Underlying bone metabolic disorders are often neglected when managing acute fractures. The term fracture liaison services (FLS) refers to models of care with the designated responsibility of comprehensive fracture management, including the diagnosis and treatment of osteoporosis. Although there is evidence of the effectiveness of FLS in reducing health-care costs and improving patient outcomes, podiatric practitioners are notably absent from described FLS models. The integration of podiatric practitioners into FLS programs may lead to improved patient care and further reduce associated health-care costs.
Podiatric Medical Students’ Perceptions of Professionalism in the Clinical Setting
A Qualitative Analysis
The teaching and assessment of professionalism have become central areas of research and practice in medicine and in allopathic and osteopathic undergraduate and graduate medical education generally. In contrast, discussion of professionalism as it relates to podiatric medical education is nearly nonexistent in the literature.
A study of podiatric medical students’ perceptions of professionalism-related issues in the clinical setting was performed using a qualitative analysis. A written survey was sent to 88 students who had recently completed their clinical training experiences. The survey was completed anonymously, and all identifying information was redacted before analysis of the data, which was performed using thematic content analysis with constant comparative analysis. In addition, basic demographic information was acquired as part of the data collection process.
Sixty-six students (75%) responded and agreed to participate in the survey. Students provided written reports of lapses in professional behavior that they had witnessed, heard about, or been personally involved in performing. The study confirmed that podiatric medical students had experienced various types of professional lapses in behavior, and six predominant themes were identified.
This study, which was performed with a selected group of individuals at a single institution, serves as an initial assessment of the needs of podiatric medical students and will be useful for developing professionalism-related instructional activities that could benefit students in the future. (J Am Podiatr Med Assoc 102(6): 434–445, 2012)
In the podiatric medicine profession, there are a variety of manual tasks that require precision and skill beyond what would be usually expected in everyday living. It is the expectation of employers, regulatory bodies, and the public that graduating podiatric physicians sufficiently meet certain minimum competencies for that profession, including those for manual skills. However, teaching and evaluation methods seem to be inconsistent between countries, institutions, and programs. This may be the consequence of uncertainty regarding the safest and most effective methods to do so. A review of available international literature pertaining to psychomotor learning across a range of health professions was undertaken. As a result of this broad review, we present herein the available evidence and make recommendations for the teaching of psychomotor skills in the podiatric medicine profession. Specific aspects considered important include methods of teaching, practice, and feedback.
The unpleasant and subjective sensation resulting from a noxious sensory stimulus defines the phenomenon of pain. The podiatric physician is no stranger to the difficulties in achieving optimal pain therapy. Podiatric physicians must develop analgesic regimens to treat patients with acute, chronic, and postoperative pain. Because opioid therapy is the cornerstone of the pharmacologic management of acute and chronic pain, this review focuses on the prescribing of opioid analgesics to treat lower-extremity pain. The pharmacology of frequently prescribed opioids is introduced. Then, criteria for selecting appropriate opioid analgesics as found in the current medical literature are reported. Finally, a review of the literature describing legal and ethical considerations regarding the prescribing of opioid analgesics is presented. (J Am Podiatr Med Assoc 96(4): 367–373, 2006)
This 6-month prospective study investigated the outcomes of foot surgery performed by Fellows of the Australian College of Podiatric Surgeons. The study recruited 140 patients who were treated for orthopedic, neurological, or integumentary diseases of the foot. The majority of subjects who underwent podiatric surgery experienced significant postoperative improvements in a range of health-related quality-of-life dimensions as measured by the disease-specific Foot Health Status Questionnaire (FHSQ) and the generic Short Form 36 (SF-36) questionnaire. Subjects reported a reduction in foot pain, increased levels of physical function, improved general foot health perception, and improved footwear-related quality of life. No significant adverse outcomes or unplanned re-admissions to the hospital were reported. This study demonstrates the advantage of assessing health-related quality of life as opposed to patient satisfaction. (J Am Podiatr Med Assoc 91(4): 164-173, 2001)
Lower-extremity pathologic abnormalities have been common in military recruits for many years. Many of these conditions can become chronic and persist even after retiring from military service. We hypothesized that certain foot abnormalities are more prevalent in veterans versus nonveterans. The purpose of this study was to evaluate what foot and ankle disorders are associated with veteran status while controlling for other demographic factors.
The National Health Interview Survey (Podiatry Supplement) from 1990 was used for this secondary data analysis. The data were divided into veterans and nonveterans, and the prevalence of podiatric medical problems, including callus, flatfoot deformity, bunion deformity, hammer toe deformity, arthritis, and sprain, was evaluated for each group.
Flatfoot deformity and arthritis were significantly more prevalent in veterans versus nonveterans in the United States. Bunion deformity was significantly more prevalent in male veterans than in male nonveterans. Male veterans were less likely than male nonveterans to have sprains, and female veterans were more likely than their nonveteran counterparts to have sprains.
These results may help us understand the potential risk factors for podiatric medical problems and may be used for formulating prevention programs. (J Am Podiatr Med Assoc 101(4): 323–330, 2011)
Dermatologic, vascular, neurologic, and musculoskeletal complications are common among persons with acquired immunodeficiency syndrome (AIDS). These manifestations frequently involve the lower extremities and may be the initial presenting symptoms of human immunodeficiency virus (HIV) infection. It is important that practitioners of podiatric medicine be aware of these syndromes to facilitate early diagnosis of AIDS and to provide the best possible care for immunodeficient patients. The author provides a review of the manifestations of AIDS frequently encountered in podiatric practice, along with guidelines for treatment.
The practice of the clinical podiatrist traditionally focuses on the diagnosis and treatment of conditions of the foot, ankle, and related structures of the leg. Clinical podiatrists are expected to be mindful of “the principles and applications of scientific enquiry.” This includes the evaluation of treatment efficacy and the research process. In contrast, the forensic podiatrist specializes in the analysis of foot-, ankle-, and gait-related evidence in the context of the criminal justice system. Although forensic podiatry is a separate, specialized field, many aspects of this discipline can be useful in the clinical treatment and management of foot and ankle problems. The authors, who are forensic podiatrists, contend that the clinical podiatrist can gain significant insights from the field of forensic podiatry. This article aims to provide clinical podiatrists with an overview of the principles and methods that have been tested and applied by forensic podiatrists in their practice, and suggests that the clinical practice of the nonforensic foot practitioner may benefit from such knowledge.
In 2003, the American Podiatric Medical Association conducted its second annual “Walking City Competition.” The objective of the study was to update and expand on the results of a previous study conducted in 2002, taking into account a wider variety of measures of walking and walking conditions and identifying the best cities for walking in the United States on a regional basis. (J Am Podiatr Med Assoc 94(2): 211-215, 2004)
High levels of occupational stress have been reported in podiatric physicians practicing in Australia. One possible stressor is the predominance of the treatment of aged patients with chronic disease in podiatric medical practice.
Forty podiatric physicians attending a regional podiatric medical conference were invited to participate in the research using a convenience sampling method. Podiatric physicians were asked to complete a survey examining occupational stress in general and specifically in relation to practice with older adults (defined as those older than 65 years).
The survey of sources of occupational stress among podiatrists identified patient demands and expectations as the most significant stressor in general and geriatric practice for the podiatric physician. The perceived limited clinical gains and chronic nature of the conditions in older patients was also ranked highly as a stressor.
Working with the elderly is a substantial part of podiatric medical practice and, as such, needs to be seen with a more positive attitude by many practitioners. The development of geriatric practice as a speciality within the profession may help raise the value of working with the elderly. This has implications for preparing podiatric physicians for practice with the geriatric population along with the need for strategies to avoid or minimize these work stressors.