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  Leader

The

  Medical & Surgical

in

Care of the Foot & Ankle

 

 

You may have seen recent news stories involving Dr. Schumacher.  

From CTV News:  “Working From Home Causing An Increase in Foot Pain Injuries, Experts Say”  January 18, 2021, Brooklyn Neustaeter,  Doctors report an increase in foot pain, injuries as more Canadians remain at home | CTV News 

In 2017 and 2018 articles appeared in the Globe and Mail as well as the Vancouver Sun about Dr. Schumacher's work at the Abbotsford Dialysis Foot Clinic.  

“Free Foot Care Pilot Project in Abbotsford, BC Showing Positive Signs for Patients” January 8, 2018, the Globe and Mail by Megan Devlin.  Free foot care pilot project in Abbotsford, B.C. showing positive signs for patients - The Globe and Mail 

"Specialized foot care saves limbs, but patients pay out-of-pocket to get it”  January 16, 2017 – January 18, 2017  Vancouver Sun, by Erin Ellis.  Specialized foot care saves limbs, but patients pay out-of-pocket to get it | Vancouver Sun

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What You Need to Know About Diabetes and Foot Ulcerations

Diabetes affects nearly one person in ten in Canada, and the majority will develop some type of neuropathy (abnormal nerve function) as a result.  A variety of other conditions--alcohol abuse, compressed nerves in the back, kidney disease, dialysis, liver disease, infections, chemical toxins and so forth--will develop neuropathy as well.

Up to a quarter of diabetic and other neuropathic patients will, at some point in their lives, develop an ulcer, or hole in the skin.  This leaves them susceptible to infection, amputation and shortened lives.


Frequently patients are not referred for foot screenings or proper foot treatment once symptoms develop. 


Podiatrists have a unique skill set when it comes to treating these patients.  We're foot specialists, medially trained, biomechanically trained, and surgically trained. 

Every patient at risk for neuropathy should be seeing a podiatrist, both for screening and for treatment.  And whenever possible, look for a podiatrist with a diabetic foot specialty.  D. Schumacher is a diabetic foot specialist, with certification in wound healing.  

ABOUT DR. SCHUMACHER


Dr. Schumacher is the founder and director of the Achilles Foot Health Centre, a facility devoted to medical and surgical care of the foot and ankle.

Dr. Schumacher is Board Certified by both major certification boards of his profession.  He is a Board Certified Founder and Emeritus Diplomate with the American Board of Podiatric Medicine.  Dr. Schumacher is also board certified in foot surgery by the American Board of Foot and Ankle Surgery.  

 

Dr. Schumacher is the only practitioner in the province of British Columbia with both certifications.

 

Dr. Schumacher is also a Physician Certified in Wound Healing (CMET).  And he was certified in shockwave medicine by the International Society of Medical Shockwave Therapy in Vienna, Austria.

To learn about his areas of specialization in surgery, diabetic and neuropathic wounds, designing custom orthotics, braces, and shoes, extracorporeal shockwave therapy and regenerative medicine, the treatment of chronic, non-responsive arch, heel and ankle pain, and musculoskeletal sonographic imaging, click here.

Dr. Schumacher works at the office Monday through Thursday, and speaks both English and Spanish.

ABOUT OUR FACILITY

​At nearly 4,000 square feet, the Achilles Foot Health Centre is the largest podiatric facility in western Canada.   

In fact, we recently expanded our office, adding two new treatment rooms to accommodate our expanding roster of podiatric surgeons.

 

Our state-of-the-art facility has a multiple treatment rooms and a self-standing surgical centre, which allows us to perform surgery on site, without a wait.  We are the only podiatric facility in British Columbia to have on-site ultrasonographic imaging (to image soft tissues like tendon and connective tissues), and the only facility with on-site fluoroscopy (a form of live, moving x-ray to visualize bone). 

We also offer several

unique treatments for

chronic, difficult-to-treat

conditions found in

few other facilities--

treatments like true,

focused Extracorporeal

Shockwave Therapy

(ESWT), using both

piezoelectric and electro-

hydraulic technologies. 

 

We use Platelet-Rich

Plasma injections, and

Radiosurgery. 

 

Learn more on these technologies here

We also provide vascular testing--ABI (Ankle Brachial Indices), Doppler, and photoplethysmography--for diabetics and others with poor blood supply.  These tests can predict healing potential and direct treatment.

We provide neurological testing for diabetics and other neuropathic patients.

We provide diabetic and neuropathic foot examinations and perform comprehensive wound care, including surgical debridement and offloading
with all manner of devices, including total contact casting.

We make custom orthotics, custom foot and ankle braces, and custom shoes to accommodate, correct, and control foot dysfunction and deformity. 

We also carry diabetic wound supplies, off-the-shelf orthopedic shoes, night
splints, bandages and a variety of other foot products. 

And we have a fully-functional surgical suite that allows us to perform surgical procedures on a convenient out-patient basis, with no wait.

Doctors and / or staff speak English, Spanish, Mandarin, Taiwanese, Korean, Vietnamese, and Japanese.

The Achilles Foot Health Centre provides for all your medical foot care needs.

IMG_9651.jpg

 

We're Conducting A New

Diabetic Foot Ulcer Study!


 

Dr. Schumacher and Dr. Liou are conducting a novel study on diabetic foot ulcers at the Achilles Foot Health Centre.  

The study will run through 2021 and aims to investigate a new treatment for ulcerations that have proven difficult to heal by traditional means.  The treatment involves a new way to kill bacteria, viruses and fungi from a wound site, often preventing the closure of wounds.  The technology is non-invasive, and very promising.   It could change the landscape on how we treat ulcerations.  Recent work has shown it is promising in a variety of areas, including Covid.

To qualify for the study, patients must have a difficult-to-heal diabetic foot ulcer over 0.5 cm2.  The patient must be over 19 years old, able to read English and perform basic tasks with regards to their foot ulcer.  Patients must not be on antibiotics or dialysis, and cannot be currently treated for metastatic cancers.  In addition, A1c levels must be under 12%, there cannot be any osteomyelitis (bone infection) present, and patients cannot be immunocompromised or using systemic steroids. Women cannot be pregnant. 

 

All visits and materials involved in the study are completely free.  If you think you may qualify, contact our office at 604 589 5234.

Electrohydraulic Shockwave

To Treat Diabetic Foot Ulcerations

For patients who may have difficult wounds to heal, but may not qualify qualify for the study above,  we at the Achilles Foot Health Centre are the first in BC to offer a novel form of electrohydraulic shockwave to stimulate wound healing in difficult-to-heal wounds. 

 

This technology, too, has shown great promise, and Dr. Schumacher has been using shockwave and transductive medicine for over twenty years.

MAPLE has sprouted!
 

In the Spring of 2017, Dr. Schumacher founded an organization for the education and advocacy for patients with neuropathic wounds, who too frequently do not receive the care they deserve to close their wounds and keep them closed. 

Our group is called the Canadian Medical Alliance for the Preservation of the Lower Extremity, or MAPLE

 

The MAPLE website can be found by clicking here. We hope one day every diabetic and neuropathic patient with an ulceration, or at risk for an foot ulcer, will be given a link to our site for a better understanding of their condition, and how to treat it.

What You Need to Know When Considering Foot Surgery

It's difficult to know what to look for when you need medical advice.  How do you know if the advice is correct for you?   

 

First you need to know something about

your doctor.  You might want to consider

how long the doctor has been in practice. 

 

You might want to know if your doctor is a

specialist in surgery of the foot by having

obtained board certification in foot surgery. 

 

Not all foot specialists are board certified.  Fewer still are certified in foot surgery.  The process of certification is lengthy, and involved successful completion of appropriate surgical training during residency, demonstration of surgical skills through a review of dozens of procedures in a variety of categories, a written examination and an oral examination.  The one surgical board recognized throughout the podiatric profession is the American Board of Foot and Ankle Surgery (ABFAS), and Dr. Schumacher has been a board certified Diplomate with that organization for nearly two decades.  (Click here to learn about Dr. Schumacher's other credentials and here to learn about his areas of specialization.)

Drs. Hyowon Choi and Midy Liou, recently finished a 3-year surgical residency program in Chicago and New York City, respectively, two of the best teaching programs in North America.  Each has been trained in the most recent advances in foot surgery.  And Dr. Mollica was the residency director for Vancouver General Hospital's podiatric surgical residency for over 25 years.

Having faith in your doctor is even more true when you're considering surgery.  In addition to asking if your doctor is board certified in foot surgery, ask yourself,

  • Does your doctor give you enough time to ask all your questions?  Or do you feel rushed?

  • Does your doctor explore non-invasive alternatives to surgery with you? 

  • Does your doctor discuss when is the right time for surgery?  Can it be delayed, or is there some urgency? 

  • Does your doctor go over various surgical options with you, to help tailor your procedure to your specific needs?

  • Does your doctor welcome second opinions?


If you are ever uncertain when it comes to an elective surgical procedure, there is never any harm in having a second or third opinion.

He is a Certified Fellow of the Academy of Physicians in Wound Healing, and a member of theAssociation of Diabetic Foot Surgeons, Wounds Canada, and the European Wound Management Association.For more information on diabetic wounds and how to treat them, visit www.CanadianMAPLE.org.  This is the website for the Canadian Medical Alliance for the Preservation of the Lower Extremity, an organization Dr. Schumacher founded for education and advocacy in the treatment of at-risk, diabetic and neuropathic feet. 

Covid-19 Virus Update

 

We are open during this Covid-19 / Corona virus outbreak and operating normal hours.   Our staff has all received vaccinations.

To diminish exposure for everyone, please bring as few people into the office to accompany the patient, and whenever possible, we will bring only one person in the treatment room. 

You will be asked to wash your hands before being seen and to wear a mask if you have one.    

And of course, if you are feeling ill, with symptoms of a cold, flu or fever, please stay home.   

Clinic Expansion! 

Despite Covid disruptions, our clinic is expanding.  In addition to Dr. Schumacher, we have three new doctors working at our facility--Dr. Midy Liou, Dr. Hyowon Choi, and Dr. Bert Mollica.   You can read more about them below. 

 

We also have expanded hours, and are open Monday through Saturday, with two doctors working most days of the week.    

 

Meet our new doctors

Dr. Midy Liou grew up in 

Vancouver.  He attended

the University of British

Columbia, where he

received a Bachelor of

Science in Biology.  He

then earned his doctorate

at Barry University School

of Podiatric Medicine in

Miami, Florida. 

While in school, Dr. Liou

volunteered at events to

raise awareness about

diabetic foot complications,

and to treat those afflicted with those issues. 

Upon graduation, Dr. Liou completed a comprehensive three-year surgical residency in Foot and Ankle Reconstructive Surgery at Montefiore Medical Center in New York City, serving as Chief Resident in his third year.  

 

During his residency, Dr. Liou received extensive training, and worked with the diverse population

of New York City which helped him develop the skills and knowledge to treat a wide variety of foot and ankle problems, including sport injuries, bunions, and hammertoes, diabetic feet, flat- and high-arched feet, warts and fungal nails.  He has special interest in Minimally Invasive Surgical (MIS) correction of bunion deformities, in which he has completed clinical research.

 

In 2020, Dr. Liou became a Board Certified physician from the American Board of Podiatric Medicine. 

Dr. Liou joined our practice in 2020, and currently works in our office on Tuesdays and Wednesdays, in addition to surgical hours.  He is dedicated to providing his patients exceptional care and compassion.

 

When not at the clinic, Dr. Liou enjoys playing badminton, hiking and fishing.  He is fluent in English, Taiwanese and Mandarin.

 

Dr. Hyowon Choi is a BC

nativehaving grown up

just across the Fraser

River in Coquitlam. 

Dr. Choi is a 2010 UBC
graduate
in microbiology

and ecology.  Her medical

training was performed

at the Rosalind Franklin

University of Health

Sciences in Chicago. 

 

Dr. Choi completed her surgical residency at Presence St. Joseph Hospital in Chicago, and she will practice in both Bellingham in Washington State, and in our Surrey office.

Dr. Choi practices in both Washington State and at our office in Surrey, BC.  She holds regular clinical hours at our office on Fridays and Saturdays.  She'll also provide surgical hours.

Dr. Choi is kind, empathetic, talented and highly trained.  She is also fluent in both English and Korean. 

Dr. Albert (Bert) Mollica

hales from Welland,

Ontario.  He did his

undergraduate studies

at McMaster University

in Hamilton, Ontario,

where he received 

bachelor degree in 

biology. 

Dr. Mollica attended the

Ohio College of Podiatric

Medicine (now part of

Kent State University) in Cleveland, Ohio, and he

completed his surgical residency at the Lindell program in St. Louis, Missouri.  Dr. Mollica was one of the first podiatric surgeons in Canada certified by the American Board of Foot and Ankle Surgeons.

Dr. Mollica operated a practice on Broadway in Vancouver since 1984.  While Dr. Mollica has held a variety of positions in the College of Podiatric Surgeons and BC Podiatric Medical Association, Dr. Mollica is best known as having served as residency director for the Vancouver General Hospital podiatric surgical residency program for over two decades.  Dr. Mollica trained a generation of podiatric surgeons in Canada and the US--including Dr. Schumacher.

Dr. Mollica closed his Vancouver office at the end of 2020, after 36 years of practice.  He joined our practice in Surrey in January of 2021. 

 

Dr. Mollica holds hours Monday and Thursday.  

 

 
What You Need to Know When You Need Orthotics, Foot Braces or Custom Shoes


A true orthotic is a medical device.  It's a custom-made appliance designed to treat a medical problem.  It may be designed to change a biomechanical abnormality causing pain in your foot, leg, knee, hip or back.  Perhaps it's meant to redistribute weight from a painful area.  Or maybe it's needed to offload pressure and decrease friction from a diabetic ulceration prone to limb-threatening infection.   

As a medical device, it's no different than a custom-made brace designed to improve a musculoskeletal or neurological abnormality, a custom-made shoe designed to address a deformity, or custom-made glasses to correct your vision.

Whatever your medical issue, your problem is important.  You need the right fix.  And as these can be expensive devices, you don't want to invest your money poorly.

 

But did you know that in British Columbia, there is no minimum standard of training required to design and make an orthotic?   In fact, you, yourself, could open up an orthotic store with no training whatsoever.

 

The result of this lack of regulation is that a variety of individuals sell orthotics and similar devices and purport themselves to be experts. 

 

  • This includes health providers, whose field of study and training have little to nothing to do with the foot or biomechanics, who have made a business decision to go into the orthotic business.   

 

  • This includes storefront retail operations who have hired simple sales staff making your health care decision.  Many patients have spent $300, $400, $500 or more on an over-the counter devices that can be purchased in a catalog for as little as $15 or $20. 

 

  • This includes many shoe stores who are effectively diagnosing your medical condition and prescribing a correction.  Would you go to a sunglass store and have the sales staff examine your eyes and prescribe corrective lenses?  Or would you rather have a doctor do it?

  • There are large, retail stores selling such devices. 

  • There are even people selling orthotics door to door, or showing up at a business to examine everyone there "for free."  When everyone they examine ends up with an orthotic costing hundreds of dollars, that free exam doesn't end up quite so free.  This makes extended health insurance plans less likely to cover you when you do need a real orthotic appliance. 

These providers might have people walk across a pressure plate, get a quick computer scan, or step into a foam box, and that's it!  You're diagnosed and assessed! 

 

Others even sell pre-fab devices, "adjust" it in some minimal fashion, and label it as "custom"--because now the off-the-shelf device is deemed "custom-ized" or "custom fit."  But that's far different from "custom-made," with the wording misappropriated to mislead the consumer. 

Compounding the problem are referring physicians who know little about the biomechanics of the foot, and often make referrals to inappropriately-trained individuals.  

Medicine is rarely so simple.  The wrong orthotic, brace or shoe can be, at best, a waste of money.  They may also make your problem worse.

As an example, we recently had a dialysis patient who had a custom brace that caused three new ulcerations (holes in the skin on his left foot.  They became infected and required a 6-week hospitalization for IV antibiotics.

 

The current cost of a hospitalized day in BC is well over $1,000 per day, plus the cost of antibiotics--not even considering the effect on the patient for being away from home and family. 


Another patient recently spent over $2000 on custom-made orthotics and shoes for a deformity in his foot.  They didn't do anything to address the deformity, and they were unwearable.  The shoes and orthotics had to be remade, and the $2000 initially invested was lost.

A patient with a Charcot deformity and a foot ulcer was referred to a storefront operation for offloading footwear and was dispensed a $2,400 brace and a separate $700 orthotic, neither of which offloaded the foot or were appropriate for her affliction.

We recently saw a woman with went to a shoe store complaining of foot pain.  The cause of the pain was poor circulation, but the store told her she had plantar fasciitis and made an inappropriate orthotic.  The orthotic created a hole in her foot known as an ulceration.  This became infected and the patient passed away.  A case could be made that the orthotics literally killed her.

So how do you know who to trust?

First, start with your extended plans.  Many extended plans require a podiatrist to make the appliance in order to reimburse you.  

If your plan doesn't specify who should make the device, ask the person making the orthotic or brace if they are licensed to diagnose you.  Or do you have to get a prescription from a doctor who is licensed to diagnose you?  If the maker of your orthotic is not licensed to diagnose your condition, do you want them designing your treatment plan? 

When you need an orthotic, brace or shoe, ask what level of training the health provider has.  Do they have a doctorate level of training?  Or do they have a bachelor's degree?  Or perhaps just a foot course of a few weeks duration?  As a patient, what level of training would you prefer?

If your provider has a doctorate, is that degree in a field specifically specializing in the foot and leg?  Or is the doctorate in some other unrelated discipline?

If they're making orthotics with a quick computer scan, but don't know how to make custom braces or custom shoes--that, too, is a flag.  Is the level of expertise you want in your provider someone who simply holds a computer imaging device at your foot? 

Podiatrists in BC are foot specialists with a doctorate-level of training, with extensive training in biomechanics (foot and body function).  Who better that that to understand your foot complaint and make your orthotic? 

In Dr. Schumacher's case, he has further distinguished himself by going a step beyond, as a practitioner board certified in this field by the American Board of Podiatric Medicine, specifically in the field of podiatric orthopedics and the biomechanical function of the lower extremity and human body.

If you wish to be seen by Dr. Schumacher or one of our fine associates, or get a second opinion, contact us at 604.589.5234.