Portsmouth Foot & Ankle - Blog

There are many gratifying aspects to my job,

- getting patients feeling better quickly

- having same day treatments available

- seeing a variety of foot ailments making two days never the same

But one of my favorite things is how rarely I have to utter the words “today we HAVE to do __________treatment”  to a patient. Podiatry offers so many opportunities for shared decision-making (the practice of an informed patient participating in treatment decisions) and as a physician I really enjoy the highly collaborative treatment planning.

When see a new patient my goal is to not only give them a timely and accurate diagnosis but to tailor a treatment plan that works for them. Most of my patients know that following all the questions I ask regarding their symptoms comes, “What do you do for work? What is your day to day like?”  I enjoy getting to know each of my patients and arming them will a full gamut of options to help treat their foot pain.

Let’s take plantar fasciitis (or heel pain) for example. I can see upwards of 10 patients a day, either new or in follow-up for heel pain, and each of them are at a different stage in their treatment and have chosen different treatment paths. Some are in physical therapy, others for a cortisone injection, or our EPAT (shockwave) therapy and one post-operatively after a plantar fascial release. None of these patients I treated the same because every one of them has different goals and lifestyles.

By giving my patients all the treatment options available to them I can create a truly patient focused treatment regime, aimed at getting each individual person better on their terms. Every day I am delighted to work with my patients and actively involve them in the decision making process regarding their foot pain versus saying, “this is what you have to do”.

I believe that an informed patient is a happier and in the end healthier patient and many industry executives agree…

Real Word Example: Why Value-Based Care Must Include Shared Decision-Making : Shared decision-making is a key patient engagement strategy, but not yet widespread.  By Sara Heath (February 26, 2018)  - via, patientengagementhit.com

Shared decision-making integrates the patient into the healthcare process and gives the patient more claim in her wellness journey.

Shared decision-making has shown to reduce preventable hospital readmissions among cardiac patients by at least 19 percent, and can also decrease patient anxiety and healthcare costs.

“Although shared decision-making has been around for quite a few years, and although there is a significant evidence basis about the expected outcomes of shared decision-making interactions, it is really more the exception than the rule in clinical practice today,” Goldbach said in a recent interview with PatientEngagementHIT.com (Peter Goldbach, Chief Medical Officer for Rite Aid’s RediClinic and Health Dialog).

“There are islands of excellence that do exist, specifically people that have taken an interest in shared decision-making,” Goldbach added, making a nod to SDM researchers and specialists.

Some medical professionals do believe they are practicing shared decision-making, but when Goldbach spends more time with the provider and breaks down the details of shared decision-making, it becomes clear that the art has not yet been perfected.

The healthcare industry landscape has never been conducive to integrating shared decision-making, Goldbach explained. Although shared decision-making has fairly clear benefits, evolving healthcare initiatives such as emerging technologies and reporting requirements have made it hard for providers to adopt the technique.

 “Shared decision-making has not been part of providers' education,” Goldbach noted. “It's not part of the current culture. And people who practice medicine today are beset by a very busy, difficult environment where they have a lot of new requirements and a lot of new operating systems distracting them. That is a difficult environment to bring in new ways of working with patients.”

The time is ripe for more widespread adoption of shared decision-making, Goldbach added. Healthcare professionals are becoming more comfortable with new technologies, and strategies have emerged to enhance, not distract from, shared decision-making.

Shared decision-making has a considerable human component to it – educating and partnering with patients for better care is an important part of the patient experience and puts patients in control of their own health.

We support and encourage collaborative medicine at Portsmouth Foot and Ankle. It is our goal to offer patient focused care and to encourage our patients to make informed decisions about their treatment options.  

Read More:  Dr. Natasha Baczewski  Extracorporeal Pulse Activation Technology (EPAT)  Plantar Fasciitis  Sports Injuries  ... and rememeber - no foot pain is normal! -  Appointment Request

By Reid Christie, DPM
March 20, 2018
Category: Injury
Tales of a Barefoot Diabetic
It has long been known that one of the most common pedal side effects in a diabetic patient is peripheral neuropathy which manifests into a loss of protective sensation in the feet and lower legs.  The symptoms of diabetic neuropathy can be described in many different fashions, including burning, tingling, numbness, stiffness, as well as many other descriptions. 
However, one thing remains true of all patients suffering from diabetic peripheral neuropathy – they are at increased risk of pedal complications due to their lack of sensation.  Complications can arise when insensate patients walk barefoot around their home or outside. Due to the inability to feel sharp things on the bottom of their feet, patients can step on any number of things (glass, splinter, metal object) and not even know it.  The area can become infected and lead to a much deeper infection if the injury is not quickly identified and treated.  Often times a patient will not be aware they stepped on something until blood or drainage is noticed on a sock or slipper. 
The following is a very common case presentation of a neuropathic:
An 82 year old diabetic male with peripheral neuropathy presented to our office with complaint of drainage and blood noted to his sock.  He denied any pain, as well as any signs of systemic infection such as fevers, chills, nausea or vomiting.  He said that if he had not noticed any of the drainage on his sock, he would not have known anything was wrong.  After examination, the patient had a small puncture wound in the area of concern with surrounding blister and subdermal hemorrhage (bleeding) formation noted.  Following debridement of the area, a small piece of glass was removed from the patient’s foot.  
Luckily, the patient acted quickly by presenting to our office as soon as he noticed the problem, allowing for prompt assessment and treatment before any aggressive measures (such as amputation) was required. 
Unfortunately, sometimes these issues can progress towards amputation because neuropathic patients do not always act quickly enough. If infection is not noticed quickly, it can spread rapidly.  If infection goes deep enough and reaches bone, the indicated treatment is amputation of the associated bone. 
For these reasons, daily foot exams in the neuropathic diabetic patient can be critical!
Helpful Links: Foot Check Friday  +  Foot Self-Exam
Dr. Reid Christie is a podiatrist working out of our Portsmouth & Nashua, NH locations. He is currently accepting new patients. If you would like to request an appointment with Dr. Christie please go here - Appointment Request
By Natasha Baczewski, DPM
March 13, 2018
Category: Foot Care

Will My Nail Care Be Covered By My Insurance?

Many patients come to us for routine foot care. During these appointments nails are trimmed or debrided and calluses cared for. Unfortunately, many patients, especially the elderly or those with mobility issues have trouble performing this care themselves. We are always happy to help out those who need. However, insurance doesn’t always cover this care.

Below are some scenarios under which nail care would or would not be covered. 

I’m a diabetic, is my nail care covered?

If you have diabetes with no other complications such as neuropathy or PVD (peripheral vascular disease) routine foot care is NOT covered.

  • Generally we try and see our diabetic patients 1-2 times per year for a diabetic foot check.
  • At your appointment the doctor will assess for any sensation loss (neuropathy) or poor blood flow (PVD).
  • They will then discuss these topics with you and ways to prevent issues.
  • If you meet the criteria for neuropathy or PVD your nail care may be covered.

 I have poor blood flow, is my nail care covered?

  •  This depends on a couple of factors that will be assessed during your appointment.
  •  The doctor will check your pulses and peripheral blood flow along with your skin and even your lower legs for signs of PVD
  •  If adequate signs are met your nail care may be covered.

My nails are thick and hard to trim, is my nail care covered?

  • Generally speaking nails that are painful, cause an inability to walk and are greater than 3mm in thickness are covered for routine foot care.

My nails are normal but I can’t trim them myself, is my nail care covered?

  • Generally speaking no. Unless you meet one of the above criteria your nail care would not be covered.

We have made the following chart to help you determine if your nail care will be covered -

Please do not hesitate to call our office for more information. Please note that we cannot determine or guarentee coverage over the phone. An evaluation by the doctor is always necessary to determine coverage. Please use the scenarios and chart above as a reference - they are not a guarantee of coverage. Every insurance company is different and we cannot guarantee coverage without a medical evaluation. 

Natasha Baczewski, DPM is a podiatric surgeon at Portsmouth Foot and Ankle (Portsmouth Office). She currently accepts new patients. To read more about Dr. B or to make an appointment with her please use the following links: Dr. Natasha Baczewski  |  Appointment Request 

For More Reading: Diabetic Shoes    Diabetes and Your Feet    Diabetic Foot Care    How To: Trim Toenails    November is Diabetes Month

By Reid Christie, DPM
February 22, 2018
Category: Foot Pain
Tags: surgery   big toe   arthritis   fusion   mtpj  
I Can’t Move My Big Toe
One of the more common complaints heard in our office setting is pain with any movement of the big toe joint.  And the most common underlying cause of pain in this area is arthritis.  Arthritis can occur in almost any of the joints in the foot, but the first metatarsal phalangeal joint (big toe joint) is one of the most often affected due to a variety of reasons.  Once arthritis is present within the big toe joint, it can be progressive and worsen with time if preventative measures aren’t taken. 
The most common preventative measures for arthritis include cortisone injection therapy (Read More: Cortisone Just a Band-Aid?) or custom orthotics (Read More: Orthotics 101).  Early intervention with these conservative measures can often prevent patients from ending up in surgery.
However, when the arthritis becomes too painful in the big toe joint and/or preventative measures fail often times surgical intervention is the best solution. The surgery I often perform on patients with arthritic joints is a fusion (or arthrodesis).  A fusion of the joint is when the joint is essentially removed and it no longer allows motion.  The thought process behind this procedure is that the pain is occurring within a deformed joint, so if the joint is removed the pain will resolve. The biggest part of the procedure that patients worry about is the fact their big toe will no longer bend up and down.  While this sounds like an undesirable result, the fact is that patients are still active and perform normal activities and exercise following this procedure.  When this procedure is discussed with patients, two things must be emphasized:  first, there will be relief of pain, and second, normal daily activities and exercise may be resumed once the arthrodesis heals. 
The following case photos are from a patient who had undergone a bunion procedure six years prior, however started having pain two years following her procedure.  After a long discussion with the patient, it was concluded that an arthrodesis of her big toe joint was the best long term solution.  Patient is currently in the post-operative time frame and healing without complication.
before and after photo
By Allen Clark, DPM
February 15, 2018
Category: Foot Care
Tags: winter   frostbite   cold   exposure  

Frostbite is a real danger in New England. Hands and feet account for 90% of all cold related injuries. Men are affected by it more than women by a ratio of 10:1. 

Frostbite occurs when the tissues of the body are reduced to a temperature that stops blood flow. As fluids in the body cool they can slow to a halt. 

When the core temperature of the body decreases significantly, the body reacts by shunting blood away from non-vital organs and limbs.  As the fingers and toes are the furthest from the center of the body, they are easily cooled.  Without blood reaching the tissues the affected parts begin to die. In extreme cases of frostbite in children, growth plates are affected resulting in abnormal growth of bones. 

Frostbitten fingers and toes may be salvaged if re-warmed and cared for properly. It is important to get the person to warm place where they do not risk becoming cold again. Medical attention is absolutely necessary. There are medications and procedures that can improve outcomes if sought out in a timely manner. The degree of irreversible damage is more closely related to the length of time that tissue remains frozen rather than the absolute temperature change. 

Things to be careful of when going into cold temperatures:

Tight shoes, tight ski boots, standing in the snow or ice, smoking.  Be sure to keep your fingers and toes warm with thick socks, keep your feet dry, wear protective shoes that are waterproof.  If you have neuropathy in the feet be extra careful and warm your feet regularly.

More Winter Reads: Winter is Here... Protect your Feet!  |  Winter Injuries  |  Polar Vortex  |  Its getting colder!


Dr. Allen Clark

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