Podiatry Today

Modifying Orthotics To Resist Rearfoot Eversion In Hallux Limitus

December 19, 2014

When the rearfoot everts, it forces the medial forefoot into the ground. This results in a dorsiflexion force on the first ray and jamming of the first metatarsophalangeal joint (MPJ) as the patients begins to toe-off. An article published several years ago in the Journal of the American Podiatric Medical Association gives us some good data on this relationship

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Distal Tibial Epiphysitis

December 16, 2014

From Podiatry Today: Diagnosing And Treating Distal Tibia Epiphysitis

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Are Physical Therapists Overlooking The Benefits Of Orthotics For Runners?

December 16, 2014

Last month, I attended the second annual Science of Running Research Symposium, sponsored by the California Physical Therapy Association and CAL-PT-FUND. I was the only podiatrist in attendance

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Minocycline and the Treatment of Multidrug-Resistant Acinetobacter baumannii

December 15, 2014

When most of us think about minocycline it is for the oral treatment of gram positive infection, in particular MRSA.  In fact, the drug is effective against multidrug resistant gram negative organisms, including Acinetobacter baumannii (AB). This point was driven home to me recently when I saw that my favorite ID journal Clinical Infectious Diseases just published a supplement on the topic.  Here is the link to the Table of Contents.  All of the articles are available as free full text and can be downloaded from this link: http://cid.oxfordjournals.org/content/59/suppl_6.toc#MINOCYCLINEFORTHETREATMENTOFMULTIDRUG-RESISTANTACINETOBACTERBAUMANNII This supplement was sponsored by The Medicines Company www.themedicinescompany.com who are now marketing an IV formulation of minocycline for this purpose so take that into account while reading the papers. That being said, both of the Guest Editors, Debra Goff, PharmD and Keith Kaye MD, MPH are top quality, fair balanced researchers and authors

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Is Swedish Snuff Tobacco A Viable Alternative For Smokers Prior To Surgery?

December 15, 2014

Big Tobacco will have to change to survive.

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The Press Reporting of ID and Antibiotics

December 12, 2014

USA Today ran an interesting story yesterday about a 19 year old woman given an antibiotic by a friend for a “sore throat” who developed Stevens Johnson Syndrome.  This is a terrible incident and my thoughts and prayers go out to the young woman and her family.  What bothered me however was the way in which USA Today reported it.  Here is the link: http://www.usatoday.com/story/news/nation/2014/12/11/teen-antibiotic-burn-inside-out/20249585/ Yes, it was reported that there was a teen who took an antibiotic making her “Burn From the Inside Out” .  Talk about sensationalism!  It appears that they got that phrase from a physician they contacted.  Now, I’m not questioning the accuracy of that description but it is the use of it in the headline that makes me shake my head.  CNN reported the same story with a more sedate headline: “ A friend gave her an antibiotic; now she’s fighting for her life” http://www.cnn.com/2014/12/10/health/california-antibiotic-allergic-reaction/index.html?hpt=hp_t2 This just got me thinking about other ways in which the lay press reports on infectious diseases and antibiotics.  How many articles have been written on “Super Bugs”?  What ARE “super bugs” anyway?  In one story they may be MRSA, in another CREs.  What about “flesh eating bacteria”?  Some of us remember back about 15 years ago when this term first became popularly used in the press.  It referred to a series of cases of Group A Streptococcal necrotizing fasciitis.  This was hardly a new infection, even back then.  It has probably been around since the beginning of time but boy did they run with it.  Then, within the past few years “flesh eating bacteria” somehow morphed from Group A Strep to MRSA.  Which is it?  Is it both?  I guess. Finally, since I have been asked frequently, let’s look at Ebola.  Now I am not, and have never claimed to be an expert on viral diseases in general and Ebola in specific.  I have never seen or treated a case and hope to never come across it.  However, just a few weeks ago you could not turn on the TV, pick up a newspaper or magazine and not read about this terrible disease.  In fact, Time Magazine, rightly IMHO, just named those who fight Ebola as their “People of the Year”.  However, let’s put this into perspective.  To the best of my knowledge there were only TWO cases actually contracted in the US and both of those were health care workers directly treating the first unfortunate patient in Dallas.  That did not stop the news sources from rolling out expert after expert about how this disease could potentially spread here in the States, or maybe not.  People were freaking out.   For the first time in all my years of travel I was seeing folks wearing surgical masks on airplanes and taking out sanitizing wipes to treat the airplane seats and trays before sitting down (actually, probably not a bad idea!).  But, as the old saying goes, “today’s news is tomorrow’s fish wrapper”. Other than the Time story, I don’t think I have seen anything about the disease in a few weeks.

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Key Considerations With The Costs And Use Of Dalbavancin And Oritavancin

December 12, 2014

In my blog last month ( http://tinyurl.com/kknvjw9 ) I mentioned I would write a follow-up to discuss my opinions on the use of dalbavancin (Dalvance, Actavis) and oritavancin (Orbactiv, the Medicines Company) for lower extremity infections.

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Comparing AFOs Versus Foot Orthoses For Adult-Acquired Flatfoot

December 10, 2014

I recently got an invitation to participate in a grand rounds presentation at the Western University School of Podiatric Medicine where two podiatric residents debated the question: “What is the preferred treatment for adult-acquired flatfoot: ankle-foot orthoses (AFOs) or foot orthoses  (FOs)?” Both of the residents did a good job of presenting the scientific evidence and theoretical evidence for each of the two interventions.

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Medscape Interview about Diabetic Foot Osteomyelitis

December 8, 2014

Just over a week ago my good friend and colleague in lower extremity ID, Mark Kosinski, DPM, FIDSA and I were interviewed by Miriam Tucker, a reporter for Medscape, about a recent paper that compared 6 weeks vs 12 weeks of antibiotic therapy for DFO that did not undergo surgical debridement.  The impetus for this interview was a study published in Diabetes Care by Tone, et.al.  Here are links to the PubMed abstract for that paper, and the original interview on Medscape along with a link to David Armstrong’s excellent “diabeticfootonline” blog where, with his permission and my thanks to him, I am cutting and pasting his reporting of this below. Although the article is a bit longer than my usual posting, I think it is worth reading as both Mark and I discuss what is unique and interesting about this excellent study

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Understanding Your Customers To Make Your Practice Successful

December 8, 2014

Like it or not, our patients are our “customers.” As healthcare in the United States has evolved, so has the doctor-patient relationship. It is a foolish physician or medical group that doesn’t appreciate that patients are customers.

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