Relevancy of PM News

[Adam Smasher]

Honestly though.... do any of them actually stretch? Or get better if they do?
Personally I think Sketchers shoes are more of a cause of P fasciitis than equinus.
90% of my p fasciitis patients wear sketchers.

Do they have plantar fasciitis because of their skechers? Or do they buy skechers because they figure it's good for their plantar fasciitis?

Did you know there's no t in skechers? This is thought to be an example of the Mandela effect.

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[Adam Smasher]

Ive had topaz work wonders. Gastroc release not so much.

I've had the opposite result, topaz was hit and miss for me, gastroc recession is my silver bullet. We may occupy alternate realities where my patients wear skechers and yours wear sketchers.

 

[heybrother]

Ive had topaz work wonders. Gastroc release not so much.

My residency did isolated gastrocnemius recession. I start pulling all the charts to look back through our results and my initial impression was not favorable. I initially felt gastrocnemius recession was "complication free" but having done enough of them - it isn't. The rehab on medial instep plantar fascial release is substantially easier with faster return to a shoe Also, surgery doesn't fix fibromyalgia. At least at the level of the gastrocnemius aponeurosis or the plantar fascia.

 

[DYK343]

My residency did isolated gastrocnemius recession. I start pulling all the charts to look back through our results and my initial impression was not favorable. I initially felt gastrocnemius recession was "complication free" but having done enough of them - it isn't. The rehab on medial instep plantar fascial release is substantially easier with faster return to a shoe Also, surgery doesn't fix fibromyalgia. At least at the level of the gastrocnemius aponeurosis or the plantar fascia.

Sural neuritis post lengthening?
Ive seen a lot of it.

Edit. Long day. Youre talking about p fascial release. I was referring to gastroc release.

 

[heybrother]

Sural neuritis post lengthening?
Ive seen a lot of it.

Edit. Long day. Youre talking about p fascial release. I was referring to gastroc release.

I'm throwing you off because I'm talking about both. I left a "gastrocnemius recession" only program and started predominantly doing medial plantar fascial instep because the return to work is so much faster. I will do both if I think they need it, but I've lost some of my gastrocnemius recession excitement for exactly what you described - sural complications, people taking their boot off and falling in a hole etc.

The real problem with surgically treating plantar fasciitis is - why is this person the 1% who needs surgery when almost everyone else gets better. Why is it that anecdotally a patient who tells you they will need surgery at their first visit may be more likely to need surgery. Can't prove that, but I had 3 people in a short period of time who went down that path.

 

[DYK343]

I'm throwing you off because I'm talking about both. I left a "gastrocnemius recession" only program and started predominantly doing medial plantar fascial instep because the return to work is so much faster. I will do both if I think they need it, but I've lost some of my gastrocnemius recession excitement for exactly what you described - sural complications, people taking their boot off and falling in a hole etc.

The real problem with surgically treating plantar fasciitis is - why is this person the 1% who needs surgery when almost everyone else gets better. Why is it that anecdotally a patient who tells you they will need surgery at their first visit may be more likely to need surgery. Can't prove that, but I had 3 people in a short period of time who went down that path.

I havent done a plantar fasciotomy in along time. Years. Do you see long term problems? Or CRPS?

Like I said above Ive done topaz and I am 5/5 with it. Low n but its been super successful for those few patients that just dont get better w conservative care/cortisone injections.

 

[heybrother]

I havent done a plantar fasciotomy in along time. Years. Do you see long term problems? Or CRPS?

Like I said above Ive dont topaz and I am 5/5 with it. Low n but its been super successful for those few patients that just dont get better.

A skeptical person will point out I"ve only been practicing for like 3.5 years.

-I make a small plantar incision. It can be closed by like 4-5 simple interrupted sutures. It takes under 5 minutes to perform in the OR not including closure.
-I allow immediate same day weight-bearing in a post-op shoe and return them to a tennis shoe at like day 11.

I've seen it work (most common). I've seen it fail (fibromyalgia is the number one no improvement patient). I've seen it generate some new moving around mechanical pains. No CRPS yet. My suspicion is the very limited trauma and immediate return to walking is in my favor in that regards.

I do not like doing it. I do everything I can to beat plantar fasciitis with injections and therapy. To the best of mya bility I enforce a 2 months of PT rule. My partner routinely sends me patients for surgery who have gotten a shot a year for 3 years and say its a chronic problem they want surgery for with no PT. That makes my skin crawl.

 

[PlainsPod]

I have been in practice for 15 years and my silver bullet for plantar fasciitis is a good old 2-3 stitch in step plantar fasciotomy. I’m in PP, treat heel pain all day every day and maybe do 2-3 release per year.

 

[PeaJay]

What are thoughts on the current poll in pm news? The physicians assistant org looking to gauge interest on a DPM to PA pathway.

I for one think this would be a great exit strategy for some…

 

[111111194]

What are thoughts on the current poll in pm news? The physicians assistant org looking to gauge interest on a DPM to PA pathway.

I for one think this would be a great exit strategy for some…

This would be amazing. Is this a real thing? I would actually go for it.

 

[icebreaker32]

This would be amazing. Is this a real thing? I would actually go for it.

DPM admissions are sadly probably so easy it might be a back door to a PA program if would happen and be guaranteed.

If there was not saturation it would be a horrible idea......but theoretically with the way things are it is interesting if nothing else.....if it ever happened you would probably have to actually apply to both programs and pay more, but maybe only add another year to the DPM degree or at least go year round.

 

[DYK343]

What are thoughts on the current poll in pm news? The physicians assistant org looking to gauge interest on a DPM to PA pathway.

I for one think this would be a great exit strategy for some…

Its kind of insulting as its a step down (nothing against PAs of course but why go 7 years to do what some do in 2)

PAs make about 113k nationwide (per their own org website MGMA posted data) so its not like its going to pay more.

Edit. Now that I think of it It would absolutely make ortho and hospital jobs easier to get though. Probably more valuable than a fellowship in that regard. Would actually make you extremely valuable to a hospital/ortho clinic.

 

[heybrother]

This is so hilarious it deserves its own thread.

 

[PatchAdamsFan]

Most DPMs wouldn't even be competitive GPA-wise to apply to PA schools. I can already picture a couple of pods in the back of the classroom with their stethoscopes on, curling their mustaches, with their ears perked up at every mention of a 'medical spa'. No doubt their questions would be amazing - "No, Dr. ___ you probably didn't hear S1/S2 heart sounds on your PT artery", "No, Dr. ___ the tongue depressor would not make a good Mortons extension".

 

[Adam Smasher]

Random thoughts:

18-24 months online? I'm assuming this is evenings and weekends because otherwise just get an actual PA degree in the usual 25-26 months it takes. Also how would you do clinical didactics online?

Also, I tried to research this on google and found this 10-year-old sdn thread featuring some familiar characters. I remember being this positive about podiatry too:

DPM vs. PA

Which career is better? I did a quick search for jobs for podiatrists on reliable websites such as indeed.com, career builder, and my local newspapers, and I yielded a net result of 0 jobs for podiatry. Is this career in demand, will I be guaranteed to find a job after I graduate? I did a search...

forums.studentdoctor.net

 

[heybrother]

Random thoughts:

18-24 months online? I'm assuming this is evenings and weekends because otherwise just get an actual PA degree in the usual 25-26 months it takes. Also how would you do clinical didactics online?

Also, I tried to research this on google and found this 10-year-old sdn thread featuring some familiar characters. I remember being this positive about podiatry too:

DPM vs. PA

Which career is better? I did a quick search for jobs for podiatrists on reliable websites such as indeed.com, career builder, and my local newspapers, and I yielded a net result of 0 jobs for podiatry. Is this career in demand, will I be guaranteed to find a job after I graduate? I did a search...

forums.studentdoctor.net

Blast from the past there

-Maxilofacial guy - talked a ton of **** on this forum, went over to the ortho forum and told them we were better than them, then flunked out of DMU year 1 and came back to this forum and told us podiatry sucks and he makes more money in IT.

-PADPM - interesting poster, but banned because he could be easily baited by schizophrenic trolls

-Anklebreaker - had all of his posts deleted but we can see him in there presumably defending podiatry based on context which is HILARIOUS because he's the ultimate f&*(podiatry guy now. Fun fact - when his posts got deleted all of his fellowship reviews got deleted also. Why would a person who hates fellowships go on a fellowship interview. The world may never know. 🙂 wink wink

Podfather - Rest in Peace.

Dyk - must have been covering his tracts deleting all of them posts!

Some other well intentioned people.

Thankfully no posts by me defending podiatry. Sigh of relief.

 

[msuDPM]

Blast from the past there

-Maxilofacial guy - talked a ton of **** on this forum, went over to the ortho forum and told them we were better than them, then flunked out of DMU year 1 and came back to this forum and told us podiatry sucks and he makes more money in IT.

-PADPM - interesting poster, but banned because he could be easily baited by schizophrenic trolls

-Anklebreaker - had all of his posts deleted but we can see him in there presumably defending podiatry based on context which is HILARIOUS because he's the ultimate f&*(podiatry guy now. Fun fact - when his posts got deleted all of his fellowship reviews got deleted also. Why would a person who hates fellowships go on a fellowship interview. The world may never know. 🙂 wink wink

Podfather - Rest in Peace.

Dyk - must have been covering his tracts deleting all of them posts!

Some other well intentioned people.

Thankfully no posts by me defending podiatry. Sigh of relief.

I thought we determined that PADPM is ExperiencedDPM, did we not?

 

[heybrother]

I thought we determined that PADPM is ExperiencedDPM, did we not?

I think that was a widely held belief but I don't know if it ever went any further than that.

 

[DYK343]

A skeptical person will point out I"ve only been practicing for like 3.5 years.

-I make a small plantar incision. It can be closed by like 4-5 simple interrupted sutures. It takes under 5 minutes to perform in the OR not including closure.
-I allow immediate same day weight-bearing in a post-op shoe and return them to a tennis shoe at like day 11.

I've seen it work (most common). I've seen it fail (fibromyalgia is the number one no improvement patient). I've seen it generate some new moving around mechanical pains. No CRPS yet. My suspicion is the very limited trauma and immediate return to walking is in my favor in that regards.

I do not like doing it. I do everything I can to beat plantar fasciitis with injections and therapy. To the best of mya bility I enforce a 2 months of PT rule. My partner routinely sends me patients for surgery who have gotten a shot a year for 3 years and say its a chronic problem they want surgery for with no PT. That makes my skin crawl.

I deleted the original DYK343 account as I was being censored for most of my posts by mods. Ive been posting here under this handle since about 2010 but in 2017 I deleted the account then rejoined in 2018 (dates approximate).

I remember deleting every post I made under the original DYK account because I was pissed off.

 

[Scrantonicity]

Oh, the drama on SDN...

 

[NatCh]

What are thoughts on the current poll in pm news? The physicians assistant org looking to gauge interest on a DPM to PA pathway.

I for one think this would be a great exit strategy for some…

The reply options didn't include an "LOL no" so I went with the next best thing.

 

[Adam Smasher]

I voted yes.

DPMs who are struggling or otherwise disgruntled with their job self-select out of the profession, alleviates the saturation problem we all have.

I imagine you could parlay your DPM-PA into a position in an ortho group where you treat hallux valgus etc 1 day a week and the rest of the week you're assisting on TKAs etc. No idea how the salary/benefits situation works out in that scenario.

Or just don't touch feet again, work a GP clinic on an Indian Reservation.

Overall a lousy career trajectory, just a reflection of the buyer's remorse many of us have.

 

[DYK343]

I voted yes.

DPMs who are struggling or otherwise disgruntled with their job self-select out of the profession, alleviates the saturation problem we all have.

I imagine you could parlay your DPM-PA into a position in an ortho group where you treat hallux valgus etc 1 day a week and the rest of the week you're assisting on TKAs etc. No idea how the salary/benefits situation works out in that scenario.

Or just don't touch feet again, work a GP clinic on an Indian Reservation.

Overall a lousy career trajectory, just a reflection of the buyer's remorse many of us have.

I dont think this outlook is true. If you can function as an MD and a foot surgeon the future is bright.
If this becomes mainstream I (and my fellowship trained counterparts) become a dinosaur.

 

[DYK343]

Also DYK343 was the password I was assigned for my first univeristy email account.

It has zero reflection of anything other than I was too lazy to think of a thoughtful handle as I thought it might be a 1 month ordeal while I asked some questions.

 

[air bud]

Also DYK343 was the password I was assigned for my first univeristy email account.

It has zero reflection of anything other than I was too lazy to think of a thoughtful handle as I thought it might be a 1 month ordeal while I asked some questions.

And here we are all those years later...

 

[AttackNME]

Also DYK343 was the password I was assigned for my first univeristy email account.

It has zero reflection of anything other than I was too lazy to think of a thoughtful handle as I thought it might be a 1 month ordeal while I asked some questions.

Mine was from an online game I used to play when I was in high school lol

 

[Winograd1717]

Looking into this DPM - PA pathway I see you guys talking about I tried to look it up but found nothing... UNLESS you're talking about the recent push from PA's to allow podiatry to be a specific area for PA, such that they want us to supervise them and have Pediatric PA's... not an academic pathway to go from a doctorate degree to a masters degree... how does that make sense?

 

[heybrother]

Looking into this DPM - PA pathway I see you guys talking about I tried to look it up but found nothing... UNLESS you're talking about the recent push from PA's to allow podiatry to be a specific area for PA, such that they want us to supervise them and have Pediatric PA's... not an academic pathway to go from a doctorate degree to a masters degree... how does that make sense?

I have only seen it in PM News.

 

[Adam Smasher]

This is too memable

 

[Pronation]

View attachment 367266

This is too memable

Doctor of Pedicure Medicine

 

[Utvolsdpm]

Do you all not tell your diabetics to cut back on the epsom salt (like half the recommended dose)? I had always heard that too it dries them out too much. Didn’t think too much of the message other than it was common knowledge.

 

[Pronation]

Do you all not tell your diabetics to cut back on the epsom salt (like half the recommended dose)? I had always heard that too it dries them out too much. Didn’t think too much of the message other than it was common knowledge.

I tell them that epsom salt can help with hemorrhoids. Here’s some important info below that you can tell your patients.

Epsom salt contains magnesium and sulfate, which are absorbed into the skin around your anus and can offer relief from hemorrhoids.

Source: Can Epsom Salt Baths Give You Relief From Hemorrhoids?

 

[billBOB213]

Just spit up my Jimmy John’s sandwich for lol’ing

 

[HardRoadPaved]

I tell them that epsom salt can help with hemorrhoids. Here’s some important info below that you can tell your patients.


Source: Can Epsom Salt Baths Give You Relief From Hemorrhoids?

I only can treat hemorrhoids that hang below the tibial tuberosity, where my scope begins.

 

[PlainsPod]

View attachment 367266

This is too memable

When people ask me about stuff like this I pretend I didn’t hear them and change the subject. I never said I was the best podiatrist.

 

[AttackNME]

I only can treat hemorrhoids that hang below the tibial tuberosity, where my scope begins.

In California we can treat soft tissue up to hip, does inbetween count?

 

[DYK343]

In California we can treat soft tissue up to hip, does inbetween count?

Pretty sure in california you can do anything as long as its related to the foot/ankle.
If you wanted to harvest iliac crest for bone graft its in scope as long as its for the foot/ankle.

 

[GreenHousePub]

I like how PMNews went from "they are gonna change the DPM to MD degree any day now" decades ago to "what about getting a PA degree" instead.

 

[dtrack22]

Pretty sure in california you can do anything as long as its related to the foot/ankle.
If you wanted to harvest iliac crest for bone graft its in scope as long as its for the foot/ankle.

I’ve seen CA DPMs surgically treating distal tibia fractures on social media. Apparently you can do whatever you want over there.

 

[Utvolsdpm]

Apparently in Arkansas you can give knee injections? Weird detail from this incident that was in PM news as well

Local physician pleads ‘Not Guilty’ to Rape and Sexual Assault charges

Disclaimer: The following individuals have been arrested and accused of a crime. All information included in this story was obtained through testimony and/or police reports provided. The charge(s) they have

www.rivervalleynow.com

 

[shadesofgrey]

I know every profession has its fair share of dishonest folks, but for such a small field it sure seems like we have a lot of crooks.

 

[diabeticfootdr]

Pretty sure in california you can do anything as long as its related to the foot/ankle.
If you wanted to harvest iliac crest for bone graft its in scope as long as its for the foot/ankle.

This is true. It is a treatment based law. If you’re treating an in scope condition, it’s in scope.

I was reported to the state board in 2009 by a plastic surgeon for operating out of scope when I harvested a STSG from the thigh, something I’d done numerous times before. The ruling from the board was that a podiatrist could legally harvest skin or bone from elsewhere in the body or prescribe/supervise a systemic treatment like HBOT for in scope conditions.

Subsequent to that in 2010, I asked for an email from the state board when Cellutome was being popularized for DPMs and hospitals who were uncertain if a SBEG harvest from the thigh was in scope. Attached is that response.

 

[wakaflocka88]

I’ve seen CA DPMs surgically treating distal tibia fractures on social media. Apparently you can do whatever you want over there.

Ya it’s scary. And doesn’t even involve the plafond.

 

[DYK343]

This is true. It is a treatment based law. If you’re treating an in scope condition, it’s in scope.

I was reported to the state board in 2009 by a plastic surgeon for operating out of scope when I harvested a STSG from the thigh, something I’d done numerous times before. The ruling from the board was that a podiatrist could legally harvest skin or bone from elsewhere in the body or prescribe/supervise a systemic treatment like HBOT for in scope conditions.

Subsequent to that in 2010, I asked for an email from the state board when Cellutome was being popularized for DPMs and hospitals who were uncertain if a SBEG harvest from the thigh was in scope. Attached is that response.

View attachment 367322

I really wish states had a standard of care global to all states. The state I practice in has such odd wording its really unclear what is and is not legal. Its so grey I think I can do just about anything as long as I did it to treat the foot/ankle.

I am relatively new at my new job but I do a lot of STSGs and so far have not had any pushbacks. They work really well. I requested the privileges at the hospital and was granted them so I should be golden.

Funny another surgeon turned you in for such an easy straightforward procedure.

 

[Bored Snorlax]

I have only seen it in PM News.

View attachment 367239
View attachment 367240

Looking into this DPM - PA pathway I see you guys talking about I tried to look it up but found nothing... UNLESS you're talking about the recent push from PA's to allow podiatry to be a specific area for PA, such that they want us to supervise them and have Pediatric PA's... not an academic pathway to go from a doctorate degree to a masters degree... how does that make sense?

A podiatrist would be pursuing a degree to supervise himself? AAPA is very creative.

 

[dtrack22]

Ya it’s scary. And doesn’t even involve the plafond.

Yup these are flow blown distal tibia fractures with enough distal bone to nail that instead gets a big arse incision and plate because the podiatrist has never thrown a tibial nail from the top down.

Question for someone like @diabeticfootdr though, how is a midshaft tibia fracture within scope in CA? Is it because the fibula is also broken so somehow treating the tibia is treating the “ankle fracture?”

 

[Pronation]

Ok but what about if the patient says their pain shoots down from their hemorrhoids down to their foot. Can I go ahead and tell them about the therapeutic effects of epsom salt on the anus?

 

[wakaflocka88]

Yup these are flow blown distal tibia fractures with enough distal bone to nail that instead gets a big arse incision and plate because the podiatrist has never thrown a tibial nail from the top down.

Question for someone like @diabeticfootdr though, how is a midshaft tibia fracture within scope in CA? Is it because the fibula is also broken so somehow treating the tibia is treating the “ankle fracture?”

All of the ones I’ve seen do not involve plafond, like you said - HUGE incision, with one medial plate and TONS of screws.

Above all - they have zero clue on AO fracture technique but just throw hardware thinking that’s how it’s done.

Goes to show how bad our training is and majority of programs do “ankles” just to do it but have no idea on the foundation of AO technique and principle behind it.

 

[diabeticfootdr]

Question for someone like @diabeticfootdr though, how is a midshaft tibia fracture within scope in CA? Is it because the fibula is also broken so somehow treating the tibia is treating the “ankle fracture?”

I don’t know if that is in the scope of practice in CA. It would depend on the definition of ankle and related structures. That definition is either set by the legislature, defined by the Board, or defined by the court.

 

[deleted285117]

Ok but what about if the patient says their pain shoots down from their hemorrhoids down to their foot. Can I go ahead and tell them about the therapeutic effects of epsom salt on the anus?

Dont forget to include the Whirlpool!