Janet McCormick, MS
Saylee Tulpule, DPM is correct. Getting pedicures can “increase potential risks of bacterial, fungal, and viral infections.” However, further qualification of that statement should be made. Blanketing judgment of all nail salons and technicians through a statement such as this one is not only unfair, but also inaccurate. Safety-trained nail technicians do not cause transfer of infections of any kind.
True, the licensing education of nail technicians is inadequate and constantly being reduced by uninformed state legislators, but nail technicians who target a higher level safety in the practice of their craft are out there for patients to experience safe aesthetic services, such as pedicures. These technicians are safety certified as medical nail technicians through advanced education and can be sought out by...
Editor's note: Janet McCormick's extended-length letter can be read here.
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 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
10/19/2024
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.
10/17/2024
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
|
| |
|
|
|
