The second part of our chilblains double-header focused on these skin manifestations alongside the current global pandemic, specifically the chilblains (ie COVID toes), and what the changing and emerging evidence is telling us (currently). We were joined by Nadia Dembskey, who obtained her Bachelors and Masters degrees from the University of Johannesburg, sits on the Podiatry Association of South Africa National Executive Committee and has just submitted her PhD proposal to investigate this exact phenomena of ‘COVID toes’.
In this episode we were joined by the Podiatrist, Joseph Frenkel. Joseph has 15 years clinical experience, a professional diploma in Dermatology and a Masters degree in Wound Healing & Tissue Repair. In this episode he was kind enough to walk us through everything we need to know about Chilblains, including the pathophysiology, the clinical manifestations, management and (as always) the importance of a history taking, with an emphasis on the key things which may raise the index of suspicion of the lesion in front of you being a Chilblain.
About Joseph Frenkel:
Joseph Frenkel is a podiatrist in Melbourne, Australia having completed both a Bachelor of Podiatry and a Master of Science with a specialty in Wound Healing and Tissue Repair. Joseph has also completed a Professional Diploma of General Dermatology. Joseph has over 15 years clinical experience in all areas of Podiatry and has worked extensively across private practices, aged care facilities and hospitals. His most recent role is Consultant Podiatrist at the Skin Health Institute where he works with a team of Dermatologists to manage complex nail problems. In addition to his clinical work, Joseph Frenklel holds academic positions at several Universities where he provides clinical supervision and part-time lecturing. He also has regular speaking engagements at seminars, workshops and conferences and mentors Podiatry graduates.
In this episode we were joined by Matthew Klein who is a Physical Therapist based in California and is currently studying for his PhD. He runs 70-100 miles per week and has a 5k PB of 14:45 and a marathon PB of 2:32:44. He co-owns the brilliant Doctors of Running website and we spent the hour as three shoe nerds would – just talking shoes! How should we appraise shoes? What features matter (or don’t)? How can we take our improved understanding of shoe design features and apply that pragmatically to the patients/athletes we see in clinic? And what do Craig and legendary basketball coach Phil Jackson have in common? All this and more. Audio Podcast of Episode 79:
Paul Ingraham is a Vancouver science journalist and creator of PainScience.com, a website about the science of pain, injury, treatment, and rehab with about a million monthly readers. In this episode he discussed the reasons people ritualistically stretch (beliefs about flexibility, injury reduction, improving performance etc) and the whether the scientific literature backs them up. He also made reference to certain structures which are biomechanically awkward/impossible to stretch, some of the sensory adaptations/neurology that may be involved, and whether stretching is indeed as beneficial as it society believes it to be.
In this episode we were joined by Richard Blake from his home in San Francisco for a trip down memory lane back to 1981 and the genesis of his inverted orthotic technique. He talks us through the responses he got from Drs Root & Weed when he began inverting devices by 25 degrees or more, the response he got from JAPMA when he submitted his first paper on it, and how by 1983 Dr Root was one of his biggest supporters. Rich stated the most he has ever inverted a device was 70 (seventy) degrees, and also how one of his fresh faced young students by the name of Kevin Kirby was part of the group that helped him at the time.
For this epsiode we assembled a superb panel of paediatric specialists from the UK and Australia. We were joined by Dr Cylie Williams (Associate Professor at Monash University, guest on episode 04), Dr Alicia James (who was on our hugely popular episode 28 talking about her Calcaneal Apophysitis research) and Antoni Caserta (currently completing his PhD in the field of toe walking) from Australia. From the UK we had Nina Davies (Education officer of the Childrens Podiatry Special Advisory Group who covered Paediatric Gait back in episode 38), James Welch (Vice Chair of the Childrens Podiatry Special Advisory Group who joined us as a guest presenter for episode 50) and Matthew Hill (completing his PhD in children’s footwear at the Centre for Biomechanics and Rehabilitation Technologies Staffordshire University). We briefly talked about podopaediatric services during the current global pandemic, online consultations in paediatrics and the early evidence emerging for skin manifestions of the feet associated with COVID-19. We then discussed 3 paediatric cases: A 6 year old idiopathic toe walker, and 18 month old with ‘curly toes’ and a 12 year old with asymptomatic “flat feet” who had been told they needed foot orthoses.
In this episode we were joined by Sports Podiatrist (and 2:14 marathoner) Thomas Do Canto to talk through his approach to taking a thorough history from an injured runner. Given the current global climate it is reasonable to assume there may be an increase in running injury rates: The Running “Coverload” Injury Phenomena – Griffiths (2020). Combine this with more remote/online consultations (where we may have to prioritise the subjective over the objective) and it should become clear why taking a good history from a runner is so important. Thomas talked us through his 4 page form which he sends to all runners for them to fill out before the consultation; and the rationale behind many of the questions on there and how they may really help him formulate a provisional diagnosis and management plan before he has even met the patient.
In this episode we were joined by JFAR editor in chief Professor Keith Rome to be taken on a deep dive of Gout. What is gout, and what important comorbidities should be considered? What is Pseudo-gout? How might it clinically present in acute and chronic contexts? Are blood tests helpful? What theories explain its prevalence in the 1st MTPJ, and should we consider it as a differential of midfoot pain more than we do? Along with a discussion on its management this is an hours revision we’d recommend to clinicians of all levels of experience.
Foot in Diabetes UK (FDUK) have recently developed a COVID-19 Amputation Prevention Pathway with the goal of getting all Podiatrists and lower limb clinicians comfortable and confident calling out the two biggest risks for immediate amputation – severe infection and ischaemia – to help triage skills and knowing when to generate urgent referral requests. We were joined by Mike Edmonds (Consultant Physician and FDUK Honorary President), Martin Fox (Vascular Specialist Podiatrist), Paul Chadwick (Clinical Director of College of Podiatry), Naseer Ahmad (Consultant Vascular Surgeon) and Emma McConnarchie as a Private practitioner representative.
In this episode we were joined in this episode by Kate Atkin (Fellow of Professional Speaking Association, Masters degree in Applied Positive Psychology, PhD candidate studying Imposter Syndrome and World Debating Champion – thoughts and prayers for Kate’s husband!!) She is also the Author of the book “The Presentation Workout”. She took us through the journey of a good presentation, from preparing both the presentation (with tips for how slides should look) and yourself (mentally), delivering the talk with a strong and powerful opening and conclusion, why you should NEVER apologise during a talk, and how to handle difficult questions. Hope you enjoy.
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