New ‘Advance By Podiatry Today’ Meeting Set To Debut In October 2017

Podiatric physicians who are hungry for practical continuing education will have an opportunity to gain CECH credits at a new podiatric conference.

The inaugural Advance by Podiatry Today meeting will be held Oct. 13–15, 2017 in Chicago. The co-chairs for the new conference will be Michael Downey, DPM, FACFAS, Ryan Fitzgerald, DPM, FACFAS, Tracey Vlahovic, DPM, FFPM, RCPS (Glasg), and Stephanie Wu, DPM, MSc, FACFAS. Although the educational program of the meeting, sponsored by the North American Center for Continuing Medical Education (NACCME) has yet to be set, some of the co-chairs recently offered their vision for the conference.

“The Advance by Podiatry Today meeting is exciting in that it literally brings the articles and the topics that we read either in print or online to life,” says Dr. Wu, the Associate Dean of Research and the Director of the Center for Lower Extremity Ambulatory Research (CLEAR) at Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science. “The clinical insights and practice pearls that we look forward to reading on a monthly basis will be live and interactive, allowing podiatric physicians to further enhance their daily practice.”

Dr. Downey says the new meeting can benefit by focusing on current topics for which there may not yet be one answer for the condition or problem. He also advocates integrating practice management and coding pearls with the current topics. He says this approach will let the participant leave with a better understanding of the current status of a condition or problem, and also show physicians how to maximize their effectiveness in integrating these concepts into their daily practice.

“Podiatry Today has always focused on bringing forth the most current treatment and practice management ideas in a timely fashion,” says Dr. Downey, the Chief of the Division of Podiatric Surgery at Penn Presbyterian Medical Center in Philadelphia. He says Advance by Podiatry Today will feature rapid-fire panel discussions, controversial debates and case presentations on current topics of interest to podiatric surgeons and physicians. Dr. Downey notes these formats will move the audience to have more direct involvement and will provide answers, ideas and, in many cases, an emerging consensus regarding current controversial subjects and novel approaches to a wide variety of pathologies.

Dr. Wu cites Podiatry Today’s “enhanced clinical focus in all areas relating to the foot and ankle.” With the co-chairs specializing in different areas of podiatry (ranging from podiatric surgery and the diabetic foot to dermatology and wound care), Dr. Wu says this will help ensure the exploration of key clinical topics in these specific areas and that participants gain significant clinical insight in the areas that pertain most to their specific practice.

Dr. Fitzgerald emphasizes that the new meeting is going to be fundamentally different than other meetings because the starting premise was evaluating the current available offerings for CME meetings and recognizing that many meetings have relatively similar content and formats. He says the organizers of the Advance meeting will look at the gaps and potential weak spots, and build a program to address the needs of clinicians.

“It is the goal of those involved in the project to make Advance clinically useful and a rewarding experience, a conference people enjoy attending as opposed to attending simply to earn continuing education credits,” says Dr. Fitzgerald, a Clinical Assistant Professor of Surgery at the University of South Carolina School of Medicine in Greenville, SC.

Dr. Fitzgerald says the co-chairs have all participated in a variety of conferences, both as speakers and attendees, and they can use those experiences to try to craft a meeting that addresses the needs of the attendees.
Many conferences seem to be somewhat cookie-cutter, according to Dr. Fitzgerald. He feels many meeting participants focus less on content and more about the price, the location of the conference, and the number of available educational credits to earn.

Dr. Fitzgerald says the conference’s goal is to provide a fresh educational agenda that inspires enthusiasm for the content, which is curated by the co-chairs with the intent of providing real-world utility to the clinical provider.

With the various national and regional podiatry meetings, why should DPMs attend this one? Dr. Downey says Advance by Podiatry Today will be the only seminar to focus on topical themes and provide integration of podiatric medicine, podiatric surgery and practice management into one meeting.

“Everyone wants a seminar with ideas they can put into practice when they return to the office on Monday and I think this will be the seminar to potentially maximize that concept,” says Dr. Downey.

Editor’s note: Advance by Podiatry Today will be held October 13-15 in Chicago. For more information on Advance by Podiatry Today, visit www.podiatrytoday.com/advance . Registration for the meeting will open in January 2017.

Study Says Insole Design Can Affect Balance In Patients With Diabetic Neuropathy

By Brian McCurdy, Managing Editor

A recent study in the Journal of Foot and Ankle Research finds that the design of insoles can alter the static balance in patients with diabetic neuropathy, potentially making people more unstable.

Researchers observed a random sample of 50 patients with diabetic peripheral neuropathy both standing and stepping. They each wore several types of footwear: footwear with no insole; a standard diabetic shoe consisting of a standard offloading insole made from ethylene vinyl acetate (EVA)/Poron; a diabetic offloading insole with arch fill removed; a diabetic offloading insole with the cover substituted with low resilience memory; and a diabetic offloading insole with a textured polyvinyl chloride polymer (PVC) surface added. Researchers noted that insole design affected static balance and balance perception, but not stepping reaction time.

The study concludes that the current best practice of providing offloading insoles with arch fill to increase the contact area and reduce peak pressure could lead to instability. The authors call for the development of an offloading insole that can reduce diabetic foot ulcer risk without compromising balance.

In contrast with the study, Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, has not observed any effect on static balance or stepping reaction time of the insoles that are currently available.

Breanne Everett, MD, cites the profession’s success in providing mechanisms that facilitate “static offloading.” Through a variety of modalities, podiatrists can quantify the shape of a patient’s foot, design a support that will help realign the foot and ankle, and redistribute pressure along the plantar foot, according to Dr. Everett. She notes this type of intervention can be particularly impactful for the patient with diabetic peripheral neuropathy by stabilizing and/or supporting foot deformities, limiting movement on joints, and relieving areas with excessive pressure.  

One must address the foot of the patient with diabetic peripheral neuropathy as one would address a patient who is immobilized or bedbound. Sufficient dynamic offloading needs to occur to prevent pressure-related injury, says Dr. Everett, a resident in the Department of Surgery, Section of Plastic Surgery at the University of Calgary in Calgary, Alberta.

Dr. Lehrman, a Diplomate of the American Board of Foot and Ankle Surgery, does not use arch fill on any devices his patients wear. He supports conducting a similar study with differing degrees of arch fill. If the advantage of arch fill is to increase contact area, Dr. Lehrman suggests trying different degrees of arch fill to find the sweet spot where contact area increases but not to the degree that it might contribute to instability.

What the profession is not good at systematically doing, says Dr. Everett, is providing mechanisms for “dynamic offloading,” which can have a particular impact in managing patients with diabetic peripheral neuropathy. Even with the best static orthotic and footwear support, the redistributed pressure that occurs with the foot, particularly on bony prominences, will exceed capillary pressure, according to Dr. Everett. She says this low-pressure threshold will not cause damage in bursts but when it is exceeded for a prolonged period of time without sufficient offloading — a situation that commonly occurs in the context of diabetic peripheral neuropathy — tissue damage will occur.

“It is only with a combination of appropriate static offloading and dynamic offloading tools in our clinical armamentarium that we will be sufficiently armed to best assist these patients in managing their disease and avoiding unnecessary wounds and limb loss,” maintains Dr. Everett.