The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

July 04, 2009 #3,588 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2009- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Skateboards Can be Hazardous to Feet: VA Podiatrist

Foot and ankle surgeons around the country warn they continue to see serious lower-extremity skateboard injuries among their patients. These injuries range from minor bruises to open wounds or cuts to more serious foot and ankle sprains and fractures, which may require surgical repair.

Dr. Jennifer Purvis

Virginia-based foot and ankle surgeon, Jennifer Purvis, DPM, AACFAS, advises skateboarders to use caution and wear protective gear, including properly supportive shoes, when Skateboarding. “Skateboarding can be particularly hard on your feet and ankles because of the impact caused when performing jumps and tricks,” Dr. Purvis explains. “Skateboarders should be aware that the strain from repetitive, forceful motions can also cause painful foot and heel conditions such as plantar fasciitis, bone spurs and Achilles tendonitis, which may require more intensive, longer-term therapies,” she said.

Even minor cuts or abrasions on your feet can cause serious problems.  Dr. Purvis recently treated a 21-year-old skateboarder for scrapes on his feet and ankles that were not healing. Tests indicated he had contracted MRSA – a very serious and sometimes deadly staph infection, which required surgery and four weeks of antibiotic therapy.

NJ Podiatrist is World-Renowned Flower Photographer

For the first time in nearly 70 years, an Amorphophallus titanum, dubbed the “corpse flower” for the stench of decay it gives off, was in bloom in New York, and Jonathan Singer had only five minutes to photograph it. That photograph is the first in Singer’s tome, Botanica Magnifica, a collection of 250 images, mostly endangered tropical flowers. The first set of the five-volume work occupies a place of honor in the Smithsonian Institution Libraries.

Jonathan Singer in front of his photograph of a Hippeastrum "Toscana,' a new hybrid amaryllis. Photograph by Howard Schatz.

Botanica, which weighs 35 pounds, was printed with handmade ink on handmade paper measuring about 26.5 inches by 39.5 inches. The price tag: $2.5 million—though you won’t need a hand truck or a trust fund to buy the $185, 12-inch-by-15-inch version Abbeville Press is publishing this fall.

With his shoulder-length gray hair, thick black-rimmed Versace glasses with gold detailing, and penchant for draping his six-foot-plus frame in unusual clothing (like flowing shirts and designer pajama pants), the 60-year-old Singer looks much more an artist than a podiatrist—his profession for the past 30 years. “I loved taking pictures from a young age,” he says. “I had to have every new Polaroid that came out.”

Source: Audubon Magazine {July/August 2009]

The Whole World's Watching

Many professionals are using the Internet to market their practices very successfully. Many have now started using Facebook, Twitter, and Linked In with astounding results. But a word of warning. Your online reputation is very important and it must be protected. Never post anything that you wouldn't want your mother to read. The Internet is a very open community. Keep your comments professional. Avoid political rants, or discussions of any topic that would compromise your precious reputation. And get online to be sure that no one else is speaking inappropriately about you too.

Source: Rem Jackson, CEO of Top Practices. For information on the American Academy of Podiatric Practice Administration click here.

RE: Bony Repair vs. Fat Augmentation
From: Ivar Roth, DPM 

This is a follow-up on a case I sent in as a query several months ago about a Indian man whose feet were so thin that he was afraid that his in-laws would refuse to allow him to marry their daughter. 

Atrophied Feet - Pre-op

After much consideration of doing bony repair vs. fat augmentation, I decided to use liquid silicone, a procedure I was taught by the late Dr. Sol Balkin. The plastic surgeon who referred the patient to me  said that the patient would have to gain at least twenty pounds to harvest enough fat from his buttocks area to perform the procedure. I have never done a silicon augmentation to this extent before (I also fixed the plantar aspect of his foot). 

Atrophied Foot - Post-op

The procedure took me approximately two hours to perform. I later spoke to the patient and he told me that the foot was now fixed enough that he could pass the in-laws cleansing of his feet ritual and get married.

Ivar E. Roth DPM/MPH, Newport Beach, CA,ifabs@earthlink.net

RE: Surgical Closure of First Metatarsal Growth Plate to Correct For a High IM Angle (Nick Tanner, DPM)
From: Multiple Respondents

I suggest considering epiphysiodesis for high IM angle in adolescent bunions. Steve Smith, DPM is the pioneer in this procedure, having performed it for the first time more than 30 years ago. Steve practices in California and can be reached at sdsmith@footandanklewest.com
 
Lowell Scott Weil, Sr., DPM, Des Plaines, IL, weil4feet@aol.com

This type of procedure where you operate on a growth plate to correct an HAV deformity seems like quite a novel approach. There is one caveat however to operating on any kid's growth plate. If something should go awry and the patient is not happy with the outcome, and somewhere down the pike, the originators of the procedure no longer think it was a great surgical idea, that patient, who is now 11 years old, will have 7 years plus the applicable statute of limitations to think about suing you. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

I am both perplexed and incredulous after reading this query. We are a medical profession dedicated to advancing foot care in the USA, based on  treatments that are supported both scientifically and clinically. No evidence exists in our profession to remotely support performing closing of a growth plate to achieve correction of juvenile HAV. I suggest combining a McBride procedure with an Austin osteotomy. In experienced hands, this should more than adequately reduce this deformity. 
 
Stephen J. Leonard, DPM, sjleonard56@hotmail.com

RE: Forefoot Striker With LLD (Chris Seuferling, DPM)
From: Stanley Beekman, DPM

The short answer to your question is that if there is no equinus, then the sole lift should equal the heel lift. The more the equinus, the less the thickness the sole lift should be. There is a much longer answer, and that has to do with why you see what you do posturally.

Stanley Beekman, DPM , Cleveland, OH, sbkmn1@gmail.com

RE:  CMS Proposes 21.5% Cut in Medicare Doc Payments
From: Lloyd S. Smith, DPM

There are other issues of concern to podiatrists in this new rule.  CMS has proposed that the consult codes will no longer be paid to specialists. The initial visit codes will be paid instead. This will shift dollars from specialists to primary care physicians and is part of a major effort to shift dollars from specialists to PCPs.
 
There are also proposals on certifying imaging services that will make it more difficult for office-based, high-cost imaging services to quality for Medicare payments.  In addition, areas that might affect payment to DPMs, changes to the practice expense and malpractice expense components, are proposed. Finally, there are issues of interest to DPMs that include PQRI and eRX.
 
The proposed rule can change and will be finalized in the Federal Register sometime in the late Fall of 2009. APMA typically sends an extensive comment letter to CMS on the relevant issues but all interested parties can comment. The proposed rule can be found on the CMS website. But, beware; it is often about 2000 pages in length. I confess that I have only read the summaries on line.
 
Lloyd S. Smith, DPM, Newton, MA, lloydpod@yahoo.com
 

RE: DC Podiatrist Supports Public Healthcare Option (Marc Garfield, DPM)
From: Dan Waldman, DPM, John Hahn, DPM

Dr. Marc Garfield summed it up eloquently. Government and the 'corporatocracy' are eroding our freedoms while the average American (dazed and confused) struggles to make ends meet.   Government will not solve the health care problem but it will dictate and ration it. Social safety nets can play an important role; but never forget the words of George Washington, "Government is not reason; it is not eloquent; it is force. Like fire, it is a dangerous servant and a fearful master." 

While on vacation with my family, I will be privately meeting with Rep. Ron Paul (R-TX) at his Washington DC office July 15th to personally discuss my concerns about health care and the decline of our personal freedoms. I welcome my colleagues' ideas to share with him about podiatry. If you don't know much about him just go to You Tube for his speeches.

As an aside, I highly recommend the book: Web of Debt by Ellen Brown, JD. Ever wonder why Dorothy's shoes (see a podiatry reference!) were not ruby but silver in the book The Wizard of Oz by Frank Baum? Find out before it's too late. 
 
Dan Waldman, DPM, Asheville, NC, dpmcareer@aol.com

Editor’s note: Dr. Hahn’s extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=27217&start=1
 

PRACTICE FOR SALE - ALABAMA, GULF COAST

Established 26 year old practice. Owner desires to sell and relocate. Operated 25 hours per week. Mixture of surgery and general podiatry. MD referrals. Surgery center and hospitals in close proximity. Highly profitable. Priced to sell.  Will lease office to buyer. Call Mike Crosby at 888-776-2430 or email mcrosby@providerresources.com

ASSOCIATE POSITION AVAILABLE-MIDTOWN MANHATTAN 
 
Looking for Full-time associate to work in well established practices in midtown Manhattan and Forest Hills. Immediate opening for PSR 24-36 surgically trained Podiatrist. Great opportunity with competitive salary along with malpractice benefits. Position includes Saturday office hours. Please send CV to slurie@papapc.net

ASSOCIATE POSITION - CHICAGO AREA

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.