Foot Care Trends: Views from the Field

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A practitioner examines the feet of a patient who has diabetes.
A practitioner examines the feet of a patient who has diabetes.

What are pedorthists and podiatrists seeing as the big trends in foot problems? The O&P EDGE talked to an orthotist/prosthetist/pedorthist, a pedorthist, and a podiatrist for their views.

"The most common pedorthic-related problem we treat in O&P as well as pedorthics is posterior tibial tendon dysfunction (PTTD)," says Roger Marzano, CPO, LPO, CPed, vice president of clinical services, Yanke Bionics, Akron, Ohio, and a former president of the Pedorthic Footwear Association (PFA). Marzano feels this trend is due to an increase in adult obesity combined with people spending more hours per day in jobs that are often sedentary. He notes that most patients are unable to relate a specific event or injury that started their symptoms; rather, the condition "insidiously crept up on them."

Faulty footwear could be a culprit too, he points out. "I often wonder if some of this could be prevented by wearing better footwear," he says. "The majority of our patients spend the most amount of money on the shoes they wear the least, and the least amount of money on the shoes they wear the most! The market is full of shoes with injection molded out-soles with little or no shank or midfoot reinforcement. Could PTTD be a product of more poorly constructed, inexpensive footwear being used by the majority of our patients?"

Marzano says he is also seeing more overweight pediatric patients with flexible pes planus. Diabetes-related foot disorders are on the upswing too. "This goes hand in hand with increasing obesity as well. We are treating more and more diabetic wound and Charcot foot disorders in a younger, more overweight population."

A positive trend Marzano is seeing is a decrease in metatarsal stress fractures in women with diminishing bone density. "I would attribute that decrease to the increased recognition and treatment of those suffering with osteoporosis and the increased advertising and literature supporting aggressive management with prescription medicine and frequent screenings."

"You can't get away from diabetes," says Dennis Janisse, CPed, president and CEO of National Pedorthic Services, Milwaukee, Wisconsin, and a former PFA president. "Obesity and inactivity are big factorsand what's scary is that a large number of people don't even know they have diabetes until complications show up. We're seeing some pretty nasty thingsamputations, ulcerations, Charcot deformities, and other diabetes-related foot complications. I've seen people with transmetatarsal amputations that didn't know they had diabetes until they wound up with [the] amputation. That really disturbs metoo many people are just not taking care of themselves!" Janisse is seeing more diabetes-related complications in younger peoplepatients in their 50s and early 60s. "People are living longer. Too bad so many are not taking care of themselves so they can enjoy those extended years more."

On a positive note, Janisse is seeing fewer foot complications due to arthritis. "There have been significant advances in medications for people with arthritis. I think the new medications may slow down the progression of arthritis, and they certainly better control the pain."

Kirk Woelffer, DPM, Raleigh Foot and Ankle Center, Raleigh, North Carolina, says that plantar fasciitis"all ages, all body types, and all foot types"is the most common foot/ankle problem he sees. In second and third places respectively are second metatarsophalangeal joint (MP J) pain and first MP J pain.

An increasing problem is the surge of children with foot pain"all types of aches and pains, from apophysitis to tendinitis," he says. "I imagine it is due to increasing body weight and increasing athletic activities. The obese kids are really suffering...!"

Woelffer notes that he has not seen any particular reduction in the various foot/ankle disorders treated in the facility.

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