© Kseniabravo | Dreamstime.com M www.podiatrym.com The RoleofPodiatricMedicine Public the healthcarecommunity. ception ofpodiatricmedicinewithin health providersregardingtheirper- influence onpolicymakersand paradigm shiftcanevenhaveamajor to thepublic.Indeed,makingthis the addedvaluethatwecanprovide a personconnected tothepedalex- slowly: observe… notethatthereis and besuretolookup look up time to remember what Plato wrote medicine inpublichealth,now isthe there isasignificantrolefor podiatric pendages called feet. If we believe down atthetwoweight-bearing ap- up. Lookupslowly.Don’tjustlook well.“ never bewellunlessthewholeis to bestudiedalso,forthepartcan disregard thewhole,whichought of Hellas (i.e., Greece), because they eases isunknowntothephysicians the reasonwhycureofmanydis- body without the Soul. And this … is ther oughtyoutoattemptcurethe the headwithoutbody,sonei- cure theeyeswithouthead,or “{A}s yououghtnottoattempt BCE, there is the following statement: Temperance writtenbyPlatoin380 I So whenseeingpatients,look n a play entitled Charimedes or Hea public healthandto expanded context in our professiontothis needs tobegivenby uch moreemphasis l in PublicHealth t h

professions, do so? community, includingthose in other the public,whyshouldothers inthe ize ourbroaderroleinthehealth of to realizeit.Ifwedonotfully real- of thoseinourprofessionhave failed vironment isvast.However, many health, thecommunity,anden- should makeforpeople,thepublic tion thattheprofessioncanmake, a footdisorder.Theaddedcontribu- who cometouscomplainingabout prevent, diagnose,andtreatpeople to thestructurecalledfeet.We member, thereisapersonattached live and inwhich theypractice. Re- serve theenvironmentinwhichwe on PublicHealth Implications oftheEnvironment extent oftheabilitytoambulate. partially determining the type and and isinfluencedbythatcommunity, some influenceonthatcommunity, environment inacommunity,has tremity and thatperson exists inan

Look beyondthefeet. Humans have beengiven Podiatric physiciansshouldob By Leonard Look up slowly. Don’t just look down at the two Look upslowly.Don’tjustlookdownatthetwo weight-bearing appendagescalledfeet. So when seeing patients, look up. So whenseeingpatients,lookup. A . Levy, D PM, MPH the APRIL/MAY 2018|PODIATRY MANAGEMENT - hopefully preventing painforalife- weight andfacilitateambulation, cles sothatourfeetcansupport our growth, and the strength of our mus- the musculoskeletalsystem, bone function. needed tostimulatecardiovascular reducing amajorsourceofexercise fect one’scardiovascularhealthby at all,cananddoesadverselyaf- to walk,ornotbeingablewalk when walking,inhibitingourability of health. Indeed having foot pain ing (orhindering)themaintenance a major contributiontofacilitat- the processoflocomotion,makes or running, but also by virtue of not onlypermitsstanding,walking, is anintegralpartofourbody.It play. Butremember,thatstructure munity in which we live, work, and ing withtheenvironmentandcom- in anuprightpositionwhileinteract- our weightandpermitsustomove using thepedalextremitythatbears ability togetfromplace I t also allows for stimulation of Continued onpage 120 119 Public health

Podiatric Medicine Role (from page 119) Furthermore, if one has difficulty maintenance of the health of people walking, it also may have a major in the community rather than solely time. People who are unable to walk impact on one’s ability to fully in- in the individual. Indeed the “pa- comfortably or engage in appropriate teract in society. tient” of public health is, in fact, the physical exercise due to a podiatric Therefore, focusing only on the community. Public health is a term disorder are much more likely to be- foot not only limits the potential role that is not specific to any disease come overweight or obese, develop of the clinician, but it is also a disser- and, therefore, does not focus on any

Table 1: Natural History of Podiatric Medical Disorders

Period of Pre-pathogenesis Period of Pathogenesis

Early Diagnosis & Disability Health Promotion Specific Protection Prompt Treatment Limitation Rehabilitation

• Health Education • Proper Shoes • Regular Ft Exam • Early Treat • Focused Exercise • Regular Exercise • Reg Med Care • Prenatal Care • Orthotics • Rehabilitative Surgery • Safe Environ. • Preventive Surgery • Physical Therapy • Physical Therapy 120 Primary Prevention Secondary Prevention Tertiary Prevention

life-threatening cardiovascular dis- vice to patients if all we did was treat specific disease, illness, or part of the ease, or become the victim of diabe- foot symptoms and signs. However, body. Its concern begins before one tes and perhaps suffer from its many while signs and symptoms people has a problem and before we put a systemic complications. have in their feet lead us to a diag- label on a disease or disorder; it fo- Many who go to a cardiologist nosis, this may and should also raise cuses initially on the maintenance of or internist and are advised to do our index of suspicion for disorders health. more walking and are prescribed that, while manifested in the foot, Indeed, the maintenance of exercise they need to stimulate may originate somewhere else in the health is not disease-specific at all. their heart, too often leave that body. These signs and symptoms As already hinted, by providing ad- vice to people who may not yet have foot complaints but who may have Focusing only on the foot not only limits the potential questions about how to preserve their foot health, we will also be con- role of the clinician, but it is also a disservice to patients tributing to their general health and to the health of the community in if all we did was treat foot symptoms and signs. which they are a part. In addition, not only will people be in a better position to avoid foot problems, si- doctor’s office and just forget the may be due to local disorders, but in multaneously they will be preserving whole thing. Why? It’s not because many situations, they are manifesta- normal locomotion and facilitating they are non-compliant, but simply tions of diseases and disorders that general health such as contributing to because their feet may be painful or emanate from other parts or systems the ability to engage in cardiovascu- stiff, and engaging even in such a of the body. lar and musculoskeletal-stimulating seemingly simple exercise as walk- locomotion. ing is impossible without experienc- Podiatric Medical Contributions to They will be able to better inter- ing pain. Or neuropathy affecting the Maintenance of Health act with and contribute to the society their feet makes it difficult or even So why is all this important? in which they live. Therefore, public impossible to move more than short What does all this have to do with health, in the broad sense, not only distances because of discomfort, public health? And what does it have refers to the individual but to the numbness, or instability affecting to do with podiatric medicine? First, public, or more specifically, to the the plantar surface of their feet. public health is concerned about the Continued on page 121

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Podiatric Medicine Role (from page 120) haps be even lifesaving. more frequently than they see their Also, its effect on the community primary care physician. This provides community. It focuses on the natural cannot be overestimated since podi- a major opportunity for the podiatric history of disease which begins with atric disorders and podiatric medical medical practitioner to be a vital part health promotion which is not dis- conditions contribute to the rising of the team participating in the con- ease-specific (Table 1). It has as its costs of healthcare. tinuity of healthcare. For example, purpose promoting health by focus- A recent release by the U.S. Cen- many patients frequently see their ing on the human host, disease-pro- ducing agents, and the environment in which we live. No patient should visit a DPM without having

Podiatric Medical Role in their blood pressure checked. Preventing Falls For example, what can be done in and to the environment and to and ters for Disease Control and Preven- primary care physicians annually or by the human host to prevent falls? tion (CDC) concluded that walking is semi-annually, and as part of those The incidence of falls continues to the most commonly reported physical visits, they have their blood pressure grow as the world population ages, activity by adults. To encourage in- checked. and its relevance to podiatric med- creases in the prevalence and fre- Since there may be sever- icine cannot be overestimated. The quency of walking, podiatric medi- al months between the visits they consequences of a fall are some of cal practitioners, in cooperation with make to their primary care physi- the most prevalent causes of serious communities, can be leaders in pro- cian, the provider of their podiatric injury or death, especially in older moting and encouraging the imple- medical care should, as a routine people. The causes of falls often in- mentation of strategies that create or part of the visit, take the patient’s 121 clude host and environmental condi- enhance access to places for walking, blood pressure. No patient should tions that lead to such consequences. or enhancing design and land use visit a DPM without having their Among the more frequent causes of policies and practices that emphasize blood pressure checked. This could be done each visit very quickly by the podiatric physician or their assis- A recent release by the U.S. Centers for Disease Control tant on a routine basis. So many of our podiatric medical patients may and Prevention (CDC) concluded that walking is the have undiagnosed hypertension or hypertension that is either not ade- most commonly reported physical activity by adults. quately being treated or out of con- trol. Not only would such a finding be useful in the establishment of a falls are pedal deformities such as, mixed-use communities and pedestri- podiatric treatment plan, but it also but not only, hallux valgus, other an-friendly streets. would be vital to the overall health metatarsophalangeal conditions, The impact of these strategies on of the patient. hammer toes, improperly fitting walking should be monitored system- In addition, referring patients shoes, objects on the stairs inside atically at national, state, regional, with abnormal blood pressure to homes, cracks in sidewalks, just to and local levels. Public health efforts the physician who is managing their name a few.1-4 to promote walking as a way to meet overall healthcare would be a major Diabetic neuropathy and other physical activity guidelines can help contribution to their health. This rel- diseases causing neuropathy may improve the general health of peo- atively simple, benign procedure can cause foot pain or affect the foot in ple internationally. Noting this, the be a significant contribution to the ways that reduce proprioception or role of podiatric physicians in ensur- health of patients, while also provid- the ability to perceive its place in ing painless, stable, and safe walk- ing a major communication to pa- space, not infrequently precipitating ing environments cannot be over- tients and the healthcare community a fall. The growing population of emphasized, not only because of its of the role that podiatric medicine older people globally is facilitating importance to foot health but its im- has as part of the healthcare team. the production of a much larger set portance to the overall health of the Similarly, because of the fre- of individuals with diabetes, foot de- public.5 quency that podiatric medical care formities, and osteoarthritis affecting is provided to patients, the practi- the foot, each of which are inciting Participating in the Continuity of tioner is also in an excellent posi- factors leading to falls. Preventive or Healthcare tion to observe changes in a patient definitive podiatric medical care not It is important to point out that from one visit to another in such only will improve foot health and people with foot problems are often functions as gait, and could make function, but can be extremely im- seen several times a year by podiat- extra-pedal observations including portant to overall health, and per- ric medical practitioners, sometimes Continued on page 122 www.podiatrym.com APRIL/MAY 2018 | PODIATRY MANAGEMENT Public health

Podiatric Medicine Role (from page 121) ity disorders. This undervalues the at home. National Center for Biotechnol- very important role that we have in ogy Information. Age and Ageing. 28 (2). speech patterns, skin lesions on ex- the total health of our patients and pp 121-125; 1999. 2 posed parts of the body that were not the community. An expanded role in Impact of falls on disability. 65+ in previously observed, just to name a public health and prevention that po- the United States: U.S. Census Bureau: pp 44-45;2010. few. Such findings could be clues of diatric medical care can provide both 3 Fall prevention: Simple tips to pre- health problems that, while perhaps directly and indirectly has an impact vent falls—Mayo Clinic; www.mayoclinic. not podiatric in nature, require the not only on the health of the com- org/healthy-lifestyle/healthy-aging/in.../ attention of another healthcare prac- munity and on individuals but on the fall-prevention/art-20047358. titioner such as the family physician enormous costs to society. Much more 4 Fall Prevention NeuRa;https:// or another healthcare provider. emphasis needs to be given by our www.neura.edu.au/health/falls-preven- profession to this expanded context in tion/?gclid=CJCinbvovdQCFciIfgodk- Conclusion public health and to the added value BQF6Q. 5 Because of the often long-term, that they can provide to the public. More people walk to better health. doctor-patient relationship podiatric Indeed, making this paradigm CDC Vital Signs. Centers for Disease Con- trol and prevention (CDC); August 6, 2013. physicians develop, patients may be shift can even have a major influ- considerably more likely to take their ence on policy makers and health advice or share with the podiatric providers regarding their perception physician some of their non-podiat- of podiatric medicine within the Dr. Levy is Professor ric health problems. Suggesting to healthcare community. Hence, the Emeritus at the Dr. patients to refrain from smoking or, message, don’t just look down—look Kiran C. Patel College if they already are smokers, to con- up…very slowly. PM of Osteopathic Medi- vince them to enter a smoking cessa- cine, Nova Southeast- 122 tion program is an example. References ern University in Fort Too often we focus our role only 1 Donald IP and Christopher JB. The Lauderdale, Florida. on preventing intrinsic lower extrem- prognosis of falls in elderly people living

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