“We Shouldn’t Be Doing It”: Lecturer Calls Out Serious Podiatric Myths
During his lecture entitled “Righting the Wrong: Exploding Myths in Podiatric Medicine” last month, Bradley W. Bakotic, DPM, DO, Bako Pathology Services in Alpharetta, GA called out some myths which have inexplicably become part of the modus operandi of the modern podiatrist.
“Podiatry is a little bit incestuous,” Dr. Bakotic said. “If you go to MD school, you’re taught dermatology by a dermatologist. In podiatry, you’re often taught dermatology by a podiatrist who has an interest in dermatology. It’s incestuous in the sense that we don’t get out into other disciplines like we should. We pass on ideas, and sometimes they’re frankly wrong.”
The first myth Bakotic tackled was “Soft tissue mass? Just cut it out!” school of thought.
“That’s a big one” he continued, “It’s profession-wide and can actually end up in frank negligence. I think this came from the fact that 70 percent of pedal soft tissue masses are ganglia, which are pseudo cysts. The problem is other neoplasms happen.”
“If you just cut it out blindly, you almost never have appropriate margins, so you’re going to have a higher recurrence rate,” he said. “It almost doubles. Distant metastasis also almost doubles.”
Bakotic went on to state the potential litigative repercussions of this; “When you go in and cut out soft tissue mass with positive margins, you cannot do limb-sparing surgery in the aftermath,” he said. “It has big repercussions.”
His conclusion on the myth was strong; “Cutting out soft tissue mass is something that should be left behind in this profession, we shouldn’t be doing it. We hurt people.”
Dr. Bakotic continued to dispel another myth – that acral dermatitis should be seen as tinea pedis until proven otherwise.
“When I was practicing podiatry, I wrote [a prescription] for one corticosteroid in seven years,” he said. “That’s incompetence. I was led to believe every time you saw a rash on the foot, it was tinea.”
Like many podiatric physicians, Dr. Bakotic said, he commonly writes prescriptions for antifungals.
“If you get the prescription data, you’ll see it’s an absolute fact. Only 25 percent of podiatrists prescribe a topical corticosteroid at least once a month. That’s ridiculous.”
After sharing results of studies that show nearly two-thirds of skin biopsies thought to be tinea pedis are not, Dr. Bakotic shared 10 photos with the audience, asking them to identify how many were cases of tinea pedis.
The answer? None.
“Many of us were just taught to assume everything’s a fungal infection,” Dr. Bakotic said. “When I was a student, if someone came in with dermatitis I was already running to the cabinet with the Spectazole samples.”