Lower Extremity Review
In the quiet halls of the Gillis W. Long Hansen’s Disease Center in Carville, Louisiana, the legendary Dr. Paul Brand once faced a clinical mystery. He was conducting a study with a hypothesis that seemed like a mathematical certainty: total bed rest should heal a foot ulcer faster than any other intervention. By removing the variable of weight-bearing pressure entirely, the skin should have had the perfect environment to repair itself.
By Dr. Dennis Janisse
The current landscape of healthcare regulation is no longer a series of predictable updates. It has evolved into a “tornado” of shifting policies, reimbursement challenges, and administrative complexity. For mobile wound care practitioners, the outlook for 2026 remains promising, provided they pivot from a volume-based mindset to a meticulous, documentation-driven business model. As veterans of regulatory compliance and mobile clinical operations, we outline the essential realities for surviving and succeeding in the coming year.
By Windy Cole, DPM, CWSP, FACCWS, FFPM RCPS (Glasg) and Martha R. Kelso, RN, CWHS, DAPWCA, HBOT
For many podiatrists, the workday doesn’t end when the last patient leaves. It continues through documentation, claim reviews, prior authorizations, patient messages, billing questions, and a growing list of administrative tasks that have become as much a part of practice as diagnosing plantar fasciitis or treating diabetic foot ulcers.
By Hersh Solanki, Chief Business Officer, Athelas
For years, I believed that the art of making a great custom orthotic began with experience. The more feet I evaluated, the more I realized that even the best prescription could only be as good as the information I sent to the laboratory. Like many clinicians, I worked through the evolution of plaster casts, foam boxes, and eventually digital scanning. Digital technology made the process faster, but I still found myself asking the same question: Am I consistently capturing the foot in the position I want the laboratory to build from?
By Dr Robert Conenello, DPM
Wild et al. defined “fall” as “an unintentional change in position resulting in coming to rest at a lower level or on the ground.” Falls and fall-induced injuries among older individuals represent a worldwide problem with substantial clinical and public health implications. More than 14 million U.S. adults aged 65 years or older report falls annually, leading to significant morbidity, mortality, and healthcare expenditures.
By Robert G. Smith, DPM, MSc, R.Ph.
It began with a simple question to Phil Johnson, a Certified Prosthetist-Orthotist in private practice in Blacksburg, Virginia: “Can you help a boy in Guatemala who lost his leg?” Phil, who never shies away from a challenge, said yes. He traveled to Guatemala and successfully crafted a prosthetic leg for the 14-year-old boy. But the story didn’t end there. The very next day, 18 more children arrived at the door with their parents, all hoping for the same life-changing help.
By Reed Kennedy Volunteer Executive Director of Hope to Walk
Preferred Podiatry Group (PPG) is the leading provider of on-site foot and ankle care for senior living and long-term care communities across the country. Founded in 1972, PPG built its model around a simple idea: letting podiatrists focus entirely on patient outcomes while a dedicated corporate team handles all the operational noise behind the scenes.
I’m often asked about the operational benefits of using AI in clinical practice, and how to use it without feeling like a robot, has quietly moved into the exam room. Honestly, I wrestle with the same concern. Sometimes it feels like I may have created a monster. But as I learn to use this technology, I’ve realized that I don’t need (or want) AI acting like a junior doctor inside my electronic health record (EHR).
By Mikel D. Daniels, DPM, MBA, President and Chief Medical Officer, WeTreatFeet Podiatry
Digital synostosis of the foot–the osseous fusion of the middle and distal phalanges of the lesser toes, resulting in a biphalangeal rather than triphalangeal digit–is a radiographic finding that has received remarkably little systematic attention in the podiatric and orthopedic literature. When noted on routine foot radiographs, it is most commonly documented as an incidental observation and seldom pursued as a subject of clinical or scientific inquiry.
By Elie C. Daniel, B.S., D.P.M. Mendota Princeton Peru Foot and Ankle Clinics
For many living with diabetic foot disease, the sidewalk has become a source of fear. There is a persistent medical boogeyman suggesting that every step is a gamble, a potential trigger for a devastating ulcer. This fear often leads to a life of inactivity, fueled by the belief that staying off your feet is the only way to stay safe.
By Ryan Crews, PHD
Many patients with chronic foot and ankle conditions face treatment decisions that often fall into a frustrating gray area. Conservative therapies such as orthotics, physical therapy and injections may no longer provide relief, yet the prospect of surgery and its associated downtime can feel premature or undesirable. In response, clinicians are increasingly turning to minimally invasive procedures that offer…
By Keith Loria
In healthcare, one pattern has become hard to ignore. Every time the system identifies a problem, the default solution is to add another task, another field, another attestation, another screen, and another layer of proof for the physician to produce. In podiatry, that pattern is especially visible because so much of what should be straightforward diabetic foot prevention has been converted into a…
By Mikel D. Daniels, DPM, MBA, President and Chief Medical Officer, WeTreatFeet Podiatry
In the demanding arena of revision digital surgery, success is predicated on a strict “Proximal-to-Distal” hierarchy. The primary driver of surgical failure in this discipline is the isolated digital approach–addressing the toe as a localized deformity without considering the global biomechanical forces acting upon it. Long-term stability requires the neutralization of these forces through a systematic stabilization of the forefoot foundation.
By Tom Chang, DPM
The strategic transition from open to minimally invasive surgery (MIS) for hallux metatarsophalangeal (MTP) arthrodesis represents a significant shift in delivery, yet the biomechanical mandate remains unchanged. Correction mechanisms in the forefoot are fundamentally grounded in soft-tissue dynamics. Regardless of the surgical approach, the realignment of the hallux is predicated on the appropriate tensioning and pull of the surrounding structures.
By Amiethab Aiyer, MD
I often classify exercise as what I teach clients/patients to do to improve impairment at the body structure function level often targeting joint range of motion and muscle strength. Gains in joint flexibility and muscle strength through isometric, concentric or eccentric force generation is based on the position of the body part in open or closed chain and whether resistance is placed close to or far from the joint and or muscle insertion or origin.
By Dr. Jennifaye V. Brown
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