How Patient Gender Can Affect Lower Extremity Treatment Plans

Karen Langone:
Good morning and thank you. I appreciate all that podiatry today has done in allowing me to be scheduled for this interview to talk about my upcoming lecture at the New York Clinical Conference and the American Association for Women Podiatrist Track at the New York Clinical Conference.

My name is Karen Langone. I'm a podiatrist in Southampton, New York. I'm the current president of the American Association for Women Podiatrists. I'm a trustee for the New York State Pediatric Medical Association as well. I'm also a member of the APMA DEI committee.

The lecture track that we are putting together is looking at the differences between male and females. We are really going to focus on the differences between sex assigned at birth and what implications that has for us as practicing physicians. Should we be altering our treatment plan? Are there different considerations that we need to look at when we deal with our female versus male patients? And one of the things that stands out as we do our research always is that there are differences between the sex assigned at birth patients. So we're going to look at this today.

I feel this is important because, often, as we deal with patients, we are not always taking into account all these other factors that may impact, not only our treatment plan, but our outcomes as well and the way we need to approach our patients and that we may need to tweak and alter our treatment plans specifically for the patient. Much as we do for any individual patient, this takes it to the next level and depth.

I think one of the things that is most important for practitioners to learn from this panel is that there are differences that we need to look at, specifically the fact that when boys and girls, prior to maturity undergoing puberty, are pretty similar in how we address their needs. And then, once puberty begins, the introduction of hormones starts to change the things that we notice and the things that young men and young women are subject to, the ways we should help them train, the ways we should help them to avoid injury and the impact that that has upon them.

We also have a major difference in that women over time will constantly undergo more hormonal changes at regular intervals in addition to the fact that they will undergo hormonal cyclical changes in the course of one month. And these things can impact what we see in them, when they're most subject to particular types of injury, when they should focus more on one aspect of their training versus another. So it's really very interesting as we start to look at those things.

One of the things that I've found very interesting also is that, now, as we start to work with baby boomers who wish to remain active, who wish to continue their athletic activity, we have to take other factors into account as well, such as bone health and changing their training patterns to address these things. We certainly need to look at balance as we work with our patients through the years because often, as people get older, they don't do the things that challenge their balance on a regular basis. And this applies to men as well as to women. But we do notice that things like falls, hip fractures do affect women more than they affect men, and therefore, it's something we really should be looking at and screening all our patients for.

We really need to be looking at things... Once our patients are at that 55 year age, we really want to look at things like, are they protecting their bone health? Are they doing things to protect their balance? Are they doing things to offset the loss of bone mass and particularly muscle mass, the sarcopenia that will occur with age? So I think these are all important factors to look at.

We want to look at these things in conjunction with how we are addressing a treatment plan, but also, as we make a surgical plan, these things really come into play. If we're looking at doing surgery that's going to cause somebody to be in a cam walker or immobilized or perhaps on crutches, what is their balance? What is their strength level? Are they going to be able to do that successfully or is this going to pose additional challenges for them? We also need to look at bone health muscle strength as we do our surgical planning as well because these things will certainly then arise up as we get into the post-operative period and often intraoperatively as well.

We are going to focus too on first grade morphology as we start to look at surgical planning. That is a big issue. Probably the most common surgical procedures we perform are on the first metatarsal in first ray, and so, again, these factors of sarcopenia, of bone mass are going to impact upon that as well.

We're going to look at in our track also what's called RED-S, which is relative energy deficiency syndrome, which was renamed from the female athlete triad by the Olympic Committee in the early 2000s to reflect the fact that we are seeing these changes in males as well as in females. So we'll focus on that as well. And then we'll also look at the implications for sexual identity differences in our medical practice on a day-to-day basis, particularly as it relates to the diabetic patient.

All in all, we have a really fascinating track upcoming and something that will give you information to take back on Monday morning and to utilize in the office. And with that, I wish to thank you.