lateral ankle ligaments
The term sprain refers to an injury of the ligaments of the ankle. 10 to 1 that injury occurs on the lateral or outside aspect of the ankle. The lateral ankle is supported by a much weaker network of ligaments that often fail to support the ankle as your body weight move over the ankle.
One of the often overlooked aspects of ankle sprains is the position of the heel at heel strike. If the heel is inverted at heel strike, the body’s center of gravity is thrown to the outside of the ankle setting up the stage for an ankle sprain.
For more information on ankle sprains, please check out our knowledge base pages on ankle sprains or join us in The Foot Talk Forum.
Jeffrey Oster, DPM
Medical Director
Myfootshop.com
Is scar tissue always bad tissue? I think scar tissue has traditionally been thought of as a post-operative or post trauma problem. But surgeons will often use scar tissue as a tool to rebuild damaged tissue.
One example of this technique in foot and ankle surgery is using scar tissue to rebuild the anterior talo-fibular ligament (ATF) in a Brostrom lateral ankle surgery. Surgeons rely on adjacent tissue structures to repair the damaged ATF.
Brostrom lateral ankle stabilization
For more information on this technique visit the Myfootshop.com knowledge base pages on lateral ankle sprains and this discussion in The Foot Talk Forum.
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
Whether a fracture is surgically induced or the result of trauma, fractures can heal more slowly than expected. We’ll expect most fractures to heal in a period of 6-8 weeks. But what if fracture healing takes a bit longer?
If a fracture is not healed in 6 months, we begin to view the fracture as a delayed union. Delayed unions have all the cellular potential to heal and can heal over time with just a little help.
If the presence of the fracture is still found at 12 months, we then term the fracture a non-union. Non-unions can be viewed as a fracture where the body just ran out of time and energy in its’ attempt to heal. Non-unions do need a bit of help healing.
For more information on delayed unions and non-union of bone, please join us in this discussion in The Foot Talk Forum on Myfootshop.com.
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
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Takeda Pharmaceuticals of Osaka, Japan won FDA approval yesterday to market a new uricosuric agent in the US market for the treatment of gout. The drug will be marketed as Uloric (febuxostat) and will be marketed as an alternative to allopurinal.
I’ve prescribed allopurinal for years with no ill effects. My question is this; what are the benefits of Uloric? As a new patented medication, Uloric is sure to cost much more than generic allopurinal. I think the jury is still out.
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
Charcot arthropathy is commonly associated with diabetes. But diabetes only represents one of many ways in which the normal sensation to the foot is disrupted. This disruption of normal sensation is called peripheral neuropathy (PN). Other common contributing factors to PN include lumbar radiculopathy (lumbar pain), lumbar surgery, alcohol abuse or chemotherapy. PN diminishes the ability to feel pain. As a result of this loss of sensation, patients undergo micro-fractures that propagates within the the bone adjacent to the joints of the midfoot or ankle.
What’s the standard of care for Charcot arthropathy? In newly diagnosed cases, the standard of care is prompt off-loading of the foot. The diagnosis of Charcot arthropathy does require a high degree of suspicion on the part of the physician and is an often overlooked diagnosis.
But what about long term management of Charcot arthropathy? That’s where the standard of care is poorly defined. Will reconstructive surgery help? When is amputation indicated?
I think we have a lot to learn about the long term management of Charcot arthropathy. But most importantly, the bottom line is to prevent the onset of PN in the first place.
Jeffrey Oster, DPM
Medical Director
Myfootshop.com
In the early stages of a sesamoid injury, it can be difficult to differentiate between these conditions. Remember, when I say injury, it’s not necessarily a fall or abrupt injury that can lead to sesamoid injuries. Many cases are simply due to foot structure that makes you predisposed to sesamoid injury.
Join us in this discussion on sesamoid injuries in The Foot Talk Forum for more information. You can also find more information in our pages on sesamoiditis and sesamoid injuries.
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
I’ve worked in a lot of hospitals. And I’ve worked in a lot of medical offices. And in each location, the services provided create a record. So who owns that record? That’s the question that is at stake as we move towards the integration of medical records.
Ask a hospital administrator. They’ll puff up their chests and tell you how imperative it is to continuity of care that the hospital own and preserve the record. Why it’s their lab that cultured the bacteria. And their scanner that diagnosed the tumor. It’s only logical that the hospital maintain the patient record. Why they’re the only entity that would be capable of doing so, right?
Or ask any doctor. They’ll tell you hands down that the record stays in their office. “How would I defend myself in a malpractice case without the original record?” And they would have a good point. But wait a minute. Let’s see. Who’s that other party that’s part of the health care equation? Oh yeah; the patient. How could I have forgotten the patient.
Ultimately, if there is to be one party who owns and is to be responsible for their comprehensive medical record, it’s the patient. Now don’t conjure up images of patients with lose pieces of paper and notebooks with test results in tatters. There’s so many web based alternatives for patients to use. And the one that will rise to the top? The one alternative for medical health records that will become the universal medical record? Google Health.
We’re going to spend the next few years hearing from the pontiffs of the major medical organizations about how they feel a universal medical record should be handled. But if you know anything about web 2.0, you know that simple, open source applications are what will prevail in the long run. And Google Health is just that. Google Health doesn’t want to take ownership of your individual medical record. It simply wants to act as the repository for your record. And quite honestly, I think Google has proven themselves over time to be pretty darned good at data management.
Google Health. It’s simple and eloquent. And just waiting for its’ day.
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
There’s been a lot in the news as of late regarding the virtues of adding on-line Rx (prescription) capabilities to your electronic medical record. Sounds like a good idea, right? But what’s the reality adding on-line prescribing capabilities to your solo practice?
To answer that question I called my EMR vendor (Eclipsys) to get a bit more information. Granted, many of these programs are new. And there are (in theory) some advantages for both patient and doctor. For instance, if I write an Rx and submit it to the pharmacy, the Rx program at the pharmacy will cross reference the script with those approved medications on the patient’s insurance formulary. Also, the program will cross reference the medication that I am prescribing against the other medications that the patient is taking, picking up any cross reactions between medications. Sounds pretty effective, eh?
Now let’s take a step into my practice. Face to face time with patients is limited due to the need to see more patients. That’s simply a fact. As reimbursement drops, you need to see more folks/day to be able to meet the overhead. The light bill, salaries and the rent keep going up while reimbursement to providers keeps going down. So what happens if I add a new module to my daily routine?
First, when I submit a script to the pharmacy, the neat functions we just alluded to above take upwards of 60 seconds to process. The database that the script has to access is vast and just simply takes time to process. Now remember, here you’re asking the top producer in the office to sit and wait a minute. 30 patients a day with a script each? That’s a half hour a day. Is on-line Rx worth that? No can do.
Next is the cost. Eclipsys charges $495/year for the module to accomplish what we’ve described above. Now let me get this straight; I’m in solo practice aka small business. I can write a script on my EMR for free. That script is type and legible. And did I say, free? So if you were in small business, what choice would you make?
Don’t get me wrong, I’m for EMR. I’m a technophile at heart. But it’s going to be a cold day before I buy into on-line Rx.
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
There’s a good article in iHealthBeat today that calls for focus on sharing of information between providers. The report from Government Health IT calls for a move away for IT development towards a focus on sharing information. The article states,
Merely creating EHRs doesn’t give doctors and other health care providers any incentive to use those records or add updated information to them, the report states. “We need to incent the use of the information,” said Kristine Anderson of Booz Allen Hamilton, one of the report’s authors. “It just won’t happen naturally. We believe public payers can lead this charge” by offering providers incentives to share information, Anderson added.
As a physician, I see a couple of issues here. First, an incentive. That’s code for we’re going to pay you less unless you conform to our new system. I’ve been down that road a number of times before.
Physicians aren’t used to sharing. And there’s a number of historical reasons why. First, other doctors may represent competition to my ability to earn a livelihood. Second, there’s an issue of competence. Do I want to share my treatment with another doctor who I feel is less capable of providing the same care to ‘my patient’?
My patient. What does that mean? It means that we take ownership of care. A good physician vests themselves in the care of their patient sharing in the successes and failures of care. From a philosophical basis, it’s going to be hard for a doctor to not take ownership of the people for whom they treat.
It may not sound like it, but I’m behind these changes. I currently use an EMR but I’m also a vocal advocate for my patients. There I go again…my patients. I might have to just get over it.
Jeff
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
One of the keys to Mr. Obama’s proposed economic stimulus plan is to push money into the economy where it can work quickly. We saw with the financial sector bailout that the money given to the financial sector was used to prop up the banking industry and never made it out into the general circulation. From an article in Politco, it seems Mr. Obama’s health care restructuring plan is to use Medicaid as a tool to accomplish a number of goals.
The first goal would be to float and estimated $700 billion into the economy through Medicaid. These payments would be made to doctors and hospitals based upon the traditional fee for service method we now have in place.
The second goal would be to aid the states who are now crippled by a Medicaid burden they can no longer sustain. An influx of federal funds into the state coffer via Medicaid would be a welcome relief to all states.
And lastly, the third goal would be to benefit the general population through improving health. The Medicaid plan may not be perfect but it’s a good place to start. Sure, we need to fix this system. But more importantly, we need to fix the economy. And heck, why not save a few lives while we’re at it.
So the big question is whether it’ll work. As a doctor, I’ve contemplated the collapse of the US health care system. You have to realize that the majority of the health care system is now dominated by publicly held companies. The share holders of those companies will only stay the course for so long if their investments in health care start to drop. If we saw a mass exodus from health care by those investors, we’d be seeing the next economic bail out. That’s right, a bail out of the health care sector.
I’m no economist. But as a doc, I like Mr. Obama’s proposal. And yes, I think it will have a positive impact on my practice.
Jeff
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
