Is There A DPM Shortage On The Horizon?

A decline in the number of graduating podiatric medical students combined with increasing demand for podiatric services could result in a shortage of DPMs, according to a recent study in the Journal of the American Podiatric Medical Association (JAPMA).

Study authors note that since the late 1990s, podiatric medical schools have experienced a decline in the number of applications, resulting in a decreased number of DPMs per capita in the United States. The study notes that the number of DPM graduates must increase “dramatically” or the supply of podiatrists will not keep up with the demand for services. Approximately 52 million people, about 19 percent of the U.S. population, experience foot problems every year, according to the study authors.

In 1995-96, 680 students graduated from podiatric medical programs yet this number dropped to 331 in 2006-07, according to the study. In addition, the Bureau of Labor Statistics projects podiatric medicine job growth of about 16 percent between 2004 and 2014.

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Study Cites Impact Of Chronic Heel Pain On Quality Of Life

Chronic plantar heel pain (CPHP) can significantly affect patients’ foot function and their quality of life, according to a recent study in JAPMA.

Utilizing Foot Health Status Questionnaire scores, researchers compared 80 patients with chronic plantar heel pain to 80 control patients. Patients with CPHP related a “significantly poorer” quality of life, which researchers measured via lower scores in foot pain, foot function and footwear.

Authors say those with heel pain also related “significantly poorer” scores in general quality of life, including physical activity, social capacity and vigor. The study notes that the degree of heel pain’s impact on the quality of life did not depend on age, sex or body mass index.

Eric Feit, DPM, agrees that chronic plantar heel pain does have an adverse effect on quality of life and DPMs should keep that in mind during treatment. One should combine several types of treatment, starting at the initial office visit, to help patients return to activities sooner, according to Dr. Feit, a Fellow of the American College of Foot and Ankle Surgeons.

He categorizes his heel pain patients into three groups. The first group consists of patients who can go about daily activities and work but cannot exercise due to heel pain exacerbating their symptoms. This is the most common group, notes Dr. Feit, who is in private practice in Torrance, Ca.

He says these patients will improve in one to three months and should be able to exercise again after treatment by a well-trained podiatrist. Treatment for such patients will likely consist of a corticosteroid injection, night splint, physical therapy, stretching and ice, according to Dr. Feit. He says custom orthoses will be necessary to help prevent recurrence.

Dr. Feit says the second group of patients can perform work activities but cannot do recreational activities and many of their daily activities because of limping and aggravation of the symptoms. He notes these patients may become frustrated, stressed, gain weight and have less energy. These patients may need modified work duties to help facilitate healing. For example, Dr. Feit notes that patients who are on their feet at work may need to sit or require a below knee CAM-walker when weightbearing at work.

The third type of heel pain patients cannot work or engage in recreational or daily activities. “This will greatly increase the patient’s stress level due to lost income and possibly losing his or her job if it requires a prolonged period of time to heal,” points out Dr. Feit.

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Study: Most Patients Wear Compression Stockings Incorrectly

By Lauren Grant, Editorial Assistant
Although graduated compression stockings can decrease the risk of conditions like deep vein thrombosis, a recent study in the American Journal of Nursing concludes that a majority of patients are wearing such stockings in an incorrect size or manner.

The study focused on 142 hospitalized, postoperative patients. Of those patients, 37 had thigh-length stockings and 105 had knee-length stockings. Researchers found that compression stockings were used incorrectly for 29 percent of patients while 26 percent of patients had incorrectly sized stockings.

The study authors note that overweight patients suffered more with incorrect application and size. Knee-length stockings were reportedly more comfortable for patients and 20 percent did not understand the purpose of compression stockings, according to the study.

Understanding The Impact Of Incorrect Compression Stockings

Leon Brill, DPM, CWS, has seen many complications occur as a result of incorrectly applied compression stockings. He says this can lead to “sausage” digits, uneven swelling, blisters, and new wounds.

“Most often, compression stockings are not applied high enough and the compression is often uneven when it should be uniform,” says Dr. Brill, a Fellow of the American College of Foot and Ankle Surgeons. He says compression stockings are most effective when they have “uniform tightness for graduated compression going from distal to proximal.”

Proper application is especially important for elderly patients, who often reposition themselves in bed, causing the hose to move or become unraveled, notes Dr. Brill, a consultant in wound care and reconstructive foot and ankle surgery at the Wound Care Clinic at Presbyterian Hospital in Dallas.

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In Brief

Smith & Nephew’s Advanced Wound Management division has appointed Thomas Dugan as the President of its North American business. The company says Dugan was formerly SonoSite’s Senior Vice President of Global Marketing and U.S. Sales.
Innocoll, Inc. says the last patient has been dosed in the first of three ongoing phase 2 clinical trials to investigate CollaRx® Bupivacaine Surgical Implant for the management of postoperative pain. The company says the biodegradable and bioresorbable collagen matrix has potential applications in bunionectomies.

Clarification

In regard to the article, “A Guide To Current And Emerging Antibiotics For MRSA,” which ran in the July 2008 issue, linezolid is indicated for the treatment of MRSA bacteremia, complicated skin and skin structure infections, hospital-acquired pneumonia and community-acquired pneumonia. It is not formally indicated for VISA or VRSA infections.