Podiatric medical resources on the Internet

Abstract

The authors discuss Internet sites that provide information on podiatric medicine relevant to practitioners and students. Before going online, the podiatric health professional should be aware that the information located at these sites may vary in quality, reliability, and level of sophistication. A brief introduction to the history of the Internet is presented, along with useful sites and general medical resources.

The authors discuss the many sites on the Internet that provide information on podiatric medicine relevant to practitioners or students. Before going online, the podiatric health professional should be aware that the information located on the Internet may vary in quality, reliability, and level of sophistication. For this reason, the podiatric health provider or student should filter all information, evaluating all data received and verifying new information with appropriate medical texts, peer-reviewed journal articles, or consultation with experts in the field.

The authors assume that readers have a basic working knowledge of computers and the Internet, although readers unfamiliar with one or more of the technical aspects will be able to appreciate the value of the sites that are presented. For those professionals who are not currently online, perhaps this article will spark interest in acquiring the necessary skills and equipment in order to become an Internet user.

To facilitate finding information, there are host computers that serve as repositories of information, which are called search engines. Some of the more popular search engines are AltaVista^®, Excite^®, InfoSeek^®, Lycos^®, Webcrawler^®, and Yahoo^® (

Table 1. Web Search Engines. 

Search Engine	Uniform Resource Locator Address
AltaVista	http://www.altavista.digital.com/
Excite	http://www.excite.com/
InfoSeek	http://guide.infoseek.com/Home?pg=Home.html&sv=IS&lk=noframes
Lycos	http://lycos.cs.cmu.edu/
Webcrawler	http://www.webcrawler.com
Yahoo	http://www.yahoo.com

). The list of sites that include information on podiatric medicine is included in

Table 2. Podiatric Sites on the Web. 

Name of Site	Uniform Resource Locator Address
3-D Foot and Ankle	http://rpisun1.mda.uth.tmc.edu/se/anatomy/cine/ankle/
A Foot Talk Place on the ’Net	http://www.foottalk.com/
American Podiatric Medical Association	http://www.apma.org/
California College of Podiatric Medicine	http://www.ccpm.edu/
California College of Podiatric Medicine-CME	http://www.footandankle.com/ccpm/cme/
CataList	http://www.lsoft.com/lists/listref.html
Center for Podiatric Information	http://www.infowest.com/podiatry/
Clinical Gait Analysis	http://www.curtin.edu.au/curtin/dept/physio/pt/staff/kirtley/cga/
Dr. Pribut’s Running Injuries Page	http://www.clark.net/pub/pribut/spsport.html
E-mail Discussion Groups	http://www.nova.edu/Inter-Links/listserv.html
Foot and Ankle Link Library	http://www.footandankle.com/podmed/
Foot and Ankle Web Index	http://www.footandankle.com/
Foot Web - Your Foot Treatment Information Resource	http://www.footweb.com/
HyperDOC: National Library of Medicine	http://www.nlm.nih.gov/
Mailbase Hypermail Archive	http://www.mailbase.ac.uk/lists-p-t/podiatry/
Medical Matrix	http://www.slackinc.com/MATRIX/index.html
MedWeb Podiatry	http://www.gen.emory.edu/MEDWEB/keyword/Podiatry.html
Podiatric Medical Education Network	http://www.podiatry.org/podiatry.html
Podiatric Residency Exchange	http://www.res-exchange.com/index.html
Podiatry FAQ	http://www.slip.net/~soredawg/podfaq.txt
Podiatry Home Page (University of Huddersfield)	http://www.hud.ac.uk/schools/human+health/podiatry/homepage/podiatry.html
Podiatry Management	http://www.podiatrymanagement.com
Podiatry Online	http://207.158.247.38/footman/pdonline.html
Podiatry Online Clinical NetForum	http://www.smartfoot.com/footman/index.htm
Podiatry Quick Reference	http://pages.ripco.com:8080/%7Ehaddon/index.html
Search the List of Lists	http://catalog.com/vivian/interest-group-search.html
Virtual Medical Center — Martindale’s Health Science Guide	http://www-sci.lib.uci.edu/HSG/Medical.html#MCTM
Virtual Seminars	http://medicaledu.com/welcome.htm
WWW Virtual Library: Biosciences: Medicine	http://www.ohsu.edu/cliniweb/wwwvl/

.

Overview

The Internet, a vast network of interconnected computers, has grown tremendously since its inception. A survey in July 1996 estimated that 12,881,000 computers are connected to the Internet, which is believed to be doubling in size every 12 to 15 months. For example, the Internet survey conducted in July 1995 showed a connection of 6,642,000 computers, which has almost doubled within 1 year [1]. The World Wide Web (the Web) is a subset of the Internet that supports multimedia. The Web has had exponential growth [2]. It has been estimated that approximately 7.7% of the adult population in the US currently use the Web [3,4].

The idea of an Internet began in the early 1960s, during the Cold War [5,6]. Fearing the possible consequences of a nuclear strike, the US Department of Defense funded research through private companies to build a computer network for facilitating military strategic communication.

In the late 1960s, the Pentagon’s Advanced Research Projects Agency funded a larger and more ambitious project. Supercomputers were to be connected on the network for national research and development projects so scientists and researchers could work together and share information. The Advanced Research Projects Agency Network (ARPANET) was then created with four interconnected computers. By 1983, there were approximately 600 computers connected and by 1989, there were 80,000 [6]. As stated above, the July 1996 estimate is about 12.9 million [1].

Currently, different types of computers can be connected to the Internet network. This is made possible by the standardization of the way data are sent and received. The standard for communication is called Transmission Control Protocol/Internet Protocol (TCP/IP) [5]. Transmission Control Protocol converts messages into standard signals at the sending site and then reassembles them back into meaningful messages at the destination site. Internet Protocol handles the addressing, making sure that the signals are correctly routed to the destination. It was the establishment of the TCP/IP protocol that allowed the Internet to grow at such a tremendous rate.

The Internet’s growth is largely a consequence of its extremely powerful capabilities. Spanning more than 100 countries, the Internet allows a user to correspond with colleagues from all over the world, have meetings through video-conferencing, read professional journals, send electronic photographs to relatives, chat with friends and family, review weather reports from around the globe, and shop for goods and services [7].

These features are accomplished by using many of the Internet features, which include electronic mail (e-mail), Usenet news, file transfer protocol (FTP), telnet, gopher, and the Web [8–19].

The Internet is a powerful tool that is of much potential benefit to users in any medical field. There are many companies that offer Internet service to the general public. There is usually a fee to use their services, depending on the user’s needs. Some of the major US companies are America Online^®, Netcom^®, and Prodigy^®. Physicians Online^® is an Internet provider for physicians and students. Free services include e-mail, MEDLINE^® searches, discussion channels such as “H. Pylori Discussion,” pharmacology references, and others.

Internet Resource Location

Although many techniques are available for locating information on the Internet, one of the quickest and easiest methods is to use the various Web search engines (Table 1) [10]. Each of these search facilities will enable an information seeker to enter one or more key words. After entering these terms, either a listing of sites containing those keywords appears or an indication that no such sites could be located appears. Many search engines offer the option of requesting summaries of the retrieved information. It is the authors’ experience that although some duplication of sites will occur when different search engines are selected for an identical keyword query, it is not unusual to find that each engine will contribute at least one or more unique Web locations. A comprehensive search should therefore include the use of as many search engines as possible.

Since each facility works slightly differently, visit the home pages of the different search engines, browse through examples, and read the help information that is available. Search for complete phrases such as “podiatry online” while doing a search by enclosing the phrase in parentheses. The sites that allow phrase searching using parentheses are Webcrawler, Excite, AltaVista, and InfoSeek. Webcrawler, AltaVista, and Excite allow the use of Boolean searches using “AND,” “OR,” and “NOT.” Other sites use special symbols such as a “+” before a word to require that specific word and any additional words proceeded by a “+” symbol are present in the retrieved document, accomplishing the same effect as the Boolean “AND” operator. Truncation of words is allowed by some sites such as Lycos, which can be a useful and time-saving feature. An example is typing “podiatr$” and expecting to find the words podiatry, podiatrist, podiatrists, and podiatric. AltaVista allows the same search using “podiatr*” as the proper form for truncation. Yahoo has a special search “options” feature that allows the choice of considering a single group of letters to be either a whole word or a word fragment. This is accomplished by choosing either “complete words” or “substrings” respectively from the special “options” search menu. This “substring” feature is similar in effect to performing a search using word truncation.

Electronic Mail (E-mail) and Listservs

Electronic mail (e-mail) allows the transmission of text and other electronic files such as images or sound from one computer to another throughout the Internet [9,10,12,16]. By this powerful and rapid means of communication, podiatric health professionals, students, and patients may become connected electronically. A Listserv® is a specific special software on a host computer that maintains a list of e-mail addresses of groups of people with a similar purpose or interest in communicating [8,9,10,16]. Individuals send an e-mail message to the Listserv computer with a specific message allowing them to join. Mailbase®, Listproc®, Mailserv^®, and Majordomo^® are other software programs that enable groups to manage their own discussion topics and permit archiving of their correspondence. Further details concerning e-mail and joining Listserv-type discussion groups are given elsewhere. [8,9,10,16]

Both Listserv and Mailbase allow varying numbers of people to form a discussion group devoted to one particular topic or to a specific purpose, such as a support group for people with a certain podiatric medical condition or a general discussion group for podiatric medical practitioners. Members of a particular unmoderated group may send e-mail messages to the entire discussion group roster through the Listserv or Mailbase software, which will automatically send that message by e-mail to all the other members of that group. Once reviewed by the individual members of the group, responses may be posted to the entire group for further group discussion, or responses may be made only to the individual who posted the original message, depending on the nature of the first query. Moderated groups function similarly with the exception that all messages are first screened by the owner of the list or other moderator who will then decide if a particular message is suitable for posting.

There are several ways to discover if a group exists for any given topic. One method is to send an e-mail message to a large Listserv such as “listserv@vm1.nodak.edu” or “listserv@listserv.net.” [2] Leave the subject area blank. In the message area, type “list global/” followed by a whole keyword or keyword fragment chosen to describe the type of Listserv of interest. The Listserv software will search itself for discussion groups that include the requested keyword in the title or description of the various groups and then send a reply e-mail message listing all groups meeting the keyword criteria with information on how to subscribe. Some of the larger Listservs such as those given above may also search other known Listserv sites for relevant groups, all in one step. In order to find any discussion groups in the field of podiatric medicine, this method was tried with the keywords “podiatric medicine,” “podiatrist,” “foot,” and “feet,” but only discussion groups relating to football and square foot gardening were found using this methodology.

The Mailbase software, which is similar to the Listserv software, allows a user to search for other discussion groups by posting a message to the Mailbase address, leaving the subject area of the message blank, and placing the words “find lists searchterm” in the message area, where “searchterm” represents any text word of relevance to the topic being sought. Using this methodology, a podiatric discussion group was located which will be discussed later. Currently, there are approximately 1,300 discussion groups using the Mailbase system.

Another method of discovering potentially relevant Listserv discussion groups makes use of the Web. “CataList” lists the catalog of Listserv lists, which allows the user to enter keywords and receive a listing of discussion groups that include that keyword in its title or description. Other similar sites such as “Search the List of Lists” and “E-mail Discussion Groups” are available for searching. “The Medical Matrix” details medically related Internet resources and contains a section with information on allied health resources in which an area for podiatric medicine is included. Check this section for the appearance of new podiatry-related discussion groups.

Additionally, many of the Web podiatric medicine sites maintain current listings of Internet resources of interest to podiatric physicians or podiatric medical students and may include any available Listserv discussion groups. Other sites of a more general medical nature will often include listings of Listservtype discussion groups devoted to a myriad of medically related topics.

The Mailbase “podiatric medicine” discussion group is accessible through the “Podiatry Home Page” presented by the Department of Podiatry at the University of Huddersfield in England. The reader may subscribe to this list by sending an e-mail message to their address with the subject line left blank and the words “join podiatry firstname lastname” inserted in the message area, where “firstname” and “lastname” represent the potential subscriber’s name. The Mailbase discussion group software is similar to the Listserv discussion group software.

The Mailbase podiatry discussion group maintains an archive of previous discussion topics. This archived listing of topics can be searched through the “Mailbase Hypermail Archive” for the Podiatry Mailbase List. Boolean text word searches can be searched for topics of interest. The archived topics are arranged monthly and begin with July 1995. The list is funded by the Joint Academic Network (JANET) in England and, as stated in its home page, its goal is to promote research and academic excellence in podiatric medicine. Acting as a forum for debate and the exchange of ideas and protocols related to podiatric medicine, it is a good resource of which to be aware. Presently, there is an international membership of approximately 150 persons.

Although “Podiatric Residency Exchange” is not a Listserv discussion group, it maintains a listing of podiatric residency programs in addition to students at many of the podiatric medical colleges. E-mail addresses of podiatric medical students may be found here.

Searching for a professional Listserv-type discussion group on a specific topic may be necessary because of the provision of electronic access to a group of persons who have the potential to help solve clinical problems. As an example, one of the authors needed to know specific information about the use of vitamin A in a child with retinitis pigmentosa [19]. A search was carried out using the keyword “retinitis.” Within minutes, a Listserv discussion group dealing specifically with this topic was found. Members of this group included physicians who specialize in this condition and patients with this condition. The required query was then posted to the group. An additional request was made that responses not be sent to the group as a whole but to the first author’s personal e-mail address since the author elected not to join the group because of the large number of postings that were being generated. Shortly, information was received from physicians and parents of children with the illness that led to the solution of the clinical problem. At the time of that posting, no literature existed that had the required solution. Only by asking appropriate experts in the field could this information be obtained. The use of e-mail and the knowledge of how to find an appropriate Listserv discussion group greatly facilitated this information gathering.

Of note is the fact that some groups allow posting of a query only if the user is a subscriber. Yet, a user can subscribe, post the question, and then unsubscribe to the list. If a group is moderated, the moderator will decide if the query is appropriate to the group [8,9,10,16].

Useful Web Sites

The American Podiatric Medical Association (APMA) sponsors its own Web page that includes foot health information, facts about the human foot, and a member services section, which has listings of local, national, and international meetings and events of interest to podiatric medical professionals. The “Foot Health Information,” an excellent resource for consumers, consists of the texts from brochures produced by the APMA, and includes such topics as general foot health, arthritis, athlete’s foot, occupational foot health, and foot orthoses. Also available is a listing of products approved by the APMA. A listing of the schools of podiatric medicine is provided with details about the curricula.

“Virtual Seminars” are case presentations available on the Web. To hear the cases presented, VoxWare^® is needed but can be downloaded at no cost by clicking on the appropriate section of the page and following directions. This site was viewed in its early stages with Netscape^® Version 3.0. Continuing education credits for doctors, nurses, and therapists will be available shortly. New teaching modules will be added periodically to this site.

The California College of Podiatric Medicine has a home page with a link to its own “Continuing Medical Education” site. A multiple-choice quiz can be taken on “Polylactic Acid Screws and the Juvara Osteotomy” and the answers sent to the software server by clicking on the appropriate screen button. Shortly, an e-mail message from the serving software reveals the correct answers to all the questions and shows which answers were selected by the examinee.

“Podiatry Online Clinical NetForum” is a site where clinicians present cases for open discussion and suggestions from colleagues. Difficult clinical cases may be brought to the attention of other podiatric physicians. Registration must be completed to use this facility by completing a brief series of questions, at which time a “user id” and password are provided free of charge. It is best to have a formscapable Web browser, such as Netscape Version 3.0, to fully view and interact at this site.

“A Foot Talk Place on the ’Net” is primarily for consumer health. Another site of interest to patients is “Foot Web–Your Foot Treatment Information Resource.” The “Center for Podiatric Information” has a link to general foot care information that has drawings and pictures of common foot problems and their care and treatment from a layperson’s perspective. “Podiatry FAQ” (Frequently Asked Questions) answers basic questions about the profession of podiatric medicine and medical education for the consumer.

The American Association of Colleges of Podiatric Medicine (AACPM) sponsors “Podiatric Medical Education Network,” for podiatric medical students or for those recently graduated. Available for browsing or downloading are two publications from the AACPM: “Dispatch” is a weekly newsletter and “Footnotes” is a monthly publication designed specifically for fourth-year podiatric medical students. Recent copies of these publications will be made available. Other materials such as monographs, position papers, and other information affecting the education of podiatric physicians will also be available soon from this site.

Also available is information about late-breaking news about podiatric medical education. Members of Congress are listed at this site together with their postal and e-mail addresses.

This site presents a career center that can be accessed for information about becoming a podiatric physician and where current and relevant information on graduate podiatric medical education and licensing requirements is available.

The “Foot and Ankle Link Library” is a site for both podiatric medical physicians and students, with some general information about the field of podiatric medicine for patients. Particularly useful are links to “Podiatry Organizations,” “Podiatric Pathology and Therapeutics,” and “Podiatry Related Periodicals.”

“MedWeb,” hosted by the Health Sciences Center Library at Emory University, includes a page titled “MedWeb Podiatry” with some useful links to various podiatric medicine sites, including the online podiatric medical journal currently available.

“Podiatry Quick Reference” is loaded with links to lots of places filled with information. There is a “3-D Foot and Ankle” link, which leads to another site called “The Foot” that demonstrates an x-ray of a foot and ankle rotating 360° showing an excellent three-dimensional appreciation of the anatomy. Image quality is excellent but a fast Internet connection is necessary, otherwise the rotating image will take a long time to complete the full turn.

The “Podiatry Home Page,” previously mentioned in the discussion of the Mailbase software system for discussion groups, is presented by the University of Huddersfield’s Podiatry Department. This site is particularly useful because of the convenient direct link to the Mailbase podiatry discussion group. Another excellent feature of this site is the list of general medical resources.

A “Clinical Gait Analysis” home page offers case discussions and the ability to view videos of the presented cases. Special video-viewing software such as QuickTime^® is needed to view these films, but again, this software can be downloaded from the home page at no charge. From this site, a user can join a discussion group, using Listproc software, on the subject of clinical gait analysis. This site has pointers to other sites related to biomechanics of potential interest to the podiatric medical professional or student.

“Dr. Pribut’s Running Injuries Page” provides pertinent information for podiatric physicians in the area of sports medicine. This page contains many useful topics on running, including avoiding injuries, common running injuries, basic biomechanics, sports shoes, stretching, cold and hot weather training, and children’s sports injuries.

“Podiatry Online” provides access to much practical information. It has an “Online Journal Club” where a physician can browse or submit a paper for online publication. This page also provides a link to the “American College of Podiatric Medical Review.” For a fee, “Podiatry Online” will create a Web page for podiatric physicians that will be listed in the “Doctor’s Office Homepages” link. A link to the “Podiatry Office Practice Workshop” offers patients instructional booklets and other useful links including an “Office Equipment Exchange” and a “Practice Opportunities Classifieds.”

Finally, the “Foot and Ankle Web Index” provides free podiatric patient information and serves to provide podiatric physicians with patient referrals through the Internet. Specific product recommendations are made to both patients and podiatric physicians. This site also provides links to many additional information sources related to podiatric medicine.

Podiatric Medical Journals Online

Currently, there is one site for electronic podiatric medical journals. “Podiatry Management” has a cumulative index arranged by such topics as: clinical, computers and technology, education, estate planning and finances, legal, managed care, marketing and patient relations, and practice management.

The Journal of the American Podiatric Medical Association will appear on the home page of the American Podiatric Medical Association. The link will provide information on the table of contents for the current and past issues, including any future special issues. Abstracts will be available along with authors’ guidelines.

General Medical Resources

Many excellent review articles have appeared in the recent medical literature summarizing the available medically related Internet information sources. Several monographs are also available to the interested reader [8,9,11,12,13,14,15,16,17,18,19,20,21,22].

The previously mentioned “Medical Matrix” is a continuously updated, annotated compilation of medical Internet resources. It should be one of the first places to look for information on where to find a site on a given topic within medicine and the allied health fields. This resource has its own search engine for locating specific information within its many sections.

The National Library of Medicine makes many resources available through their Web page “HyperDOC.” There are more than 40 databases from the links on this page, some of which will require the obtaining of a username and password. Some of the databases are provided at no cost, and others have fees based on use time such as MEDLINE searching through GratefulMed^®. The card catalog of this library is available for searching at no cost. The National Institutes of Health Consensus Development Conference Statements may be searched for specific textwords, and once a relevant document is located, it can be read or downloaded for later study.

The “Web Virtual Library: Biosciences: Medicine” sponsored by the Biomedical Information Communication Center at the Oregon Health Sciences University, is another starting point when looking for general medical resource locations. A search engine for this site is in its early stages but is currently able to do limited searching. A large and comprehensive list may be downloaded and searched by any “Find” type facility or else manually. “Find” is located under the “Edit” area in standard Windows^® tool bars.

The “Virtual Medical Center - Martindale’s Health Science Guide” is another site worth visiting. It is a stepping stone to a vast listing of resources. Subjects range from the purely scientific aspects of the basic medical sciences to the clinical. This is a superb site for locating reference information. Tutorials on many subjects can be found along with medical words in Danish, German, Spanish, French, Italian, Dutch, or Portuguese. There are more than 27,500 multimedia medical teaching files and modules, more than 34,500 multimedia medical case presentations, and more than 8,300 video selections available for viewing.

Conclusion

With an optimal Web browser such as Netscape Version 3.0 and a fast Internet connection, the podiatric physician or student can access an amazing variety of resources of potential relevance. With subjects such as podiatric medical education, consumer health education, practice management, biomechanics and gait analysis, continuing medical education, discussion groups for podiatric health care providers, and podiatric medical groups and associations, the Internet offers a wealth of information to those who know how to access this network of information-serving computers.

Searching methodologies were presented that will enable the user to locate specific discussion groups. Other methods used to locate sites on the Web with various search engines, such as AltaVista, Excite, InfoSeek, Lycos, Webcrawler, and Yahoo, were also discussed. Since the Internet is a rapidly growing and evolving network, some of the Uniform Resource Locator addresses presented may have changed since this article was published. The reader may therefore need these skills to find discussion groups or locate specific information or sites on the Internet.

Since information at the various sites on the Internet may vary in quality, reliability, and level of sophistication, the podiatric health provider should filter all information. Readers should evaluate all data received and verify all new information with appropriate medical texts, peer-reviewed journal articles, or by consultation with experts in the field.

A brief introduction to the history of the Internet was presented. The rapid rate of Internet growth was also addressed. Relevant references were provided for readers interested in learning more about the many facilities of the Internet.

The general medical sites offer many services to the busy practitioner of podiatric medicine, including the ability to search the MEDLINE and other databases provided by the National Library of Medicine, some of which require that the user register and obtain a password.

Trade Names

AltaVista: Digital Equipment Corporation, Maynard, MA.

America Online: America Online, Inc, Dulles, VA.

Excite: Excite, Inc, Mountain View, CA.

Grateful Med: National Library of Medicine, Bethesda, MD.

InfoSeek: InfoSeek Corp, Santa Clara, CA.

Listproc: Corporation for Research and Educational Networking (CREN), Washington, DC.

Listserv: L-Soft International, Inc, Landover, MD.

Lycos: Lycos, Inc, Marlboro, MA.

Mailbase: University of Newcastle, Newcastle upon Tyne, United Kingdom.

Mailserve: fitz@iquest.com (Patrick Fitzgerald) Majordomo: SparkNET Corp, Green Bay, WI. Netcom: NETCOM On-Line Communication Services, Inc, San Jose, CA.

Netscape: Netscape Communications Corp, Mountain View, CA.

Physicians Online: Physicians Online, Inc, Tarrytown, NY.

Prodigy: Prodigy Services Co, White Plains, NY.

QuickTime: Apple Computer, Inc, Cupertino, CA.

VoxWare: Voxware, Inc, Princeton, NJ.

Webcrawler: America Online, Inc, Dulles, VA.

Windows: Microsoft, Redmond, WA.

Yahoo: Yahoo! Corp, Santa Clara, CA.