Kelly Ripa's Broken Foot

Yesterday Kelly Ripa came out to host her morning show with a walking boot on her left foot.  It turns out that the day before she "stepped wrong" on a weight left on the floor during her dance class.  She later found out that she broke multiple bones in her foot after hearing a "bubble wrap" sound.  She is told that she does not need surgery but will require 6 weeks of immobilization in the boot.  I am not sure whether or not she was joking but she says for her it will be "more like 3."

As a podiatrist who treats foot fractures, I find this interesting.  Fractures anywhere in the body take at least 6 weeks to heal.  So she is not going to cut down her time to 3 weeks unless she wants to have a non-healing fracture or even further damage that may require surgery.

I also found interesting her choice of a shoe for the other foot.  (Apparently she was advised to wear an appropriate shoe on the other foot and refused according to her discussion on her show). One does want to balance a walking boot with a shoe of equal height on the other foot, but she is not weight bearing yet.  She is wearing a fairly high heel on her right foot and I certainly worry about a foot or ankle injury on the right limb as well.

The National

Since Orlando is only a couple hours away, I was excited to see that the National Scientific Seminar of the American Podiatric Medical Association was to be held in Orlando this year.  I decided that I would attend my first national conference and just returned home to Spring Hill.  Podiatrists from all over the country came to Orlando this past weekend.  I must say I was very impressed with the conference.  I have, of course, attended many conferences more regional in the past, but this one was so much bigger.

In addition to well respected speakers, the exhibit hall was great.  I have again found products and services to make the practice and care I provide to my patients even better.  I am eager to get to the office Monday morning and get to work!

A Personal Milestone

I am the type of person who does my best to avoid bragging.  I really do not have an ego and consider myself a fairly humble guy.  However, I am also a person who has been blessed with many experiences throughout my life and enjoy reflecting on my life.  July 2015, specifically July 10, 2015, marks the completion of 10 years in private practice.

I hope readers of this blog will bear with me as I have a little fun and look back on these 10 years:

Indianapolis:
July 11, 2005 - August 2008

As a doctor fresh out of residency, this was a time to grow in my career.  Medical school and residency does not do a lot to prepare someone for private practice and I learned a great deal during my 3 years here.  Indianapolis is a wonderful city and my wife and I will certainly treasure our time here.

Pittsburgh:
September 2008 - October 2011

I specifically lived and worked a little south of the city in the West Mifflin area.  (About 6 miles south of downtown).  Growing up in NE Ohio (and a Cleveland sports fan), I was not raised to love Pittsburgh, but it is a unique and beautiful city.  With me being from Akron, and my wife being from Dubois, PA, this put us exactly in between and 100 miles away from each of our hometowns.  In Pittsburgh, I learned a lot about caring for patients in the hospital setting and wound care.  These are certainly valuable skills.  The surgeries I performed here completed my requirements for board certification which I achieved during the end of my time here.

Winter Haven (Polk County), Florida:
November 2011 - April 2013

You can see from the Pittsburgh picture that snow was always part of my winters.  I was thrilled to move to "Winter Haven" and haven't seen snow since.  I would say that my experience here was concentrated on "practice management."  Having learned the medicine part pretty well, this allowed me to focus on learning how to run a practice.  More than just billing and coding, but also providing valuable services that give patients great outcomes.

Spring Hill, Florida (Absolute Healthcare, LLC):

April 2013 - April 2015

Coming to Spring Hill and working with a multi-specialty group was invaluable.  I have a great deal of respect for Dr. Gaurav Malhotra.  Working with an MD helped me figure out where I fit in with the medical team to care for patients.  Having only worked with podiatrists in the past I missed different viewpoints.  Medicine is changing, the primary physician is going to direct care in the future to cut down costs and focus on prevention.  Though no one really knows exactly where we are headed with all of this, my time here allowed me to better determine my role in patient care within the medical team.

Spring Hill, Florida (Donald J. Adamov, DPM, PA):

May 2015 - Present

Never would have I imagined, as a young doctor going into work for the 1st time on July 11, 2005 in Indianapolis, that 10 years later I would be practicing in my own practice 1000 miles south in Florida.  I moved around a lot in those 10 years, but the experience I gained has been so important in the forming of the philosophy of the care I provide my patients.  I appreciate the trust that my patients have placed in me.  I never take the responsibility of caring for my patients lightly.



Pascal Dupuis

Most of the people that read my blog know I love to watch ice hockey, and also know that I especially like the Pittsburgh Penguins.  Today, the Penguins announced that winger Pascal Dupuis has a a "blot clot in his lung."  This is more specifically a pulmonary embolism.   A few months ago, I blogged about how American Idol contestant, Michael Johns, lost his life due to a pulmonary embolism.

The Penguins say that Pascal had chest pain and was evaluated and the embolism was found.  He apparently had a blood clot in his leg (DVT = deep vein thrombosis) that traveled to his lungs.  A DVT in the leg is, in and of itself, not the problem.  However, it can cause very painful leg swelling and inflammation.  The problem is if that blood clot breaks away and travels to the lungs it can be deadly.  Most people would go to the ER if they had trouble breathing, but people need to take sudden painful swelling in the leg just as seriously.  Immobilization after injury, as well as being seated for long periods of time (eg, a long airplane trip), can be a couple of the common causes.

Pascal will be unable to play hockey for at least 6 months as he will need to be on anti-coagulants, or blood thinners, for at least that time to prevent further clots.  As most of you know, hockey is a contact sport and blunt trauma and blood thinners are not a good combination.

The Penguins say that Pascal should be able to return to hockey.  Unfortunately, however, this is his second blood clot.  One has to wonder if he would want to risk coming off anti-coagulation as he is obviously prone to developing thrombi in this body.  I guess time will tell, but either way, he will have to closely watch for developing symptoms for the rest of his life.

5 common things medical professionals can overlook with treating the foot and ankle

To continue my "5 things" thoughts from earlier in the year, I want to focus on some of the things I see that medical professionals can commonly overlook when treating foot and ankle issues.  This list includes some things that I, myself, might not always have noticed at first glance as a podiatrist.

1) Poor circulation:  There is a common misconception, especially with general medical practitioners, that if one can feel a pulse and the foot is warm then the circulation is OK.  I have seen many patients that I have diagnosed with peripheral vascular disease in the lower extremity that has been overlooked by some pretty well-trained and respected clinicians.  Often times, these patients are told it is just their neuropathy or arthritis.  I always become suspicious when a patient admits cramping at night, when they have been or are a smoker, and when they have a history of cardiac bypass and stenting.  A simple doppler test that is abnormal can give an indication to me that can be followed up by other studies.

2) Stress fractures:  A stress fracture in the foot (usually a metatarsal) is often overlooked.  These can be "hairline" fractures caused from injury or non-traumatic simply from a change in activity.  Problem is, normal everyday x-rays usually do not show an early stress fracture.  These are read as negative by radiologists who do not have an opportunity to examine the patient.  (These studies are, in fact, negative most of the time).  I have treated true painful stress fractures for several weeks diagnosed clearly by MRI that not once showed up on regular x-rays.  If a patient comes in with a swollen foot more painful after activity, I tell my patients, "if it looks like a duck, and quacks like a duck, it's probably a duck."  In other words, if I think it is a stress fracture due to what I see, I can do little wrong by treating it as such with immobilization.  Usually, if a stress fracture is caught earlier it resolves more quickly.

3) Not giving an injection when appropriate:  With a lot of conditions we treat, injections are very helpful.  I often see, and was guilty of this earlier in my career, doctors with-hold injections in favor of conservative treatment.  This is fine, if after discussion with the patient, that is what is desired.  However, I have seen people who do not mind injections come in with severe heel or acute arthritis inflammation that have went to other doctors and were given very little treatment.  If appropriate, an injection of a corticosteroid can quickly and safely give a patient great relief.  There is nothing wrong with giving an injection on an initial visit if indicated.

4) Giving an injection when inappropriate:  On the other hand, I have seen injections given when they likely maybe should not have.  Fortunately, it is rare to cause significant harm from giving an injection, but doing so may delay resolution of the condition or frustrate a patient because other treatment is often not given and only temporary relief is gained.  A stress fracture is a perfect example.  A quality practitioner will often get a negative x-ray and inject a painful foot.  If a stress fracture is present, the corticosteriod can delay healing if injected in the area of the fracture.  Also, I have seen injections in areas that are debatable for injecting.  A good example is a tendon.  Corticosteroids can increase the risk of tendon damage and rupture.  Thankfully it is not common, but, in my opinion, conservative immobilization can often heal these patients without taking this risk.

5) Not advising a patient on footwear:  Especially here in Florida, flip-flops and flimsy shoes are common all year.  I have seen patients treated by more than one other doctor when no one talked to the patient about his or her shoes at all.  Many foot and ankle problems will not resolve if people do not at least change their shoes or shoe wearing habits a little.  Sometimes a change in shoes to something more supportive will be all it takes to alleviate foot pain.

So there is my list of "5 common things medical professionals can overlook with treating the foot and ankle."  Please keep in mind that good practitioners disagree on how to appropriately treat many conditions.  I do not make this list to criticize, but instead just highlight some things I have learned throughout my over 10 years of experience as a podiatrist.

MRSA from an Ingrown Toenail

A local football player is battling MRSA for the 2nd time.  The Tampa Bay Buccaneers have confirmed that their guard, Carl Nicks is again being treated for MRSA.  Media sources indicate that the initial cause was an ingrown toenail.

MRSA is an infection of Staph aureus that is found to be resistant to the antibiotic Methicillin.  The media makes the population fearful of MRSA but we do have antibiotics that can fight it.

Additionally, ingrown toenails can become bacterially infected and MRSA can be the cause.  It is important to point out, however, that most ingrown toenails can be treated in the office through excision and oral antibiotics.

As is true with most foot problems, any pain or problems are easier to address earlier rather than later.  I do not know what happened with Carl Nicks but I suspect his ingrown toenail became so infected that the bone in the toe got infected necessitating IV antibiotics.

The moral of the story: If you think you have an ingrown nail, see a podiatrist as soon as you are able for treatment.