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FirstHealth of the Carolinas
The practice of podiatry By Dick Broom
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Many of us tend to ignore our feet and take them for granted—until they start causing problems. Then we realize how much we depend on them.

Podiatrists are medical specialists who are very familiar with how we treat—or mistreat—our feet. Podiatry is the surgical or medical treatment of ailments of the foot and ankle. In the course of a day, a podiatrist is likely to see everything from ingrown toenails to sprains to limbthreatening infections.

“We see quite a bit of trauma, from stubbed toes to stress fractures, as well as Achilles tendon injuries and plantar fasciitis, which causes heel pain,” says Phillip Ward, DPM, of the Foot & Ankle Center of N.C. in Pinehurst.

Plantar fasciitis is a strain of the long, flat ligament on the bottom of the foot. That condition, along with soreness or tearing of the Achilles tendon, is an example of what Dr. Ward calls “overuse syndrome,” which is common among “weekend warriors.”


FirstHealth-affiliated
podiatrists

Glenn H. Dunlap, DPM
Board certified
Pinehurst Foot Specialist PA
(910) 295-9255

Hospital Affiliation: Moore Regional
Training: DPM, College of Podiatric Medicine, Iowa
Internship/Residency: VA Hospital, Pennsylvania; Dr. William M. Scholl College of Podiatric Medicine&
Surgery

Kevin N. Eberhardt, DPM
Board Certified
Eberhardt Foot & Ankle Clinic
(910) 695-3338

Hospital Affiliation: Moore Regional
Training: DPM, William M. Scholl College of Podiatric Medicine, Illinois
Internship/Residency: Florida Hospital

Joan D. Evans, DPM
Troy Foot Clinic
(910) 576-2212

Hospital Affiliation: Montgomery Memorial
Training: DPM, William M. Scholl College of Podiatric
Medicine, Illinois
Internship/Residency: VA Medical Center, Michigan

Alfonso A. Haro III, DPM
Board certified
Foot and Ankle Center of N.C.
(910) 295-9262

Hospital Affiliation: Richmond Memorial, Moore Regional, Montgomery Memorial
Training: PDM, Ohio College of Podiatric Medicine
Internship/Residency: Womack Army Medical Center, North Carolina; College of Podiatric Medicine, Ohio

Fattah Mirian, DPM
Board certified
(910) 997-3779

Hospital Affiliation: Richmond Memorial
Training: DPM, Ohio College of Podiatric Medicine
Internship/Residency: University Medical Center, Pennsylvania

Phillip E. Ward, DPM
Board certified
Foot and Ankle Center of N.C.
(910) 295-9262

Hospital Affiliation: Moore Regional, Montgomery Memorial
Training: DPM, University of Osteopathic Medicine
and Health Sciences, Iowa
Internship/Residency: College of Podiatric Medicine and Surgery, Iowa; Veterans Administration Medical Center, Maryland; Podiatry Association of Winston-Salem, N.C.

The heel pain of plantar fasciitis can also be caused by structural problems of the foot and by shoes that don’t provide proper support.

“Heel pain is common with flip-flops,” says Fattah Mirian, DPM, of Rockingham. “You need a shoe with decent arch support and a good fit around the heel to avoid repeated trauma, which leads to strain and inflammation.”

Podiatrists perform surgery for a variety of foot and ankle problems including structural abnormalities such as bunions and hammertoes. A bunion is a bony knob that develops on the inside of the foot at the base of the big toe. With hammertoes, the toes curl under because of an imbalance between the tendons on the top and bottom of the toes.

Among the most common and most serious problems that podiatrists treat are complications of diabetes. These typically take the form of sores or ulcers that are slow to heal and sometimes harbor difficult-to-treat infections. Poorly controlled diabetes causes damage to nerves and blood vessels.

“We often see diabetics who have lost all feeling in their feet, and if something irritates their foot and creates a sore, they may not even know it until it starts to bleed,” says Glenn Dunlap, DPM, of Pinehurst Foot Specialist. “And because they have such poor circulation, it’s very hard for the sore to heal.”

According to Dr. Dunlap, many things can cause sores including tight shoes that press against bunions or hammertoes or something sharp that punctures the skin.

“I’ve seen all kinds of things stuck in shoes—golf tees, nails, keys—that people couldn’t feel because their feet were numb,” he says.

In people with normal blood circulation in their feet and toes, sores usually get enough oxygen to heal on their own. If someone has poor circulation, “we may need to work with a vascular surgeon to try to increase the blood flow,” Dr. Ward says.

Podiatrists clean sores and remove dead tissue, and they can prescribe antibiotics for infection.

“Off-loading—that is, getting weight off the foot—is also a key to treating ulcers and infections,” says Dr. Mirian.

For some patients, Dr. Mirian uses the hyperbaric (high pressure oxygen) chamber at the Wound Care & Hyperbaric Center at FirstHealth Richmond Memorial Hospital. “That helps wounds heal faster by increasing the oxygen level in tissues,” he says.

(There is also a hyperbaric chamber at the Wound Care & Hyperbaric Center at FirstHealth Moore Regional Hospital in Pinehurst.)

Early detection and treatment of foot sores in people with diabetes is essential to prevent infections from getting too much of a head start. Once an infection gets down into the bone, Dr. Dunlap says, it can be extremely difficult to treat, and amputation of the toe or foot may be the only option.

As Dr. Mirian says, “Sometimes we have to sacrifice a limb to salvage a life.”

Education for podiatrists includes four years of college, four years of medical school and typically two or three years of residency training in foot surgery. Some podiatrists do more surgery than others, depending on the focus of their practice.

“Like most surgical specialties, we are doing more surgery now than in the past because the training is better,” Dr. Ward says. “We can do more procedures and more advanced procedures.”