Sep-09

Online Poll Reveals Initial Hesitance About ASPS Membership

By Brian McCurdy, Senior Editor

   How will the recent establishment of the American Society of Podiatric Surgeons (ASPS) as the new surgical affiliate of the American Podiatric Medical Association (APMA) affect the American College of Foot and Ankle Surgeons (ACFAS) and the profession in general? A recent Podiatry Today online poll provides some preliminary clues.

   Out of 163 DPMs who responded to the poll, 44 percent (71 people) say they would not apply to the ASPS while 18 percent (30 people) are current members. Twenty-seven percent (44 people) are taking a “wait and see” approach before joining. Nine percent (14 votes) are applying soon for membership while 2 percent (four people) have applied and are waiting to hear about approval.

   Mary Crawford, DPM, the President of ACFAS, is not surprised by the poll results.

    “Podiatric surgeons are evidence-oriented, rational thinkers and are likely to assess very carefully the best choice for their professional affiliations before making any decisions,” notes Dr. Crawford, who adds that the current ACFAS membership numbers (6,000) have not been impacted by the establishment of the ASPS.

   Granted, the ASPS is a relatively new organization as it became an official affiliate of the APMA in March. Comparatively, the ACFAS has been around for nearly seven decades as it was founded in 1942. Another key distinction is that the ACFAS requires Board status for membership, emphasizes Dr. Crawford. She says ACFAS Fellows “have significant prestige and credibility with patients, hospitals, and other healthcare providers” and this reputation is built over time.

    “I think that is the reality of building a successful professional society,” notes Dr. Crawford. “You have to prove your value and relevance year after year. We have tried to be very careful with our brand—especially now that it is so established in the community.”

   Alan Catanzariti, DPM, praises the educational resources of the ACFAS for podiatric surgery, seminars, CME, print materials, Webcasts and podcasts. He notes that the ACFAS is well organized, accessible and adept at managing political issues. He thinks the ASPS needs to provide the aforementioned benefits for its members.

   With the establishment of the ASPS, does the ACFAS need to do anything to adapt? In two surveys in June, the ACFAS membership noted that they wanted the college to “stick to the mission” regarding CME, patient referrals, surgical health policy, parity issues and practice management, according to Dr. Crawford. She says while the ACFAS will listen to its members and tweak its business plan accordingly, they see no dramatic mission changes in the future. Dr. Catanzariti, a Fellow of the American College of Foot and Ankle Surgeons, feels that the college should stick to its mission.

How Will Two Surgical Groups Affect Podiatry?

   Dr. Catanzariti feels the presence of two podiatric surgery organizations will have an adverse effect on the profession, saying the groups will duplicate their efforts and possibly dilute the pool of resources. Dr. Crawford believes it is too early to predict the effect of having two surgical groups. She does note that ACFAS members are able to choose their own professional affiliations just like physicians in allopathic or osteopathic medicine.

    “ACFAS membership is at an all-time high, which would seem to indicate that one surgical organization in the profession is sufficient,” notes Dr. Crawford. “However, competition is always healthy so the college’s job will be to focus on its strengths and deliver the best value for its members. This has always been our formula for success.”

   In regard to legislative efforts in podiatry, Dr. Crawford says the APMA and ACFAS have rarely disagreed on any legislation. She feels the two groups will continue to advance podiatric surgery and patient care at the state and federal levels.

    “We have stated publicly our support for the APMA’s advocacy efforts and we will continue to offer partnership in any way that can help advance the overall causes of podiatry and foot and ankle surgery,” notes Dr. Crawford.

Study Assesses Impact Of Running Shoes On Plantar Pressures

By Lauren Grant, Editorial Assistant

   A recent study published in the Journal of the American Podiatric Association assessed the impact of cushioning and motion control running shoes on plantar pressures in both low and high arched feet.

   The study focused on 75 participants, 40 with low arches and 35 with high arches. Researchers compared runners across three different conditions including nonshod, motion control running shoes and cushioning running shoes (employing New Balance athletic shoes). Participants walked 3 mph on a treadmill and researchers measured the mean plantar contact area and mean plantar pressure measurements.

   The study says participants with low-arched feet showed a significant decrease in the modified arch index when wearing motion control shoes in comparison to wearing cushioned shoes. The study authors note that the running shoes increased the mean midfoot plantar contact area and decreased the mean plantar pressure.
   This combination with the mean plantar pressure distribution from the rearfoot to the midfoot may have significance in terms of decreasing force transmission and enhancing shock attenuation in the lower extremities, according to the study authors.

   Alan MacGill, DPM, and Joseph Conte, DPM, say people with high-arched feet should look for athletic shoes that offer increased cushioning. For those with low-arched feet, a motion-control or anti-pronation shoe would work best. For those whose feet fall somewhere in the middle, people should look for a neutral design that offers both cushion and support, according to Dr. MacGill, who practices in Boca Raton, Fla.

   Dr. MacGill and Dr. Conte have also noticed some common mistakes people make when choosing an athletic shoe.

    “People often try using an athletic shoe for a sport for which it was not designed. Many athletic shoes are sport-specific and are built to withstand the rigors that come with that sport,” says Dr. MacGill.

   Dr. Conte, who is in private practice in Orlando, Fla., emphasizes the importance of shoes being more flexible near the toes as opposed to the laces. He says athletic shoes should show “good torsion strength” so feet land evenly during the activity.

    “You get what you pay for. If a shoe costs less than $75, chances are the shoe is poorly constructed,” maintains Dr. Conte.

Can First MPJ Arthrodesis Improve Faulty Mechanics In Hallux Valgus?

By Brian McCurdy, Senior Editor

   For patients with arthritic deformities of the great toe, first metatarsophalangeal (MPJ) arthrodesis can be an effective treatment option. A recent article in Clinics in Podiatric Medicine and Surgery maintains that first MPJ arthrodesis can improve the faulty mechanics that are secondary to a dysfunctional joint.

   In addition to first MPJ arthrodesis facilitating a predictable outcome in geriatric and rheumatoid patients with hallux valgus, the authors note arthrodesis is an “excellent” revisional surgery for failed bunion surgery in patients with recurrent hallux valgus or iatrogenic hallux varus. Graham Hamilton, DPM, FACFAS, and his co-authors, say surgeons should also consider performing first MPJ arthrodesis in patients with severe hallux valgus deformities with or without coexisting degenerative changes.

   Biomechanically, Dr. Hamilton and colleagues say first MPJ arthrodesis will lead to “little to no disability” in regard to transfer stresses to the joints that remain, and the procedure has minimal adverse effect on gait. The authors note that arthrodesis will restore the first ray’s weightbearing function via increased force that carries through the hallux during toe-off. Revision bone-block arthrodesis is effective for active patients with failed fusions, according to the authors. ­­

   What types of patients attain the best results with first MPJ arthrodesis? The procedure is effective for patients of any age with end-stage arthritis as well as geriatric patients with severe hallux valgus, maintains Dr. Hamilton, who is affiliated with the Department of Orthopedics and Podiatric Surgery at Kaiser Permanente in Antioch, Calif. He notes those with failed bunion surgery and failed implants also will benefit.

    Dr. Hamilton notes absolute contraindications of active infection and relative contraindications of active smoking and severe arthrosis of the interphalangeal joint of the hallux. He notes several drawbacks to the surgery, including limited motion, potentially altered running patterns and limiting patients to heels of 1 to 1.5 inches. However, Dr. Hamilton notes that patients who have a first MPJ arthrodesis will be able to walk fast, ride a bike and play golf postoperatively.

   When it comes to properly selected patients, “all can get great results and relief of their pain with this procedure,” says Dr. Hamilton, a Fellow of the American College of Foot and Ankle Surgeons.

In Brief

Barry University’s School of Podiatric Medicine will celebrate its 25th anniversary with a “Barefoot Ball” Jan. 10, 2010. The Florida-themed gala will take place at the Caribe Royal Resort in Orlando, Fla. during the Florida Podiatric Medical Association’s (FPMA) annual Science and Management Symposium. The school notes that proceeds will benefit the Dr. Marvin and Ruth Steinberg Memorial Scholarship.