BROOKINGS – Fresh out of a three-year surgical residency next door in Iowa, Nephi Jones, 38, DPM (doctor of podiatric medicine), is now a member of the staff at Avera Medical Group Specialty Care in Brookings.
“I completed my surgical training in June; then I came right here and started my practice about a week ago,” the doctor said. “I’m already seeing patients. I’ll be getting surgeries lined up soon.”
The Hawkeye native grew up on a little farm outside the small town of Coin: “Born and raised down there. Been in Iowa most of my life,” Jones added.
He got his undergraduate education at Bellevue (Nebraska) University, in a suburb of Omaha; Medical School in Chicago, at the Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science. He graduated in 2018 and moved on to three years surgical training, at Unity Pointe Health in Des Moines. Unity Pointe “has a lot of outreach clinics and hospital systems throughout most of the major cities in Iowa,” Jones said. “It’s trying branch out outside of Iowa, I think.”
What does a podiatrist do?
“I didn’t know what a podiatrist did before I really dove into it,” Jones explained, smiling. “I thought they just trimmed toenails and things like that. So once I started looking into it, before I got into school, I realized the depth that we actually do.
“Basically, (podiatry) is the foot-and-ankle health from the knee down. Any problem that anybody has, whether it’s with skin lesions, rashes or broken ankles, anything. We’re trained to take care of everything.”
The doctor added that he’s also been “trained to deal with open fractures, closed fractures and diabetic patients.”
And they’re a big part of his practice.
“There’s a lot that can go wrong with diabetic patients,” Jones explained. “There’s a lot of different pathology that they experience. I would guess we spend 50 percent or more of our time assisting patients with diabetes that have either wounds or breakdown of their feet, which causes wounds. A lot of them have no sensation in their feet; and so they get different calluses and things that can lead to wounds. So we help prevent that.”
Jones briefly described the difference between the two types of diabetics he treats: Type 1 diabetes is “congenital, usually a juvenile thing. It’s usually diagnosed in adolescence or early 20s; the pancreas “produces no insulin at all, so they have to have insulin. They’re usually thin, not obese. They look healthy.”
Type 2 diabetes “is a prolonged, acquired disease. Over the years, by the time you’re 30, 40, 50, cells that produce insulin don’t work as well. Oral medications can help provide control.”
Type 2 at epidemic levels
How severe is the diabetes that leads to a podiatrist’s intervention?
“A lot of it is type 2 diabetics who don’t realize they have diabetes for many years,” Jones explained. “During that course of time when they don’t know they have it, there’s a lot of damage that’s going on to blood vessels, nerves and even skin, that’s kind of subtle. You don’t know it’s happening until you finally get that diagnosis: ‘Hey, you’re diabetic, likely for a long time.’
“At that time, they’re probably starting to lose sensation in their toes, feeling tingling or maybe a lack of feeling for a long time. By the time of their diagnosis, there has probably been irreversible damage going on.”
Jones noted that diabetes is more that just having high blood-sugar. “It affects all your organs, your blood vessels. Then it starts affecting your nerves and you lose sensation and everything.”
Early diagnosis of diabetes is key for most people, and once that’s known, it’s time to get a yearly foot exam to learn what to look for. A routine physical exam is a good time to have feet screened.
There are oral medications to help control blood sugar, the doctor noted. He added that “diet is a big factor. Sometimes that alone can be sufficient to control diabetes.”
Jones sees Type 2 diabetes reaching near epidemic levels in the United States and he cites one key player.
“Diet is a factor,” he explained. “We see our obesity level in our country going up, and that kind of goes hand-in-hand with diabetes.
“We’re seeing more cases of Type 2 diabetes than we did 20 or 30 years ago; however, at that time many cases of diabetes may have gone undiagnosed. Maybe we’re screening it more and catching it more because we’re testing for it.”
One treatment now available in a regimen for treatment of wounds in diabetic patients is “hyperbaric oxygen therapy” (HOB). The doctor noted that it can be “very effective; but the patient must have enough of a decent blood supply to the area.”
Jones ended with the note that Type 2 diabetes “is preventable; we try to educate diabetics. It can be limb- or life-threatening. It can kill you.”
Treating flat feet
In addition to caring for diabetics, Jones treats a lot of patients for heel pain and foot pain; many times it is due to plantar fasciitis, a condition that involves inflammation of a thick band of tissue that runs across the bottom of the foot and connects the heel bone to the toes.
“As we get older, our feet get flatter, for the most part,” the doctor explained. “Our ligaments and tendons are like rubber bands. After so many stretches, they start to wear. Our feet start to flatten out, and that’s when we start to see more aching and foot problems that can be addressed with good shoes, orthotics and conservative things like that.”
“The biggest thing is a good supportive shoe,” Jones added, noting that healthy feet have to last a lifetime. “That doesn’t mean some sort of orthotic, ugly shoe. But a shoe shouldn’t be picked based on style. A shoe should be sturdy and supportive. Then go for looks after that.”
And take basic preventative measures: “Keep your feet clean; wash your feet daily; change your socks. Change your shoes once or twice a year, getting new shoes. Always wear socks inside your shoes.”
The doctor explained that longstanding fungus of the toenails can be treated with oral medications, but he added a caveat.
“They can affect your liver functions. So we have to check your oral functions. And for those to work, to be effective, you’ve got to catch the toenail fungus early.
“Somebody who’s had if for 20 years and comes in and says, ‘Give me the magic pill.’ I don’t think it’s going to work, but we can try it.
“Then you’ve got to worry if the side effects are worse than the treatment. Can I live with ugly toenails?”
Jones and his wife, Andrea, have four children: a freshman in college and three at home, ages 14, 12 and 8 years. The Jones family likes outdoor activities, such as fishing and spending time in South Dakota’s state parks.
Contact John Kubal at [email protected]