Podiatric Health
Section Newsletter
Fall 2005


Our fall edition offers history, current events and heartfelt emotions. I thank all our contributors for their timeliness. A special note of appreciation to Chih Yen, DPM, who found her computer "fried" and first article missing due to after effects of a Florida hurricane.

Information pertaining to the New Annual Meeting Dates:

As announced, the APHA Annual Meeting will be in Philadelphia, Dec. 10-14, 2005. The APHA Web site is being updated as new information becomes available. Please visit <http://www.apha.org/meetings/new_orleans_update.htm> for details.

With the change of venues and times for the APHA Annual Meeting, a second fall Newsletter may be considered to update all Section members as to Philadelphia happenings. The relocation of this meeting has several positives for our section. First, Philly is a bit more accessible and additional members have expressed intent that they will be attending. Discounted rates have been extended through November for members who previously had not registered. Housing details are being worked on. Second, our Section will be planning to host a program for Temple podiatry students to further our goal of increasing student involvement in public health. I would ask members who plan on attending the December meeting to RSVP their attendence to me. That way, our plans can include you!

APHA has been working to connect members with opportunities for taking direct action in responding to the hurricane and providing links on how to contribute. Please visit <http://www.apha.org/preparedness/Katrina_relief.htm> for the latest information and opportunities. The Association has offered its assistance to federal officials and provided technical resources in the form of relevant APHA publications to relief teams and others. Text from our Public Health Management of Disasters, 2nd Edition, is now available on the above Web page

Information regarding our New Orleans Partners:

APHA has contacted our New Orleans-based partners and is happy to report that the Association will be contracting with several of them for the meeting in Philadelphia. This includes the child-care provider, official photographer, florist and security vendor, who are all based in New Orleans.

Each year APHA designates a local charity from our host city to receive contributions from Annual Meeting attendees. This year's New Orleans-based charity is Bridge House, a long-term alcoholism and drug addiction treatment center. Bridge House will receive all contributions received to date. Since the hurricane has had widespread damage across the entire Gulf Coast, we're planning to broaden the reach of our contributions and are now coordinating donations during the time of our Annual Meeting on behalf of APHA to assist in the recovery and rebuilding efforts. APHA has made a lead contribution of $5,000 and will ask Annual Meeting attendees to join us in contributing what they can.


My original plan for this edition of my message was to speak to each of you about how public health fits into our podiatric life. It is my sincere belief that we all have vested interest in keeping public health at the forefront of podiatric medicine and podiatric medicine at the forefront of public health. Many who are active in their practices may not realize that what they do every day impacts the public health of their patients. Keeping people walking and moving is one of the most basic ways to combat obesity in all age groups. That’s what we do. Fighting the loneliness and isolation of the elderly and disabled by providing home visits is also what we do. Working as a team to educate and treat patients with chronic diseases such as diabetes mellitus and arthritis to save limbs and relieve suffering -- that’s what we do. Fully participating in special populations such as Veterans’, HIV/AIDS patients, poor and rural areas -- that’s what we do. Addressing global health problems such as clubfoot and other orthopedic conditions where lack of ambulation can sentence one to a lifetime of social dependency -- well, that’s what we do.

Each podiatrist who has a special interest in solving the problems of patients wherever they may be found has a home in the Podiatric Health Section of the American Public Health Association. This home is where you can bring your creativity, energy and concern to bear on our professional problems along with the resources of an entire cadre of like-minded professionals. Why is it so hard to recruit new members?

The podiatric role within a larger picture of the health arena is evident in so many areas that one needs to only look at the role of podiatrists in the latest crisis to see that we still have much work to do. APMA has taken a leading role in aiding our colleagues affected by hurricane Katrina. Jobs are being found, and efforts are being made to help wherever we can. THAT’S WHAT WE DO. Unlike the response at Ground Zero in New York, which was established with the leadership of the NYCPM, there has been no clear-cut role for podiatrists in the aftermath of the flooding of New Orleans and destruction of much of the Gulf Coast. Barry University students have experience in responding to local needs in previous hurricanes, but this has not translated into a defined role and response on a national basis.

While thousands are homeless, I want each of you to find your way home to this effort and this organization. We need you today to change the face of public health to reflect the reality and talents of today’s podiatrists. Please come to Philadelphia to further WHAT WE CAN DO.


The evolution of the Podiatric Health Section of the American Public Health Association began in the 1950s, when two members of the profession, Marvin W. Shapiro, DPM, and the late Abe Rubin, DPM, joined APHA. Shapiro believed that podiatric medicine's greatest contribution could come in the field of public health, and he recognized the potential for that by urging the integration of the profession within APHA. He initiated his plan by exhibiting at APHA annual meetings, a practice that continues today. He sought to demonstrate the wide range of foot problems and the services offered by podiatric physicians to not only treat these problems, but also to prevent many of the complications associated with them. Shapiro's perseverance resulted in his being awarded fellowship status in APHA, the first podiatric physician to be so honored.

Continuing with Shapiro's projected goal, the American Podiatry Association, which became the American Podiatric Medical Association (APMA) in 1984, established a series of committees in the 1960s that had public health issues as their focus, including committees on podogeriatrics, podopediatrics, and health mobilization for civil defense.

In 1962, the Public Health Service funded the first podiatric project in Philadelphia, called "Keep Them Walking.” The program was designed to provide education and information for the older patient. The data from this three-year study later would furnish the documentation for podiatric medicine's eventual inclusion in Medicare. During the following year, the APA developed an exhibit for the APHA meeting in Kansas City called "Keep Them Walking.” This was a cooperative effort involving APHA, the Philadelphia Department of Public Health, and St. Luke's and Children's Medical Center. Eugene Gillis, health commissioner; Norman Ingraham, deputy health commissioner; Catherine B. Hess, chief of chronic diseases; and James C. Giuffre, medical director, lent their support to the project.

Several members of the Public Health Service -- especially Austin B. Chinn, Donald Conwell, and Glen W. McDonald -- recognized the importance of foot health for the older patient and helped the podiatric profession gain visibility for the project. Arthur E. Helfand, DPM, became the second podiatric fellow of APHA in 1963, an honor that resulted from his "Keep Them Walking" project.

In 1970, APMA established a Council on Public Health, which brought all of the APMA-related committees under one umbrella, fostering a coordinated public health policy and a mechanism for pursuing APHA section status for the profession.

John R. Carson joined the APMA staff in 1969 and had public health as one of his primary responsibilities. With the support of Executive Director Seward P. Nyman, DPM, APMA invested its talent to bring its message to the public health community. When the records are written, John R. Carson's dedication and integrity will clearly surface and show that he was the catalyst that brought about the relationships that were to follow.

APMA expanded its efforts to include not only an exhibit, but also scientific programs at APHA meetings. Additionally, APMA sponsored receptions honoring APHA's leadership at annual meetings in Houston and Minneapolis. Many past APMA presidents were just a few of the leaders who lent their active support for an APHA section as a high priority issue for the profession.

In 1972, at the 100th APHA Annual Meeting, the association’s governing council created the Podiatric Health Section. What is important to note is that APMA agreed to provide staff and financial support during the developmental stages of this effort. Helfand was installed as the first Section chairperson. The Section was granted three seats in APHA's Governing Council for the 1973 APHA Annual Meeting, and active podiatric medical participation has remained constant ever since.

Over the years, APHA has adopted many resolutions that have dealt specifically with podiatric medicine. Some treated podiatric medicine's need to participate and be included in all comprehensive health care programs. In 1975, APHA adopted and published the Functional and Educational Qualifications of Podiatrists in Public Health. Chaired by Helfand, this important publication received input from Irvin Kanat, DPM; Darrel Darby, DPM; Clarence Bookbinder, DPM; Jerome Shapiro, DPM; Robert Heil; Richard Baerg, DPM; Dave Rubenstein, DPM; Theodore H. Clarke, DPM; and Gerald A. Gorecki, DPM.

During these early years, the Section boasted a membership of 750 podiatrists, two times greater than today. Hopefully, that level of involvement can be achieved again.

Over the years, APHA has funded two major podiatric projects. The first, from 1974 to 1976, was "Big Foot,” a health education project for elementary school children. The second, which is currently in progress, is the re-casting of the function and educational qualifications document, which will be embraced by APHA as a position paper. No other external organization has opened so many doors for podiatric medicine and made it an equal partner in the development of health policy than has APHA.

A document of the American Public Health Association's Podiatric Health Section, "The Functions and Educational Qualifications for Podiatrists in Public Health,” published in the American Journal of Public Health in 1975, has continued as the official definition and delineation of the profession in the arena of public health.

In 1996, a mini-grant from APHA established a special commission to develop a revised and formal position for the Podiatric Health Section in order to assure quality foot care for the American people through the next decade.

In this time of change, the profession needs a national formal statement that outlines the functions of the doctor of podiatric medicine in the public health sector in order to effectively identify the profession's roles and responsibilities for the future. APHA is the organization to take the lead in this endeavor, as it did in 1975.

The members of the special commission appointed to develop the new report on podiatric medicine and public health are: Arthur E. Helfand, DPM, director; David Arlen, DPM, MPH; Lelia F. Banks, DPM; James R. Black, DPM, MPH, PhD; Kenneth C. Canter, DPM; Gerald A. Gorecki, DPM, MPH; Melvyn Grovit, DPM, MS, CDE; Robert Guytine, DPM; Howard G. Malin, DPM; Katheryn M. Moss, DPM; Jeffrey M. Robbins, DPM; Michael A. Robinson, DPM, MPH; and Marco Rubio-Ardila, DPM, MPH.

Podiatric medical activities in the field of community or public health span many areas of concern. While maintaining the traditional base of primary care as a major delivery function, the podiatric medical practitioner is also involved in education and prevention efforts, as well as newer methods of administration.

The functions of DPMs in public health can generally be divided into six primary categories: preventive, diagnostic and therapeutic care; program administration; program development and consultation; podiatric health education; professional education; and research. The categories are not mutually exclusive, and each is often related to, and dependent on, one or more of the others. For example, research activities include, but are not limited to, the following areas:
  • Methods for the prevention and control of foot and related conditions.

  • The social science and educational aspects of achieving better health for individuals and groups in their community setting.

  • Effective administrative methods and evaluation programs.

In August 1983, the APMA House of Delegates formally approved podiatric public health as a special area of podiatric medical practice. The American Public Health Association had already established its Podiatric Health Section in 1972. The American Board of Podiatric Public Health granted life diplomate emeritus status to all of its existing diplomates on January 31, 1995, certifying all diplomates without any time limitation. Of these diplomates, those who remain continue to serve as the core of the special area of practice.

Podiatric public health embraces the concept of total community involvement and care, which has as its aim the prevention and maintenance of a healthy and ambulatory population. Podiatric public health must now look to the future and to the policies relating to the development of health care. Future objectives and goals for this special area of podiatric medical practice are as follows:

  • Advocating a national, preventive foot health strategy.

  • Ensuring the consideration of podiatric medical concerns in the formation of public health policy.

  • Promoting the importance of foot health and increasing the public's access to foot health prevention and treatment services.

  • Monitoring and communicating foot health needs to the public.

  • Promoting recognition of the need for an effective, equitable, and affordable foot care system for the public.

  • Advising on the organization, delivery and financing of foot care services.

  • Promoting public health policy for the prevention and treatment of foot and related conditions.

  • Developing public policy positions and guidelines for clinical care.

  • Promoting the functions and educational qualifications for podiatric medical physicians in public health.

  • Focusing attention on the pedal and related complications of systemic disease and the educational and preventive measures required to reduce disability.

  • Working to assure podiatric medical care for the elderly and supporting policies for ambulatory care, long-term care, and mobility.

  • Promoting the role of podiatric health in improving health service administration, including cost-benefit and operations research, outcomes measurements, critical pathways, algorithms, and monitoring the organization of health services.

  • Advancing health promotion and education.

  • Promoting the activities related to training public health professionals.

  • Establishing guidelines for podiatric medical care in health care settings.

  • Promoting podiatric medical programs in the field of public health.

The ability of podiatric medicine to participate as an equal partner in the development of the nation's health policy has been earned. Recognition of that need is a solid base for the profession as it moves to the next century.

Conference on Aging Resolution


Whereas, there is a critical need to recognize the public health relationship to the entire fields of gerontology and geriatrics, and

Whereas, the American Public Health Association working through its Task Force on Aging, has appointed a Task Force on Aging to develop a framework to help guide the future of services for the aging, with a special emphasis on prevention, and

Whereas, the content of that plan is as follows:

Scope of Public Health and Aging

Population of interest
All adults aged > 65 years; adults aged < 65 years with chronic illnesses and disabilities.

Population diversity must be adequately documented and considered based on:

• Ethnic identification
• Socioeconomic status
• Age, particularly adults aged 75-84 years and those aged > 85 years

Orientation to health and disease

Place strong emphasis on healthy aging by maximizing health promotion, disease prevention, and injury risk reduction initiatives at individual, community, state, and national levels.

Encourage initiatives and solutions that recognize the scarcity of public funds, but also strongly advocate to creatively maximize access to health and supportive services according to need in the least restrictive environment.

Encourage the development and maintenance of strong familial and/or friendship networks.

Promote the value of intergenerational programs to expand social networks.

Infectious disease prevention and control:

  • Encourage prevention and timely detection of influenza, pneumonia, and human immunodeficiency virus.

Chronic disease and injury prevention and control:

  • Encourage use of all chronic disease screening procedures insured by Medicare.

  • Encourage appropriate assessment for risks of falling.

  • Minimize incidence of adverse drug events due to polypharmacy.

  • Encourage appropriate and indicated use of vision, hearing, dental, and podiatric care services.

  • Encourage adoption of exercise regimens and smoking cessation. Encourage proper nutritional habits and adequate fluid intake.

  • Promote awareness of the potential health risks associated with excess alcohol consumption and self- medication.

Tertiary prevention to improve or prevent further decline in function due to acute illness, chronic illness, or injury:

  • Maximize availability of rehabilitation therapy services, including gait, balance, and strength training.

  • Maximize availability of mental health services.

  • Promote recovery to resume prior activities and maximize quality of life.

  • Terminal illness care:

    • Maximize access to palliative care to assure death with dignity.

    • Increase involvement of public health organizations in end of life care initiatives.

    Community orientation

    Encourage uniform surveillance methods to monitor and report trends in acute and chronic diseases and injuries at state and local levels.

    Promote partnerships among public health departments, Area Agencies on Aging, State Units on Aging, and disease-specific voluntary organizations in carrying out health promotion, disease prevention, and injury risk reduction programs.

    Maximize availability of alternative living arrangements.

    Promote awareness of the critical role played by family, neighbors, and friends (i.e., informal caregivers).

    Enhance efforts to educate informal caregivers about chronic disease management and available community resources to promote their own health and well-being.

    Population-based interventions

    Encourage replication or adaptation of Abest practices@ aimed at health promotion, disease prevention, and injury risk reduction.

    Encourage intergenerational social and recreational activities.

    Promote public policies for chronic care oriented toward consumer choice and service delivery in home and community-based settings.

    Encourage expansion and adaptation of existing service delivery models that pool diverse public and private funding sources to serve chronically ill adults living at home but at risk for nursing home admission (e.g., Program of All Inclusive Care to the Elderly, or PACE).

    Encourage adoption of evidence-based interventions to minimize the incidence of elder abuse and neglect.

    Environmental issues

    Maximize opportunities for repairing and retrofitting private residences to promote aging in place at home.

    Maximize protection of the nation=s food supply.

    Encourage development of transportation and mobility alternatives.

    Regulation, consumer protection, and access to services
    Simplify eligibility and application procedures to maximize access to publicly financed health and social services.

    Improve opportunities for consumers with literacy limitations to learn about services.

    Ensure physical access to all available health and long term care services.

    Empower consumers to communicate more routinely with their health care providers about diagnosis and treatment options.

    Maximize safety and quality of care in supervised living environments.

    Maximize financial access to, and awareness of quality of, privately financed living arrangements and supplemental health/long-term care insurance products.

    Encourage evaluation of Medicare benefits to reorient focus on healthy aging and maximization of independence rather than to disease treatment.

    Encourage vigorous investigation of elder abuse and neglect complaints, and strict enforcement of regulations protecting older adults from abuse and neglect.

    Health care workforce

    Promote education and training initiatives to increase the supply of health care professionals and paraprofessionals with proven expertise in geriatrics and long term care practices and policies.

    Promote education and training initiatives to increase the supply of administrative personnel with proven expertise in geriatrics and long term care settings.

    Encourage all Schools of Public Health and Masters of Public Health programs to expand curricula to maximize opportunities in aging and public health careers.

    Strongly encourage existing health care providers to be proactive in explaining benefits under the Medicare program.


    Promote research efforts with funding from public sector and private sector sources to continue building scientific evidence about:

    • Promising public health interventions that could improve health status and quality of life.

    • Quality of care in existing health care services and service coordination programs.

    • Encourage the development and dissemination of state of the art approaches to measure the processes and outcomes of new interventions and existing services.

      Therefore Be It Resolved, that the 2005 White House on Aging adopt THE SCOPE OF PUBLIC HEALTH AND AGING as a working document to plan for the future needs of aging in the United States.

APMA Resolution 11-05

APMA's House of Delegates in April 2005 passed Resolution 11-05
supporting APHA's endorsement of the 2005 White House Conference on Aging.

WHEREAS, The American Public Health Association will submit to the 2005 White House Conference on Aging a resolution that focuses attention on a framework entitled "A Scope of Public Health and Aging" to articulate a plan for promoting, encouraging, and enhancing services, programs, and education for elderly Americans (see attached resolution); and

WHEREAS, The APMA Public Health Committee has approved an endorsement of this resolution;

RESOLVED, That the American Podiatric Medical Association endorse the “Scope of Public Health and Aging” resolution to be submitted by the American Public Health Association to the 2005 White House Conference on Aging.

APMA notified the APHA Task Force on Aging of its support for the APHA resolution, and gave permission for APHA to use this endorsement in any way for the benefit of APHA and its efforts to serve the needs of the aging population through the WHCOA.

Richard H. Fortinsky, co-Chair of the APHA Task Force on Aging,responded:

On behalf of the APHA Task Force on Aging, thanks for the endorsement by the APMA of the WHCOA resolution that evolved from the "Scope of Public Health and Aging," a document written by the Task Force on Aging and approved in 2002 by the APHA Executive Board. APHA staff members are determining how the endorsement process for this resolution will proceed within APHA.


All the APHA policy statements except Late Breakers are on the APHA Web site for review. These will be included in the package given to all Governing Councilors. They will be introduced at the first session of the Governing Council but before being voted on. Tt the Tuesday Governing Council session, there will be public hearings, at which time sections, affiliates and other interested parties will express support, request changes, request withdrawal or defeat of each policy. The hearings will be held during the Annual meeting in Philadelphia.

The policy statements are divided into four groups which will have concurrent hearings. It is important that the Podiatric Health Section comment on these resolutions if we wish to have a seat at the table. Too often we are left out, because we were not there. On some of these policy statements, where they list all of the health professions involved in public health, podiatry is conspicuously absent. In order for the Section to comment on the resolutions, it is necessary for all the members of the Section to read the resolutions and send comments to Pat or to me. These should be discussed by the full Section to decide what action should be taken by the POD section. You can read the policy statements by going to the APHA Web site – then to the members only page, under V. Policies, click on ‘2005 Proposed Policies’. There you will find them listed under four groups:

A. Health Disparities
B. Environmental and Occupational Health
C. Access to Health Care
D. Public Health Science and Infrastructure

Among the issues that may impact podiatry are:

C-2 LB04-6 ‘Responding to Threats to Health Care for Immigrants’.

POD should be able to support this, but we may have some problems with translation services. There should be no objection to requiring hospitals to have these services available, but this becomes odious in a single practitioner office. We may want to request a change.

C-3 LB04-3 ‘Supporting the WHO Global Strategy on Diet and Physical Activity and Health’.

Are there any specific changes we feel should be made to this policy statement?

Please review all the policies under group D for their impact on our Section. We will need four people to present the POD Section’s viewpoint, one at each of the hearings.

Marvin J. Rubin, DPM
Chair: Policy Committee

APHA Section Chair-Elect Meeting

July quickly approached, and it was time for the APHA Section Chair-Elect Meeting in D.C. On the flight down, I couldn’t help wonder who else would be there, what types of individuals they would be, what we would we talk about for a day and a half. I was excited about having the opportunity to make Capitol Hill visits. Having participated in the APMA PPAC march on Capitol Hill several times, this one wouldn’t be as intimidating since I knew what to expect.

The meeting started with a welcome from Joyce Gaufin and Susan Radius. We introduced ourselves and told a little something about our life that would not be common knowledge to just an acquaintance. What an absolutely unbelievably diverse, intelligent group it turned out to be. The accomplishments of the participants were incredible. Everyone held a high position in a major university or organization. Some spoke multiple languages and were well traveled throughout the world. It was an honor to have the occasion to spend this short period of time with these individuals.

There were representatives from several different sections: Gerontological Health; Community Health Planning and Policy Development HIV/AIDS; Population, Family Planning and Reproductive Health; Vision Care; Medical Care; Injury Control and Emergency Health Services; Student Assembly; Food and Nutrition; Alcohol, Tobacco & Other Drugs; Health Administration; and Podiatric Health. The concern for health care could be felt in the room. Every group had its own particular issues with the present system. There were some problems that were common among the various groups. However, there wasn’t a shortage of solutions to these issues. These individuals have contemplated the dilemmas for some time with excellent resolutions.

After a hard day’s work, the group went out for a wonderful dinner. The conversations at dinner were just as interesting as our introductions. Despite the fact that everyone was scholarly and well versed about the world, they still knew how to laugh and joke. There were no stuffed shirts at this table. This is a rare and welcomed combination in my experience.

We finished up Tuesday morning with a few presentations on governance. It was lunch and off to Capitol Hill. I am looking forward to working with these individuals over the next couple of years. What was expected to be just another meeting turned out to be a great day and a half.

Public Health in Our Podiatry Colleges

Public health sounds like something to do with statistics or epidemiology to many people. However, its significance to a subspecialty such as podiatry has much more depth and meaning. As a podiatrist, public health is simply defined as health-related issues that pertain to the field of podiatry. Public health covers a multitudes of areas, from educating the general public regarding the inner workings of podiatry to promoting health awareness in foot care. The profession of podiatry has only about 14,000 podiatrists across the country. Many regions of the United States are without podiatrists, and those individuals that may be afflicted with ailments that are commonly treated by podiatrists are not treated because of their ignorance or hesitance about the field itself. In the American Public Health section of Podiatric Medicine, introducing and prompting the profession of podiatry has always been a priority: however, the focus should not only be to the general public, but also, within the profession itself.

We are proposing a plan to introduce the concept of public health to the podiatry students in podiatric schools through various lectures, and presentations. The profession of podiatry has come a long way, and our knowledge and surgical skills in treating diseases have far advanced. There are many students, clinicians, and faculty involved in research. However, we as a profession will not be advanced as a whole, but individually. If we do not start advocating or promoting our profession to the general public and other health professions, this realm of medicine will simply be regarded as a pseudo-science that succinctly possessed purpose. The goal for teaching public health to the future generation of podiatrists is to instill a sense of responsibility and passion for podiatry as a whole. We, as a profession, must recognize the issue that is plaguing podiatry, and that issue seems to be complacency, a complacency to watch over the shoulders of other podiatrists that have made their contributions for the advancement of the field, instead of having those pioneers stand behind a new generation in awe of their skills.

Podiatric Section Member Updates

Art Helfand, DPM of Narbeth, Pennsylvania, was elected to a two-year position as a member of the Board of Directors of the Philadelphia Corporation for Aging (PCA). PCA is the largest Area Agency an Aging (AAA) in Pennsylvania and the largest nonprofit AAA in the United States. There are 665 AAAs in the United States.

"I am delighted to see podiatry recognized in this fashion," Helfand said. "Given my personal interest in aging and public health during my career, it is wonderful to contribute to a program that has as its primary mission the improvement of the quality of life of citizens who are older and who have disabilities."

Helfand also contributed a chapter on aging for Drs. Levy and Heatherington's Second Edition of their text as well as the chapter on Diseases and Disorders of the Foot for the 6th Edition of the Geriatric Review Syllabus for the American Geriatrics Society. Helfand had also written the chapter and questions for the 5th edition and did the slides for their Web-based teaching presentations. And if that wasn't busy enough, Art completed co-authoring a chapter on the Geriatric Foot with a colleague in Wales whom he had worked with on the 2nd, 3rd. and now 4th. editions.

Philip H. Demp’s paper entitled, "Morphometric Evolution of the Metatarsal Length Pattern: Biomechanical Implications," was presented at the national conference of the Society of Industrial and Applied Mathematics in Orlando, Florida. It has been accepted for publication in the next issue of the International Journal of Podiatric Biomechanics. Demp is adjunct clinical professor at the Temple University School of Podiatric Medicine and Department of Mathematics. This pilot study gives a unique numerical measure to the metatarsal length pattern (configuration of the metatarsal heads) and shows a difference of this measure between the nonhuman primates and healthy modern humans. These findings suggest that those modern humans whose metatarsal length patterns have a measure similar to a nonhuman primate are considered to have an atavistic pattern. This may promote biomechanical inefficiency that could lead to biomechanical pathology. In order to validate this pilot study, Howard Hillstrom, PhD, director of the Motion Analysis Laboratory at the Hospital for Special Surgery in New York City, has put together a research team to pursue a larger research study. He has submitted a formal research proposal to the National Insitutes of Health. Meaningful data will enable the design of more effective conservative and surgical therapies for those patients with pedal pathologies.

DPM's who are Dually Degreed in Public Health

David I. Arlen, DPM, MPH
Houston, TX
University of Texas Hlth. Sci. Ctr., 1979 (MPH)

Richard H. Baerg, DPM, MPH, MS
Las Vegas, NV
University of California at Berkeley, 1971 (MPH)

Barry S. Collet, DPM, MPH
Brockton, MA
Harvard University, 1979 (MPH)

Philip H. Demp, DPM, MS, PhD
Cinnaminson, NJ
Polytechnic University, Brooklyn, 1979 (MS)

James J. DiResta, DPM, MPH
Newburyport, MA
Dartmouth Medical School. 2004 (MPH)

Lloyd Eisenberg, DPM, MPH
Chevy Chase, MD
GWU School of Public Health, 1994 (MPH)

Allan Evangelista, DPM, MPH
Sarasota, FL
Loma Linda University, 1998 (MPH)

Richard B. Feldman, DPM, MHSA
West Haven, CT
University of Michigan Sch. Of Pub. Hlth., 1976 (MHSA

Johnnie B. Felkins, DPM, MPH
Amarillo, TX
University of Illinois Sch. Of Pub. Hlth., 1978 (MPH)

William. D. Fishco, DPM, MS
Phoenix, AZ
Long Island University, 1995 (MS)

Robert G. Frykberg, DPM, MPH
Phoenix, AZ

Gerald A. Gorecki, DPM, MPH
West Haven, CT
University of Pittsburgh, 1972 (MPH)

Drew A. Harris, DPM, MPH
New Brunswick, NJ
Univ. of Medicine & Dentistry NJ, 1999 (MPH)

Elizabeth S. Hawkins, DPM, MPH
Baton Rouge, LA
University of Tennessee at Knoxville, 1976 (MPH)

Richard O. Jones, DPM, MPH
Tacoma, WA
University of Washington, 1990 (MPH)

Lawrence Lavery, DPM, MPH
Temple, TX
University of Texas Hlth. Sci. Center, 1992 (MPH)

Leonard A. Levy, DPM, MPH
Ft. Lauderdale, FL
Columbia University Sch. Of Public Health, 1967 (MPH)

Loretta Logan, DPM, MPH
Bronx, NY
Hunter College School of Hlth. Sciences, 1995 (MPH)

Victor S. Marks, DPM, MPH
White Plains, NY
New York medical College, 1998 (MPH)

Catherine A. Page, DPM, MPH
University of Illinois at Chicago, 1991 (MPH)

Richard B. Patterson, DPM, MSPH
Bridgeport, WVa
University of Missouri at Columbia, 1980 (MSPH)

Mark Rothstein, DPM, MPH
Phoenix, AZ
Univ. of Illinois Medical Center Sch of Pub Hlth (1983)

Marco A. Rubio-Ardila, DPM, MPH
Brownsville, TX
University of Texas Hlth Sci Ctr (San Antonio)

Lily Shimahara, DPM
Parker, AZ
University of California at LA, MSHS (2005)
University of California at LA, MPH (2006)

Nicholas Sol, DPM. MBA
Colorado Springs, CO
University of Colorado-Denver, 2004 (MBA)

Scott M. Solier, DPM, MSPH
Salt Lake City, UT
University of Utah,1981 (MSPH)

Patris Toney, DPM, MPH
Des Moines, IA
Des Moines University, 2004 (MPH)

John V. Tran, DPM, MPH
Brandon, FL
New York Medical College, 2002 (MPH)

Jacqueline Truong, MPH
Chicago, IL
Columbia University School of Public Health, 2002 (MPH)
Student, Scholl College, 2006 (DPM)

Nsima Usen, DPM, MPH
Dearborn Hts., MI
Temple University, 2002 (MPH)

John Waddell, DPM, MPH
Lorain, Ohio
Case Western Reserve University, (MPH)

Marvin Waldman, DPM, MPH, MS
Detroit, MI
University of Illinois Sch. of Pub. Hlth, 1981 (MPH)
University of Michigan Sch of Pub. Hlth., 1986 (MS)

James Wrobel, DPM, MS
White River Junction, VT
Dartmouth College, 1996 (MS)

Michael Zapf, DPM, MPH
Agoura Hills, CA
UCLA, 1972 (MPH)

APMA's Public Health Campaign

Go Ahead, Knock Your Socks Off!

Reflexes, blood pressure, eyesight and respiration — all are commonly checked during an annual physical exam. But frequently overlooked during checkups is what many call “the mirror of your health” — the feet.

The human foot often is the first to show initial signs of severe medical conditions, such as diabetes. That’s why the American Podiatric Medical Association’s "Knock Your Socks Off" campaign urges those at risk for diabetes to ask for foot exams during their regular checkups.

Unfortunately, many Americans — nearly 5.2 million, according to the Centers for Disease Control and Prevention — don’t recognize the disease’s early warning signs, which usually occur in the feet. When it’s too late, the consequences often are severe: heart disease, stroke, high blood pressure, blindness, kidney disease and even amputation. In fact, diabetes is the leading cause of non-traumatic foot amputations each year. The good news: there are ways to detect diabetes at its onset, before it does further damage.

“Early detection is paramount, and something as simple as taking your shoes and socks off for a foot screening could assist in diagnosis of diabetes earlier,” said APMA President Harold Glickman. In fact, annual foot screenings could reduce diabetic foot amputations by as much as 85 percent, according to APMA. Knowing foot-related diabetes warning signs also is vital in early detection. Alert a family physician or podiatrist to these signs:

  • Redness

  • Numbness

  • Swelling

  • Decrease in blood circulation to the feet

  • Inflammation

  • Noticeable changes to the feet

For more information about APMA’s “Knock Your Socks Off” campaign, log on to <www.apma.org/diabetes>.


Podiatry has always dealt with prevention. Secondary prevention is early detection of impeding disabilities and a treatment program to prevent, slow the development and/or lessen the severity of the disability. Tertiary prevention deals with minimizing the effects of the disability and by increasing the ability to function at maximum capability with the disability.

Public Health is that science that deals with the health of populations as defined by C.E.A. Winslow over a century ago, “the science and art of preventing disease, prolonging life and promoting physical and mental health --- through organized community efforts --- and the development of social machinery which will ensure every individual in the community a standard of living adequate to health.” How do we differentiate public health from clinical health? In its simplest form, public health deals with the health of the community (population based programs), while clinical health deals with the health of an individual. Certainly there is a great deal of overlap. The health department that operates a clinic is providing clinical health to the individual patient, while the physician who treats a patient whose health will impact the community is practicing public health by preventing that individual’s health from having adverse effects on the health of the population.

Public health has long recognized podiatry’s roll in tertiary prevention in the geriatric population but has not looked upon developmental disabilities of the lower extremity as a public health problem. Public health has tended, except in the case of gross deformity, to look at the lack of physical activity as laziness (couch potato), lack of suitable environment or time (note APHA resolutions 9709, 200113 and LB04-3). The Canadian Centre for Policy Alternatives in their May 2004 publication ‘Making Early Childhood Development a Priority: Lessons From Vancouver’ by Clyde Hertzman stresses that the early child development affects health, well-being and competence for the entire lifetime. The early developments that matter most are the physical, the social/emotional and the cognitive/language. They are concerned that when kindergarten screenings for hearing, vision, and/or dental problems are eliminated as not being central to the mandate of patient care, children's long-term health, well-being and coping skills may be considerably affected. There is no mention of screenings for developmental deformities of the lower extremity.

With the recognition that there is a worldwide epidemic of obesity, exercise and physical activity have become a major concern of public health. The exercises most commonly recommended involve the lower extremities. This makes good sense as the skeletal musculature of the lower extremity is the largest and most powerful in the body. When utilizing only the upper extremity musculature, it becomes very difficult to lift the body weight. However, with the simple act of walking we lift the full body weight with each step. In ‘Canada On The Move,’ Tudor-Locke states “Walking for exercise is consistently the most commonly reported leisure-time physical activity (Centers for Disease Control, 2000; Rafferty, Reeves, McGee & Pivarnik, 2002). According to the Canadian Fitness and Lifestyle Research Institute, “Walking is ranked as the top physical activity in which Canadian adults participated over the three years prior to the survey (65 percent), followed by gardening (41 percent), and home exercise (24 percent)” (CFLRI,2005). Walking is therefore an important leverage point for promotion efforts. Walking is inexpensive and highly accessible, requires little skill or equipment, and is the recommended exercise prescription by physicians, public health professionals and other practitioners.

Multiple clinicians have long understood that there is a high percentage of untreated structural and functional disabilities of the lower extremities in both child and adult populations. These disabilities discourage the individual from engaging in activities that require the use of the lower extremities. This is seen with great clarity in the child. The normal child is extremely active, has to be trained to sit quietly and prefers physical activity. There is a great deal of energy that he must burn off. This becomes part of his normal development process. Children, particularly in the lower grades, when asked what is their favorite class will often respond, recess or physical education. Adults may laugh, but the child is expressing his inborn need for physical activity to remain healthy.

The human foot at birth is mostly cartilage with rudimentary areas of calcification. During this period, treatment is most effective and more likely than at any other period to afford full correction. As the child grows and develops, more of the structure becomes ossified and more resistant to treatment. Giannestras states many of the therapeutic regimens both conservative and surgical which are recommended would be unnecessary if the flat foot deformity were recognized at birth and definitive therapy were immediately instituted. It behooves us ‘to spread the gospel,’ so to speak, to the pediatricians, the generalists and the obstetricians and to educate them to be conscious of these ever-present foot problems. With prompt recognition (rigid flat foot) and with the institution of conservative measures, a large number of these feet could be made normal. He goes on to say, “The past thinking that correction of this deformity is spontaneous as the infant grows is fallacious.” Tachdjian, when discussing metatarsus adductus (which apparently is becoming more common in recent years) states the deformity is present at birth but may go unnoticed for as long as several months to a year. Later, he continues, “that when a diagnosis of congenital metatarsus is made, the infant should be referred for immediate treatment, and it is very unfortunate that often mild deformities are kept under observation by the pediatrician to see whether they will correct themselves spontaneously. During this period of procrastination, the deformity increases and becomes more rigid and progressively more resistant to correction.” If one does not think that these untreated children’s foot problems do not result in painful, poorly functional feet, let him look at the plethora of orthoses -- “pedic” shoes, insoles, arches and other devices available in shoe stores, drug stores and sporting goods stores.

As podiatrists and members of the Podiatric Health Section, it behooves us to stress to the public health community the need for early and frequent screenings for developmental disabilities of the lower extremities. The entire population should be encouraged to be more physically active and participate in activities that promote health and reduce disease, such as walking. This would reduce obesity and lower the rate of diabetes and heart disease. In order to engage the entire population, all newborns should be examined for lower extremity disabilities and treatment plans immediately established. Treatment should be aggressive with the intent of achieving as much complete and permanent correction as possible. In those cases where complete correction is not possible, long range programs should be put into place to allow each individual to function at his maximum capacity. Physical activity should be promoted in both preschool and school age children. Children that have difficulty or seem reluctant to participate should be examined for lower extremity disabilities. All schools should have an active physical education program.

Visiting APHA Headquarters

Section Chair Pat Moore and Section Councilor Janet Simon, April 2005.