From the Editor: Focus on Feet

  A patient of mine developed a popular prescription drug that’s frequently advertised on TV. A brilliant physician who presented with plantar foot ulcers on both feet the first time we met, he claimed to have acquired the ulcers from walking on the hot, sandy beaches of his second home in the Bahamas. But he was baffled when I inquired about the etiology of his obvious peripheral neuropathy. “I just have a high pain tolerance,” he mused. I suggested undiagnosed diabetes, with other possibilities including B12 deficiency or too many martini lunches. Despite his brilliance, it took a lot of convincing for him to agree to total contact casting and checking his hemoglobin A1c. He now self-treats the diabetes he previously did not want to admit he lived with. His foot ulcers have healed with aggressive offloading.

Focus on Feet

  Given how difficult it was for me to “persuade” a fellow physician to get tested for diabetes, how can we expect to succeed with the average patient? We hope to help answer that question in this issue of Today’s Wound Clinic. In “Addressing Diabetes Control: What Clinicians Must Know” on page 8, Pamela Scarborough, PT, DPT, MS, CDE, CWS, CEEAA, and Jason Hardage, PT, DPT, DScPT, GCS, NCS, CEEAA, address the impact of diabetes on overall health, the impact of hyperglycemia on wound healing, and current treatment interventions. My patient was able to walk barefoot on hot sand without realizing the trauma to his feet because he did not have the “gift of pain,” a term coined by the late Paul Brand while he worked with leprosy patients in India. As an indicator that lets us know something is wrong, the value of pain becomes clearest in its absence. The great irony of peripheral neuropathy is that patients lose protective sensation even as they develop neuropathic pain. Podiatrist Richard Kobylar, DPM, reviews the pathophysiology of peripheral neuropathy and discusses the latest treatment modalities in “Treating Painful Neuropathy Associated With Diabetes” on page 17. Podiatrist Steven J. Lieberson, DPM, discusses what it takes to offload an ulcer to achieve healing and the options for long-term offloading of the diabetic foot in “Lower Extremity Ulcer Management: Practical Concepts” on page 14.

Constructive Collaboration

  There are many wonderful clinicians with whom I collaborate on a regular basis, but it becomes a challenge to keep lines of communication regarding patients and their care open the more people become involved in that care. Recently, I played “telephone tag” with a vascular surgeon, a hematologist, a rheumatologist, a cardiologist, a podiatrist, and an orthopedic surgeon over the course of one day. In our special feature article “Navigating the Inherient Dangers of Patient Referrals” on page 22, fellow TWC editorial board members Desmond Bell, DPM, CWS, and Moira Hayes, MHA, RRT, CHT, share personal experiences regarding the challenges they face when referring patients to other providers. We also provide the results of a survey that saw more than 500 TWC readers and SAWC attendees participate. Additionally, Kathleen D. Schaum, MS, addresses new Medicare Summary Notices in her “Business Briefs” column beginning on page 6. I easily realize how each of these articles is pertinent to patients I’ve seen just today. This further strengthens why we aptly call this journal Today’s Wound Clinic! Caroline Fife, co-editor of TWC, chief medical officer at Intellicure Inc., cfife@intellicure.com.