Foot and nail care specialists spend a great portion of their day using nail drills to reduce nail thickness and smooth foot callouses. This process generates a large amount of dust, some of which is small enough to breathe in and deposit into the deepest regions of the respiratory tract, potentially causing health problems. Foot and nail dust often contain fungi, from both fungally-infected and healthy-looking nails. While the majority of healthy individuals can tolerate inhaled fungi, the immune systems of older, immunocompromised, and allergy-prone individuals often react using the inflammatory TH2 pathway, leading to mucus overproduction, bronchoconstriction, and, in severe cases, lung tissue damage. To protect vulnerable podiatry professionals, wearing a surgical mask, using a water spray suppression system on nail drills, installing air filtration systems, and considering drilling technique can help reduce the exposure to nail dust.
BACKGROUND: Burnout and medical resident well-being has become an increasingly studied topic in medical degree (MD) and doctor of osteopathic medicine (DO) fields and specialties which has led to systemic changes in postgraduate education and training. Although an important topic to address for physicians of all experience levels and fields of practice, there is little research on this topic as it pertains specifically to the podiatric community. METHODS: A wellness needs assessment (WNA) was developed and distributed to podiatric residents via electronic survey. This was used to assess levels of overall wellness of residents as well as highlight several subdomains of well-being within the training programs of the podiatric profession. RESULTS: A total of 121 residents completed the wellness needs assessment. Survey respondents indicated that they suffer from high levels of professional burnout with large numbers of them experiencing depression and anxiety. When analyzing the different subdomains of wellness, intellectual and environmental wellness was high, while financial and physical wellness were reported as low. Additionally, free response answers were recorded within the survey regarding well-being initiatives that have been implemented within residency programs, and in many cases no such programs are reported to exist. CONCLUSIONS:Podiatry residents experience compromised well-being similar to their MD/DO counterparts. These exploratory survey group results are concerning and warrant further investigation as well as organizational introspection. Analysis of well-being and implementing changes that can support podiatric physicians at all levels of training could decrease the deleterious effects of burnout in all its forms.
This report discussed an unusual case of a 23 year old woman with a painful bipartite medial cuneiform, (BMC) and severe arthritic and cystic changes at the partition with no history of trauma. MRI taken confirmed a large cyst with subchondral erosions at the dorsal and plantar segments with significant bone marrow edema. Definitive treatment consisted of arthrodesis on the dorsal and plantar segments using one lag screw, demineralized bone matrix grafting, and a bone stimulator.
The publication of the Global Vascular Guidelines in 2019 provide evidence-based, best practice recommendations on the diagnosis and treatment of chronic limb-threatening ischemia (CLTI). Certainly, the multidisciplinary team, and more specifically one with collaborating podiatrists and vascular specialists, has been shown to be highly effective at improving the outcomes of limbs at risk for amputation. This article uses the Guidelines to answer key questions for podiatrists who are caring for the patient with CLTI.
Background: Despite prevention efforts, suicide rates continue to rise, prompting the need for novel evidence-based approaches to suicide prevention. Patients presenting with foot and ankle disorders in a podiatric medical and surgical practice may represent a population at risk for suicide, given risk factors of chronic pain and debilitating injury. Screening has the potential to identify people at risk that may otherwise go unrecognized. This quality improvement project (QIP) aimed to determine the feasibility of implementing suicide risk screening in an outpatient podiatry clinic and ambulatory surgical center. Methods: A suicide risk screening QIP was implemented in an outpatient podiatry clinic and ambulatory surgical center in collaboration with a National Institute of Mental Health (NIMH) suicide prevention research team. Following training for all staff, patients ages 18 years and older were screened for suicide risk with the Ask Suicide-Screening Questions (ASQ) as standard of care. Clinic staff were surveyed about their opinions of screening. Results: Ninety-four percent of patients (442/470) agreed to be screened for suicide risk and nine patients (2%; 9/442) screened non-acute positive; zero for acute risk. The majority of clinic staff reported that they found screening acceptable, felt comfortable working with patients who have suicidal thoughts, and thought screening for suicide risk was clinically useful. Conclusions: Suicide risk screening was successfully implemented in an outpatient podiatry clinic. Screening with the ASQ provided valuable information that would not have been ascertained otherwise, positively impacting clinical decision-making and leading to improved overall care for podiatry patients.
As of 2016, Medicaid accounted for nearly 20% of state general fund budgets. Optional Medicaid services like podiatry are often subject to cost-cutting measures in periods of economic downturn, as was the case in the wake of the 2007 financial crisis. Although the cuts were intended as a cost-saving measure, research indicates they had the opposite effect. The restriction and limitation of these services during the Great Recession resulted in both poorer health outcomes for beneficiaries, and poorer financial outcomes for state Medicaid programs. With states citing record levels of unemployment as of April 2020 and projecting significant declines in annual revenue in 2021, the economic conditions resulting from the COVID-19 pandemic are likely to rival those of the Great Recession. Given the historical precedent for restricting or eliminating optional Medicaid services as a cost-saving measure, it is likely that podiatric services will once again come under scrutiny. Previous efforts by state-level podiatric societies have proven successful in lobbying for the reinstatement of coverage under Medicaid by conveying evidence of the negative outcomes associated with elimination to stakeholders. The specialty must once again engage policymakers by drawing on evidence gleaned and lessons learned from past cuts of optional Medicaid services to avert counterproductive coverage restrictions intended to mitigate the financial impact of the COVID-19 pandemic.
The COVID-19 pandemic is driving significant change in the healthcare system and disrupting the best practices for diabetic limb preservation, leaving large numbers of patients without care. Patients with diabetes and foot ulcers are at increased risk for infections, hospitalization, amputations, and death. Podiatric care is associated with fewer diabetes-related amputations, ER visits, hospitalizations, length-of-stay, and costs. But podiatrists must mobilize and adopt the new paradigm of shifts away from hospital care to community-based care. Implementing the proposed Pandemic Diabetic Foot Triage System, in-home visits, higher acuity office visits, telemedicine, and remote patient monitoring can help podiatrists manage patients while reducing the COVID-19 risk. The goal of podiatrists during the pandemic is to reduce the burden on the healthcare system by keeping diabetic foot and wound patients safe, functional, and at home.
BACKGROUND: Diabetic Foot Osteomyelitis (DFO) is a common infection where treatment involves multiple services including Infectious Disease (ID), Podiatry, and Pathology. Despite its ubiquity in the hospital, consensus on much of its management is lacking. METHODS: Representatives from ID, Podiatry, and Pathology interested in quality improvement (QI) developed multidisciplinary institutional recommendations culminating in an educational intervention describing optimal diagnostic and therapeutic approaches to DFO. Knowledge acquisition was assessed by pre- and post-intervention surveys. Inpatients with forefoot DFO were retrospectively reviewed pre- and post- intervention to assess frequency of recommended diagnostic and therapeutic maneuvers, including appropriate definition of surgical bone margins, definitive histopathology reports, and unnecessary intravenous antibiotics or prolonged antibiotic courses. RESULTS: A post-intervention survey revealed significant improvements in knowledge of antibiotic treatment duration and the role of oral antibiotics in managing DFO. There were 104 consecutive patients in the pre-intervention cohort (4/1/2018-4/1/2019) and 32 patients in the post-intervention cohort (11/5/2019-03/01/2020), the latter truncated by changes in hospital practice during the COVID-19 pandemic. Non-categorizable or equivocal pathology reports decreased from pre-intervention to post-intervention (27.0% vs 3.3%, respectively, P=0.006). We observed non-significant improvement in correct bone margin definition (74.0% vs 87.5%, p=0.11), unnecessary PICC line placement (18.3% vs 9.4%, p=0.23), and unnecessary prolonged antibiotics (21.9% vs 5.0%, p=0.10). Additionally, by working as an interdisciplinary group, many solvable misunderstandings were identified, and processes were adjusted to improve the quality of care provided to these patients. CONCLUSIONS: This QI initiative regarding management of DFO led to improved provider knowledge and collaborative competency between these three departments, improvements in definitive pathology reports, and non-significant improvement in several other clinical endpoints. Creating collaborative competency may be an effective local strategy to improve knowledge of diabetic foot infection and may generalize to other common multidisciplinary conditions.