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The author presents the perspective that the nation's health care initiatives demand that greater attention be given to primary care providers. Inasmuch as the credibility of the podiatric medical profession must function in a health care environment dominated by allopathic and osteopathic physicians, the podiatric primary care initiative must be pursued within the guidelines and definitions for primary care that are present in all of mainstream medicine. The author argues that primary care podiatric medicine must establish itself as a specialty that stands as an equal along side of the other recognized specialties in podiatric medicine. Also, in keeping with the essential educational needs for specialty training, the development of residencies in primary podiatric medicine is crucial to assuring a credible area of special practice.
Spinal stenosis, involving pressure on either the central spinal cord or nerve root exiting the spinal canal, can cause a variety of symptoms in the lower extremities. A classic symptom is that of neurogenic claudication, involving leg pain and weakness brought on by walking. The pain is relieved by sitting or lying down, not by standing and resting as would be seen in arterial insufficiency-induced claudication. Other symptoms of spinal stenosis can involve paresthesia, weakness or cramping in one or both extremities, rest pain, or burning pain, and are commonly misdiagnosed as peripheral neuropathy, especially in patients with diabetes. Symptoms are often chronic, frequently missed, or misdiagnosed in the medical community, and may cause severe disability or reduction in the quality of life. Spinal stenosis is in some patients the unidentified cause of failure of treatment of foot and leg pain. Podiatric physicians, who focus on the patient's lower extremities, are in a unique position to be able to identify spinal stenosis and facilitate appropriate treatment. The authors provide current information regarding symptoms of spinal stenosis, a guide to diagnosis including the anatomical etiologies, and a basic understanding of treatment.
Podiatric physicians play an important role in the field of public health. In 1975, the Podiatric Health Section of the American Public Health Association (APHA) formulated an official statement of the roles and responsibilities of podiatrists in the public health field. Entitled Functions and Educational Qualifications of Podiatrists in Public Health, the document was published in the September 1975 issue of the American Journal of Public Health. For more than 2 decades, it remained the primary document defining and delineating the activities of the specialist in podiatric public health. Recently, it was recognized that in this time of rapid change in health-care delivery, a revision of this important statement was needed. A mini-grant from the APHA in 1996-1997 supported the formation of a special commission to update the formal position of the APHA and its Podiatric Health Section with respect to podiatric public health and to provide direction for the future. This article is a shortened version of the report issued by the special commission of the APHA.
