—PM Pulse Exclusive—
More Miles, Less Recovery: Sports DPMs and lower extremity injuries
For most of the history of professional sports, a ruptured Achilles tendon usually happened to older players and typically signaled the end of their time as a productive athlete. More recently, advances in medical technology and techniques have made this less of a death knell. Kobe Bryant tore his Achilles in 2013 and returned strong enough to play several more years, famously ending his career with a 60-point game in 2016. And Aaron Rodgers is still the starting QB for a winning team in 2026, at age 43, three seasons after his own Achilles injury.
Although the data don’t prove that these injuries are more prevalent today, they certainly do seem to be. Among numerous recent high-profile examples, San Francisco 49ers linebacker Dre Greenlaw popped his Achilles simply running onto the field during Super Bowl LVIII in 2024. And the 2025 NBA playoffs were significantly impacted by the Achilles tears suffered by Jayson Tatum and Tyrese Haliburton. All three of these players were in their mid-20s when the mishaps occurred, and all have resumed playing at a high level.
One byproduct of all this is that the evolving sports injury landscape offers opportunities to podiatrists. As athletes and trainers try to prevent such injuries, sports-focused DPMs are examining the problem in the office and in the lab. Potential culprits include increased sports specialization from younger ages, the pace and intensity modern high-level sports demand, and the equipment these athletes use—namely, is it the shoes?
—Reader Feedback—
Partnering With Other Medical Providers
I’m interested in expanding my professional partnerships in my area. This is about establishing a network of complementary medical providers (not necessarily just DPMs) who can share information, make patient and/or supplier referrals when appropriate, and so on. Does anyone have any advice about how best to get started with this and anything I should consider as I go?
—Name Withheld
To respond to this query, email [email protected].
—PM Pulse Exclusive—
High-Tech Wounds, Human Problems
What a Global Conference Revealed About the Future of Healing
We can image wounds with artificial intelligence, manipulate the wound microenvironment, engineer sophisticated tissue matrices, and deploy technologies that would have seemed unimaginable just a decade ago. Yet, despite these advances, one uncomfortable question remains: Are we getting better at treating wounds, or are we truly getting better at healing patients?
Walking away from the recent World Union of Wound Healing Societies (WUWHS) conference held Sept 23-26, 2026, in Kuala Lumpur, Malaysia, I was struck not only by the breadth of scientific innovation presented but also by an equally important undercurrent woven throughout the program: the need to reconnect technological progress with the realities of the patient experience. Perhaps the next great advancement in wound care won’t come from what we put on a wound, but from rethinking everything that happens around it.
—Windy Cole, DPM, CWSP
To read this entire article, click the button below. To submit a response or question, email [email protected].
Coding for Skin Lesions
Question: Is my ICD-10-CM D49.2 or D48.5 for a suspicious skin lesion? I am told it can be either one, but I’m not sure how one distinguishes the coding, Can you tell me how to apply these correctly?
Response from Codinghelpline.com:
When the physician does not yet know what the lesion is, the diagnosis should be based on what is documented before the pathology result, not on what the biopsy is intended to determine.
The official Neoplasm Table distinguishes:
ICD-10-CM D48.5 — Neoplasm of uncertain behavior of skin
ICD-10-CM D49.2 — Neoplasm of unspecified behavior of bone, soft tissue, and skin
Uncertain behavior means the provider has characterized the neoplasm as one whose behavior is uncertain.
Unspecified behavior means the provider has identified/diagnosed a neoplasm, but its behavior has not been specified.
Bottom line: it all depends on what is stated in the documentation.
Example, "Lesion on left foot, rule out basal cell carcinoma (BCC). Shave biopsy performed." That does not automatically support ICD-10-CM D48.5 merely because BCC is in the differential. The physician is saying, in effect, "I don't know what this is; pathology is needed." If the physician documents it as a neoplasm of unspecified behavior, ICD-10-CM D49.2 is the corresponding code.
Example, "6mm irregular pigmented lesion, concerning for melanoma. Biopsy performed." The physician is concerned about melanoma, but that wording by itself doesn't necessarily establish ICD-10-CM D48.5.
Example, "Neoplasm of uncertain behavior of skin, biopsy today to determine benign vs malignant." This is a very clear ICD-10-CM D48.5 scenario.
—David J Freedman, DPM, CPC, CSFAC, CPMA
Additional coding and billing questions and responses can be found at www.Codinghelpline.com. To ask a question or add your thoughts, email [email protected].
Overcoming Workplace Anxiety
Everyday workplace occurrences—including formal and informal public speaking, negotiating conflict with supervisors and coworkers, meeting deadlines, competition, burnout and more—may cause stress, leading individuals with anxiety to avoid specific situations entirely.
Source: RepertoireMag.com
How Confident Are You in Your Cybersecurity Setup?
New Review of GLP-1s and Foot and Ankle
I already covered Ozempic feet, the soft tissue and volume loss patients notice in their feet after rapid weight loss. A newer, and in some ways more important, question researchers are now asking is what these medications do to bone itself, and that matters enormously in a body part made up of twenty six small bones per foot.
A 2026 review of sixteen studies on GLP-1 medications raised questions about the bone effects of semaglutide, the active ingredient in Ozempic.
Source: Dana Figura, DPM, Yahoo Creators
From the Magazine
The Butterfly Effect and the Medical Practice
The concept of the butterfly effect is used to illustrate the way that some complex dynamic systems exhibit unpredictable behaviors such that small variances in the initial conditions could have profound and widely divergent effects on the system’s outcomes. Because of the sensitivity of these systems, outcomes are unpredictable. This idea became the basis for a branch of mathematics known as chaos theory, which has been applied in countless scenarios since its introduction.
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Does Diabetes Have a New Wonder Drug?
Researchers at Michigan Medicine have uncovered a mechanism that may explain why sotagliflozin, an FDA-approved diabetes medication marketed as Inpefa, reduces the risk of heart attack and stroke. In a series of laboratory experiments, the research team found that the drug helps prevent excessive platelet activation, a process that can lead to dangerous blood clots that block flow to the heart and brain.
Source: U of Michigan
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