Brian Zinsmeister, DPM, a podiatrist who joined the Emerson medical staff 26 years ago, says there is nothing boring about the practice of podiatry. As the podiatry service chief, he hopes to build greater collegiality among Emerson’s six separate practices. Dr. Zinsmeister is the third generation of podiatrists in the same practice, which has had various locations in Lexington.
What first attracted you to podiatry?
I was in college, pre-med, when my aunt, who was a nurse, suggested I consider podiatry. Sports medicine was in its infancy, and she knew a podiatrist in the New Jersey hospital where she worked. She said “come visit,” so I did. I think people like podiatrists, perhaps because we’re by necessity somewhat humble. Podiatry is a kind of orphan profession that is unique to the U.S. in the way it is practiced.
People ask me if I get bored practicing podiatry, but I don’t. Foot problems may be the same, but the people attached to them are different. Everyone has unique circumstances, whether it’s family, job or responsibilities. The patient’s treatment plan has to involve all of that.
Are there misconceptions about practicing podiatry?
The big misconception is that you treat a lot of old people. But on a typical day, I might see a 10-year-old, a 15-year-old, a 95-year-old — and everybody in between. It runs the gamut. Foot problems include sports injuries, inherited foot problems and joints that wear out due to arthritis. I would say older people represent 15 percent of my practice. The average person walks 100,000 miles during a lifetime; as a result, there are plenty of age-related foot problems, such as hammertoes and bunions.
What is the most common diagnosis you see?
It’s plantar fasciitis, which the world suffers from, partly due to what we do and partly due to the shoes we wear. Shoes are important; they either help you get better, or they hinder you, which is why I have a list of recommended shoes on my website. We have a regular protocol we follow for plantar fasciitis aimed at taking the stress off the fasciia. It involves wearing the right shoes, stretching, massage, anti-inflammatories and possibly a cortisone shot. This works 80 percent of the time.
Chronic fasciitis is a different animal — a degenerative condition that requires micro-irritation in order to stimulate healing. I perform a procedure called Topaz, which uses radiofrequency waves and is successful 85 percent of the time. We will often inject stem cells to promote healing.
Is it a challenge to get a patient to stay off their foot after surgery or an injury?
Whether it’s after surgery or an injury, there needs to be a commitment to get better. When a patient says “I don’t like this bunion,” I ask if they are willing to commit to eight weeks of restricted activity and lifestyle to get better. If they say no, then I know they’re not ready for treatment. Pain is usually the impetus that gets people to make the commitment. I probably talk as many people out of surgery as I convince to have surgery. They need to understand that the foot takes a long time to heal for one reason: you walk on it.
You currently serve as podiatry service chief.
These are changing times; health care is kind of stressful. One of the things I would like to see in our department is more collegial relationships among our six independent practices. We’re all in this together, so if somebody discovers something new, they should share it. It might be related to a regulation or the use of a code that doesn’t work anymore. I’m in my first year as chief, and my goal is that we avoid functioning like islands not joined by a bridge.
What do you enjoy during your time off?
I garden in the warm weather. I love the Cape; I’ve been going to Wellfleet for 55 years. I go there year-round, including the middle of winter. The mountains don’t do it for me; the ocean does. I dabble in the antique business. My grandmother was an antique dealer, and my mother had antiques, so I grew up with them.