Dr. Robert Greenhagen and his coauthors, Drs. Dane Wukich and Robert Frykberg, recently published their findings on vitamin D and the risk of various diabetic foot complications.  The authors found that low vitamin D increased the risk of ulceration, infection, and peripheral arterial disease.  While the use of supplementation to prevent these conditions was not performed, we suggest that everyone consider vitamin D supplementation.  This is especially important for individuals that live north of the 37 degrees latitude, which includes the Nebraska and Iowa areas.

A free copy of the article is available by following this link: Serum vitamin D and diabetic foot complications

Humans started wearing shoes between 10,000 to 40,000 years ago.  The oldest surviving shoe is about 5,500 years old and was found in Armenia in 2010. But the history and purpose of shoes is more interesting and important than just the fashion statement they have become.

Shoes are one of the most important inventions in human history.  Shoes allowed men and women to explore new terrain and prevented injuries.  Without shoes, humans could not venture out into the cold and/or rocky areas of the world limiting out ability to migrate. The Roman army's caligae is an excellent example of how shoes have changed humna history.  Roman soliders were provided Army issued caligae.  The design of the sandal seems flimsy and inappropriate for a solider, but the this is not true.  The open-air design allowed improved ventatilion so that they could be worn all day.  The shoe also had a custom fit and proper leather which reduced blisters and allowed safety on a long journey (soliders were known to march up to 25 miles each day).  The Roman army also had other designs that allowed protection against the cold.  Closed toe boots and wool socks were common in various regions of the Roman expansion.

But even in the Roman army fashion became a big part of shoes; in fact the emperor had to ban soliders from adiing decorations or changing the color of the leather.  In today's world fashion many times comes before function.  Shoes such as high heels can cause alterations of the normal weight bearing surface of the foot.  This change can lead to long term damage to the soft-tissue and joints of the forefoot.  The risk of damage can be reduce by the use of orthotics or padding.  Also, some hoe designers such as Vionics have design shoes with a function first mentaility.  That does not mean that fashion suffers; instead the shoes are made fashionable around a solid functioning shoe structure.  Our offices are offical Vionic Medical Retalor.  Our pedorthitist team can assess your proper fit and design to ensure that you have the proper shoe gear.

Athletes are also very vunerable to injuries due to improper shoe gear.  Recently, Zion WIlliamson suffered from a major shoe failure but more common is runners that develop tendonitis or stress fractures due to the use of old shoes gear. Like tires, shoes should be changed on a regular basis and this is many times based on miles not months.  Athletes must also ensure that they have the proper style of shoe. The pedorthotist team is also available to assess your sport and foot type to help you select the proper shoe gear and shoe inserts.  We distribute many different manufacturers such as Brooks, New Balance, and Propet.

If you are interested in seeing our pedorthotist team, call 402.391.7575; appointments are needed.  We have many items in stock but some items may need to be ordered and can take up to 4 weeks to arrive.

The importance of independent medical providers cannot be stressed enough.

For everyone that is frustrated in the rising cost of health care, know that your independent provider is too. A recent study showed that hospitals and hospital-owned physicians are the real sources of the skyrocketing cost of health care.  Most people are not aware that physicians that are owned by the hospital are paid more than independent providers; as a matter of fact, this higher rate costs Medicare and Medicare patients over $750 million each year.  Independent physicians and services were responsible for a 6% increase in health care costs while hospital-owned physicians and services increased 25%.

Are you seeing the best possible provider?

Did you know that most hospital systems require providers to internally refer and may be terminated if they don't comply? Sadly, these policies have recently made news in the Omaha area; Children's Hospital appears to have selected a less qualified surgeon due to internal referrals.

Choose wisely when you select your physician; ask questions when you are referred. Is this provider the best or just in the hospital system? You have the right to choose, and that choice has a big effect on the outcome and price of your care.  

Why are we different?

We are proud to say that the providers at the Foot and Ankle Center of Nebraska and Iowa and FAST Physical Therapy have earned our referrals through hard work, unmatched skills, compassion, and dedication.  We are always concerned about controlling costs and providing the most cost-effective therapies.  We also use the most advanced therapies to improve outcomes and speed recovery. 

Come see the difference, set-up an appointment with one of our providers by calling 402-391-7575.

 LB 37 at Nebraska Unicameral Legislature  

The cold weather did not keep Dr. Greenhagen from traveling to Lincoln, Nebraska on January 30, 2019 to speak on behalf of the Nebraska Podiatric Medical Association concerning LB 37.  LB 37 is a bill being introduced to change the Podiatry Practice Act.  The change would impact podiatry in Nebraska to allow and authorize a physician assistant to assist a podiatrist.  The bill is being sponsored by Senator Hilkemann.                                                                            

Introduction of LB 37    

The bill was introduced by Senator Hilkemann to a committee of 10 senators on Wednesday, January 30.  Dr. Greenhagen was asked by Senator Hilkemann to speak on his knowledge and expertise in the area of podiatric care. Dr. Greenhagen provided data as to why a physician assistant would be helpful in growing podiatry care in rural Nebraska and helping to continue to provide exceptional podiatry care in current podiatric practices and hospitals. 

When a bill is introduced to Legislature, the bill must receive a public hearing by a committee.  The information Dr Greenhagen provided was transcribed and recorded to become a part of the official committee records.  To view the official site of the Nebraska Unicameral Legislature, please click on the link below.

https://www.nebraskalegislature.gov/bills/view_bill.php?DocumentID=37384

What happens next?

The committee now has three options to take, they can: 

• Vote to send the bill to general file with or without amendments
• Indefinitely postpone the bill
• Take no action on it

The surgeons at Foot and Ankle Center of Nebraska and Iowa will continue to follow the progress of this bill.  LB 37 will hopefully make its way to the Legislature floor and find its way to the desk of the Governor for signing.

What can you do?  

If you support LB 37 you can contact your Senator. Click the link, you can find your Senator by name or district number at:

 https://nebraskalegislature.gov/senators/senator_list.php