Spring 2010 - Canadian Federation of Podiatric Medicine

The Journal of The Canadian Federation of Podiatric Medicine | Volume 3 Number 1 | spring 2010 

Dynamic Duo! 

seminar 

practice management 

CFPM Journal | February 2008 1 

See page 15 

for more 

details 

cfpm & aappm

podiatry_ad_rev 1/15/10 2:26 PM Page 1 

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risk of cross-contamination to you and your patients. 

SciCan provides a full spectrum product line as well as 

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CFPM CONTACTS 

PRESIDENT 

Dr. Brian Johnson – St. John, NB 

1-888-706-4444 

CEO 

Stephen Hartman – Waterloo, ON 

1-888-706-4444 

BOARD OF DIRECTORS 

Elmer Biscaia – Brampton, ON 

Dr. Brian Brodie – Regina, SK 

Brian Cragg – Markham, ON 

Julie DeSimone – Sudbury, ON 

Peter Guy – Whitby, ON 

David Kerbl – Stittsville, ON 

Olga Lalande – Barrie, ON 

Hannah Shenouda – Prince Albert, SK 

Vish Ramcharitar – Brampton, ON 

COMMITTEES 

Conference 

Chair – Stephen Hartman 

Education 

Chair – Brian Cragg 

Extended Health Insurance 

Chair – Stephen Hartman 

International Relations 

Chair – Dr. Brian Brodie 

Membership 

Chair – Olga Lalande 

National Issues 

Chair – Dr. Brian Johnson 

Professional Liability 

Chair – Olga Lalande 

Research Funding 

Chair – Peter Guy 

JOURNAL 

spring 2010 | Volume 3 Number 1 

In this issue... 

President’s Message ............................ 5 

An Alternative Treatment 

for OA Affected Joints ....................... 5 

CFPM 11th Annual Conference ...... 6 

Improve Your Clinic 

With a Mission Statement ................ 11 

Family Physician Conference ........... 13 

By the Numbers ............................... 13 

CFPM & AAPPM Practice 

Management Seminar ...................... 15 

Balancing Your Personal 

and Professional Lives ...................... 17 

Stepping Back, Reflecting... 

And Moving On .............................. 19 

Bridging the Gap Between Research 

and Clinical Practice: A Podiatric 

Musculoskeletal Perspective ........... 22 

Forensic Podiatry Seminar............... 25 

New Research... Running Barefoot 

is Better, But Not Recommended.... 25 

Superior Medical ........................... 29 

A Case Study for Off Loading ......... 31 

Employment Opportunity – 

Part Time Chiropodist Required.... 38 

Upcoming Conferences .................. 39 

CFPM journal 

Editor 

Cindy Hartman 

1-888-706-4444 

Advertising & Classifieds 

Cindy Hartman 

1-888-706-4444 

Published By 

CFPM 

Printed By 

St. Jacobs Printery Ltd. 

CFPM 

200 King Street South 

Waterloo, ON N2J 1P9 

1-888-706-4444 

Fax: 519-888-9385 

www.podiatryinfocanada.ca 

disclosure 

The Editor and Board of Directors of the 

Canadian Federation of Podiatric Medicine do 

not accept responsibility for opinions expressed 

by contributors to the Journal; and while every 

effort is made to ensure accuracy, they cannot 

accept responsibility for any inaccuracies in the 

information provided. 

© Canadian Federation of Podiatric Medicine, 

Spring 2010 

highlights... 

CFPM 11th Annual 

Clinical Conference 

by the numbers: 

demographics in canada. 

new research... 

running barefoot is better, 

but not recommended 

a case study 

for off loading 

page 6 

page 13 

page 25 

page 31 

CFPM Journal | Spring 2010 3

highlights 

message from the president 

Dr. Brian johnson, 

D.pod.m. 

In North America, the standard is to refer 

to members of the Podiatry Profession 

as doctors. The word doctor literally means 

teacher. The first doctors were the Greek 

doctors of philosophy. Most doctors fall 

into one of three groups. That is honorary, earned or legislated. 

The first two are awarded by universities, the latter by acts of 

parliament. For example, in New Brunswick, the 1983 Podiatry 

Act states that any person licensed under the act may use the 

title Doctor as long as it is used in conjunction with the word 

podiatrist. The Michener and U.K. graduates in New Brunswick 

are quite comfortable using their legal right to use the title Doctor. 

An Alternative Treatment 

for OA Affected Joints 

By Rich Verman, 

River Biomechanics 

Our background, along with specialized pharmaceutical 

and medical device licenses, allows River Biomechanics 

to bring a diverse range of products from around the world to 

Canadian practitioners. 

“We are always looking; that’s how we find this stuff.” says 

company president Rich Verman. 

“Two years ago we introduced Suplasyn m.d. to the 

Chiropodial and Podiatric medical community. Since then, 

hundreds of people have found pain relief, mobility and have 

avoided surgery.” 

Suplasyn m.d. (mini dose) is a viscosupplement engineered for 

intra-articular injection, directly into the synovial cavity of OA 

affected big toe joints in order to restore joint function and decrease 

OA symptoms. 

Suplasyn m.d. (Hyaluronic Acid) is similar to Orthovisc and 

Synvisc and has been available in Canada for a number of years 

as a “Class 3 Medical Device” (Health Canada) it’s action being 

mechanical rather than pharmaceutical. 

“With its low molecular weight Suplasyn m.d. easily passes 

thru a 25G needle; small enough to enter small synovial joints” 

Mr. Verman explains. HA is a common substance throughout 

the body and Suplasyn m.d. is non-animal derived, eliminating 

any risk of avian protein sensitivities. 

Ontario is out of step with the other 

provinces and states when it comes 

to using the title. It is a great shame 

that the U.S.A. graduates with earned 

doctorates have been restricted in the 

use of this title in Ontario. 

Our profession needs to work diligently both nationally and 

provincially towards changes in the legislation that will allow for 

legislated use of the term doctor by podiatrists throughout Canada. 

The first move towards legislative change is often initiated by the 

profession itself. I do not practice in Ontario but as I understand 

the situation in Ontario licensed practitioners may not refer to 

themselves as Doctor. Can they refer to their peers as Doctor? 

In anticipation of legislative change, and if not already doing 

so, I would encourage all our members to refer to all Ontario 

practitioners as Doctor. 

“Two years ago we introduced 

Suplasyn m.d. to the Chiropodial and 

Podiatric medical community. Since 

then, hundreds of people have found 

pain relief, mobility and have avoided 

surgery.” 

Best suited for mild to moderate OA damage, Suplasyn m.d. 

is recommended for patients who have failed conventional 

therapeutic options or as an adjunct to the therapeutic pyramid. 

“The beneficial effects of treatment usually last 6-9 months 

or more and appear much longer lasting than corticosteroid 

injections and superior to NSAIDs for treatment of OA affected 

joints”. 

Suplasyn m.d. is available in pre-loaded .7 ml syringes. A 

treatment course consists of 3 injections given at one week 

intervals. For cosmetic applications such as fat pad augmentation, 

Suplasyn is available in 2ml syringes. River Biomechanics has 

prepared an instructional 

DVD to walk you through 

the injection process. They 

are available upon request. 

We also offer injection 

workshops to groups of 6 

-10 practitioners. 

4 CFPM Journal | spring 2010

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CFPM Journal | spring 2010 5

canadian federation of podiatric medicine 

11 th annual conference 

November 12 & 13, 2010 

crowne plaza hotel, ottawa, ON 

featuring: 

Thank you to our 

sponsors: 

• Landis International Inc. 

• Paragon Orthotics 

• Superior Medical 

• Vasyli Medical 

• Vittoria Phoenix 

terry grant (aka mantracker) 

Reality Show star Terry Grant will introduce us to his version of hide and seek. Terry Grant is a cowboy and volunteered with 

the Foothills Search and Rescue Team for approximately 13 years. Like other members of his SAR team, he participated in 

various missions, training courses and exercises in the area south and west of Calgary, Alberta. 

dr. howard dananberg, d.p.m. 

Howard Dananberg is a podiatrist in practice in Bedford, New Hampshire. He has gained international recognition for 

his work in the biomechanics of human gait, and for the development of the Sagittal Plane Facilitation Theory. He is a 

consultant to the Vasyli Medical Group, and has developed a prefabricated foot orthotic which bears his name. 

lynn homisak, prt 

Lynn has an extensive podiatric background that started in 1971 and has spent most of her 39 year career as a certified 

podiatric medical assistant/office manager in both east and west coast practices. She is CEO of SOS Healthcare 

Management Solutions, podiatry’s leading podiatric practice management consulting and educational company. Lynn has 

a certificate in Human Resources Management from the Cornell University School of Business and previously received 

a teaching certificate in NJ after co-developing and teaching a formal introductory course for podiatric medical assistants. 

topics 

• New and Improved 1.5 Day Assistant Program 

• Manipulations of the Ankle and Cuboid 

• Treatment and Management of Cutaneous Warts 

• High Heeled Footwear and Pre-fabricated Foot Orthoses 

• Role of Modern Medical Acupuncture in Podiatry and Sport 

exhibitors 

Faculty 

Dr. John Guiliana, D.P.M. Hackettstown, NJ 

Dr. Guiliana is a nationally recognized speaker and author on topics pertaining to medical practice management. He 

holds a Master’s in Health Care Management and is a Fellow of the American Academy of Podiatric Practice 

Management. He is a physician advisor for SOS Healthcare Management Solutions, LLC and is in private practice in 

Hackettstown, New Jersey. 

Lynn Homisak, PRT Renton, WA 

Lynn Homisak has 36 years of experience as a podiatric medical assistant and office manager. Today, she is a team 

partner and trainer with SOS Healthcare Management Solutions, a podiatric consulting company. She is a nationwide 

lecturer and author in areas of practice management and human resources. 

• Sagittal Plane 

Facilitation Theory 

• Patellofemoral Joint Pain 

• Infectious Diseases 

• Numerous Workshops 


Sponsors 

Dr. Jack Hutter, D.P.M. Oconomowoc, WI 

Dr. Hutter is a graduate of the Illinois College of Podiatric Medicine (1981) and Lakeview Hospital Podiatric 

Surgical Residency program. He is certified by the American Board of Podiatric Surgery and is a fellow of The 

American College of Foot and Ankle Surgeons. Dr. Hutter is also a board certified pedorthist. 

Mr. Jason Kraus Seldon, NY 

Jason Kraus has held executive management positions in the healthcare industry for 29 years. Currently Mr. Kraus is 

partner in the practice consulting firm S.O.S. Healthcare Management Solutions, LLC and Executive Vice President of 

Realm Labs. 

Mr. Stuart Metcalf , FCPodS Solihull, UK 

Mr. Metcalfe is a Consultant Podiatric Surgeon and current post is Clinical Lead for Podiatric Surgery at Solihull. He 

graduated in 1990 from Northampton School of Podiatry and later completed his surgical residency in 1996 being 

awarded Fellowship of Faculty of Surgery, College of Podiatrists in 1997. Mr. Metcalfe also conducts clinical research 

within the field of Podiatric Medicine and Surgery. 

Dr. Hal Ornstein, D.P.M.,FACFAS Howell, NJ 

Dr. Hal Ornstein is an international speaker and author on topics pertaining to practice management and patient 

satisfaction. He is Chairman and Director of Corporate Development of the American Academy of Podiatric Practice 

Management and Consulting Editor for Podiatry Management Magazine. 

Dr. Karen Philp Toronto, ON 

the full program will be available soon! 

Dr. Karen Philp has been responsible for the Canadian Diabetes Association’s Office Public Policy and Government Relations for the past 

5 years. As Vice President, Ms. Philp leads the activities of staff and volunteers with federal, provincial and territorial governments across 

Canada. She is also responsible for development of public policy positions on diabetes prevention and management, pharmaceutical policy 

and health human resources. 

6 CFPM Journal | spring 2010 

Dr. Axel Rohrmann, B.Tech.Pod (SA) Regina, SK 

Dr. Rohrmann is the clinical head podiatrist of the Regina QuAppelle Health Region. He was born and raised in 

South Africa where he received his initial training in Podiatric Medicine. He spent almost 8 years in Singapore 

working in various multidisciplinary high risk diabetic foot clinics and has a keen interest in wound care and diabetic 

biomechanics. 

Dr. Michelle Spruce, Ph.D Diabetes Southampton, UK 

Canadian Diabetes 

Canadian Diabetes 

Association 

Association 

Dr. Michelle Spruce qualified from the University of Southampton with a first class honours degree and then undertook 

her doctoral studies at the Cardiovascular Division, Kings College London, in collaboration with the University of

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March 5-7 Vancouver, BC Compression Therapy Seminar & Custom Orthotic Therapy & Gait Analysis 

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April 17-18 Edmonton, AB Custom Orthotic Therapy & Gait Analysis 

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Improve Your Clinic With a Mission Statement 

By Penny Tremblay, 

ACG, CL 

Headline Speaker at 

the upcoming CFPM 

11th Annual Conference 

in Ottawa, ONtario, on 

November 12 & 13, 2010. 

How can your team achieve a target that it doesn’t even have? 

If you have a mission statement already – great; if it’s a few 

years old it could use some polishing, and if you don’t have one 

yet, here are a few reasons why you should, and how you can 

create one with total team involvement and commitment. 

Why a mission statement? When a team is laser focused 

on a common goal, they are much more efficient. Passion and 

enthusiasm are a result of defining a mission. In the process of 

creating one, you are able to identify and rekindle your purpose 

for choosing this profession. With this clarity you can better 

articulate that purpose within a philosophy that has meaning 

for your team and your clients. A mission statement will help 

you make a commitment to excellence, which means constantly 

striving to be the best you can be. 

Even if you don’t perform perfectly, you cannot fail when you 

strive to perform to the best of your ability, maintain a team of 

good people who are focused on the same mission, and provide 

clients with quality care and consideration. 

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One of the common challenges that health care providers 

communicate to me is that they want their clients / patients to 

value their care, regardless of insurance limitations. A mission 

statement helps combat this challenge because when everyone 

in the clinic understands their purpose, they can demonstrate 

the value of service they provide with action and verbal skills 

from their hearts. The passion shines through as they explain the 

advantages of treatment. What clients / patients sense, is that 

you care about their health and they will certainly place more 

value on what you do offer, regardless of what their coverage 

is. Wouldn’t you agree that when you hold a clear vision of the 

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health, that you take every opportunity to educate the patient 

with more information? 

What clients / patients sense, is that 

you care about their health and they 

will certainly place more value on 

what you do offer, regardless of 

what their coverage is. 

Getting started with a Mission Statement - I wish I could 

say that it’s a quick process, but developing a mission statement 

takes time and thought. The following items could be included: 

1. A statement to declare the quality and 

value of the service you offer. This is 

where your head, heart and hands become 

one. Your commitment and knowledge 

in your field (head) combined with the 

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so that the entire team (staff ) can take 

initiative on their individual purpose and 

passion for the business. 

4. The types of clients that you prefer to 

serve and any specialty areas that you are 

choosing to focus on. 

(Continued on page 33) 


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12 CFPM Journal | Fall 2009

CFPM represented at the Ontario College 

of Family Physician’s Conference 

On Nov. 26-28, 2009, the Canadian Federation of Podiatric Medicine attended the 

Ontario College of Family Physician’s Conference in Toronto as an exhibitor. Board 

of Directors Elmer Biscaia and Julie DeSimone successfully represented the CFPM. This 

was the first time the CFPM was represented at an event with an exclusive audience of 

family physicians. 

The primary goal of reaching family physicians to educate them on the regulated 

profession of chiropody and podiatry was achieved. However our attendance at this event The primary goal 

emphasized the need for continued education. There are still many misconceptions and of reaching family 

misinformation within the medical community. The CFPM board of directors feels physicians to 

educate them on the 

strongly that this is a useful experience and will continue to build relationships with the 

regulated profession 

Ontario College of Family Physicians. 

of chiropody and 

Thanks to Elmer and Julie for their hard work and commitment to the CFPM. 

podiatry was achieved. 

ANN AKILDIA CANADA 22/12/09 8:30 Page 1 

By the Numbers: 

Demographics in Canada 

• In 2005 the average life expectancy for Canadians was 

78 for men and 82.7 for women. This gap is narrowing. 

• In Canada the median age (half the population is older, 

half is younger) was 39.1 years in 2008, 37.2 years in 2001. 

It was 26.3 in 1972. 

• Since 2000 the Canadian population has grown 1 % a year 

to 33.5 million mostly due to immigration. Canada has one 

of the highest immigration rates among wealthy nations. 

• Almost 60 % of new immigrants came from Asian nations 

during the past decade 

• In 2000, Ontario gained over 23000 people from other 

provinces. In 2007 it had a net loss of over 17000 people. 

• Alberta continued to grow throughout the past decade 

and in 2006, recorded over 58000 people coming into 

its province. 

• During the 2000 decade women in their 30’s became the 

dominant age group of new mothers, for the first time. 

It was part of a trend to start families later in life. 

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CFPM represented at the Ontario College 

of Family Physician’s Conference 

On Nov. 26-28, 2009, the Canadian Federation of Podiatric Medicine attended the 

Ontario College of Family Physician’s Conference in Toronto as an exhibitor. Board 

of Directors Elmer Biscaia and Julie DeSimone successfully represented the CFPM. This 

was the first time the CFPM was represented at an event with an exclusive audience of 

family physicians. 

The primary goal of reaching family physicians to educate them on the regulated 

profession of chiropody and podiatry was achieved. However our attendance at this event The primary goal 

emphasized the need for continued education. There are still many misconceptions and of reaching family 

misinformation within the medical community. The CFPM board of directors feels physicians to 

educate them on the 

strongly that this is a useful experience and will continue to build relationships with the 

regulated profession 

Ontario College of Family Physicians. 

of chiropody and 

Thanks to Elmer and Julie for their hard work and commitment to the CFPM. 

podiatry was achieved. 

ANN AKILDIA CANADA 22/12/09 8:30 Page 1 

By the Numbers: 

Demographics in Canada 

• In 2005 the average life expectancy for Canadians was 

78 for men and 82.7 for women. This gap is narrowing. 

• In Canada the median age (half the population is older, 

half is younger) was 39.1 years in 2008, 37.2 years in 2001. 

It was 26.3 in 1972. 

• Since 2000 the Canadian population has grown 1 % a year 

to 33.5 million mostly due to immigration. Canada has one 

of the highest immigration rates among wealthy nations. 

• Almost 60 % of new immigrants came from Asian nations 

during the past decade 

• In 2000, Ontario gained over 23000 people from other 

provinces. In 2007 it had a net loss of over 17000 people. 

• Alberta continued to grow throughout the past decade 

and in 2006, recorded over 58000 people coming into 

its province. 

• During the 2000 decade women in their 30’s became the 

dominant age group of new mothers, for the first time. 

It was part of a trend to start families later in life. 

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and info pack 

1-800-387-1990 

mail@larima.ca 

www.larima.ca 

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◗ Restores the skin barrier function 

◗ Improves skin’s natural defence 

◗ Prevents hyperkeratosis 

◗ Helps to prevent skin lesions 

◗ Promotes healing of the skin tissues 

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practice 

management 

seminar 

june 25 & 26, 2010 

novotel hotel 

toronto, ON 

The CFPM and AAPPM are collaborating on this invaluable seminar, June 25 & 26, 2010, at the Novotel Hotel in 

Toronto, ON. For the first time ever, Rem Jackson, CEO and founder of Top Practices, will be lecturing in Canada. 

Top Practices is a company dedicated to helping professionals and businesses reach their full potential through innovative 

marketing, sales, management and professional development programs. Also speaking is Hal Ornstein, Chairman and 

Director of Corporate Development of the AAPPM. Hal’s mantra, “Life Just Gets Better”, helps practitioners define and 

reach the pinnacle of their success. 

Highlights from this intense 2 day event include: 

• From 0 to 60 in 90 days - How to turn your practice around in 90 days. 

• Maximizing Your Revenue and Patient Outcomes... Make More Money 

While Improving Patient Care and Loyalty 

• How to Build a Relationship with Referring Offices - Learn, both internally 

and externally, how to build a solid relationship with your referring offices 

• Internet Marketing and Social Media: How Do You Position Your Podiatric 

Practice for the New Communication World? 

• Roundtable Discussions 

Grow Your Practice 

DME, Ancillary, Orthotic Devices and Wound Care Products 

and In-Office Dispensing 

Staff Issues and Training 

exhibitorsFaculty 

Dr. John Guiliana, D.P.M. Hackettstown, NJ 

Dr. Guiliana is a nationally recognized speaker and author on topics pertaining to medical practice management. He 

holds a Master’s in Health Care Management and is a Fellow of the American Academy of Podiatric Practice 

Management. He is a physician advisor for SOS Healthcare Management Solutions, LLC and is in private practice in 

Hackettstown, New Jersey. 

Lynn Homisak, PRT Renton, WA 


Sponsors 

Lynn Homisak has 36 years of experience as a podiatric medical assistant and office manager. Today, she is a team 

partner and trainer with SOS Healthcare Management Solutions, a podiatric consulting company. She is a nationwide 

lecturer and author in areas of practice management and human resources. 

Dr. Jack Hutter, D.P.M. Oconomowoc, WI 

Dr. Hutter is a graduate of the Illinois College of Podiatric Medicine (1981) and Lakeview Hospital Podiatric 

Surgical Residency program. He is certified by the American Board of Podiatric Surgery and is a fellow of The 

American College of Foot and Ankle Surgeons. Dr. Hutter is also a board certified pedorthist. 

Mr. Jason Kraus Seldon, NY 

Jason Kraus has held executive management positions in the healthcare industry for 29 years. Currently Mr. Kraus is 

partner in the practice consulting firm S.O.S. Healthcare Management Solutions, LLC and Executive Vice President of 

Realm Labs. 

Mr. Stuart Metcalf , FCPodS Solihull, UK 

Mr. Metcalfe is a Consultant Podiatric Surgeon and current post is Clinical Lead for Podiatric Surgery at Solihull. He 

graduated in 1990 from Northampton School of Podiatry and later completed his surgical residency in 1996 being 

awarded Fellowship of Faculty of Surgery, College of Podiatrists in 1997. Mr. Metcalfe also conducts clinical research 

within the field of Podiatric Medicine and Surgery. 

and more... 

Dr. Hal Ornstein, D.P.M.,FACFAS Howell, NJ 

Dr. Hal Ornstein is an international speaker and author on topics pertaining to practice management and patient 

satisfaction. He is Chairman and Director of Corporate Development of the American Academy of Podiatric Practice 

Management and Consulting Editor for Podiatry Management Magazine. 

Dr. Karen Philp Toronto, ON 

Dr. Karen Philp has been responsible for the Canadian Diabetes Association’s Office Public Policy and Government Relations for the past 

5 years. As Vice President, Ms. Philp leads the activities of staff and volunteers with federal, provincial and territorial governments across 

Canada. She is also responsible for development of public policy positions on diabetes prevention and management, pharmaceutical policy 

and health human resources. 


alancing your personal and professional lives 

By hal ornstein, dpm 

and neil baum, md 

Doctors are highly motivated to be 

effective in their professional life 

but maintaining a balance with their 

personal lives is a challenge for all of 

us. How you maintain this balance will 

ultimately determine not only your success 

but also your happiness. I have noted 

that occasionally I feel discouraged about 

various aspects of medical care such as the 

vast amount of paper work that I must 

complete in order to care for my patients or 

the continued decrease in reimbursements 

that we are all experiencing. When I meet 

with my colleagues, I know that many are experiencing the same 

feelings about their practices. I get very discouraged when I hear 

doctors talking about leaving practice when they should be at the 

most productive and enjoyable aspects of their career, or when 

they state that they wouldn’t recommend their children or family 

to enter the medical profession. I still believe that medicine is the 

most noble profession that provides the greatest satisfaction and 

gratification and that all that we need to do is to find techniques 

of putting balance into our careers. This article will discuss 10 

suggestions that may help level the scale between your personal 

and professional life. It is my intention that all physicians who 

read this article will have gained new insight into achieving 

balance in their practices and balance in their personal lives. 

1. Always be a student. Medicine is a life-long commitment 

to learning. No doctor can be on top of his\her game if 

they are using the knowledge and skills that they received 

when they completed their education or training. Balance 

is achieved if you continue to pursue a life-long pursuit 

of knowledge. A medical career is a journey and not a 

destination. You should always make time to be a student 

for your entire career. Sir William Osler, honorary 

professor of medicine at Johns Hopkins University, 

recommended to physicians and students at the end of 

the 19th Century, “In order to receive the education of 

not a scholar, at least of a gentleman, you should read for a 

half hour before you go to sleep, and in the morning have 

a book open on your dressing table. You will be surprised 

how much can be accomplished in the course of a year.” 

2. Be ethical. A recent report in a pediatric journal states 

(Arch Pediatr Adolesc Med. 2008;162(4):368-373), “that 

44.7% rated their ethics education during residency as 

fair or poor.” As a result most of us have received very 

little training in medical ethics. All of us have or will be 

faced with ethical decisions we will have to make for or 

on behalf of our patients. Examples include treatment of 

AIDS patients, care for under-aged patients (children), 

release of sensitive information, termination of the 

physician/patient relationship, etc. Balance in our lives 

includes making the right ethical decisions at the right 

times on behalf of our patients. Perhaps the best advice 

we can offer when confronted with an ethical issue is to 

do what is in the best interest of the patient, and you will 

probably make the right decision. Most state licensing 

boards now require that continuing medical education 

include regular courses in ethics. Regard this not as a 

burden, but rather an opportunity to look at your patients 

and your profession from a different and balanced angle. 

3. Take active control of your finances. Most young 

doctors today enter practice with nearly $250,000 of debt, 

which will take years to pay off. However, balance comes 

from financial security at the end of your career when 

you can practice because you truly enjoy the practice of 

medicine not because you have to work. In order to have 

that security and that balance, we recommend that you 

start the saving process early. Even in the face of daunting 

debt, you need to start a savings plan for your children’s 

education and for your retirement. 

4. Learn to say “no”. There is no faster road to burn-out 

than taking on too many projects and accepting too many 

responsibilities. The next time you are called to join a 

hospital committee, to become a member of a board in the 

community, or to accept an invitation for an evening dinner 

ask yourself these questions: 1) Will the obligation enhance 

my career? 2) Will the commitment take away from my 

time with my family and friends? 3) Will this obligation 

lead to balance or imbalance in my life? If the answer is that 

you are not furthering your career, and if it distracts from 

your family time, then you should probably turn down these 

requests. Remember it is not a sin to say “no”. 

5. Set your priorities. For most physicians that have balance 

in their lives they place their religion, their family, and 

then their practice as the order of importance in their 

lives. Rabbi Harold Kushner, author of “When Bad 

Things Happen to Good People,” pointed out that “He 

never met a man on his death bed who said he wished 

he spent one more day at the office” or “saw one more 

patient.” This is good advice—it is never too late to spend 

one more day with your significant other, your children 

and your grandchildren. 

6. Find a niche. Ross Perot described success as finding an 

unmet need, becoming an expert, and filling that unmet 

need. If you can do that, others will be knocking on your 

Continued on page 35 


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By andrea watts 

In the fall of 2004, I started with the 

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A day at the CFPM head office included phone calls and emails 

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idging the gap between research and clinical 

practice: a podiatric musculoskeletal perspective 

invited review Sarah A. Curran, PhD, BSc (Hons) 


Abstract 

In the past, research and clinical practice in podiatry could be considered 

as separate concepts; however modern day understanding perceives them 

to be closely and directly related. Using the area of musculoskeletal 

practice and our change in understanding of Rootian biomechanics as an 

example, this article provides an overview of how research has influenced 

clinical practice. 

Introduction 

Across the world, governments insist that professional clinical practice 

is driven by evidence. This stance applies to all health disciplines and 

is aimed at understanding the impact of clinical practice on the health 

and well being of individuals. Research provides the basis of the 

available evidence which continually changes as research progresses and 

advancements are made in understanding. Historically, podiatry has been 

linked with a poor research base that was largely reliant on anecdotal 

clinical findings. However, in the last decade the appreciation for research 

within the podiatry profession has gained momentum. This review seeks 

to provide an overview of the changes and issues of integrating research 

with clinical practice using the area of musculoskeletal practice and 

Rootian biomechanics as an example. 

Musculoskeletal Injuries and Pain 

In the last 3 decades, participation in running and other sporting events 

(i.e. soccer, rugby, hockey, tennis and golf ) have gained in popularity 

worldwide. In spite of the alleged health benefits associated with an active 

lifestyle, many physical activities have been linked with a high incidence 

of lower limb injury and pain. These injuries include patellofemoral 

pain syndrome, plantar fasciitis, stress fractures, iliotibial band friction 

syndrome, early knee osteoarthritis (i.e tibiofemoral joint) and Achilles 

tendinopathy. 1, 2 Whilst the causes are complex and multifactorial in 

nature, abnormal lower limb and foot biomechanics are frequently linked 

as a contributing factor. 3-7 Management strategies typically follow a 

combination of interventions that focus on strengthening and stretching 

of muscle groups, heat and ice therapy, taping and foot orthoses. 

The profession of podiatry is strongly associated with the use of 

foot orthoses and is based on correcting malalignment of the foot and 

lower limb which in turn prevents associated musculoskeletal pain and 

symptoms. This mechanical approach is based on Rootian biomechanics 

(paradigm) that was described over 30 years ago. At that time, the work of 

Dr. Merton Root DPM and his colleagues Dr. John Weed and Dr. William 

Orien DPM was innovative being presented in what can be described as 

one of the most influential Podiatry textbooks: “Normal and Abnormal 

Foot Function”. 8 The content of the book provided a comprehensive 

clinical, biomechanical, diagnostic and management system that was 

based on their clinical experiences and existing literature. Although the 

phrase “subtalar joint neutral position theory” became synonymous with 

Root”s name, they also provided a detailed hypothetical description of 

foot function during gait. Whilst this paradigm has stood the test of time 

for many clinicians and academics, recent opinion suggests that Root’s 

biomechanical paradigm is “dying”. 9 This view is based on a number 

of studies that have questioned the various elements of the paradigm 

(i.e. “ideal” foot structure, neutral subtalar joint position), hypothetical 

descriptions of foot function and the ability of foot orthoses to influence 

lower limb alignment. 10-13 

In response to these findings and improved understanding, Schools 

of Podiatry based in Australia, Canada, Spain and the United Kingdom 

have introduced alternative paradigms including the “tissue stress 

theory, 14 sagittal plane facilitation theory, 15 “subtalar joint axis/rotational 

equilibrium theory” 16 and “preferred movement pathway”. 17 The 

recognition and need to change and adapt understanding new evidence 

within this field is clearly apparent. However, there is a temptation to 

combine newer more appropriate methods with those already in use. In 

a recent article, Harradine and Bevan presented a “theoretical unified 

approach to podiatric biomechanics”. 18 Although a “hybridization” 

model at first glance seems appealing since it merges concepts, further 

evidence is required to substantiate its use in clinical research. Further 

alternative approaches from other disciplines may however prove useful 

to the understanding of lower limb and foot function. Whilst still in 

developmental stages, these models are based on tensegrity, mathematics, 

and gait theories of robots and prosthetics. 

Desire for Knowledge: Integrating 

Clinical Practice and Research 

“It is no good to try to stop knowledge from going forward. 

Ignorance is never better than knowledge” Enrico Fermi 19 

Evidence continuously evolves through the progression of research, 

and an increase in knowledge and understanding. This statement can 

be supported by the changes in understanding and delivery of new 

and alternative paradigms of lower limb and foot function as discussed 

previously. Research therefore can be considered an important part in 

the development and quality of podiatry. Whilst a career in research will 

not be to everyone’s interest, a number of opportunities are beginning to 

emerge worldwide with a number of PhD studentships offered by Schools 

of Podiatry. These funded opportunities within established academic 

settings provide an ideal environment for a new enthusiastic researcher to 

develop. However in reality, this will only appeal to a minority, but what 

happens to those clinically based podiatrists who show an interest for 

research, and in this context musculoskeletal research? 

Barriers to Undertaking Research 

“Knowing is not enough, we must apply. Willing is not enough, 

we must do” Johann Wolfgang von Goethe 20 

Unfortunately having a curious nature for research is often not 

enough, since only a few podiatrists will actually “go ahead” and proceed 

fully with their ideas. This may seem a harsh and cynical statement, but 

there are common and valid reasons for this failure. These include work 

and family commitments, a change in location, and financial constraints. 

However for many individuals, it is the realisation that research is not 

straightforward. Whilst clinically a podiatrist may be very advanced 

demonstrating a wide range of expertise, they become a novice when 

beginning the research process. In addition, the topic area and the aims 

of the research will pose a challenge. A frequent mistake made by many is 

devising a research proposal that is impracticable or too ambitious. This 

in turn requires guidance from a suitable mentor to develop the research 

into a workable and achievable proposal. A lack of research knowledge 

can also cause frustration and impatience. Perhaps more importantly is 

the failure to understand that it takes time to produce good research, 

which incidentally comes with no guarantee. 

In the context of musculoskeletal research and lower limb 

biomechanics, a major barrier for many is the restrictive access to various 

forms of instrumented gait analysis systems (i.e. Qualisys Motion Capture 

System - 3 dimensional kinematics, Novel EMED plantar pressure 

system - kinetics). Since gait and foot function has been shown to be 

varied and complex, instrumented analysis is often required to provide 

objectivity, validity and reliability to the data. This viewpoint represents 

only one aspect of musculoskeletal research within podiatry. Other areas 

of valid and useful research which is not reliant on these systems include 

outcomes research (i.e. quality of life / health status questionnaires). 



Celebrating 10 Wonderful Years 

of the Canadian Federation of 

Podiatric Medicine 

The Canadian Federation of Podiatric Medicine 

recently celebrated its 10 year anniversary at the 

latest CFPM annual conference in London, Ont. The 

idea of an inclusive, national organization was conceived by three guys 

in 1998. Elmer Biscaia, Brian Harper and Stephen Hartman worked to 

develop an association that helped practitioners support one another. 

Through consistent communication with its members, unsurpassed 

conferences and cutting edge seminars, the chiropody and podiatry 

community is flourishing. 

The CFPM has seen many changes and growth in the past decade. We 

had only a handful of members that first year and about 25 delegates at 

our first conference. The name of the association also changed from the 

Canadian Federation of Foot Specialists to its present name. We now have 

an array of products available to our members, an educational pamphlet 

series and the CFPM office management software. All this was developed 

in an effort to assist our members in their day to day activities. 

We continue to address several ongoing challenges with the extended 

health coverage and the insurance industry, educating the public on 

regulated professionals and international recognition. 

Through all these changes the CFPM’s mission has been simple. Help 

our members, help their patients; regular and consistent communication 

and enjoyable learning and networking. We plan to be around for another 

successful 10 years!! 

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Highlights from the 10th Annual CFPM conference. 

On November 6 & 7, 2009, the CFPM had an excellent attendance of over 200 delegates at our CFPM 10th 

Annual Clinical Conference in London. 

3. 

The delegates enjoyed topics on pediatrics, diabetes, practice management and special lectures on how to 

manage your business in the current economic climate. Assistants took part in a special podiatric assistants 

workshop brought to Canada for the first time! The exhibit hall was sold out with 41 companies featuring their 

best products and services! 

We celebrated 10 Years of the Canadian Federation of Podiatric Medicine on 

Friday evening with a dinner, awards ceremony and a dance. Congratulations to the 

5 award winners: 

1. 4. 

1. The Community Involvement Award was presented 

to Michael Turcotte. 

2. The New Clinician Award was presented to 

Stephanie Miscampbell. 

3. The Student Mentor Award was presented to 

Pam Brown- Vezeau 

4. The Best Website Award went to Tony Abbott 

5. The Award of Distinction Award was presented 

to Julie DeSimone 

2. 5. 


Forensic Podiatry Seminar 

Regina, Saskatchewan 

Summer, 2011 

T 

he CFPM is extremely excited to 

announce the Forensic Podiatry 

Seminar scheduled for August 4-6, 

2011 in Regina, Saskatchewan. 

This is a tremendous opportunity 

to become proficient in a growing 

field of podiatry. With the skills 

you will learn during this 3 day, intense seminar you could 

become one of a select few to obtain this expertise. Podiatric 

forensic scientist, Wesley Vernon, D. Pod. M. Ph. D. will 

bring his world renowned program to Canada. Regina 

is also home to the RCMP headquarters and we hope to 

tap into their resources as part of this program. Don’t miss 

this opportunity to truly separate ourselves from the other 

professions and reveal the true foot specialists. Stay tuned for 

all the complete details. 

new research...running 

barefoot is better, 

but not recommended 

Harvard biologist and runner, Daniel Lieberman’s new 

research indicated that running barefoot produces much 

less impact stress compared to running in fancy, expensive 

shoes. Lieberman’s recent research is published in the current 

issue of Nature. Individuals who grew up running barefoot 

tend to land mostly on the front or middle of the foot and 

when they use shoes they continue to run that way. People 

who have always worn shoes usually hit the ground heel first, 

producing a much more stressful impact. 

Lieberman also looked at the evolution of long-distance 

runners and deduced that the 1970s development of modern 

running shoes changed our 

strides when running, possibly 

resulting in more heel 

injuries. 

Although running barefoot 

is not recommended for 

North Americans, barefoot 

running is becoming more 

common. Be prepared to see 

a few more runners who have 

ditched their shoes. 


Continued from page 22 

Establishing a Way Forward 

“We will move forward, we will move upward, and yes, we will 

move onward” Dan Quayle 21 

Whilst podiatry as a profession has important strengths in 

terms of understanding musculoskeletal injury and pain, and foot 

biomechanics, there are opportunities to learn from other professions 

including physical therapy, orthopaedics, and mechanical engineering. 

For example, the following research groups led by Hamill, McClay 

Davis, Ferber and Kerrigan have all contributed to the understanding 

of lower limb biomechanics (i.e. coupling mechanism, relationship 

between foot function and proximal lower limb pathology).3, 22-29 

In common with other clinicians, podiatrists aspire to adapt 

management strategies to the needs of each patient. However, the 

process of change can be difficult for the clinician who has established 

methods that have success (i.e. foot orthoses work for patients so why 

change?) For example, research over the last few years is changing the 

way in which we view foot orthoses. Traditionally, custom made foot 

orthoses were perceived to be superior compared to off-the-shelf/ 

pre-fabricated foot orthoses. Evidence now suggests however that 

pre-fabricated orthoses are just as effective. 30-32 Whilst there is no 

doubt that podiatry should focus on evidence that is undertaken at 

a highest level in the hierarchy of evidence (randomised controlled 

trials, category I); lower levels of evidence from other types of studies 

set the scene and direct ways forward for higher levels of research. 

Professional collaboration that enhances the quality of patient 

care is one of the most important goals. This is already evident with 

work undertaken by research groups based at two UK universities, the 

University of Leeds 33 and Glasgow Caledonian University 34 in the area 

of rheumatology. Whilst this provides approach provides an excellent 

model, there is a need to bridge the gap between academic and service 

communities worldwide. In addition, an improved interaction and 

understanding is needed for musculoskeletal podiatric practice. In 

particular, this should be between clinical podiatrists and academics, 

as well as research active clinical podiatrists and the wider clinical 

community. 

Funding will always be an issue in the context of any research, 

however funding for podiatrists should be maximized. The likelihood 

of securing substantial funding musculoskeletal podiatry research 

will be through interdisciplinary working (i.e. collaboration with 

orthopaedic surgeons, rheumatologists, physical therapists). Since 

podiatry is a relatively new profession to research, funding streams 

are required to support new and emerging groups, new models (i.e. 

paradigms), and new methodologies. This is critical not only to 

increase diversity within podiatry, but to improve its position as an 

allied health profession by responding to changes in knowledge that 

underpin clinical practice. 

Conclusion 

It can be stated that a profession will only survive and progress forward 

if it bases clinical judgements on knowledge that is underpinned 

by evidence. Podiatry, and in particular the area of musculoskeletal 

podiatry (i.e. paradigms) is in the process of adapting fundamental 

biomechanical principles. However, to allow this change to continue 

and our profession to evolve in status, research that is collaborative in 

nature should be at the forefront. 



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a case study for off loading 

(Originally published in Wound Care Canada, Vol.6 NO.1 2008;58-59) 

By Andrew Hoar C. Ped. (C) 

Although total contact 

casting (TCC) is considered 

to be the gold standard when 

off-loading neuropathic 

ulcers, it must be reapplied 

weekly and requires 

considerable experience on 

the part of the clinician to 

avoid creating new lesions. 

Introduction 

Ulcers occur in the diabetic neuropathic 

foot due to repetitive stress on 

insensitive feet. This repetitive stress 

causes the foot to develop hot spots, 

callus build-up, pressure necrosis, and 

ultimately ulceration. The most common 

area for pressure and excessive callus 

build-up occurs over the metatarsal 

heads, in particular the first metatarsal 

phalangeal joint (MTPJ) and the plantar 

surface of the Hallux 1 . Effective reduction 

of pressure (off-loading) is considered 

essential in the healing of plantar 

ulcers 2 . Useful off-loading mechanisms 

include reduction of walking speed, alteration 

of foot rollover during gait, and 

transfer of load from the affected areas to 

other areas of the foot or lower leg. 

Although total contact casting (TCC) 

is considered to be the gold standard 

when off-loading neuropathic ulcers, it 

must be reapplied weekly and requires 

considerable experience on the part of the 

clinician to avoid creating new lesions. 

Some mechanisms used as alternatives to 

TTC are removable walking casts; custom 

neuropathic walkers, half shoes and 

the wound care shoe system (WCSS). 

Key components of offloading 

the forefoot during 

ambulation are the use of a rocker 

sole and relief of the local area of 

the ulceration. Peak pressures in 

the rocker-soled shoe are reduced 

by approximately 30% compared 

to a conventional shoe in the 

medial and central forefoot, but 

pressures are elevated in the heel 

and midfoot 3 . Local relief of 

the ulceration is accomplished by the 

removal of material from the supporting 

surface below the point of contact 

(ulceration). 

Discussion 

When assessing the neuropathic 

foot ulcer it is important to test the 

joint range of motion of the foot and 

ankle. The foot must have a dorsiflexion 

range of at least 10 deg. to allow 

ambulation without harm to the Hallux 4 . 

Recognition of biomechanical issues 

such as Hallux Rigitus is key to successful 

off-loading. Without alteration of 

biomechanical stresses caused by bony 

or structural deformities, wound healing 

may be compromised and will likely be 

unsuccessful due to continued trauma. 

The WCSS is versatile, requiring 

minimal equipments to modify. It offers 

the clinician off-loading mechanics in 

conjunction with standard best practice 

protocols, promoting optimal wound 

healing in areas without access to TCC. 

If TCC is contraindicated due to poor 

balance, infected wound or ischemia, 

then this is an acceptable alternative. 

Recognition of biomechanical issues such as Hallux 

Rigitus is key to successful off-loading. Without 

alteration of biomechanical stresses caused by bony 

or structural deformities, wound healing may be 

compromised and will likely be unsuccessful due to 

continued trauma. 

Case Vignette 

Mr. H. is an active 29 year old. He 

has Type I diabetes, is a 1-ppd smoker, 

works full time at a warehouse, and plays 

softball on weekends. 

Mr. H. was presented to the Leg 

Ulcer Clinic (LUC) with the development 

of callus over the first MTPJ and 

inter-digital joint (IPJ) of his left and 

right great toes. The multidisciplinary 

team consisting of a Vascular Surgeon, 

a Wound Care Nurse, a Vascular Technologist 

and a Pedorthist completed a 

detailed history and physical assessment. 

Part of this holistic assessment included 

an ankle brachial pressure index, Hgb 

A1C, Semmes Weinstein monofilament 

test and gait analysis. 

The vascular lab reported an ankle 

brachial index of 1.15. A Semmes 

Weinstein monofilament test revealed 

loss of protective sensation to both 

feet. The range of motion of the 

first metatarsal phalangeal joint was 

evaluated by manual manipulation of the 

joint, which identified no movement in 

dorsiflexion, and this is known as Hallux 

Rigidus. Gait analysis identified altered 

mechanics of the foot during the stance 

and propulsion phases of gait, resulting 

in localized repetitive pressure upon 

the Hallux. The shoe wear pattern was 

consistent with Hallux Rigidus. 

Treatment Plan 

Pressure off-loading with a pressure 

reduction footwear system, debridement 

of callus, standard wound care best 

practices and enrolment in a Vascular 

Risk Reduction Program. 

Mr. H. was fitted with a WCSS (fig#1). 

Proper fitting included total width and 

length, velcro strap closure length and 

placement of apex of the rocker sole. 

To ensure optimal effect of the rocker 

sole the apex must be located proximal 

to the metatarsal heads 5 . The plantar 



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Examples: 

“Treat the person, not just the foot, in a professional 

manner to achieve a desired result.” 

“Our mission is to provide excellent podiatric medical 

service to our patients while maintaining a progressive 

and successful working environment beneficial to all 

concerned.” 

“Our practice mission is uncompromising excellence in 

podiatry. We are committed to listening to those we 

are privileged to serve, earning the trust and respect of 

our patients, profession and community. We strive to 

exceed your expectations while ensuring a creative and 

compassionate professional environment committed to 

continuous education and improvement.” 

I prefer the third option for its quality of content regarding the 

vision and purpose, and what actions will be taken to achieve it. 

The first two do not demonstrate this same clarity. 

A consultant can assist you in this process, which is well worth 

the investment. The team’s involvement with the consultant is 

Once you create and commit to your 

mission, you can build the podiatric 

environment that will allow you to 

practice what you believe in. 

powerful. I often point out the ill concept of “no involvement, 

no commitment”. Each individual on the team can answer 

these two questions. Why did you get into this field of podiatric 

medicine? Where do you see yourself in 5 years? (your family life, 

your career etc) 

Once you create and commit to your mission, you can build 

the podiatric environment that will allow you to practice what 

you believe in. Walk the talk and enjoy the journey of constant 

improvement and forward steps on your path of achieving your 

target - your mission - a guiding light shining on a brighter 

tomorrow. 

Penny Tremblay, ACG, CL is the Director of Education for the 

Tremblay Leadership Center located in North Bay, Ontario, 

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training to assist organizations and individuals achieve their 

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door to be your patients or to do business with you. It 

is amazing how successful you can be if you focus your 

energies on a single area of interest or expertise. 

7. Hang out with people one generation older or younger 

than yourself. If you are a young, new physician, then 

meet older more seasoned doctors who can show you the 

ropes, share their valuable experiences, and give you wise 

counsel when you need it. If you are an older physician, 

hang out with the Gen Xers. This contact with younger 

people can keep you current, keep you energized, and 

keep you on top of your game. My advice is to balance 

your friendships. 

8. Exceed patients’ expectations. To truly enjoy your medical 

practice it is important to not just meet patient’s expectations 

but to go beyond what is expected and exceed 

those expectations. We suggest that you adhere to “the 

extra mile philosophy.” This philosophy requires you to 

go the extra distance for your patients, to exceed their 

expectations, to provide a little more than other doctors. 

And your patients will remember you for it. Many businesses, 

from office product suppliers to upscale department 

stores, have found that providing deluxe services to 

their customers ensures that those customers will keep 

coming back. A medical practice is no different from 

other businesses in this respect. In today’s health care 

market, it is very difficult to compete on price... they can’t 

cut our Medicare reimbursements any further. What you 

can do is to make sure you’re filling your appointment 

book. This can be accomplished by asking two questions: 

1) What do patients want and give them more of it, and 

2) Ask them what they don’t want and make every effort 

to avoid it. It’s just that simple. 

9. Be a disciplined doer and a decider, not a procrastinator. 

Nothing adds more anxiety to our lives than having 

deadlines and commitments that we are having trouble 

meeting. If you have several projects looming in the future, 

break them down into smaller projects and make a 

calendar marking off the completion of these little projects. 

That way you won’t be left with a huge project with 

only days to complete. Discipline can bring balance to 

the busy professional: clean out your inbox, fill up your 

outbox, complete your medical records before the delinquency 

notice arrives, and look for an end point to your 

day. There will be a new set of mail, results, and problems 

tomorrow, and a clean slate creates a balanced perspective. 

Confront those challenging decisions: a professional 

who can decide in a few minutes to recommend radical 

extirpative cancer operation to a relative stranger ought 

to be able to decide about the new 3-year lease with a few 

days’ reflection. 

10. And finally have fun. The best advice to achieve balance 

is to take your profession seriously, but not yourself. 

Find ways to put inject a little humor into your daily 

activities. Start your day by listening to a humor CD of 

Jeff Foxworthy, Bill Cosby, or an old Abbott and Costello 

routine. A smile is the shortest distance between two 

people. Let us not forget that medicine is the most enjoyable 

profession, and it can be the most fun and rewarding 

especially if we add a little humor. 

Bottom Line: No one ever said medicine was easy or 

fun. But it can be both and even more if you have made an 

effort to balance your professional and personal lives. It can be 

done; just follow these 10 suggestions. 

Hal Ornstein, DPM 

Dr. Ornstein proudly serves as Chairman and Director of Corporate 

Development of the American Academy of Podiatric 

Practice Management (www.aappm.org) and Consulting Editor 

for Podiatry Management Magazine. He is a Distinguished 

Practitioner in the National Academies, has given over 200 presentations 

internationally and has written and been interviewed 

for over 250 articles on topics pertinent to practice management, 

patient satisfaction and efficiency in a medical practice. In 2009 

he was inducted into the Podiatric Hall of Fame and received the 

Podiatry Management Magazine Lifetime Achievement Award. 

His mission is clear; to share and help create smiles, discuss how 

others can change their paradigm to show that “Life Just Gets 

Better” and have them define and reach the pinnacle of their success. 

Dr. Ornstein is in private practice for eighteen years and 

serves as Medical Director of Affiliated Foot and Ankle Center, 

LLP with their main office in Howell, NJ where he also lives 

with his amazing wife Anna and two lovely boys, Tyler and Zack. 

Dr. Ornstein also has an office in Edison and Monroe, NJ and 

can be contacted at hornstein@aappm.org and (732) 905-1110. 

Neil Baum, MD 

Dr. Neil Baum has been a physician in private practice in New 

Orleans for more than 30 years. He has published more than 

150 articles in the peer-reviewed medical literature, and is also 

on the clinical faculty at Tulane University and Louisiana State 

University Medical Schools. He has written over 1000 articles 

including six books. Dr. Baum often speaks to groups of podiatrists, 

physicians, hospital medical and nursing staffs nurses, office 

managers and other healthcare professionals throughout the 

nation on topics of practice enhancement. 

Dr. Baum has incorporated the extra mile philosophy into his 

medical practice. He and his staff believe that all patients should 

have a positive healthcare experience every time they visit the 

doctor’s office. That belief is expressed in the practice’s mission 

statement, which is to provide expert medical care, to exceed every 

patient’s expectations during their interaction with Dr. Baum 

and his staff, and to pay attention to the little details because they 

make a big difference. This book is written with that philosophy 

in mind and will provide numerous examples of how you can 

incorporate that same philosophy into your medical practice, and 

reap the rewards of improved efficiencies, increased productivity, 

and ultimately enhanced profitability. 


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contact system enables the practitioner 

to off-load plantar ulcerations with four 

layers (multiple durometer) of material 6 . 

The top layer of the four-layer system 

to contact the foot is always a solid 

interface (plastizote®) that will mold to 

the foot contours. There are two layers 

of higher density ethel vinyl acetate 

(EVA) that are relieved using scissors 

and a small grinder to smooth the edges. 

Great emphasis was placed on the importance of 

wearing the WCSS when weight bearing and limiting 

ambulation to self-care. 

tissue were debrided exposing category 4a 

plantar ulcerations of the left first MTPJ 

measuring 1cm by 1cm. and the IPJ of the 

Hallux measuring .5cm by .5cm. 

By week four (fig #4) the MTPJ 

wound had reduced measuring .5cm x. 

5cm. The wound at the IPJ of the Hallux 

had closed and developed minimal callus. 

By week six (fig#5) the MTPJ wound 

had reduced measuring .2cm by .3cm. 

position requiring less ambulation. 

Sadly, he no longer plays softball. Mr. 

H. still wears the WCSS as a house shoe 

every day and avoids walking in bare feet. 

Mr H. continues to be screened every 

3 months, at which time the orthotic 

plastizote cover is replaced due to 

compression and the footwear condition 

is evaluated. 

References: 

The location of the relief is transferred 

to the top layer by demarcating the 

ulcer with a jel ink pen and having the 

patient stand wearing the WCSS. The 

ink is transferred to the top layer. The 

centre of the ulcer is then determined. 

A relief larger than the ulcer is cut out 

of each of the lower layers directly under 

the ulcer .5cm wider medially, laterally, 

proximally and 1.25 cm wider distally. It 

is important to skive the edges (approx. 

30 degrees) so that the relief away from 

the foot is slightly larger than the relief 

on the upper surface (fig#2) 

Mr. H. was informed of the purpose 

and proper use of the WCSS. Great emphasis 

was placed on the importance of 

wearing the WCSS when weight bearing 

and limiting ambulation to self-care. 

Follow-up appointments were scheduled 

every 2 weeks where the fit, function 

and wear pattern of the 

WCSS was evaluated. 

Adjustments such as 

the replacement of 

top plastizote layer 

due to compression of 

the material were then 

completed. 

Initial visit (fig#3) 

the callus and necrotic 

1. 2. 

The Hallux callus remained minimal. 

The staining in the area of the MTPJ is 

residual Cadexomer Iodine. 

By week eight (fig#6) the wounds 

have closed and callus development was 

minimal. 

Results 

Mr. H. has progressed to wearing 

custom foot orthotics and modified 

athletic footwear. The orthotics 

incorporate a 5mm accommodation at 

the first metatarsal joint on the right 

and 7.5mm on the left, metatarsal pads 

and full-length poron/plastizote covers. 

Footwear was selected to provide a deep 

wide toe box and has been modified to 

include a 12mm rocker sole bilaterally. 

He has stopped smoking, returned 

to work, and with the assistance of his 

employer changed jobs to a clerical 

3. 4. 5. 

1. Levin ME, Pathogenesis and 

Management of Diabetic Foot 

Lesions. The Diabetic Foot Fifth 

Edition 1993; 2:17-56 

2. Birke J, Lewis K, Penton A, 

Pittman D, Tucker A, Durand 

C. The Effectiveness Of a 

Modified Wedge Shoe in 

Reducing Pressure at the Area of 

Previous Great Toe Ulceration in 

Individuals with Diabetes Mellitus 

Wounds 16(4): 109-114, 2004 

3. Schaff PS, Cavanagh PR. Shoes for 

the insensitive foot: the effect of a 

“rocker bottom” shoe modification 

on plantar pressure distribution. Foot 

Ankle 1990 Dec; 11(3):129-40 

4. Perry J. Normal and Pathological gait. 

Atlas of Orthotics. St Louis: 

CV Mosbey; 1985:83-96 

5. Janisse DJ. Pedorthic Care of the 

Diabetic Foot. The Diabetic Foot 

Fifth Edition, 1993:25:549-75. 

6. Elftman N. Management of the 

Neuropathic Foot Supplement to 

Journal of Orth/Pros April 2005 

vol. 17 #2; 4-25 

Andrew Hoar, CPED (C), 

is a pedorthist in the Orthotic and 

Prosthetic Department at the QE11 

Health Sciences Centre in Halifax, 

NS. He also works with OrtoPed in 

a professional advisory capacity. 


Continued from page 26 Continued from page 19 

References 

1. Hesar NGZ, Van Ginckel A, Cools AMJ, et al.: A prospective study on gait-related intrinsic 

risk factors for lower leg overuse injuries. Brit J Sports Med 2009; doi:10.1136/ 

bjsm.2008.055723. 

2. Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD: A 

retrospective case-control analysis of 2002 running injuries. British Journal of Sports 

Medicine 2002; 36: 95 - 101. 

3. Ferber R, Hrelijac A, Kendall K: Suspected mechanisms in the cause of overuse running 

injuries: A clinical review. Athletic Training 2009; 1(3): 242 - 246. 

4. McClay IS, Manal K: A comparison of three-dimensional lower extremity kinematics during 

running between excessive pronators and normals. Clin Biomech (Bristol, Avon) 1998; 13(3): 

195 - 203. 

5. Bellchamber TL, van den Bogert AJ: Contributions of proximal and distal moments to axial 

tibial rotation during walking and running. Journal of Biomechanics 2000; 33(11 (November)): 

1397 - 1403. 

6. Tiberio D: The effect of excessive subtalar joint pronation on patellofemoral mechanics: A 

theoretical model. Journal of Orthopaedic and Sports Therapy 1987; 9(4): 160 - 164. 

7. Hintermann B, Nigg BM: Pronation in runners: Implications for injuries. Sports Medicine 1998; 

26(3): 169 - 176. 

8. Root ML, Orien WP, Weed JH: Normal and Abnormal Function of the Foot. Los Angeles: Clinical 

Biomechanics Corp, 1977. 

9. Kirby KA: Are Root biomechanics dying? Podiatry Today 2009; 4(April): http://www. 

podiatrytoday.com/are-root-biomechanics-dying Accessed 12th February 2010. 

10. Nester CJ: Lessons from dynamic cadaver and invasive bone pin studies: do we know how 

the foot really moves during gait? Journal of Foot and Ankle Research 2009; 2: 18. 

11. Heiderscheit B, Hamill J, Tiberio D: A biomechanical perspective: do foot orthoses work? 

British Journal of Sports Medicine 2001; 35: 4 - 5. 

12. Stacoff A, Reinschmidt C, Nigg BM, et al.: Effects of foot orthoses on skeletal motion during 

running. Clinical Biomechanics 2000; 15(1): 54-64. 

13. Nigg BM, Nurse MA, Stefanyshyn DJ: Shoe inserts and orthotics for sport and physical 

activities. Medicine and Science in Sports and Exercise 1999; 31:: S421 ñ 428. 

14. McPoil TG, Hunt GC: Evaluation and management of foot and ankle disorders: Present 

problems and future directions. Journal of Orthopaedic and Sports Physical Therapy 1995; 

21(6): 381 - 388. 

15. Dananberg HJ: Sagittal plane biomechanics. American Diabetes Association. Journal Am 

Podiatr Med Assoc 2000; 90(1): 47-106. 

16. Kirby KA: Foot and Lower Extremity Biomechanics II: Precision Intricast Newsletters 1997- 

2002. 2002; Precision Intricast, Inc. Payson, Ariz. 

17. Nigg BM: The role of impact forces and foot pronation: a new paradigm. Clin J Sports Med 

2001; 11(1): 2 - 11. 

18. Harradine P, Bevan L: A review of the theoretical unified approach to podiatric biomechanics 

in relation to foot orthoses therapy. JAPMA 2009; 99(4): 317 - 325. 

19. Fermi E: http://www.quotationspage.com/quote/26270.html Accessed 4th February 2010. 

20. Wolfgang von Goethe J: http://quotationsbook.com/quote/565/ Accessed 4th February 2010. 

21. Quayle D: http://thinkexist.com/search/searchquotation.asp?search=moving 

forwards&page=2 Accessed 7th February 2010. 

22. Pohl MB, Muillneaux DR, Milner CE, Hamill J, Davis IS: Biomechanical predictors of 

retrospective tibial stress fractures in runners. Journal of Biomechanics 2008; 41(6): 1160 

- 1165. 

23. Milner CE, Hamill J, Davis IS: Are knee mechanics during early stance related to tibial stress 

fracture in runners? Clinical Biomechanics 2007; 22(697 - 703): 6. 

24. Milner CE, Davis IS, Hamill J: Free moment as a predictor of tibial stress fracture in distance 

runners. Journal of Biomechanics 2006; 39(15): 2819 - 2825. 

25. Ferber R, McClay Davis IS, Williams DS: Effect of foot orthotics on rearfoot and tibia joint 

coupling patterns and variability. Journal of Biomechanics 2005; 38: 477 - 483. 

26. Kerrigan DC, Johansson J, Bryant M, Boxer J, Della Croce U , Riley P: Moderate-heeled shoes 

and knee joint torques relevant to the development of the progression of knee osteoarthritis. 

Archives of Physical Medicine Rehabilitation 2005; 86(5): 871 - 875. 

27. Kerrigan DC, Lelas JL , Karvosky ME: Women’s shoes and knee osteoarthritis. The Lancet 

2001; 357(9262): 1097 - 1098. 

28. Hamill AJ, Sharkey NA, Buczek FL, Michelson J: Relatives motions of the tibia, talus and 

calcaneus during stance phase of gait: a cadaver study. Gait and Posture 2004; 20(2 

(October)): 147 - 153. 

29. Hamill J, Bates BT, Knutzen KM, Kirkpatrick GM: Relationship between selected static and 

dynamic lower extremity measures. Clinical Biomechanics 1989; 4: 217 - 225. 

30. Collins N, Crossley K, Beller E, Darnell R, McPoil TG, Vicenzino B: Foot orthoses and 

physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial. 

Brit Med Jour 2008; 337: a1735. 

31. Davis IS, Zifchock RA, DeLeo AT: A comparison of rearfoot motion control and comfort 

between custom and semi custom foot orthotic devices. JAPMA 2008; 98(5): 394 - 403. 

32. Landorf KB, Keenan AM, Herbert RD: Effectiveness of foot orthoses to treat plantar fasciitis: A 

randomised trial. Archives of Interntal Medicine 2006; 166: 1305 - 1310. 

33. University of Leeds: http://www.leeds.ac.uk/medicine/FASTER/ Accessed 12th February 

2010. 

34. Glasgow Caledonian University: http://www.gcal.ac.uk/shsc/research/researchgroups/ 

musculoskeletalresearchgroup/ 

Accessed 12th February 2010. 

Sarah A. Curran, Senior Lecturer, Wales Centre for Podiatric Studies, 

University of Wales Institute, Cardiff, Western Avenue, Cardiff, CF5 2YB 

(email: scurran@uwic.ac.uk / Phone: 029 2041 7221) 

The author reports no conflicts of interest. 

Over the years I developed lasting relationships with the 

CFPM Board of Directors, CFPM members, exhibitors and advertisers. 

It was a pleasure to work with each and every one of you. 

In the summer of 2009, I ventured across the country to 

Alberta from Ontario, where I am currently residing. I worked 

electronically with the CFPM head office, planning the fall 2009 

conference and maintained many duties with the association. It 

is truly amazing what technology can do for you. At year end, I 

completed my duties with the CFPM and have handed over my 

reigns to Cindy Hartman. 

I will miss you all greatly and am proud to have been part of 

the profession of chiropody/podiatry in Canada over the past 5 

years. My ears perk up every time I hear people mention feet and 

promptly say “Have you seen a chiropodist or podiatrist about 

your foot problem? I know just the place I can help you find one.” 

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upcoming conferences 

2010 

April 2010 

April 8-11, 2010 

Atlanta, GA 

• Reconstruction Surgery 

of the Foot & Ankle 

• www.podiatryinstitute.com 

April 29 - May 2, 2010 

Newport, RI 

• Surgical Pearls by the Sea: 

Current Trends in Foot & Ankle 

Surgery 

• www.podiatryinstitute.com 

April 30 - May 1, 2010 

Toronto, ON 

• Ontario Society of Chiropodist 

Annual Conference 

• www.ontariochiropodists.com 

May 

May 12 - 15, 2010 

Amsterdam, The Netherlands 

• FIP World Congress 

• www.fipworldcongress.org 

June 

June 2 - 5, 2010 

Baltimore, MD 

• ACSM Annual Meeting 

• www.acsm.org 


Seattle, WA 

• ACFAS Annual Summer Seminar 

• www.nwpodiatryfoundations.org 


Philadelphia, PA 

• NATA Annual Meeting 

• www.nata.org 

June 25 & 26, 2010 

Toronto, ON 

• CFPM & AAPPM 

Practice Management Seminar 

• www.podiatryinfocanada.ca 


Anaheim, CA 

• The Western 

• www.thewestern.org 

July 

July 8 - 17, 2010 

• Bermuda and Bahamas Cruise 

• www.nwpodiatryfoundation.org 

July 14, 2010 

Seattle, WA 

• AAPSM 40th Anniversary 

Celebration 

• www.aapsm.org 


Seattle, WA 

• APMA National Meeting 

• www.apma.org 


Providence, Rhode Island 

• AOSSM Annual Meeting 

• www.sportsmed.org 


• Practice Management 

Alaskan Cruise 

• www.podiatrym.com 

August 

Aug 26 - 29, 2010 

• ACFAOM Annual 

Clinical Conference 

• www.acfaom.org 

September 2010 

September 23 -25, 2010 

Las Vegas, NV 

• Annual Las Vegas Seminar 


October 2010 

Oct. 16 - 23, 2010 

Kauai, Hawaii 

• Annual Hawaii/Kauai Seminar 


October 28 - 31, 2010 

Disney, Florida 

• ACFAOM Annual Meeting 

• www.acfaom.org 

November 2010 

November 12 & 13, 2010 

Ottawa, ON 

• CFPM 11th Annual Conference 


December 2010 

2011 

Jan. 15 - 22, 2011 

• Eastern Caribbean Cruise 

• www.nwpodiatric foundation.org 

Jan.30 - Feb. 6, 2011 

Mexican Riviera 

• CFPM Seminar at Sea 


Feb. 19 , 2011 

San Diego, CA 

• AOSSM Specialty Day 


July 2011 

• Danube Riverboat Cruise and Tour 

(Prague, Vienna, Budapest) 

• www.nwpodiatricfoundation.org 

July 7 - 10 

San Diego, CA 



July 28 - 21, 2011 

Boston, MA 

• APMA National Scientific Meeting 


Aug. 4 - 6, 2011 

Regina, SK 

• CFPM Forensic Podiatry Seminar 


September, 2011 

• Annual Las Vegas Scientific Seminar 


October 15 - 22, 2011 

Maui, Hawaii 

• Annual Hawaii Seminar 

• Hyatt Regency Maui 

Resort and Spa 


2012 

July 12 - 15, 2012 

Baltimore, Maryland 



August 16 -19, 2012 

Washington, DC 

• APMA National Scientific Meeting 


2013 

July 11 - 14, 2013 

Chicago, IL 



July 21 - 25, 2013 

Las Vegas, NV 

• APMA Annual 

Scientific Conference 


2014 

July 10 - 13, 2014 

Seattle, WA 



July 24 - 27, 2014 

Honolulu, Hawaii 




2015 

July 23 - 26, 2015 

Orlando, FL 




classifieds 

employment opportunity 

- part time chiropodist 

required: 

I am looking for an enthusiastic, registered 

chiropodist to join our foot clinic team and work in 

a busy private clinic on a part time basis, beginning 

March 15th, 2010. 

Our private practice foot clinic has two locations, 

Oakville and Milton. Both offices are located in 

medical buildings beside local hospitals. The clinics 

have administrative staff and are fully equipped 

with everything you need to practice chiropody. The 

position is available in one or both of the clinics for 

appropriate candidates. 

If interested please contact me by email or fax, 

and provide a brief description of current and past 

chiropody experiences. Elisabeth Hibbert, B.Sc., 

D.Ch., Chiropodist Fax no.: 905-815-1542, Email: 

elisabethhibbert@hotmail.com. 

chiropodist wanted: 

Immediate full or part time chiropodist required 

within well established Hamilton clinic. New 

graduates welcomed. The candidate must possess 

the ability to work in a fast paced environment. Salary 

negotiable. Please call: 905-537-2448 or apply directly 

to Shannon Frizzell, B.Sc., D.Ch. at: sf@oolab.com or 

shannon.frizzell@rogers.blackberry.net. 

chiropodist 

Position: Chiropodist (Full-time and part-time) 

Location: Scarborough, ON 

Description: Full-time and part-time chiropodist 

position available immediately, within a busy private 

clinic. Qualified candidate must be skilled in providing 

palliative footcare treatment; nail surgery; biomechanical 

assessment/gait analysis. 

Qualifications: Registration in good standing with 

the College of Chiropodists of Ontario. 

Ability to work both independently and as part of 

a small cohesive team. 

Excellent interpersonal communication skills, 

patient-friendly approach. 

Contact: Please e-mail resume to: jrdunphy@ 

sympatico.ca or fax to 416-299-4206 ATTN: Clinic 

Manager (indicate full or part-time position on 

resume) 

chiropodists wanted: 

The Toronto Community Chiropodists Network 

is looking for Chiropodists to join their locum 

list. Chiropodists available for long or short term 

assignments to fill in for chiropodists on vacations, 

short term sick leaves, maternity leaves, etc. Toronto 

Community Health Centres are multi-service centres 

providing primary health care, health promotion, 

community support and community development 

programs and activities for children, youth, women, 

adults, seniors, families of diverse cultures. 

Qualifications: Registration with the College of Chiropodists 

of Ontario; Knowledge of diabetic wound 

care; Experienced in biomechanical assessments and 

gait analysis-Orthotics; Strong clinical assessment 

skills; Flexible schedule; Ability to work in a cohesive 

and fast paced environment; Experience working 

in a community setting and multidisciplinary team; 

Current malpractice insurance; New Graduates are 

welcome to apply. 

For more information call 416-744-6312, ext. 

232, Wayne Bassargh, D. Ch., Email: wayne. 

bassaragh@rexdalechc.com

Spring 2010 - Canadian Federation of Podiatric Medicine

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