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Podiatry
Robert Bertram, DPM
Sarika Parikh, DPM
Podiatry (Foot & Ankle)
Agnesian HealthCare
Presentation Outline
Introduction
 Robert Bertram, DPM
 Sarika Parikh, DPM
What is podiatry?
Common foot and ankle issues
Diabetes and diabetic foot care
Agnesian Health Shoppe
Questions
What Is Podiatry?
 Podiatry, or podiatric medicine, is a
specialized area of medicine dedicated to
the diagnosis, treatment and prevention of
diseases and disorders of the foot, ankle
and lower extremities.
 Foot/ankle anatomy is complicated
 26 bones, 33 joints, 100+ ligaments,
19 tendons
 Many areas that can become an issue
Common Foot and Ankle Issues
Plantar fasciitis (heel pain)
Achilles tendonitis
Bunions/hammertoes
Flatfeet
Arthritis
Diabetic foot care (corns, calluses, toenails)
Plantar Fasciitis
 Most common cause of heel pain in adults
 Typically due to repetitive or excessive stress on the foot
 Symptoms
 Gradual onset of pain at bottom of the heel
 Worse when taking first steps in the morning or after prolonged
sitting
 Conservative treatment: Shoe
inserts/orthotics, stretching, appropriate
footwear, NSAIDs, rest, ice, other
(physical therapy, injections, etc.)
 Surgical treatment
Inflammation often caused by
repetitive stress on the tendon
Achilles tendon runs down back of
lower leg
Symptoms:
 Aching, stiffness, soreness or tenderness within
the tendon
Treatment: RICE, physical therapy, stretching
exercises, orthotics, night splints/custom
bracing
Achilles Tendonitis
 More than just a bump
 Reflects changes in the bony structure
 Big toe leans toward second toe, misaligning the bones
 Progressive - gets worse and bump is more prominent
 Symptoms
 Pain or soreness
 Redness and inflammation
 Burning or numbness
 Difficulty wearing certain shoes
 Treatment
 Conservative
 Surgical
Bunions
Hammertoes
More severe cases - open
sores
Treatment
 Conservative
 Surgical
Abnormal bend in the second, third, fourth or little
toe
Bend in the toe
Pain/irritation when wearing shoes
Corns and calluses
Redness and inflammation
Flatfeet
Structural abnormality leading to abnormal
foot alignment/positioning
Progressive weakening of supportive structures
and gradual collapse of the arch
Conservative treatment: orthotics, bracing,
functional supports, physical therapy
Surgical treatment: reconstructive procedures
to recreate arch of foot
Arthritis
 Most common in the mid-foot, big toe or ankle
 Inflammation of the joint - breakdown in joint
cartilage
 Symptoms
 Pain and stiffness
 Swelling in or near the joint
 Difficulty walking or bending the joint
 Treatment
 Conservative - shoes, boots, bracing, orthotics
 Surgical - joint fusion or joint replacement
Diabetic Foot Care
 Elevated blood sugars damage nerves, blood
vessels, joints, skin
 Vascular disease
 Neuropathy
 Ulceration
 Infection
 Gangrene
 Amputations
Diabetic Facts
Number of people with diabetes has risen from 108 million
in 1980 to 422 million in 2014.
Global prevalence of diabetes among adults over 18 years
of age has risen from 4.7 percent in 1980 to 8.5 percent in
2014.
Diabetes prevalence has been rising more rapidly in middle-
and low-income countries.
Diabetes is a major cause of blindness, kidney failure, heart
attacks, stroke and lower limb amputation.
Why Screen the Diabetic Foot?
15 percent of people with Type I and Type II
diabetes will develop one or more foot
ulcers in their lifetime.
10 percent of these will go on to have a
major lower limb amputation.
Of all non-traumatic lower limb
amputations, 85 percent are due to diabetic
foot ulcerations.
Five-Year Mortality Rate
Foot Care Tips
 Check your feet every day
 Look at your bare feet every day for cuts,
blisters, red spots and swelling
 Use a mirror to check the bottoms of
your feet or ask a family member for
help if you have trouble seeing
 Wash your feet every day
 Wash feet in warm, not hot, water
 Dry feet well; be sure to dry between the toes
 Keep the skin soft and smooth
 Rub a thin coat of skin lotion over the tops and
bottoms of your feet, BUT NOT BETWEEN
YOUR TOES
Foot Care Tips, cont.
Wear shoes and socks at all times
 Never walk barefoot
 Wear comfortable shoes that fit well and protect your feet
 Feel inside your shoes before putting them on each time to
make sure the lining is smooth and there are no objects
inside
 Make sure the shoe fits properly
Take care of your diabetes and try to be more active
 Work with your healthcare provider to keep your blood
sugar within a safe range
 Plan a physical activity program with your healthcare
provider
Footwear Tips
 Type of shoe
 Proper fit
 Shoe wear, patterns of
wear
 Lining wear
 Foreign bodies/objects
 Insoles, orthotics
Agnesian Health Shoppe
 How does podiatry work with the Agnesian Health
Shoppe?
 Diabetic/therapeutic shoes
 Compression stockings
 Over-the-counter shoe orthotics
 Walkers
 Crutches
 Roll about knee scooter
 Wheelchair
 Surgical shoes/boots
Agnesian Health Shoppe
Deb Winterhack
Services
 Sleep management
 Home oxygen
 Women’s health
 Mobility and home
access
 Diabetic shoes
 Retail DME shop
 Wound care
 Re-supply program
 Repair and service
 Benefits
 Additional products
Sleep Management
Sleep Management Program
Respiratory therapists on-site
 Four full-time respiratory therapists
 Technicians on-call 24/7
 Flexible schedules to meet patient’s needs
Patient education and exceptional compliance
Re-supply program for masks and
supplies
 Direct mailing to patient’s home
with permission
Retail products, such as pillows
and wedges for sleep comfort
Home Oxygen
 Home Oxygen program consists of:
 Respiratory therapists and certified
delivery technicians
 Provide home delivery at set-up and 10
tanks per month
 Provide education on proper use of
equipment and supplies
 Our team has many years of experience
and have established relationships with
our customers providing a sense of
security and compassion.
 Strive for same day service, on-call 24/7
 Respiratory therapists available for
consultation with patients and their
providers
Women’s Health
Post mastectomy supplies,
including:
 Breast prosthesis, bras, swimwear, fashionable
scarfs and head coverings, wigs
Mom and baby products
 Medela and Ameda Breast pumps and supplies
 Earth Mama Angel Baby skin care products
Compression garments
 Ready-to-wear and custom fitted (for both genders)
 Two certified compression and mastectomy fitters
with a licensed registered nurse on staff
Private fitting rooms - call for
appointments
Agnesian HealthCare Know & Go Friday, March 2017: Podiatry & Health Shoppe
Staying Home Safely
Falls inside and outside are the number one
cause of injury among the elderly
Stairs lifts assist in climbing the stairs
More access to your entire home
Funding sources available
Wheelchair ramps provide access into your
home or garage
Vehicle ramps provide easier transports
Free home assessments for safety, equipment
and home modifications
Staying Home Safely
Mobility & Home Access
Two nationally-certified assistive technology
professionals (ATP).
Work with patients and providers to ensure proper
equipment is built to fit the patient’s needs, home
and lifestyle.
High-end custom specialty mobility devices and
equipment including:
Power wheelchairs
Power lifts
Scooters
Agnesian HealthCare Know & Go Friday, March 2017: Podiatry & Health Shoppe
Diabetic/Therapeutic Shoes
Complete Dr. Comfort line of diabetic and
therapeutic shoes, inserts and socks.
Full-time certified associates dedicated to
assisting customers with their orders for
shoes and inserts.
Medicare and most private insurances
will cover one pair of shoes and three
pairs of inserts per year
for qualified diabetic
patients.
Lift Chairs
For patients who have trouble getting in and out of
living room furniture
Available in a variety of fabrics to complement décor
Provides safety and independence
Mattresses and covers for sleep
Wide range of styles, colors and price
Delivery and set-up provided
Hydro-lift product for any surface
Retail DME Shop
DME specialists assist with in-home medical
equipment and supplies, and third party
reimbursement for private insurances and
Medicare
Expanded cash and carry product lines
 Exercise equipment – Zone recommended
 Pain management products
 Dietary supplements & chiropractic recommended
products
 Podiatry orthotics and bracing
Ambulatory aids, bathroom & bedroom safety
Agnesian HealthCare Know & Go Friday, March 2017: Podiatry & Health Shoppe
Wound Care Registered Nurse
Registered nurse on-site working with patients and
providers on wound care supplies and reimbursement.
 Answers questions
 Product education
 Liaison for patient as it relates to
reimbursement
 Works hard to find products that will be
covered
 Conveniently located next to the Agnesian
Wound Care
 Products delivered right to the patient’s home
Re-Supply Program
Re-order program with trained specialists:
Place monthly reminders to patients for supplies for
CPAP, ostomy, wound care, urological, enteral or
incontinent products
Monthly and quarterly reminder calls
Never call a patient without permission
Never ship product without speaking to the patient
Repair & Service
On-site maintenance of all rental equipment
Repair of purchased power mobility devices,
wheelchairs, lift chairs and motorized scooters
Questions?
Thank you for your support
and loyalty.

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Agnesian HealthCare Know & Go Friday, March 2017: Podiatry & Health Shoppe

  • 1. Podiatry Robert Bertram, DPM Sarika Parikh, DPM Podiatry (Foot & Ankle) Agnesian HealthCare
  • 2. Presentation Outline Introduction  Robert Bertram, DPM  Sarika Parikh, DPM What is podiatry? Common foot and ankle issues Diabetes and diabetic foot care Agnesian Health Shoppe Questions
  • 3. What Is Podiatry?  Podiatry, or podiatric medicine, is a specialized area of medicine dedicated to the diagnosis, treatment and prevention of diseases and disorders of the foot, ankle and lower extremities.  Foot/ankle anatomy is complicated  26 bones, 33 joints, 100+ ligaments, 19 tendons  Many areas that can become an issue
  • 4. Common Foot and Ankle Issues Plantar fasciitis (heel pain) Achilles tendonitis Bunions/hammertoes Flatfeet Arthritis Diabetic foot care (corns, calluses, toenails)
  • 5. Plantar Fasciitis  Most common cause of heel pain in adults  Typically due to repetitive or excessive stress on the foot  Symptoms  Gradual onset of pain at bottom of the heel  Worse when taking first steps in the morning or after prolonged sitting  Conservative treatment: Shoe inserts/orthotics, stretching, appropriate footwear, NSAIDs, rest, ice, other (physical therapy, injections, etc.)  Surgical treatment
  • 6. Inflammation often caused by repetitive stress on the tendon Achilles tendon runs down back of lower leg Symptoms:  Aching, stiffness, soreness or tenderness within the tendon Treatment: RICE, physical therapy, stretching exercises, orthotics, night splints/custom bracing Achilles Tendonitis
  • 7.  More than just a bump  Reflects changes in the bony structure  Big toe leans toward second toe, misaligning the bones  Progressive - gets worse and bump is more prominent  Symptoms  Pain or soreness  Redness and inflammation  Burning or numbness  Difficulty wearing certain shoes  Treatment  Conservative  Surgical Bunions
  • 8. Hammertoes More severe cases - open sores Treatment  Conservative  Surgical Abnormal bend in the second, third, fourth or little toe Bend in the toe Pain/irritation when wearing shoes Corns and calluses Redness and inflammation
  • 9. Flatfeet Structural abnormality leading to abnormal foot alignment/positioning Progressive weakening of supportive structures and gradual collapse of the arch Conservative treatment: orthotics, bracing, functional supports, physical therapy Surgical treatment: reconstructive procedures to recreate arch of foot
  • 10. Arthritis  Most common in the mid-foot, big toe or ankle  Inflammation of the joint - breakdown in joint cartilage  Symptoms  Pain and stiffness  Swelling in or near the joint  Difficulty walking or bending the joint  Treatment  Conservative - shoes, boots, bracing, orthotics  Surgical - joint fusion or joint replacement
  • 11. Diabetic Foot Care  Elevated blood sugars damage nerves, blood vessels, joints, skin  Vascular disease  Neuropathy  Ulceration  Infection  Gangrene  Amputations
  • 12. Diabetic Facts Number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014. Global prevalence of diabetes among adults over 18 years of age has risen from 4.7 percent in 1980 to 8.5 percent in 2014. Diabetes prevalence has been rising more rapidly in middle- and low-income countries. Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.
  • 13. Why Screen the Diabetic Foot? 15 percent of people with Type I and Type II diabetes will develop one or more foot ulcers in their lifetime. 10 percent of these will go on to have a major lower limb amputation. Of all non-traumatic lower limb amputations, 85 percent are due to diabetic foot ulcerations.
  • 15. Foot Care Tips  Check your feet every day  Look at your bare feet every day for cuts, blisters, red spots and swelling  Use a mirror to check the bottoms of your feet or ask a family member for help if you have trouble seeing  Wash your feet every day  Wash feet in warm, not hot, water  Dry feet well; be sure to dry between the toes  Keep the skin soft and smooth  Rub a thin coat of skin lotion over the tops and bottoms of your feet, BUT NOT BETWEEN YOUR TOES
  • 16. Foot Care Tips, cont. Wear shoes and socks at all times  Never walk barefoot  Wear comfortable shoes that fit well and protect your feet  Feel inside your shoes before putting them on each time to make sure the lining is smooth and there are no objects inside  Make sure the shoe fits properly Take care of your diabetes and try to be more active  Work with your healthcare provider to keep your blood sugar within a safe range  Plan a physical activity program with your healthcare provider
  • 17. Footwear Tips  Type of shoe  Proper fit  Shoe wear, patterns of wear  Lining wear  Foreign bodies/objects  Insoles, orthotics
  • 18. Agnesian Health Shoppe  How does podiatry work with the Agnesian Health Shoppe?  Diabetic/therapeutic shoes  Compression stockings  Over-the-counter shoe orthotics  Walkers  Crutches  Roll about knee scooter  Wheelchair  Surgical shoes/boots
  • 20. Services  Sleep management  Home oxygen  Women’s health  Mobility and home access  Diabetic shoes  Retail DME shop  Wound care  Re-supply program  Repair and service  Benefits  Additional products
  • 21. Sleep Management Sleep Management Program Respiratory therapists on-site  Four full-time respiratory therapists  Technicians on-call 24/7  Flexible schedules to meet patient’s needs Patient education and exceptional compliance Re-supply program for masks and supplies  Direct mailing to patient’s home with permission Retail products, such as pillows and wedges for sleep comfort
  • 22. Home Oxygen  Home Oxygen program consists of:  Respiratory therapists and certified delivery technicians  Provide home delivery at set-up and 10 tanks per month  Provide education on proper use of equipment and supplies  Our team has many years of experience and have established relationships with our customers providing a sense of security and compassion.  Strive for same day service, on-call 24/7  Respiratory therapists available for consultation with patients and their providers
  • 23. Women’s Health Post mastectomy supplies, including:  Breast prosthesis, bras, swimwear, fashionable scarfs and head coverings, wigs Mom and baby products  Medela and Ameda Breast pumps and supplies  Earth Mama Angel Baby skin care products Compression garments  Ready-to-wear and custom fitted (for both genders)  Two certified compression and mastectomy fitters with a licensed registered nurse on staff Private fitting rooms - call for appointments
  • 25. Staying Home Safely Falls inside and outside are the number one cause of injury among the elderly Stairs lifts assist in climbing the stairs More access to your entire home Funding sources available Wheelchair ramps provide access into your home or garage Vehicle ramps provide easier transports Free home assessments for safety, equipment and home modifications
  • 27. Mobility & Home Access Two nationally-certified assistive technology professionals (ATP). Work with patients and providers to ensure proper equipment is built to fit the patient’s needs, home and lifestyle. High-end custom specialty mobility devices and equipment including: Power wheelchairs Power lifts Scooters
  • 29. Diabetic/Therapeutic Shoes Complete Dr. Comfort line of diabetic and therapeutic shoes, inserts and socks. Full-time certified associates dedicated to assisting customers with their orders for shoes and inserts. Medicare and most private insurances will cover one pair of shoes and three pairs of inserts per year for qualified diabetic patients.
  • 30. Lift Chairs For patients who have trouble getting in and out of living room furniture Available in a variety of fabrics to complement décor Provides safety and independence Mattresses and covers for sleep Wide range of styles, colors and price Delivery and set-up provided Hydro-lift product for any surface
  • 31. Retail DME Shop DME specialists assist with in-home medical equipment and supplies, and third party reimbursement for private insurances and Medicare Expanded cash and carry product lines  Exercise equipment – Zone recommended  Pain management products  Dietary supplements & chiropractic recommended products  Podiatry orthotics and bracing Ambulatory aids, bathroom & bedroom safety
  • 33. Wound Care Registered Nurse Registered nurse on-site working with patients and providers on wound care supplies and reimbursement.  Answers questions  Product education  Liaison for patient as it relates to reimbursement  Works hard to find products that will be covered  Conveniently located next to the Agnesian Wound Care  Products delivered right to the patient’s home
  • 34. Re-Supply Program Re-order program with trained specialists: Place monthly reminders to patients for supplies for CPAP, ostomy, wound care, urological, enteral or incontinent products Monthly and quarterly reminder calls Never call a patient without permission Never ship product without speaking to the patient
  • 35. Repair & Service On-site maintenance of all rental equipment Repair of purchased power mobility devices, wheelchairs, lift chairs and motorized scooters
  • 36. Questions? Thank you for your support and loyalty.

Notas del editor

  1. Overview of IH, discuss specific complementary therapies. Acupuncture demo
  2. Podiatry Subspecialties: Sports Medicine, Dermatology, Podo-pediatrics, Diabetic Wound Care/Limb Salvage, Trauma, Reconstructive Orthopedic Surgery, Ankle Surgery, Ankle Replacement
  3. Discuss on-call – but not RT
  4. Discuss – Did you know – it is the law that insurance companies need to pay for breast pumps.
  5. Discuss falls and deaths from falls Discuss trama Discuss fire safety regarding wheel chair ramps Discuss falls down stairs Costs of falls multiple places Talk about funding
  6. Go through assessment & safety Check list
  7. Discuss other reasons to wear the shoes. Crop the picture Talk about Katie
  8. Add different picture Discuss funding We will load front door Use for respiratory and sleep Note – we will load into a truck if they need to pick up.
  9. Cash Sales
  10. Discuss how hard Nikki works on getting coverage – even if she has to find a different product. She will find the best product, best overage.