Real Issues

[whynotfeet?]

A. Number one complaint of our pt's (heel pain), has no definitive treatment.

B. We prescribe a topical for onychomycosis that has an efficacy of 7%

C. We do ORIF's on 5th metatarsal Fx's

D. After all the mumbo jumbo Biomechanics and angles, most of us still perform Austin/Akin procedures.

E. .........

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[doclm]

A. Number one complaint of our pt's (heel pain), has no definitive treatment.

B. We prescribe a topical for onychomycosis that has an efficacy of 7%

C. We do ORIF's on 5th metatarsal Fx's

D. After all the mumbo jumbo Biomechanics and angles, most of us still perform Austin/Akin procedures.

E. .........

Most people can be treated for (plantar fasciitis) heel pain.
-custom orthosis, stretches, cortisone, Extracorporal Shock Wave Therapy, Topaz, more invasive surgery, ect, ect.... It works for most people, unless they have pain due to a tendonitis, entrapment of a nerve or a lumbar radiculopathy.

The topical treatments (like Penlac) for onychomycosis is tough, considering its hard to penetrate and it takes so long to see results. However, oral Lamisil or Gris-Peg has a much better success rate if the patients liver can handle the treatment.

However, I do believe that there are people out in the field that are not using the best modalities to treat patients for their conditions. Either, its always been done a certain way so Podiatrists stick with it or there is not enough research done on the problem to invent better modalities.

 

[whynotfeet?]

Let me first announce I am not here to bash Podiatry or any potential commentators. Your responses are what you are taught but not proven. There is no physical proof of plantar fasciitis(by definition, inflammation of the plantar fascia). CMO's are a joke(show me one study against OTC orthotics that states CMO's are better). ECSW is a joke(don't even need to justify). Injection therapy? What modality? Lido? Marcaine? Depo? Kenolog? Dex? How much? The only accepted research was by the NEJM which showed that >85% of people with PF recovered without/despite treatment.

 

[biocmp]

A bump for residents and attendings. I would also like to hear how some of these issues are approached.

 

[jonwill]

A. Number one complaint of our pt's (heel pain), has no definitive treatment.

B. We prescribe a topical for onychomycosis that has an efficacy of 7%

C. We do ORIF's on 5th metatarsal Fx's

D. After all the mumbo jumbo Biomechanics and angles, most of us still perform Austin/Akin procedures.

E. .........

You make some good points but I'm confused by some of your comments. Anyone who still prescribes penlac is mad! The austin/akin has to do with training. It is simply the only procedure they feel comfortable doing but you're right, a good pod would realize their limitations and send them to someone who could give them what they needed. One of my attending ONLY does Reverdin Lairds!

Heel pain has been argued since I can remember. I've always thought that the whole "plantar fascitis vs fasciosis" argument was a bit lame myself. Yea, it may have no definitive treatment but neither do a lot of things in medicine. The fact of the matter is that things like injections, orthotics, night splints, PT all EXPEDITE healing. Their are many self-limiting entities in medicine that are still treated. And why wouldn't you do an ORIF of a 5th met if it is indicated?

 

[Feli]

A. Number one complaint of our pt's (heel pain), has no definitive treatment.

B. We prescribe a topical for onychomycosis that has an efficacy of 7%

C. We do ORIF's on 5th metatarsal Fx's

D. After all the mumbo jumbo Biomechanics and angles, most of us still perform Austin/Akin procedures.

E. .........

None of those are true IMO.^

I have to read for a big OR day tomorrow and don't have time to reply at length, but there are big holes in all of those statements. You can answer your own questions and you will see the flaws...

A) Does most heel pain respond to conservative tx? In recalcitrant cases, what are success rates of EPF, InStep, or Topaz... +/-TAL/gastroc?
B) Where does the tinea have to colonize/infect before it gets into nails? What is the success rate of topicals for that initial area?
C) Do you really believe that ORIF the standard of care for nondisplaced or adequately reduced 5th met fx?
D) Way too general of a statement... too many factors (both pt and doc)

...When you think about it, does the top complaint in all of medicine (cold/flu) have a highly successful or definitive cure/treatment? Does diabetes? Do stress or depression have a 100% surefire fix? What about a sore low back? Heartburn or migrane? If not, then every doc out there is a quack by your standards, huh?

 

[whynotfeet?]

Calm down fledgling. I never used the term Quack. Good points- keep it up. Remember I am pro podiatry. Now, since you brought it up; why are we so concerned with toes? We don't need them, Ducks don't have toes and they walk just fine!

 

[biocmp]

why are we so concerned with toes? We don't need them, Ducks don't have toes and they walk just fine!

Haha, I hope you are not serious. I have seen some incredible questions, but this one ranks up there with the best of them. Assuming you want an answer:

I'm going to assume it has to do with our biomechanical differences. We are heel to toe walkers, something only we and chimps share (and maybe other new world monkeys). This presents a host of new adaptations required to be as good as possible.

Anything we were born with, we should be concerned with. Evolution has deemed these parts important for our survival, so salvaging them should be of ut-most importance.

That is as good as I can do. I'm sure some of the residents or current students could elaborate on the biomechanical effects the toes have on stability and balance.