Category: P

Podiatric surgery integration

Posted on April 17, 2023 by Steve - P

Podiatric surgery has increasingly integrated with other specialties and mainstream hospital systems around the world in recent years. This integration has been driven by the growing recognition of the importance of foot and ankle health in overall patient care and the need for a multidisciplinary approach to managing foot and ankle conditions. Here are some ways in which podiatric surgery has integrated with other specialties and mainstream hospital systems:

Collaborative care models: Podiatric surgeons often work collaboratively with other healthcare providers, such as orthopedic surgeons, vascular surgeons, plastic surgeons, dermatologists, endocrinologists, and other specialists, as part of a multidisciplinary team approach to managing complex foot and ankle conditions. This collaborative care model allows for comprehensive evaluation, diagnosis, and treatment planning, leading to better patient outcomes.
Inclusion in hospital systems: Podiatric surgery has been increasingly integrated into mainstream hospital systems, with podiatric surgeons gaining privileges to perform surgical procedures in hospitals alongside other surgical specialties. This integration allows for streamlined patient care, access to advanced surgical facilities, and coordination with other medical services, such as radiology, pathology, and anesthesia.
Education and training: Podiatric surgeons receive extensive education and training in foot and ankle surgery, which is on par with other surgical specialties. This has helped establish podiatric surgery as a recognized specialty within the broader surgical community, leading to increased collaboration and integration with other specialties in hospital systems. Podiatric surgeons may also participate in interdisciplinary conferences, seminars, and workshops to enhance their knowledge and skills and foster collaboration with other specialties.
Research and innovation: Podiatric surgeons contribute to research and innovation in foot and ankle surgery, leading to advancements in surgical techniques, implant technology, and treatment protocols. This research is often published in peer-reviewed journals and presented at national and international conferences, fostering collaboration and integration with other specialties.
Patient-centered care: The focus on patient-centered care has also led to increased integration of podiatric surgery with other specialties. Many foot and ankle conditions, such as diabetic foot ulcers, Charcot arthropathy, and peripheral arterial disease, require a multidisciplinary approach involving podiatric surgeons, vascular surgeons, endocrinologists, and other specialists to provide comprehensive care to the patient.
Improved patient outcomes: The integration of podiatric surgery with other specialties has been shown to improve patient outcomes. Collaborative care models, inclusion in hospital systems, and interdisciplinary approaches allow for better coordination of care, leading to more accurate diagnoses, optimal treatment plans, and improved patient outcomes.

In summary, podiatric surgery has integrated with other specialties and mainstream hospital systems around the world through collaborative care models, inclusion in hospital systems, education and training, research and innovation, patient-centered care, and improved patient outcomes. This integration has facilitated a multidisciplinary approach to foot and ankle health, leading to better patient care and outcomes.

Surgery considerations for patients with Parkinson’s disease

Posted on April 17, 2023 by Steve - Neurology, P, S

Parkinson’s disease (PD) is a chronic neurodegenerative disorder that affects movement and is characterized by symptoms such as tremors, rigidity, bradykinesia (slowness of movement), and postural instability. When patients with Parkinson’s disease undergo surgery, there are several perioperative considerations that need to be taken into account to optimize their care and minimize potential complications. Some of these considerations include:

Medication management: Patients with Parkinson’s disease often require ongoing medication management to control their symptoms. During the perioperative period, it is essential to carefully manage their medications, including levodopa, dopamine agonists, and other anti-parkinsonian medications. Abrupt discontinuation of these medications can result in worsening of Parkinson’s symptoms, including rigidity, tremors, and bradykinesia. The timing and dosing of medications may need to be adjusted in consultation with the patient’s neurologist or movement disorder specialist to ensure optimal control of Parkinson’s symptoms during and after surgery.
Parkinson’s disease-specific symptoms: Parkinson’s disease can present with a variety of symptoms that may affect perioperative care. For example, patients with Parkinson’s disease may have difficulty with mobility, balance, and coordination, which can increase the risk of falls and injuries during the perioperative period. Close attention should be paid to fall prevention strategies, including providing assistance with ambulation and mobilization, using appropriate assistive devices such as walkers or canes, and minimizing environmental hazards.
Anesthesia considerations: Patients with Parkinson’s disease may be more susceptible to adverse effects of anesthesia due to their impaired motor function, autonomic dysfunction, and potential drug interactions with their anti-parkinsonian medications. Anesthesia choices should be made carefully, taking into consideration the patient’s individual needs and the potential impact on Parkinson’s symptoms. Regional anesthesia techniques, such as spinal or epidural anesthesia, may be preferred over general anesthesia in some cases to minimize the risks associated with anesthesia.
Postoperative care: Postoperative care for patients with Parkinson’s disease should focus on optimizing their recovery and managing their Parkinson’s symptoms. Early mobilization, physical therapy, and occupational therapy may be important components of the postoperative care plan to improve functional outcomes and reduce the risk of complications such as pneumonia, pressure ulcers, and deep vein thrombosis. Medication management should be resumed promptly postoperatively, and any adjustments should be made in consultation with the patient’s neurologist or movement disorder specialist.
Multidisciplinary approach: Managing perioperative care for patients with Parkinson’s disease often requires a multidisciplinary approach involving coordination among the surgical team, anesthesiologist, neurologist or movement disorder specialist, physical and occupational therapists, and nursing staff. Close communication and collaboration among the different healthcare providers involved in the care of the patient can help ensure optimal perioperative management and outcomes.
Parkinson’s disease-specific complications: Patients with Parkinson’s disease may be at increased risk of certain complications during the perioperative period. For example, they may be more prone to develop postoperative delirium or cognitive impairment, which may require close monitoring and management. Additionally, some anti-parkinsonian medications may interact with other medications used during the perioperative period, leading to potential adverse effects or drug interactions. Careful consideration of the patient’s overall medical condition and medication regimen is crucial to minimize these risks.

In conclusion, perioperative care for patients with Parkinson’s disease requires careful consideration of their individual needs, Parkinson’s disease-specific symptoms, medication management, anesthesia choices, postoperative care, and a multidisciplinary approach. Close collaboration among the healthcare team and proper coordination with the patient’s neurologist or movement disorder specialist are essential to optimize perioperative care and minimize potential complications.

Polymetatarsia

Posted on March 15, 2023 by Steve - Accessory bones, P, Uncategorised

Polymetatarsia is a rare condition in which there are more than five metatarsal bones in the forefoot. The most common type of polymetatarsia involves an additional metatarsal bone between the fourth and fifth metatarsals, which is called a “supernumerary metatarsal.” This extra bone can cause pain, discomfort, and difficulty with shoe fitting.

Polymetatarsia may be congenital (present at birth) or acquired (due to injury or disease). It can be diagnosed through physical examination, X-rays, and other imaging studies. Treatment options include wearing custom orthotics or padding to relieve pressure on the foot, modifying shoes to accommodate the extra bone, or surgical removal of the supernumerary metatarsal. The best treatment option depends on the individual’s symptoms and the severity of the condition.

Progressive collapsing flatfoot deformity – Classification system

Posted on March 15, 2023 by Steve - Classification systems, Hindfoot, P

Progressive collapsing flatfoot deformity can be classified according to the severity of the deformity, as well as the underlying cause. There are several classification systems used by healthcare providers to describe the different stages of the condition. Here are two common classification systems:

Johnson and Strom’s classification system:

Stage I: The foot is flat when bearing weight, but the arch returns when the foot is lifted off the ground.
Stage II: The arch does not return when the foot is lifted off the ground, but the foot is still flexible.
Stage III: The foot is rigid, and there is significant arthritis and deformity.

Myerson’s classification system:

Stage I: The hindfoot is in a valgus position (tilted outward) and the arch is slightly flattened.
Stage II: The hindfoot is in a valgus position, the arch is more severely flattened, and there is evidence of instability in the ankle joint.
Stage III: The hindfoot is in a valgus position, the arch is severely flattened, and there is significant ankle joint arthritis.

The classification system used will depend on the healthcare provider’s preference and the specific needs of the patient.

Progressive collapsing flatfoot deformity

Posted on March 15, 2023 by Steve - P

Progressive collapsing flatfoot deformity is a condition in which the arch of the foot gradually collapses over time, causing the foot to become flatter and longer. This condition is typically caused by a combination of factors, including genetics, obesity, injury, and age.

As the arch of the foot collapses, the foot becomes less stable, which can lead to pain and discomfort in the foot, ankle, and lower leg. Other symptoms may include swelling, stiffness, and aching in the foot and ankle.

Treatment for progressive collapsing flatfoot deformity may include a combination of non-surgical and surgical approaches. Non-surgical treatment may include rest, ice, compression, elevation, physical therapy, and the use of supportive footwear and orthotics. Surgical treatment may be recommended in cases where non-surgical methods are not effective, and may involve procedures such as tendon transfers, bone realignment, or fusion.

If you are experiencing symptoms of progressive collapsing flatfoot deformity, it is important to consult with a healthcare provider for proper diagnosis and treatment recommendations.

Polydactyly

Posted on March 14, 2023 by Steve - P, Paediatrics

Polydactyly is a genetic condition characterized by the presence of extra fingers or toes on a person’s hands or feet. Instead of the typical five digits on each hand or foot, a person with polydactyly may have six, seven, or even more digits. The extra digits can be fully formed and functional or they may be small, non-functional nubs.

Polydactyly can be inherited in an autosomal dominant pattern, meaning that a child has a 50% chance of inheriting the condition if one parent carries the gene. In some cases, however, polydactyly can occur spontaneously as a random mutation.

Polydactyly is usually not a serious medical condition, and many people with the condition are able to live normal, healthy lives without any problems. In some cases, however, surgery may be necessary to remove the extra digits if they are causing problems with mobility or other issues.

Pott’s fracture

Posted on March 10, 2023 by Steve - Ankle, Fractures, P

Pott’s fracture, also known as a bimalleolar ankle fracture, is a type of ankle fracture that involves the tibia and fibula bones. It is typically caused by a twisting injury or direct trauma to the ankle.

In a Pott’s fracture, both the medial malleolus (the bony protrusion on the inner side of the ankle) and the lateral malleolus (the bony protrusion on the outer side of the ankle) are fractured. This can cause significant pain, swelling, and difficulty bearing weight on the affected foot.

Treatment for Pott’s fracture typically involves immobilization of the ankle with a cast or brace to allow the bones to heal. In some cases, surgery may be necessary to realign and stabilize the fractured bones. Rehabilitation and physical therapy may also be necessary to regain strength and mobility in the affected ankle.

If left untreated or improperly treated, a Pott’s fracture can lead to long-term complications such as chronic pain, instability of the ankle joint, and an increased risk of developing arthritis in the ankle.

When is it time to see a podiatrist?

Posted on March 9, 2023 by Steve - Frequently asked questions, P

A podiatrist is a healthcare provider who diagnoses and treats conditions related to the feet, ankles, and lower legs. Here are some signs that it may be time to see a podiatrist:

Foot or ankle pain: If you are experiencing pain in your feet or ankles that is not improving with rest or over-the-counter pain medications, it may be time to see a podiatrist. They can help diagnose the cause of the pain and recommend appropriate treatments.
Changes in the appearance of your feet or nails: If you notice any changes in the appearance of your feet or nails, such as discolouration, swelling, or abnormal growths, it may be a sign of an underlying condition that requires treatment.
Foot or ankle injuries: If you have suffered an injury to your foot or ankle, such as a sprain, strain, or fracture, a podiatrist can provide treatment and rehabilitation to help you recover.
Difficulty walking or performing daily activities: If you are experiencing difficulty walking or performing daily activities due to foot or ankle pain or other issues, a podiatrist can help determine the cause of the problem and recommend appropriate treatment.
Chronic conditions: If you have a chronic condition such as diabetes or arthritis that affects your feet, it’s important to see a podiatrist regularly to monitor for any complications and manage your symptoms.

Overall, if you are experiencing any problems or concerns related to your feet, ankles, or lower legs, it’s a good idea to see a podiatrist. They can help diagnose and treat a wide range of conditions and provide recommendations for maintaining good foot health.

Puncture wounds of the foot

Posted on March 9, 2023 by Steve - P

Puncture wounds in the foot can occur when a sharp object penetrates the skin, such as stepping on a nail or a piece of glass. These types of injuries can be particularly dangerous because the object may carry bacteria or other harmful organisms that can cause infection.

Symptoms of a puncture wound in the foot may include pain, swelling, redness, and bleeding. In some cases, a puncture wound may also cause a feeling of numbness or tingling in the affected area.

If a puncture wound occurs, it is important to clean the wound thoroughly with soap and water and apply an antiseptic solution to prevent infection. In some cases, a tetanus shot may be necessary if the person has not had one in the past 10 years or if the wound is particularly deep or contaminated.

In addition to cleaning the wound, it is important to seek medical attention to evaluate the extent of the injury and determine if further treatment is necessary. This may include removing any foreign objects that are still embedded in the foot, prescribing antibiotics to prevent infection, and administering a tetanus shot if necessary.

It is also important to monitor the wound for signs of infection, such as redness, swelling, warmth, or drainage. If these symptoms occur, it is important to seek medical attention promptly to prevent the infection from spreading.

Overall, puncture wounds in the foot can be serious injuries that require prompt treatment and monitoring to prevent complications. Taking steps to prevent these types of injuries, such as wearing appropriate footwear and being mindful of potential hazards, can also help reduce the risk of puncture wounds in the foot.

Psoriatic nails

Posted on March 9, 2023 by Steve - Dermatology & nail pathology, P

Psoriatic nails are a common symptom of psoriasis, a chronic autoimmune skin condition that affects the nails, skin, and joints. Psoriatic nails can cause a variety of changes to the nails, including pitting, ridging, thickening, discolouration, and separation of the nail from the nail bed.

The severity of psoriatic nail involvement can vary from person to person, and in some cases, it can lead to functional impairment and pain. Psoriatic nail changes can also be a sign of more severe psoriasis and may indicate an increased risk of joint involvement.

Treatment of psoriatic nails may include topical and/or oral medications, depending on the severity of the symptoms. Topical corticosteroids, vitamin D analogues, and retinoids may be used to treat mild to moderate cases of psoriatic nails. In more severe cases, systemic medications such as methotrexate, cyclosporine, or biologics may be necessary.

It is important for people with psoriatic nails to take good care of their nails and to see a dermatologist or podiatrist regularly for treatment and monitoring. This may include keeping the nails clean and dry, avoiding trauma to the nails, and wearing protective gloves when working with chemicals or doing other activities that could damage the nails.

Overall, psoriatic nails can be a chronic condition that requires ongoing treatment and management to control symptoms and prevent complications. Working with a healthcare provider can help develop an individualised treatment plan that meets the specific needs of the patient.