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The Voice of Podiatrists
Serving Over 15,710 Podiatrists Daily
February 06, 2014 #4,981  Publisher-Barry Block, DPM, JD
A partner of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2014- No part of PM News can be reproduced without the
written permission of Barry Block
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| PM NEWS QUICK POLL | |
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| PODIATRISTS IN THE COMMUNITY | |
TX Podiatrist Runs for School Board of Trustees
Dr. David Schwartz has submitted an application with the Rockwall Independent School District for election candidacy for the School Board of Trustees. Schwartz brings more than 25 years of experience as a clinical pharmacist and podiatric physician, with direct patient care and hospital director-level experience.
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Dr. David Schwartz |
Schwartz is currently pursuing an MBA in finance and is registered to practice before the IRS as an enrolled agent. Schwartz said that, if elected, he will provide fiscal conservatism, combined with organizational operations knowledge.
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| PODIATRIC PRODUCTS IN THE NEWS | |
Biomet Sponsors Cadaver Foot and Ankle Symposium
Steve Sharlin, DPM and George Bucciero, DPM of Chicago, IL, took time off from their practice to update their surgical skills in internal fixation for foot surgery. "New minimally invasive plate osteosynthesis (MIPO) techniques in fracture care are going to change the way surgeons treat fractures," says Dr. Sharlin. According to leading device manufacturers, the foot and ankle represents the fastest growing segment in orthopedic device sales.
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(L-R) Drs. George Bucciero and Steven Sharlin in Cadaver Lab |
Drs. Bucciero and Sharlin participated in a cadaver lab session at The Center for Medical Learning in Tampa. The symposium, "Establishing the Foundation in Foot & Ankle Technologies in Surgical Podiatry" was sponsored by Biomet.
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| QUERIES (CLINICAL) | |
Query: Unusual Tibial Sesamoid Fracture
My patient is a healthy male in his twenties with an unusual tibial sesamoid fracture. The fracture is oriented from distal to proximal and from dorsal to plantar. The lateral half appears to be completely intact, whereas the medial half appears to be shattered. It was present for about 18 months before the patient sought treatment. He is currently in a post-op type shoe.
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Unusual fracture of lateral sesamoid |
We are considering a bone stimulator, but the literature indicated poor results. We are also thinking about surgery, but since this is an unusual fracture, I do not feel that total removal of the sesamoid would be a good idea, especially when the possibility of future hallux deviation is so great. I am debating removing only the shattered medial half by currettement or other means. Does anyone else have any suggestions, recommendations or experience with this?
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| RESPONSES/COMMENTS (CLINICAL) - PART 1A | |
From: Mark K. Johnson, DPM
We separately image the medial (4 mm normal thickness), central, and lateral (2-3 mm normal thickness) bands of plantar fascia with office ultrasound exams. Clinically, patients with more dramatic hypoechoic intrasubstance areas of the fascia and/or small partial thickness tears AND fascial thicknesses > 8.0 mms are usually (but not always) associated with chronicity of symptoms, and appear to typically take longer to "cool off" from symptoms.
Barring partial thickness tears, I believe infiltration of anesthetic/steroid below fascia, icing, topical transdermal analgesic/anti-inflammatory, Hames airbrace, rest, and transition to OTC inserts or custom orthotics is reasonable. Some studies have pointed to decreasing plantar fascial thickness with "healing" of fasciitis/fasciosis, but we have noted cases where symptoms abate with or without "shrinkage" in thickness of the fascia. It seems that patients with thicker fascia approaching 1.0 cm on US, with variations in body weight, activity level, foot type etc. do not necessarily, or frequently, have fascia return to "normal" following treatment. Diagnostic ultrasound is useful in grading fasciitis/osis, identifying tears, and as part of the decision- making in treatment and prognosis. Keep us posted!
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| RESPONSES/COMMENTS (CLINICAL) - PART 1B | |
From: Peter Bregman, DPM
If an ultrasound shows a 50% or more increase in thickness compared to the other side, I perform an US-guided injection. I inject the medial calcaneal nerve and the area to be injected first with 5cc of a mix of lidocaine and Marcaine plain. I let it diffuse for 5 minutes, then go back and, under direct visualization with US, I inject a cocktail mixture of 20 to 30 mg of Kenalog with 4 mg of Decadron and Marcaine in a 5 mL syringe using a 25 gauge needle. I make sure to inject in at least five different areas and purposefully needle the plantar fascia. I see the cocktail expand the fascia. I then strap the patient.
I see patients back in a week and 90% of the time, they are at least 80% better. At this point, you can now evaluate the tarsal tunnel and medial calcaneal nerve for any pathology. Note that when I use the US, I do not use it transversely. I put the transducer in the same plane as the needle or perpendicular to the fascia, which makes the target easier to see. This is very effective. Perhaps only 5% of the time, I need to give another shot. If I do, I use amnion, if possible.
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| RESPONSES/COMMENTS (CLINICAL) - PART 2 | |
RE: Partial Plantar Facial Tears (Lloyd Smith, DPM)
From: Jeffrey Kass, DPM
I have to respectfully disagree with Dr. Smith's assessment "So, just about the easiest diagnosis to make" with regard to partial plantar fascial tears. I have seen about half a dozen over the last few years. Five out of six of them came to me after seeing two or three other doctors. If the diagnosis was so easy, I think the other doctors before me would have made the diagnosis. I made the diagnosis, part in parcel because their treatment failed.
In the cases I have had, all were partial tears, meaning one of the three bands; usually the medial band, although two cases were central. I did not feel a palpable defect in ANY of the cases. The tip off to me was the severe pain and the lack of response to steroid injections by colleagues. (maybe, the steroid injections helped cause the problem, who knows). I did confirm all cases with an MRI. They're expensive, but since I was the third or fourth doctor treating the patient, I felt the documentation was needed in my chart. I find ultrasonography to be a good modality when the reader is the technician. This is not always the case. I would argue that a bunion is an easier diagnosis.
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| RESPONSES/COMMENTS (NON-CLINICAL) | |
From: Leonard A. Levy, DPM, MPH
In 1967, I became the first member of the profession to receive a Master of Public Health degree (Columbia University). At the same time, Arthur Helfand, DPM was laying the ground work for a Podiatric Health Section in the American Public Health Association. I then worked with him to support his vision for board certification in podiatric public health. This was successful, resulting in both of us becoming founding members.
As indicated by Victor Marks, DPM, MPH, board certification in podiatric public health no longer exists. For our profession to be part of the mainstream in providing podiatric public health and preventive services, it is important that this board be reconstituted. Medicine and dentistry have had this certification for decades.
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MEETING NOTICES - PART 1
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ARGENTINA IS CALLING YOU -
BUENOS AIRES, BEAUTIFUL ESTANCIA & MENDOZA
3 Stops - Leisure Agenda - CME Hours - Great Food !
Director-Sam Mendicino, DPM. Program benefits Houston Residency Programs.
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| YOU CAN'T MAKE THESE THINGS UP | |
RE: The 36 Year Old Orthotic
I dispensed Rohadur orthotics to a young women in 1978. She used them faithfully at her job as a flag person. She has not had problems until she broke the heel off of one of them, but she continued to wear it anyway for the last three months.
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36 year old Rohadur orthotic |
The photo is of the one that is still intact. What is fascinating is the wear of the heel and forefoot posts. They are gone, worn to near nothing. The edges are literally sharp enough to cut paper. Now that is a compliant patient!
A. James Fisher, DPM, Eureka, CA
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MEETING NOTICES - PART 2
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| CLASSIFIED ADS |
PODIATRY OFFICE FOR RENT - STATEN ISLAND, NY
1000 square foot (approximate) office in large modern medical center. Good parking, public transportation, 36 years as a podiatry office. 5 exam rooms, business office, lab, reception room, bathroom, central air. Great layout. Designed for Podiatry/medical. Call 212 794 0089.
PRACTICE FOR SALE - CONNECTICUT
Well-established, 35-year-old reputable practice/condo with approx 2,500 Square ft. Grossing approximately $450,000. Outside Hartford area. All phases of podiatry. Contact drsch52@hotmail.com
PRACTICE FOR SALE - SOUTHWEST FL
Multilocation multidoctor practice in beautiful Southwest Florida. Practice has grossed over seven figures consistently and currently shows 10-15% growth in revenues with increase in new patients and patient visits. EHR is already implemented with meaningful use criteria met. Practice has been professionally evaluated by Provider Resources. Only serious inquiries to this email address. This is a great practice in Paradise and a good opportunity for the right doctor or doctors. Email to: practiceforsaleswfla@gmail.com
ASSOCIATE POSITION - CALIFORNIA (SANTA CRUZ COUNTY)
The Foot Doctors of Santa Cruz County is a multi-office podiatric group looking for a self-motivated, committed podiatrist with a CA license. Offices are up-to-date with EMR, digital x-ray, and laser. Duties include all aspects of podiatry including wound care, surgical cases and nursing homes. There is great surgical growth potential. Must intend to reside locally. Send CV to: srfctysc@gmail.com
ASSOCIATE POSITION - KENTUCKY
Immediate opening for palliative/general podiatric care provider in established clinics, nursing home and assistive living settings in beautiful Southern Kentucky. Travel involved, but transportation provided along with ability to provide a wide range of clinical care including DME. Board certification not mandatory, but must be eligible for KY state license. Base salary with incredible bonus opportunity/full benefits. Join Kentucky’s largest and most respected podiatric group. Email CV and letter of interest to:jonkim12000@yahoo.com
ASSOCIATE POSITION – SOUTHERN, NJ
Part-time position available in Southern NJ. Podiatrist wanted for house calls as well as some facilities. Flexible schedule, possibly leading to office hours in the future. Well established practice, now extending services. Looking to fill this position immediately if you are available. Please respond to drjpel@aol.com.
ASSOCIATE POSITION - PUERTO RICO
Looking for a well-motivated surgically trained podiatrist for a 20 year-old hospital-based multi-office practice. WILL BE INTERVIEWING PERSONALLY AT 2014 ACFAS MEETING IN ORLANDO Candidate must be personable, ambitious, and knowledge of SPANISH language a must. Hospital surgical privileges available with heavy load of high-risk diabetic foot patients. This position leads to PARTNERSHIP, and eventually ownership. Offices located near San Juan Metro area nearbBeaches, great schools, and major shopping malls. Please send CV to medicopodiatra@aol.com.
ASSOCIATE POSITION - CENTRAL PA
Looking for an associate with strong surgical training. Personal and energetic a must. The physician will provide all aspects of podiatric practice, including sports medicine, wound care, and foot and ankle surgery. Competitive compensation package. Partnership opportunity for right person. To apply, please email, letter of intent and CV to premierfootpa@outlook.com
ASSOCIATE POSITION - WASHINGTON, DC/MD
High volume practice with sports medicine emphasis looking for a PSR24/36 month trained full-time associate to replace retiring senior partner. Work with a prominent residency program with an opportunity to invest in an outpatient surgery center. Please send CV and cover letter of practice philosophy to hgodpm@gmail.com
ASSOCIATE POSITION- MANHATTAN AND BROOKLYN
Podiatrist wanted for busy, expanding group practice which covers all aspects of podiatry including surgery. Must be able to work in both Manhattan and Brooklyn locations. Position available asap. Please send resume and references to yfrierson@starrettpodiatry.com.
FULL TIME PODIATRIST NEEDED - BROOKLYN, NY
Excellent opportunity for a motivated, ethical and enthusiastic associate. Practice is established and hospital affiliated. PSR 24/36 and Board eligible/certified by ABPS preferred. Must be competent in forefoot and rearfoot surgery. Competitive salary with incentives. Email CV to manfootcare@aol.com or fax to (718) 875-3171.
ASSOCIATE POSITION – SW FLORIDA
Immediate position available in SW Florida. Podiatrist to join a small group. Must be Florida licensed, surgical privileges pending experience. Board Certification or Qualified preferred but not necessary. Some nursing home care and limited travel. Excellent pay and lifestyle. Send CV to: 1foot.ankle@G-Mail.com
ASSOCIATE POSITION - MISSOURI
Midwest practice opportunity for PSR 24/36 BQ/BC associateship leading to ownership. Surgical and general podiatric practice with high volume foot surgery, wound care and hospital affiliations. Email stcpod@att.net
ASSOCIATE POSITION – CHICAGO, IL
Podiatrist in Chicago. Independent, energetic Dr. needed to do house calls; schedule will be accommodated due to Dr.'s preferences; both full- and part-time will be considered. Send your inquiries to: dpms2@hotmail.com
HOME FOOT CARE, INC. – LOS ANGELES, CALIFORNIA
Be part of the fastest growing podiatric house call company on the West Coast! We need motivated, honest, caring podiatrists to treat our growing network of home patients located in the greater LA area. Flexible hours, independence and great compensation! If interested, send CV to:homefootcare@hotmail.com. Check us out @ www.footdocs2u.com
ASSOCIATE POSITION - TENNESSEE
Opportunity for fully credentialed podiatrist(s) needed to join or purchase a high-volume practice with enormous growth. Located on the largest medical center/hospital campus in East Tennessee. Please email CV, letter of intent, and references to PodiatryFootAnkle@gmail.com.
ASSOCIATE POSITION - NY (ROSLYN AND HUNTINGTON)
Join one of the largest podiatry groups on the East Coast. Well established and progressive offices, including EMR, digital x-ray, PVR and NCV studies, PinPointe laser, and Microvas therapy. For more info, www.GreatFootCare.com. Send resume to: Dr.Kassaris@yahoo.com.
ASSOCIATE POSITION – CONNECTICUT
High volume practice seeking a hard-working, motivated, Connecticut licensed podiatrist. Duties to include diabetic foot care, wound care and minor office procedures. Please submit CV to: podiatrypeople@gmail.com
ASSOCIATE POSITION - OHIO
Group practice in Ohio seeks a well-trained surgeon, PSR24/36 preferred. Our practice provides all of the latest technology needed to provide patients with the best care, including Lasers, PAD Testing, DME, EMR and Digital X-ray. Competitive compensation package including salary and bonus. Please send CV to: DPMgroup1@yahoo.com
ASSOCIATE POSITION – TEXAS
Corsicana Foot and Ankle is seeking an PSR-24 associate with possible future partnership. Brand new state-of-the-art facility, one hour south of Dallas, complete with EMR, digital x-ray, PADnet, ultrasound and hospital privileges. Competitive salary with benefits. Please send Letter of Interest and CV to footdoc3143@gmail.com
PM News Classified Ads Reach over 15,500 DPMs and Students
Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 15,500 DPMs. for details, click here or write to: bblock@podiatrym.com or call (718) 897-9700 for details. For commercial or display ads contact David Kagan at (800) 284-5451
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| Disclaimers |
Acceptance and publication by this newsletter of an advertisement, news story, or letter does not imply endorsement or approval by Barry Block or Kane Communications of the company, product, content or ideas expressed in this newsletter. Podiatric Medical News does not represent the views, and is a separate entity from Podiatry Management Magazine and Podiatry Management Online. Any information pertaining to legal matters should not be considered to be legal advice, which can only be obtained via individual consultation with an attorney. Information about Medicare billing should be confirmed with your State CAC.
THIS MESSAGE IS INTENDED ONLY FOR THE USE OF THE INDIVIDUAL OR
ENTITY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS
PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE.
If the reader of this message is not the intended recipient or an
employee or agent responsible for delivering the message to the
intended recipient, you are hereby notified that any dissemination,
distribution, or copying of this communication is strictly
prohibited. If you have received this communication in error, please
immediately notify me and you are hereby instructed to delete all
electronic copies and destroy all printed copies.
DISCLAIMER: Internet communications cannot be guaranteed to be
either timely or free of viruses.
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