Foot and ankle problems usually fall into the following categories:

• Acquired from improper footwear, physical stress, or small mechanical changes within the foot.
• Arthritic foot problems, which typically involve one or more joints.
• Congenital foot problems, which occur at birth and are generally inherited.
• Infectious foot problems, which are caused by bacterial, viral, or fungal problems.
• Neoplastic disorders, also known as tumors, which are the result of abnormal growth of tissue anywhere on the foot and may be benign or malignant.
• Traumatic foot problems, which are associated with foot and ankle injuries, such as fractures.

Leading foot problems are:

• Bunions—misaligned big toe joints that swell and become tender, causing the first joint of the big toe to slant outward and the second joint to angle toward the other toes. Bunions tend to be hereditary, but can be aggravated by shoes that are too narrow in the forefoot and toe. Surgery is frequently performed to correct the problem.
• Hammertoes—usually stemming from muscle imbalance, this condition occurs when the toe is bent into a claw-like position. Hammertoe can affect any toe, but most frequently occurs to the second toe, when a bunion slants the big toe toward and under it. Selecting shoes and socks that do not cramp the toes may help alleviate any aggravation of pain or discomfort.
• Heel Spurs—growths of bone on the underside, forepart of the heel bone. Heel spurs occur when the plantar tendon pulls at its attachment to the heel bone. This area of the heel later calcifies to form a spur. Proper warm-up and the use of appropriate athletic shoes can reduce the strain to the ligament and prevent the formation of heel spurs.
• Ingrown Toenails—toenails with corners or sides that dig painfully into the skin. Ingrown toenails are usually caused by improper nail trimming, but can also result from shoe pressure, injury, fungus infection, heredity, and poor foot structure. Women are more likely to have ingrown toenails than men. The problem can be prevented by trimming toenails straight across, selecting proper shoe styles and sizes, and responding to foot pain in a timely manner.
• Neuromas—enlarged benign growths of nerves, most commonly between the third and fourth toes. Neuromas are caused by tissue rubbing against and irritating the nerves. Pressure from ill-fitting shoes or abnormal bone structure can also lead to this condition. Depending on the severity, treatments may include orthotics (shoe inserts), cortisone injections, and, in extreme cases, surgical removal of the growth.
• Plantar Fasciitis—an inflammation on the bottom of the foot that leads to heel and/or arch pain. A variety of foot injuries or improper foot mechanics can lead to plantar fasciitis. Treatments range from icing and foot exercises to the prescription of custom orthotics to correct the foot position and help alleviate pain.
• Sesamoiditis—an inflammation or rupture of the two small bones (known as sesamoids) under the first metatarsal bone. Proper shoe selection and orthotics can help.
• Shin Splints—pain on either side of the leg bone caused by muscle or tendon inflammation. Shin splints are related to excessive foot pronation, but also may be related to a muscle imbalance between opposing muscle groups in the leg. Proper stretching before and after exercise and corrective orthotics for pronation can help prevent shin splints.
• Stress Fractures—incomplete cracks in bone caused by overuse. With complete rest, stress fractures in toes or any bones of the foot heal quickly. Extra padding in shoes can help prevent the condition. Left untreated, stress fractures may become complete bone fractures, which require casting and immobilization.

1. Don’t ignore foot pain. It is not normal. If you experience any type of persistent pain in the foot or ankle, please contact our office.
2. Inspect your feet regularly. Pay attention to changes in color and temperature. Look for thick or discolored nails (a sign of developing fungus), and check for cracks or cuts in the skin. Peeling or scaling on the soles of feet may indicate Athlete’s Foot. Any growth on the foot is not considered normal.
3. Wash your feet regularly, especially between the toes, and be sure to dry them completely.
4. Trim toenails straight across, but not too short. Be careful not to cut nails in corners or on the sides; this can lead to ingrown toenails. Persons with diabetes, poor circulation, or heart problems should not treat their own feet, because they are more prone to infection.
5. Make sure that your shoes fit properly. Purchase new shoes later in the day when feet tend to be at their largest, and replace worn out shoes as soon as possible.
6. Select and wear the right shoe for each sport or activity that you are engaged in (e.g., running shoes for running).
7. Alternate shoes—don’t wear the same pair of shoes every day.
8. Avoid walking barefooted. Your feet will be more prone to injury and infection. At the beach or when wearing sandals always use sunblock on your feet.
9. Be cautious when using home remedies for foot ailments. Self-treatment may turn a minor problem into a major one.
10. If you are a diabetic, please contact our office and schedule a check-up at least once a year.

People call a doctor of podiatry for help diagnosing and treating a wide array of foot and ankle problems. Please contact our office if you experience one of the following:

• Persistent pain in your feet or ankles.
• Changes in the nails or skin on your foot.
• Severe cracking, scaling, or peeling on the heel or foot.
• Blisters on your feet.

There are signs of bacterial infection, including:

• Increased pain, swelling, redness, tenderness, or heat.
• Red streaks extending from the affected area.
• Discharge or pus from an area on the foot.
• Foot or ankle symptoms that do not improve after two weeks of treatment with a nonprescription product.
• Spreading of an infection from one area of the foot to another, such as under the nail bed, skin under the nail, the nail itself, or the surrounding skin.
• Thickening toenails that cause discomfort.
• Heel pain accompanied by a fever, redness (sometimes warmth), or numbness.
• Tingling in the heel; persistent heel pain without putting any weight or pressure on your heel
• Pain that is not alleviated by ice or over-the-counter painkillers (such as aspirin, ibuprofen or acetaminophen).
• Diabetics with poor circulation who develop Athlete’s Foot.

Dr. Lullove, in an effort to bring new technologies to the Boca Raton community for wound healing, has partnered with Osiris Therapeutics and Skye Biologics to bring you two new human amniotic tissues for wound healing and orthopedic injuries.

Grafix Prime and Grafix Core, from Osiris Biotherapeutics, is a cryo-preserved human amniotic allograft tissue to help patients with chronic non-healing wounds who have failed conservative therapy.

PX50, from Skye Biolgics, is an injectable human amniotic tissue allograft used for tendon, ligaments, joint and soft tissue injuries to help heal from those sports or traumatic injuries faster.  Through the use of ultrasound-guided technique, Dr. Lullove is able to place the allograft directly into the injured area to allow for quicker return to activities without the long-term need for surgery and/or extended physical therapy.

Please contact the office at 561-989-9780 to speak with Dr. Lullove regarding these new technologies.

How to Market Your Office in the 21 ^st Century

“Thank you for calling XYZ Office”. My name is Ms. Jones, how may I help you?” For most of us, this is standard opening for any wound center. But even before we get to that point, the issue for most of us is to ask, “How did we receive the referral?”

It is important to understand that the nature of the medical referral business for offices is based on three inherent resources: a) internal referrals from the inpatient facility; b) external referrals from the staff physicians of the hospital community; and c) external referrals from outside physicians or facilities to the office. Over the years, this conceptual idea that these sources of referrals would be endless, yet our facilities are striving and straining to stay profitable in a changing healthcare environment that is setting up facilities to have smaller and smaller margins.

So how do we, as health care professionals, market newer areas of source referrals? In order to answer that question, we have to review the traditional models of marketing a facility-based office.

Traditionally, hospital-based office models would (and should) be getting a majority of its referrals from the inpatient side of the facility. The physicians in the wound center in conjunction with the inpatient wound care team, should be seeing patients on the inpatient side and those patients who are ambulatory on discharge would naturally be followed-up for post-hospital care in the outpatient center.

A secondary source of traditional model is directly from the external marketing efforts. Whether is done by the physicians, staff or the hospital marketing team – it does not matter. To venture into the community to provide education, lecture series or health fairs is an integral part of the marketing effort by the hospital-based center to attract, educate and compile new demographic populations for admission visits. Targeting primary care physicians and the on-staff podiatrists, dermatologists and surgeons is also a necessary traditional step in the marketing process.

A third source of traditional referrals has been the most expensive and may have yielding the least amount of revenue for a facility. Advertising, whether in print or television or radio media, has been a staple of marketing efforts for years. This avenue of sourcing has become antiquated and partially obsolete. It may still work in certain demographic areas of the country where the patient populations are geriatric and not internet savvy, but for the upcoming baby-boomer generation it may not be the best monies to invest in marketing.

So what are the newer ways to market office centers in the 21 ^st century? First, you have to decide that you are going to be IN the 21 ^st century as a marketable wound center. Market analysis shows that the use of social media appropriately can be very effective means to get your message across. Day after day and week after week, the use of social media “buzzing” through Twitter, FourSquare, Facebook, HootSuite and Google can increase traffic on a wound center’s website from 2x to 10x. Here is a list of reasons why social media is better than traditional print or TV:

• They can reach as many people or more people as radio or TV, and in whatever country.

• They have sophisticated targeting like AdWords, notwithstanding different criteria.

• The minimum spend is just $1 per day.

• They are the lowest cost per 1,000 impressions ad in history. They average around $0.25

per 1,000, which is only 1% of the cost of TV. Are you kidding me? Nope, it’s for real.

In other words, Facebook ads are mega-awareness raising, have good targeting, require very little commitment, and are unbelievably affordable.

Source: Facebook Advertising, 2013

Twitter has been gaining ground in the direct response marketing industry. As such, Twitter may be a better option for wound center marketing than Facebook in the long-term investment of marketing budgets:

• Twitter has 140M+ active users.

• 55% of users access Twitter on mobile, with 40% growth quarter over quarter.

• Twitter users create over one billion Tweets every three days.

• 60% of Twitter users tweet; 100% are listening.

• 79% of people follow brands to get access to exclusive content.

• During this year’s Super Bowl, one in five commercials contained a hashtag.

• Promoted Tweets get an average engagement rate of one to three percent.

In the end, both Facebook and Twitter have found that direct-response advertising is where the money is. What’s more, direct-response advertising has long been powered by user data, which both Facebook and Twitter have abundant amounts. The trick now for both social platforms is how to continue building their direct-response businesses while also infusing the same data-driven virtues in their forays into brand building. The other trick is to show how hospitals and their associated wound centers how to use this technology and advance their “brand” better than their neighboring and competitive hospital system.

So now that the office center has been using Facebook and Twitter or other social media campaign, how to you get the patients to the facility? Use of a novel, new method of interactive web designs can help. Having a full interactive web site with on-line new patient PDF packets, information on location, lists of “need to know info” as well as being able to view and see with whom they have an appointment with is huge. In today’s digital world, patients look for information, research their condition. The goal of the wound center should be not just only to increase its revenue, but also to educate patients when they come in. It would not be appropriate to have clinicians not reading up on newer technologies that are available and when patients inquire because they “read it online” you have to be able to answer their questions. The clinic patient today is smarter and increasingly more researched because of the internet/web community. A new interactive website with examples of state-of-the-art treatments and basic explanations of the care process can alleviate anxiety and reduce clinic times for patients.

Another ideal marketing ploy can open up the office center for an open house to the community once to twice a year. Have an event, usually starting around 5pm and ending at 7pm. Have the clinicians available with some of the new technology and products that the center has initiated or will be starting. Make it somewhat of a trade show and defer costs to the manufacturers to have informational tables or kiosks at the event. Outreach to the office managers and staff that refer patients as well as communities in the area to draw traffic to the office.

Finding the “untapped” resources of referrals may be the hardest of the marketing strategies to employ. For so many years as I detailed in the above part of the article, wound centers would try to survive on their in-patient and common outpatient referral sources. In today’s world of mid-level practitioners, targeting just the primary care physicians is not enough. Marketing strategies that target not just the PCPs, but their nurse practitioners, physician assistants and medical assistants is vital to the survivability of a wound center in today’s slashed medical market. Hosting informational education dinners, with or without CME and invited “lunch and learn” programs can help boost the referral sources. Of course, the best way to ensure these referral sources stay in the mix is to have good patient outcomes and excellent communication with these offices.

Another resource that may or may not be utilized efficiently is the referrals from the local urgent care and free-standing “ER” facilities. These are welcome sources of new patients as most of these clinics are good at stabilizing the original injury or complaint, but often are not able to provide the long-term care needed to continue the healing process. Targeting these short-term clinics is another vital way to ensure new patients.

Ultimately, the need for a wound center to have a comprehensive marketing strategy with a 1-3-5 year business plan is essential for growth and stability. Ensuring that the professionals that are operating in your clinic obtain certifications beyond their primary specialty boards is crucial. The clinic’s director must make sure that the clinical specialists are regularly attending meetings and conferences, having routine lunch and learn case review meetings, regularly learning about new technologies and products in the marketplace and most of all, ensuring that the patient care being delivered is above the norm for standard of care. Taking care of these items will ensure the clinic’s prosperity and financial future.

Dr. Lullove, a member of the Hollister Wound Care Speaker’s Bureau, will be speaking on Friday, October 17, 2014 at the Symposium for Advancement of Wound Care conference in Las Vegas, NV.  Dr. Lullove will be sharing the podium Friday evening with Dr. Gregory Schultz, PhD, Univeristy of Florida.  Dr. Lullove and Dr. Schultz will be speaking about protease activity in wound healing and will discuss treatment options to improve healing rates.

Dr. Lullove is a member of the Hollister Wound Care Speakers’ Bureau, Consultant for Medline Industries and ABL Medical.  Dr. Lullove is the Medical Director for the West Boca Center for Wound Healing, Boca Raton, FL.  Dr. Lullove is the Liaison to the Alliance for WoundCare Stakeholders on behalf of the Association for Advancement of Wound Care.

Exclusively at Dr. Lullove’s office:

Have a wound on your leg or foot that just won’t get better?  Dr. Lullove is proud to introduce exclusively from Hollister Wound Care, ENDOFORM dermal template.  Endoform dermal template is a FDA approved Collagen dressing derived from the forestomach of sheep.   The tissue acts as a mediator substrate and allows the wound to progress to healing without the need for extensive skin grafting, expensive enzyme debriding agents, or other expensive skin substitue tissues.

If you have a wound that you want evaluated, please contact the office at 561-989-9780.