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Updated: 1 hour 17 min ago

Diagnosing And Treating A Large Nevus With Irregular Borders On The Back Of The Heel

Tue, 09/26/2017 - 16:03
Issue Number: Volume 30 - Issue 10 - October 2017Author(s): Joseph Vella, DPM

A 38-year-old African-American male presented to the clinic with a complaint of a painful callus on his left fifth digit. On examination, however, there was a large nevus with irregular borders on the back of his right heel. Upon questioning, the patient stated he thought it had been there for a long time and wasn’t changing, but he wasn’t sure. He had no personal or family history of skin cancer.

Section: Dermatology Diagnosis

Current Insights On Neutral Casting And Biomechanical Exams For Orthotic Prescriptions

Tue, 09/26/2017 - 14:44
Issue Number: Volume 30 - Issue 10 - October 2017Author(s): Guest Clinical Editor: Robert D. Phillips, DPM

These expert panelists discuss the necessity of neutral casting for orthoses as well as what biomechanical exams to perform before prescribing an orthotic device.


Many people believe that the only requirement to make a good in-shoe orthotic is to take a neutral cast of the foot. Do you agree?

Section: Orthotics Q&A

Residency Corner: How To Address The Underperforming Resident

Fri, 09/01/2017 - 10:51
Issue Number: Volume 30 - Issue 9 - September 2017Author(s): Clinical Editor: David Bernstein, DPM, FACFAS; Panelists: Robert Eckles, DPM, MPH, Matthew G. Garoufalis, DPM, FASPS, FACFAOM, CWS, FFP, RCPC(Glasg)

These residency directors share their insights and discuss the role, impact and effectiveness of remedial programs to get residents back on track.


How do you address a disappointing performance by your resident?

Section: Online Exclusive

Reassessing The Diagnosis When Chronic Heel Pain Doesn’t Respond To Treatment

Thu, 08/31/2017 - 12:13
Issue Number: Volume 30 - Issue 9 - September 2017Author(s): Brian Fullem, DPM, FACFAS

This author discusses the need for additional imaging when a 55-year-old patient complained of worsening pain after getting extracorporeal shockwave therapy (ESWT) for plantar fasciitis and flexor hallucis longus tendonitis. 

Section: Online Exclusive

Diagnosing And Treating Primary Malignant Melanoma In The Hallux

Thu, 08/31/2017 - 10:52
Issue Number: Volume 30 - Issue 9 - September 2017Author(s): Ronald Troxell, DPM, Jared Cicero, DPM, and Zachary Ogden, DPM

Noting the danger of misdiagnosis, these authors discuss the diagnosis and treatment of primary malignant melanoma in the hallux in a 94-year-old patient.

Section: Online Exclusive

A Few Memorable Quotes After More Than 35 Years In Podiatry

Thu, 08/24/2017 - 14:54
Issue Number: Volume 30 - Issue 9 - September 2017Author(s): George Wallace, DPM

I graduated from podiatry school over 35 years ago and there have a variety of memorable quotes along the way. The quotes below are probably the best. They are from me, patients, attendings, residents, students, and others I have encountered along the way. It’s funny how you are able to remember them, yet I couldn’t tell you what I had for dinner last Sunday.

• “Doc, the first 99 years are the toughest. After that, it’s a piece of cake.” — A patient

• “Bones in the same room will heal.” — An attending

• “Partners are for dancing.” — An attending

Section: Forum

Software Provides All-In-One Practice Management Solution

Thu, 08/24/2017 - 14:45
Issue Number: Volume 30 - Issue 9 - September 2017Author(s): Robi Garthwait, Contributing Editor

Section: Technology In Practice

Emerging Concepts In Treating Freiberg’s Infraction

Thu, 08/24/2017 - 13:57
Issue Number: Volume 30 - Issue 9 - September 2017Author(s): Bob Baravarian, DPM, FACFAS, and Laura Bohman, DPM

Section: Treatment Dilemmas

A Review Of Soccer Shoes For Adolescent Athletes

Thu, 08/24/2017 - 13:53
Issue Number: Volume 30 - Issue 9 - September 2017Author(s): Jenny Sanders, DPM

With the explosion in participation in youth soccer in recent decades, becoming more familiar with soccer shoes will help podiatric physicians advise patients on preventing lower extremity injuries. This author provides a guide to soccer shoe anatomy, field conditions and fitting shoes.

Section: Feature

Point-Counterpoint: Is First Ray Hypermobility A Myth Or Reality With Hallux Valgus?

Thu, 08/24/2017 - 13:25
Issue Number: Volume 30 - Issue 9 - September 2017Author(s): Brett J. Waverly, DPM, AACFAS, Sarah E. Haller, DPM, AACFAS, and Lowell Weil, Jr., DPM, MBA, FACFAS; Neal Blitz, DPM, FACFAS, and Adel Aitali, DPM Myth.

These authors argue that first ray hypermobility is a result of a bunion deformity and not its cause, and assert that the term “instability” is more accurate.   

By Brett J. Waverly, DPM, AACFAS, Sarah E. Haller, DPM, AACFAS, and Lowell Weil, Jr., DPM, MBA, FACFAS

Section: Feature

Current Concepts In Treating Acute And Chronic Toenail Injuries In Runners

Wed, 08/23/2017 - 13:32
Issue Number: Volume 30 - Issue 9 - September 2017Author(s): Kristine Hoffman, DPM, FACFAS, and Jamie Mieras, DPM, FACFAS

Paronychias, subungual hematomas and nail bed lacerations are all toenail injuries that can bedevil runners after a race. These authors provide a practical guide to treating these injuries and their possible complications.

Section: Feature

Preventing Complications Of Plantar Plate Repair

Wed, 08/23/2017 - 11:45
Issue Number: Volume 30 - Issue 9 - September 2017Author(s): Erin E. Klein, DPM, MS, FACFAS and Lowell Weil, Jr., DPM, FACFAS

Sharing insights from their experience as well as the emerging literature on plantar plate surgery, these authors examine current controversies over the alleged association between second metatarsal length and plantar plate pathology, review the benefits of the dorsal approach and offer step-by-step pearls to help thwart potential complications.

Section: Feature

Are You Getting A Custom Orthotic From The Lab?

Wed, 08/23/2017 - 11:05
Issue Number: Volume 30 - Issue 9 - September 2017Author(s): Craig Payne, PhD

When the lab sends back an orthotic based upon your custom orthotic prescription, is it truly a custom orthotic that meets the specific needs of the patient? Drawing upon his experience, this author discusses compromises that may happen at the orthotic laboratory and what steps podiatrists can take to cast orthoses more accurately.

Section: Feature

Addressing Multiple Failed Attempts At First Ray Surgery

Wed, 08/02/2017 - 15:10
Issue Number: Volume 30 - Issue 8 - August 2017Author(s): Jakob C. Thorud, DPM, MS, FACFAS, Himani Patel, DPM, John Yuhas, DPM, and Evangelos Kyprios, DPM

Emphasizing the importance of a contingency plan, these authors discuss revision surgery for a patient who had two bunionectomies, a first metatarsophalangeal joint fusion and subsequent hardware removal.

On occasion, surgery in everyone’s hands does not meet the expected results. Every surgeon should have a contingency plan should these complications or failures occur.

Section: Online Exclusive

Residency Corner: What Third-Year Residents Would Recommend To First-Year Residents

Mon, 07/31/2017 - 10:43
Issue Number: Volume 30 - Issue 8 - August 2017Author(s): Clinical Editor: David Bernstein, DPM, FACFAS; Panelists: Alaa Mansour, DPM, Michael Reed, DPM, and Alexandra Scrimalli, DPM

These third-year residents advise their younger peers on how to navigate and maximize their first year of residency.


What did you do in your first year of residency to improve your knowledge level? In retrospect, what would you have done differently?

Section: Online Exclusive

Managing Complications With A Failed Tendo-Achilles Allograft

Mon, 07/31/2017 - 09:37
Issue Number: Volume 30 - Issue 8 - August 2017Author(s): H. John Visser, DPM, FACFAS, Jesse Wolfe, DPM, Robert Schergen, DPM, Anne Maestas, DPM, and Neil Ermitano, DPM

These authors discuss the use of tendon transfers and Achilles tendon resection for a 56-year-old patient who presented with drainage and dermatitis after receiving an allograft for an injury to the Achilles tendon.

Section: Online Exclusive

How Long Will The Podiatric Myths Of The Midtarsal Joint Survive?

Thu, 07/27/2017 - 11:05
Issue Number: Volume 30 - Issue 8 - August 2017Author(s): Kevin A. Kirby, DPM

The midtarsal joint is probably one of the least understood but most important joints of the human foot. During daily weightbearing activities, the midtarsal joint must be compliant enough to allow the foot to adapt to uneven terrain and stiff enough to allow the powerful gastrocnemius and soleus muscles to push the body efficiently forward off the plantar forefoot. The ability of the midtarsal joint to biomechanically optimize the load versus deformation characteristics of the foot is what makes this pedal joint such an important part of the human bipedal locomotor apparatus.

Section: Forum

What Your Practice Can Learn From The Anatomy Of A Mega Group Podiatry Practice

Thu, 07/27/2017 - 10:42
Issue Number: Volume 30 - Issue 8 - August 2017Author(s): Kevin C. McDonald, DPM, and Todd Maccoy

Economic and regulatory changes in the American healthcare system have created a challenging environment for small to midsize private podiatry practices. It is difficult to have pricing power when the majority of our patients have either government-controlled health insurance or private insurance offered by a dwindling number of companies that seem to show favor to larger entities.

Section: Practice Builders

Treating Occult Stress Fractures In Athletes

Thu, 07/27/2017 - 10:36
Issue Number: Volume 30 - Issue 8 - August 2017Author(s): A. Douglas Spitalny, DPM, FACFAS

At Ft.

Section: Sports Medicine

Billing Pitfalls: How To Avoid An Audit

Thu, 07/27/2017 - 09:12
Issue Number: Volume 30 - Issue 8 - August 2017Author(s): Anthony Poggio, DPM

No podiatric practice wants to risk the hassle and stress of an audit. This author provides advice on keeping your documentation in order to avoid an audit, including the correct use of modifiers and ensuring accurate coding for new technology and durable medical equipment.

Section: Feature