Exam 1 Flashcards
Ancient civilization references to foot problems
-Hippocrates described clubfoot and suggested treatment
-foot references on tombs and in the bible
David Low
- Euro
-One of the earliest professionals
-Published in English the medical
record Chiropodalgia (1768)
-Coined the term “chiropody” (1774)
Lewis Durlacher
-Euro 1816
-surgeon-Chiropodist to Queen Victoria
– Published “Treatment of Corns,
Bunions and Disease of the Nail”
– One of the most distinguished
chiropodists of the 19th century.
FV Runting
- Euro
-Considered the founder of
modern chiropody
– President of the National
Society of Chiropodists
(1913)
– Established School of
Chiropody of London Foot
Hospital (1919)
1st American Influence in Podiatry
- Nehemiah Kenison
– First American chiropodist (1846) - Issachar Zacharie
– Chiropodist to President Lincoln
– Proclaimed himself Chiropodist-General to the Union
Army
– Plagiarized a text on chiropody - Maurice J. Lewi, M.D.
– Founder of New York School of Chiropody (1911)
– Suggested the term “podiatry”
Beginning Educational Requirements For Pod School
-1918-Council on Education (Council on Podiatric
Medical Education-CPME) was established and
requires a high school education and two years of
full-time study (after formation of five colleges)
-1954-Council on Education requires two years of
college preparation for admission
Educational Pivot Points
-1964-All podiatric medical schools grant same degree-Doctor
of Podiatric Medicine (DPM)
-1985-Project 2000, affiliation or association of podiatric
colleges with academic health science centers
The fab 5
NY, Chi, San Fran, Cleveland, Philly
More recent school additions
*1932-American Association of
Colleges of Chiropody. Now
AACPM
* 1963-Pennsylvania College of
Podiatric Medicine (Philadelphia)
* 1981-Des Moines University-
College of Podiatric Medicine and
Surgery (Des Moines)
* 1985-Barry University School of
Podiatric Medicine (Miami)
2004 Midwestern University School of Podiatric
Medicine (Phoenix)
* 2009 Western University College of Podiatric
Medicine (Pomona)
What is the CPME?
-Council on Podiatric Medical Education
(CPME)
– US Department of Education
– Accreditation
* Colleges (CPME Document 120)
– Student complaint mechanism
* Residencies
* Continuing Medical Education
* Fellowships
Residency Training
- 1957-First podiatric residency program at St. Luke’s and Children’s Medical Center (Philadelphia)
- There was an adequate number of
residencies positions for all qualified
graduates in the class of 2012. - Residency shortage in classes of 2013-2015.
- More residencies than qualified graduates in
the classes of 2016-2021.
Important Dates for Professional Organizations
- 1939-AMA formally recognizes
podiatry - 1942 American College of Foot
Surgeons, now ACFAS - 1958-Name of profession officially
changed to podiatry
1972-American Board of Podiatric Surgery now
American Board of Foot and Ankle Surgery - 1985-Name of Profession officially changed to
podiatric medicine (APMA) - 1967-Joint Commission on Accreditation of Hospitals
permits podiatrists to operate in hospital OR without
M.D. present - 1968-Medicare included podiatric medicine and
defined DPMs as physicians within scope of
podiatric practice - 2018-VA Provider Equity Act (HR 3016/S 2175),
Legislation to recognize DPMs as physicians under
the Veterans Health Administration. - 2017-Locally, Polk County Medical Society
approved DPM membership
What is the 2015 vision?
- “Podiatric physicians are universally accepted and
recognized as physicians consistent with their education,
training, and experience.”
– Evaluate and ensure podiatric medical education is comparable to that
of allopathic and osteopathic physicians. - Comparable competencies*
- Three-year residencies*
- One certifying board
-marketing pods as physicians
-obtaining state and federal government recognition that pods are physicians
What is the APMA?
-american podiatric medical association
-board of trustees
-state component associations/societies
-house of delagtes
-vision 2015 and parity plan
-national and state representation
What is the IPMS
-Iowa podiatric medical society
What is the APMSA?
-american Podiatric Medical Student Association
-The American Podiatric Medical Students’ Association (APMSA) is the only national organization
representing roughly 2,500 students enrolled at the nine colleges of podiatric medicine. By virtue of
enrollment in a college of podiatric medicine, all students are members of the Association
-the structure of the APMSA provides equal representation from each podiatric medical college.
Each college has a student body president and president-elect and every class elects an APMSA
delegate and one or more alternate delegates. These student leaders comprise the APMSA House of
Delegates who meet twice annually with the third- and fourth-year student delegates forming the
APMSA Board of Trustees
What is the AACPM?
-American Association of Colleges of
Podiatric Medicine
-Mission: To serve as the leader in facilitating and promoting excellence in podiatric medical
education leading to the delivery of the highest quality lower extremity healthcare to the
public
-application processes for school and residency matching
What is AMPLE?
-American Podiatric Medical Licensure
Exam(s
– Part I Basic Sciences (APMLE 1)
– Part II Clinical Sciences (APMLE 2)
– Part II Clinical Skills Patient Encounter (CSPE)
– Part III APMLE
How do pods gets board certified?
- American Board of Foot and Ankle Surgery (ABFAS)
- American Board of Podiatric Medicine (ABPM
-certification exam
-then present cases for review to show ability
What is the ASPS?
-American Society of Podiatric Surgeons
-Surgical Affiliate of APMA
What is ACFAS?
-American College of Foot and Ankle Surgeons
-The American College of Foot and Ankle
Surgeons (ACFAS) is a professional
society of more than 7,500 foot and ankle
surgeons. Founded in 1942, ACFAS seeks
to promote the art and science of foot,
ankle and related lower extremity surgery;
address the concerns of foot and ankle
surgeons; ensure superb patient care; and
advance and improve standards of
education and surgical skill.
-not an affiliate of APMA
What is ACFAOM?
-American College of Foot and Ankle Orthopedics and Medicine
-ACFAOM is a professional society of doctors
dedicated to excellence in orthopedics and
medicine of the lower extremities as the
cornerstone of contemporary podiatric practice.
State licensure board process?
- May be a subsection of the State Medical
Board - May be a separate Podiatric Medical Board
– Iowa Podiatric Medical Board reports to
the Iowa Department of Public Health
CPME VS APMA
The Council on Podiatric Medical Education (CPME) is an autonomous, professional accrediting agency designated by the American Podiatric Medical Association (APMA) to serve as the accrediting agency in the profession of podiatric medicine
1st educational requirements to attend a pod school
-1918 CPME requires HS graduation and two years in chiropody school
-1954 DOE requires HS diploma, and two years of undergrad before pod school
-1960 seldon commission upgraded to bachelors and 4 years pod
1985- project 2000
-affiliate pod schools with other academic health centers/programs
-1981 DMU was first school to integrate pod with other med programs
What was the revised CPME document in 2011?
3 year residency standard to mirror allopathic
MOST IMPORTANT ORG DATES
-1942- ACFAS
-1958 - profession changed to podiatry
-1985 - profession changed to podiatric medicine
Why does it matter if you are anxious or
depressed?
Poor decision-making
Irritability
Exhaustion
Increased errors
Lower adherence to best practices
How Much is Too Much Alcohol?
High-risk drinking
Men: 14 drinks/week OR 4 drinks/day
Women: 7 drinks/week OR 3 drinks/day
1 drink = 12 oz. beer, 5 oz. wine, or 1.5 oz. liquor
Driving While Intoxicated (0.08 BAC)
Most adult men: 5 drinks in 2 hours
Most adult women: 4 drinks in 2 hours
Varies by body weight, consumption of food, mixer used with
alcohol, etc.
Impaired Driving
1 drink consumed by a 140 lb. woman on an empty stomach
increases the odds of death in a single-vehicle accident
Why does it matter if you drink too
much?
It degrades your health over the long- (and
potentially short-) term
It increases your risk of injury, and both
perpetration of and victimization by criminal acts
It can progress to impairing your professional
judgment
But it’s my private life!!
Role modeling
Reputation of profession
Personal reputation
Trust
Women and Alcohol
Women tend to weigh less
Even with identical body weight, women have
less water in their bodies, so because alcohol
disperses in water, women have a higher BAC
with the same alcohol intake
Women are more likely to suffer health problems
as a result of heavy drinking than men are,
including damage to the liver, brain, and heart
The 7 Bigger life practices
Gratitude
Compassion
Acceptance (not all you plant bears fruit)
Higher Meaning (whats important to you)
Forgiveness
Tribe (nurture relationships, share struggles)
Relaxation and Reflection
Steps to compassion
Recognize suffering
Validate suffering
Set an intention
Take action
David Myers (2000) Happiness
Research: 5 factors that contribute most to happiness and
well-being:
Work/leisure experiences that lead to flow
Finding meaning/purpose in
religion/spirituality
Having positive relationships that provide
social support**
Being physically healthy
Community service/helping others
Stages of Change: pre-contemplation
Patient:
Not thinking about change
May be resistant to change
May be resigned – a feeling of no control
Obese patients may have tried unsuccessfully
many times to lose weight and have given up
Denial - do not believe it applies to them
Patients with high cholesterol levels may feel
immune to health problems that strike others
Believe consequences not serious – or pt
is unaware of consequences
Cons of change outweigh pros
Doctor:
Goal: Patient will begin thinking
about change
Build a relationship
Express caring concern - don’t use scare tactics
Personalize risk factors
Educate in small bits
Stages of Change: Contemplation
Patient:
“Some day – getting ready
– thinking about it”
Acknowledging a problem, but ….
Not yet committed to change
Ambivalent about change, but giving it serious
consideration
Doctor:
Goal: Elicit from pt
reasons to change & consequences of not
changing
Explore ambivalence
Praise pt for considering difficulties of change
Restate both sides of the ambivalence
Question possible solutions for one barrier at a
time
Pose advice gently to reduce natural
resistance
Stages of Change: preparation
Patient:
Has decided change is needed
Preparing to make a specific change
Experimenting with small changes as
determination to change increases
Doctor:
Goal: Pt will discover
elements necessary for decisive action
Has decided a change is needed
Encourage the pt’s efforts
Encourage taking small steps
Stages of Change: Action
Patient:
“Taking steps to change”
A stage clinicians are eager to see patients
reach
Sometimes too eager
Patients take definitive action to change
Any action taken by patient should be
praised
Demonstrates a desire for life style change
Doctor:
Goal: Patient will take
decisive action
Reinforce the decision
Build and facilitate increased self-efficacy
Delight in even small successes
View problems as helpful information
Ask what else is needed for success
Stages of Change: Maintenance
Patient: “Forever” – a process of
keeping changes made in place
Patient incorporates the new behavior “over
the long haul”
Broad implications for one’s life
Doctor:
Goal: Patient will
incorporate change into daily lifestyle
Continue reinforcement & support
Explore & lift up internal rewards &
benefits from change
Identify risks for relapse and helpful
strategies to manage them
Stages of change: relapse
Patient:
Most patients find themselves “recycling”
through the stages several times before
change becomes established
Part of the change process, but not one of
the stages
Points of caution and proactive planning
Doctor:
Goal: Patient will
communicate
honestly with clinician
Learn from the temporary successes
Use this to re-engage patient in the change
process
Remind patient that change is a process,
& most people “recycle”
Reframe the relapse
“failure” to “successful for a while,” and
“new lessons for continued success”
Identify & evaluate triggers
Patient Motivation
A patient’s level of motivation for change is
not fixed
Motivation for change is affected by the
quality of the relationship
How you communicate impacts not just how
patients feel, but what they do
Guiding Principles: RULE
Resist the righting reflex
Understand and explore the patient’s own
motivations
Listen with empathy (OARS)
Empower the patient by encouraging hope
and optimism
“OARS” Listening Skills
Open Questions
Affirmations- If you affirm a strength, the person will expand on how they accomplished something, rather than
focus on barriers
Reflections- use purposefully. Stay on topic, reflect
ambivalence about change. A primary strategy.
Summaries- focus on person’s strengths and capacity to
change, in a way that avoids overshooting where
the patient really is
Processes of MI
-Engage-You engage with a patient by listening to them first
Two functions
Enables accurate understanding of the patient
Communicates to patient that what they are
saying is important to you
Encourages the patient to reveal more and
keep thinking about the topic at hand
Makes patients feel like you have spent a lot
of time with them
-Focus-
Lay a menu of options on the table, including
both their stated concerns and your concerns
Allow patient to choose
If the patient does not choose your concern,
you have at least planted a seed
Evoke-
-diecting, guiding,
All three styles are useful
Goal is to match the best style for a given
context
Ability to flexibly shift between the 3 styles is
important to effective practice
Current culture in medicine favors too much
directing regardless of context of interaction
MI is a refined form of the guiding style
Plan-
Assess the patient’s level of commitment to
change
“So what do you make of all this now?”
“What do you intend to do?”
Do not try to push a patient into more
commitment than they are ready to make.
Instead, continue conversations about their
desires, abilities, reasons, and needs
Overwhelmed by acronyms?
RULE (guiding principles)
OARS (listening techniques)
DARN (pre-commitment types of change talk)
Change talk
Empathy and good listening evoke change talk.
Confrontation and the righting reflex evoke sustain talk
Themes in change talk:
Desire
Ability Pre commitment
Reasons
Need
Commitment
Taking steps
Recognize and affirm change talk
Helping patients to express change talk gradually
moves them towards changing behavior
History of a return patient
- Chief Complaint
- History of Present
Illness - Review of Systems
How to write a chief complaint
-Short description of presenting complaint
* In patient’s terms – main complaint
* Subjective
* Doesn’t have to correlate with the final
diagnosis
Components of a foot and ankle physical exam
- Vascular - pulses, swelling, temp
- Neurologic - sensation, reflexes
- Dermatologic - lesions, discoloration, texture
- Musculoskeletal - strength, ROM, palpitation, deformity
- Gait - cadence, stride length, speed, pattern
How to write the assessment section in a SOAAP note
- What’s your differential?
- Can be very general or
specific based on your
findings - Two formats:
- Narrative
- List
Foot and Ankle Proximal vs Distal
-proximal- closest to the head from point of reference
Distal- closest to the toes from point of reference
Calcaneus
superior and interior of heel bone
Foot and Ankle Dorsal vs Plantar
- dorsal - top of foot
- plantar - bottom of foot
Greater trochanter
thigh-femur, where your hips stick out
Fibular head
bone at the lateral border of the patella
Tibial tuberosity
inferior bone to patella (bottom bone of knee cap)
common peroneal nerve
nerve running lateral/the outside of the leg
Medial Malleolus
ball on inside of your ankle
Navicular tuberosity
bone before your foot gets more narrow
posterior tibial artery
artery that runs through inside ball of ankle
Dorsalis pedis artery
artery that runs diagonally across top of foot
Tibial nerve
runs parallel with posterior tibial artery
Clinical relevance: Tarsal tunnel syndrome
*Burning, tingling
*Elicit symptoms with palpation
-medial side of ankle
tibial nerve issue and gets too much pressure put on it/ gets irritated
-will palpate nerve to see if there is tingling to diagnosis
Fibula
outside ankle ball
Plantar Fascia
arch of foot
Achilles Tendon
-the gastrocnemius and a deeper muscle, the soleus, join distally to form the Achilles tendon.
-largest tendon in body
What does it mean to be a member of a profession?
Trusted with access to information and power that is not available to everyone
Specialized skill set that is societally necessary
The motive is service to others rather than profit
There is a code of ethics developed by the profession that must be followed
Social contract between medicine and society
In exchange for its service according to the values above, medicine receives:
Autonomy/Self-regulation
Trust
Respect
Non-financial and financial rewards
The Goals of (the profession of) Medicine
Promotion of health and disease prevention
Maintenance/improvement of quality of life by relief of symptoms, pain and suffering
Cure of disease
Prevention of untimely death
-Improvement of functional status/maintenance of compromised status
Education/counseling re: condition/prognosis
Avoidance of harm to patient in course of care
Providing relief and support near time of dea
Ethics
Branch of philosophy related to morals, moral principles and moral judgment
Way of examining and interpreting moral life (and guide/evaluate conduct)
Uses reason and logic to analyze problems and find solutions
Medical (professional) ethics
-Identification, analysis, and resolution of moral problems that arise in care of a particular patient
Based on moral principles or practice customs of medical profession
Involves consideration of others in deciding how to act
-Can we? , Should we? Do we have to?
The AMA Physician Charter Fundamental Principles
-Primacy of patient welfare
Patient autonomy
Social justice
Application of Medical Oaths
Regulation and oversight of professional conduct
Moral dilemmas
Ethical conflicts
Sources of Ethical Conflict
Different reasoning:
-Consequences and Liability
Different loyalties:
-Patient, institution, society
Different perceptions:
-Personal or professional experiences
Different values
-Culture, religion, etc.
The 8 Virtues
Prudence—wisdom
Justice
Fortitude
Temperance
Fidelity to trust
Compassion
Integrity
Effacement of self-interest
An approach to evaluating ethical problems: 4 topics
Medical indications
-Good ethical decisions always begin with good (correct) information
Patient preferences
Quality of life
Contextual features
Informed Consent
Historical Perspective
Requirement that physician obtains consent from patient before
proceeding with treatment has been a part of Anglo-American
jurisprudence since eighteenth century England
Schloendorff v. Society of New York Hospital
Admitted to the hospital in January 1908 suffering from stomach disorder.
Physician discovered a tumor which was ultimately diagnosed as a fibroid
tumor.
She was advised that the nature of the lump could not be determined without
an ether examination.
She consented to the examination AND informed the surgeon, the
anesthesiologist and others that there must be no surgery.
The ether examination was undertaken and while she was unconscious, the
tumor was removed.
Post-op she developed gangrene in her left arm necessitating the amputation
of some of her fingers.
Arguments followed regarding “where the fault rested” given that this was a
charity hospital that hired physicians and others to provide charity care.
Ethical Purpose of Informed Consent
Collaborative decision-making process
To create an ongoing partnership between health care professional and
patient
Designed to prevent coercion or deception
Opportunity to assess patient’s understanding and to review risks and benefits
Process can be difficult (and time-consuming), but always important
Optimal result is shared decision-making
Promoting Shared Decision Making
-Encourage the patient to play an active role in decisions
-Encourage that patients are informed
-Protect the patient’s best interests
Elements of informed consent
Autonomous authorization
Decision-making capacity:
-Competence (of legal age), Judgment, Understanding, ability to choose between options
Adequate disclosure
Patient comprehension*
Difficulties with Informed Consent: For Doctors
- Use of technical language, lack of effective
communication skills - Difficulty interpreting to patient the uncertainty
intrinsic to medical information - Concern re: information overload, alarming patient
- Time pressure
- Diminishing the process as bureaucratic and
unnecessary (Have you “consented” the patient?)
Difficulties with Informed Consent: For Patients
- Limited in understanding
- Inattentive and distracted
Evidence shows very few patients remember most of what
they consented to as little as a day after the consent
process - Overcome by fear and anxiety
Implied Consent
Life threatening emergencies or threat of severe
disability creating inability to express preferences or
give consent
Immediate action is necessary to preserve life and/or
function
No surrogate available (Document what was done to
identify and/or contact surrogate decision makers.)
Customary for physicians to presume patient would
give consent if he was able to do so. (Recommend: Do
what is medically necessary for preservation of
life/function; implied consent is not carte blanche
permission for HCP to do everything they believe is
medically important.)
The law has embraced this practice, entitling it
“Implied Consent”
Provides physician with defense against battery – but may
not defend against charges of negligence if emergency
treatment falls below acceptable standards of care
Patient Self-Determination Act
-Requires many health care providers receiving
Medicare/Medicaid payments to provide adults, at the time
of admission or enrollment, certain information re: their
rights under state laws governing advance directives,
including:
the right to participate in and direct their own
healthcare decisions
the right to accept or refuse medical or surgical
treatment
the right to prepare an advance directive
The receipt of information on the provider’s policies
that govern the utilization of these rights
Health Care Professional has obligation to act in accord with patient’s wishes, except when _____
- Patient lacks medical decision-making capacity
- Patient wants more than medical standard: medical futility debates
- Patient requests not in keeping with standards of treatment**
- Conscientious refusal by physician
Defining Decision Making Capacity
Medical Decision-making Capacity ≠ Competence
only a judge can declare a person incompetent
Medical Decision-making Capacity is determined by a qualified health care
professional
Steps in determination of capacity
- Engage patient in conversation
- Observe patient’s behavior
- Talk with third parties – family, friends, or staff
Testing for
Medical Decision-making Capacity
Tests for cognitive functioning, psychiatric disorders, or
organic conditions that affect medical decision-making
capacity can be used – mental status exam most common
No single test sufficient to capture concept of medical
decision-making capacity – interaction with patient best tool
(MacArthur Competence Assessment Tool)
The patient’s primary HCP who has known the patient over time
is often in the best position to determine presence or absence
of medical decision-making capacity (and is rarely consulted!!)
Durable Power-of-Attorney
for Health Care
Important element of advance planning
Identifies who will make decisions when patient lacks medical decision-
making capacity
May be a relative or friend (not mandated)
Speaks with the patient’s own voice
Potential Problems with Surrogate Capacity
Conflict of interest
Monetary or other gain
Beliefs/values differing from patient’s (when
they motivate the decision)
Lack medical decision-making capacity
Standards for Surrogate Decisions
Substituted judgment:
“What would the patient want?”
surrogate relies on known preferences of patient
Best interest:
“What do I believe is best for patient?”
used when patient’s preferences unknown
Concluding Thoughts: Consent Lecture
Shared decision-making respects patient self-determination/autonomy.
For patients to make informed choices, physicians must discuss the
alternatives for care and the benefits, risks, and consequences of each
alternative.
Physicians need to encourage patients to play an active role in decision
making and to ensure that patients are informed.
Be aware of the role of the community in shaping values and in
contributing to decision-making
Privacy
Limiting access of others to one’s body or mind, such as through physical contact or
disclosure of thoughts or feelings.
Individuals usually desire to preserve, protect, and control privacy.
Privacy and right to privacy are not always clearly distinguished.
Privacy in Health Care
Physical privacy: Touching, imaging, direct observation, single v. shared hospital room-personal spaces
Informational privacy:
Human Genome Project, HIPAA (Health Information Portability and Accountability Act) 1996, 2009, GINA (Genetic Information Nondiscrimination Act) 2008
Proprietary privacy: Ownership of human identity—photos, genome
Decisional privacy: Control over intimate aspects of personal identity—”choices”
Confidentiality
Concerns the communication of private and personal information from one
person to another with the expectation that the recipient of the information
(healthcare professional) will not ordinarily disclose the confidential
information to third persons*
Physicians may disclose personal health information without specific consent of the patient (or authorized surrogate) to _______
To other health care personnel for purposes of providing care or for health care
operations
To appropriate authorities when disclosure is required by law
To other third parties to mitigate the threat when, in the physician’s judgment
there is a reasonable probability that
Disclosing Protected Health Information
When disclosing PHI, only the “minimum necessary” to fulfill the request
should be disclosed to anyone
And disclose only to those who “need to know”
Who Owns the Medical Record?
Physical “paperwork” is owned by the clinician
Information contained in the medical record is owned by the patient
Patient has the right to access the chart and copy the records at their
expense (or for a standard fee)
How do I tell the difference between a subpoena and a court order?
-A subpoena is a lawyer’s assertion that she/he is entitled to the requested
information, while a court order determines that the lawyer is in fact entitled
to it.
A health care provider or health plan may share PHI if it has a court order, and
only what is specifically described in the order
A provider or plan may disclose information in response to a subpoena but must
satisfy notification requirements (signed release or objection)
In general, minors may not authorize release of medical records nor consent
to treatment unless
STDs, contraception, substance abuse
Testing for HIV may be done confidentially, but if positive, parent or legal
guardian MUST be notified
Confidentiality and divorce
Each parent has a right to a minor’s medical record unless:
Child is seeking care for addiction, contraception or sexually transmitted
infections
Divorce decree prohibits one parent from access
Parental rights have been legally terminated
Step-parents have no right to medical records of a minor unless natural
parent(s) have signed consent form allowing it
Confidentiality and Public Safety
Most states have statutes requiring physicians to report cases of certain
disorders/circumstances:
STDs: Syphilis, Gonorrhea, Chlamydia
Gunshot and stab wounds
Suspected child and dependent adult abuse**
Infections that are considered reportable: TB, ebola, etc
AXIS OF SAGITTAL PLANE MOTION
-Horizontal axis “X” (“side to side”)
-Lies in the frontal and transverse plan
AXIS OF FRONTAL PLANE MOTION
-Horizonal axis “Z” (“front to back”)
-Lies in the sagittal and transverse plane
AXIS OF TRANSVERSE PLANE MOTION
-vertical axis “Y” (“up/down”)
-Lies in the frontal and sagittal plane
Chose the pairing which correctly describes motion in the frontal plane
inversion and eversion
Choose the correct pairing of the cardinal plane and the halves of the body which it separates.
A: Sagittal: upper and lower
B: Frontal: Right and left
C: Transverse: Front and back
D: Transverse: Right and Left
E: Frontal: Front and back
E
Ankle joint consists of_____
tibia, fibula, talus
ANKLE JOINT AXIS
-Imaginary line bisecting the inferior-lateral fibula and inferior medial tibia
-primary motion of the ankle joint is sagittal
SUBTALAR AXIS
-complex triplanar joint (motion occurs simultaneously in all planes) consisting of the three “facets” of the talocalcaneal joint.
-STJ axis shows an inclination from dorsal medial and anterior to plantar, lateral and posterior
-Motion is pronation/supinatio
MIDTARSAL JOINT AXES
-functional articulation between the rearfoot and forefoot.
- midtarsal joints will lock and unlock with supination and pronation
First ray
-Big toe –> metacarsals –> navicular
-almost no motion transverse plane motion at this joint
Varus vs Valgus (not motion but position)
-valgus - lock knee inwards and foot eversion
-varus - foot is inversion position
Equinus vs calcaneus
-Equinus- walk on toes
-Calcaneus - walk on heel
Closed vs open chain, what is the distinction?
-foot on ground = closed
-foot dangling = open
NBPME
- The organization that sets the policy, guides the
development, and sponsors the administration of the
licensing examination used throughout the United
States - Administers the APLME via Prometric
– Part I - Basic sciences exam taken in year 2.
– Part II - Advanced sciences exam taken 2nd semester in year 4. - Written exam - medicine, radiology, orthopedics, biomechanics, surgery,
community health, jurisprudence, and research - Clinical Skills Patient Encounter – assesses skills needed to enter
residency
Scope of practice
- General category breakdown
– Allows toe amputation
– Allows partial foot amputation
– Allows foot amputation
– Includes ankle
– Includes leg
– Includes hand
– Can administer anesthesia
LICENSURE
- Licensure is granted by each state in which you intend
to practice
– Granted based on education and examination
– Licensure allows you to treat patients within that states scope
of practice
– Licensure is governed by a state podiatry board
– Practicing in multiple states requires multiple licenses - The purpose of licensure is to protect the public by
verifying licensees are qualified to practice
Licensure renewal
- The state board is the link between the consumer and the
licensed practitioner and, as such, promotes public health,
welfare, and safety. - The state board evaluates new applicants and monitors current
licensees via renewal requirements. - Licenses are typically renewed every 2 years
- A condition of license renewal is accruing Continuing Medical
Education (CME) hours.
– The number of hours varies by state - IA requires 40 CME hours per 2 year cycle (20 hours per year)
- WA requires 50 CME hours per 2 year cycle (25 hours per year)
– Verified by a random audit
Iowa Licensure
- The composition of the state podiatry board will vary
by state.
– IA – Board executive, secretary, attorney, 5 licensed
podiatrists, 2 licensed orthotists, and 2 members of the
general public - Board members are typically appointed by the
governor and confirmed by the senate
Privileges
- Application for privileges is dependent on training/skill
level
– Most require submission of your logged cases from residency
as proof of your competence.
– Most institutions require board qualification to get privileges
and can require board certification to keep them (ABFAS). - A committee designated by the hospital (privileging
board) must approve or deny your privilege requests.
