August 1, 2017
The American Podiatric Medical Association (APMA) is proud to announce it has joined the Choosing Wisely Campaign, led by the ABIM Foundation and Consumer Reports, to reduce waste in the health-care system and avoid risks associated with unnecessary treatments.
APMA joins more than 80 Choosing Wisely partner organizations in providing a set of evidence-based recommendations for the campaign.
The recommendations, designed to spark conversations between podiatric physicians (and other clinicians) and their patients about avoiding unnecessary tests or procedures, were developed by APMA's Clinical Practice Advisory Committee of member podiatric physicians.
APMA’s recommendations include:
- Avoid routine use of pharmacologic DVT prophylaxis in elective foot and ankle surgery.
The decision to implement pharmacologic prophylaxis should take into account the risk of deep venous thromboembolism (DVT) in the absence of prophylaxis, and the potential adverse effects associated with the use of pharmacologic prophylaxis.
- Don't culture or treat clinically uninfected lower extremity wounds with oral antibiotics.
Uninfected wounds are contaminated with surface flora and will yield false positive culture results. Wounds that are not clinically infected do not require antibiotics.
- Avoid ordering MRI in patients with suspected acute Achilles tendon ruptures.
History and physical exam findings can establish the diagnosis of acute Achilles tendon ruptures in nearly all instances. Physicians should reserve MRI for atypical presentations and subacute or neglected ruptures when preoperative planning is needed.
- Don't use synthetic or donated grafts on diabetic foot wounds without first allowing an adequate trial of proper standard wound care.
Most diabetic foot wounds will heal with proper wound care. If a wound has not healed by at least 50 percent in four weeks, synthetic or donated grafts may then be necessary.
- Don't routinely use MRI to diagnose bone infection (osteomyelitis) in the foot when the diagnosis can be reliably established by less expensive means.
When the diagnosis of osteomyelitis can be reliably established by clinical means and/or serial plain film radiographs, MRI is generally unnecessary.
"Podiatrists play a vital role in today's health-care system, and we are very excited to be part of this important and timely conversation regarding safe and effective care," said APMA Director of Clinical Affairs Dyane Tower, DPM, MPH, MS. "APMA's recommendations will provide opportunities for open communication between physicians and patients so wise choices can be made."
Read APMA's full recommendations and learn more about the Choosing Wisely Campaign at www.choosingwisely.org.