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Chicago 2021 MIFAS Event

Jul 29 2021 05:08:54 AM

Chicago

TJ Ahn’s 2021 International MIFAS Cadaver Lab Workshop was yet again, a very impressive event held at the Orthopedic Learning Center in Rosemont, Illinois. Dr. Ahn (MIFAS diplomate # 001) successfully doubled the size of his learning group to nearly 70 participants, and 2 dozen faculty for this event despite the challenges of COVID over the past 18 months. His staff organized a seamless and incredibly successful event.

The legendary Dr. Steve Isham brought his expertise and support to this meeting. Canadian expert and speaker Dr. Hartley Miltchin was able to get a special waiver to attend, while other international speakers, Dr. Naranjo-Ruiz, Dr. Juanto, Dr. Benavides, Dr. Carbone, were “Zoomed” in for their presentations. We are proud that our MIFAS Board certified Diplomates Dr. Timothy Shea and Dr. Larry Kales participated as both speakers and lab faculty.

About two dozen candidates took the MIS practical exam in anticipation of board certification. Both novice and experienced minimally invasive foot and ankle surgeons from the US and around the globe participated to share knowledge, improve skills, and enhance business strategies. Dr. Ahn showcased his Mastermind strategies for doctors to remain financially viable in the rough seas of today’s medical economics.

ABMSP booth of the MIS..
ABMSP booth of the MIS “royalty” that gathered (Center Dr. Beth Pearce).
(From left to right) Doctors TJ Ahn, Oscar Benavides (Past President of the Academy), Steve Isham and Borys Markewych.
Outstanding facility
Outstanding facility
International MIFAS CADAVER LAB Workshop, July 16-17, 2021
INTERNATIONAL MIFAS CADAVER LAB WORKSHOP July 16-17, 2021
Dr. Steve Isham
Dr. Steve Isham

Informational webinar on unique 401k solution for your medical practice

Feb 1 2021 12:52:03 AM

Join us on Tuesday, February 23 at 8:00 pm (Eastern Time) for an informational webinar to learn more about a new Diplomate benefit from the ABMSP: The Sovereign Retirement Edge – What a 401k Should Be. The Sovereign Retirement Edge is a unique 401k solution for your medical practice.

  • Would you like an easier and more cost-effective way to offer yourself and your employees a retirement plan solution?
  • Would you like to shift the fiduciary burdens of sponsoring a 401(k) from yourself to professional fiduciaries?
  • Would you like to have access to virtually all investment options and strategies available today, and get access to those investment options directly in your 401(k)?
  • Would you like to never sign a 5500 form again?

If your answer to any or all these questions is “yes”, then, you will want to attend this webinar to learn more about this new Diplomate benefit being offered by the American Board of Multiple Specialties in Podiatry:

Thanks to new legislation, small to mid-sized employers, like ABMSP Diplomates, can now pool together in the same retirement plan, providing affordable benefits similar to some of the largest companies in the country.

Overview and Advantages of a PEP

Under the SECURE Act, the first significant retirement-related legislation in more than a decade, employers can offer retirement plans to their employees through a Pooled Employer Plan (PEP). A PEP, available starting in January 2021, is a new kind of defined contribution plan similar to the 401(k) plans offered today by individual employers, but with many advantages for you and your employees. In a PEP, employers of all sizes, industries, locations, etc. can join together and become a “member employer.” The PEP is offered by a Pooled Plan Provider (PPP) who is responsible for the establishment, management, fiduciary oversight and operations of the plan on behalf of all the member employers.

The Offer

The ABMSP has negotiated special pricing for its members for this retirement plan solution being provided by Sovereign Financial Group Inc., and The Newport Group. Specifically, ABMSP Diplomates will receive a $500 annual rebate towards the plan costs each year they remain active with ABMSP.

Advantages of a PEP

  • Cost Efficiencies – Costs are lower because they are spread across a larger participant and asset base reducing the costs for each member of the plan.
  • Fiduciary Risk Mitigation – Fiduciary duties are outsourced to Sovereign Financial Group, Inc. as an ERISA 3(38) investment fiduciary.
  • Operational Outsourcing – Newport, as the pooled plan provider, assumes many of the administrative burdens on behalf of member employers including eligibility, beneficiary tracking and plan disbursements.
  • Increased Focus – Member employers use fewer resources allowing more focus on growing revenues and profits in their business.

Other Benefits

  • Integrated trust and custody services
  • Digital access to all plan functions and information
  • Payroll contribution tracking and integration
  • Integrated non-qualified plans
  • Full-function participant website and call center
  • English & Spanish website
  • Full suite of participant educational materials
  • Financial wellness program

If you are interested in joining this Zoom call, please email [email protected] or contact us online to get the Zoom link instructions for February 23 at 8:00 pm Eastern Time.

Distinguished Authors Series
The opinions expressed here are those of the authors and do not necessarily reflect the positions of the American Board of Multiple Specialties in Podiatry or its Directors.

The Role of Topical Oxygen Therapy in the Treatment of Wounds

Windy Cole, DPM

Introduction
When you think back to your early studies in General Biology you may recall memorizing the steps of the Krebs Cycle. It is through this process of aerobic respiration that most living things generate energy. In aerobic organisms, cells utilize Oxygen (O2) as a final electron acceptor to synthesize high-energy adenosine triphosphate (ATP) from Adenosine Diphosphate (ADP). This ATP is what fuels most cellular processes. Wounded tissues exhibit an increased energy demand leading to a hypermetabolic state.1Therefore, wound healing is heavily reliant on attaining adequate levels of oxygenation within the injured tissues. Oxygen is essential to multiple wound healing processes including oxidative killing of bacteria, cellular signaling and proliferation, collagen deposition, and angiogenesis.2

The Antimicrobial Effects of Oxygen
Oxygen is a necessary component for control of bacterial burden during the inflammatory phase of wound healing. After tissue injury has occurred, chemical signals such as histamine are released. These stimuli induce migration of monocytes and neutrophils into the wound site. These cells then produce reactive oxygen species (ROS) by the process of a respiratory burst. ROS are responsible for the oxidative killing of bacteria that protects the wound from infection. 2 Without adequate local tissue oxygenation, the respiratory burst is impaired, resulting in increased susceptibility to infection. Hohn et al. conducted a study in which they determined that skin wounds of rabbits exposed to air containing low oxygen concentrations had more elevated levels of Staphylococcus Aureus than skin wounds of rabbits exposed to air containing high levels of oxygen. 3 Local tissue oxygen levels are a determining factor in the microbial contamination of wound tissues.

Growth Factor Regulation
ROS in low levels play a role in both cellular signaling and growth factor release. Growth factors use various mechanisms such as fibroblast migration and keratinocyte proliferation to stimulate healing. Acute hypoxia stimulates growth factor production, but chronic hypoxia inhibits or eliminates it.4 Siddiqui and colleagues investigated the proliferation of fibroblasts in varying environments. They compared cells grown in a hypoxic environment (1% O2) vs standard culture conditions (20% O2). The results of the study showed cell proliferation was 3 times slower with exposure to 1% oxygen versus 20% oxygen. The investigators concluded that chronically low levels of local oxygen were detrimental to growth factor production and led to decreases in fibroblast proliferation.5

Collagen Synthesis
Fibroblasts are responsible for the synthesis of collagen fibers. Collagen is the most abundant protein produced in the human body. Deposition of collagen is a fundamental step in the wound healing process as it provides a natural scaffold or substrate for new tissue growth. The formation of the collagen triple helix is O2 dependent. Without the triple helix, procollagen is non-functional. It is these extracellular cross-linkages that are ultimately responsible for the tensile strength needed in prolonged wound healing.6 Hunt and colleagues, used a rabbit model to track the rate and density of collagen formation with changes in oxygen levels. The results demonstrated that exposure to hyperoxic environments accelerated collagen synthesis.6

Angiogenesis
The formation of new blood vessels, or angiogenesis, is critical in wound healing. This neovascularization provides channels for active cells, nutrients and O2 to travel to the wounded tissues. Vascular endothelial growth factor (VEG-F) is a major angiogenic stimulus. Initially, hypoxia acts as a stimulus to VEG-F. However, prolonged hypoxia inhibits VEG-F formation and function and obstructs neovascularization.7 Topical oxygen therapy has been shown to increase both VEG-F levels as well as angiogenesis.

A 2008 study by Gordillo et al evaluated outcomes in 1,854 outpatient wound clinic patients who were screened for non-randomized enrollment into either hyperbaric oxygen therapy treatment (HBOt) or topical oxygen (TO) for the treatment of their chronic wounds. The investigators determined that there were no significant changes in wound measurements in the HBOt patient group. However, the TO treatment group did exhibit a noticeable decrease in overall wound dimensions. Tissue biopsies were obtained from wounds in both treatment arms. There was an increase in VEG-F found within the TO group. Overall, the investigators concluded that TO showed better wound healing benefits compared to HBO.7

Case Example
It has been the authors’ experience that continuous topical oxygen therapy (cTOT) offers an effective non-invasive chronic wound treatment that may speed healing by improving microcirculation and oxygenated hemoglobin as demonstrated by this case:
85 y.o. male with a left lower leg venous ulcer of 62-weeks duration Past Medical History: Peripheral Vascular Disease; Venous Insufficiency; Venous Stasis Dermatitis, Non-Insulin Dependent Diabetes Mellitus; Degenerative Joint Disease; Hypertension Previous failed wound therapies: Alginate; Foam and Compression Dressings; Iodine; Silver Dressing; Collagen; Medihoney; Santyl

ABI: 1.07

ABI- 1.07_1

At baseline, the wound oxygenated hemoglobin level was 65% and wound measurements were 9.2cmx2.8cmx0.2cm. cTOT was initiated at this visit along with standard of care consisting of secondary compression bandages.

ABI- 1.07_2

After 3 weeks of cTOT, the wound oxygenated hemoglobin level increased to 79%, and the wound dimensions decreased to 8.7cm x1.6cmx 0.1cm. The patient continued with cTOT and compression until healing at 11 weeks.

Discussion
Oxygen is an important biomarker when determining a wound’s ability to heal. As demonstrated above, oxygen is essential for all phases of wound healing. The oxygen gradient in wounded tissue is unequal. Supply may not meet demand. This is especially true in patients suffering from small vessel disease. Although the etiology of non-healing chronic wounds is multi-factorial, hypoxia is a common component in a vast majority of cases. Chronic wounds continue to pose a challenge to clinicians. For many years hyperbaric oxygen therapy (HBOt) has been employed to deliver high-pressure 100% oxygen to the tissue in the hopes of increasing wound oxygenation. HBOt relies on adequate arterial perfusion in order to transfer oxygen to the wounded tissue. The advent of newer technologies can now enable small, portable battery-powered oxygen generators to allow continuous oxygen therapy (cTOT) to be applied directly to the wound base at normospheric pressure. cTOT is a novel treatment that could prove to be a more cost-effective alternative to HBOt that may potentially be applied to a broader cross-section of patients, including some that may not be eligible for HBOt.

References

  1. Tandara AA, Mustoe TA. Oxygen in wound healing–more than a nutrient. World J Surg. 2004;28(3):294–300.
  2. Rodriguez PG, Felix FN, Woodley DT, Shim EK. The role of oxygen in wound healing: a review of the literature. Dermatol Surg. 2008;34(9):1159–1169.
  3. Hohn DC, MacKay RD, Halliday B, Hunt TK. Effect of O2 tension on microbicidal function of leukocytes in wounds and in vitro. Surg Forum. 1976;27(62):18–20. Bishop A. Role of oxygen in wound healing. J Wound Care. 2008;17(9):399–402.
  4. Siddiqui A, Galiano RD, Connors D, Gruskin E, Wu L, Mustoe TA. Differential effects of oxygen on human dermal fibroblasts: acute versus chronic hypoxia. Wound Repair Regen. 1996;4(2):211–218.
  5. Hunt TK, Pai MP. The effect of varying ambient oxygen tensions on wound metabolism and collagen synthesis. Surg Gynecol Obstet. 1972;135(4):561–567.
  6. Gordillo GM, Sen CK. Revisiting the essential role of oxygen in wound healing. Am J Surg. 2003;186(3):259–263.
Author Biography
Windy Cole, DPM

Dr. Windy Cole is a native Ohioan. She holds a bachelor’s degree in biology from the University of Cincinnati where she graduated summa cum laude. She is also an honors graduate from the Kent State University College of Podiatric Medicine. Dr. Cole has practiced in Northeast Ohio for 20 years. She serves as Medical Director of the Wound Care Center, University Hospitals Ahuja Medical Center and Adjunct Professor and Director of Wound Care Research at Kent State University College of Podiatric Medicine. She is board certified by the American Board of Foot and Ankle Surgery and the American Board of Wound Management. She has been a dedicated wound care advocate for two decades with interests focused on medical education, diabetic foot care, wound care, limb salvage, & clinical research. Her passion to help others has led her participate in humanitarian efforts including a medical mission to Jordan in 2018 to aid the large Syrian refugee population seeking asylum from civil war. Dr. Cole has published numerous articles on these topics and is a sought-after speaker both nationally and internationally. She is a feature writer for Podiatry Management and Today’s Wound Clinic as well as a contributing writer for Podiatry Today. She is an Editorial Board member of Wound Management and Prevention, Podiatry Today, and Lower Extremity Review. She is a wound care advocate on the forefront of technology-driven research. She sits on the advisory board of multiple emerging biotech companies and has been integral in collaborating on innovative research protocols in the space.

Champions Blog

The Birth of Podiatric Sports Medicine: The Academy and Now Board Certification

A number of important figures present and past have made possible the new podiatric sports medicine certification.

BY KENNETH B. REHM, DPM

The long-awaited board certification in podiatric sports medicine is now available to all doctors who want a valuable credential allowing them to declare that they are a qualified podiatric specialist in sports medicine. It has been a long and interesting journey involving two unique organizations and a host of talented individuals. Here is the full story… highlighting those whose contributions made it possible.

The 1970’s brought about the birth of podiatric sports medicine. The impetus for most of the interest in sports medicine by podiatrists back then arose out of the running boom and the development of the American Association of Podiatric Sports Medicine. Doctors George Sheehan, Robert Barnes, George Pagliano, Richard Gilbert and Steven Subotnik brought the role of the podiatrist in sports medicine to national attention.

The momentum they created has not stopped; and now the field is in full bloom where physicians such as Dr. Jeff Ross merges his expertise in diabetic foot medicine and surgery with biomechanics and sports medicine, culminating in an efficacious bridging of podiatry with collegiate and high-school sports. Dr. Ross served as team podiatric physician for the Baylor University football team and is a consultant for the University of Houston track team, while also playing an active role in high school sports. Adding to his credentials and fueled by his intense love for skiing, his in-depth research defined its biomechanics. His incredible passion was a driving force that propelled podiatric sports medicine to the pinnacle of recognition and the establishment of the highly anticipated board certification by the American Board of Multiple Specialties in Podiatry (ABMSP).

“Dr. Richard Gilbert, podiatrist to the San Diego Chargers, was a pioneer in the development of the AAPSM.”

The Trailblazers
The idea of a board certification in podiatric sports medicine was initially seeded by the esteemed Dr. Richard Gilbert (Figure 1), pioneer in the development of the American Academy of Podiatric Sports Medicine (AAPSM) and podiatrist to the San Diego Chargers. His powerful motivation was to unite the various avenues of podiatric medicine and surgery through an amalgamation of talents vital to forming a complete spectrum of podiatric sports medicine expertise, where trained DPMs could interchange ideas and knowledge with seasoned professionals.
Arguably, the first podiatric sports medicine celebrity was Dr. Steve Subotnik, an athlete himself who was featured in Runner’s World.

Figure 1: Richard Gilbert, DPM, The Father of Podiatric Sports Medicine

Magazine and author of The Running Foot Doctor (Figure 2). Because of his groundbreaking work in surgery, biomechanics and sports medicine, Dr. Subotnik was possibly the single most influential force in putting podiatry on the map. He cut his “sports medicine teeth” as a professor at the California College of Podiatric Medicine where he taught surgery and biomechanics. This period of his 50-plus year career was especially gratifying to him, particularly when established doctors, who were students of his in those fledgling years, came up to him at meetings and told him what an impact he had on their career.

Dr Subotnik’s sports medicine career rocketed when he became a marathon runner, and his intense involvement and resulting contributions brought the podiatry profession new recognition and acceptance. His notable cabal included health-related celebrities such as Dr. George Sheehan, a cardiologist who became the legendary philosopher of the recreational running movement in the 1970’s and 1980’s.

For years, Dr.Subotnik, one of the founding fathers of the American Academy of Podiatric Sports Medicine, felt that board certification in podiatric sports medicine would take this specialty to the next level, as it separates the spectators from the players. His commitment to board certification was key to the formation of the new certification by The ABMSP. Dr. Subotnik states: “Sports medicine helps define modern podiatry because biomechanics is the defining factor in podiatry and is also an integral part of sports medicine. The podiatric practice of sports medicine is so important, now more than ever, because it will continue to keep podiatry on the map; because through biomechanics we can make a real difference.” He goes on to say, “Once you’re an athlete who sustains a foot injury, and being active is part of your life, you will seek the help of a sports medicine podiatrist at any cost, regardless of any bureaucratic or insurance limitations.”
His driving philosophy summarizes the importance of the foot and its biomechanics: “Controlling the feet controls the rest of the body”, which is philosophically apropos coming from this champion podiatric sports physician.

“Arguably, the first podiatric sports medicine celebrity was Dr. Steve Subotnik, an athlete himself.”

The Protégés
From these trailblazers came their protégés who turned out to be the innovative architects of modern podiatric sports medicine. A key figure is Dr. Tim Dutra, who has advanced the traditional teachings as well as integrated this established doctrine with up-to-date sophisticated computerized gait and motion lab analysis of the athlete. His position as an assistant professor and clinical investigator at Samuel Merritt University allows him to parlay his knowledge of biomechanics and sports medicine into skillfully watermarked ideas and principles commendably driven into his students’ psyche. His uncompromising enthusiasm for improving the podiatric health of athletes is demonstrated through his tireless engagement in the Special Olympics, consulting for the Golden State Warriors basketball team as well as working with the University of California, Berkeley as a consultant for inter-collegiate sports. He has been active with the AAPSM since he started the student chapter while at the California College of Podiatric Medicine. What Dr. Dutra brings to sports medicine is merging the podiatry profession with the community; to memorialize the podiatrist’s vast training, knowledge and experience and to encourage the sporting community to take advantage of this valuable resource.

Figure 2: What started it all: Dr. Steve Subotnik and The Running Foot Doctor

Dr. Jeff Ross, president of the Texas Podiatric Medical Association and an associate professor of surgery in the division of vascular surgery and endovascular therapy, as well as a clinical associate professor in the department of medicine at Baylor College of Medicine, brings to sports medicine a whole new perspective. He not only served as president of the AAPSM but also co-chaired the Governor’s Council on Physical Fitness, served for 12 years as a member of the Texas Department of State Health Services Council and was an esteemed member of the Texas Diabetes Council. His credentials sanction him as a national and international expert in sports medicine, biomechanics, wound healing and limb preservation. Dr. Ross’s unique contribution, therefore, is being able to fuse the disciplines and surgical principles of diabetic foot medicine with sports medicine, as there are pathways common to both that are brought to light through his extensive lecturing and vast publications. Dr. Ross, inspiring to all, is a valued and motivated partner in the creation of the new certification.


AAPSM and ABMSP

This new board certification could not have happened without the genius of Stephen B. Permison, M.D., who serves as president of Standards Based Programs, Inc. (SBP Inc.), director of the ABMSP Standards Development Organization (www.abmsp-sdo.com) and a voting member of multiple professional boards. SBP Inc. has developed and is currently developing standards, credentialing and certification programs for private industry, medical professional boards and the U.S. Government. Professional credentials, such as the ABMSP certification in sports medicine for podiatrists, assures the public that certified professionals have the proper skills to practice their designated professions with consistent medical outcomes. These intensely scrutinized policies bestow a hand of trust, allowing the public to expect quality and consistency in both in the practice of podiatric sports medicine and any products or devices that support this discipline. Dr. Permison states that “the definition of professional is quality, consistency and integrity”, exactly what his expertise imprinted into the structure of the new board certification.

“Dr. Earl Horowitz’s focus on the geriatric patient contributed powerfully to the unique quality of this new board certification.”

Dr. Victor Quijano is Chief of Podiatric Medicine and Surgery at the Veterans Administration Medical Center in Portland, Oregon. His Ph.D. and his knowledge of molecular endocrinology boosts his pursuit of comprehensiveness in the practice of podiatric sports medicine beyond the treatment of the traditional athlete. He calls for more academic and clinical inclusiveness in the discipline of podiatric sports medicine to embrace those challenges that deal with diabetes and other metabolic disorders, as well as those conditions that affect our country’s veterans. His was a needed voice in the development of this quality certification.

Dr. Earl Horowitz (Figure 3) is the president of the ABMSP and most recently became one of the first podiatrists in the United States to become board certified in Geriatric Podiatry. Dr. Horowitz is a true visionary with a passion for the health of the senior population. Preventing the geriatric patient from developing unnecessary muscle weakness, inactivity and immobility, through sports, exercise and precaution is what fuels Dr. Horowitz’s zeal for the field of podiatric sports medicine. “Maintaining foot health, balance and strength as we age are essential considerations in preventing such things as falls, which often starts a downhill spiral that can even lead to death in an elderly person. This can all be prevented by seriously addressing this part of our practice.” His focus on the geriatric patient contributed powerfully to the unique quality of this new board certification.

Figure 3: Earl Horowitz DPM, A True Visionary, President of American Board of Multiple Specialties in Podiatry

Rita Yates, executive director of the American Academy of Podiatric Sports Medicine worked hand in hand with the Executive Director of the American Board of Multiple Specialties in Podiatry, Joan Campbell, to formulate a meaningful advancement from Fellow of AAPSM to Board Certification by ABMSP. This was done in collaboration with the formative team which, in addition to those already discussed, also included the following doctors whose contributions were invaluable: David Jenkins, D.P.M; Diane Mitchell-Prey, D.P.M; Doug Taylor, D.P.M; Richard Blake, D.P.M; and Steven Tager, D.P.M.

To summarize, world-class talent representing a wide range of expertise, each having intense passion for their individual niche, brought this board certification to fruition. The intended and expected outcome is to support the highest level of practice in sports medicine for the modern podiatrist; and to secure the optimum level of care for their patients. This bright light will undoubtedly ensure a brilliant future for the unabridged formidable field of podiatric medicine and surgery.

In conclusion, podiatric sports medicine defines the future of podiatry because it’s an area where committed athletes are committed to staying in the game no matter what; and there is no better place to get help for those with sports-related problems of the lower extremity than a podiatric physician and surgeon who is board certified in podiatric sports medicine.