Associate Editor's Note

Associate Editor's Note:

Thomas G. Peters, M.D., FACS
Chairman, Department of Surgery, Methodist Medical Center
Clinical Professor of Surgery, University of Florida College of Medicine

Management of the diseased foot is a challenge to many physicians including endocrinologists, family practitioners, internists, podiatrists, and surgeons of numerous fields including general, vascular, and orthopedic specialists. The pathophysiology and therapeutic aspects of foot disease encompass these and other specialties. In addition, the problem foot is of great importance in rehabilitation of the affected patient and remains the target end organ of a number of disease processes.

In this issue of Jacksonville Medicine, several topics related to foot problems are reviewed. We have invited our Podiatric colleagues, Dr. Michael Friedman, Dr. Steven Greenhut, Dr. Bradley Herbst, Dr. James Koon, Dr. Mark Matey, and Dr. Stephen Meritt, to bring us up-to-date on certain aspects of podiatric practices. Podiatric medicine has advanced just as allopathic medicine has over the last decade or so. New operative approaches to foot disease as well as orthotic and physical therapeutic interventions have accompanied a better understanding of foot physiology and function. As a general surgeon, I have had an interest in extremity disease, and it has occurred to me through my career that our Podiatric colleagues have developed an expertise which can be a great plus in a collegial approach to our mutual patients. Certainly, new materials and engineering in orthotic appliances are an important advance to retaining function in the diseased foot.

Just as Podiatric medicine has grown, Orthopedic surgery now recognizes a special area in foot surgery. Fellowships and special training programs are available, and Dr. Hiram Carrasquillo has taken advantage of such training. He brings us up-to-date in several common foot diseases and treatments. Our Editor, Dr. Michael Bernhardt presents an interesting but not (unfortunately) unique case of dermatologic disease which highlights a life threatening circumstance related to a foot lesion. Finally, it is my privilege to review limb salvage with limited amputation of the distal foot. In the past, the reaction to an infected-ischemic foot was intravenous antibiotics, ice packing overnight, and above or below-the-knee amputation at an interval of 8 to 24 hours. In the 1980's and 1990's, the approach to the infected or ischemic foot has often allowed for salvage of a functional extremity, a most important goal in the care of foot disease.

As medicine becomes more involved with high technology and molecular biology, I believe that there may be no set of patients more grateful than those who have a substantial problem with the foot which is appropriately diagnosed and treated resulting in a functional lower extremity. Clearly, our issue doesn't cover the wide range of problems attendant with the numerous congenital, metabolic, traumatic, structural, and infectious problems related to foot disease. Nonetheless, this fresh view of approach to common problems of the foot may enlighten all of us who treat patients with foot problems and assume the bipedal position many times each day. Enjoy!

Jacksonville Medicine / April, 1998