Diabetic News in Podiatric Medicine

The current issue of the Journal of the American Podiatric Medical Association, (March/April 2011, volume 101, number 2), contains several articles on current podiatric practices regarding diabetic foot care. It goes without saying that regular podiatric care can reduce disease-related foot problems such as diabetic ulcers. One article in this edition showed how costs associated with diabetic foot ulcers can be dramatically reduced if one is treated by a lower-extremity medical care specialist such as podiatrist. Today now more than ever, anything which helps lower the cost of medical care is a goal shared by very one, no matter their financial interest of political persuasion. This study shows in “hard numbers” how this can be achieved in diabetic foot care.

The same Journal featured a study which found that non-ambulatory patients in nursing homes, who frequently suffer from chronic non-healing pressure ulcers of the heel, can benefit greatly in terms of limb (leg) salvage if an aggressive surgical plan is considered involving partial or total excision (removal) of all or part of the heel bone (calcaneus). The value of a leg, even to the non-walking nursing home patient, is incalculable so consideration of the removal of bone from the foot to preserve the leg seems a viable alternative, if not the best way to approach infection and limb loss associated with pressure ulcers for this population.

An interesting article in The Journal of Foot and Ankle Surgery, (March/April 2011, volume 50, number 2), shows that surgical techniques for correction of bunions (hallux valgus or hallux abductovalgus) are always improving. Here a popular technique called “crescentic” (or crescentic shelf) bunionectomy is studied comparing the long-arm versus the short-arm style of this first metatarsal osteotomy. The crescentic osteotomy was developed to address (minimize) first metatarsal shortening. It also gives the podiatric surgery options for in multi-planar correction. This study showed the some benefits of the short-arm version. The data from this studied seems to suggest that the short-arm might be the better choice for earlier weight bearing. Although your podiatrist will not likely discuss with you these two versions of this type of bunion correction, you should be informed if you have the type of deformity which can be corrected with the crescentic technique particularly in view of the fact that it minimizes shortening. But your podiatrist should know that this study shows it can make a difference which version is selected.

Nothing substitutes for your podiatrist being aware of current thinking and recent scientific studies on the topic of surgical correction of a bunion deformity. Some operate the same way, over and over again, as they were taught in school fostering the saying “if it works, why change it.” But nothing is a substitute for your podiatrist subscribing to accepted podiatric publications and incorporating new and current techniques into her surgical planning.

About the Author
Of all the different areas in medical malpractice, it is podiatry malpractice that has had a particular interest to me. With 42 years practicing law and representing hundreds of victims of malpractice, I have created a law practice in which my clients are comfortable knowing that their case is being handled with my personal attention, in the most professional manner, and without unreasonable delays.