Medically Speaking #8

So welcome to our next episode of Medically Speaking. Today we have two special guests with us, Kelly Mandile and Alex Barnett. We're going to be talking about podiatry. These are our two podiatrists we have here in Greenwood, a new service line we just started about a year ago. And we'll start maybe with some introductions. So again, I'm Matt Logan, CEO of South Regional. Hi, I'm Kelly Mandile. I'm, I guess, the first podiatrist of Greenwood for a while. I just moved down here about a year ago, and we've been starting the podiatry program. Things have been going great. I'm originally from Ohio, and I'm happy to be local South Carolina native now. I'm Alex Barnett. I just started in August, so a new addition here, but originally from Sumter, South Carolina. And I just came from Fort Worth, Texas. Awesome. Awesome. So some people may not know exactly what a podiatrist does. So we'll just start with that. So let's talk a little bit about like, what is podiatry? Like what conditions do you treat? What are some common things that you guys may see in your practice? Well, podiatry is a pretty broad topic. Pretty much any foot and ankle problem is covered in the scope of podiatry so if you have problem with your skin problems with your ankles the ligaments the tendons the joints if you have hammer toes or bunions plantar fasciitis I mean foot and ankle where you're where you're go to I kind of second that you know podiatry is such a broad spectrum and we specialize in it so we're taught everything about the foot and ankle. We can do sports-related injuries. We can do fracture care, routine foot care, plantar fasciitis, flat foot, and different type of clubfoot deformities as well. The beauty of podiatry is that we can treat things conservatively from a toenail all the way to reconstruct a whole flat foot and give people an arch again. So it's a unique specialty because it's kind of a touch of a lot of different specialties all just in the same area. Sure. I think there's some confusion now just in general on what is a podiatrist? But then what's the training? Just talk about that. It's not just, oh, you just go be a podiatrist. I mean, walk us through what does it take? What is the background of becoming a podiatrist? So a podiatrist is a specialized medical degree. So it's a doctor of podiatric medicine. Instead of an MD, it's a DPM. So we go to four years of your undergraduate degree, and then we go to four years of specialized medical school. So the first two years of that medical school is just the same as any other medical school we do. Full body anatomy, you're taught to be a doctor first and then a specialist second. And then the second two years, it's more focused on just foot and ankle pathologies. But we do focus some of that education on different specialties that would be emphasized in the foot, like vasculature and rheumatology and different conditions that kind of pop up more commonly in the foot. and then after you finish your medical degree then you have to go on and do a minimum of a three-year residency program and that's for your surgical training so you go and you do specialized foot and ankle surgery for three years in order to be you know efficient and qualified in that and then some people go on and will even do a fellowship and even more specialized training after that whether it be trauma surgery or anything foot and ankle related so it it kind of mimics the MD program in that you still have to have a residency. Um, and it still takes quite a lot of years, um, and dedication, but, uh, at the end of the day, you know, you're going to be working on the foot. Yeah, absolutely. Well, um, yeah, so I guess that's just exactly what I wanted to say. And it's like, this is a, uh, it's a highly specialized field. You go through four years of college, four years of podiatry school, and then, and then another three years of residency minimum to really become a podiatrist. And so a lot of training and a lot of expertise in the foot and ankle. And so kudos to you guys. That's really awesome that you guys have done that. And we are so glad that y'all are here bringing that to Greenwood. When Kelly started, we weren't sure exactly how the service line was going to go. Within about a month, she's booked out like three or four or five months. And so we were so glad that Alex was able to just join us to try to get the wait times down uh for the community um because there's a lot of people with foot and ankle problems out there i am surprised i mean i kudos to you and self for realizing the need of the community and and getting us here and starting this whole program from the ground up and i'm i'm impressed with the leadership of the hospital and getting this whole thing started and all the administration has been wonderful in getting us what we need so we are fully equipped um basically to do everything we want now. Yeah. Numerous of my patients have told me they've been waiting four months to see me. So I'm very grateful to be here and treat those patients and provide the necessity that they need. So, yeah. Oh, well say, uh, certainly we're glad to have you guys too. Like what are the most common things that you may see in your office on a daily basis? You want to start with that one? Yeah. So, you know, it kind of varies, uh, has a wide range. One of the more common pathologies we see is plantar fasciitis, which is kind of inflammation of your plantar fascial band at the bottom of your foot. So that's pretty common. We can also see routine diabetic care, including just foot checks, making sure there's no new wounds or infections on the diabetic foot. And then sometimes we do get ingrown toenails or sports-related injuries, including ligament sprains, um, or tendonitis. Yeah. And then, you know, we'll have the patients that come in with the big bunions on the side of their foot that are hurting them. They want cut off. Um, you got the hammer toes that come in, um, people with arthritic joints, um, Achilles tendon ruptures have come in, walked through the door, unfortunately. Um, and so it really is a broad scope, but so day to day, you never know what you're going to get, but every day is an adventure. And one thing I really appreciate you guys helping out with too, is you guys know we have a pretty strong vascular surgery program here and the help that you guys have been doing in the limb salvage program. Could we maybe share a little bit about that? Yes. So that we, so with diabetic limb salvage and really just peripheral vascular disease in general down here, it's such a need and such a demand. It's the culture that it has that's kind of going against us. But the vascular program has been excellent. We have a really good working relationship with both of the vascular surgeons down here and the technicians to get patients seen quickly and efficiently. And if they need revascularization and then offloading with us, either surgically or just with orthotics, it's been a really pleasant experience. And I don't think I've ever worked at a program where you could just call someone and say you know hey i have this patient really needs to be seen and they do the best they can to get them you know in the door as quick as possible because at a lot of a lot of time with these pathologies time equals tissue and so if you can get that revascularized quicker then we don't have to amputate as much the whole goal with the limb salvage program is trying to save as much as you can without you know taking too much or leaving bad disease tissue behind and so previously i think a lot of options here were either amputation or you know a big foot amputation or a big leg amputation now we can kind of do other strategies to keep people active and keep their feet having such a close relationship with vascular surgery that we have at this hospital really helps to the advantage of the patient so as kelly was saying we're able to see stuff quicker, get it treated faster, preferably save the patient's foot and then save their limbs, save their lives. So I do want to also just say the wound center that we have here, it's kind of like the trifecta because you have the revascularization from peripheral or from the vascular surgery. And then you have the podiatrist that's coming in to make sure that if we have to amputate some, that we leave an appropriate amount so that you still function with the foot that you're left with. And then you have the wound center that makes sure that their hyperbarics, um, the hyperbaric chambers there and the wound nurses and the, um, wound PA, everyone works kind of all together and we're kind of updating each other constantly on how the patient's going. And, um, I think that that's a beautiful thing that we have that kind of perfect little group there to kind of save as many limbs as we can. Absolutely. And you know, that's really all about is keeping that patient in the center and us working kind of around them for their benefit, right? You know, certainly that's the goal for all of our service loans. And I'm glad to see you guys really doing a great job with that. That's awesome. I just feel like we came down here and we were just grandfathered into a great system. And so we're lucky to be able to offer our services. And they go so well together. Great. So one of the things we're going to be working on, particularly now that Alex is here too, is, you know, certainly want to meet the need in Greenwood, but as we're growing some too, um, particularly, you know, I think about Abbeville and that's one of podiatry is one of the services that we want to try to move over to Abbeville and, and, and provide a similar service over there. Um, talk to me a little bit about like your capacity to do that now. And like, where do you see that potentially going in the future? Um, I think the growth is important because there's need all over South Carolina. Um, and we're kind of in a podiatry desert. So the need is out there, and we're growing. Right now, my current schedule is still booked out about three months. So with the addition of Dr. Burnett here, we're able to see patients that are more emergent kind of quicker, and the goal is that we're each going to be seeing outreach patients at clinics, and we're growing to expand hopefully into Abbeville soon. We're already in Edgefield. We were in Edgefield, and then we kind of bounced back because the growth in Greenwood was just so high. We're going to be starting back in the next month out at Edgefield, and then Alex here is going to start in Saluda soon. So we're already trying to expand the scope or the horizon there, and then hopefully more to come. Yeah, I think the growth to smaller towns or outreach is very crucial for the population to get them the need that they require. I'm starting a saluta pretty soon, so I'll be seeing patients down there. And a lot of patients, you know, it's kind of a far drive to Greenwood to come see us. So I think having the outreach is going to be crucial for them. Yeah, absolutely. Well, certainly we're glad you guys are doing that. And so, again, super excited about the program and the development of podiatry here in Greenwood. Tell me about anything you all want to tell me about that you would like for the community to know about your practice, about you guys personally or really anything else you'd like to share with with the community that may hear this message you can go ahead and start well i just want to say thanks because i'm glad to be back in south carolina now i'm closer to family so that that's great um being within a car ride to family has been you know very appreciative of all that not having to catch a plane flight but i'm just happy to be here to treat patients a lot of them tell me they haven't seen a podiatrist in over years since the last one in Greenwood was here so I think us being here is definitely a pillar for the community and I'm just very happy to see everybody and like we were saying the spectrum that we treat is so broad includes pretty much anything foot and ankle related if you twist your ankle if you step something wrong kind of had arthritis pain that's been bugging you for a while there's normally a treatment that can help you out so I think just getting that message out to patients that to come see us even if they you know aren't having tremendous pain but kind of have achy pain that's been going on a while is key um yeah i'm gonna piggyback off that and just thank the community so much for the welcome that we've had down here so i'm not from the south originally and i really like a lot of aspects of the south including the weather the weather um that we have down here which is so much better than ohio um i'm the opposite so I like moved away from my family to come and start down here but with my husband and my daughter and we've we're growing roots down here and we we've kind of dug into the community we love it so far everyone's so personable and friendly and I don't think we went went to a place so far where we weren't engaged by somebody and it's wonderful and so so interesting to be in a smaller town because I'm used to living in bigger cities and so I think I was telling somebody earlier so my mom came down um for a wedding ceremony that we had and uh she was at a bakery and she was saying oh yeah my daughter she's having her ceremony and um she was saying oh what's your daughter do and she's oh she's a foot doctor and she's oh dr mandyle oh she's the picasso of feet and you know like it's just such a nice thing that the community kind of has heard about us and they're so welcoming and engaging about podiatry i have patients that come in and they're just excited to get their foot checked just to make sure things are they're okay and that's okay you know we want to see the feet we want to know that they're good and can you can do everything you want there shouldn't be pain when you walk there shouldn't be pain you know with every step you take there is something that can be done to alleviate a lot of those symptoms you know at least to make it so that you can do activities that you want to do a lot of times with arthritis even in people that thought like oh it's either surgery or nothing you know we can get you into a nice sturdy insert a good supportive shoe please this is to the community you stop wearing crocs um i can't i can't comment enough yeah um kids are okay kids feet are flexible but as we get older we just need a little more support a little better shoe wear um so i think greenwood needs a little bit of that but yeah the uh if if you just have pain in your foot and you want it looked at you might have to wait a little bit but we're happy to look at it I have some people that come in and they say you know I'm not I wasn't sure if I needed to come that's okay we're here to help yeah so pretty much if it hurts you're glad to take a look exactly if it hurts we're glad to see it that's great let's see here oh I did want to ask just real briefly just for the audience I'm just and I'm just curious myself too so like what are some of the procedures that you may do in your office versus something that you might need to go to an operating room for? And what are some common procedural type things that you guys do? Okay. So a lot of procedures that we do in the office are all the minimally invasive procedures. So we can fix a very flexible hammer toe in the office. We can take care of plantars, warts in the office, ingrown toenails in the office. If you can tolerate like a nice numbing solution. We can do a lot of little skin flaps and rotations if you have deep calluses and things in the office. If it's something that's a little more invasive or we couldn't numb you up appropriately, then it's usually a trip to the OR. And most of our surgeries, I would say the majority of our surgeries can be done under local anesthesia. So you're just kind of in a little sleepy state, you're asleep, you don't feel what's going on, and it's outpatient surgery. So a lot of people get a little nervous because they think it's the full intubation full general anesthesia and it's not it still comes with risks but it's outpatient and you're back on your feet you know a couple weeks after depending on the procedure um yeah i mean in office like dr mandel was saying we can offer you know injections sometimes a steroid injection will help out quite a bit uh where you don't need a big procedure uh so that's something to consider and like i said ingrown toenails kind of smaller procedures in the office if it does require a bigger procedure it does require to get to the OR but it's normally like a twilight phase a local anesthetic will do quite a bit to make sure there's no pain so the recovery process on a normally foot surgery you do it does require to stay off it depending on where the incision is but there's a bunch of good, uh, knee scooters and I walks that will help the patient, um, be compliant with that. Good. Excellent. I think, um, so I wanted to point to my foot here because it was, so it's interesting because so your body has 206 bones and your foot has 26 bones. So if you multiply that by two, you're at 52. So 25% of the bones in your body are in your feet. So that's impressive. That's a lot of little joints that can become arthritic and can cause you pain. So I like to emphasize that when people ask, like, well, why did you become a foot doctor? Because there's a lot to do down there. Yeah, there's a lot. Yeah. And so and and I think one of the things I want to highlight because I've noticed so much of it down here is flat foot, huge flat foot population down here. And I think a lot of people are just living with it. They're living with the pain. They're starting. They get to the point where they're walking on their ankles. And by then you need a big, huge reconstruction to fix that. And a lot of people don't want to do that. But if we catch it a little earlier and get you into the proper shoe gear and some inserts, then you save yourself that need for reconstruction down the line. If you do get to the point where you need it, then we're happy to help. It's one of the surgeries that we perform all the time. But that's a huge, I just feel like flat foot's really common down here. And I wanted people to know that you don't have to necessarily live with it if it's causing you pain. So what age should that start to be treated? I just ask, I actually had flat feet when I was like in, oh, probably seventh or eighth grade, and I had an orthotic insert in my shoe for a while, and it did help. It did make a difference. So what age should that be treated? So usually if you're starting to have pain, it's going to be kind of on the inside of the ankle region, and that's usually once your foot stops becoming as flexible. So late 30s, you might start noticing it. Into your 40s, you might start becoming a little stiffer. That's kind of, I think, the prime age to fix it if you can reconstruct the flat foot. I think also it's really key to catch them early before they start having pain. Even if you just have a flat foot, but you're not getting good support in your shoes, there's orthotics that can help out with that and prevent you from having pain later in life where you do require that procedure to fix the flat foot. So what ages do you guys treat? So right now we're seeing kids two and up. Two and up? Yeah. So, and a lot of times patients will come in, parents will come in and their kids are either walking on their toes or their toes are a little crossed or crunched and they're not sure like what's going to happen with it. And oftentimes those are self-limiting. So once the kid starts walking regularly, then they're good to go. Everything kind of stabilizes itself. It's kind of after the age of two is when you kind of notice, okay, this is sticking around, what's going on is if something can be done about it yeah I agree with that I mean most most times when you're uh two around two um adolescent a lot of times the foot will kind of solve itself as you grow gotcha so um just another question too so um you guys have talked a lot about some of the things you treat are there any things in the foot and ankle that may be like oh I'm not sure I may want to refer this one to somewhere else or are there any of those type cases that you see from time to time um so i think limb lengthening is one of the things that can be an issue um if you've had a osteosarcoma or some sort of bone cancer in the past or something had to be resected and they come in they can get problems in their feet problems in their ankles and that's something where they can like the orthopedic doctors um can kind of do procedures um in osteotomy so cut the bone and kind of lengthen and correct that so that you don't have the pain anymore because you equalize that length so that's something that we would definitely refer to ortho for yeah i agree i mean that's probably one of the few things that i think we would probably need to refer out um but besides that i can't really think of too many other anything at all that we'd refer out um neuropathy sensations that's another one we don't have a we don't have i don't think a lot of people have a great toolbox to attack neuropathy sensations i love to sit there and focus on the different sensations and tell the patient that you know what they're feeling is normal for small fiber neuropathy which we see all the time especially in diabetics um not that there's tremendous treatments for it but at least it helps people understand that it's not just them and that these sensations that they're feeling that usually they describe as kind of just weird like thickness of the foot feeling like cardboards on their foot little tingling little burning something squeezing your foot over in the toes wakes you up at night those are all small fiber neuropathy symptoms um and so people will come to us thinking it's foot problem it's a nerve problem and so you know we we do a lot of education on that to kind of inform them but that should really truthfully be more addressed by like the neurology team so that would be referred out. Also, we send lots of referrals to physical therapy. The physical therapy team that we have itself is wonderful. They have a treatment for the neuropathy, the anodyne laser therapy, which is a new more cutting edge therapy for neuropathy symptoms. But the physical therapists have been tremendously helpful in saving us from having to cut on people and preventing them that trip to the operating room, but also knowing that there's a limitation to that as well and sometimes things just do need to be fixed if a tendon is torn and you try to strengthen the other tendons erratic you try to do your stretching your strengthening and your flexibility but at some times you just have to go and repair it so there's a limitation to it but that's a huge referral source too and physical therapy is key about getting you know especially post-heart patients back to ambulating back to normal life, uh, good quality of life before like what they had before the surgery, um, without pain. So, so tell me real quick, how does someone get plugged into the podiatry clinic? Can they just call themselves or do they need their doctor to refer them? Just tell me how that works. So there's, um, two options. So you can have your primary care physician send a referral into us. Um, and if it's an urgent matter, if you have an infected ingrown toenail or, um, something that needs to be seen urgently, usually that's your quickest method. If you don't have that and you're just having kind of pain in the foot or you just want to be checked out, you can also self-refer. So you can give us a call and then we'll schedule you an appointment and we'll figure out what's going on. Oftentimes we need radiographs before the people are coming. And this is a huge learning curve, I think, for a lot of people that haven't dealt with podiatrists before. But most of the radiographs that we need have to actually be weight-bearing. So we'll get x-rays from the emergency room that are looking for fractures because they have foot pain and if you look at a non-weight-bearing x-ray and then compare it to a weight-bearing x-ray you see a whole different story of the foot um so that's something that we uh like to like to let people know the weight bearing x-ray is important for us so that we can see what actually is going on when your foot is functioning um so how's that flat foot now that's much better actually you know i had the orthotics for gosh i'll probably wear them for about 10 years i don't even wear them anymore and i'm good good no worries make sure you're wearing those nice supportive shoes you know you notice it now though right so like my son plays basketball and i'll see kids on their team without their shoes i'm like oh goodness gracious my friend you need some orthotics oh yeah i'll be walking around the stores and i'll point out to my husband you know oh they need they need a little ankle brace you know and you just you can't help yourself right exactly yep it's one of the pitfalls of being in medicine i think because you notice things other people may not see sometimes yeah yeah but good Well, awesome guys. Listen, I've really enjoyed chatting with you guys today. Thank you all for joining me on today's Medically Speaking episode. And again, everyone who's watching, we really appreciate you watching and two great podiatry physicians here with us and excited to have them in Greenwood. And thank you all for watching Medically Speaking today. Thank you.