Mental health has a substantial impact on physical health outcomes, and acts as a crucial component of overall well-being. Untreated mental health disorders, such as depression, anxiety and professional burnout, can significantly increase the risk of chronic diseases – including cardiovascular disease, diabetes and stroke – by up to two times, and can worsen both pain management and patient compliance. The COVID-19 pandemic further exacerbated the mental health crisis by adding layers of medical and social distrust, uncertainty and instability that continue to endure. Further, both shame and stigma still have an impact on how people view mental healthcare, and often act as a barrier in our healthcare system overall.
But, what has caused (or contributed to) this mental health crisis in the United States? Contemporary America has seen rapid socioeconomic change, hyper-individualistic philosophy and lifestyle shifts that have significantly impacted collective mental health in the digital era. Primary drivers in this crisis include social isolation, financial debt, digital dependency and a perceived failure to meet personal expectations – factors that are harmful to anyone in the general population, but that carry a unique weight for patients at risk of severe complications of diseases such as diabetes.
This issue of Foot and Ankle Quarterly explores the serious, complex and persistent mental health-related consequences that face the diabetic population, as well as the unique set of risks for the physicians who treat them.
Data Trace Publishing Company Continuing Education Mission Statement
Data Trace Publishing Company is committed to providing high-quality print and internet-based enduring continuing education programs, including lectures, feature articles, and condensations and commentaries on current clinical podiatric topics and medical risk management topics which lead to improved delivery of patient care and help reduce the potential for medical errors. These programs are provided to meet the educational needs of the podiatric medical profession and thereby enhance the quality of patient care.
Program Objectives
Foot and Ankle Quarterly (FAQ) is a unique program designed to help today’s podiatric physician manage an ever-increasing flow of information. After completing the Foot and Ankle Quarterly, Volume 37 program, the learner should be better able to: develop and refine a perspective on current treatment recommendations, updates, and advances pertinent to podiatric practice; evaluate the implications of the learned information as it pertains to the diagnosis and treatment of podiatric disorders and societal issues and barriers, and; apply current trends, standards, and best practices into learner’s own practice.
Data Trace Publishing Company Continuing Education Accreditation Statement
Data Trace Publishing Company is approved by the Council on Podiatric Medical Education (CPME) as a provider of continuing education in podiatric medicine. Data Trace Publishing Company has approved this activity for a maximum of 6 continuing education contact hours (CECHs). Physicians should claim only the contact hours commensurate with the extent of their participation in the activity.
Estimated time to complete activity: 6 hours Date of release: May 26, 2026 Expiration Date: May 26, 2029 (unless further validated and extended by provider). For amended dates of activity expiration, please see FAQ Activity Effective Dates at www.datatrace.com).
Commercial Interests
No commercial interest provided financial support for this continuing education activity.
CECH Note
Participants of Volume 36, Issue 4 will receive a maximum of 6 CECHs for a correctly-completed CME Answer Form submitted to Data Trace Publishing Company for scoring. In order to qualify for CECHs, a score of 70% or more must be achieved on the writ- ten examination material. Any participant who does not pass the first time may take the exam one additional time (within 90 days of receipt of results). A new test must be submitted to Data Trace Publishing Company with a fee of $15. Data Trace Publishing Company will score the tests and notify participants of their scores within 30 days. You will be responsible for notifying your state of the number of contact hours you have received. Participants are requested to complete a course evaluation for use in developing future issues and to meet the unique educational needs of podiatric physicians.
FINANCIAL DISCLOSURE INFORMATION
It is the policy of Data Trace Publishing Company to ensure balance, independence, objectivity, and scientific rigor in all of its educational programs. All faculty, presenters, speakers, authors, and reviewers participating in any programs provided by Data Trace Publishing Company are expected to disclose any relevant financial relationships with CPME-defined commercial interests to the program audience. “Relevant financial relationships” are financial relationships of the individual (including those of the individual’s spouse or partner) in any amount occurring within the past 12 months that create a conflict of interest. A commercial interest is any organization manufacturing, producing, marketing, re-selling, or distributing healthcare goods or services consumed by or used on patients. The CPME mandates that the content of accredited activities be objective and independent of commercial bias. The intent of this policy is that readers may form their own judgements about the presentations, using independent review to resolve all identified conflicts of interest.
In addition to disclosing commercial relationships, faculty are advised of the following policies: Each continuing education planner and author has submitted a Conflict of Interest Disclosure in order to identify relevant financial relationships and resolve conflicts.
Limitations on Data: Presenter will ensure, to the ex tent possible, meaningful disclosure of limitations on data (e.g., ongoing research, interim analyses, preliminary data, or unsupported opinion).
Discussion of Unapproved Uses: If unapproved (unlabeled) uses are discussed during the continuing education activity, the presenter will disclose when a product is not approved in the United States (and/or the nation where the activity takes place) for the use under discussion.
Data Trace Publishing Company has identified the option to disclose as follows:
The following authors have disclosed whether they or a member of their immediate family:
Will be receiving an honorarium for this activity
Within the past 12 months, had a financial or other significant relationship with a commercial organization that markets a product to which they willrefer as speaker or author:
Received monetary or other significant research support
Are or had been a paid consultant
Are or had been a full-time or part-time employee
Are or had been a paid or unpaid member of an advisory or similar board
Are or had been a member or on the Board of Trustees
Other
Within the past 12 months, had a financial or other significant relationship with a commercial organization that markets a product to which they will refer as speaker or author, BUT will not be recommending any of their products over similar competitor products
Within the past 12 months, had a financial or other significant relationship with a commercial organization that markets a product to which they willrefer as speaker or author, AND will be recommending one or more of their products over similar competitor products. Recommendation will be based on:
Exclusively on data and/or clinical experience not generated by the manufacturer or derived from manufacturer-sponsored studies
Data and/or clinical experience most of which were not generated by the manufacturer or derived from manufacturer-sponsored studies
Data and/or clinical experience, most of which were generated by the manufacturer or derived from manufacturer-sponsored studies
Exclusively on data and/or clinical experience generated by the manufacturer or derived from manufacturer or derived from manufacturer-sponsored studies
Have no conflicts to disclose
Article Authors and Lecturers
Bradley M. Brooks (n.)
Brandon M. Brooks (1. Data Trace Publishing Co.)
Malachi I. Brown (n.)
Savannah Santiago (n.)
FAQ Journal Planning Committee
Chrissy Wesolowski (n.)
Lauren Molander (n.)
Stephanie Wu, DPM, MSc (n.)
Foot and Ankle Quarterly
37-1 Contributors
Guest Editor
Brandon M. Brooks, DPM, MPH, FACPM, FFPM RCPS(Glasg) Vice President, American College of Podiatric Medicine; Staff Podiatrist, Columbia VA Health Care System, Columbia, SC; 6th Public Health Fellow, American Podiatric Medical Association; Diplomate with Certificate of Added Qualification in Podiatric Surgery, American Board of Podiatric Medicine
Contributors
Bradley M. Brooks, DO Assistant Professor of Psychiatry, University of South Alabama College of Medicine, Mobile, AL
Malachi I. Brown, DPM Podiatric Medicine and Surgery Resident, Year 1, Palmetto General Hospital, Hialeah, FL; Alumni, Barry University School of Podiatric Medicine, Miami, FL; Past President, Student Body and Florida Podiatric Medical Student Association; Public Health Ambassador, Florida Department of Health; Incoming Treasurer, American Public Health Association, Foot and Ankle Health Section
Savannah Santiago, DPM Ascension St. Vincent Indianapolis, PGY2; Alumni, Western University of Health Sciences College of Podiatric Medicine; Resident Representative, Foundation for Podiatric Education; Resident Liaison, American College of Podiatric Medicine.
37-1 In This Issue
FEATURE ARTICLE: Mental Health and Behavioral Medicine in Podiatry: Challenges and Opportunities
Brandon M. Brooks, DPM, MPH, FACPM, FFPM (Glasg)
CONDENSATIONS and COMMENTARIES
The Diabetic Foot-Pain-Depression Cycle
Commentary by Bradley M. Brooks, DO
Burnout in Podiatrists Associated with Individual Characteristics, Workplace and Job Satisfaction: A National Survey
Commentary by Malachi I. Brown, DPM
Burnout among the Podiatry Profession: A Survey of Podiatrists in Aotearoa New Zealand
Commentary by Savannah Santiago, DPM
Suicide Prevention in Podiatry
Commentary by Malachi I. Brown, DPM
Depression: The Fourth Pillar of Classifying Risk of Diabetes-Related Amputation in Veterans
Commentary by Savannah Santiago, DPM
Depression in Diabetic Foot Ulcer: Associated Factors and the Impact of Perceived Social Support and Anxiety on Depression
Commentary by Malachi I. Brown, DPM
Depression and Anxiety in 336 Elective Orthopedic Patients
Commentary by Savannah Santiago, DPM
Relationship between Resilience and Depression in Individuals with Diabetic Foot Ulcers: A Longitudinal Study
Commentary by Malachi I. Brown, DPM
Depression and Incident Diabetic Foot Ulcers: A Prospective Cohort Study
Commentary by Malachi I. Brown, DPM
AUDIO LECTURE 1: Understanding D.R.E.A.D.D: Diabetes-Related Extremity Amputation Depression and Distress
Brandon M. Brooks, DPM, MPH, FACPM, FFPM (Glasg)
AUDIO LECTURE 2: The US Mental Health Crisis and the Diabetic Foot-Pain-Depression Cycle
Brandon M. Brooks, DPM, MPH, FACPM, FFPM (Glasg)