1. Low back pain/radiculopathy and its impact on healthcare costs. Need for early assessment and treatment to avoid future disability. By SANDRA GOTMAN, DPM Kendall Regional Medical Center

2. Presenter Disclosures (1) (1)The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose. SANDRA GOTMAN, DPM

3. Common area for L.S radiculopathy. Nerve roots L4,5 and S1,2

4. Introduction: definition and causes What is radiculopathy? Onset of neurological compromise. Some Common Causes: 1) Improper postural position of lumbo- sacral spine 2) Ergonomic factors 3) Abnormal foot biomechanics

5. Full body dermatome chart.

6. Connecting the dots… Lumbo-sacral radiculopathy Sciatica Disc disease Restless leg syndrome All of the above are related

7. Classification of nerve damage Neuropraxia Axonotmesis Neurotmesis Can be used to grade nerve damage

8. Incidence According to NIH: 12 million people affected by restless leg syndrome Sciatica, anywhere from 1.2% to 43% of US population (demonstrates inaccuracy of studies) Lumbo-sacral radiculopathy, 3 to 5% of the US population

9. Diagnosis Signs- Strange sensation feet/legs Imbalance when walking/running Burning bottom of both feet Tripping/fatigue of lower extremities Symptoms- Nerve compression with radiation to lower extremity Back pain Urinary Incontinence Tingling/numbness/pulling sensation of legs

10. Cost to healthcare system Over $90 billion, of which $26 billion spent on treating the back pain Remainder includes lost wages, disability payments, and retraining costs

11. Treatment Conservative Treatment: Physical conditioning of musculature Lumbo-sacral area Physical therapy Ergonomics-Changes in ones body movements Use of DME equipment Lumbar supports/ Supportive shoe gear Non-conservative Treatment: Oral Medications Local Nerve blocks Surgical Intervention when all else fails

12. Prevention Musculoskeletal assessment of children- as soon as walking starts. Adults- Musculo-skeletal assessment Lower extremity neurological assessment Implementation of multiple conservative modalities.

13. Conclusion Lumbo-sacral radiculopathy has a significant impact on quality if life Contributes to Obesity problem that is plaguing this country Cost to healthcare system is significant. Early diagnosis and treatment can decrease healthcare cost, and improve the lives of many people.

14. The New Jersey Nets Senior Hip Hop Team.

15. Acknowledgements Dr. Francis Wodie: Creation and preparation of Power Point presentation. Contribution to research Audio visual support and troubleshooting Dr. Amy Bodart: Review of oral presentation slides and written format.

16. References Free MD (2008), Sciatica. Retrieved September 18 th 2010 from the free MD Web site http://www.freemd.com/sciatica/incidence.htmhttp://www.freemd.com/sciatica/incidence.htm Konstantinou, k. (2008). Sciatica: Review of epidemiological studies and prevalence estimates. Spine, 33, 2464-2472. National Institute of Neurological Disorders and Stroke (2010). Restless legs syndrome Fact sheet. Retrieved October 1 st, 2010 from the National Institute of Health Web site http://www.ninds.nih.gov/disorders/restless_legs/detail_restless_legs.htm http://www.ninds.nih.gov/disorders/restless_legs/detail_restless_legs.htm Simon H. (2009). Back pain and sciatica. Retrieved Sepember 18th, 2010 from the A.D.A.M. Web site http://adam.about.com/reports/Back-pain-and- sciatica.htmhttp://adam.about.com/reports/Back-pain-and- sciatica.htm Taruli, A.W. (2007). Lumbosacral radiculopathy. Neurol Clin, 25, 387-405. The University of Wisconsin (2006). Radiculopathies. Retrieved September 15 th, 2010 from the Neuroscience Resource Page Web site http://www.neuroanatomy.wisc.edu/SClinic/Radiculo/Radiculopathy.htm#low limb http://www.neuroanatomy.wisc.edu/SClinic/Radiculo/Radiculopathy.htm#low limb Wikipedia (2010. Dermatome chart. Retrieved October 6 th, 2010 from the Wikipedia Web site http://en.wikipedia.org/wiki/Dermatomic_areahttp://en.wikipedia.org/wiki/Dermatomic_area

17. Dr. Sandra Gotman, Podiatry Education Director at Kendall Regional Podiatric Residency Program. 11760 SW 40th St, suite 616, Miami, FL 33175. Phone number: 305-229-9595. Fax number: 305-229-9596. E-mail: sgotman@bellsouth.net sgotman@bellsouth.net