Seeking Insight Through A Variety Of Perspectives

   Every June, we start thinking about next year. We actively seek out suggestions from our Editorial Advisory Board and other key contributors on the latest topics that would make for solid feature articles. We sit in on lectures during the Western Podiatric Medical Congress and subsequently approach the lecturers about converting their talks into future articles. It is all part of the process in developing the right editorial mix of innovative approaches and practical insights for both common conditions and other dilemmas one may see in practice.    Last year, one of the common topics that came up during conversations at the Western was the need for more articles on treating flatfoot. With this in mind, we present two roundtable discussions this month. In the cover story, “Roundtable Insights On Adult-Acquired Flatfoot (AAF)”, some of the leading voices in podiatry share their thoughts on the subject (see page 34).    They agree about the value of neutral position X-rays in determining the degree of deformity and facilitating appropriate procedure selection. They also share common ground in their experiences employing conservative therapy for this condition. However, it is interesting to see the divergence of opinion when it comes to discussing the significance of the posterior tibial tendon in AAF. Particularly intriguing is the panelists’ discussion of calcaneal osteotomies in treating AAF.    Flatfoot treatment also plays a prominent role in “A Closer Look At Subtalar Implants,” the accompanying supplement to this month’s issue. While this supplement is more specific to the topic of subtalar implants, these panelists discuss the use of arthroereisis procedures in children, adolescents and adults.    In the supplement, Donald Green, DPM, emphasizes the importance of a thorough patient history in catching unsaid symptoms and signs of significantly pronated feet in young children. The panelists also offer insights on how their post-op protocol has evolved over the years for arthroereisis procedures.    A unifying link to both roundtables is a strong emphasis on equinus and how it plays a significant role in selecting an appropriate course of treatment.    Delving back into the regular issue, Anthony Iorio, DPM, MPH, provides a very timely article in “NSAIDs: Where Do We Go From Here?.” (see page 52). While most of the media attention has focused on the recent withdrawal of Bextra from the market, the FDA has also recently called for labeling changes to all non-selective NSAID medications. Accordingly, Dr. Iorio shares his insights on the pharmacology and pharmacokinetics of NSAIDs, and offers pertinent points one should consider when prescribing these medications.    Another intriguing article is “Current Concepts In Medial Column Hypermobility” (see page 68). While many articles offer reviews of the available literature on a given subject, Neal Blitz, DPM, establishes key connections between divergent views and makes his own salient points in the process. In the article, Dr. Blitz clarifies first ray insufficiency and provides an insightful view on what studies have revealed about measuring first ray motion. Rounding out the article with a discussion of how hypermobility affects procedure selection, Dr. Blitz brings his own experience into play when discussing isolated first MCJ fusions.    From an editor’s perspective, the great thing about these articles and roundtable forums is they provide insights into the clinical decision-making of the authors. Not only do you get to peer into their thought process when weighing all the relevant factors to arrive at an appropriate treatment course, you get a feel for their rationale when they challenge conventional wisdom to bring a fresh perspective to the table.