December 2016 Journal Club

[SLCpod]

Journal club overview:
- An article will be selected and posted each month. Please PM me an article you are interested in and I will select one. Please keep them as recent as possible.
- We will discuss how we can use what we learned from the selected article in practice and perhaps share some clinical experiences (remember not to disclose specific patient information)

This is open to DPM's, students and pre-pods!! All are invited.

Last month we looked at and discussed different treatment options for plantar fasciitis. I have selected a short article which I found in the current issue of Clinics in Podiatric Medicine and Surgery. It is brief and very educational. I think it is a good overview for those of us preparing for upcoming interviews. If you have some time, look through some of the references. There are some exceptional studies referenced.

For those who are treating Charcot patients surgically, what is your preferred method?

---

Members don't see this ad.

 

[dr.phoot]

Essentially a combination of both is good. What they mentioned about the internal that they didn't point out with everything else is strength and for the deformity to achieve correction...


In the end anything is better than doing an amputation. I voted for both but I think I would take internal

 

[AttackNME]

The "academic" part of this article tells us that we are far from having evidence based medicine to support specific surgical techniques for treatment of Charcot and it starts with a good staging system placing populations with similar prognostic factors together. For treatment, I have very little experience with it and none of the orthos I've worked with would do it... which speaks to the difficult nature and probably unpredictable results of Charcot recon. Only few do a lot of it, so for my Charcot patients I would either have someone who does it a lot coscrub with me or I refer them out.

 

[ldsrmdude]

Not a direct response to the article, but I pretty much agree with @AttackNME in that I might refer out the tough ones. I typically offer my patients a few options depending on the individual case. If I think it's a reasonable option, I'll offer an exostectomy +/- TAL, reconstruction (either at one of a few large centers within 2-3 hours or with me), or continued conservative care with total contact casting, grafting, possibly even a TAL if needed. I'm pretty open with my Charcot patients that this isn't a case that I do that often, but if they want to stick with me, I would do the case if I think it's within my capabilities.

 

[ldsrmdude]

In the end anything is better than doing an amputation.

While I think that's usually right, the truth is unfortunately much more nuanced than just this. There are times when amputation is the best option. We can sometimes forget that and usually consider it a failure anytime an amputation happens, but sometimes an amputation can get a patient active faster and with a potentially more stable long-term outcome