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From: Dan Klein, DPM


I provided podiatric services to about 10 nursing homes for about 20 years. I advised patients about the “routine foot care” clause and collected fees from the patient’s family. I was approached by a Chicago-based company run by a podiatrist, who asked me to work for them doing essentially routine foot care for a salary. They would, in turn, bill CMS for these services. When I explained to this company that these services were non-covered, and I would not commit fraud, they suggested that I diagnose conditions that would allow them to bill for the services. 


When I refused to collude with this company, they advised me that my relationship with these homes was in jeopardy and they would find another podiatrist who would work with them. To my dismay, I was advised by these same homes that my services would no longer be needed and they were going with another podiatrist who would do these services. So after 20 years of service to these homes, I lost out to a podiatrist who would create diagnoses, and often embellish conditions that didn’t exist for each resident.


Years later, the same Chicago-based company was cited by the Federal Government and the owners of the company were fined and going to prison for fraud. My integrity cannot be bought! Without integrity, a podiatrist, a doctor, a person is nothing!


Dan Klein, DPM

Other messages in this thread:



Kent Biehler, DPM, Middleburg FL


From an evidence point of view, I agree with Simon Bartold's statement... it's a myth that running shoes reduce injury. It goes along with the similar mythology regarding subtalar joint neutral orthotics that claim to control motion by reducing pronation and putting feet in a “perfectly healthy position”.


Ten years ago, I started working with Dr. Dennis Shavelson's functional foot typing. It is a well thought out innovative paradigm for diagnosing foot pathology. It produces a vaulted, centered custom foot orthotic that, in my ten year experience, replaces subtalar joint neutral orthotics. His protocols are less myth and more time tested reality. It brings control and certainty back when practicing individual biomechanics. The major draw back is they can't be mass produced with one size fits all.


Kent Biehler, DPM, Middleburg, FL



From: Steven Kravitz, DPM


I’d like to thank Dr. Sutera for discussing and bringing to attention that DVT associated with long-term air travel and resultant pulmonary embolism is all too often not well recognized. There are a few well done scientific articles on the topic because it is very difficult to follow up the fact that the DVT and especially PE is often not noticed until several days following the air travel. This presents in many variables that can make the causality scientifically difficult to make. 


A very good paper terms the phrase “Economy Class Syndrome” identifying the differentiation between a business class seating long-term travel and sitting in a tight seat in the rear of the plane with knees, hips, and ankles all flexed at 90°. While traveling from ther West to East coast U.S. is a concern, much more concern is transcontinental travel to the Mideast or Asia. These flights can incur more than...


Editor's note: Dr. Kravitz's extended-length letter can be read here.



From: Steven J Berlin, DPM


I want to congratulate Dr. Robert "Bob" Hilkemann on his dramatic rise from retired podiatrist to the highest office in the State of Nebraska (even if it was just for two days). Bob and I served many years together on The Fund For Podiatric Medical Education (now the APMA Educational Foundation). I just knew he had more successful days ahead. My sincerest congratulations to you on your service to the citizens of Nebraska and to your profession.  


Steven J Berlin, DPM, Baltimore, MD



From: Brian Lee, DPM


I loved the story about the three generations of DPMs in the Caneva family. Reno was one of my residency directors back in “the day”, which was 1985! Great guy. I’m glad to see him still having an impact on the podiatric community. 


Brian Lee, DPM, Mt. Vernon, IL



From: Allen Jacobs, DPM


Mark Twain is credited as saying, "There are 3 types of lies; lies, damn lies, and statistics." 


Dr. Paul Dayton has devoted considerable time and effort to examining the current state of bunion deformity and correction. His work is worthy of consideration. It appears to me that those positing opinions in PM News on this subject may not be particularly familiar with his work regarding the need for stability and triplane 1st ray correction. 


One question which needs to be addressed is whether or not...


Editor's note: Dr. Jacobs' extended-length letter can be read here.



From: Dieter J Fellner, DPM,


Dr. Borreggine succinctly provides an excellent rebuttal to the overtly enthusiastic (premature) endorsement of Lapiplasty.  Meanwhile, citing the research evidence, Dr. McAleer, perhaps unwittingly, provides further ammunition to a counterpoint of view: the Lapiplasty has yet to be put to the test, for long-term outcome success. Conspicuously absent also from the literature review is the long-term outcome for Lapidus.


On the issue of frontal plane rotation: I agree that this should be evaluated pre-operatively and addressed surgically, when present. This can be easily accomplished with a regular Lapidus (and fixation of a surgeon’s preference). This problem does not specifically require the ‘Lapiplasty’ with its complex cutting rigs, an over-engineered bone clamp, two plates and a bag of screws.


While obvious to the foot surgeon, this information is lost to the Lapiplasty marketing hype. I will go one step further: frontal plane rotation can be addressed differently, much more easily and without expensive fixation. I have addressed this issue in a lecture presentation prepared for the AAFAS, New Orleans meeting June 2018. I have posted the lecture on YouTube for open access and will provide narration in the next week or so.


Dieter J Fellner, DPM, NY, NY 



From: Ralph Graham, Larry Aronberg, DPM


In regard to the discussion about Lapiplasty, I agree with others that this is just a method for performing a fusion at the metatarsal cuneiform joint. In addition to other comments which I endorse, why on earth is it named “plasty”. The last thing it produces is mobility so it is not a sensible title.


Ralph Graham, Witham, Essex, UK


I'm concerned about the biomechanical effect of fusing the 1st ray. I have a friend in his late 50s who hikes, plays golf, and tennis. He's considering getting bilateral procedures (I would send him to another DPM since that's beyond my training). Lapiplasty may be too new for long-term results to be apparent, but Lapidus itself is not. Any comments? I can't even envision an orthotic that could compensate for a fused 1st.


Larry Aronberg, DPM, Lake Worth, FL



From: JP McAleer, DPM


Colleagues, I invite you to read the requested sources found below. I agree it is a disquieting thought when we realize that there may be a better way to approach our surgical specialty. I have found that the Lapiplasty 3D Bunion Correction Procedure has been a ‘game changer’ for my patients, and I am proud to offer it to them. I respectfully invite you, the podiatric and foot/ankle ortho community, to read Dr. Paul Dayton’s book -Evidence-based Bunion Surgery as well as the current journal literature touting the benefits of triplane correction.


30% radiographic recurrence after Scarf at 10 years (Bock, et al., JBJS 2015)

65% radiographic recurrence after proximal open wedge at 2.4 years (Iyer, S et al., FAI 2015)

73% radiographic recurrence after distal chevron at 8 years (Pentikainen, et al., FAI 2014)

73% & 78% radiographic recurrence after Scarf and chevron respectively at 14 years (Jeuken, et al., FAI 2016)

Incomplete reduction of the sesamoids - 10x recurrence risk (Okuda, et al., JBJS 2009)

Incomplete reduction of metatarsal rotation - 12x recurrence risk (Okuda et al., JBJS 2007)


Also - please note that I was misquoted. I stated “Traditional bunion surgery has up to a 70% rate of recurrence based upon the literature.” I am working on having the printed article corrected. 


JP McAleer, DPM, Jefferson City, MO



From: Joseph Borreggine, DPM


The “new” bunion procedure that is called the lapiplasty which was brought to fruition by Dr. Paul Dayton, et al. and his team certainly has “changed” the way we look at the biomechanics  of a bunion deformity, let alone, how to correct it. But, the question I pose to the PM News readers and to my podiatric colleagues: is this bunion procedure the pinnacle of podiatric surgical success because of its continual outcome of “reproducible” results along with reduction in bunion deformity re-occurrence? 


Or is this procedure driven like most of our profession’s innovations by the vendor dollars created by performing said procedure? Or is this procedure’s ability to stay in the limelight of surgical success fueled by the...


Editor's note: Dr. Borreggine's extended-length letter can be read here



From: Patrick J. Nunan, DPM, Richard A. Simmons, DPM


While I commend the new innovation of bunion surgery, I would like to know the source of the comment that traditional bunion surgery fails 70%!  Having been in practice for 33 years, I have yet to see that many bunion procedures fail at that rate. If bunion surgery had that high of a failure rate, very few, if any, would be performed. Malpractice would be outrageous and hospitals, insurance plans, etc. would not allow the procedure to be performed.  


Patrick J. Nunan, DPM, Savannah, GA


I hope this article about this one-year-old, “game-changing” lapiplastly, 100% bunion correction procedure was more “tongue-in-cheek” rather than something that is supposed to be factual and peer reviewed.


Richard A. Simmons, DPM,  Rockledge, FL



From: Stephen Kominsky, DPM


I read and have been reading PM News since its inception. Many times over the years, I have disagreed with comments and assertions made by our colleagues either through an interview for a media outlet, or straight up for this platform. I generally hold my tongue and don’t comment, but this time I have to.


In the piece regarding the lapiplasty procedure, Dr. McAleer asserts that “traditional bunion surgery has a 70% recurrence rate.” I find that comment to be a lot of things including egregious, damaging, and laughable, but mostly, just wrong. Yes, of course there is an inherent recurrence rate with bunion surgery, but with today’s level of training and education, and the skill of the today’s podiatrist, the rate is more like 10%. 


The lapiplasty is a good tool (that IS what it is, an expensive piece of equipment used to accomplish the Lapidus procedure), but it is NOT responsible for the reduction of recurrence; make no mistake about that. A Lapidus procedure would accomplish the same thing. But that is not the point. To simply disseminate a false piece of information is misleading and smacks of trying to increase sales of the equipment for the company that manufactures it.  


Stephen Kominsky, DPM, Washington, DC



From: Brian W. Fullem, DPM


In reading Dr. Zuckerman's comment on Shockwave Therapy, I disagree with his statement: "Comparing high-energy FDA-approved ESWT with the EPAT is false and misleading. They are entirely different modalities with different uses and outcomes." 


EPAT produces a sound wave; it is commonly known as Radial Extracorporeal Shockwave Therapy. The old terminology would be low energy, whereas the machine is similar to the Dornier EPOS. The new terminology is Radial ESWT and Focused ESWT. They both produce sound waves. There is also no difference in the literature as to which technology works best, both produce similar results which are in general better than any other technology for soft tissue injuries. 


I highly recommend that people read this medical article. The article is a... 


Editor's note: Dr. Fullem's extended-length letter can be read here.



From: Jeffrey Kass, DPM


I would like to congratulate Dr. Reilly-Fallon, a classmate of mine. She has appeared in PM News regularly as a selfless individual who is involved in various charitable organizations. A true "menchette" (female mench) who deserves to be applauded for her good-hearted work. 


Jeffrey Kass, DPM, Forest Hills, NY



From: Dennis Shavelson, DPM


While I agree that well cast, well prescribed, well fabricated, and well dispensed custom foot orthotics are beneficial to foot and postural sufferers (i.e., they can reduce heel pain, metatarsalgia, and flat foot suffering), Caroline Leverett sums up what I see involving mainstream $300-600 podiatry custom cast, scanned, and prescribed foot orthotics marketing on websites and media postings and interviews.


She uses her soapbox to claim that her custom orthotics: align feet, prevent foot deformities, improve foot function, and correct biomechanical causes of pain. 95% of all custom cast foot orthotics I see and work with (backed by scientific and engineering facts and the existing evidence), cannot fulfill these promises. Unless she can produce x-rays, photos, videos, and clinical success stories implying that she is dispensing orthotics that can do what she claims, I suggest she is promoting fake news and owes us an apology.


Dennis Shavelson, DPM, NY, NY  



From: Richard A. Simmons, DPM


Once again, Dr. Beaton has quoted the Florida statute and stated: “Routine Footcare Services defined by the Florida Podiatry Practice Act and performed by anyone other than a licensed podiatrist constitutes practicing podiatry without a license. Anyone who allows a non-licensed assistant to practice podiatry, is in violation of the Florida podiatry practice act.” And once again, the unified response from Florida podiatrists is “crickets” (nothing). Where is the voice of the FPMA on this?  Will no one challenge Dr. Beaton?


The performance of routine foot care by non-licensed assistants is pervasive in Florida. No one dares to state that it is legal, or to show where in any practice act, that a podiatrist can oversee routine foot care; yet the performance of routine foot care by non-licensed assistants is pretty much standard throughout the state. Thirty-five years ago, I sat in a podiatrist’s office (while he was on vacation), where the unlicensed staff did everything. When a staff member was finished, she would bring me in to inspect. We saw about 20 patients an hour. He was a past president of the FPMA. I guess it is one of those things that happens and no one talks about it.


Richard A. Simmons, DPM  Rockledge, FL



From: Forest Hills, NY


I read with great interest that the expanded podiatric scope bill passed in South Carolina. Congrats to all those involved in helping with the expansion. I am curious why many of these recent expansions completely leave out the ABPM board and what if anything ABPM is doing to rectify the situation. I am also curious if there is an opportunity for advancement in the scope for all those members of the profession who graduated prior to the implementation of a 3-year RRA program. 


There are many conditions such as skin lesions, wounds, etc. that should not require three-year training in an RRA program and passage of ABPS testing in forefoot, rearfoot/RRA to treat these aforementioned conditions. One should not have to master a compound ankle fracture in order to prescribe a steroid cream for a dermatitis on the leg. If those with the ABPM credentials can't increase their scope like their ABPS brethren, what good is that certification?


Jeffrey Kass, DPM, Forest Hills, NY



From: Bruce Jacob, DPM 


In response to Dr. Beaton, I am not sure of Florida laws, but here in Michigan, ANY physician can delegate to ANY employee whatever medical tasks he or she is willing to delegate as long as that physician is within the confines of the office. It is the old "captain of the ship" policy.


Bruce Jacob, DPM, Sterling Heights, MI



From: Bill Beaton, DPM


Since when are podiatry practices overwhelmed by RFC? Not all podiatrists are three-year residency trained, and in many states are not able to practice to the extent of their education and training. In order to find more treatment-oriented care, one must see all patients and provide all appropriate examination and treatment. Florida's practice act states that the practice of podiatric medicine "means the diagnosis, or medical, surgical, palliative, and mechanical treatment of the human foot and leg."


As to hiring licensed nail techs to perform RFC in a podiatry office, I caution against that since the Florida state cosmetology statutes do not allow for palliative foot care as that is not defined within their state licensure. I quote from the Florida Board of Cosmetology occupational definition. "A nail registration means a person licensed to engage in the practice of manicuring and pedicuring in the State of Florida. Manicuring means the cutting, polishing, tinting, coloring, cleansing, adding, or extending of the nails, and massaging of the hands. Pedicuring means the shaping, (not cutting or trimming), polishing, tinting,or cleansing of the nails of the feet, and massaging or beautifying of the feet. These services must be performed in a licensed salon."


Routine Footcare Services defined by the Florida podiatry practice act and performed by anyone other than a licensed podiatrist constitutes practicing podiatry without a license. Anyone who allows a non-licensed assistant to practice podiatry, is in violation of the Florida podiatry practice act. This may also apply to other states which have similar statutes.


Bill Beaton, DPM, Saint Petersburg, FL



From: Janet McCormick


Though I am not a podiatrist, I fully agree with Dr. Lauren Perico's description of necessary foot care and that it is important to prevent foot problems from getting serious. However, many persons cannot perform some of these self-care tasks for various reasons, such as poor eyesight, arthritis, and other deficiencies, even cognitive ones. These persons have two options: having a caregiver perform the care or going to their podiatrist for monthly care.


Two problems are obvious with these options. First, podiatrists would be (and many are already) totally overwhelmed with RFC in their practices; and second, these visits would be self-pay/not be covered by Medicare or insurance. An additional problem would be that the podiatrist could not take more treatment-oriented care.


A resolution of these problems was found many years ago by physicians through the hiring of licensed extended care professionals. For example, many derms and plastics hire estheticians to perform the routine care that is important for their patients and to perform non-medical care. These services are also not covered by Medicare or insurance. 


Many podiatrists are reducing their overload of RFC by hiring trained nail techs to perform this care. These technicians are state licensed in performing the skills within RFC and have completed a medical nail tech program of 20 modules online, followed by an internship to prepare them to work appropriately in a podiatry office. 


Janet McCormick, Frostproof, FL



From: Howard Friedman, DPM


I am responding to the letter from Bill Beaton DPM which appeared on April 26, 2018 saying I recommended Crocs for medical professionals in a recent article in In fact, I recommended Dansko clogs which have an APMA seal of approval. I did not mention Crocs in that interview. The article specifically says "Clogs are also a good choice, says Howard Friedman, DPM, a Suffern, New York-based podiatrist. They tend to have a wide toe box, which helps accommodate feet as they naturally expand throughout the day."


Howard Friedman, DPM, Suffern, NY



From: Cosimo Ricciardi, DPM


Dyane Tower, DPM, MS is a CURRENT star, not a future star! Congratulations, Dr. Tower.


Cosimo Ricciardi, DPM, Fort Walton Beach, FL



From: Bill Beaton, DPM


Anyone who read the recent recommendation by Dr. Howard Friedman for the use of Crocs as footwear for medical professionals needs to read this article on Crocs by Tom Carlson.  


Bill Beaton, DPM, Saint Petersburg, FL



From: Ira Baum, DPM


What a beautiful story. Godspeed to Dr. Hodson and his family!


Ira Baum, DPM Naples, FL



From: Marc Haspel, DPM


Bravo to Governor Walker of Wisconsin for signing a bill allowing podiatric physicians to delegate services to a PA. While I’m not sure if this is the first state to do so, it is a welcome sign of parity for this profession. The use of PAs has become the norm in other fields and should be allowed in this one. While many may not be able to financially avail themselves of this opportunity, some may well be able to incorporate PAs into their practices, thereby elevating the stature of their practices, expanding patient bases, and improving revenues especially in the presence of non-podiatric competition for patients in need of foot care.


Marc Haspel, DPM, Clifton, NJ 



From: Paul Langer


Congratulations to the FPMA cycling team for your fund-raising efforts supporting the American Diabetes Association's Tour de Cure. I have enjoyed being a riding marshal on the Long Island tour for many years. .


Paul Langer, Executive Vice President, McClain Laboratories, LLC
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