PodiatryRobert Bertram, DPM

Sarika Parikh, DPM

Podiatry (Foot & Ankle)Agnesian HealthCare

Presentation Outline Introduction

Robert Bertram, DPM Sarika Parikh, DPM

What is podiatry? Common foot and ankle issuesDiabetes and diabetic foot careAgnesian Health Shoppe Questions

What Is Podiatry? Podiatry, or podiatric medicine, is a

specialized area of medicine dedicated to the diagnosis, treatment and prevention of diseases and disorders of the foot, ankle and lower extremities.

Foot/ankle anatomy is complicated 26 bones, 33 joints, 100+ ligaments,

19 tendons Many areas that can become an issue

Common Foot and Ankle IssuesPlantar fasciitis (heel pain)Achilles tendonitisBunions/hammertoesFlatfeetArthritisDiabetic foot care (corns, calluses, toenails)

Plantar Fasciitis Most common cause of heel pain in adults Typically due to repetitive or excessive stress on the foot Symptoms

Gradual onset of pain at bottom of the heel Worse when taking first steps in the morning or after

prolonged sitting Conservative treatment: Shoe

inserts/orthotics, stretching, appropriate footwear, NSAIDs, rest, ice, other (physical therapy, injections, etc.)

Surgical treatment

Inflammation often caused by repetitive stress on the tendon

Achilles tendon runs down back of lower leg

Symptoms: Aching, stiffness, soreness or tenderness within

the tendonTreatment: RICE, physical therapy, stretching

exercises, orthotics, night splints/custom bracing

Achilles Tendonitis

More than just a bump Reflects changes in the bony structure Big toe leans toward second toe, misaligning the bones

Progressive - gets worse and bump is more prominent Symptoms

Pain or soreness Redness and inflammation Burning or numbness Difficulty wearing certain shoes

Treatment Conservative Surgical

Bunions

Hammertoes

More severe cases - open sores

Treatment Conservative Surgical

Abnormal bend in the second, third, fourth or little toe

Bend in the toePain/irritation when wearing shoesCorns and calluses Redness and inflammation

FlatfeetStructural abnormality leading to abnormal

foot alignment/positioningProgressive weakening of supportive structures

and gradual collapse of the archConservative treatment: orthotics, bracing,

functional supports, physical therapySurgical treatment: reconstructive procedures

to recreate arch of foot

Arthritis Most common in the mid-foot, big toe or ankle Inflammation of the joint - breakdown in joint

cartilage Symptoms

Pain and stiffness Swelling in or near the joint Difficulty walking or bending the joint

Treatment Conservative - shoes, boots, bracing, orthotics Surgical - joint fusion or joint replacement

Diabetic Foot CareElevated blood sugars damage nerves, blood

vessels, joints, skinVascular diseaseNeuropathyUlceration InfectionGangreneAmputations

Diabetic FactsNumber of people with diabetes has risen from 108 million

in 1980 to 422 million in 2014.Global prevalence of diabetes among adults over 18 years

of age has risen from 4.7 percent in 1980 to 8.5 percent in 2014.

Diabetes prevalence has been rising more rapidly in middle- and low-income countries.

Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.

Why Screen the Diabetic Foot?15 percent of people with Type I and Type II diabetes will develop one or more foot ulcers in their lifetime.

10 percent of these will go on to have a major lower limb amputation.

Of all non-traumatic lower limb amputations, 85 percent are due to diabetic foot ulcerations.

Five-Year Mortality Rate

Foot Care Tips Check your feet every day

Look at your bare feet every day for cuts, blisters, red spots and swelling

Use a mirror to check the bottoms of your feet or ask a family member for help if you have trouble seeing

Wash your feet every day Wash feet in warm, not hot, water Dry feet well; be sure to dry between the toes

Keep the skin soft and smooth Rub a thin coat of skin lotion over the tops and

bottoms of your feet, BUT NOT BETWEEN YOUR TOES

Foot Care Tips, cont.Wear shoes and socks at all times

Never walk barefoot Wear comfortable shoes that fit well and protect your feet Feel inside your shoes before putting them on each time to

make sure the lining is smooth and there are no objects inside

Make sure the shoe fits properlyTake care of your diabetes and try to be more active

Work with your healthcare provider to keep your blood sugar within a safe range

Plan a physical activity program with your healthcare provider

Footwear Tips Type of shoe Proper fit Shoe wear, patterns of

wear Lining wear Foreign bodies/objects Insoles, orthotics

Agnesian Health Shoppe How does podiatry work with the Agnesian Health

Shoppe? Diabetic/therapeutic shoes Compression stockings Over-the-counter shoe orthotics Walkers Crutches Roll about knee scooter Wheelchair Surgical shoes/boots

Agnesian Health ShoppeDeb Winterhack

Services Sleep management Home oxygen Women’s health Mobility and home

access Diabetic shoes Retail DME shop

Wound care Re-supply program Repair and service Benefits Additional products

Sleep ManagementSleep Management Program

Respiratory therapists on-site Four full-time respiratory therapists Technicians on-call 24/7 Flexible schedules to meet patient’s needs

Patient education and exceptional compliance

Re-supply program for masks and supplies Direct mailing to patient’s home

with permissionRetail products, such as pillows

and wedges for sleep comfort

Home Oxygen Home Oxygen program consists of:

Respiratory therapists and certified delivery technicians Provide home delivery at set-up and 10

tanks per month Provide education on proper use of

equipment and supplies Our team has many years of experience and

have established relationships with our customers providing a sense of security and compassion.

Strive for same day service, on-call 24/7 Respiratory therapists available for

consultation with patients and their providers

Women’s HealthPost mastectomy supplies,

including: Breast prosthesis, bras, swimwear, fashionable

scarfs and head coverings, wigs

Mom and baby products Medela and Ameda Breast pumps and supplies Earth Mama Angel Baby skin care products

Compression garments Ready-to-wear and custom fitted (for both genders) Two certified compression and mastectomy fitters

with a licensed registered nurse on staff

Private fitting rooms - call for appointments

Staying Home SafelyFalls inside and outside are the number one

cause of injury among the elderlyStairs lifts assist in climbing the stairs

More access to your entire home Funding sources available

Wheelchair ramps provide access into your home or garage

Vehicle ramps provide easier transportsFree home assessments for safety, equipment

and home modifications

Staying Home Safely

Mobility & Home AccessTwo nationally-certified assistive technology professionals

(ATP).Work with patients and providers to ensure proper

equipment is built to fit the patient’s needs, home and lifestyle.

High-end custom specialty mobility devices and equipment including:Power wheelchairsPower liftsScooters

Diabetic/Therapeutic ShoesComplete Dr. Comfort line of diabetic and

therapeutic shoes, inserts and socks.Full-time certified associates dedicated to

assisting customers with their orders for shoes and inserts.

Medicare and most private insurances will cover one pair of shoes and three

pairs of inserts per year for qualified diabetic

patients.

Lift ChairsFor patients who have trouble getting in and out of

living room furnitureAvailable in a variety of fabrics to complement décorProvides safety and independenceMattresses and covers for sleepWide range of styles, colors and priceDelivery and set-up providedHydro-lift product for any surface

Retail DME ShopDME specialists assist with in-home medical

equipment and supplies, and third party reimbursement for private insurances and Medicare Expanded cash and carry product lines Exercise equipment – Zone recommended Pain management products Dietary supplements & chiropractic recommended

products Podiatry orthotics and bracing

Ambulatory aids, bathroom & bedroom safety

Wound Care Registered NurseRegistered nurse on-site working with patients and

providers on wound care supplies and reimbursement. Answers questions Product education Liaison for patient as it relates to

reimbursement Works hard to find products that will be

covered Conveniently located next to the Agnesian

Wound Care Products delivered right to the patient’s home

Re-Supply ProgramRe-order program with trained specialists:

Place monthly reminders to patients for supplies for CPAP, ostomy, wound care, urological, enteral or incontinent products

Monthly and quarterly reminder callsNever call a patient without permissionNever ship product without speaking to the patient

Repair & ServiceOn-site maintenance of all rental equipmentRepair of purchased power mobility devices,

wheelchairs, lift chairs and motorized scooters

Questions?Thank you for your support

and loyalty.