July 19, 2016
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5 Gnarly Foot Problems All Runners Can Relate To — And How To Fix Them

 

Slipping on a new pair of flats or heels, it’s safe to assume you’re going to end up with a blister at the end of the day. Runners have the same expectation—that guaranteed foot unhappiness will ensue—after a long run or a few months training for a race.

While spending lots of time on your feet in any situation can lead to some nagging pain, there are some ~special~ things about running that doom your dogs. “There’s a sheer repetitive nature to running, where you’re constantly doing the exact same motion over and over and over again,” Lori Weisenfeld, D.P.M., a New York City sports podiatrist, tells SELF. “Also, we sweat a lot when running, and sweat and friction combined are not the best combo.” And here’s a reason to dislike hills even more: “Even if it’s not a monumental one, slightly going up or down puts stresses between [your shoes] and your feet.” All these factors combined make runners particularly prone to some gnarly foot problems.

Wearing a good pair running sneakers that fit you properly is your first line of defense. “The proper sneaker is absolutely essential when you’re running,” Weisenfeld says. But if we’re being honest, even the most perfect pair of kicks won’t make you immune to runners’ feet. Here’s how to handle the most common issues.

1. Blisters

Plain and simple, blisters are caused by friction. If you’re prone to them, it means your foot is moving around too much in your shoe. This could be because you’re not wearing the right size, or you’re not wearing the right socks. Weisenfeld says to look for sport-specific socks with a lot of cushioning and made with synthetic materials (not 100 percent cotton or wool “because that will absorb the moisture but not allow it to evaporate”). She recommends the running socks from Thorlo. If you get blisters in between your toes, try rubbing Vaseline in between them before slipping into your socks, or use a blister block stick like Body Glide Foot Anti Blister Balm.

If a blister is tense and painful, Weisenfeld suggests draining it with a sharp, sterilized instrument. “On the roof of the blister but close to where it attaches to the skin, lance the blister so all the fluid comes out.” If you use a tiny pinhole, it will most likely seal up and fill up again, she adds, so use something a little thicker so it can fully drain. Just don’t rip the top layer of skin off—no matter how tempting it is. “It acts as the body’s natural biologic dressing for the blister, so the best thing to do is leave that in place.” If a blister elicits a throbbing pain or turns red, it could be a sign of infection.

2. Calluses

If this hardened mass of skin tends to build up on your heels, it’s probably from the edge of your shoe rubbing against the back of your foot. If your callus resides on the side of your big toe, it can be from wearing too-tight shoes or your running form, Weisenfeld explains. “If you over-pronate, your arches roll inward and as that happens, you’re rolling onto the big toe when you’re pushing off.” Over time, a big ol’ callus can form.

If calluses are a problem for you, make sure your shoes are wide enough across the front so there’s no pinching. Weisenfeld also recommends switching to a more supportive and stabilizing shoe to stop your foot from rolling, and wearing good running socks that wick away sweat and reduce friction. They might not look so great in sandals, but calluses are usually harmless and shouldn’t be painful. If they’re bothering you, Weisenfeld recommends gently filing them down with a pumice stone twice a week in the shower and moisturizing with a foot cream. If one hurts, it could be that a blister has formed underneath. It could also be a corn or a wart, not actually a callus. If a callus is dry, red, and cracking, it could be a sign of chronic athlete’s foot. All these scenarios deserve attention from a chiropodist.

3. Thickened toenails

Ever notice your toenails seem thicker and harder to cut than they used to? That’s their response to the constant banging and pressing against your shoes. “Nails will respond to constant repetitive trauma by thickening up,” Weisenfeld explains. If you’ve had some bruising, sometimes the nail will start to regrow before the old one has grown out or fallen off, causing an unnatural thickness. This can also be confused for fungus, so if your nails appear very thick and dense, see a foot doc to make sure it’s not something that needs to be treated with antibiotics. They may want to thin the nail out, too, especially if it’s causing you pain or discomfort.

4. Black toenails

Oftentimes, a bruised, black toenail is often the result of ill-fitting sneaks. “If shoes are old and floppy and stretched out, your toes are more likely to start slipping and jamming into front of the shoe,” Weisenfeld says. This trauma can cause bruising between the nail and the nail bed. “Once blood or even clear blister fluid gets under the toenail, it separates the nail from the nail bed and it won’t reattach. In that spot, the nail is dead.” If your entire nail is black, a full new toenail will eventually grow in. Weisenfeld says it takes about a year for a new big toenail to completely grow in.

If the nail hurts, you can try to drain the blood, but this may be best left to a physician or chiropodist. “It won’t save the nail, but it will relieve pressure and pain. “To stop feet from sliding as you pound the pavement, try custom insoles that lock them in place. If you ever just have a persistent black spot on your nail and there’s no pain, visit a chiropodist to rule out skin cancer.

5. Ingrown toenails

An ingrown nail looks (and feels) like the nail is piercing the flesh around it. “Your body doesn’t care it’s a nail, it just knows something’s poking that doesn’t belong there, so it acts like it’s a foreign body,” Weisenfeld explains, leading to pain and infection. Running isn’t the most common cause of ingrown toenails, but if you’re prone to them, it can make things worse: An ill-fitting shoe and repetitive pressure on your big toe can push it into the skin around it, especially if your nail tends to curve downward. You should never try to remove an ingrown nail yourself—it can seriously damage it and make it become more infected (talk about gnarly)—so be sure to book an appointment with a chiropodist to get it properly taken care of.

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Addressing The Rising Concern Of Antibiotic Resistance With Surgical Prophylaxis

Currently, the United States Centers for Disease Control and Prevention estimate that antibiotic resistance is responsible for more than 2 million infections and 23,000 deaths annually.2 The direct cost of antibiotic resistant infections is an estimated $20 billion and indirect costs due to loss of productivity are an estimated $35 billion.

A recent study by Teillant and colleagues at the Center for Disease Dynamics, Economics and Policy examined the potential consequences of increased antibiotic resistance on the 10 most commonly performed surgical procedures.3 The authors predict that antibacterial resistance may threaten the safety of many surgical procedures.

In this study, the researchers first reviewed published literature to determine the current efficacy of prophylactic antibiotics to prevent infections in the 10 most common surgical procedures.3 They then modeled the effect of reducing the effectiveness of antibiotic prophylaxis by various amounts from 10 to 100 percent. The study showed that currently, an estimated 38.7 to 50.9 percent of pathogens that cause surgical site infections are resistant to standard prophylactic antibiotics. They predicted that a 30 percent reduction in antibiotic efficacy due to the development of drug resistance would result in 120,000 additional surgical site infections and 6,300 additional surgery-related deaths.

The authors conclude that increasing antibiotic resistance presents a significant threat to the safety of many common surgical procedures.3 They highlight the need for further research as to how one should modify prophylactic antibiotic administration to combat the rising incidence of antibiotic resistance.

Kristine Hoffman DPM
Podiatry Today Magazine

Friday, 10/30/15 | 716 reads

References

1.      Center for Disease Dynamics, Economics and Policy, and the Global Antibiotic Resistance Partnership. The State of the World's Antibiotics 2015. Available at http://cddep.org/publications/state_worlds_antibiotics_2015 .

2.      Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States, 2013. Available at http://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf .

3.      Teillant A, Gandra S, Barter D, Morgan DJ, Laxminarayan R. Potential burden of antibiotic resistance on surgery and cancer chemotherapy antibiotic prophylaxis in the USA: a literature review and modelling study. Lancet Infect Dis. 2015; epub Oct. 15.

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May 18, 2016
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Diabetes affects 30 million people in the US and more than 415 million people worldwide.

Diabetesatlas.org/American Diabetes Association

 

The big picture: Diabetes, Diabetic Foot Ulcers, Peripheral Artery Disease and Limb Loss Visualized

 

The top 10 diabetes nations 
International Diabetes Federation / Diabetesatlas.org

 

Worldwide trends in diabetes from 1980 to today

 

Diabetes kills more people annually than breast cancer and AIDS combined.

American Diabetes Association, 2009

 

Two thirds of all new cases of type 2 diabetes are diagnosed in low- and middle-income countries, such as Mexico, India, China and Egypt.

Pharmacoeconomics, 2015

 

Diabetes reduces a woman’s chances of employment by 50%

Pharmacoeconomics, 2015

 

If diabetes were a country, it would be the 4th largest in the world

International Diabetes Federation / Diabetesatlas.org

 

80% of people with diabetes are from low and middle income nations

International Diabetes Federation, 2012

 

The number of people with diabetes is increasing in every single nation

International Diabetes Federation/World Health Org 2012

 

Half of people with diabetes don’t know they have it.

American Diabetes Association / International Diabetes Federation, 2012

 

Quiet. Slow. Deadly. Expensive: Chronic Diseases Account for 75% of our Healthcare Costs.

CDC

 

25% of all medical care is consumed by 1% of the population and nearly 50% is consumed by 5%.
AHRQ, 2013

__

1 Day with #Diabetes in USA:  5000 diagnosed, $670M, 280 lives, 200 limbs. We can do better. Today.
American Diabetes Association, 2014

 

Seconds Count: Every 7 seconds someone dies from diabetes. Every 20 seconds someone is amputated.

International Diabetes Federation / Diabetesatlas.org

Armstrong, et al, Diabetes Care 2013

 

The cost of diabetic foot ulcers is greater than that of the five most costly forms of cancer

Barshes, et al, Diab Foot Ankle 2013

 

The cost to heal a complex diabetic foot ulcer is between 3 months and 6 years’ salary depending on nationality

Cavanagh, et al, Diabetes Metab Res Rev, 2012

 

Diabetic Foot Ulcer patients are twice as costly to US Medicare as those with diabetes alone

Rice, et al, Diabetes Care, 2014

 

Inpatient care constitutes nearly two thirds of insurance costs for diabetic foot ulcers
Rice, et al, Diabetes Care, 2014

 

The estimated annual US Burden of Diabetic Foot Ulcers is at least $15 Billion
Rice, et al, Diabetes Care, 2014

 

By 2030, at least 550 million people will have diabetes- approximately 10% of the world’s adult population.

International Diabetes Federation (IWGDF), 2011

 

There are now approximately 86M people with pre-diabetes in the USA
That’s the total population of 30 states. 
American Diabetes Association, 2014
2010 United States Census

 

The population of diabetes in the USA is greater than the population of the nation’s 10 largest cities.
American Diabetes Association, 2012
2010 United States Census

 

Today with Diabetes In America: 200 Lives, 200 Limbs, 86 million at risk.
American Diabetes Association 2014

 

The population of Diabetes in Arizona (home of SALSA) would make it the fourth largest city in the state.
American Diabetes Association, 2012
2010 United States Census

 

60-70% of those with diabetes will develop peripheral neuropathy, or lose sensation in their feet.

Dyck et al.  Diabetic Neuropathy 1999

 

More than 90% of people with diabetic peripheral neuropathy are unaware they have it.

Bongaerts, et al, Diabetes Care, 2013

 

Up to 25% of those with diabetes will develop a foot ulcer.

Singh, Armstrong, Lipsky.  J Amer Med Assoc 2005

 

The yearly incidence of diabetic foot ulcers ranges from 2% to 32%, depending on ADA risk classification
Boulton, Armstrong, et al, Diabetes Care 2008
Lavery , et al, Diabetes Care  2008
Sibbald, et al, Adv Skin Wound Care, 2012

 

More than half of all foot ulcers (wounds) will become infected, requiring hospitalization and 20% of infections result in amputation.

Lavery, Armstrong, et al.  Diabetes Care 2006

 

Diabetes contributes to approximately 80% of the 120,000 nontraumatic amputations performed yearly in the United States.

Armstrong et al. Amer Fam Phys 1998

 

“Every 20 seconds, somewhere in the world, a limb is lost as a consequence of diabetes”

DFCon11, Bakker (after Boulton), DFCon.com

Boulton, The Lancet (cover), Nov. 2005

 

After a major amputation, 50% of people will have their other limb amputated within 2 years.

Goldner. Diabetes 1960

Armstrong, et al, J Amer Podiatr Med Assn, 1997

 

More than half of people with  osteomyelitis of the heel will undergo high level amputation

Faglia, et al, Foot Ankle Int, 2013

 

The relative 5-year mortality rate after limb amputation is 68%. When compared with cancer – it is second only to lung cancer (86%).  (Colorectal cancer 39%, Breast cancer 23%, Hodgkin’s disease 18%, Prostate cancer 8%)

Armstrong, et al, International Wound Journal, 2007

 

Median time to healing for diabetic foot wounds: 147,188, and 237 days for toe, midfoot and heel ulcers.

Pickwell, et al, Diabetes Metab Res Rev, 2013

 

People with a history of a diabetic foot ulcer have a 40% greater 10 year mortality than people with diabetes alone.

Iversen, et al, Diabetes Care, 2009

 

Every 30 minutes a limb is lost due to a landmine, Every 20 seconds, a limb is lost due to diabetes.

Bharara, Mills, Suresh, Armstrong, Int Wound J, 2009

 

Having a wound immediately doubles one’s chances of dying at 10 years compared with someone without diabetes

Iversen, et al, Diabetes Care 2009

 

One third of patients seeking care for ischemic wounds die unhealed
Elgzyri, et al, Eur J Vasc Endovasc Surg, 2013

 

For people on dialysis receiving an amputation, 2 year mortality is 74%

Ndip, et al, 2012, Diabetes

 

Diabetic foot ulcers double mortality and heart attack risk while increasing risk for stroke by 40%
Brownrigg, et al, Diabetologia, 2012

 

Chronic wounds affect some 8 million Americans each year. That’s one wound every 3.8 seconds in the USA, alone.
Harsha , 2008 and Tomic-Canic 2010

 

Each $1 invested in care by a podiatrist for people with diabetes results in $27 to $51 of healthcare savings.

JAPMA, 101(2), 2011

 

Podiatry care not only reduces amputation risk, but also dramatically impacts rate of hospitalization and reulceration
Gibson, et al, Int Wound Journal, 2013

 

Podiatric medical care in people with history of diabetic foot ulcer can reduce high level amputation from between 65% and 80%
Gibson, et al, Int Wound Journal, 2013

 

Instituting a structured diabetic foot program can yield a 75% reduction in amputation rates and a near four-fold reduction in inpatient mortality
Weck, et al,  Cardiovascular Diabetology, 2013

 

When footcare is removed from a population with diabetes, there is a 37% increase in hospital admissions for limb threatening wounds and 45% increase in individual patient charges.

Skrepnek, Mills, Armstrong, Diabetes Care, 2014

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As the technology of three-dimensional printing becomes more ubiquitous, these authors note that 3D printing could be a viable adjunct for surgical planning and orthotic fabrication, and suggest that increased access to this technology may have broader implications on healthcare delivery in the future.

Three-dimensional printing has become an awe-inspiring, household term for the creation (and recreation) of amazing items, and we suspect it will play a major role in the forthcoming third Industrial Revolution. As we will have the ability to rapidly create and iterate physical objects much in the way that we have been able to create and modify computer files, the only thing that remains clear about the future of this disruptive technology is that it will drive change.

In practical terms, 3D printing is nothing more than a newer means of manufacturing. Original patents for 3D printing date back to the late 1970s and early 1980s as it was originally referred to as “rapid prototyping” or stereolithography. As with desktop paper printers of that era, 3D printing was crude and low resolution in comparison to today’s standards. However, 3D printing (or additive manufacturing as it is more properly known) largely went unnoticed until this current decade. Why is that? Supply and demand.

Rapid prototyping machines originally required a bit of technical expertise to operate and were prohibitively expensive. Prices of these machines ranged from three to ten times more expensive than the cost of a reasonable desktop paper printer. It was not until these original technology patents expired in the late 2000s that tinkerers and hardware hackers began developing inexpensive desktop-sized 3D printers. Although the reliability and overall quality of these printers were fairly poor, the use of these printers was a truly captivating experience for many technology enthusiasts of their time, and the open-sourced designs became a foundation for much of what the mainstream media has popularized.

Today, some of the more common demonstrations of 3D printing in education, art and commercial business are part of an overnight explosion that is a quarter of a century in the making. In what direction does this lead the next five to ten years of everyday manufactured goods and services?

To understand additive manufacturing, it is important to understand manufacturing in general. As you read this article, the large majority of everything surrounding you was likely manufactured by one of several processes. Casting, molding, forming and machining are the most common categorical descriptions. Everyday examples include a craft doorknob poured from a cast, injection-molded protective smartphone cases, vacuum-formed plastic bottles and machine-carved (a.k.a. subtractive manufacturing) wooden table legs. Additive manufacturing is essentially just one more member of this family.

Additive manufacturing is a process that starts with nothing and creates the final product one layer at time. Three-dimensional printing is showing great promise with exceedingly intricate manufacturing capabilities as well as custom applications. Whereas most of the previously mentioned processes have inherent limitations to complexity with corresponding cost increases, 3D printed products often do not increase in price or time when one adds more details to the printed result.

Can 3D Printing Reinvent Surgical Planning For Complex Deformities?
Three-dimensional printing has become a poster boy for Silicon Valley technological innovation and status quo disruption. As empowering as this may seem, 3D printing still has a longer and gradual transition, and has yet to achieve widespread, everyday use. However, this movement is already inspiring healthcare modalities, generating new opportunities for personalized patient care and pre-surgical education via the utilization of computer drafting and additive manufacturing (3D printing).

Complex, challenging surgical procedures have the potential to create stress on care providers and patients alike.1 Research has shown that these stressors have the potential to adversely affect intraoperative performance and human interactions, ultimately reducing the quality of patient outcomes.2 Multiple researchers have investigated methods of reducing stress and improving operating circumstances in a variety of theaters.3-5

The reconstruction of complex deformities secondary to Charcot neuroarthropathy continues to pose challenges for diabetic limb preservation efforts. Failure to properly address this problem has the potential to reduce mobility and increase mortality.6 The senior authors have previously described the use of simulated perioperative surgical planning by means of computer-aided design (CAD) software as well as computer-aided manufacturing (CAM) methods via additive manufacturing.6 In this article, the senior authors described a novel, inexpensive 3D template printing technique that uses a normal printer to produce multiple “copies” of the foot that is slated for surgical repair. We believe one could use this technology to plan surgical repair or revision of other complex foot deformities.

Surgeons have likewise replicated this technique in orthopedic and other surgical specialties. Zein and colleagues described the use of 3D printing to simulate liver transplantation.7 These advantages of simulated surgical planning are further elucidated in the field of neurosurgery, where researchers have observed complex challenges and considerations.8 Modeling advantages to additive manufacturing and computer-assisted design are also happening in pediatric plastic surgery.9

While simulated perioperative surgical planning functions well as a surgical training tool and a tangible adjunct for patient education, it is likely still too costly and cumbersome for high volume workflow.

Much of these accomplishments are admittedly minuscule in comparison to the glaring potential benefits that additive manufacturing could bring to individualized regenerative medicine. Atala and his tremendous work with bioprinting of tissues and organs demonstrate some of these advantages.10,11 While stem cells alone have limitations with growth patterns and morphogenetic tendencies, additive manufacturing may overcome many challenges to organ replacement and other pathologies such as tissue degeneration in people with arthritis.

Does 3D Printing Facilitate Increased Access, Collaboration And Innovation?
Recently, popular crowdfunding opportunities have laid the foundation for progressive market developments, increasing widespread “homebrew” endorsement for personal additive manufacturing platforms. In tandem, works to make products more available and low-cost by the “open source movement” have pioneered renovations in recently expired software, successfully “remixing” purchaser-only applications into industry-leading “free to use” programs.

Previously, the exploration and advancement of technology was the sole work of industry professionals or highly skilled enthusiasts. A relatively new phenomenon termed “hackerspaces” or “makerspaces” has brought about nationwide venues for hobbyist, educational and collaborative work, facilitating a dynamic change in the availability of resources.12  These movements strive to lower the barriers to education and training, revolutionizing the means by which we obtain individual skills. Direct examples of this include Makerspaces in Tucson and Atlanta. In addition, the triad of increasing machine capabilities, decreased material and technological costs as well as patent expiration in tandem with the aforementioned educational centers have led many theorists to predict an upcoming third Industrial Revolution.13,14

The resonating effects of these penetrating sociological ideals and educational opportunities are quite intriguing. It is likely that many of these principles will produce unexpected results, circumventing the accepted limitations of education and defying established socioeconomic rules and traditional business models.15 Disruptive changes as a result of technological advancements are a common thread throughout human history.

Just as the widespread adoption of viable free software and rapid Internet connectivity disrupted the previously accepted form factor of purchasing compact discs, it is our belief that the current healthcare practices will be revolutionized by the concepts currently developing by the means of homebrew, think tank and startup technology operations. While the safety and legality of these practices have yet to resolve, the end result is no less inspirational. Never before has a consumer been so connected with a digital engineer, an evolving relationship already influencing widespread commercial segments. The advances in all 3D technologies, from 3D design, scanning and capturing, “augmented reality” and additive manufacturing, can theoretically help “open source” the world itself. In the coming decades, digital sharing and replication of everyday commodities may be as accessible as current consumer technology.

Additive manufacturing will likely not replace everyday items until the material properties of these goods can improve. Currently, additive manufactured materials do not hold up well against repetitive loading and high impact forces like many traditionally manufactured goods do. Also, there is a significant limitation on material choices. Improvements to resolution, printing methods and chemical mediums will likely overcome much of this in the next 20 to 30 years.

Will 3D Printing Redefine The Roles Of Healthcare Providers?
Orthoses and prostheses, perhaps like no other technologies in podiatric medicine and surgery, may conceptually benefit from the democratization of 3D printing. Already, many “legacy” orthotic companies advertise the use of variants of additive manufacturing in this area. The fact is, however, that this technology has been around in one form or another for a long while. Whether the near term shows benefits from 3D printed insoles over other insoles remains to be seen. The particular excitement in the area involves “homebrewed” technologies that may result in a greater number of individual clinicians (and perhaps individual patients at some point) making their own orthoses.

While this sounds heretical, we believe that it is ultimately inevitable. Whether this fundamentally changes the roles of podiatric and orthopedic surgeons, physical medicine and rehabilitation specialists or prosthetists from “prescriber” to “adviser” remains to be seen. Additionally, issues surrounding intellectual property for these technologies are no less complex than when the Napster file sharing service upended the music industry in the 1990s.

Where Do We Go From Here?
The social implications of 3D printing’s advancement will likely be very profound and yet unexpected. Although bootlegging and digital piracy are major concerns for product designers and patent holders, premium services will still likely rise to prominence among the noise. One meaningful comparison is with streaming media, whereby “free-to-play” models exist with support from advertising revenue.16,17 Donations and the recently described “thank you economy” are showing increased gains.18 Naming one’s price and patron support of content providers are becoming prominent business models.

YouTube may be the best example of this from the authors’ perspective. From a variety of hardware machines running several different operating systems and web browsers, users are able to experience a variety of different content. Users can upload artist- and user-generated content, and advertising revenue supports the means of hosting. Users can upload, download, share, promote, comment and vote on content based on merits or relevance. This fundamental platform has been one of the centerpiece platforms of social media, next to Facebook and Twitter.

Whereas the Internet provides the digital backbone of this tight social integration, digital 3D models and blueprints will also be shared and created by collaborative social efforts. This future is both promising and somewhat startling based on recent news. Less than three months apart, popular news outlets promoted coverage of both a 3D printed handgun, “The Liberator” and a 3D printed prosthetic hand replacement for children, the “Robohand.”15,19-20 Additive manufacturing is yet another empowering technology for the masses.

Could medical care providers and patients soon be witnessing a rapidly evolving change of interaction and delivery of service? Scientific literature as well as popular news sources have already demonstrated significant enhancements to medical treatments as a direct result of novel collaborative efforts and technology. Many of these stories emphasize the partnership between physicians, surgeons and scientists as being critical to positive outcomes. For instance, our team has worked with teams of surgeons at UCSD to rapidly prototype a human ear to surgical repair a congenital defect (microtia) by simply scanning the healthy ear and “flipping” it 180 degrees much as we would do in Photoshop before sending the template to a 3D printer.6

Additionally, the continued collaboration between patients and physicians further demonstrates an independence from commercial reliance. As the influence of consumer-driven technology subverts the industry-dominated creation and delivery of media, so too will the influence of patient-centered technology supersede the industry-dominated formulas for healthcare diagnostics and treatment. The ability to self-generate will continue to emphasize inexpensive personalized care, pushing traditional industry further from the frame of influence in the healthcare setting. Healthcare stands to benefit greatly from these technologies, both from large industrial and academic developments in machine design and sophistication, as well as from the consumer and hobbyist level.

 
Author(s): 
Nicholas A. Giovinco, DPM, John D. Miller, BS, and David G. Armstrong, DPM, MD, PhD
 

Mr. Miller is a third-year podiatry student at Des Moines University and a former research intern with the Southern Arizona Limb Salvage Alliance (SALSA).
Dr. Giovinco is an Assistant Professor in the Department of Surgery at the University of Arizona. He is the Director of Education with SALSA.
Dr. Armstrong is a Professor of Surgery at the University of Arizona College of Medicine. He is the Director of SALSA.

References

  1.     Mongin C, Dufour F, Lattanzio F, Champault G. Evaluation of stress in surgical trainees: prospective study of heart rate during laparoscopic cholecystectomy. J Chir. 2008;145(2):138–42.
  2.     Ahmed N, Conn LG, Chiu M, et al. Career satisfaction among general surgeons in Canada: a qualitative study of enablers and barriers to improve recruitment and retention in general surgery. Acad Med. 2012;87(11):1616–21.
  3.     Parvaneh S, Grewal G, Grewal E, et al. Stressing the dressing: Assessing stress during wound care in real-time using wearable sensors. Wound Medicine. 2014; 4(1):21–26.
  4.     Schwenk M, Mohler J, Wendel C, et al. Wearable sensor-based in-home assessment of gait, balance, and physical activity for discrimination of frailty status: baseline results of the Arizona Frailty Cohort Study. Gerontology. 2014; 61(3):258-67.
  5.     Rankin TM, Mailey B, Cucher D, et al. Use of 3D printing for auricular template molds in first stage microtia. Plast Reconstr Surg. 2014; 134(1):16–17.
  6.     Giovinco NA, Dunn SP, Dowling L, et al. A novel combination of printed 3-dimensional anatomic templates and computer-assisted surgical simulation for virtual preoperative planning in Charcot foot reconstruction. J Foot Ankle Surg. 2012;51(3):387–93.
  7.     Zein NN, Hanouneh IA, Bishop PD, et al. Three-dimensional print of a liver for preoperative planning in living donor liver transplantation. Liver Transpl. 2013;19(12):1304–10.
  8.     Klein GT, Lu Y, Wang MY. 3D printing and neurosurgery—ready for prime time? World Neurosurg. 2013;80(3-4):233–5.
  9.     Rankin TM, Giovinco NA, Cucher DJ, Watts G, Hurwitz B, Armstrong DG. Three-dimensional printing surgical instruments: are we there yet? J Surg Res. 2014; 189(2):193-7.
  10.     Skardal A, Atala A. Biomaterials for integration with 3-D bioprinting. Ann Biomed Eng. 2015;43(3):730–46.
  11.     Merceron TK, Burt M, Seol YJ, et al. A 3D bioprinted complex structure for engineering the muscle-tendon unit. Biofabrication. 2015;7(3):035003.
  12.     Adam AE. Hacking into hacking: gender and the hacker phenomenon. SIGCAS Comput Soc. 2003;33:3.
  13.     Gershenfeld N. Fab: The Coming Revolution On Your Desktop--From Personal Computers To Personal Fabrication. Basic Books, New York, 2008.
  14.     Anderson C. Makers: The New Industrial Revolution. Crown Publishing Group, New York, 2012.
  15.     Turner F. From Counterculture to Cyberculture: Stewart Brand, the Whole Earth Network, and the Rise of Digital Utopianism. University Of Chicago Press, Chicago, 2010.
  16.     Wilson F. The freemium business model. AVC Blog. Available at http://avc.com/2006/03/my_favorite_bus/ . Published March 2006.
  17.     Pujol N. Freemium: attributes of an emerging business model. Social Science Research Model. Available at http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1718663 . Published Dec. 1, 2010.
  18.     Kay G. The Thank You Economy: Gary Vaynerchuck. Int J Adv. 2011;30:721.  
  19.     Frauenfelder M. Make: Ultimate Guide to 3D Printing 2014. Maker Media, Inc., Sebastopol, CA., 2013.
  20.     Vincent CJ, Niezen G, O’Kane AA, Stawarz K. Can standards and regulations keep up with health technology? JMIR Mhealth Uhealth. 2015;3(2):e64.
  21.     Blackman J. The 1st Amendment, 2nd Amendment, and 3D Printed Guns 2014. Available at http://joshblackman.com/blog/2012/10/22/1-2-3-the-first-and-second-amend... . Published Oct. 22, 2012.
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CBC's I-Team catches nail salon health violations on camera

The CBC I-Team visited two salons previously written up by Manitoba Health inspectors and found violations and unsafe practices continue even after they had been sanctioned.

Aloha Nails on Regent Avenue had previously been cautioned by provincial health inspectors for high bacteria counts in foot baths, for its "dirty and dusty" workstations and for reusing single-use tools like files and buffers.

Mike LeBlanc

The I-Team reviews what its secret shoppers saw in salons to Manitoba's Chief Health Inspector Mike Leblanc (CBC)

The I-Team's secret shoppers observed staff working again on work surfaces coated in nail dust and dead skin and reusing nail files and buffers on clients.  

The province's chief health inspector wasn't impressed.

"Not good," Mike LeBlanc said, when the I-Team presented its findings. "They should be doing better than that."

Public health inspectors have written up Aloha on Regent four times since 2012. The last inspection in March 2015, prompted by a complaint from a customer who believed she had contracted a foot fungus after a pedicure, found Aloha to be compliant with all regulations.

In Manitoba, inspections of spas and salons are only prompted by public complaint. The I-Team's secret shoppers visited Aloha in December, nine months after its last inspection.

"We would be revisiting them and reinforcing with them, encouraging them to maybe get more training and to follow their training and the guidelines," said LeBlanc.

The I-Team also visited Chic Nails, which was the subject of a complaint in September of 2015. During the I-Team's visit, the nail technician failed to sanitize the secret shopper's hands before starting the manicure and used a previously used single-use nail file and buffer.

"They should be disposing of the disposable ones in between clients, and they should be doing that in a public way to show, 'Look, we're throwing this away. We're not reusing it for the next person,'" LeBlanc said.

Aloha Nail File

A worker at Aloha Nails uses a previously used emery board on I-Team secret shopper. (CBC)

As for sanitizing a client's hands before starting work, LeBlanc said: "They should be washing people's hands beforehand."

"We would take another look at them and to make sure that they're complying with our guidelines," he said.

Carter Chen speaks for Chic Nails. When told of the infraction caught on camera, he told the I-Team it was an isolated incident.

"Well, we do have some turnover within the salon," Chen said. "Sometimes you can't always check on each employee."

The salon keeps a list of salon rules in the back of the salon, which tell staff how to treat single-use items, Chen said.

The I-Team's calls to Aloha were not returned.

The Registrar of the College of Podiatrists of Manitoba said podiatrists occasionally have to deal with the after effects of poorly performed or unsanitary pedicures: ingrown nails, infections and fungus.

Martin Colledge

Martin Colledge is concerned after a sales consultant contacted him about buying advertising on the RateMDs website. (CBC)

"Forty to 60 per cent of the population over the age of 50 has clinical evidence of fungal infections in the nail.  The questions is, is that something that is transmitted through spas and pedicures?" Martin Colledge asked.

Colledge also worries about the ways some spas and salons advertise their services.  Some are advertising that they have "master pedicurists" on staff who claim to be able to treat people with health problems as opposed to offering cosmetic services

"The competency of what they are offering is unclear," Colledge said, "As a regulator I have some concerns about that."

In particular, Colledge worries about pedicure clients with diabetes.

"What may appear to be a callous can actually be underneath that quite a deep ulcer," Colledge said. "So if you have someone who despite their best intention starts cutting away at a callous in someone who has that what they may reveal is a whopping great hole in the foot which they probably wouldn't be competent to deal with."

Colledge cautions people looking for serious foot care to seek a regulated health care provider like a podiatrist, rather than an esthetician.

 'If it's too good to be true, it probably is.' - Jocelyn Diamond, esthetician

 

But if you're just looking for a straightforward pedicure, how can you be sure your salon or spa is compliant with regulations?  Esthetician Jocelyn Diamond said price can often be a good indicator of whether a spa is following the rules.

"Price says a lot," Diamond said. "If it's too good to be true, it probably is.  They're probably not throwing away their disposable items and their service provider may not be paying a fair wage."

Diamond estimates a basic pedicure should be between $35 and $45 which would factor in the cost of using new single-use tools like emery boards and quality sterilized re-usable tools.  She said a basic manicure should cost at least $25.

Diamond urges consumers to be wary of bargain prices on esthetics services because those businesses could be "cutting corners with products, cutting corners with your health, cutting corners with their staff, not using good, quality product."

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