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01/11/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Dennis Shavelson, DPM


 


When minimalist running, one reduces heel contact running, which for most of us, would be a good thing. Runners must be willing to break in their new stride, speed, and distances slowly to reduce fractures and other overuse injuries such as Achilles tendonitis. These rules apply when breaking any new activity or sport.  


 


The article states, “These days, more of Kirby’s patients are running with thicker-sole shoes than ever before. Every third runner he sees wears Hokas, a sneaker brand with the thickest underfoot cushions in the market today." I must interject that they may be dangerous for many runners. I published a white paper regarding Sketchers Rocker Shoes. I eventually wrote the 41 page brief involved in the successful lawsuit against Sketchers Rocker Shoes involving 300 injuries.


 


Rockers and flexible soled shoes designed to shock absorb and create cushioning using thick and flexible materials when married to the flexible foot types of many runners, will result in injuries to some of those feet, especially if runners transition too quickly. Rockers obviate the need for healthy internal biomechanics and predictably allow feet with high SERM-PERM Intervals to degenerate to the point that they need rockers all the time. Hokas are unproven short- or long-term as to safety and they are being poorly disclaimed. They are not the next Nike Waffle Trainer yet!


 


Dennis Shavelson, DPM, NY, NY

Other messages in this thread:


07/20/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1



From: Jack Ressler, DPM


 


Confused about MACRA/MIPS and MedPAC? Let me try to explain. Watch American Ninja Warrior. This is a show where contestants (podiatrists) must manipulate an obstacle course. Once you conquer one obstacle, you are faced with another. Obstacles become harder to maneuver  as you go on. But wait, this is where it gets tricky. After spending many hours of your time and money training, the producers/administration realize the course wasn’t set up properly, so they make changes. If one is lucky enough to stay the course and see their way through all the obstacles, they win. Your prize? Probably nothing. You get to keep the same amount of money you worked hard to earn, except you have to work harder and jump through more hoops to get it. 


 


Jack Ressler, DPM, Delray Beach, FL

07/18/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Michael Forman, DPM


 


I read about the Pollack family's move to Israel. I wish them well. The U.S. lost another podiatrist to Israel a number of years ago. That was Dr. Richard Jaffe who left a very successful practice in California to open a very successful practice in Jerusalem.  Richard was one of my very best students.  His emigration was our loss and Israel's gain.  


 


Michael Forman, DPM, Cleveland, OH

07/13/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Philip Seeber, DPM


 


Dr. O.A. Mercado demonstrated after hundreds of cases and cadaver dissection that the plantar fascia is not attached to the heel spur. In his original paper, he only discussed resecting the spur, leaving the fascia intact.The spur was also shown to be a shelf across the medial condyle. Post-op, patients had tenderness which lasted several months. Most podiatrists started to performing releases of the fascia after publication of Mercado's paper. The rest is history.  


 


Philip Seeber, DPM, Rockford, IL

06/29/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 2B



From: Steven J. Kanidakis, DPM


 



Bret, likely you are among the growing number of DPMs reading about the uncertainty of rendering the various podiatry-type procedures. It is not about asking for "cash". Even taking cash, performing the procedure "free", or not getting paid does not mean you are free from guilt. I give the podiatrist in question much more credit than to stoop to the answer of taking "cash" as the answer to our problems. (Yes, our problems, since all these problems are not just his.) If any podiatrist currently in practice, or ever in practice, thinks he has never broken one rule or law, then stand up. Or else, sit down.


 


Steven J. Kanidakis, DPM. Saint Petersburg, FL

06/29/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 2A



From: Thomas Graziano DPM, MD


 


As Dr. Ribotsky points out, it's a sad commentary on not only our profession but the insurance industry. The fact that one has to "bend the rules" to help patients get covered by the Teflon coated insurance providers is the travesty here. When has anyone seen one piece of legislation going against any insurance company in this country? Never. Because their lobbyists are all over the policymakers like a cheap shirt, lining their pockets with gold.


 


It's over for healthcare providers in this country, at least for those who continue to take the abuse. Certainly if everyone dropped out of network, these issues would go away. Think about it. No that won't happen, so docs will continue to bend over and take it.


 


Jail time for nail care. Ridiculous. It would be helpful to the younger practitioners to have a clear understanding of what "qualifies" for nail care. For those with the exact criteria, list it on this forum. It would be a service to your fellow colleagues and keep them out of the "watchful" eye of the insurance companies and government.


 


Thomas Graziano DPM, MD, Clifton, NJ

06/29/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1



From: Robert Scott Steinberg, DPM, Tip Sullivan, DPM


 


I have to wonder if Dr. McClanahan has ever studied the midfoot?


 


Robert S. Steinberg, DPM, Schaumburg, IL


 


I was taught that structural deformities of the foot were caused by repetitive abnormal forces through bones and joints over a long period of time that followed Wolff’s law. I was also taught that we (in the modern world countries where shoes are worn –not to mention restrictive shoes, heels) hear more complaints about painful bunions and other structural deformities because we try to stuff feet in restrictive shoes causing pressure and the resulting sequelae of pain. I also heard somewhere that if one went to a country where shoes were not worn, the incidence of structural deformities would be about the same as places where shoes were worn.


 


I have never seen any real data comparing populations to back up this assumption and would love to hear from anyone who is aware of any. If one wore unstable shoes for the majority of time (24/7), then I think that the statement that bunions and/or other deformities are  “CAUSED” by heels or ill-fitting unstable shoes is reasonable. I think some of us explain to patients and/or the public that “bad shoes cause bunions” because it is easy for people to understand but I believe it is far from the truth. Are we doing ourselves a disservice by doing so?


 


Tip Sullivan, DPM, Jackson, MS

06/28/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1



From: Bret Ribotsky, DPM


 


Incredible - Jail time for nail debridements. It's a shame that we hear about DPM “bending the rules" of coverage to help patients be covered for things that insurance just does not cover all the time. Here in South Florida, when I was practicing, never did a week go by when I saw a patient say, “my other podiatrist gets it covered.” We have such a great profession, and if doctors would just spend the time and re-learn how to practice today, you can make a great living. I lectured 10 years ago, saying if you continue to do tomorrow what you did five years ago, you would be out of business or in jail. - I’m shocked to see many have not learned. Just learn a little dermatology, take a biopsy, do a flap, and ask for CASH for nail care that does not meet guidelines.  


 


Bret Ribotsky, DPM, Boca Raton, FL

06/23/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1



From: Josh White, DPM, CPed


 


DPMs who adopt protocols espoused by the American Diabetes Association's “Standards of Medical Care” and the CDC’s STEADI program for fall prevention, endorsed by the APMA, can easily satisfy 4 of the 9 required 2017 registry MIPS Quality Measures (126, 127, 154, 155).  


 


Such an approach not only helps avoid what’s now a 4% penalty but also offers the opportunity to bill 99213 E&M visits for comprehensive diabetic foot exam and fall risk assessment provided that evaluation determines a qualifying risk factor and that a plan of care is provided.


 


Incorporating a thorough, routine approach to care offers the best way to identify risk factors that often go untreated and makes clear indications when shoes, foot orthotics, and AFOs may be prescribed as preventative care modalities.


 


Josh White, DPM, CPed, Maplewood, NJ

06/23/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 2



From: Elliot Udell, DPM


 


Congratulations Dr. David Armstrong for once again blazing another trail for our profession. His article titled "Diabetic Ulcers and Their Recurrence" was published in the June 15th issue of the New England Journal of MedicineNot only should we be proud of Dr. Armstrong's latest accomplishment for being the lead author in a paper published by one of the world’s leading medical journals but many of his references at the end of the paper were papers also published by podiatrists.


 


Reading this article today brought tears to my eyes for the same reason that many civil rights leaders cried when the first Black president was inaugurated eight and half years ago. Both represented breakthroughs and in the case of Dr. Armstrong's well-written paper, a breakthrough for our entire profession. Thirty five plus years ago when I first graduated, it would have been a pipe dream for a person with a DPM after his name to have a major paper on foot pathology published in any prestigious non-podiatric medical journal. This "glass ceiling" has now been broken and I salute the authors who made this possible.


 


Elliot Udell, DPM, Hicksville, NY

06/21/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 2



From: Ron Werter DPM


 


When Dr. Katzen talks about a "good man with a gun," I assume he's talking a about a good man (or woman) who has undergone months of intensive training in use of his weapon in many situations, has years of experience, and has undergone frequent repeat training and practice sessions, not some average Joe with a 3-hour gun safety course. It would be like comparing Dr. Wenstrup's actions as a skilled medical professional in saving his Congressional colleague's life to an average Joe with a 3-hour first aid course. 


 


Let's not let our agendas get in the way of reality.


 


Ron Werter, DPM, NY, NY

06/21/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1



From: Ben Pearl, DPM


 


I wish John a speedy recovery. I hope that witnesses of events like this become aware of the all too often case of people who speed off rather than stop to help the persons that they injured  so that they can be held accountable for their actions. I witnessed an upperclassman get hit by a car while we were riding our bikes after classes in Philadelphia at PCPM. I made sure that at the deposition for the accident, the lawyer representing the driver who hit my friend was not able to twist the sequence of events as lawyers sometimes do.


 


Ben Pearl, DPM, Arlington, VA

06/20/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Steven Kravitz, DPM


 


Congratulations to Dr. Arthur Helfand for receiving this national allopathic award from the American Geriatrics Society (AGS). The AGS recognized Helfand, the only podiatrist to attain fellowship in the group, when it marked its 75th anniversary in May in San Antonio. 


 


Recognition of this physician as being a leader in education is very well deserved. In the late 60s and 70s, he published numerous articles in allopathic publications. To this day, he continues to author more allopathic literature than any podiatrist I'm aware of; literally hundreds of articles. His involvement set the stage for the recognition of podiatrists in diabetic care as well as geriatrics. As residency director in a leading hospital in Philadelphia, he trained more than 250 podiatric physicians and is a past president of the APMA. The Academy of Physicians in Wound Healing presented him with its national achievement award in 2014. He's also a recipient of the Lifetime Achievement Award from Podiatry Management Magazine.


 


Steven Kravitz, DPM, Winston-Salem, NC 

06/19/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1A



From: Leonard Levy, DPM, MPH


 


Brad Wenstrup, DPM and Member of Congress was the first person to tend to the serious wounds inflicted by the shooter in the Virginia attack this morning on a ball field where other congressmen were engaged in a baseball competition. He did not identify himself as a podiatric physician, a CNN interviewer referring to him as a medical doctor. This unfortunate shooting incident, while a national tragedy, dramatically points out the potential role of our profession still not properly recognized by the medical community, as well as state and federal agencies. Rep. Scalise was so lucky to have had the benefits of Rep. Wenstrup's skills.


 


Leonard Levy, DPM, MPH, Ft. Lauderdale, FL 

06/19/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1B



From: Steven Selby Blanken, DPM, Burton J. Katzen, DPM


 


Congrats to a hero who went into DOCTOR mode during a shooting in VA to help a fellow congressman. He was well prepared from all of his training. I pray for the health of all five people wounded in this horrible act that happened. Thank you, Dr. Wenstrup.



 


Steven Selby Blanken, DPM, Silver Spring, MD



 


Kudos to Rep. Dr. Brad Wenstrup for his bravery and quick action in the Virginia tragedy yesterday where Rep. Steve Scalise was seriously wounded by a crazed gunman. Also, as someone who has many law enforcement patients including a number of Capitol policemen, I also congratulate their quick action, which by some accounts, might have saved 15-20 lives, proving once again that the only thing that can stop a bad man with a gun is a good man with a gun. We all wish the congressmen and wounded policemen a speedy and full recovery.



 


Burton J. Katzen, DPM, Temple Hills, MD


06/19/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 2



From: Elliot Udell DPM


 


Kudos to Dr. Shapiro for coming out against walking without shoes and socks. For years, I felt like I was waging a one-man war on this issue.


 


In addition to catching diseases by walking barefoot, a problem that we also see in the warm weather months are patients with foreign bodies in their feet. Removing spicules of glass is always a challenge. The problem could be prevented by wearing a pair of shoes or sneakers.


 


Elliot Udell, DPM, Hicksville, NY

06/14/2017    

RESPONSES/COMMENTS (NEWS STORIES)


RE: NY Podiatrist Gets Probation for Oxycodone Distribution 


From: Name Withheld 


 


As a daily reader of Newsday (among other daily papers frequented), the above news line is unfortunately not surprising. For the last few years, Long Island, in particular, has been an epicenter of an Oxycodone epidemic. There are almost daily stories, many of which illustrate lives of youngsters whose lives have been ruined if not lost not by illegal drugs, but by legal pharmaceuticals, many of which have been prescribed by greedy or addicted medical practitioners. 


 


It unfortunately took a drug store robbery several years ago which resulted in the deaths of several store employees for NYS law authorities to finally take action against medical practitioners who...


 


Editor's note: Name Withheld's extended-length letter can be read here.

06/08/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1A



From: Elliot Udell, DPM


 


Thank you, Dr. Kravitz and the APWH for fighting on behalf of our profession.


 


When I first entered practice many years ago, orthopedic surgeons and podiatrists related to each other like cats and mice. The hatred and animosity could be measured with a "fever thermometer." At that same time, orthopedists were allowed to testify against our colleagues. In my geographic area, there were several orthopedists who testified against any and every podiatrist they could. Even if there was nothing wrong with a patient, one of those orthopedists would go out of his way to tell his patients (even if he was examining a back or knee) that "the podiatrist messed you up and that is why your knee or back hurts." The same doctor was quick to testify in court. The fear of his testimony resulted in early settlements against us. I hope that Dr. Kravitz's efforts will prevent those dark days from once again returning.


 


Elliot Udell, DPM, Hicksville, NY

06/08/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1B



From: Howard Bonenberger, DPM


 



While the idea of allowing unqualified "expert" testimony would seem to muddy the waters for the jury at best and lead to bad decisions at worst, in this specific case there may be a silver lining for the defense:


1. Perhaps the plaintiff was unable to find a foot and ankle orthopod willing to testify.


2. It may come out that the spine doctor is a relative of someone on the plaintiff's side just in it for the fee which would look really bad if he/she is unable to add anything of value with their testimony.


3. Apparently, even podiatry's own hired guns weren't interested.


 


Two questions for the lawyers out there:


1. Would the decision by the judge to allow this testimony be made before depositions? If so, then after being shredded by the defense lawyers in deposition, the "expert" may not even be used by the plaintiff.


2. Is this case a red herring?


 


Howard Bonenberger, DPM, Amherst, NH


06/07/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Steve Kravitz, DPM


 


The APWH is very concerned about the ruling described in the above referenced article. The judicial system is one that must be fair and balanced and it is for that reason that juries are made of members who are essentially “peers” of the accused. This is important for criminal law but also civil law as well, especially in subject areas that require knowledge that is specific and based on extensive education and experience in a particular field. The ruling that an orthopedic surgeon, seven years out of practice, with no experience in foot and ankle surgery but only in spinal surgery could participate is inappropriate and does not reference a “peer reviewed” process. 


 


Such testimony should be held “inadmissible”; the court’s decision to not uphold the principle is extraordinary. Specifically in this particular case, there is a lack of knowledge which is necessary to make an appropriate judgment but there’s also a complete lack of experience practicing as a podiatrist. Medicine is not only a science but is an “art” which is totally dependent upon years of experience (in this case) as a podiatrist and is why testimony should be field-specific. This and many other factors are apparently ignored by this overturn of the lower court. 


 


This decision should be challenged. The APWH is a wound care-related organization consisting of allopathic as well as podiatric physicians. The Academy will assist podiatric organizations that have interest in challenging this very disturbing decision.  


 


Steve Kravitz, DPM, Executive Director, Academy of Physicians in Wound Healing

06/07/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1B



From: Michael M. Rosenblatt, DPM


 



Could a ruling by a state supreme court be considered an act of unreasonable support for the malpractice industry? The PA State Supreme Court is composed entirely of lawyers. They recently decided to permit an orthopedist who has not performed surgery in over 8 years...and even before then specialized in spinal surgery...to testify against a podiatrist.


 


It is definitely in the interest of lawyers and the malpractice industry to "widen" the availability of expert testimony. But what if that "widening" is just an opening for feeding the malpractice industry itself? I believe that this ruling is in that category. 


 


Could this defective ruling be itself subject to Sherman Anti-Trust Act regulation? Why should lawyers have complete control over our society? When is it against the law for a group of well-placed lawyers to make a defective ruling that in itself furthers and benefits only lawyers? This ruling stinks of professional self-aggrandizement. If lack of merit forced plaintiffs to not be able to find a qualified expert to testify for them, they should drop their case. Perhaps it should never have been concocted in the first place. 


 


Michael M. Rosenblatt, DPM, Henderson, NV


06/06/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Leonard A. Levy, DPM, MPH


 


While I am certainly flattered by Dr. Ivar Roth referring to me as a "gem", I truly believe it is the profession of podiatric medicine that is the "gem", even if it is so very much underestimated by other healthcare professionals. Certainly in a parochial sense, our focus is on the pedal extremity, but the impact that we make every day on the total health of people is immense, essential not only in saving limbs but also life itself.


 


Leonard A. Levy, DPM, MPH

06/01/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Tip Sullivan, DPM


 


This article presents some very interesting research that may have applications in podiatry (besides CVA rehab) that come into mind: Application of yoked prisms in gait alteration may alter weight-bearing gait in diabetics, particularly those with Charcot foot. This area of research is just itching for some podiatric input!


 


Tip Sullivan, DPM, Jackson, MS

05/26/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From:Joseph Borreggine, DPM


 


I suggest Foot Function, Foot Pain and Falls in Older Adults: The Framingham Foot StudyFoot pain has long been linked to fall risk among seniors, according to a study published in the journal Gerontology, but the new Framingham Foot Study has examined the contributions of pain severity, foot posture, and foot function. A total of 1,375 participants with an average age of 69 were asked about falls over the last year, with logistic regression used to calculate odds ratios (ORs).


 


According to the results, 21 percent reported foot pain: 40 percent mild pain, 47 percent moderate, and 13 percent severe. Roughly 33 percent reported falls in the last year, with foot pain associated with a 62 percent increased risk of recurrent falls. Those with moderate and severe foot pain showed increased odds of less than two falls versus those with no foot pain. Foot function was not associated with falls, according to researchers.


 


Finally, compared to normal foot posture, those with planus foot posture had a 78 percent higher chance of two or more falls. The results indicate that both foot pain and foot posture may play a part in increasing the risk of falls among seniors.


 


Joseph Borreggine, DPM, Charleston, IL

05/25/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Tip Sullivan, DPM


 


I would like to suggest research in the area of neuro-opthalmic rehabilitation (NORA) to Dr. Richie. I look at it as a “brain retrain”.


 


Tip Sullivan, DPM, Jackson, MS

05/24/2017    

RESPONSES/COMMENTS (NEWS STORIES)



From: Doug Richie, DPM


 


I was astounded to learn that Dr. Kimberly Eickmeier has discovered that a brace can prevent catastrophic falls in the elderly! It appears to work by improving dynamic balance by improving feedback to the brain to "re-develop balance" in these elderly patients. As someone who has published research in this area, I am most interested to learn if there are any studies to substantiate such monumental treatment effects?


 


Doug Richie, DPM, Seal Beach, CA
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