Think about this

[billclinton]

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The lower limb is the only part of the body most dental students do not study (although there are some lower limb questions on our board examination... ). I actually would like to know, how many bones are there in the foot?

I believe that most curriculums teach 26... but if you want to get picky and count the sesamoid bones at the base of the big toe then there are 28.

 

[WildcatDMD]

distal phalanges 5
intermediate phalanges 4
proximal phalanges 5
metatarsals 5
tarsal bones (3 cuneiforms, navicular, cuboid, talus, calcaneus) 7

For a grand total of 26 bones per foot (bilaterally that ends up being 1/4 of the bones in the whole body) 😀

Ahh, thank you very much. 👍 Good trivia knowledge for a dentist (not so trivial for a podiatrist).

 

[krabmas]

To the poster above who asked questions about the foot and gait: those are questions that are taught in any intro anatomy class. Knowing the answers to those does not make you podiatrist, much less a physician. I am really sure a patient will come into your office and the only way you will be able to cure him is if you know how many bones he has in is foot. 🙄

If they are taught in any intro to anatomy class why did you not answer then?

And by the gait cycle do they teach exactly what each bone in the foot is doing at each point in the gait cycle, and with different pathologic gaits.

If you say yes - then maybe you are in a podiatry school and you do not know it 😱

 

[billclinton]

Wow if they taught you the gait cycle, that is one tough intro to anatomy.

yes i know for a fact that we learned gait cycle in the intro course in undergrad and again (but more involved) in med school. also, i know of at least on other intro class that still goes over gait cycle for a fact, but from what i saw of his notes, not as in depth as med school or what would be covered in ortho training.

 

[WildcatDMD]

I believe that most curriculums teach 26... but if you want to get picky and count the sesamoid bones at the base of the big toe then there are 28.

Ahh, you MD's always tryin' to one-up everyone. Haha. Nice.

 

[Dr_Feelgood]

so at DMU - you do not include the FHB sesamoids?

If you want to include sesamoids, than you can have more than just the FHB. I didn't include sesamoids b/c they all are transient. The tibial and fibular sesamoids in the FHB are the most common, but the os peroneum is pretty common also. You could also have the distal and intermediate phalanges fused in the 5th digit. 😀

Quit splittin’ hairs krabmas!

Here are some more foot facts:
-Each foot has 107 ligaments

-People take between 8,000 and 10,000 steps a day or 115,000 miles in a lifetime 😱

 

[billclinton]

Ahh, you MD's always tryin' to one-up everyone. Haha. Nice.

haha. yeah, it looks like i was about ~1 min late.

anyways, if i recall correctly, we had 1-2 lectures specifically on gait, but most of the lower limb was self study. Basically, at the end of our anatomy course they assigned us the chapters from gray's anatomy on lower limb and said we had know every bit of it, while they finished up the pelvis. So it was all crammed in there, but we were tested on everything. Probably not as much emphasis as what would be need for a podiatrist, I admit.

 

[Dr_Feelgood]

Ahh, you MD's always tryin' to one-up everyone. Haha. Nice.

Just like a women she has to have the last word

 

[Dr_Feelgood]

haha. yeah, it looks like i was about ~1 min late.

anyways, if i recall correctly, we had 1-2 lectures specifically on gait, but most of the lower limb was self study. Basically, at the end of our anatomy course they assigned us the chapters from gray's anatomy on lower limb and said we had know every bit of it, while they finished up the pelvis. So it was all crammed in there, but we were tested on everything. Probably not as much emphasis as what would be need for a podiatrist, I admit.

Are you talking about undergrad or med school?

 

[krabmas]

If you want to include sesamoids, than you can have more than just the FHB. I didn't include sesamoids b/c they all are transient. The tibial and fibular sesamoids in the FHB are the most common, but the os peroneum is pretty common also. You could also have the distal and intermediate phalanges fused in the 5th digit. 😀

we just include the sesamoids in the FHB because it is very rare to see someone with out them (besides surgical removal) The others although common are not as common as FHB's. (my 2 cents) not trying to split hairs.

Quit splittin’ hairs krabmas!

Here are some more foot facts:
-Each foot has 107 ligaments

-People take between 8,000 and 10,000 steps a day or 115,000 miles in a lifetime 😱

did you get that from a snapple bottle?

 

[Dr_Feelgood]

we just include the sesamoids in the FHB because it is very rare to see someone with out them (besides surgical removal) The others although common are not as common as FHB's. (my 2 cents) not trying to split hairs.

did you get that from a snapple bottle?

Okay I'll give you the FHB sesamoids so we can say 28 bones.

I go that info from AACPM presentation. I keep it in the back of the mind b/c it blows peoples mind. It is an easy way to let people know how complex the foot is compared to the other musculoskeletal parts of the body. Only the hand gets close to the foot but it doesn't have as many anatomical variations and it doesn't have to weight bear. Another fact but it isn't as interesting is that the lower limb can carry about 3-4 times the weight of the human body. Not bad but it makes it I guess it gives American's an excuse to get fatter. 😡

 

[krabmas]

Okay I'll give you the FHB sesamoids so we can say 28 bones.

I go that info from AACPM presentation. I keep it in the back of the mind b/c it blows peoples mind. It is an easy way to let people know how complex the foot is compared to the other musculoskeletal parts of the body. Only the hand gets close to the foot but it doesn't have as many anatomical variations and it doesn't have to weight bear. Another fact but it isn't as interesting is that the lower limb can carry about 3-4 times the weight of the human body. Not bad but it makes it I guess it gives American's an excuse to get fatter. 😡

it's not as good as an ant 😛

 

[billclinton]

Are you talking about undergrad or med school?

that post referred to the med school anatomy.

anyways, i don't deny the importance of feet. But I remember someone making the comment they would rather lose an arm or hand. For me, I would rather lose a foot/leg than my dominant hand. If it were my left hand/arm vs a leg, that would be a tough one. I think I would still say leg/foot though. It seems easier to use a prosthetic leg than a prosthetic hand. I know I would definately rather lose both legs than both hands. But anyways... both woud be horrible and I would wish it on no one.

Plus... how would I keep up with you guys if I only had one hand.

 

[WildcatDMD]

Okay I'll give you the FHB sesamoids so we can say 28 bones.

I go that info from AACPM presentation. I keep it in the back of the mind b/c it blows peoples mind. It is an easy way to let people know how complex the foot is compared to the other musculoskeletal parts of the body. Only the hand gets close to the foot but it doesn't have as many anatomical variations and it doesn't have to weight bear. Another fact but it isn't as interesting is that the lower limb can carry about 3-4 times the weight of the human body. Not bad but it makes it I guess it gives American's an excuse to get fatter. 😡

Sorry, the teeth are far more interesting and complicated. 🙂 There are 32 teeth in the adult dentition and 20 in the primary dentition all with very different crown and root anatomy. And that's not even getting into the attachment apparatus, periodontium, and facial bones/facial musculature/muscles of mastication/cranial nerves.. and I won't even start with occlusion. 👍

Just kidding, I felt like I was an MD student trying to prove how much smarter I was that a DPM. 😉

 

[billclinton]

check this out...
http://forums.studentdoctor.net/showthread.php?t=262271&page=5

timtye is pretty much saying pods are not physicians. you better go attack him. the main focus of this post is ripping on chiros though.

 

[capo]

One more thing Bill I think they are adding the podiatry area to the medical school area. I only asked the guy to move the pre-podiatry forum but this was his reponse.

"You bet -- actually, I'm doing a re-structuring of the mainpage to fully incorporate podiatry. It should be ready later this week. "

I don't know if this means the all of the pod forums are moving but that's the way it sounds. Sorry bud. Oh and your mama.

PS I'd be happy to forward the private message.

Any more word on this? I think it'll improve everyone's perception once this happens. bill since I know you're out there, will you also "waste" your time there insulting pods -- as of course only YOU can do? 🙄

 

[billclinton]

Any more word on this? I think it'll improve everyone's perception once this happens. bill since I know you're out there, will you also "waste" your time there insulting pods -- as of course only YOU can do? 🙄

they agree with me, no need to say anything. i really do not see it as an insult. i don't see it as knocking the profession or your training (although i agree with pruritis ani and the others who have commented on the training).... but, i do not see it as a knock on your profession.

 

[JustMyLuck]

physician-wanabees --> physbees 😉

(this is one of bill's babblings on the med student forum http://forums.studentdoctor.net/showthread.php?t=262271&page=6&pp=25

 

[capo]

There's no sense giving him an audience. All he seeems to want here is attention. He feeds off this fact that people get annoyed by his posts. Just ignore him.

 

[Dr_Feelgood]

that post referred to the med school anatomy.

anyways, i don't deny the importance of feet. But I remember someone making the comment they would rather lose an arm or hand. For me, I would rather lose a foot/leg than my dominant hand. If it were my left hand/arm vs a leg, that would be a tough one. I think I would still say leg/foot though. It seems easier to use a prosthetic leg than a prosthetic hand. I know I would definately rather lose both legs than both hands. But anyways... both woud be horrible and I would wish it on no one.

Plus... how would I keep up with you guys if I only had one hand.

You might change your mind when you look some of the amputation stats. Depending on the study, the 3 year survival rate is about 41.5% (some say 20s all the way up to the 70s) after one amputation. The risk of losing the other leg goes through the roof also. The reason is all of that gait cycle you learned is "efficient" use of energy. When you cut off a leg it costs a heck of a lot more energy. Heck if you just remove a patient’s patella, it will cost about 30% more energy to walk.

Yes losing a hand would be bad but it won't kill you. 😀

 

[psionic_blast]

What a bunch of idiots. I can tell you that in my practice I will be very, very hesitant to refer any patients to a DPM. You guys appear to be a bunch of tools that wish you went to medical school!

FYI...attending 2 years with MD/DO students does not make your school medical school! You do NOT take every class with them in the first 2 years, and you certainly do not take very many classes with them in the last 2 years.

Because your title or school has the word medicine or medical in it does not make you a physician. Using this logic vets and chiros are physicians.

Also, take a look at the real world. In any community where there is any orthopod in practice that will work on the foot and ankle, he/she will get all of that business! I am starting to see why...you guys appear to be a bunch of MD wannabes that cannot deal with the limited scope of your degree and practice. And please don't give me that BS about "we can take care of the whole body, we learn about the whole body". Please. Until you do a MD/DO internship and residency you have NO BUSINESS treating anything outside of the foot and ankle. All MD's are trained and licesensed to practice unlimited medicine and surgery. Period.

Man, I can see why I have never seen a referal to a DPM for anything outside of a bunion or a diabetic. I swear I will send my patients 100 miles to an orthopod to avoid the DPM delusions of grandeur.

At DMU there are no real classes after the 2nd year for d.o.s so what classes are you talking about. Externship? That is learn on the job training not very much of a class, everyone passes pratically unless the stupid, so that must be some amazing training, Do you think you're going to even get to do much. you probably be likely if you can ask your questions to a 1st year resident. 😀
They are pass fail classes c'mon

 

[IlizaRob]

Bill, I am just curious to know your thoughts on ProzackMI's comments about DPMs being physicians. He is probably one of the most critical posters on SDN yet he seems to think pods are physicians. You might want to ask him why. Hes also a lawyer so he should be able to give you a good fight. Since you are here mostly for kicks anyway. Oh wait, Prozack must be a pod in disguise, thats the only explanation right?

http://forums.studentdoctor.net/showthread.php?t=253339&page=3 (page 3)

 

[box29]

At DMU there are no real classes after the 2nd year for d.o.s so what classes are you talking about. Externship? That is learn on the job training not very much of a class, everyone passes pratically unless the stupid, so that must be some amazing training, Do you think you're going to even get to do much. you probably be likely if you can ask your questions to a 1st year resident. 😀
They are pass fail classes c'mon

Actually, there is quite of bit of teaching done which I am sure happens on your rotations...don't forget the morning or noon lectures and case presentations...

After all is said and done, med students are required take NBME shelf exams after most of those rotations. This is also used to determine your grade on rotations. By the way, there are still schools like mine that give A, B, and C or F as grades for rotations...it's still basically the equivalent of H, HP, P, or F. Some schools require a 90% on the shelf in order to honor the rotation in spite of a glowing evaluation from the attending.

Just an FYI

 

[jonwill]

Actually, there is quite of bit of teaching done which I am sure happens on your rotations...don't forget the morning or noon lectures and case presentations...

After all is said and done, med students are required take NBME shelf exams after most of those rotations. This is also used to determine your grade on rotations. By the way, there are still schools like mine that give A, B, and C or F as grades for rotations...it's still basically the equivalent of H, HP, P, or F. Some schools require a 90% on the shelf in order to honor the rotation in spite of a glowing evaluation from the attending.

Just an FYI

I've got some good friends in their 3rd year of DO school and I'm told that those NBME shelf exams can be pretty rough.

 

[krabmas]

I've got some good friends in their 3rd year of DO school and I'm told that those NBME shelf exams can be pretty rough.

traitor 🙁

 

[Dr_Feelgood]

I've got some good friends in their 3rd year of DO school and I'm told that those NBME shelf exams can be pretty rough.

I've heard the same thing, sorry krabmas.

 

[jsh]

I don't understand what the big fuss is all about.

 

[Dr_Feelgood]

I don't understand what the big fuss is all about. A while ago, it was easy to get into Med school...like my older brothers got into med school with 2.8-3.0 gpa. Why? because back then there was a high demand for docs. But then more people thought, hey, i want to be a doc too...so more kids applied...raising the standards etc.etc. Podiatrists will be in high demand soon...i.e. baby boomers....so in a few years...kids will be like....hey, I want to be a podiatrist....then...know what will happen liberal?.....podiatry school will raise their standards.....and fyi....people do get rejected from pod schools b/c they didn't meet today's standards so it's not as easy as you think.

I already see this happening. If you check out the stats on www.aacpm.org you'll see that the number of applicants, GPAs and MCAT scores are going up.

 

[cg2a93]

Capo, read my posts....I never for one minute intimated that MD's trained in one field practice in another. I clearly stated that LEGALLY we can. We don't. However, as one of your esteemed coleagues in podiatry was claiming that DPM's and MD/DO's had the same licensing privileges, I was impelled to point out how truly wrong he was. Additionally, this is pretty clear evidence that the training in these fields is truly NOT equal, as your fellow foot students would have others believe. If they were equivilent, you would get a medical license. You do not. You get a podiatry license.

What is funny is that you are the third podiatry student that has failed to grasp this message, which I made very, very clear. Again, doctors DO NOT practice outside of the specialty we pursue. But, legally we can. DPM's cannot legally go beyond the foot and ankle. Understand it yet? I hope so...otherwise it is pretty clear just how low DPM admission standards must have gone.

FYI...referalls. I have worked in primary care for 10 years before med school. In FP, for the most part. We NEVER sent a complex bone or joint problem to a DPM. Only to ortho. DPM's got the warts, bunions and diabetic foot care. Oh yeah, they got the fungi and the nail trims too. That is it.

Another key concept to getting referals...the three A's. Availability, ATTITUDE and Ability. In that order. It appears to me that A #2 is going to block a lot of referrals to you guys before you even get a chance to prove your ability. There are a lot of very capable docs in all specialties that cannot fill the book due to an inability to get along with the refering doctors. Don't be one of them.

When you guys get into the real world you will look back and see how silly this argument is.
You will find that Medicine is a business and fretting about what degree is behind someones name will be the least of your problems ie malpractice, reimbursements, employees ect..
Whether someone thinks your are a "physician " or doctor or whatever doesn't matter the least bit.
For you young so to be pods, be good at your craft and you wont have to worry about some MD, DO,DC,DDS,xyz sending you referrals, they will come by word of mouth. Your biggest referral base will be from your past patients, not the MD or DO or whatever is next door or down the street. Work hard, get as much education as you can and you will be fine.
Good luck to you all
Charlton Woodly DPM

 

[lillytwig]

Originally Posted by pruritis_ani
Capo, read my posts....I never for one minute intimated that MD's trained in one field practice in another. I clearly stated that LEGALLY we can. We don't. However, as one of your esteemed coleagues in podiatry was claiming that DPM's and MD/DO's had the same licensing privileges, I was impelled to point out how truly wrong he was. Additionally, this is pretty clear evidence that the training in these fields is truly NOT equal, as your fellow foot students would have others believe. If they were equivilent, you would get a medical license. You do not. You get a podiatry license.

What is funny is that you are the third podiatry student that has failed to grasp this message, which I made very, very clear. Again, doctors DO NOT practice outside of the specialty we pursue. But, legally we can. DPM's cannot legally go beyond the foot and ankle. Understand it yet? I hope so...otherwise it is pretty clear just how low DPM admission standards must have gone.

FYI...referalls. I have worked in primary care for 10 years before med school. In FP, for the most part. We NEVER sent a complex bone or joint problem to a DPM. Only to ortho. DPM's got the warts, bunions and diabetic foot care. Oh yeah, they got the fungi and the nail trims too. That is it.

Another key concept to getting referals...the three A's. Availability, ATTITUDE and Ability. In that order. It appears to me that A #2 is going to block a lot of referrals to you guys before you even get a chance to prove your ability. There are a lot of very capable docs in all specialties that cannot fill the book due to an inability to get along with the refering doctors. Don't be one of them.]

Doesn't the name say it all??
Pruritis Ani-a chronic itching of the skin around the anus. The skin of the perirectal area is exposed to irritating digestive products in the stool; this may lead to an itchy rash, especially when stools are frequent. Often the rash is worsened by vigorous use of toilet tissue or scrubbing with soap and water. (http://www.skinsite.com/info_pruritus_ani.htm)

i must say i experience a sensation similar to this nearly everytime i read a post from our contemporary, Ani. has anyone else experienced this after exposure to the shi* Ani posts on here? I mean talk about attitude!! 😀 (Another key concept to getting referals...the three A's. Availability, ATTITUDE and Ability. )

 

[JohnfootDr]

I'm going to throw in again here.

I did my first year of residency in Chicago. I was in with Interns (MD primarily).
I treated Asthma, Chest Pain, Abdominal Pain, Lacerations (all over the body), I & D's of multiple abscesses, infections, etc in the ER. Same as all the other interns. In Ortho Sx (2 1/2 months out of my year there), I did the same as the ortho 2nd year residents--basically assisted the Senior Ortho Residents in Sx, rounds, etc. Same expectations as the new Ortho residents.

I've rotated in Behavioral Medicine, Orthopedics, Pathology, Radiology, Nuclear Medicine, Internal Medicine (x2), ER (x 3 months), along with Podiatry. Each group expected the same from me as they did from the Interns or Residents (MD or DO) rotating on their services. I've assisted ER docs (1 1/2 times--the first, the OB/GYN finally showed up to catch the placenta) deliver babies. I even got to spend a day on a StatMedEvac helicopter.

Do I consider myself trained to do general medicine? NO. Do I give systemic Medications? Yes--Antibiotics, Diuretics, etc. etc. have a systemic effect. Do I tell patients to STOP taking medications that their PCP prescribed--YES!!.

My Degree (as posted before) considers me a Podiatric Physician.

Most States license (under State Laws) us as Podiatric PHYSICIANS.

The APMA (American Podiatric Medical Association) is lobbying for universal language in state laws (some states allow different things--some don't allow amputations, some don't allow ankle work, etc.). The proposed language is:

(1) The practice of podiatric medicine and surgery consists of the medical and surgical treatment of ailments of the human foot, ankle, and other structures of the leg governing the functions of the foot. Podiatrist physicians may treat conditions of the foot and ankle by any system or method necessary.

The State of Colorado (just on a quick Google search--first one that came up) calls us Podiatric Physicians for licensing purposes.

I have personally operated on many members of the hospital staff, and family members of both Residents and Attending Physicians at the hospital. That is INCLUDING ortho surgeons family members--for BONE work (midfoot fusion, if I recall properly). We have an excellent referal base (my podiatric attendings in practice together). We have DO residents spend a month with us as a required surgical (they can do us or Ortho) rotation. The ER staff at the hospital refers ALL lower extremity trauma to us (regardless of which Ortho is on call).


As Anal Itch has pointed out, DO or MD is assumed to be able to have a general scope of practice based on their degree and licensure in the states. I ask, does that mean that a physician that LOSES their state license is no longer a physician? If you are licensed in New York, and you go into New Jersey, are you still a physician (remember, you are basing your arguement on state licensing)? I was also under the impression that most states REQUIRE 1 year of post graduate training to become licensed as a PHYSICIAN in the state? Does that mean that the MD or DO degree does NOT make you a physician, but your post graduate training does? What about foreign doctors? Our personal family doctor for years was a general surgeon in Poland--very, very brilliant man. For him to work over here, he had to REPEAT an internship (after being in practice for 10 years, and being a medical instructor in Poland) just to get a state license.

 

[JohnfootDr]

Have to agree with Dr. Woodly above,

For you young so to be pods, be good at your craft and you wont have to worry about some MD, DO,DC,DDS,xyz sending you referrals, they will come by word of mouth. Your biggest referral base will be from your past patients, not the MD or DO or whatever is next door or down the street. Work hard, get as much education as you can and you will be fine.

Having an excellent reputation in the community, and treating all your patients with respect, and doing the best you can to get them better, will go farther than anything else to build respect among your peers (MD, DO, Etc.) in the community.

John

 

[doclm]

Have to agree with Dr. Woodly above,




Having an excellent reputation in the community, and treating all your patients with respect, and doing the best you can to get them better, will go farther than anything else to build respect among your peers (MD, DO, Etc.) in the community.

John

well said 👍 👍

 

[pruritis_ani]

You might change your mind when you look some of the amputation stats. Depending on the study, the 3 year survival rate is about 41.5% (some say 20s all the way up to the 70s) after one amputation. The risk of losing the other leg goes through the roof also. The reason is all of that gait cycle you learned is "efficient" use of energy. When you cut off a leg it costs a heck of a lot more energy. Heck if you just remove a patient’s patella, it will cost about 30% more energy to walk.

Yes losing a hand would be bad but it won't kill you. 😀

I am curious about these stats. Can you send me a link?

It appears to me that you are saying the loss of effeciency in walking is leading to early death...that doesn't sound very reasonable to me. My thoughts are that most LE amputations would be secondary to systemic disease (ie DM), and that they systemic issues would be a pretty large contributor to mortality.

Anyhow, it would be more informative to compare apples to apples. Most hand amputations are traumatic, and I think that survival is pretty good after they patient survives trauma. My thoughts are that LE trauma would have similar outcomes, and that LE amputations due to serious underlying illness would have much higher mortality and morbidity.

 

[pruritis_ani]

Have to agree with Dr. Woodly above,




Having an excellent reputation in the community, and treating all your patients with respect, and doing the best you can to get them better, will go farther than anything else to build respect among your peers (MD, DO, Etc.) in the community.

John

I would agree with this as well. Sound advice.

 

[pruritis_ani]

It appears that some people are mistaking my position as based on the DPM's are not physicians argument. My position is not. I personally don't classify DPM as physician. But I could care less if you do.

My arguments were based on the claims on here that I have quoted earlier, and see as misleading. I have said my piece, and stand by it. If you want to continue to argue about that crap, you are going to have to find somebody else to do it with. I am over that. But, I am still interested in learning something about what I could/should feel comfortable refering, and I am also interested to see the science and critical thinking ability of the DPM crowd.

 

[JohnfootDr]

Not specifically the link mentioned above, but a good read.

LEA patients immediately become more sedentary (at least the vast majority..there are always 'good' patients that don't let it slow them down).


Take any Diabetic, make them sit on their rear end instead of moving around, and you will get an increased mortality overall.

John

Increased Mortality in Lower Extremity Amps

 

[pruritis_ani]

Thanks for the article. I gave it a look over, and came away with this

LEA is a risk factor for mortality probably because it is a highly specific marker of damage to large and small vessels, as well as peripheral nerve damage resulting from long-standing diabetes. This hypothesis is supported by our data, which show longer duration of diabetes among individuals with an LEA, a high prevalence of peripheral arterial disease and renal dysfunction among individuals with a lower-extremity amputation, a relation of these factors with mortality in our cohort, and the persistent effect of LEA on mortality after adjustment for these factors.

LEA may also be a marker for the effect of nonbiological factors on health outcomes. Individuals with an LEA may receive less adequate health care or have poor diabetes management skills compared with those without one; both factors would increase mortality risk. The majority of participants in the SHS receive health care from the IHS, which has standards for both clinical care and diabetes education. However, standards of care for diabetes are often difficult to meet in rural areas served by the IHS, as they are in the rest of rural America. An additional point is that the site of amputation may be related to practice patterns or other professional differences in how ischemic vessels are handled.

So, it appears amputation does correlate well with mortality, which makes sense. Sit on your butt too long, you die. But, it also seems to be related to the underlying cause for amputation, not simply the fact of amputation. I would like to see the stats for traumatic amputations as well, not finding them as easy on medline.

My main point was to Dr. Feelgood, however, as I think he may want to be a bit more careful with how he presents this. I didn't quite no what to make of his statements about energy effeciency so closely tied to the mortality stats. He may not have been trying to couple the two, but when I read that my chiropodist alarms went off. It sounded a bit odd to me. I am pretty sure he didn't mean it to come off that way, but I think it is a good idea to be very wary of what you say/claim and how you link things. A lot of people would look askance at that statement, IMHO.

I have yet to see any study linking decreased effeciency of walking with increased mortality! I can clearly get behind the high mortality data, as I have been doing some medline searches as well. But, the mortality does appear to be very significantly related to the underlying reason for the amputation as well, as well as many other factors.

Another thing...some people earlier where comparing hand vs. foot amputation. Now, don't get me wrong, losing either would suck royal. But, in my view, loosing a dominant hand is absolutely disabling. Any significant hand injury really interferes with daily activities as well as work. A foot loss or serious disability would really make life uncomfortable in a lot of ways, but is it thought to be as disabling as a hand injury?

 

[JohnfootDr]

I didn't quite no what to make of his statements about energy effeciency so closely tied to the mortality stats

I'd have to look for articles...however, look at it this way.

Patient in poor health, barely a community ambulator. Can walk at most a block or two, or barely make it up a flight of stairs, however, they do move some around their house, and are relatively self sufficient.

Now you do an amputation....

Increased energy cost to ambulate (relatively simple...harder to walk on 1/2 of a foot, no leg, etc.). That patient now has insufficient energy to walk the block, take any stairs, and can now barely move around their house. They just became more sedentary. The Amp may not kill them, however, just sitting around the house might (given that they had poor health status in the first place).

Preserving the ability to ambulate will often help keep the patient alive (quality of life issues aside), just by preventing exacerbation of the comorbid (Diabetes, PVD, CAD, etc. etc.) conditions due to lack of any exercise.

 

[pruritis_ani]

I'd have to look for articles...however, look at it this way.

Patient in poor health, barely a community ambulator. Can walk at most a block or two, or barely make it up a flight of stairs, however, they do move some around their house, and are relatively self sufficient.

Now you do an amputation....

Increased energy cost to ambulate (relatively simple...harder to walk on 1/2 of a foot, no leg, etc.). That patient now has insufficient energy to walk the block, take any stairs, and can now barely move around their house. They just became more sedentary. The Amp may not kill them, however, just sitting around the house might (given that they had poor health status in the first place).

Preserving the ability to ambulate will often help keep the patient alive (quality of life issues aside), just by preventing exacerbation of the comorbid (Diabetes, PVD, CAD, etc. etc.) conditions due to lack of any exercise.

I see your point with co-morbidities. Decreased ability to ambulate equals poor outcomes.

My thoughts are that without the comorbidities, the mortality is far lower. That would fly in the face of the energy theory, as the decrease in energy effeciency should be similar in both groups. Decreased ability to ambulate leads to poor outcomes, yes. But, decreased energy effeciency by itself doesn't seem to me likely as the cause.

My point is that a blanket statement implicating the poor energy effeciency sounds odd, and may cause a knee jerk correlation with something like chiro. It sure did in me. It is just very vague, and not very scientific.

Not a big deal, just some points on the wording. Scientific types can get very worked up over this sort of thing.

 

[JohnfootDr]

My thoughts are that without the comorbidities, the mortality is far lower. That would fly in the face of the energy theory, as the decrease in energy effeciency should be similar in both groups. Decreased ability to ambulate leads to poor outcomes, yes. But, decreased energy effeciency by itself doesn't seem to me likely as the cause.

Still, the answer is yes and no.

The majority of patients with Non Traumatic amputations have them because of significant comorbidities (Diabetes/Neuropathy, PAD/PVD, etc.). If an individual like myself steps on a nail and develops a raging case of Necrotizing Fasciitis (rather fun to treat, btw), causing a lower extremity amputation. Now, I'm a marginally healthy (can walk a fair distance, up multiple flights of stairs, etc. despite carrying a few extra pounds). It causes me to use MORE energy to do the same distance/height. I may be able to compensate (hell, I could probably use the exercise...maybe I should write a weight loss book and be on Oprah), and it would affect me only a bit. In 20 to 30 years, I would be likely a bit more sedentary...leading to possible health problems.

So, there is no 1:1 correlation between increased mortality in the whole population and lower extremity amputation. However, in the majority of patients with significant risk factors (neuropathy, poor circulation), LEA does show a correlation with increased mortality.

To put it in other terms:

A. There is no definite 1:1 correlation between being a female of childbearing years and becoming pregnant.
B. The correlation does increase closer to 1:1 if you are a Sexually Active Female of Childbearing Years who doesn't use BC of some sort and becoming pregnant.

If an OB/Gyn made a blanket statement "we help prevent unwanted pregnancy by giving prescriptions for BCPs" The statement is not entirely true if held against statement A above. It is if held against statement B.

 

[neilc]

xxxxxx

 

[dawg44]

It doesn't make a hoot of difference to me whether MDs or wikipedia (haha these entries can be edited by anyone) consider podiatrists to be physicians, or whether pods actually are physicians. However there is currently a bill under consideration by congress that will include DPM in the definition of 'physician' under Medicaid. Medicaid currently does not consider podiatrists to be physicians.

Good they can have all of my medicaid. No charge.

 

[jonwill]

It doesn't make a hoot of difference to me whether MDs or wikipedia (haha these entries can be edited by anyone) consider podiatrists to be physicians, or whether pods actually are physicians. However there is currently a bill under consideration by congress that will include DPM in the definition of 'physician' under Medicaid. Medicaid currently does not consider podiatrists to be physicians.

While you are correct, most states do classify podiatrists as physicians under state medicaid laws.

 

[jonwill]

Good they can have all of my medicaid. No charge.

I thought that's what county hospitals were for!!!

 

[DrBMX]

DPM is a doctor, NOT a physician as MD/DO.
This is officially from AMA.
---------------
What is the difference between a physician and a doctor?

A physician is an MD or DO (see above). Many people also refer to physicians informally as doctors, eg., "Doctor Smith." Strictly speaking, however, anyone with a doctorate degree (eg., PhD, EdD, PharmD [pharmacist], or DDS [dentist]) is a doctor as well.

Back to top
http://www.ama-assn.org/ama/pub/category/3627.html
--------------
Hope that helps

 

[Dr_Feelgood]

DPM is a doctor, NOT a physician as MD/DO.
This is officially from AMA.
---------------
What is the difference between a physician and a doctor?

A physician is an MD or DO (see above). Many people also refer to physicians informally as doctors, eg., "Doctor Smith." Strictly speaking, however, anyone with a doctorate degree (eg., PhD, EdD, PharmD [pharmacist], or DDS [dentist]) is a doctor as well.

Back to top
http://www.ama-assn.org/ama/pub/category/3627.html
--------------
Hope that helps

Well, I'm glad that the AMA has stated that. That is like the Puff Daddy saying only Bad Boy records is rap. That everything b/c it is not run by P. Diddy is just hip-hop.

Maybe I can get the APMA to release a statement about how only podiatrists are real doctors.