Journal of the American Podiatric Medical Association

A multidisciplinary team approach has become essential to modern hospital care, bringing together professionals from different specialties to collaborate on patient management. A Podiatric Hospitalist (PH) is a board-eligible or board-certified Doctor of Podiatric Medicine dedicated to the evaluation and management of acutely hospitalized patients with foot and ankle conditions. PHs play a vital role in this collaborative model, particularly in managing different conditions affecting the foot, ankle, and the lower extremities. Beyond serving as the gatekeepers for prevention and management of diabetic foot ulcers, PHs facilitate high-quality and efficient management of diverse lower extremity disorders including infection, trauma, sport-related injuries and chronic conditions related to diabetes, peripheral arterial disease, and autoimmune disorders. We present a care model, informed by our institutional experience, that positions the PH as a consultative and co-management member of a multidisciplinary foot and ankle and limb-salvage team, with the goal of advancing high-value care that improves outcomes, cost-effectiveness, and patient satisfaction. By integrating specialized lower extremity expertise into collaborative patient management, PHs help improve patient outcomes, enhance coordination of care, and support both preventative and surgical management strategies across multiple clinical settings. This collaborative approach enhances the quality and efficiency of healthcare delivery in hospitals. As the demand for limb salvage and high-value inpatient care continues to grow, the PH represents a practical and timely addition to multidisciplinary foot and ankle care.

Background: Toenail deformities are a frequent reason for medical consultation. The etiology is not always well understood, particularly in cases without trauma, where abnormal nail growth conditions have been excluded, and microbiological cultures yield negative results. Thus, identifying the underlying cause of toenail anomalies can be challenging. Patients often do empirical treatments—i.e., antifungals—for extended periods without achieving remission. Subungual exostoses, on the other hand, are an important consideration in the differential diagnosis of subungual pain, particularly in the first toe. Although exostoses have been well documented in the literature, studies specifically examining their role in nail deformity and discomfort are lacking. Methods: A retrospective analysis was conducted on 173 feet of patients with weightbearing lateral radiographs. These radiographs were classified into two groups based on the presence or absence of subungual exostoses, and we collected patient history data focusing on the presence or absence of pain localized beneath the nail and associated nail abnormalities. Results: Subungual exostoses were observed in 52% of the sample, whereas nail disorders were identified in 18.5%. Notably, among patients with nail disorders, 78% (25 patients) also presented with subungual exostoses. Subungual pain was reported in 25 patients (14.5%), of whom 76% had subungual exostoses. Conversely, the prevalence of subungual exostoses was lower in patients without nail abnormalities (46%) or subungual pain (48%). Statistically significant associations were found between nail abnormalities and the presence of exostoses and subungual pain and exostoses, as well as pain and nail deformities (p < 0.05). Conclusions: Both pain and nail abnormalities may be considered to have a high positive predictive value for the presence of subungual exostoses.

Background: To determine the overall incidence of concomitant neurological symptoms and, if present, their origin. Methods: A clinical review was conducted of 459 patients from a large Podiatric Medical practice, who presented with a diagnosis of plantar fasciitis. Results: A diagnosis of plantar fasciitis presented clinical neurological findings in 49% (225 of 459) of study patients. With conservative treatment, neurological symptoms resolved in 126 of 225 patients (56%), leaving 99 nonresponding patients having persistent neurological symptoms. Electrodiagnostic studies were obtained in 73 of 99 nonresponding patients. Of those having electrodiagnostic studies, 68 of 73 (93.15%) had positive electrodiagnostic findings, while 5 of the 73 studies performed had no signs of neurological involvement. Of the 68 positive neurological studies, 11.76% (8 of 68) were specific for tarsal tunnel alone; 22.05% (15 of 68) were specific for radiculopathy alone; and 66.17% (45 of 68) of patients had a combination of radiculopathy and tarsal tunnel syndrome. Conservative care treatment in patients with plantar fasciitis alone resulted in plantar heel pain resolution in 87% of study patients. Conservative treatment in the group having plantar fasciitis AND neurological symptoms produced a 75% resolution rate. Using a two-tailed Chi square test, the p value for this comparison was 0.00098 (highly statistically significant). Conclusions: This author believes the 12% decrease in resolution rate of symptoms in the combined symptom group is the associated difficulties found with neurological involvement. In patients with refractory plantar fasciitis, proximal neurological involvement should be highly considered as an etiology for the pain. Surgical correction, based on the MRI and electrodiagnostic findings, would include nerve release along with plantar fascia release.