The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

July 24, 2009 #3,604 Publisher-Barry Block, DPM, JD

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OH, NY Podiatrists Discuss Plantar Fasciitis

People with all arch types -- high, medium, or low -- can be prone to plantar fasciitis, says Carly Robbins, a podiatric surgeon in Columbus, Ohio. Wearing shoes with very flat or very high heels can worsen the problem. "If a shoe doesn't support the arch, the fascia will be stretched, and that can cause inflammation," says Robbins. And if your Achilles tendon often feels tight, it can exacerbate the issue.

Dr. Carly Robbins

Stretch your Achilles tendons in the morning. "The plantar fascia is in a relaxed position when you're sleeping," says Jacqueline Sutera, a podiatric surgeon in New York City. "Then it gets a jolt of tension when you put weight on it." Before hopping out of bed, wrap a towel or a T-shirt around your feet and pull the toes back to stretch the tendons.

Dr. Jacqueline Sutera

Source: Sally Wadyka, Real Simple [7/20/09]

Podiatrist Teaches How to Get Fit in High Heels

Emily Splichal, a podiatrist and fitness instructor who has created a class called Catwalk Confidence. The workout, which has become something of a sensation since it was introduced earlier this year in New York, arrives in Boston this fall. Splichal is affectionately known as Dr. Legs in some circles.

Dr. Emily Splichal

“You want to strengthen and stretch the muscles you use,’’ she says, explaining that her Catwalk Confidence class is equal parts yoga, Pilates, and stretching. This is when I found out that there are also men who take the class. They just skip the part that involves wearing women’s shoes.

Source: Christopher Muther, Boston Globe [7/23/09]

NY Podiatrist Accused of Medicare Fraud

A podiatrist wasn't just hardworking when he billed Medicare for a month's worth of services during a single day; he was downright criminal, federal prosecutors allege. Dr. Simon Levich, of Brooklyn, charged for more than 160 hours of services on one day in 2006, court papers said. In a vast, two-year fraud scheme Dr. Levich, 53, also allegedly billed Medicare through accounts of doctors no longer working for him.

He is free on $1 million bail after recently being arraigned in Brooklyn federal court on health-care fraud charges. "Dr. Levich is a very well-respected practitioner. He's helped scores and scores of patients," his Manhattan-based lawyer, Michael Rosen, said today. "He pleaded not guilty at his arraignment and is presumed innocent."

Investigation revealed Dr. Levich billed for surgical procedures when patients, in fact, merely received whirlpool treatment and pedicures. He allegedly billed for a high number of physical therapy services and submitted charges for routine foot care procedures without appropriate diagnoses.

Source: Frank Donnelly, Staten Island Advance [7/23/09]
 

CMS Moves to Ease Outpatient Compliance by Allowing Supervision by Non-Physicians   

CMS’s recently proposed changes to physician supervision requirements for outpatient services should allow hospitals to achieve compliance with less financial strain, lawyers and compliance officers agree. Proposed on July 1, the outpatient prospective payment system (OPPS) rule makes a number of provider-friendly changes to physician supervision requirements in all settings, from provider-based entities to hospital departments. Unless CMS makes modifications in the final rule, which is due by Nov. 1, these new provisions are scheduled to take effect on Jan. 1, 2010.

In a practical sense, these proposals ease most of the compliance and reimbursement burdens imposed by CMS’s recent restrictive policies on physician supervision of hospital outpatient services, which is required for all services provided “incident to” a physician’s professional services.

The most striking development is CMS’s intention, for the first time, to allow non-physician practitioners (NPPs) — including nurse practitioners and physician assistants — to directly supervise all hospital outpatient therapeutic services that they can also personally perform according to their state scope of practice and hospital privileges, CMS said in a statement. As it now stands, only physicians can directly supervise outpatient services.

Source: Nina Youngstrom, Report on Medicare Compliance [7/22/09]

Gain Confidence Before You Speak

Mentally prepare before you approach the lectern to speak. Silently repeat these lines to yourself: “I love what I do. I know what to do.”

Like an athlete taking the field, you will banish negativity and focus on doing your best.

Source: Adapted from Present Like a Pro, Cyndi Maxey and Kevin O’Connor via Communication Briefings

Query: Brachymetatarsia Surgery

My patient is 4 weeks S/P osteotomy. Distraction began at 2 weeks. Externally, the fixator appears to be in proper position.

Post-op Brachymetatarsia

Radiographically, the 4th metatarsal appears to be migrating medially. I would appreciate any suggestions.

Dale Shrum, DPM, La Quinta, CA

Query: Podiatry Chair Recommendations

I am in the market for a new podiatry chair. I am looking at the Midmark 647. Does anyone have any comments about this chair, good or bad? Any better ideas?
 
Al Musella, DPM, Hewlett, NY

RE: Warts in an HIV Patient (Tip Sullivan, DPM)
From: Multiple Respondents

Dr. Sullivan's HIV patient seems to have an "immunologic blindness" to the wart viral particle. But so do young children who come in with mosaic verruca of the heels and other sites on the feet. Since I am loathe to create large holes in the feet, because plantar verrucae invaginate (and regardless of modality a crater is produced). I turn to my 'alternative' regimen which seems to have worked these last twenty years.

1. Vitamin A orally, 100,000 units per day for two months. No, it is not toxic in this dosage for this period of time. I have researched this. Do not substitute beta-carotene for the Vit. A.
2. Forma-Ray daubed on the lesions in the a.m.
3. Vitamin E (400 unit capsule pierced) rubbed vigorously on and around the wart in the p.m.
4. Garlic oil also rubbed vigorously onto the lesion. (a recent addition per Robert Roven, MD, from his newsletter "Second Opinion.")  Try it, you may like it.
 
Robert D. Teitelbaum, DPM, Naples, FL, mfvandange@aol.com

I had a similar patient that presented with a one-year history of painful verrucous lesions on the plantar aspect of almost the entire foot bilaterally. Multiple therapies had been tried up to that point with no success. He was on a triple regimen for HIV. I contacted his physician and found that in order for me to place him on Tagamet, one of the meds had to be discontinued during the treatment. I placed him on 35mg/kg divided tid. In three weeks, he returned with absolutely no lesions.
 
Jonathan B. Purdy, DPM, New Iberia, LA, podiatrist@mindspring.com

I have used Bleomycin on several HIV patients with great results. The last patient was referred to me after having excision, laser, and cold therapy all fail. It usually requires more visits than usual, but the results have been excellent.
 
Barry A. Wertheimer, DPM, Redondo Beach, CA, bwertheimer@cox.net 

RE: Chronic Sub-Hallux Ulcer in Diabetic (Marc Greenberg, DPM)
From: Jeffrey Kass, DPM, Ira Weiner, DPM

Obviously, this is a difficult case and patient, just by the history Dr. Greenberg has given. I think the most important thing is to identify the etiology of the ulcer. Is there an IP sesamoid under the hallux? Is there a hallux limitus putting more pressure distally? Does the patient have an equinus? If you are contemplating corrective surgery to keep the digit, you have to make sure the patient has adequate perfusion.

Dr. Greenberg mentioned that  there were multiple other procedures/amputations so this would be important to know. Sometimes, you can perform a more distant procedure that may end up helping you. For example, in your case, if there is an equinus, maybe a gastroc recession will help cure the ulcer without having to do anything invasive at the toe. The circulatory status is probably better proximally than distally. I agree if the toe can be saved, you try and save it. Just find the reason why the ulcer is there (Look at a lateral film – is there hypertrophy of bone?).
 
Jeffrey Kass, DPM, Forest Hills, NY Jeffckass@aol.com

Many things have to be considered when addressing a patient such as this. First off, does the patient have an equinus deformity?  Many do, and addressing this will be necessary initially. Does the patient have a hallux rigidus? Addressing this would also be a good idea as well. What type of gait pattern does he have? Usually, an equinus deformity will lead to some type of spin gait, and this has to be taken into consideration.
 
Rocker-bottom shoes with a slight heel raise might be the best conservative option initially after good off-loading wound care.
 
Surgically, it’s difficult to say without knowing more about the causes of the ulceration, but you can be almost certain it is due, at least in part, to some gait abnormality.

Ira Weiner, DPM, Las Vegas, NV, vegasfootdoc2005@yahoo.com
 

RE: Delayed Onset Muscle Soreness (DOMS) (Bret Ribotsky, DPM)
From: Doug Milch, DPM

For DOMS affecting the quads, an old post-marathon trick is to turn around and go downstairs backwards. Of course, holding on to a bannister is advised!

Doug Milch, DPM, Asheville, NC, LDMilch@charter.net

RE: Setting the Record Straight
From: Alan J. Cantor, DPM

On March 14, 2008, I was featured in the section on "Podiatrists and the Law." "PODIATRIST ARRESTED FOR BILLING THE DEAD."  Well, who would NOT read that, and, since it was in the media: print, TV, radio, the "Court of Public Opinion" raged.  How many years in jail, etc. were all very articulately presented.

I was arrested....

Editor's note: Dr. Cantor's extended-length note can be read at: http://www.podiatrym.com/letters2.cfm?id=27626&start=1

ASSOCIATE POSITION – ILLINOIS 
 
Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings available. If interested, fax curriculum vitae to 312 225-9366 or e-mail feetwork@aol.com

ASSOCIATE POSITION – PACIFIC NORTHWEST

ASSOCIATE POSITION - BOSTON, MA 
 
Associate wanted, Full-time or part-time, for busy long time, well established, and well-rounded practice. Good mix of general podiatry and surgery. Office will generate approximately 100+ surgical cases per year. Must have surgical background, ABPS Qualified minimum needed to obtain hospital privileges. Associate position is open for partnership or purchase. Contact robert.nunberg@comcast.net 

ASSOCIATE POSITIONS - CALIFORNIA

Podiatrist needed for busy North Hollywood office. Part-time Monday-Friday 8am-2:30pm. No weekends and no call. Pay negotiable. New podiatrists are encouraged to apply. Please email resume and salary request to Coasttocoastpodiatry@yahoo.com

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

ASSOCIATE POSITION-CHICAGO AREA

Podiatrist is needed in multiple office practice part or full- time in  Chicagoland area. Please email resume to: anthony.spitz@gmail.com or call 847-971-5926

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS 

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

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 

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