Highlights from the APMA 2025 National Conference: Affiliated Organizations Session

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The Affiliated Organizations session at the 2025 American Podiatric Medical Association (APMA) National conference in Grapevine, Texas, offered timely and actionable insights from a distinguished panel of podiatric physicians. Four expert-led lectures covered topics ranging from perioperative optimization and foot intrinsic musculature to workplace safety and digital documentation tools. Below are just some of the key takeaways from this engaging track.

Perioperative Surgical Management

Melissa Lockwood, DPM, DABPM, FASPS, FACPM, FAAWP, FAAPPM – Chair of American Society of Podiatric Surgeons, emphasized the importance of thorough preoperative evaluation and shared decision-making between patients and podiatric surgeons, particularly in elective surgical cases. Key considerations included:

• Risk Stratification: She advocated for assessing nutritional status (eg, albumin levels), glycemic control (HbA1c), and autoimmune conditions. Patients undergoing elective surgery often require optimized preoperative care to reduce complications.
• Medication Management: Current observations she noted included that GLP-1 receptor agonists (eg, semaglutide) be discontinued at least 7 days prior to surgery due to their effect on delayed gastric emptying, which increases aspiration risk under anesthesia. She noted that this is an area of evolving consideration.
• Communication is Critical: Multidisciplinary coordination and documented shared expectations can work to improve outcomes, in her experience. This includes surgical plans, postop weightbearing status, and wound care protocols.
• Deep Vein Thrombosis (DVT) Prophylaxis: Dr. Lockwood warned that aspirin alone is often insufficient to achievet his goal. Instead, she discussed using pharmacologic prophylaxis and mechanical support (eg, compression devices) as appropriate and following evidence-based protocols.
• Postoperative Pain Planning: Opioid stewardship is paramount, but non-narcotic options and patient education can help bridge the gap between pain control and regulatory limits.

The Emerging Importance of Addressing the “Foot Core”

Alicia Canzanese, DPM, ATC, Immediate Past President of the American Academy of Podiatric Sports Medicine, presented on the biomechanical significance of the intrinsic foot muscles—coined with the term “foot core”—and their role in functional movement and injury prevention.

• Intrinsic Muscle Function: She shared that these muscles help maintain arch integrity, aid in balance/proprioception, stabilize the alignment of the digits, and control deformation of the foot under load. Their importance parallels that of core stability in the torso.
• Impact on Common Pathologies: Dr. Canzanese shared evidence that deficits in intrinsic strength have links to plantar fasciitis, chronic ankle instability, and bunion progression. Fatigue of these muscles may impair proprioception and increase injury risk.^1-3
• Rehabilitation and Strengthening: Exercises like toe curls, arch doming, and toe spreading (also known as “toe yoga”), can significantly work to improve intrinsic strength. Incorporating them into rehabilitation regimens may improve postural control, movement efficiency, and injury recovery, she explained.
• Footwear Implications: Narrow toe boxes limit natural toe splay and intrinsic activation, she noted. Transitioning to more anatomically shaped footwear can enhance foot muscle engagement, but should be done gradually, in her experience.
• Need for Research: While growing, the literature is still limited by small sample sizes and heterogeneous protocols, she added. More high-quality studies are needed to clarify guidelines.

Prioritizing Safety for the Female Patient and Practitioner

Elizabeth Piselli, DPM, President of the American Association for Women Podiatrists, addressed often-overlooked aspects of musculoskeletal safety, ergonomics, and occupational hazards for female podiatrists and their patients.

• Work-Related Injuries: Over 75% of podiatrists experience musculoskeletal injuries, especially in the lower back, due to prolonged leaning, awkward posture, and repetitive strain in the biomechanics of their day-to-day work.⁴
• Preventive Ergonomics: Dr. Piselli demonstrated simple stretches, posture resets, and warm-ups (eg, wrist rolls, neck stretches, shoulder pulls) that can be easily integrated into daily clinical routines.
• Core Strengthening: Strengthening the entire kinetic chain—including hips, gluteal muscles, and back muscles—is vital to protect against chronic injury and fatigue on the job.
• Radiation and Personal Protective Equipment (PPE) Awareness: Female podiatrists must be vigilant about proper lead protection and positioning during fluoroscopy. She presented multiple modalities clinicians can choose to address this risk, monitor exposure, and assure best practices.
• Burnout and Self-Care: Compassion fatigue and depersonalization were flagged as real risks for clinicians. Dr. Piselli encouraged mindfulness, community support, and engaging with mental health resources such as that offered by the APMA, to educate and promote personal/professional wellness.

Virtual Scribes, Real Impact

Andrew Schneider, DPM, President of the American Academy of Podiatric Practice Management, explored the evolving role of virtual and AI-powered scribes in modern podiatric practices.

• Types of Scribes: Three categories were discussed:
  1. In-Person Human Scribes: Dr. Schneider noted that these can be highly effective but costly. In these scenarios, the scribe can observe procedures directly, providing the most direct pathway to accurate documentation.
  2. Virtual Scribes: Often remote (sometimes international), this type of scribe provides real-time or asynchronous documentation via audio/video platforms, he explained.
  3. AI Scribes: He shared that this type of scribe may offer cost efficiency and integration with EHRs, but are limited by context (eg, cannot “see” procedures or gestures in conversation).
• Compliance and Accuracy: Regardless of type, said Dr. Schneider, scribe documentation must meet HIPAA and billing standards. Providers must validate and supplement the notes the scribe provides as needed.
• Patient Experience: When properly introduced, he shared that he finds patients generally respond positively to scribe usage, especially when it allows for more physician eye contact and engagement.
• Productivity Gains: By offloading documentation, providers can work to reduce burnout, improve charting accuracy, and potentially reclaim personal time without compromising care, he said.

Final Thoughts

The Affiliated Organizations session at APMA 2025 highlighted both cutting-edge clinical strategies and holistic wellness considerations. Whether enhancing surgical outcomes, optimizing biomechanical function, preventing practitioner injury, or embracing digital tools, these lectures reinforced the importance of informed, integrated care in podiatric medicine.

References

1. Ridge ST, Olsen MT, Bruening DA, et al. Walking in minimalist shoes is effective for strengthening foot muscles. Med Sci Sports Exercise. 2019;51(1):104-113.

2. Jaffri AH, Koldenhoven R, Saliba S, Hertel J. Evidence for Intrinsic Foot Muscle Training in Improving Foot Function: A Systematic Review and Meta-Analysis. J Athl Train. 2023;58(11-12):941-951.

3. Lee DR, Choi YE. Effects of a 6-week intrinsic foot muscle exercise program on the functions of intrinsic foot muscle and dynamic balance in patients with chronic ankle instability. J Exerc Rehabil. 2019;15(5):709-714.

4. Tan ML, Heng M, Ker PTS, Lim JW. Work-Related Musculoskeletal Disorders Among Podiatrists in Singapore. J Am Podiatr Med Assoc. 2025 Feb 19:1-26. doi: 10.7547/23-217. Epub ahead of print. PMID: 40009467.