34-4 Clinical Therapies for the Lower Extremity Specialist: A Review of New Frontiers



The foundation of primum non nocere, or “first do no harm,” was built upon the ideology of Veneni dextera dextrae Tempus, or “right poison, right time,” which grants the clinician agency to, while following clinical-based evidence, use their best judgement in prescribing and monitoring chemical medications (both brand-name and generic), over-the-counter products and even contemporary-traditional remedies. The two issues of FAQ that I previously led (“Clinical Foot and Ankle Pathology” in 2010 and its 2020 companion, “Clinical Pharmacology for the Lower Extremity Professional: An Update”) focused on the aims and essential consciousness of podiatric providers when making these decisions.

In the years since, our healthcare system has grappled with many obvious challenges – some long-standing, such as the opioid crisis, short staffing and the closure of rural hospitals, and some sudden and devastating, as with COVID-19. Great promise, however, is continuously presenting itself in the form of medical discoveries, specifically in the area of biologic therapeutics.

For the lower extremity clinician, these advancements point to the words of Hippocrates: “The physician must be able to tell the antecedents, know the present, and foretell the future… to do good or to do no harm” This keystone quote is the principal motivation for this issue.

Lower extremity specialists need to be familiar with and willing to explore critical elements of biologic therapeutics, not only because they may prescribe them to treat their patients, but also because they may be part of an interdisciplinary team whose other members are prescribing them. It is imperative that clinicians understand how these biologics may affect their patients, both outside and within their scope of practice. With this in mind, this issue’s Feature Article covers essential elements of these biologic therapeutics.

Our first Audio Lecture primarily focuses on the American drug approval process by the Food and Drug Administration (FDA), and explores the history of the organization, drug approvals, drug recalls and “black box” warnings pertinent to the lower extremity scope. The second lecture, centered specifically on platelet-rich plasma, is given by Dr. Brandon Brooks, a leader among our profession and a brilliant comet within the constellation of pain management and mitigating opioid harm. The condensations and commentaries in this issue are varied, with a general focus on updated relative pharmacology, therapeutics and innovations relevant (yet controversial) to our field, presented in recently-published investigations and narratives on the evolving ideology of pharmacotherapy.

In its review of many advances and changing viewpoints in pharmacotherapeutics, my hope is that this issue will enhance the knowledge base of the practicing foot and ankle specialist, helping them in selecting appropriate therapeutic agents for their diverse patient population with confidence.

Robert G. Smith, DPM, Msc, RPh, FNAP



34-4 In this issue:

  • FEATURE ARTICLE: Biologics Pharmaceuticals: Scientific gradus deinceps
    Robert G. Smith, DPM, MSC, RPh, FNAP
    • Immunotherapeutic Strategies for Treating Opioid Use Disorder and Overdose
      Commentary by Robert G. Smith, DPM, MSC, RPh, FNAP
    • Microenvironment-Based Diabetic Foot Ulcer Nanomedicine
      Commentary by Lauren L. Schnack, DPM, MS, AACFAS, FACPM
    • The Promising Hydrogel Candidates for Pre-Clinically Treating Diabetic Foot Ulcer: A Systematic Review and Meta-Analysis
      Commentary by Lauren L. Schnack, DPM, MS, AACFAS, FACPM
    • Toward Developing Immunocompetent Diabetic Foot Ulcer-on-a-Chip Models for Drug Testing
      Commentary by Deep N. Shah, DPM, MBA
    • Regional Anesthesia in Patients on Antithrombotic Drugs: Joint ESAIC/ESRA Guidelines
      Commentary by Ashka Trivedi, DPM
    • Drug-Induced Peripheral Neuropathy: A Narrative Review
      Commentary by Darrell R. Latva, DPM, FACFAS, FACPM
    • Topical Gel-Based Biomaterials for the Treatment of Diabetic Foot Ulcers
      Commentary by Pratibha Patel, DPM, FACPM
    • Meta-Analysis of Randomized Controlled Studies of Closed Incisional Negative Pressure Wound Therapy vs. Standard Wound Dressing in the Prevention of Surgical Site Infections for Patients Undergoing Surgeries for Lower Extremity Fractures
      Commentary by Deep N. Shah, DPM, MBA
    • A Systematic Review on Smartphone Use for Activity Monitoring during Exercise Therapy in Intermittent Claudication
      Commentary by Sai Vikas Yalla, PhD
    • Treating Severe Refractory and Augmented Restless Legs Syndrome
      Commentary by Ashka Trivedi, DPM
  • AUDIO LECTURE 1 : The Food and Drug Administration: A Primer for the Lower Extremity Specialist
    Robert G. Smith, DPM, MSC, RPh, FNAP
  • AUDIO LECTURE 2: Platelet-Rich Plasma (PRP)
    Brandon M. Brooks, DPM, MPH