Orthotics

As a common conservative practice to help treat ailments of the foot a Podiatrist may prescribe custom made orthotics as a great way to maintain control and balance of normal foot motion in the face of abnormality.

They will start by obtaining an impression cast. Plaster, as seen here, is the most common technique.

Orthotics come in many shapes, sizes, and materials. Depending on the role for which an orthotic is prescribed, an orthotic can be made to reduce frictional forces in sports training, take control of weak ankles, or even correct congenital deformities like in-toeing in small children.                                                                                                           A few indications for orthotics include:

 MMany orthotics are fabricated at this shop. Here the empty polypropylene plates are piled in the corner of the workshop.

Next the shell is given an arch-filler that is semi-rigid for cushioning and stability, and a post on the outer edge to help simulate the actual shape of my foot while standing or in motion.

This pair of orthotics is finished off with a top cover made of Spenco (neoprene with a fabric cover) which disperses shearing forces and provides shock absorption. This kind of top cover would be good for athletes, and/or to decrease callus and blister formation.

The finished product.

Yesterday I submitted my externship papers to the college with the program names where I will be attending and spending five months of my 4^th year. Externships are similar to Internships in that they provide hands on training and exceptional learning opportunities but are usually shorter and offered by learning institutions to give the students 5-6 months of clinical experiences in their field of study before graduation.

          Of the more than 225 Podiatry Residency programs that offer externships, the five that I have applied to and been accepted at are:

·       University of Pittsburgh Medical Center

·       Legacy Health/Kaiser Permanente, Portland, Oregon

·       Cleveland Clinic/Kaiser Permanente, Ohio

·       Highlands/Presbyterian St Luke’s, Denver, Colorado

·       Ohio State University Medical Center

          Responsibilities required of the Podiatry student include:

·       Travel to and reside for 1 month at each program

·       Shadow Residents and Attending Physicians in clinic and surgery

·       Take ER calls along with the Residents

·       Attend and participate in journal club, trauma conference, radiology conference, and grand rounds

·       Present a PowerPoint presentation on a chosen topic

It is during these externships that both the student and the host have the chance to observe one another on a very close basis. This provides the student with an idea of which program he/she would like to attend, at the same time a source of networking contacts that may translate over to acceptance of a residency program directly after graduation. 

Instead of banging pots and pans and lighting off firecrackers for the New Year, or should I say dancing in the ball room and bibbing wine from his goblet, King Henry VIII during the festivities in 1541 spent his time in bed and apart from his 5^th wife Catherine Howard. According to historians King Henry VIII slunked off to bed with an acute presentation of Gout which often presents with enough pain and heat in the affected area that even bed sheets may seem too much for comfort.

           Likewise, the patient I recently helped treat at a local ER as part of my 3^rd year rotation presented with these exact symptoms in his big toe (the most common joint affected in the body) and was diagnosed with Acute Gouty Arthritis after a few tests showed positive results.           

           Tests look for an elevated uric acid blood level and monosodium urate crystals in the joint fluid (examined under a special light microscope).

            Precipitating factors of gout include:

                        -High purine foods

·         All meats, including organ meats and seafood

·         Beer and other alcoholic beverages

·         Beans, peas, spinach, asparagus and mushrooms

                        -Obesity

-Genetics

                        -Kidney disease

                        -Thiazide and Loop diuretics

                        -Males (20:1 M:F ratio)

                        -Age > 30 in males; postmenopause in females

*For treatment modalities and other information click the button "Patient Education" on the home page and type the key word "Gout" in the search bar at the bottom left.

Although running and walking provide the same function for each individual person, no two persons gait cycles are the same. Just like ones’ own personal DNA, our gait is a macroscopic picture of the near microscopic complexities that make it. Some of these differences include:  weight distribution, center of gravity, anatomical variance in bone structure and muscle tendon pull, and joint range of motion just to name a few. But as mentioned in the title, a component of the running gait cycle that is similar between all runners is the “double float”.

The double float phenomenon (both feet in the air at the same time) occurs during the swing phase of a two phase gait cycle. The other phase (contact phase) makes up the remaining 40% of the total cycle. In other words, the double float can be seen in the runner between toe-off of one foot and heel-contact of the opposite foot and accounts for only 30% of the total swing phase, a very small portion of the total gait cycle.

It may first be observed anywhere from 1.5 – 4 years old or presumably when the child begins running. This explains the anti-gravity photo I recently snapped of my 2 year old son as he ran with his Grandpa Merrill (Dr. Merrill, just days after the Akron marathon) in the Cleveland Metro parks and appears to be running 6 inches above the ground.

Simple question right? They study the foot and ankle.

Though the scope of practice includes the foot and ankle and everything in between, an understanding of how the body functions holistically is vital in any medical profession including podiatry.

 The first 2 years of podiatry school are primarily didactic work in the basic sciences; the following 2 years include intense podiatric clinical and continued didactic work. According to the United States Department of Labor, “Colleges of podiatric medicine offer a 4-year program whose core curriculum is similar to that in other schools of medicine.”

 For example, first semester classes include:  

1. Medical Biochemistry
2. Medical Genetics and Embryology
3. Human Anatomy (From the waist up, only)
4. Physiology
5. Medical Ethics
6. Principles of Medical Research
7. Podiatric Medical Practice Seminar

For a total of 26 credit hours in general medicine. Others classes include:

1. Neurobiology
2. Neurology
3. Medical Microbiology and Immunology
4. Rehabilitative Medicine
5. Pharmacology
6. Pathology
7. Radiology
8. Dermatology

                What a conducive location to learning and instruction. (Ohio College of Podiatric Medicine)