Posts for: August, 2013

An interesting and informative read brought to us by a podiatrist with the American Podiatric Medical Association (APMA) concerning podiatrists and prevenatitive diabetic care.

Published on APMA.org. June 24th, 2013:

An APMA podiatrist presented a first-of-its-kind study as a late breaking research abstract     late latat the 73rd Scientific Sessions of the American Diabetes Association (ADA) Symposium in Chicago last week. The study’s findings support the need to include podiatrists in Medicaid.

In 2009, the Arizona legislature voted to eliminate podiatric care reimbursement, deeming it an optional service. In the years following the announcement, what researchers at the University of Arizona College of Medicine found surprised them.

“What we found in a very short period of time,” said co-author of the study David G. Armstrong, DPM, MD, PhD, “was that compared to the previous five years, there was a 50-percent increase in severe aggregate outcomes, or SAOs—the technical term for death, amputation, sepsis, and surgical complications.”

They also saw a 38-percent increase in hospital admissions for diabetic foot infections; a 45-percent increase in charges for those admissions; and a 29-percent increase in length of hospital stay.

In a nutshell, for every $1 removed from the Arizona Medicaid budget, there was actually a remarkable $44 increase in costs of care.

These findings suggest a marked worsening of patient care in terms of increased inpatient admissions, lengths of stay, charges, and severe clinical outcomes. Restricting preventive care among patients with diabetes may have resulted in unintended consequences, particularly among the poor and underserved.

Dr. Armstrong is professor of Surgery and director of the Southern Arizona Limb Salvage Alliance (SALSA) at the University of Arizona College of Medicine. Professor and Chief of Vascular Surgery Joseph  L. Mills Sr., MD, and Grant H. Skrepnek, PhD, RPh, of the University’s Center for Health Outcomes and PharmacoEconomic Research, co-authored the study.

See more studies that demonstrate the economic value of podiatric care on APMA.org. 


By Dr. Elizabeth Vulanich
August 28, 2013
Tags: cyst   ganglion cyst   foot lump   lump on foot   foot cyst  

My foot doctor says that the lump on my foot is a ganglion cyst.  Where does it come from?

A ganglion cyst is a benign tumor or “lump” that commonly occurs on both feet and hands. It arises in association with either a joint or a tendon both of which have tissue which produce fluid similar to what is found in a ganglion cyst.  Often they are associated with an injured tendon or arthritic joint. Sometimes they seem to develop on their own.

Typically, a patient will complain of a lump which has been present for some time but which seems to get larger toward the end of the day and sometimes seems to come and go.  It may or may not be painful depending on the location and what other structures it may be exerting pressure upon.  They are usual firm, sometimes almost squishy and slightly mobile.  Average size tends to run approximately 2.0 cm.  They are not typically found on the bottom of the foot.  Women tend to have a higher incidence of these lesions. X-rays and ultrasound examination may be used to help identify and better visualize the extent of the cyst.

Treatment may briefly consist of shoe gear modification, use of Aleve, Ibuprofen or similar medicine but is usually, eventually, surgical.  In days past, such cysts on the wrist might have been struck with a heavy book which would rupture the cyst and cause its contents to be eventually resorbed. This is not recommended as it is important to confirm a ganglion cyst with a biopsy as many other “lumps” may mimic the appearance and symptoms of a ganglion cyst.  Typically, the area containing the cyst is anesthetized and then aspiration of the contents of the cyst is performed using a large diameter needle.  A cortisone injection may be performed at this point to encourage regression.  Unfortunately there is a high recurrence rate for these cysts when treated with aspiration and injection.  Recurrence is also relatively high following surgical excision.

The usual content of a ganglion consists of a gelatinous, clear or sometimes slightly golden material which can also be manually expressed once the cyst is punctured.  This material is sent to pathology to help confirm the diagnosis.  If the pathology report is not able to confirm the diagnosis, the lesion should be surgically excised.

Surgery for these lesions is usually outpatient.  It does require some degree of immobilization with healing of an incision for 10-14 days and depending on the size and location of the lesion, a return to normal activities in 2-4 weeks. Call or submit and appointment request today if you feel you may have a ganglion cyst in need of examination.

 

 

 

 




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