| By John Howell Sr.
"How beautiful on the mountains
Are the feet of him who brings good news … "
~ Isaiah 52: 7 (a)
Though most seldom notice, Isaiah is one of the few writers anywhere ever to refer to feet as an object of beauty.
Four who might notice are Doctors Michael Whitmore, Craig Williams, Amy DeGirolamo and John Catafygiotu, Oxford podiatrists who practice as North Mississippi Foot Specialists, PC. They each spent a considerable portion of their lives as young adults studying the human foot.
In a regimen not unlike the education and training required to become a medical doctor, doctors of podiatry spend four years in undergraduate study followed by four years in podiatric medical school. Then, depending on the subspecialty chosen, doctors of podiatry spend one to four years in residency training.
While the Doctors of Podiatric Medicine did not mention the foot as an object of beauty, their discussion described the basic appendage of locomotion as an object of intense interest and as an often-ignored indicator of the overall health of the body to which they are attached.
Their interest in foot care has led to a plan to open offices in every county north of Highway 82, which runs from Greenville to Columbus. Currently, they have 18 clinic locations, he added, and have yet to open offices in Tunica and DeSoto counties. They frequently rent office space from primary care physicians, Williams said, to see patients, often those referred by the primary care physician, one day a week.
Their practice brings them to Batesville each Friday; to their office at 555 Highway 6 East in the Convenient Care building and usually on Wednesdays frequently to Tri-Lakes Medical Center where they perform 90 percent of their surgeries, Williams said.
Typical surgeries include flat foot correction, bunionectomies and hammer toe correction, a spokesman said.
The doctors in the practice also see patients in about 40 nursing homes, Catafygiotu said.
Fueling the need for podiatric care in Mississippi is a skyrocketing rate of diabetes linked to the state’s dubious distinction as having the largest percentage of obese people in the country, Williams said. Diabetes decreases circulation and sensation in feet, Whitmore said. The combination leads to foot sores that are difficult to heal, he added.
Obesity and diabetes coupled with the state’s poverty level influenced the business model that North Mississippi Foot Specialists adopted, based on "a need we identified, given the fact that there’s such a large diabetic population (that is) medically under served and the socioeconomic factors," Whitmore said.
"That’s one of the reasons we take our coverage to the people; … it is a very (medically) under served state," Williams added. Poor people seldom have the means to travel to see specialists, he added.
Compounding the difficulties of treating diabetics is a lack of understanding of the role of podiatry in overall health care.
"A lot of docs don’t know what we do," Williams said. "How many times have you been to the (primary care) doctor and he asked you to take off your socks and shoes so he could look at your feet," he added.
"A lot of people think we do nothing but trim toenails, and that’s not true," DeGirolamo said.
"We were the first people in the state to use stem cells of your blood to pack back onto your wound so your body can heal itself," Williams said. He emphasized that the stems cells were harvested from the patient and were not related to embryonic stem cells.
The podiatric practice has also adopted other leading edge technologies to "help your body heal itself" through use of "high energy radio frequency waves" and "high energy ultra sound," Williams continued.
And yet, "trimming fungal toenails is hugely important," Whitmore interjected. Many foot sores among people with diabetes begin with improperly trimmed nails, he said. Foot sores that are not properly treated too often lead to amputations.
"Everybody in Mississippi has someone in their family or a friend who has had some part of a foot cut off, …" as a result of a foot sore aggravated by diabetes, Williams said.
"It’s incredibly hard work; it’s easy to cut things off, but it’s hard to save them," Williams continued.
Podiatry is not limited to foot problems associated with diabetes. Many people are familiar with carpal tunnel syndrome, a wrist injury caused or aggravated by repetitive motion of the wrist in a strained position. Tarsal tunnel syndrome has the "exact same pathology," for the ankle, Catafyfiotu said.
Catafyfiotu said that he sees patients with the tarsal tunnel syndrome who hold industrial jobs that require them to stand on concrete floors for long periods of time, usually in poorly-fitted, steel-toed footwear.
The podiatrists also see athletes who seek treatment for everything from stress fractures to heel pain, but it was Williams’ experience with his own child playing soccer which led to his discovery that "soccer shoes are poorly designed." He’s now working on an insert to improve the fit of the shoe for the sport that involves much running, stopping, starting and turning.
Shoe fitting and footwear are an area of concern for podiatrists, not only for diabetic patients but also for all patients, Whitmore said.
"When your feet hurt, you hurt all over; people have it in their minds that foot pain is normal," Williams said. "That’s one thing that blows my mind: people assume they’re supposed to hurt," he added.
Foot pain has also come to be routinely associated with the removal of ingrown toenails, said Williams. The podiatrist recalled a lady who, when she came to him as a patient, recalled her previous experience in having ingrown toenails removed as "worse than childbirth."
"It’s just a matter of the right instruments and the right techniques; if you have that it’s a relatively painless procedure," Whitmore said.
Podiatrists coordinate care of their patients’ feet with other health care professionals who are attending other patient needs. With diabetics, this often involves a nutritionist, an endocrinologist, a cardio-vascular surgeon and others.
"We spend a lot of time on the phone," Williams said. He described a typical patient in the Delta whose foot problems were caused by her diabetes which also caused or contributed to her congestive heart failure, renal failure and other health problems.
"The extent of the pathology is staggering at times," he said.
But, "that makes podiatry fun for me; you see the full spectrum of patient care. A lot of what goes wrong with the body shows up first in the feet," Whitmore added.