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Healthcare Heroes

Patient/Resident/Client Care Provider

Doctor and Owner, DeCaro Total Foot Care Center

Dr. Louis J. DeCaro

Dr. Louis J. DeCaro

This Specialist Has Helped Patients of All Ages Take Huge Strides

Dr. Louis J. DeCaro is firm of the opinion that no one actually has good feet.

Rather, experience tells him that everyone has one of 24 variations of bad feet.

“That includes high arches, low arches, no arches … people come in and they think flat feet are the only bad feet,” said DeCaro, owner of Hatfield-based DeCaro Total Foot Care Center, referencing a chart of what he calls the ‘24 Foot Structures.’ “But you can have an arch that causes not foot pain, but back pain. So often, high-arch people have back pain, but they don’t realize it’s coming from their feet.”

This chart, and DeCaro’s extensive use of it to explain problems people are having now — or might have later — is just one of many reasons why he was named the Healthcare Hero for 2021 in the always-competitive Provider category. Indeed, he has made pediatric podiatry his specific specialty, and throughout his career he has helped people of all ages, but especially children, make great strides, both figuratively and quite literally.

“To get a hug from a parent who tells me that their child is finally walking or is able to run or keep up with their friends … that’s really priceless.”

He has done this through everything from education to complex surgical procedures, to the development of new orthotic products, such as littleSTEPS, orthoses created specifically for young people and designed to improve coordination, balance, pain, posture, and strength, while aiding in the development of a more stable and functional gait.

He even makes an impact through his photography. DeCaro, who travels often with his family and through his work, photographs animals wherever he goes and winds up selling prints of some of his best shots, with the proceeds going to help families in need offset the cost of orthotics.

Thus, his work can be — and often is — described as life-changing, and that’s why he finds all facets of it, but especially his work with children, so rewarding.

Dr. Louis DeCaro, seen here with his children, Eliza and Lucas, and wife Jamie, says foot issues impact people of all ages, starting with the very young.

Dr. Louis DeCaro, seen here with his children, Eliza and Lucas, and wife Jamie, says foot issues impact people of all ages, starting with the very young.

“People often ask me why I do pediatrics,” he said. “And I tell them that one of the wonderful things I get to experience is when a child follows up who couldn’t walk, and I helped them walk; that’s got to be one of the most rewarding things in the world. To get a hug from a parent who tells me that their child is finally walking or is able to run or keep up with their friends … that’s really priceless.”

Over the years, DeCaro has received many hugs like that, and that just begins to explain why he is one of the Healthcare Heroes for 2021.

 

Positive Steps

Like many in healthcare, DeCaro said that, while he ultimately chose his specialty, in many ways, it chose him.

Relating the story of how he ventured into podiatry, he said he had just finished his junior year at Stony Brook University on Long Island and was on a path to a career in allopathic medicine when he got a letter from someone at Barry University, a podiatry school in Florida.

“I didn’t know anything about podiatry at all,” he recalled, adding that the school was impressed with his MCAT scores and offered to fly him down for a visit. He took them up on their offer and came away impressed with the school, the specialty, and the opportunities it presented.

“Podiatry seemed like a wonderful profession because I could specialize in whatever I wanted — I could do surgery if I wanted to, I could treat kids if I wanted,” he said, adding that he wound up skipping his final year at Stonybrook and getting on an airplane to attend Barry.

“It was the best decision I’ve ever made; getting into this specialty has been wonderful, “he went on. “It was an opportunity-knocks moment — and I opened the door to see what was behind it.”

Dr. Louis DeCaro photographed this bear while visiting Alaska. The image is one of many he has sold to help families pay for needed orthotics for their children.

Dr. Louis DeCaro photographed this bear while visiting Alaska. The image is one of many he has sold to help families pay for needed orthotics for their children.

To say that DeCaro has made the most of his opportunity and had a profound impact on patients and their families during his career in his chosen field would be a huge understatement. Indeed, as noted, he has been changing and improving lives in many ways — through education, treatment, and the development of new orthotic solutions, such as littleSTEPS.

DeCaro Total Foot Care Center now counts 30,000 active patients, with some of them coming from other states and the four corners of Massachusetts.

“Besides Boston Children’s, which is two hours away, there’s really no other pediatric specialist in this state for foot care,” he explained. “So we get patients all the time who travel two or three hours to see me, just because of the lack of pediatric specialists.”

He said podiatry is regarded by many as a specialty focused on the elderly and the diabetic, and while many of the practice’s patients are in those categories, foot issues impact people of all ages. And many problems of the foot develop when people are young.

DeCaro said he treats many children on the autism spectrum with sensory-processing disorders, others with neuromuscular diseases like cerebral palsy, children who are late walkers or delayed walkers with low muscle tone, athletes with injuries that start with their foot structure, kids with growing pains, and those with other ailments.

“Often, orthopedic issues, especially in the pediatric population, are caused by poor mechanics in the foot,” he explained. “And it starts with the minute we walk.”

He said he sees roughly 20 patients a day, fewer than many specialists, because he enjoys spending time not only with his younger patients, but their parents as well, because they often must be educated about their child’s condition.

Similarly, when he sees a child, he will often then examine the parents as well because, by looking at their respective foot structures, he can often gain some perspective on where that child might be headed when it comes to overall foot health. “Like hair color and eye color, foot structure is genetic,” he explained.

As noted earlier, treatment of his patients is just one of the reasons why DeCaro has become a standout in his field — he has been listed among the 150 Most Influential Podiatrists in America by Podiatry Management magazine — and why he will join seven others as Healthcare Heroes on Oct. 21 at the Log Cabin. He’s also an educator who lectures often; pens articles such as one called “Assessing the Role of Gait Analysis in Pediatric Patients with Flatfoot,” which appeared in Podiatry Today magazine; and teaches the ‘24 Foot Structures’ to many of his colleagues.

Within the 24 different foot structures there are six distinct foot types or categories — A to F — and given each names, like ‘John Wayne.’ “You actually turn your legs out and walk like a gunslinger,” he explained, adding that there are fun names for each category, and they are designed to help patients understand their feet and the treatment being given them.

He’s also an entrepreneur; in addition to littleSTEPS, he and business partner Roberta Nole have also developed the RX24 Quadrastep System, a state-of-the-art alternative to traditional custom orthotic management.

There’s also his photography — and philanthropy, by which he uses his hobby to help children and families in need.

The walls of the rooms in his office are covered with photos — his favorite is one of a puma he “met” in the rain forest of Costa Rica, although he’s also fond of a bear he photographed in Alaska — primarily his feet (paws), which are prominently on display.

When asked how he gets so close to his subjects, he quipped, “big lenses.”

 

Toeing the Line

In many ways, DeCaro has spent his career  helping patients, and especially the younger ones, understand the proverbial big picture when it comes to their feet and how they are never to be overlooked when it comes to one’s health, well-being, and quality of life.

Suffice it to say that he has made the most of that opportunity-knocks moment when he got on a plane bound for Florida and podiatry school. He found a profession that has been rewarding in every way imaginable.

But the real winners from that decision he made are his patients, who have benefited from his compassion, his desire to educate, and even his ingenuity and prowess as an entrepreneur.

His ability to change their lives has made him a Healthcare Hero.

 

George O’Brien can be reached at [email protected]

Healthcare Heroes

‘There’s a Magic Here,’ Built on Dedication, Innovation, and Culture

H. Lee Kirk Jr. was speaking at a public event recently, when a woman stood up to tell him about her 3-year-old grandson’s experience at Shriners Hospitals for Children – Springfield.

“She said, ‘when we take him to the doctor’s office or another healthcare provider, he cries going in, and he’s sprinting out the door to get back home. When he comes to Shriners, he’s sprinting on the way in and happy to be coming, and he’s kicking and screaming when he has to leave,’” he related. “There’s a magic here that’s really hard to get your arms around.”

But Kirk, administrator of the 94-year-old facility on Carew Street in Springfield, tried to explain it the best he could over the course of a conversation with BusinessWest after the hospital was chosen as a Healthcare Hero for 2019 in the Patient/Resident/Client Care Provider category.

“This is a special healthcare organization because of the mission,” he said. “The culture is unlike any other I’ve been involved in. We want to be the best at transforming the lives of kids. And we get the privilege of seeing that every day here.”

It’s a culture that employees find attractive, said George Gorton, the hospital’s director of Research, Planning, and Business Development, adding that consulting physicians from other hospitals say, after visiting, that it’s the happiest place they’ve ever worked.

“It’s a palpable difference,” he went on. “As employees, we love that caring, family feeling of being employed by an organization that aligns with our own personal mission. That’s just not seen anywhere else.”

Last year, the hospital produced some short videos with employees to celebrate the opening of its inpatient pediatric rehab unit. In one of them, a nurse hired specifically for that unit talked about how she’s wanted to be a nurse at Shriners since being treated there for a rheumatology issue when she was a child.

“She was in tears, expressing the joy and positivity she had, to be able to take that experience of receiving care and become the person who provides that care to other people,” Gorton said. “It was a really touching moment to hear her express that.”

Then there’s the boy Gorton — who’s been with Shriners for more than a quarter-century — examined decades ago in the motion-analysis center; he’s now a physician assistant at the hospital.

Gorton said it’s impossible to single out any individual person responsible for creating the generational success stories and culture that makes Shriners what it is. The judges for this year’s Healthcare Heroes program agreed, making a perhaps outside-the-box choice in a category that has previously honored individuals, not entire organizations.

Yet, the choice makes sense, said Jennifer Tross, who came on board two years ago as Marketing and Communications manager, because of that unique culture that draws people back to provide care decades after receiving it, and that has kids shedding tears when they have to leave, not when they show up.

“The day I arrived,” Tross said, “I went home and said, ‘I knew this place would change my life, and it has.’”

Countless families agree, which is why Shriners is deserving of the title Healthcare Hero.

Step by Step

When a boy named Bertram, from Augusta, Maine, made the trek with his family to Springfield in February 1925, he probably wasn’t thinking about making history. But he did just that, as the hospital’s very first patient. The Shriners organization opened its first hospitals primarily to take care of kids with polio, but Bertram had club feet — a condition that became one of the facility’s core services.

After the first Shriners Hospitals for Children site opened in 1922 in Shreveport, La., 10 other facilities followed in 1925 (there are now 22 facilities, all in the U.S. except for Mexico City and Montreal). Four of those hospitals, including one in Boston, focus on acute burn care, while the rest focus primarily on a mix of orthopedics and other types of pediatric care.

As an orthopedic specialty hospital, the Springfield facility has long focused on conditions ranging from scoliosis, cerebral palsy, and spina bifida to club foot, chest-wall deformities, cleft lip and palate, and a host of other conditions afflicting the limbs, joints, bones, and extremities — and much more.

While many of the hospitals overlap in services, each has tended to adapt to the needs of its own community. In Springfield’s case that includes pediatric specialties like rheumatology, urology, and fracture care, as well as a sports health and medicine program that includes three athletic trainers and a pediatric orthopedic surgeon with training in sports medicine.

H. Lee Kirk (left, with Jennifer Tross and George Gorton) says Shriners is a special healthcare organization because of its mission.

The latter, Kirk said, includes services to kids without medical problems, as the hospital works with schools, clubs, and leagues help provide more preventive and conditioning services and follow up when injuries occur.

Meanwhile, the BFit exercise program targets kids with neuromuscular problems who normally don’t participate in physical activity, sports, or even gym class. The program aims to improve the physical activity of this group, and does it by involving students from area colleges who are studying fields like physical and occupational therapy, exercise science, sports medicine, and kinesiology.

“They volunteer as personal coaches,” Gorton said. “The child learns to adapt their environment and become physically active, and those students learn what it’s like to care for children. Many have gone into pediatric healthcare to do that kind of training because of their experience here. They see it here, and it spreads like a good virus through the population.”

Then there was the 2013 community assessment determining that an inpatient pediatric rehabilitation clinic would fill a persistent need. That 20-bed clinic opened last year following a $1.25 million capital campaign that wound up raising slightly more — reflective of the community support the hospital has always received, allowing it to provide free care to families without the ability to pay (more on that later).

Still, more than 90% of the care provided in Springfield is outpatient — in fact, the facility saw 12,173 visits last year, a more than 40% expansion over the past several years.

The care itself, the clinical component, is only one of three prongs in the Shriners mission, Kirk said. The second part is education; over the past 30 years, thousands of physicians have undertaken residency education or postgraduate fellowships at the various children’s hospitals. In Springfield, residents in a variety of healthcare disciplines — from orthopedics to nursing, PT, and OT — have arrived for 10- to 12-week rotations.

The third component of the mission is research, specifically clinical research in terms of how to improve the processes of delivering care to children. That often takes the shape of new technology, from computerized 3D modeling for cleft-palate surgery to the hospital’s motion-analysis laboratory, where an array of infrared cameras examine how a child walks and converts that data to a 3D model that gives doctors all they need to know about a child’s progress.

More recently, a capital campaign raised just under $1 million to install the EOS Imaging System, Nobel Prize-winning X-ray technology that exists nowhere else in Western Mass. or the Hartford area, which enhances imaging while reducing the patient’s exposure to radiation. That’s important, Kirk said, particularly for children who have had scoliosis or other orthopedic conditions, and start having X-rays early on their lives and continue them throughout adolescence.

Averting Disaster

It’s an impressive array of services and technology, and collectively, it meets a clear need — and not just locally. While about 60% of patients hail from a 20-mile radius, the hospital sees young people from across New England, New York, more than 20 other states, and more than 20 countries as well.

Yet, only a decade ago, the hospital was in danger of closing. At the height of the Great Recession, the national Shriners organization announced it was considering shuttering six of its 22 children’s hospitals across the country — including the one on Carew Street.

In the end, after a deluge of very vocal outrage and support by families of patients and community leaders, the Shriners board decided against closing any of its specialty children’s hospitals, even though the organization had been struggling, during those tough economic times, to provide its traditionally free care given rising costs and a shrinking endowment.

To make it possible to keep the facilities open, in 2011, Shriners — for the first time in its nearly century-long history — started accepting third-party payments from private insurance and government payers such as Medicaid when possible, although free care is still provided to all patients without the means to pay, and the hospital continues to accommodate families who can’t afford the co-pays and deductibles that are now required by many insurance plans.

“It was a wise decision to accept insurance — but it was a controversial decision,” Kirk said. Yet, it makes sense, too. A very small percentage of patients in Massachusetts don’t have some kind of coverage, yet 63% of care at Shriners is paid for by donors — a disconnect explained by the fact that Medicaid doesn’t pay for care there, and gaps exist in other insurance as well.

So, if a family can’t pay, the hospital does not chase the money, relying on an assistance resource funded by Shriners and their families nationwide.

“Donor support allows us to provide free care,” Kirk said. “We don’t send families to collections and contribute to the number-one cause of personal bankruptcy in America, which is medical care. It’s a very unique model, and a unique healthcare-delivery system.”

And one that, as Kirk noted, treats a patient population that can be underserved otherwise. For instance, the cleft lip and palate program — a multi-disciplinary program integrated with providers from other hospitals in the region and serving about 30 partients at any given time — begins assessing some patients prenatally, and most need care throughout adolescence and even into young adulthood.

Those consulting relationships are critical to the success of Shriners, which doesn’t seek to compete with other providers in the region, but supplement them while striving to be, in many cases, the best place for young people to receive specialized treatment, whether for orthopedic conditions or a host of other issues.

When Kirk arrived in 2015, the hospital underwent a comprehensive self-assessment process that made two things clear, he said: that there’s a real need for what it does, and that it needs to reinvest in its core.

“And that’s what we did. And that’s about people, not bricks and mortar,” he went on, noting that the facility has added about 70 positions since that time.

“We’re a completely different place today than we were in 2009,” Gorton added, noting that the hospital is stronger in leadership, internal communication, and external connections. Among the 22 Shriners specialty hospitals, Springfield ranks second in the proportion of the budget offset by donations. “Why? Because we have a great relationship with the community. We’ve become more outward-facing, and we’re integrated everywhere in the community.”

The Next Century

Getting back to that 3-year-old who doesn’t want to leave when he visits Shriners, surely the hospital’s child-friendly playscapes and colorful, kid-oriented sculptures and artwork help create a welcoming environment, but those wouldn’t make much difference if the people providing care didn’t put him at ease.

That environment begins with employees who love what they do, Kirk said, and this Healthcare Hero award in the Provider category is definitely shared by all of them. Other families feel the same way, as the facility regularly ranks in the 99th percentile on surveys that gauge the patient and family experience.

“We have happy employees who love being here, who love working with kids, who love delivering the mission — and the patients and families sense that and respond to that,” Gorton said.

That’s why the hospital’s leaders continue to examine the evolving needs of the pediatric community and how they can continue to deepen its clinical relationships and expanding services most in demand — always with the philosophy of “mission over model,” Kirk said.

“We are always thinking about the future,” he added, “so we can sustain this healthcare system for the next 100 years.”

Joseph Bednar can be reached at [email protected]

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