Infections and Horrible Mistakes

A recent news story tells of a woman whose "minor gynecological procedure" was botched, resulting in her having both legs amputated. According to the link, her colon was perforated. This caused an infection, and she ultimately had gangrene spreading to her feet. Once gangrene sets in, the tissue is for all practical purposes dead. It is a medical emergency. All dead tissue must be removed in order to minimize the damage, and, unfortunately, this patient lost her legs below her knees.

It might seem odd that you could get an infection in a hospital. Generally speaking, hospitals will try to be as sterile as possible where patients will be exposed. However, by making efforts to sterilize the environment, it ensures that only the toughest bacteria can survive. Though a rare occurrence, being infected by these aggressive, antibiotic resistant bacteria is a very serious matter.

The more pressing question on your mind is probably, "Who's to blame?" The answer to that question will be determined in a court of law. Patient privacy prevents us from knowing the full details of how her infection progressed. Perhaps it was due to negligence on the part of the surgeon or hospital.

On the other hand, she might be one of the unlucky one-in-a-million medical catastrophes. While medical science has advanced by leaps and bounds over the years, we still don't know everything. There are no guaranteed successes in medicine. All surgeries carry the risk of infection. While the story above is an extreme case, patients need to realize that surgeries occasionally do not go as planned. Doctors, including podiatrists, make efforts to prevent these kinds of disasters, but the bottom line is that we are still searching for the fountain of youth. Until then, bad things will happen, and it might not be anyone's fault.

Calluses—What You Might Not Know

We all know what calluses are, and we all have them to some extent. They are the thick areas of skin that appear on the bottom of your feet in places where there is a high amount of friction. Of course, you can find them on your hands as well, depending on your hobbies and occupation. They are basically harmless, since they are your body's way of protecting you from the stresses you are exerting on it.

Your podiatrist's role in treatment of calluses is to get to the root causes. Yes, we can sand them or trim them away (what we call debridement). Another option is to offload the area by applying protective pads. However, it may be fruitful to ask the question, "Why is the callus appearing in the first place?" Perhaps you are walking abnormally, or maybe you have an irregularly shaped foot. Don't be embarrassed if this is the case—nobody's perfect, and that's true of feet too!

Calluses should raise a red flag for people with diabetes. Remember that a callus is the body's response to friction. However, people with diabetes are prone to developing ulcers where the callus began. This is due to a couple of things. First, some people with diabetes lose sensation in their feet, so they don't know if they're inflicting harm on them. Secondly, poor circulation is another side effect of diabetes.

Dueling Surgical Groups

Today's topic is more relevant to podiatrists than it is to patients, although it may affect patients in the future. I recently was chatting with one of my colleagues in the M.D. program at my university, and we were engaging in a little interprofessional trash talk. After I made light of the fact that the American Medical Association has less than 20% of doctors as members, she retorted that we podiatrists have "dueling surgical groups." This refers the rift between the American Podiatric Medical Association (APMA) and the American College of Foot and Ankle Surgeons (ACFAS).

Without going into too much detail, ACFAS was formerly under the umbrella of the APMA, before they decided to assert their independence and secede from the APMA. Not to be outdone, the APMA believed they needed a surgical group under their auspices and created the American Society of Podiatric Surgeons (ASPS). So now, we have two podiatric surgical societies. While I have described this conflict in cavalier terms, it should be noted that there are good arguments on each side, and I am not endorsing one over the other.

Nonetheless, this is a disaster. For decades, the APMA has lobbied on behalf of the profession to give podiatrists the clinical privileges we enjoy today. In return, podiatrists have united behind the APMA. At the same time, ACFAS has been the premier surgical group for decades. No, this will not result in a civil war. However, as the years go by, this divide could result in podiatrists going in different directions. Because podiatrists have been able to unite in the past, we enjoy tremendous recognition as medical professionals. I hope that despite these differences, we continue to be able to rally behind our common cause.