The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

July 13, 2012 #4,513 Publisher-Barry Block, DPM, JD

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Dr. Brenna Steinberg

The winner of this week's contest is Dr. Brenna Steinberg of Frederick, MD. There has been an overwhelming response to our new Facebook page, so we are giving away another prize this week. Simply "like us" and be eligible to win a free registration for the Greenbrier Coding and Practice Management Workshop (Value $395). Enter now. The contest ends July 15th, 2012. No Purchase necessary.

NY Podiatrist Performs Cosmetic Surgery on Fat Toes

When patients seek out cosmetic surgery from New York-based Dr. Oliver Zong, they're often looking to remove fat, but not from their bellies or thighs. Zong is a podiatrist, and one of his specialties is slimming down people's fat toes -- "toe-besity," he calls it. He's been in practice for about a decade, and when he started, toe reshaping was unheard of.

Dr. Oliver Zong

"When people first started asking, I said 'What?'" said Zong, who is surgical director at NYC FootCare. "We were mostly doing toe shortenings in the begining." Now, he said, more and more people are zoning in on the smaller details of their feet, like the width of their toes. This type of surgery is considered entirely elective, so insurance companies will not cover the costs, which can range from a few hundred dollars to a few thousand dollars, depending on how complicated the procedure is.

Source: Kim Carolla, Good Morning America (ABC) [7/11/12]

Flip-Flops Never Safe: FL Podiatrist

Flip-flops, a favorite footwear for many South Floridians, are “never safe,” says Dr. Scott Strolla, a West Palm Beach podiatrist. Yes, he actually said, “never safe.” Strolla practices at Good Samaritan and St. Mary’s medical centers in West Palm Beach, at Palm Beach Gardens Medical Center, and Jupiter Medical Center. Over the years, he has seen many foot injuries when patients wear flip-flops, including footwear that costs several hundred dollars. He defines flip-flops as a thong sandal with only a V-strap.

Dr. Scott Strolla

For diabetics, wearing flip-flops can be problematic for those with neuropathy. They don’t feel or don’t heal as well as healthy people, Strolla says. Consequently, when the V of a flip-flop cuts into the space between their big and index toes, they can’t feel it rubbing. He talks about one of his diabetic patients who insisted on wearing flip-flops despite being warned against doing so. That patient, who had neuropathy, developed a deep-space infection that led to the amputation of the big toe and part of his foot, he says and sighs.

Source: Jane Smith, Palm Beach Post [7/11/12]

PA Podiatrist Receives Dr. G. Dock Dockery Special Achievement Award

The International Foot & Ankle Foundation (IFAF) recently presented Dr. Guido LaPorta with the Dr. G. Dock Dockery Special Achievement Award. This special ahievement award provides special recognition to individuals who have demonstrated notable singular or multiple achievements in medicine, surgery, research, or education. This award honors living individuals who have made a positive and substantial impact on the education and advancement of the profession.

Dr. Guido LaPorta (R) is presented with the Dr. G. Dock Dockery Special Achievement Award by Dr. Bryon Hutchinson, last year's recipient.

This award was developed by the IFAF Board of Directors (BOD) in Dr. Dockery's Honor, and the BOD selects the recipient each year. The award is presented each year at the IFAF Seattle Summer Seminar or the Annual Residency Graduation Ceremony. Dr. LaPorta is a ledgendary podiatric surgeon and residency director.

CA Podiatrist Demands That Opponent Repay Preferred Countrywide Mortgage

The Democratic challenger to Rep. Howard "Buck" McKeon (R-CA) said Monday that the high-ranking House member should "pay back" the spoils from a sweetheart deal he allegedly received from former mortgage juggernaut Countrywide Financial. Last week, the House Oversight and Government Reform Committee, following a three-year investigation, released a report that confirmed existing allegations that McKeon received preferential treatment from Countrywide when obtaining a $315,000 mortgage loan in October 1998.

Dr. Lee Rogers

"It shows that, at the very minimum, he has poor judgment," said Dr. Lee Rogers, McKeon's opponent in the contest for California's 25th District. "I think the Oversight Committee's report showed that McKeon isn't being honest," Rogers argued. "If McKeon truly didn't know about the discount and fee waivers, he could just pay back the benefit he received."

Source: Greg Rosalsky, The Huffington Post [7/11/12]

VA Tests Teleconference Training for Primary-Care Docs

The U.S. Veterans Affairs Department is testing a new take on telemedicine at 11 sites across the country. The three-year, $15 million pilot program, called Specialty Care Access Network-Extension for Community Healthcare Outcomes, aims to train VA primary-care physicians to provide specialty medical care to veterans living in rural settings where specialists are scarce. If successful, such Internet-based specialty training for primary-care physicians could be rolled out throughout the VA system, according to VA officials.

The program uses one-and-a-half hour weekly video conference training sessions for primary-care physicians. Sessions are led by panels of medical specialists in select areas of medicine. The training uses specific cases to simulate the training that physician specialists receive. The aim of the program is to serve as a "force multiplier" that allows the same number of physicians to treat a larger number of patients by expanding primary-care physicians' knowledge of select specialty areas of medicine.

Rich Daly, Modern Healthcare [7/11/12]

RE: Failed Phenol Procedures (Charles F. Ross, DPM)
From: Philbert Kuo, DPM, Stanley Beekman, DPM

I always use a tourniquet when doing a chemical matrixectomy. I used phenol successfully for ten years but switched to sodium hydroxide a few years ago. Sodium hydroxide is less expensive and does not incur a hazardous material shipping fee. A single 5 to 10 second application is all that's needed followed by a vinegar flush. Keep an eye on the expiration date as the solution does weaken with time. The healing time is the same as with phenol.

Philbert Kuo, DPM, Chesapeake, VA, philbear@pol.net

I think the key to this procedure is to reduce the variables. One variable is the amount of bleeding that neutralizes the phenol, the second is not controllable - which is the patient's genetics. To control the bleeding, I use a touniquet, and then apply Monsel's solution, and then clean the excess with 2 or more cotton tipped applicators. After this, I apply the phenol.

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

RE: Failed Phenol Procedures (Charles F. Ross, DPM)
From: Howard R. Fox, DPM

I have been using 99% (crystalline) phenol for the 33 years I’ve been in practice and never use a tourniquet. It’s hard to say what my recurrence rate is since I have no way of knowing if a dissatisfied patient with a recurrence went to a colleague. I also don’t use an elevator or a nail splitter, but rather a Steven’s tenotomy scissor, which is far less traumatic. I can’t say whether it’s the pure phenol or the technique, but hardly anyone has any post-operative pain whatsoever. What I particularly like about using 99% phenol is if it’s crystalline, I know it’s pure and free of contaminates (otherwise it turns to liquid). It’s a bit of a bother heating it up into solution to make it available for an applicator tip (I use the Micro-tip applicators), and I can’t imagine that the 0.004 picograms that gets discarded on the tip of the applicator is a major source of global warming.
 
You need to purchase this from a chemical supply house, as medical supply houses don’t have the 99% stuff.  I get mine, well, I GOT mine (since 1 bottle will last you the life of your practice) from Ward’s Natural Science in Rochester, NY: (wardsci.com)
 
Howard R. Fox, DPM, Staten Island, NY, Fox.howard@gmail.com

RE: Recovery Time for Bunionectomy for Karate Artist (Richard Jaffee, DPM)
From: Barry Mullen, DPM

Unfortunately, Dr. Jaffe's question is far too generic to accurately answer at this time. A myriad of parameters exist that affect bone healing. For instance, what type of bunionectomy is contemplated? Will an osteotomy be performed? If so, which bone (metatarsal? phalanx? both?), how many, and where within the anatomy of that bone will the osteotomy be performed (distal metaphysis, proximal metaphysis, midshaft)? How will it be fixated? Is your patient's physiologic age commensurate with her chronological age? Just because she is a karate expert, can we automatically assume 100% health with no co-morbid fracture healing factors such as post-menopausal osteoporosis, etc.? ALL of these parameters affect bone healing rates.
 
As one example, a healthy 50 year old female, with no co-morbid fracture healing factors, who undergoes a distal metaphyseal 1st metatarsal osteotomy with AO fixation, should heal that osteotomy via primary bone healing between 4-6 weeks. At 8 weeks, assuming no setbacks occur, and radiographic evidence confirms primary fracture healing, then I'd likely have little qualm about allowing this patient to re-stress the forefoot. Keep in mind that following any immobilization (for me, in this example, typically 3-4 weeks in a pneumatic cam walker), patients will experience some disuse atrophy and regional, pedal osteoporosis. So, I'd want her back in flexible shoes, propelling off her forefoot and re-establishing full blood flow throughout her operated foot for several weeks prior to allowing the stress of board-breaking.
 
Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

RE: NY Podiatrist Discusses Cold Feet in Diabetics
From: Arnold Ross, DPM

Dr. Stone's article/recommendation is sensible, but overstated as a warning. If you have cold feet and can't sleep or be comfortable, just make a bowl of warm water, feel it with your hand to make sure it isn't too hot, and soak the feet. This gives tremendous relief.  

Arnold Ross, DPM, Los Angeles, CA, asross1@juno.com

RE: OH Podiatrist Facing 8 Malpractice Lawsuits
From: Mathew M. John, DPM
 
I read the posting on PM News about Dr. Janis. In reading the article excerpt, the assumption is that this doctor is guilty of malpractice. After reading the entire article, I got a better picture of the story but I find it irresponsible for PM News to post only a portion of the article. In addition, we should be cautious posting articles or news stories from a media outlet that may be biased. We all remember the skewed report from ABC’s 20/20 back in the ‘90s that painted podiatrists as not being well trained and even inferred that there was a danger to the public.

I  recommend reposting “In the Courts” stories where the podiatrist was actually found guilty or not guilty of malpractice or fraud and stop catering to the “court of public opinion.” We should set a higher standard within our profession in delivering negative stories of podiatrists. I’m sure not one of us would be happy if a malpractice lawsuit were published and republished online, tarnishing our reputation, while later the lawsuit was found to be frivolous and thrown out.
 
Mathew M. John, DPM, Marietta, GA, footdoc@afcenters.com

Editor's note:  We believe that the excerpt was objective and balanced, and there was no assumption of guilt implied. We generally run short excerpts of longer stories. Readers are invited to read the entire article and decide for themselves. PM News policy is not to run a story about a single alleged case of malpractice.  

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