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The American Board of Multiple Specialties in Podiatry Co-Sponsors World-Class Webinar in Podiatric Sports Medicine

Jun 29 2020 03:20:09 AM

Dr. Tim Dutra Assistant Professor of Applied Biomechanics with California School of Podiatric Medicine at Samuel Merritt University and Podiatric Consultant for Intercollegiate Athletics, University of California, Berkeley, Dr. Kenneth Rehm, Clinical Assistant Professor at the California School of Podiatric Medicine and Vice President of the American Board of Multiple Specialties in Podiatry (ABMSP) and Dr. Howard Liebeskind, all board-certified in Podiatric Sports Medicine by ABMSP, are proud to have facilitated the Podiatric Sports Medicine Webinar at the Virtual Western Foot & Ankle Conference, June 25-June 27th. Hats off to Dr. Liebeskind and Dr. Dutra who were the moderators and organizers of this event, sponsored in part, by the American Board of Multiple Specialties in Podiatry. The world-class speakers they arranged provided brilliant insights into the role that the podiatric sports medicine physician plays in professional, collegiate, and school sports programs. This webinar provided a pivotal opportunity for those board- certified in podiatric sports medicine to acquire knowledge in how to assert their specialized expertise. Professional certification in podiatric sports medicine is available to all medical practitioners of lower extremity medicine by the American Board of Multiple Specialties in Podiatry. This is an experienced-based, portfolio certification that requires no exam. You may find more information about or apply for certification in sports medicine at www.abmsp.org
 

President’s Letter to our Diplomates

Mar 29 2020 10:49:35 PM

To our Diplomates:

We realize that these are difficult times for all healthcare professionals, including you, the diplomates of ABMSP. During this unprecedented time, we are making adjustments to our policies to address the burdens presented by radically changing or temporarily imposed federal, state and local regulations, delayed and cancelled meetings and professional events where required CME is usually available and the culture-changing restraints imposed by social distancing and quarantine.

Your board is actively monitoring government policy, practice and market changes. As a result, in our effort to support you and your practice, we have assembled the following series of helpful articles outlining Telemedicine and Telehealth policies which have been posted to our website and can be found here:

  • APMA COVID-19 Update: Podiatrists Can Provide EM Services Remotely
  • APMA Frequently Asked Questions
  • Medicare Telehealth Information
  • States Emergency Declaration Licensure Requirements Covid-19
  • Telehealth Policy Changes COVID-19
  • Rule Concerning Telehealth and the CMMS
  • ABMSP is committed to help you through this difficult time. Please take care of yourselves and your families. We are here for you.

    Michael Salter, DPM

    President
    ABMSP

    Distinguished Authors Series
    The opinions expressed here are those of the authors and do not necessarily reflect the positions of the American Board of Multiple Specialties in Podiatry or its Directors.

    Using Nutrition to Treat Diabetic Foot Ulcer and Its Major Cause

    Bettina Newman, RDN

    James McGuire, DPM, PT

    Patricia M. O’Connell
    BSc, MBA

    Is nutrition at the top of your mind when you are initially faced with a patient with a diabetic foot ulcer (DFU)? Right away, you may wonder what their blood sugars and A1C are; you review their medical record, take their history, and establish a care plan. Will that care plan address diabetic peripheral neuropathy (DPN), one of the main causes of DFU? In addition to lifestyle modifications that you may include in your plan, supplemental nutrients may have positive direct and indirect impacts on this root cause of the ulceration, and recommending or prescribing particular nutrients may pay great dividends in the form of favorable DFU outcomes.

    According to the National Institute of Diabetes and Digestive and Kidney Diseases, up to 50% of diabetic individuals have diabetic peripheral neuropathy.1 Furthermore, it is estimated that 90% of DFUs are associated with diabetic neuropathy.2 The health of nerve structure and function is dependent upon the presence of adequate oxygen and nutrients. Decreased blood flow deprives the tissues of these vital factors. Endothelial health is therefore of utmost importance. Hyperhomocysteinemia, reduced nitric oxide (NO), and increased oxidative stress compromise the health of blood vessels. Insufficient delivery of oxygen and nutrients can also negatively impact skin integrity as well as immune health, further setting the stage for ulceration.

    Early detection of DPN is important as is observing or testing for pre-existing nutritional deficiencies, especially since an ulcer places exaggerated calorie and nutrient demands on the patient. A recent study (N=131) found that vitamin D was the most prevalent deficiency affecting 55.7% of DFU patients; 73% of the patients studied displayed suboptimal vitamin C levels.3 If a patient has had genetic testing done, consideration of these results may also be relevant to nutrient considerations.

    Among the nutrients that have been associated with wound healing are vitamins A, C, D, and E; the minerals zinc and copper; a combination of magnesium and vitamin E; the amino acids arginine and glutamine and a leucine metabolite. Generally speaking, these nutrients aid in combatting oxidative stress, inflammation, and infection; supporting mitochondrial function; and providing building blocks for new tissue formation.

    The gut microbiome has been a topic of great interest in recent years, and dysbiosis has been found to contribute to insulin resistance in type 2 diabetes mellitus (T2DM).4 A 2017 longitudinal study found that the greatest difference between the skin microbiome of individuals with T2DM compared to non-diabetics was diversity.5 In a review of 39 studies, oral or topical use of various probiotic strains appeared to reduce wound infections, especially when used in conjunction with antibiotics.6

    As beneficial as the aforementioned nutrients and probiotics may be in supporting the body’s natural wound-healing capabilities, they do not necessarily address the underlying DPN. For this purpose, the clinician may consider prescribing a trio of B vitamins B6, B9, and B12 accompanied by an antioxidant. These nutrients have roles in glucose metabolism and endothelial and nerve health via activities related to homocysteine metabolism, NO synthesis, and reduction of oxidative stress. Let’s look at vitamin B9 (folate).

    Folate may be ingested as food folate, as folic acid used in food fortification and many dietary supplements, or as one of several synthetic forms, not all of which have the same bioactive benefits. (6S)-5-methyltetrahydrofolic acid ([6S]-5-MTHF) is the primary biologically active isomer of folate; food folate and folic acid require further metabolism to become (6S)-5-MTHF. This metabolism requires the activity of several enzymes, perhaps the most crucial being methylenetetrahydrofolate reductase (MTHFR). Deciding which form of folate to recommend to a patient can be challenging. A patient may have gene variants (polymorphisms) that inhibit the efficiency with which MTHFR converts what was originally food folate or folic acid into the bioactive (6S)-5-MTHF. Polymorphisms in the MTHFR gene are common genetic causes for elevated homocysteine levels.7 Furthermore, the MTHFR SNPs (single-nucleotide polymorphisms) have been associated with vasculopathy, which has been linked to DPN.8

    A pharmacokinetic study demonstrated that the peak concentration (bioavailability) following the administration of (6S)-5-MTHF is almost seven times higher compared to folic acid, irrespective of the patient’s genotype.9 Clinical studies have shown that direct supplementation with (6S)-5-MTHF reduces homocysteine levels and increases plasma folate levels more effectively than folic acid.10-12

    (6S)-5-MTHF also increases endothelial NO synthase coupling and NO production and directly scavenges superoxide radicals. Better NO bioavailability means increased vasodilation to enhance blood flow.13,14 With respect to DFU, researchers have suggested that “nitric oxide synthesis is critical to wound collagen accumulation and acquisition of mechanical strength.”15

    We can find evidence in mice that folic acid accelerated granulation tissue formation, proliferation of fibroblasts, and tissue regeneration and reduced the healing time that diabetes typically delays. Supplementation alleviated diabetes-induced impaired collagen deposition in wounds and significantly lessened lipid peroxidation, protein nitrotyrosination, and glutathione depletion.16 Also, in a retrospective cohort study of the medical records of 29 veterans with T2DM and early stage DFU, high-dose folic acid supplementation brought significant improvement (P=<.05) in wound closure and re-epithelialization.17

    When deciding on which form of folate to recommend for optimal safety and efficacy, it is helpful to consider the patient’s known or potential genetic polymorphisms and to be aware that unmetabolized folic acid (UMFA) accumulation may carry its own health implications. Concerns have been raised about correlations between UMFA and cognitive decline and anemia, and an association with a decline in the immune system capacity to kill off malignant or pre-malignant cells was confirmed. Having given consideration to the potential harmful effects of excess folic acid, some countries have avoided establishing a folic acid food fortification program.18-22

    To alleviate concerns about MTHFR polymorphisms and about UMFA accumulation, clinicians might prefer to recommend a “finished folate.” (6S)-5-MTHF is well-absorbed regardless of gastrointestinal pH. This form is typically available as a glucosamine salt or a calcium salt. There is a patented (6S)-5-MTHF glucosamine salt form that shows good stability, and it is 100 times more water soluble and has 10% greater bioavailability compared to the calcium salt form.23

    Another bonus of supplementation with the (6S)-5-MTHF glucosamine salt form is that its risk of masking vitamin B12 deficiency is low. Nevertheless, it is still a good idea to consider including vitamin B12 in a DPN care plan because lower levels of vitamin B12 are common among the diabetic population.

    The metabolically active form of vitamin B12 is methylcobalamin. Among this vitamin’s many functions are the formation and maintenance of the myelin sheath and its participation in the homocysteine metabolic pathway. In a meta-analysis of studies comprising a total of 1114 subjects, vitamin B12 (mean 0.5 mg daily) added to folic acid supplementation produced an additional 7% (3% to 10%) reduction in blood homocysteine. Besides it neuroprotective benefits, vitamin B12 may directly aid in healing DFUs by participating in protein synthesis and functioning as a growth factor.24

    A third B vitamin to consider with respect to DPN and DFU is pyridoxal 5’-phosphate (P5’P), the metabolically active coenzyme form of vitamin B6. P5’P-dependent enzymes are involved in many biochemical reactions, including the transsulfuration of homocysteine. P5’P also helps to combat free radicals and inhibit the formation of advanced glycation end products (AGEs). These activities contribute to vascular endothelial health, a critical requisite for diabetic wound healing and for the maintenance of skin health as previously described. Especially with aging, diabetic individuals may tend toward low plasma and skin P5’P concentrations.

    We’ve seen that B vitamins have some antioxidant potential. However, since elevated blood sugar stimulates generation of free radicals and free radicals damage vascular and microvascular endothelium, it may be helpful to also consider an antioxidant, especially one with multiple actions. Alpha-lipoic acid, a water- and fat-soluble antioxidant, has therapeutic potential in the management of T2DM, a 50-plus-year track record for treatment of peripheral neuropathy, and a significantly improved wound healing time in mice (P<0.05) and in patients undergoing hyperbaric oxygen treatments, inhibited oxidative damage, and accelerated healing of chronic wounds.25-28

    In summary, we have discussed the roles of vitamins B6, B12, and B9 ([6S]-5-MTHF) as well as the powerful antioxidant alpha-lipoic acid. We have presented a rationale for their consideration in the care of a patient who is at risk for DFU or perhaps already needs treatment for the condition. Observations shared by podiatrists who have been prescribing a medical food to help patients meet their distinct nutrient requirements related to DPN reveal the difference a prescription can make in DPN symptoms and the propensity for ulcer formation. Will nutrition now be the top of your mind when you are initially faced with a patient with a diabetic foot ulcer (DFU)?

    References

    1. What Is Diabetic Neuropathy? National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies/what-is-diabetic-neuropathy#common. Accessed July 15, 2020.
    2. Alexiadou K, Doupis J. Management of diabetic foot ulcers. Diabetes Ther. 2012;3(1):4. doi:10.1007/s13300-012-0004-9.
    3. Pena G, Kuang B, Cowled P, Howell S, Dawson J, Philpot R, et al. Micronutrient status in diabetic patients with foot ulcers. Adv Wound Care (New Rochelle). 2020;9(1):9-15. doi:10.1089/wound.2019.0973.
    4. Sharma S, Tripathi P. Gut microbiome and type 2 diabetes: where we are and where to go? J Nutr Biochem. 2019 Jan;63:101-108. doi:10.1016/j.jnutbio.2018.10.003.
    5. Gardiner M, Vicaretti M, Sparks J, et al. A longitudinal study of the diabetic skin and wound microbiome. PeerJ. 2017;5:e3543. doi:10.7717/peerj.3543.
    6. Fijan S, Frauwallner A, Langerholc T, Krebs B, Ter Haar Née Younes JA, et al. Efficacy of using probiotics with antagonistic activity against pathogens of wound infections: an integrative review of literature. Biomed Res Int. 2019 Dec 12;2019:7585486. doi:10.1155/2019/7585486.
    7. Moll S, Varga EA. Homocysteine and MTHFR mutations. Circulation. 2015;132(1):e6-e9. doi:10.1161/CIRCULATIONAHA.114.013311.
    8. Yigit S, Karakus N, Inanir A. Association of MTHFR gene C677T mutation with diabetic peripheral neuropathy and diabetic retinopathy. Mol Vis. 2013;19:1626-1630.
    9. Willems FF, Boers GH, Blom HJ, Aengevaeren WR, Verheugt FW. Pharmacokinetic study on the utilisation of 5-methyltetrahydrofolate and folic acid in patients with coronary artery disease. Br J Pharmacol. 2004 Mar;141(5):825-30. doi: 10.1038/sj.bjp.0705446.
    10. Antoniades C, Shirodaria C, Warrick N, et al. 5-methyltetrahydrofolate rapidly improves endothelial function and decreases superoxide production in human vessels: effects on vascular tetrahydrobiopterin availability and endothelial nitric oxide synthase coupling. Circulation. 2006;114(11):1193‐1201. doi:10.1161/CIRCULATIONAHA.106.612325.
    11. Yuyun MF, Ng LL, Ng GA. Endothelial dysfunction, endothelial nitric oxide bioavailability, tetrahydrobiopterin, and 5-methyltetrahydrofolate in cardiovascular disease. Where are we with therapy? Microvasc Res. 2018;119:7‐12. doi:10.1016/j.mvr.2018.03.012.
    12. Smith DE, Hornstra JM, Kok RM, Blom HJ, Smulders YM. Folic acid supplementation does not reduce intracellular homocysteine, and may disturb intracellular one-carbon metabolism. Clin Chem Lab Med. 2013;51(8):1643-1650. doi:10.1515/cclm-2012-0694.
    13. Stanhewicz AE, Kenney WL. Role of folic acid in nitric oxide bioavailability and vascular endothelial function. Nutr Rev. 2017;75(1):61‐70. doi:10.1093/nutrit/nuw053.
    14. Joshi R, Adhikari S, Patro BS, Chattopadhyay S, Mukherjee T. Free radical scavenging behavior of folic acid: evidence for possible antioxidant activity. Free Radic Biol Med. 2001;30(12):1390-1399. doi:10.1016/s0891-5849(01)00543-3.
    15. Frank S, Kämpfer H, Wetzler C, Pfeilschifter J. Nitric oxide drives skin repair: novel functions of an established mediator. Kidney Int. 2002 Mar;61(3):882-888. doi:10.1046/j.1523-1755.2002.00237.x.
    16. Zhao M, Zhou J, Chen YH, Yuan L, Yuan MM, Zhang XQ, et al. Folic acid promotes wound healing in diabetic mice by suppression of oxidative stress. J Nutr Sci Vitaminol (Tokyo). 2018;64(1):26‐33. doi:10.3177/jnsv.64.26.
    17. Boykin JV Jr, Hoke GD, Driscoll CR, Dharmaraj BS. High-dose folic acid and its effect on early stage diabetic foot ulcer wound healing. Wound Repair Regen. 2020;28(4):517-525. doi:10.1111/wrr.12804.
    18. Scaglione F, Panzavolta G. Folate, folic acid and 5-methyltetrahydrofolate are not the same thing. Xenobiotica. 2014 May;44(5):480-488. doi:10.3109/00498254.2013.845705.
    19. Ulrich CM, Potter JD. Folate supplementation: too much of a good thing? Cancer Epidemiol Biomarkers Prev. 2006;15(2):189-193. doi:10.1158/1055-9965.EPI-152CO.
    20. Troen AM, Mitchell B, Sorensen B, et al. Unmetabolized folic acid in plasma is associated with reduced natural killer cell cytotoxicity among postmenopausal women. J Nutr. 2006;136(1):189–194. doi:10.1093/jn/136.1.189.
    21. Sawaengsri H, Wang J, Reginaldo C, Steluti J, Wu D, Meydani SN, et al. High folic acid intake reduces natural killer cell cytotoxicity in aged mice. J Nutr Biochem. 2016;30:102-7. doi:10.1016/j.jnutbio.2015.12.006.
    22. Field MS, Stover PJ. Safety of folic acid. Ann N Y Acad Sci. 2018;1414(1):59‐71. doi:10.1111/nyas.13499.
    23. Ismaili S. IPAS-5MTHFA-583-09. March 15, 2010. Unpublished data. Quatrefolic® Solubility Statement. Daylestown, PA: Gnosis USA, Inc; 2019.
    24. Sahasrabudhe MR, Lakshminarayan Rao MV. Effect of vitamin B12 on the synthesis of protein and nucleic acids in the liver. Nature. 1951 Oct 6;168(4275):605-606. doi:10.1038/168605b0.
    25. Gomes MB, Negrato CA. Alpha-lipoic acid as a pleiotropic compound with potential therapeutic use in diabetes and other chronic diseases. Diabetol Metab Syndr. 2014;6(1):80. doi:10.1186/1758-5996-6-80.
    26. Ziegler D, Nowak H, Kempler P, Vargha P, Low PA. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysis. Diabet Med. 2004;21(2):114‐121. doi:10.1111/j.1464-5491.2004.01109.x.
    27. Wu J, Tang H, Liu Q, Gan D, Zhou M. [Effect of alpha-lipoic acid in inhibiting oxidative stress and promoting diabetic wound healing by suppressing expression of miR-29b in mice]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 Aug 8;30(8):1034-1037. doi:10.7507/1002-1892.20160207.
    28. Alleva R, Nasole E, Di Donato F, Borghi B, Neuzil J, Tomasetti M. Alpha-lipoic acid supplementation inhibits oxidative damage, accelerating chronic wound healing in patients undergoing hyperbaric oxygen therapy. Biochem Biophys Res Commun. 2005 Jul 29;333(2):404-10. doi:10.1016/j.bbrc.2005.05.119.

     

    Author Biography
    Bettina Newman, RDN

    Bettina Newman, RDN (Registered Dietitian Nutritionist), is writer and technical support for PharmaceutiX®, a manufacturer and provider of trusted medical foods for patients with conditions associated with metabolic nutritional impairments. After running her own practice for 20 years, Bettina joined XYMOGEN®, a leading professional-channel nutraceutical company and the parent company of PharmaceutiX. For 17 years at XYMOGEN, Bettina enjoyed her position as project writer and field consultants’ technical support. Her career began in 1973 with nutrition research, teaching, and in-patient nutrition care. Dr. Robert Atkins, Bettina’s mentor from 1974 until his untimely death in 2003, hired Bettina as Chief Nutritionist for his Diet Revolution Centers. She also assisted him with his books and cookbooks as well as planning programs for the Atkins Center. Bettina co-authored Lose Weight the Smart Low-Carb Way and The Rotation Diet Planner software. She has shared her passion for nutrition from the podium at professional and public seminars and on radio and TV. Bettina is an alumna of the State University of New York College at Buffalo and was a founding member of the board of directors of Adipsy, a 501(c)(3) dedicated to providing respites away from the difficulties of cancer.

    Author Biography
    James McGuire, DPM, PT, LPed, FAPWHc

    Professor
    Temple University School of Podiatric Medicine
    Philadelphia, PA

    Director
    Leonard S. Abrams Center for Advanced Wound Healing
    Philadelphia, PA

    Dr. James McGuire is the director of the Leonard S. Abrams Center for Advanced Wound Healing and a Professor Clinician Scholar in the Departments of Podiatric Medicine and Biomechanics at the Temple University School of Podiatric Medicine in Philadelphia.

    Dr. McGuire is a board-certified podiatrist and wound care specialist. His DPM degree is from the former Pennsylvania College of Podiatric Medicine, now part of Temple University. He completed a residency in podiatric surgery at the Maryland Podiatry Residency Program in Baltimore. A fellow and founding member of the American Professional Wound Care Association, and the Academy for Physicians in Wound Healing, he also serves on the board of the Council for Medical Education and Testing. Dr. McGuire is also a licensed physical therapist and pedorthist, and is certified in wound care by the Council for Medical Education and Testing. He is also board certified by both the American Board of Podiatric Surgery and the American Board of Podiatric Medicine.

    Dr. McGuire left 10 years of private practice in Rutland, Vermont, to become a member of the Temple University faculty in 1992. He has more than 30 years of experience in wound management, has published extensively, and has participated in several research trials involving the diabetic foot and wound healing. Dr. McGuire has lectured both nationally and internationally in the areas of wound healing, diabetic foot management, off-loading, and biomechanics of the at-risk foot.

    Author Biography
    Patricia M. O’Connell, BSc, MBA

    Patricia M. O’Connell, BSc, MBA, currently Lead Technical Writer for XYMOGEN/WholeScripts, is a health and wellness executive with 15 years in the food and dietary supplements industry. Starting with a dual degree in biochemistry and environmental biology from Saint Xavier University in Chicago, she has intertwined her knowledge of plant chemistry and mammalian biochemistry with the rigors of manufacturing, quality, and safety. Through the unique lenses of evolution and biochemical interaction, Patricia has honed her ability to identify botanicals, vitamins, and minerals as bioagents and explain their pharmacological effects through technical writing and presentation storytelling. Patricia’s mid-career MBA from Hough Graduate School of Business at the University of Florida has provided her with deeper insight into how to commercialize these bioagents to scale and perfect the message that nutritional intervention works. Patricia’s career has included Coca-Cola, Ball Horticultural Company, Nephron Pharmaceuticals Corporation, Valensa International, Curaleaf, and XYMOGEN/WholeScripts.

    Champions Blog

    The Birth of Podiatric Sports Medicine: The Academy and Now Board Certification

    A number of important figures present and past have made possible the new podiatric sports medicine certification.

    BY KENNETH B. REHM, DPM

    The long-awaited board certification in podiatric sports medicine is now available to all doctors who want a valuable credential allowing them to declare that they are a qualified podiatric specialist in sports medicine. It has been a long and interesting journey involving two unique organizations and a host of talented individuals. Here is the full story… highlighting those whose contributions made it possible.

    The 1970’s brought about the birth of podiatric sports medicine. The impetus for most of the interest in sports medicine by podiatrists back then arose out of the running boom and the development of the American Association of Podiatric Sports Medicine. Doctors George Sheehan, Robert Barnes, George Pagliano, Richard Gilbert and Steven Subotnik brought the role of the podiatrist in sports medicine to national attention.

    The momentum they created has not stopped; and now the field is in full bloom where physicians such as Dr. Jeff Ross merges his expertise in diabetic foot medicine and surgery with biomechanics and sports medicine, culminating in an efficacious bridging of podiatry with collegiate and high-school sports. Dr. Ross served as team podiatric physician for the Baylor University football team and is a consultant for the University of Houston track team, while also playing an active role in high school sports. Adding to his credentials and fueled by his intense love for skiing, his in-depth research defined its biomechanics. His incredible passion was a driving force that propelled podiatric sports medicine to the pinnacle of recognition and the establishment of the highly anticipated board certification by the American Board of Multiple Specialties in Podiatry (ABMSP).

    “Dr. Richard Gilbert, podiatrist to the San Diego Chargers, was a pioneer in the development of the AAPSM.”

    The Trailblazers
    The idea of a board certification in podiatric sports medicine was initially seeded by the esteemed Dr. Richard Gilbert (Figure 1), pioneer in the development of the American Academy of Podiatric Sports Medicine (AAPSM) and podiatrist to the San Diego Chargers. His powerful motivation was to unite the various avenues of podiatric medicine and surgery through an amalgamation of talents vital to forming a complete spectrum of podiatric sports medicine expertise, where trained DPMs could interchange ideas and knowledge with seasoned professionals.
    Arguably, the first podiatric sports medicine celebrity was Dr. Steve Subotnik, an athlete himself who was featured in Runner’s World.

    Figure 1: Richard Gilbert, DPM, The Father of Podiatric Sports Medicine

    Magazine and author of The Running Foot Doctor (Figure 2). Because of his groundbreaking work in surgery, biomechanics and sports medicine, Dr. Subotnik was possibly the single most influential force in putting podiatry on the map. He cut his “sports medicine teeth” as a professor at the California College of Podiatric Medicine where he taught surgery and biomechanics. This period of his 50-plus year career was especially gratifying to him, particularly when established doctors, who were students of his in those fledgling years, came up to him at meetings and told him what an impact he had on their career.

    Dr Subotnik’s sports medicine career rocketed when he became a marathon runner, and his intense involvement and resulting contributions brought the podiatry profession new recognition and acceptance. His notable cabal included health-related celebrities such as Dr. George Sheehan, a cardiologist who became the legendary philosopher of the recreational running movement in the 1970’s and 1980’s.

    For years, Dr.Subotnik, one of the founding fathers of the American Academy of Podiatric Sports Medicine, felt that board certification in podiatric sports medicine would take this specialty to the next level, as it separates the spectators from the players. His commitment to board certification was key to the formation of the new certification by The ABMSP. Dr. Subotnik states: “Sports medicine helps define modern podiatry because biomechanics is the defining factor in podiatry and is also an integral part of sports medicine. The podiatric practice of sports medicine is so important, now more than ever, because it will continue to keep podiatry on the map; because through biomechanics we can make a real difference.” He goes on to say, “Once you’re an athlete who sustains a foot injury, and being active is part of your life, you will seek the help of a sports medicine podiatrist at any cost, regardless of any bureaucratic or insurance limitations.”
    His driving philosophy summarizes the importance of the foot and its biomechanics: “Controlling the feet controls the rest of the body”, which is philosophically apropos coming from this champion podiatric sports physician.

    “Arguably, the first podiatric sports medicine celebrity was Dr. Steve Subotnik, an athlete himself.”

    The Protégés
    From these trailblazers came their protégés who turned out to be the innovative architects of modern podiatric sports medicine. A key figure is Dr. Tim Dutra, who has advanced the traditional teachings as well as integrated this established doctrine with up-to-date sophisticated computerized gait and motion lab analysis of the athlete. His position as an assistant professor and clinical investigator at Samuel Merritt University allows him to parlay his knowledge of biomechanics and sports medicine into skillfully watermarked ideas and principles commendably driven into his students’ psyche. His uncompromising enthusiasm for improving the podiatric health of athletes is demonstrated through his tireless engagement in the Special Olympics, consulting for the Golden State Warriors basketball team as well as working with the University of California, Berkeley as a consultant for inter-collegiate sports. He has been active with the AAPSM since he started the student chapter while at the California College of Podiatric Medicine. What Dr. Dutra brings to sports medicine is merging the podiatry profession with the community; to memorialize the podiatrist’s vast training, knowledge and experience and to encourage the sporting community to take advantage of this valuable resource.

    Figure 2: What started it all: Dr. Steve Subotnik and The Running Foot Doctor

    Dr. Jeff Ross, president of the Texas Podiatric Medical Association and an associate professor of surgery in the division of vascular surgery and endovascular therapy, as well as a clinical associate professor in the department of medicine at Baylor College of Medicine, brings to sports medicine a whole new perspective. He not only served as president of the AAPSM but also co-chaired the Governor’s Council on Physical Fitness, served for 12 years as a member of the Texas Department of State Health Services Council and was an esteemed member of the Texas Diabetes Council. His credentials sanction him as a national and international expert in sports medicine, biomechanics, wound healing and limb preservation. Dr. Ross’s unique contribution, therefore, is being able to fuse the disciplines and surgical principles of diabetic foot medicine with sports medicine, as there are pathways common to both that are brought to light through his extensive lecturing and vast publications. Dr. Ross, inspiring to all, is a valued and motivated partner in the creation of the new certification.


    AAPSM and ABMSP

    This new board certification could not have happened without the genius of Stephen B. Permison, M.D., who serves as president of Standards Based Programs, Inc. (SBP Inc.), director of the ABMSP Standards Development Organization (www.abmsp-sdo.com) and a voting member of multiple professional boards. SBP Inc. has developed and is currently developing standards, credentialing and certification programs for private industry, medical professional boards and the U.S. Government. Professional credentials, such as the ABMSP certification in sports medicine for podiatrists, assures the public that certified professionals have the proper skills to practice their designated professions with consistent medical outcomes. These intensely scrutinized policies bestow a hand of trust, allowing the public to expect quality and consistency in both in the practice of podiatric sports medicine and any products or devices that support this discipline. Dr. Permison states that “the definition of professional is quality, consistency and integrity”, exactly what his expertise imprinted into the structure of the new board certification.

    “Dr. Earl Horowitz’s focus on the geriatric patient contributed powerfully to the unique quality of this new board certification.”

    Dr. Victor Quijano is Chief of Podiatric Medicine and Surgery at the Veterans Administration Medical Center in Portland, Oregon. His Ph.D. and his knowledge of molecular endocrinology boosts his pursuit of comprehensiveness in the practice of podiatric sports medicine beyond the treatment of the traditional athlete. He calls for more academic and clinical inclusiveness in the discipline of podiatric sports medicine to embrace those challenges that deal with diabetes and other metabolic disorders, as well as those conditions that affect our country’s veterans. His was a needed voice in the development of this quality certification.

    Dr. Earl Horowitz (Figure 3) is the president of the ABMSP and most recently became one of the first podiatrists in the United States to become board certified in Geriatric Podiatry. Dr. Horowitz is a true visionary with a passion for the health of the senior population. Preventing the geriatric patient from developing unnecessary muscle weakness, inactivity and immobility, through sports, exercise and precaution is what fuels Dr. Horowitz’s zeal for the field of podiatric sports medicine. “Maintaining foot health, balance and strength as we age are essential considerations in preventing such things as falls, which often starts a downhill spiral that can even lead to death in an elderly person. This can all be prevented by seriously addressing this part of our practice.” His focus on the geriatric patient contributed powerfully to the unique quality of this new board certification.

    Figure 3: Earl Horowitz DPM, A True Visionary, President of American Board of Multiple Specialties in Podiatry

    Rita Yates, executive director of the American Academy of Podiatric Sports Medicine worked hand in hand with the Executive Director of the American Board of Multiple Specialties in Podiatry, Joan Campbell, to formulate a meaningful advancement from Fellow of AAPSM to Board Certification by ABMSP. This was done in collaboration with the formative team which, in addition to those already discussed, also included the following doctors whose contributions were invaluable: David Jenkins, D.P.M; Diane Mitchell-Prey, D.P.M; Doug Taylor, D.P.M; Richard Blake, D.P.M; and Steven Tager, D.P.M.

    To summarize, world-class talent representing a wide range of expertise, each having intense passion for their individual niche, brought this board certification to fruition. The intended and expected outcome is to support the highest level of practice in sports medicine for the modern podiatrist; and to secure the optimum level of care for their patients. This bright light will undoubtedly ensure a brilliant future for the unabridged formidable field of podiatric medicine and surgery.

    In conclusion, podiatric sports medicine defines the future of podiatry because it’s an area where committed athletes are committed to staying in the game no matter what; and there is no better place to get help for those with sports-related problems of the lower extremity than a podiatric physician and surgeon who is board certified in podiatric sports medicine.