The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

February 17, 2012 #4,387 Publisher-Barry Block, DPM, JD

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DC Podiatrist Discusses Fashionable Shoe Alternatives

Flats are a fashionable substitute for high heels, but they have their issues too. Dr. Ian Beiser, a podiatrist at George Washington University Hospital, says ballet flats and flip-flops “generally do not provide adequate support, and may put excessive strain on the Achilles tendon and calf muscles.”

Dr. Ian Beiser

So what’s a fashionable, health-conscious woman to wear? Dr. Beiser recommends wedges or shoes with a low — but not flat —heel as being “ideal” for most women.

Source: Stephanie Early, Washiontonian [2/14/12]

Taking Contraceptives Can Reduce Injuries in Elite Female Athletes: Aussie Podiatrist

A leading Australian podiatrist has suggested that elite female athletes consider taking the contraceptive pill in a bid to reduce the risk of injury to their feet and ankles. Simon Bartold from the University of Melbourne is a clinical podiatrist with 23 years experience treating athletes. He says women who play elite sports can be more prone to injury than their male counterparts. 

Simon Bartold

"Our research has shown that when women train at an elite level, they become more prone to injury. We believe this is because they over-train and under-eat. This causes their estrogen levels to fluctuate more than usual," Mr Bartold said. His research is backed up by a study that has just been unveiled at the American Academy of Orthopaedic Surgeons Conference in San Francisco. Mr. Bartold says there is mounting evidence of the link between elite sports and injury in female athletes, and one that sporting bodies should address to protect their players.

Source: Australasian Podiatry Council [2/15/12]

Dazzle of Technology May Contribute to High Medicare Costs: AZ Podiatrist

Medicare's bill for artificial feet rose nearly 60 percent in recent years, although foot and leg amputations due to diabetes continued a dramatic decline. For example, Medicare has started covering a computer-controlled ankle/foot that costs $15,000, about as much as a compact car. Some major private insurers still consider it experimental and do not routinely cover it. 

Dr. David Armstrong

Several doctors were surprised by the findings. "The data are surprising because of the large increase over a short period of time," said Dr. David Armstrong, a professor of surgery at the University of Arizona and diabetes expert who directs the Southern Arizona Limb Salvage Alliance. Armstrong wonders if the dazzle of technology is the issue for some practitioners. "They can lose the forest for the trees and focus more on a high-end device because it's high-end, rather than specifically on function for the patient," he said.

Source: USA Today [2/15/12]

AZ, TX Podiatrists Sue Management Company for Overbilling Patients

Drs. Stephen Barrett, Peter Bregman and three other physicians -- running Barrett Foot & Ankle Centers in San Antonio and Phoenix have sued Michael Brown and Surgeon's Management, accusing them of siphoning money for personal "perks," tapping office phones, overbilling patients, and blocking doctors' computer access.

The podiatrists pay a 15 percent royalty to the Brown Hand Center, as well as fees to the Brown-owned Surgeon's Management Inc., which collects the money. They allege that Brown -- personally, and through his companies -- has "altered" the foot doctors' "computer access codes and passwords, thereby locking them out of their computers, clinical databases, and electronic medical records that are an integral part of providing treatment for patients."

Source: Craig Malisow, Houston Press [2/14/12]

AMA Rips Medicare Pay Deal

The AMA and other physician groups denounced Congress for failing to find a permanent solution to Medicare’s sustainable growth-rate formula after lawmakers reached a tentative agreement that forces them to revisit the issue at the end of the year. The deal would avert a 27.4% Medicare payment cut to physicians after Feb. 29 and extend current payment rates through the end of 2012, according to a GOP aide.

“The House and Senate conference committee agreement averts a 27% cut on March 1, but it represents a serious missed opportunity to permanently replace the flawed Medicare physician payment formula and protect access to care for military families and seniors,” Dr. Peter Carmel, president and CEO of the American Medical Association, said in a statement. “People outside of Washington question the logic of spending nearly $20 billion to postpone one cut for a higher cut next year, while increasing the cost of a permanent solution by about another $25 billion.”

Source: Jessica Zigmond, Modern Healthcare [2/15/12]

Query: Best Coding Book for Podiatrists

Can anyone suggest a coding book that teaches us how to code claims? We want something that starts from scratch - explains routine foot care and levels of service.

Name Withheld (NY)

RE: Complete Tear of Peroneus Longus (David Taylor, DPM)
From:  Barry Mullen, DPM

I had a fairly similar case of an isolated complete tear of the FHL which occured just distal to the posterior process of the talus and I ended up anastamosing it to the FDL. That patient did quite well. No PT was required as both the FHL and FDL are in phase with one another. That's the key! The difference for your case is that the PB and PL are not in phase with one another. The PL is mainly utilized in the stance phase of gait to plantarflex the 1st metatarsal base and stabilize the medial column of the foot just prior to propulsion, while the PB is a swing phase muscle that counteracts the AT tendon and prevents foot slap just prior to heel strike.
 
In cases where tendon transfers or tenodesis utilizing out of phase muscles are involved, generally, extensive biofeedback training is necessary so the body retrains itself when those muscles should fire at appropriate times in the gait cycle. I'd give the tenodesis a try, but be prepared to refer the patient 4 weeks post-op to a competent physical therapist who has extensive experience with those out-of-phase biofeedback techniques.
 
Barry Mullen, DPM, Hackettsown, NJ, yazy630@aol.com

RE: Gouty Tophi, 3rd Digit (Charles Baik, DPM)
From: Frank Lattarulo, DPM, Keith Gurnick, DPM

I have seen a few of these (more than normal) recently at the Wound Institute. I'm not sure why there has been a rise of these cases. Some speculate that the success of wound centers will get these patients referred more frequently, which is certainly a valid conjecture. What I can tell you is to be careful. You must make sure that the bone destruction is not from osteomyelitis. Treat this as if it were an osteo. Get complete bloods, vascular studies, ID consults, rheumatology, etc. as well as an MRI. A bone scan will not be helpful here due to the normal inflammatory process seen in gout as well as osteo. Given the age, medical history, and presentation of an open wound, infection is likely. If you rule out infection, treat this conservatively first. Gently debride weekly. Treat until all the tophi are removed from the wound. Get the wound bed clean; then proceed from there.

Frank Lattarulo, DPM, NY, NY,  doclatt@aol.com

Since the toe does not appear to be infected, you could leave it be. Suggest shoe modifications or open sandals (when appropriate) so that there is less pressure against the toe. I would caution you to be very careful administering additional cortisone shots into the toes of elderly diabetics.

Removing this gouty material may further devascularize a toe that could be already somewhat compromised, and if the toe does go on to heal, the ...

Editor's Note: Dr. Gurnick's extended-length letter can be read here. To see the original note and photo, simply click on the underlined subject heading of any message. 

RE: Podiatric Physicians Practice Podiatric Medicine: RIP Podiatry
From: Leonard A. Levy, DPM, MPH

Responding to my post in PM News, a number of people did not think we should refer to ourselves as podiatric physicians since specialties like orthopedics, dermatology, ophthalmology, and others do not refer to themselves as orthopedic physicians, dermatological physicians, and ophthalmologic physicians. That is true but, as an associate dean in a college of osteopathic medicine, I am very aware that those who hold a DO degree in the U.S. refer to themselves as osteopathic physicians, not osteopaths.

Even the DO degree is referred to as doctor of osteopathic medicine rather than doctor of osteopathy. DOs call themselves osteopathic physicians whether they practice a medical or surgical specialty. One reason is to distinguish themselves from the osteopath in other countries like England where they do not have a surgical or medical scope of practice. For similar reasons, we should call ourselves podiatric physicians.
 
Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL, levyleon@nova.edu

RE: Disposing of Old X-Ray Machines (Neil H Hecht, DPM)
From: Edmond F. Mertzenich, DPM, MBA

About two years ago, I had that dilemma. In Illinois, I contacted the Department of Nuclear Safety on how to dispose of the machine. Their requirement was that the glass of the x-ray tube be broken so that it could not be used by other people. As for the oil situation, after the bulb is broken, if your community has a program to collect hazardous waste, see if you can dispose of the part through them. 

Edmond F. Mertzenich, DPM, MBA, Rockford, IL, doctoreddpm@frontier.com

RE: Source for Medical Nail Technicians (Tracy Edwards)
From: Robert Spalding, DPM

Information on medical nail technicians can be found at Medinail Learning Center, medinails.com. The course is 14 modules online, 7 in a pre-requisite course called the "Advanced Nail Technician," and 7 more in the medical nail technician program that trains technicians specifically to work in a podiatry office. There are three exams during the courses and a 40 hour internship is required in a podiatry office or podiatry clinic following the passing of all the exams.

To find the current graduates, go to the home page and click on graduates.mln, which helps podiatrists find a nail technician who will fit well in their offices. They provide three hours of free consulting for any podiatrist who 1) hires an MNT and 2) wishes to set up a pedicure area in the offices.

The MNT can be one of three workers in your office. 1) performing cosmetic pedicures on your patients and bringing in new patients, 2) performing routine foot care and assisting the podiatrist and 3) doing both. These nail technicians are usually the top technicians in the field who wish to work aseptically and in a podiatry office. If you have questions, email me.
 
Robert Spalding, DPM, Signal Mountain, GA, rts9999999@aol.com

ASSOCIATE POSITION - NORTHEAST GA

Well-established 18 year practice in Northeast Georgia seeking full-time associate leading to partnership. General podiatric care with moderate amount of surgery to be done in local hospital or surgery center. Competitive salary and benefits.  Please respond by email to: Fivetoes1946@aol.com

ASSOCIATE POSITIONS - MULTIPLE STATES

Podiatrist Needed in Missouri, Nebraska, Iowa, Minnesota, North Dakota, South Dakota, Ohio, Texas, Colorado, Oregon, Washington, Arizona, Massachusetts, Rhode Island, Wisconsin, Indiana, Oklahoma, Connecticut and Vermont. Expanding multi-state medical practice seeking podiatrists to service long-term care community residing in nursing homes and assisted living facilities. We offer an established patient base, scheduling, equipment allowance and cover travel expenses. Provide generous compensation, bonus opportunities, disability, health insurance benefits, malpractice coverage and flexible scheduling. Looking for a Podiatrist with excellent skills, able to provide expert and compassionate care to patients. Email CV to: careers@aggeus.org or call 773-770-0140 x300/x305. www.aggeus.org

ASSOCIATE POSITION - MARYLAND

Looking for 3rd associate. Must be personable, well trained and highly motivated. Great locations in Southern Maryland, including an Ambulatory Surgical Center. We currently have EHR, digital radiography, dispensing center and PADNet. Looking for immediate hire! Please send CV to: myfeetfeet@aol.com

PART-TIME PODIATRIST NEEDED - LOS ANGELES, CALIFORNIA

Busy podiatrist looking for assistance with patients located in facilities, homes, office, etc. Flexible hours, independence, and great compensation. If interested email CV to or call Terri at 323-353-8103.homefootcare@hotmail.com

ASSOCIATE POSITION – FLORIDA

Emerald Coast on the North Shore of the Gulf of Mexico, a well-established group practice with multi-offices, seeking an associate with opportunity for partnership for a PSR-24/36 Doctor well-trained in foot/ankle/diabetic problems/wound care/surgical and medical podiatric care, covering 3 area hospitals, NO nursing homes. e-mail letter of interest, CV, and references to basewedge@yahoo.com

ASSOCIATE POSITION – F/T MARYLAND

Looking for a bright, hard-working, personality plus, extremely well trained podiatrist with both top notch surgical and non-surgical skills. Remarkable opportunity with our busy practice. Excellent salary and benefits. Email CV and salary requirements to Marylandpodiatrist@live.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Full-Time Associate needed for busy multi-office locations in LA, Orange, San Bernardino and Riverside counties. SIX FIGURE SALARY PLUS BENEFITS!! Knowledge of Spanish is helpful. Good mix of office patients, house calls, some surgery, etc. NO NURSING HOMES!! Needed in July, 2012 or sooner. If interested, please send contact information and CV to scpodgroup@yahoo.com

ASSOCIATE POSITION - MIAMI, FLORIDA

well established modern practice all phases of podiatric medicine/surgery needs associate. Respond with CV and cover letter. podistristinsouthflorida@aol.com

ASSOCIATE WANTED - MANHATTAN

Park Avenue office seeks personable, capable and experienced podiatrist, part-time. Office needs coverage March 21 until May 2, possibly longer, with one day a week position available after May 2 .Growth potential. Please fax CV to 212-889-6150 or email info@healthyfeetny.net

ASSOCIATE POSITION - UPSTATE NEW YORK

Outstanding Opportunity. Our medical surgical group is recruiting a well-trained licensed podiatric physician. Located in Beautiful upstate NY. Full hospital privileges, as well as working with two residency programs. Must be highly motivated and great with patients. Opportunity for growth. Competitive salary and benefit package. Please send CV to associateinfoot@yahoo.com

SOUTHEAST GEORGIA- SAVANNAH & SURROUNDING AREAS

Beautiful weather year round & near the Coast. Opportunity for Early Buy-in. Seeking podiatrist looking to build a career & long-term relationship. Either established practicing physician or new residency graduate. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facilities. E-mail cover letter & CV to melissafoot@pol.net

ASSOCIATE POSITION - SOUTHERN KENTUCKY

Available in beautiful southern Kentucky in progressive, multi-office practice with 6 providers. Excellent base salary, malpractice, full benefit package with 2-year track to partnership. Looking for someone that wants to grow with our practice, work hard and develop relationships with local hospitals and surrounding communities. Strong communication skills, bedside manner and willingness to learn a must. Narrow window for interviews: email CV and letter of interest before March 1: footdocky@gmail.com

ASSOCIATE POSITION - KANSAS CITY, MISSOURI

I'm not just looking for an associate. I am looking for a doctor who wants to build a highly successful career with a doctor who is as committed to their success as he is to his own. Go towww.YourFutureInPodiatry.com to find out about this opportunity.

ASSOCIATE POSITION - CENTRAL NJ

Looking for a three-year surgically-trained associate who has entrepreneurial spirit. Partnership guaranteed within three years for the right person. Must be very outgoing and personable. Great opportunity for a person who is confident and a go getter. drwfoot@verizon.net

EQUIPMENT FOR SALE  - ARE YOU CONSIDERING A PADNET UNIT? 

If so, save thousands of dollars on a lightly used unit with venous option and laptop. Why pay full price for our unit which is in perfect working order. We also have a SIUI CTS 200 ultrasound with 7 mHz probe and SONY printer. Let's Make a Deal!! Call 516-220-8258 today.  

EQUIPMENT FOR SALE

Koven Doppler, Synthes Titanium Mini Frag screw set, Zimmer & Hall Micro 100 set (all 5 heads including wire driver), Two full major surgical instrument sets, miscellaneous surgical tools including osteotome set (curved & straight). All German stainless steel. Best offer. Retired due to illness. Call 586-675-4311 or 440-285-2827. Dr. Gary Docks.

EQUIPMENT FOR SALE

Cosman Radiofrequency Generator for Sale! Model RFG-1B Like New Condition. Comes with Manual, 17 Dispersive Electrodes, 2 CSK-R 10 Kits, 2 CSK-R 5 Kits, 11 CC RF Cannula 10cm/10mm/22G, 4 CC RF Cannula 10cm/5mm/22G, 1 - 5cm RF Cannula/22G (4mm Sharp Curved Tip), & 2 Replacement Fuses. Asking $10,500 OBO Please Contact: nffpbosk@gmail.com

EQUIPMENT FOR SALE - COOL BREEZE COOT TOUCH VARIA

Cool Breeze Coot Touch Varia. Very low use. You won't find a laser at this price. $39,500. Has about 19 hours of use of it. E-mail for photos, and ask any questions. Will go fast. David Zuckerman DPM 856-229-2939 footcare@comcast.net

SPACE AVAILABLE - NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview, Long Island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

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