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From: Don Peacock, DPM


I've had the opportunity to perform the Katzen modified version of the MIS Wilson osteotomy. The procedure is very effective in some patients. I use the  procedure in mild to moderate bunion deformities with mild PASA and a relatively small bunion/ "bump".  I do agree with Dr. Greenberg and Kass with respect to head-to-head x-ray evaluations. The excellent surgical result from Dr. Cohen is in the early post-op stages and it is obvious that the patient is guarding in the post-op. Here is a patient whom I performed the procedure on, including a weight-bearing pre-op AP view along with a six week post-op view.  


Pre- and post-op weight-bearing AP views


In these views, we're seeing the deformity correction further out and the patient is not guarding as much in the post-operative views. Secondary bone healing is seen at this stage and good anatomical, clinical, and subjective results were achieved. The pre-op IM angle is 13 and the HA angle is 22. The post-op IM angle is 8 and the HA angle is 11.


Don Peacock, DPM, Whitesville, NC

Other messages in this thread:



From: Steven Selby Blanken, DPM


I am the grandson of a podiatrist/chiropodist (M.L. Selby, DPM), a TUSPM grad of 1990, and have a son, Brandon Selby Blanken, TUSPM Class of 2020. We were and are proud to be podiatrists. I am very happy my son picked the field I am in and hopefully he will join me in around 5 years. As SGA acting president at TUSPM, I find my son very active in the affairs of our profession along with student recruitment. 


There is now a push for all students at all the schools to go visit their undergraduate schools and educate them about our field. I have been a mentor for years and helped recruit over 10 students to podiatry schools. None of them are mad at me for it. You see, if you go out and learn as much as you can, you can be successful in our field. Picking podiatry means that...


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



From: Alan Sherman, DPM


I wanted to respond to the message from Gary Smith, DPM, which was very negative toward current podiatric education, and contained some inaccuracies. First of all, while the number of applicants to podiatry schools has declined in recent years, and this is a big problem for us, applications have actually gone up for medical schools (increasing by 6.2% from 2015 to 2016), and they have become more competitive. 


I do agree with his statement, “Podiatry was much more marketable when graduates could choose to be a podiatrist or a podiatric surgeon.” Our drive to make every podiatrist an advanced foot surgeon, which has been a front cover selling point used by the schools to attract...


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



From: Gary S Smith, DPM


Student recruitment is becoming a problem in all medical schools. Schools and even the medical professions as a whole are being forced to compete for students. Over the last few years, the medical profession in general has made it easier to practice in several ways like loosening restrictions on board certification and training. They have made it easier to see more patients for less money by giving PAs more privileges. At the same time, podiatry has made board certification, state licensure, and hospital privileges more difficult. Our profession, in the name of parity, has hurled towards disparity.


My son is applying to medical school right now. I would love to have him take over my practice someday, but I think it's silly to do a three-year residency to become a podiatrist with such a limited license. It just doesn't make sense financially. The same three years would allow you to be a general, orthopedic, or OBGYN surgeon. After our 7 years of medical school and residency, we have PAs with two years of medical training look down their noses at us. Podiatry was much more marketable when graduates could choose to be a podiatrist or a podiatric surgeon. There was a time when people going to podiatry school wanted to be a podiatrist and chose this profession for what it once was. The three-year mandatory residency has killed our profession.


Gary S Smith, DPM, Bradford, PA



From: Brian Butler, DPM


Dr. Jon A. Hultman’s article, Student Recruitment - The Future of Podiatry Is in Your Hands, clearly addresses the fact that podiatry faces a student “recruitment crisis” that “could signal the beginning of the end for the profession.” Despite a period of remarkable progress for podiatry, our schools are now encountering a host of student recruitment challenges from the increasing numbers of new American medical school seats (3,000 new seats since 2012), off-shore medical schools, physician assistant programs, nurse practitioner programs, and the new interest in American medical schools offering tuition free programs such as New York University now provides. These challenges are real and the trajectory is detrimental to the viability of our schools. 


Dr. Hultman’s article should be required reading for the trustees of our nation’s podiatric ...


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



From: David Zuckerman, DPM


I am writing to clear up the misinformation that EPAT technology is similar or the same as extracoporeal shock wave therapy (ESWT).  EPAT is FDA class one cleared and described as a vibration device.  Class 1 requires no medical evidence. This clearance does not indicate that EPAT uses sound waves or shock waves. If there were shock waves used in the EPAT technology, it would have to undergo Class 3 FDA criteria and regulations.  


ESWT uses shock wave technology, which requires double-blind, randomized, placebo controlled, and multiple center studies to obtain FDA approval. The Dornier Epos Ultra has been proven effective with the highest level of medical evidence criteria. The Dornier is the only FDA-Approved Class 3 (highest level) device that meets all five criteria with the Blue Cross Blue Shield tech report, and it is the false claims of lesser devices that created the insurance coverage withdrawal. 


Dornier invented ESWT as well as kidney stone lithotripsy. Comparing high-energy FDA-approved ESWT with the EPAT is false and misleading. They are entirely different modalities with different uses and outcomes.


David Zuckerman, DPM, Woodbury, NJ



From: Stephen C. Schmid, DPM


I first want to congratulate Dr. Scholnick on being named a “Future Star” by Podiatry Management Magazine. That’s quite an accomplishment! Reading his commentary, I agree with him. When it comes to our professional organizations, transparency and accountability are important attributes. I am writing this response, however, to express some concerns that I have with the comments made regarding APMA. I feel that Dr. Scholnick has either been uninformed or misinformed. 


I would like to address a few of the specific comments that were made: “There are many conflicts of interest with the APMA… .” If he was referring to potential conflicts of interest for individual members of the Board of Trustees, you can view a clearly stated list of...


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



From: Susan Anderson


I just wanted to say kudos to PM's Future Stars article on Kyle Scholnick, DPM. I was very impressed with his interview, his candor and thoughts for the future .I look forward to watching his career soar.


Susan Anderson, Northfield, IL



From: Scott Carlis, DPM


My many years as a ski boot fitter helped steer me towards my career in podiatry. I wanted to add a few additional thoughts to the in-depth article by Drs. Huppin and Scherer as well as the comments by Dr. Steinberg. 


For those podiatrists who see skiers or who get ski boot-related questions from patients, I want to provide some basic information on the design of ski boots and the most common adjustments made to ski boots by a boot fitter. 


As podiatrists, we are asked to make recommendations about...


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



From: Steven J. Kavros, DPM


I am writing to clarify the misrepresentation and inaccuracies of James McGuire, DPM in a recent article in Podiatry Management


The American Professional Wound Care Association® (APWCA) is a non-profit medical association welcoming medical providers from all disciplines involved in prevention and treatment of difficult wounds. Through a synergy of disciplines, APWCA has been a worldwide leader in clinician advocacy and education for the prevention and treatment of acute and chronic wounds since 2001. This association provides an informational and educational forum for healthcare providers, while promoting...


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



From: Robert Scott Steinberg, DPM


I have been fitting ski boots and making ski boot orthotics for 33+ years. I am a certified ski instructor. Dr. Huppin listed many of the reasons skiers call me for ski boot orthotics and custom boot fitting. There is a lot he got right, and went into great detail in doing so, but I caution podiatrists about making ski boot orthotics without being able to check the center of knee mass over the orthotic/ski boot. 


Further, it is most often the compensated forefoot varus that is the cause of foot pain in ski boots, as well as...


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



From: Gwen S. Greenberg, DPM, Jeffrey Kass, DPM


The x-rays that Dr. Cohen provides show interesting results. I was wondering if Dr. Cohen also did a lengthening procedure on the second metatarsal which is longer than the third on the post- op x-ray compared to the pre-operative x-ray. Perhaps showing the entire foot x-ray would be more revealing.


Gwen S. Greenberg, DPM, Allentown, PA


When sending in pre- and post x-rays, it would be nice if the submitted films be the same view. The Katzen Wilson bunionectomy films are hard to evaluate as the post-op foot is in such an oblique position. The metatarsals are all overlapping while the pre-op foot is splayed. It's only fair to evaluate apples to apples.


Jeffrey Kass, DPM, Forest Hills, NY (Similar response by Mark Ellis, DPM)



From: Susan Bartos


I have done considerable research in 3-D printing as it relates to medical applications, and found Dr. Hochstein's article very concise and informative. Its application in custom orthotic fabricating will require the coordinating software to not just replicate the model, but to add the appropriate correction to the device to address the patent's deformity. Software developers will need to adapt their CAD-CAM software to conform to 3-D printers. The two most significant issues in adopting 3-D printing for orthotics in its present technological stage are 1.) having quality software available from established developers such as Sharp Shape, Oretek, and/or Delcam and 2.) reducing the manufacturing time, which is much longer than current machining methods.


Currently, the CAD-CAM software used by many orthotic labs functions by merging prescription information with the negative model to create an electronic, corrected positive model. It is very sophisticated software and requires exacting technical precision, just as the precision required to create a manually-corrected plaster positive. But its patient-specific capacity to balance gait and to integrate and apply patho-mechanical accommodations, goes beyond what can be done manually. Most DPMs who prescribe orthoses have become accustomed to dispensing this type of high-quality device over the last 20 years.  


I think that there is little doubt that 3-D printing has enormous potential in fabrication of medical appliances in the very near future. It will give orthotic laboratories an additional process to offer their customers and give doctors more choices as to how they want their orthotics fabricated. Keep in mind that there is no one right way to make a prescription orthotic, just several alternative options in the processes used to create it. The art lies in the skills of the technician, rather than the process. 


Susan Bartos, President, Earthwalk Orthotics, Inc.



From: Richard M. Maleski DPM


I agree so much with what Drs. Hultman and Rosenblatt have stated in the article and post in response. However, I would make one suggestion. Just like a good attorney, who never asks a question in a courtroom  unless he already knows the answer, I recommend the following. The APMA should work with the colleges of podiatric medicine and have groups of students, or even whole classes take the licensure exams in that particular state. Let's make sure that our education is truly giving our students the ability to pass the exam before we open this up to official scrutiny. I have been involved in residency training for my entire career of 26 years, and I am absolutely certain that our graduates can be competitive in almost all aspects of medicine, but I would like to be absolutely certain that they can compete in ALL aspects of medicine.


Richard M. Maleski, DPM, Pittsburgh, PA



From: Michael M. Rosenblatt, DPM


I always read Dr. Hultman’s articles and letters. But of the hundreds he has written over the last 20 years, the article he wrote on “parity” between MDs and DOs (June/July issue, Podiatry Management Magazine) is his most important and incisive. Paraphrasing his main point, DPMs get “bogged down” in the nomenclature of the DPM degree letters, causing disagreement and in-fighting. Ultimately that has led us away from real parity. 


Dr. Hultman believes the parity issue is really one of licensure and not degree letters. He firmly believes that parity is obtaining a plenary license for DPMs just as it is for...


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



RE: Valleix’s Sign (Tarsal Tunnel Syndrome, Jan 2014 PM)

From: David Secord, DPM, Kyle Scholnick, DPM


On page 123 of the January 2014 Podiatry Management Magazine, Dr. Scholnick refers to “Apositive Tinel’s or Valleix’s sign is when paraesthesias course along the involved nerve distally or proximately, respectively.” This is my favorite 'medical urban legend' and has been my personal quest to expunge from our schools and usage. 


As opposed to what many of us were taught in medical school, Tinel's sign is both proximal and 

distal tingling upon percussion of a nerve. Valleix’s sign does not exist. There is no such thing. Valleix’s POINTS are as follows: 1. Where the nerve emerges from...


Editor's note: Dr. Secord's extended-length letter and Dr. Scholnick's response can be read here.