Tuesday, July 13, 2010

What's New in Podiatry?

Tomorrow, I will be leaving for Seattle to attend a podiatry conference - which I do at least yearly. In talking to a friend this past week and telling him of my trip, he said that he empathized with me having to travel. Since I don't travel that much, I really enjoy these trips. It got me to thinking how much I have learned AFTER finishing podiatry school in 1989. When I compare how I practiced medicine then compared to now, so much has changed. Certainly, many things are the same, but it's the constant changing requiring me to learn new things that makes podiatry exciting and challenging to me. I thought I would discuss a few of the many things that are new to podiatry in the last 21 years that I feel make me and other podiatrists better at treating our patients.

In no particular order...

1. Diagnostic ultrasound. This technology has been around for years, but its use in podiatry has really come into the mainstream in the last 10 years. X-rays do a fine job of showing problems with bone. However, if the soft tissue around bone is abnormal, x-rays can't always help pinpoint what the problem is. Diagnostic ultrasound allows me to see pathology in tendon, ligaments, joints, muscles, nerves, etc. It allows excellent visualization of cysts. What's more, it gives immediate feedback. Certainly, all these structures in the foot can be seen using an MRI, but the cost for an MRI is substantially more, and the results are not immediate. With ultrasound, I know right as the patient is sitting there what is going on.

2. Lamisil. Everyone remembers the commercial that was aired in years past with "Digger the Dermatophyte." Patients would tell me that the thought of Digger in their toenails made them shiver. Well, Digger had been in toenails before, but there was little that could be done to really rid toenails of fungus so that they could grow out normally again. Now, patient's have real options that are effective. I have treated successfully literally hundreds and hundreds of patients with this medication. It does not work all the time, but in the vast majority, significant improvement is seen, and quite often, total clearing of the toenails.

3. Wound care. The options for wound care have multiplied exponentially in the last two decades. Certainly, the basics of controlling infection, cutting away dead tissue, taking pressure off the ulcerated portion of the foot are still used and of utmost importance. However, the dressings and medications available now are far superior to what we had available to us in 1989. This gives us a much better chance not only to heal wounds, but to get them healed more quickly. Another huge improvement is the ability of vascular surgeons to improve circulation to the feet. Without adequate blood flow, ulcers will not heal.

4. E-prescribing. While this is not an advancement in medicine per se, I have found it to be a huge help when it comes to prescribing medications to my patients. Just last week, I had a patient who was in need of a prescription. She had listed her medications, and I had checked to make sure that none of her medications would interact with what I was prescribing. Everything seemed to be okay. However, when I went to process the prescription on the computer, her records through the pharmacy (which gave a COMPLETE listing of her medications) revealed that she was indeed taking a medication that was not compatible with what I wanted to prescribe. She had just forgotten to tell me about that particular prescription. So, because of e-prescribing, I was able to change her prescription to something that worked better for her.

5. Vascular testing. Newer technology makes it much easier to test my patients for poor circulation in their feet and legs. Not only easier, but I find it to be more reliable as well. This helps me identify patients who are at higher risk for ulceration and limb loss early, so that measures can be taken to improve circulation before problems develop.

This is just a short list of the improvements and advancements that I have seen over the last two decades of practicing podiatric medicine. And as I get ready to hop on my flight tomorrow, I fully expect that there will be more that I will learn to better help me treat my patients. I encourage other podiatrists to add to my list of what's new in podiatric medicine that has helped to make them better doctors.

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