Des Moines Register Editorial Article

The Des Moines Register Editorial Board, on October 14th, issued an opinion stating the following:

 “Optional Services” Aren’t Always As Optional As They Appear

In a recent editorial board opinion entitled “Amid Tough Choice Protect Priorities”, the Des Moines Register’s Editorial Board discussed options to Governor Culver’s directive to cut 10% of state agencies’ budgets. One of the statements made was in relation to the Department of Human Services averring, “The state should work to maintain basic services, but the coverage may not be as comprehensive. “Optional” services – such as visits to chiropractors and podiatrists – may need to be cut.”

Podiatrists are physicians dedicated to care of diabetic feet and other foot ailments and they are an integral part of the diabetes treatment team. Eliminating podiatrists from Medicaid will not eliminate the need for their services but rather will force diabetics and others with foot problems to seek care from other physicians or in hospital emergency rooms. This may increase costs by having these patients receive non-specialty care, which may result in prolonged wound healing and unnecessary amputations.

Nearly 24 million people or eight percent of the U.S. population are currently diagnosed with and being treated for diabetes. During their lifetime, up to 25% of these individuals will develop a foot ulcer, which is one of the most common reasons for hospital admission of diabetics. Indeed, a large majority of diabetes-related lower extremity amputations are preceded by a foot ulcer.

Dr. Lee C. Rogers D.P.M., Chair of the Foot Care Council for the American Diabetes Association, states that every year over 3,000 Iowans with diabetes are faced with a situation that threatens the loss of a limb and that 900 legs are actually amputated. The direct costs to perform one major limb amputation are estimated to be over $70,000. It is estimated that over $30 billion was spent on the care of diabetic foot ulcers and amputations in the United States in 2007.

The World Health Organization and the International Diabetes Federation have declared that eight of ten diabetic amputations are preventable. A podiatry-directed program implemented at Broadlawns Medical Center’s Amputation Prevention Center reduced amputations by 72% in just one year.

In 2008, Medicaid spending to podiatrists throughout the state totaled $882,803. In looking to “slash $565 million” as the editorial states, eliminating podiatry services, we believe, is a poor option and may actually increase Medicaid costs.

Treating diabetes and its many complications requires a complete medical management team—one part of which is a podiatric physician—to attend to the necessary foot care those with the disease require. Podiatrists work every day to help prevent these complications and reduce their costs. While we understand the challenges facing the state and its budget shortfall, we believe that eliminating so-called optional podiatry services is penny-wise and pound-foolish. Sometimes, “Optional Services” Aren’t Always As Optional As They Appear.

Vincent J. Mandracchia, DPM, MHA

Senior VP/Chief Medical Officer, Broadlawns Medical Center

Past President, Iowa Podiatric Medical Society

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If the Shoes Fit, Buy Them Quick
By DAWN SAGARIO PAULS
Moms Like Me

Stacy Lovan needs a good shoe-buying strategy.

Before buying new shoes for her four kids, the Des Moines mom checks to see if her children fit into their siblings' hand-me-downs. Lovan tries to balance finding new footwear in styles her kids like with finding shoes that also fit properly.

"I always try to go a little bit bigger because they grow so fast," Lovan said.

Ideally, kids should be wearing lace-up shoes with good cushioning, arch support and stability, said Dr. Kirk Neustrom, a podiatrist at Metro Foot and Ankle in West Des Moines.

"Running shoes, in my opinion, are the best shoes made," Neustrom said. "(They are) well-designed, and a lot of effort and biomechanic evaluation goes into running shoes."

Neustrom said while kids love to wear flip-flops and Crocs, they should be worn only for short periods of time. "Growing pains" that kids ages 8 to 13 experience are exacerbated by flimsy footwear, said Dr. R.D. Lee Evans, a podiatrist with Des Moines Orthopaedic Surgeons.

Neustrom and Evans offer this shoe-shopping advice:

• If the tread is worn off to the side or on the bottom of shoes, it's time for a new pair. Kids tend to wear out shoes before growing out of them.

• Buy shoes a little roomy. But do not buy shoes more than one size larger than their current size, Evans said.

• Choose lace-up shoes over Velcro. The laces provide a better fit to the shoe.

• Look for a stiff sole and heel. If you squeeze the top and bottom of the shoe together and you can feel your fingers (such as with some ballet flats), there's not enough arch support, Neustrom said. Squeeze the sides of the heel of the shoe; they should feel rigid, Evans said.

• Buy shoes late in the day, as feet tend to swell as the day goes on.

• Wear socks when trying on shoes.

• Most shoes do not have to be broken in, Evans said. If they are uncomfortable in the store, that won't improve much later.

• Good shoes don't have to be expensive.

Once you've found the perfect pair of shoes, make sure kids tie their laces. It may be cool for kids to leave their laces untied, but that makes shoes less stable and kids more accident prone, Evans said.

Sports shoes with cleats are "notoriously horrible," particularly because of the lack of cushioning, Neustrom said. Placing a gel pad or some other type of cushion in the shoe can help.

The American Academy of Podiatric Sports Medicine's Web site (www.aapsm.org) also provides a list of recommended shoes, said Neustrom, who sits on that group's shoe review committee.
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SURVEY SHOWS NEARLY 40 PERCENT OF AMERICANS REEL FROM HEEL PAIN

While foot problems such as bunions, corns and dry, cracked skin affect many Americans on a daily basis, one particular ailment—heel pain—stands out among foot disorders, according to a new survey by the American Podiatric Medical Association (APMA).

The 2009 APMA survey, which polled close to 420 Americans aged 18 and older, found that 39 percent of adults have experienced heel pain more than any other foot ailment within the last 12 months. Additionally, nearly 60 percent of respondents believed they suffered heel pain while wearing ill-fitting footwear. However, 64 percent of respondents said they had not yet visited a medical professional—such as a podiatrist—to diagnose and treat their heel pain.

“Heel pain is a detrimental foot ailment that affects millions of Americans every day, and foot pain of any kind is not normal,” said Vince Mandracchia, DPM, Iowa Podiatric Medical Society President. “If detected early, most types of heel pain—including the most common, plantar fasciitis—can be treated with non-invasive treatment options. However, the longer one waits to have their heel pain evaluated, the more difficult it is to successfully treat.”

Sixteen percent of Americans surveyed regularly experience heel pain. Wearing shoes that fit well, wearing the proper shoes for each activity, not wearing shoes with excessive or uneven worn heels or soles, and stretching foot and ankle muscles properly before exercising are several main ways to avoid heel pain altogether. However, visiting a podiatric physician, also known as a podiatrist, as soon as foot pain is experienced drastically improves the chance of finding a solution for heel pain.

To view a full summary of the results from the APMA’s 2009 foot ailments survey with a focus on heel pain, please visit www.apma.org/heelpain. Also,click here to view the APMA heel pain guide.