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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:



RE: The Fury of Irma Floods Florida

From: Kyle Kinmon, DPM


"To those who have been temporarily displaced from their practices due to Hurricane Irma, we would like to help. We have time slots in fully operational, staffed offices in Martin, Palm Beach, and Broward Counties available for temporary use at no charge. Email


Kyle Kinmon, DPM, Boca Raton, FL



From: Paul Kesselman, DPM


I would like to congratulate the entire PM News staff on the momentous occasion marking their 6,000 issue. It is truly a remarkable achievement for Barry and everyone else involved in putting this almost daily publication together. This effort occurs whether in their home office, on the road at meetings, or on vacation, with the small team working diligently to produce a high quality newsworthy editions.


The ripple effect is even far greater in that it has made many of its contributors far better speakers and writers than would have otherwise been possible. Congratulations on a job well done and looking forward to number 10,000.


Paul Kesselman, DPM, Woodside, NY


Editor's Note: This topic is now closed.  We thank all of the readers who sent letters or called congratulating us.



RE: The Rain Of Terror in TX

From: Marc Glovinsky, DPM & Associates


Our practice is offering assistance to Houston area podiatrists with patients who may now be located in Southeast Louisiana. Our practice can assist with patients who are displaced to the New Orleans area as a result of Hurricane Harvey.  email:


Marc Glovinsky, DPM, Celia Storey, DPM, Denise Johnson, DPM



From: Joe Starr, DPM


I’m a real real old timer, having graduated from the New York Podiatry School in 1940. I look forward to reading PM News daily. I retired thirty years ago and at 99 years old,  I still  dream of being back in practice. My very best wishes to you Barry and I wish you “a hundred un twonzek" years (120) in good health.


Joe Starr, DPM, Delray Beach, FL



From: Tip Sullivan, DPM


Congratulations and a BIG thank you for what you have done for our profession! I cannot tell you how your work comforts and informs those of us who reside and work in areas without many colleagues to talk to daily!


Tip Sullivan, DPM, Jackson, MS



From: Multiple Respondents


Thank you Barry for all you have done, are doing and will do.


Mark Feldman, DPM, Fort Lauderdale, FL. 


Congratulations on your decades of success. You have provided a service that in my opinion is invaluable to our profession. 


Jon Purdy, DPM, New Iberia, LA


Congratulations to Barry and Hermine Block on the 6,000th issue of PM News and to David Kagan who works with them the Podiatry Management Magazine side of these publications. All of your readers work very hard in their practices and hospitals with very long hours, etc. At the same time, very few realize the time and effort it takes to put together a daily e-newsletter in conjunction with the magazine monthly publication. What appears seamless to the reader does not come close to reflect the work involved on the backend, especially with a very small staff. 


Steven Kravitz, DPM, Winston-Salem, NC



RE: CMS Overhauling Medicare Fraud Audit Process (Hal Ornstein, DPM) 

From: Bret M. Ribotsky, DPM


I believe Hal’s way is too difficult. I suggest that everyone go to this website and look up "podiatry" in their city, and drill down on the top twenty codes that your competition are using, and you can easily see where you are. This data base is incredibly valuable on many issues such as trends that others are appreciating in your locality that you may be missing.


It's also fun to see which doctor in your community is making the most money. On the other hand, what an incredible invasion of privacy! There's no website to look up what patients are receiving from the federal government in assistance; it's only the doctors who must share everything. 


Bret M. Ribotsky, DPM, Boca Raton, FL



RE: CMS Overhauling Medicare Fraud Audit Process (Hal Ornstein, DPM) 

From: Melissa Lockwood, DPM


Dr. Ornstein makes good points regarding RAC audits, but there are a few things to clarify. In reality, the government has not focused on "random" audits in quite some time. They have been specifically targeting those providers who lie outside of the standard deviation of the bell curve for any given procedure - which in many cases is ANY one of us depending on if we see "more" or "less" than a particular type of patient - i.e. diabetics with ulcerations.


That said, it's critical that we all have access to the same information that CMS has in order to remain enlightened and to be aware of billing trends. I use my EHR system's  (TRAKnet) Code Audit Compliance feature (which aggregates and reports my utilization of codes  benchmarked against 2000 other users), as well as the information I glean from their monthly Virtual Practice Optimization (VPO) analysis. It's invaluable in identifying both overutilization as well as under-utilization across all of my providers in the practice so we can evaluate and adjust our coding habits accordingly.


Melissa Lockwood, DPM, Bloomington, IL



From: Multiple Respondents


Congratulations Dr. Barry Block! 6,000! A record for the ages. WOW.


Art Helfand, DPM, Narberth, PA


Happy anniversary. I look forward to my daily dose of PM News. You are a blessing to our profession. Keep up the good work!


Rich Hofacker, DPM, Akron, OH


I want to thank Dr. and Mrs. Block for doing such an excellent job for PM News and Podiatry Management. I enjoy the daily emails and the monthly journals that you have been producing for all these years.  I hope they are able to continue at least until the 12,000th issue.   


Steve Berlin, DPM, Baltimore, MD



From: Multiple Respondents


A huge hug and congratulations to Barry for issue 6,000 of PM News. Many in our profession would not have the knowledge base and ability to keep up with relevant news and trends in podiatry without this valuable publication. 


Hal Ornstein, DPM, Howell, NJ


It's just a truly outstanding contribution to our profession. Dr. Block is a pioneer with a great vision to help many. I cannot think of another individual who has worked as hard as Barry to bring educational information and news to advance podiatry. I thank Barry for this, and wish all the best of good health for the years to come. 


Robert Weiss, DPM, Darien, CT


Congratulations to Barry Block, his lovely wife Hermine, David Kagan, and all of my friends at PM News on their 6,000th issue. This is a truly remarkable accomplishment. Thank you for all of your fine work.


Richard Mann, DPM, Delray Beach, FL



RE: PM News Marks 6,000 Issue Milestone

From: Bret Ribotsky, DPM


It’s beyond words to think what an incredible accomplishment this has been. For almost 25 years, Barry Block has been the protector, godfather, and social barrister of our profession. I look back at the hundreds of letters that I have written to the readers of PM News and how Barry and his wife Hermine made editing corrections to focus my comments correctly.


I am touched with how we as a profession could never have advanced so well without their daily teamwork. I’m sure each of the readers make reading PM News a daily ritual that can’t be missed. I can’t wait for issue 10,000 in 2028 and to see where our profession will be.  


Bret Ribotsky, DPM, Boca Raton, FL



From: Hal Ornstein, DPM


The announcement that Medicare is going from random-based audits to outlier audits can have a great impact on many practices. If you are utilizing codes significantly more, or even less than the average podiatrist, you are at much higher risk of audits. These audits will be quite difficult to defend, especially if they involve over-utilization. Of course, if you have a large wound care practice, for example, you will be on top of the curve with wound debridement codes, which is by all means okay. 


I recommend that you run a CPT analysis in numerical order CPT 1xxxx – 9xxxx for the last...


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



From: Robert S. Schwartz, CPed


In our forty three years at Eneslow, we too have seen a significant increase in average shoe size equivalent to the UK research. It is important to understand that English, or UK, shoe sizes are longer than American shoe sizes. On average a UK man’s size is one size larger than an American man’s size. Size eight UK is a size nine American. According to their research, the average UK man’s size is the equivalent of an American size eleven. On average, a UK woman’s shoe size is two to two and one half sizes larger than an American woman’s shoe size. A woman’s size five is the equivalent of American size seven to seven and a half.


According to their research, the average UK woman’s size is the equivalent of American size eight to eight and one half. English and American shoe sizes increase 1/3” per size; 1/6” per half size. Euro sizes (adults 35 to 45 women’s, up to size 50 in men’s) increase ¼” per size; 1/8” per half size. Most American shoe companies provide footwear for up to American size 11 in women’s, up to American size 13 in men’s. There are quite a few companies (including Eneslow) that offer larger sizes in both men’s and women’s.


Robert S. Schwartz, CPed, NY, NY



From: Dale Feinberg, DPM, CPed


I quit the diabetic shoe program years ago when there were 57 charts on my desk that were being audited. I realized the government wanted me to provide the service but at my expense. WE have become podiatric monitors.  We can identify a condition but are not allowed to treat it or be reimbursed if we do. As Jim Morrison said 50 years ago, "This is the end....."


Dale Feinberg, DPM, CPed, Yuma, AZ



From: Bryan C. Markinson, DPM


Kudos to Dr. Paul Kesselman and other colleagues like him who navigate through the morass of regulatory BS surrounding the diabetic shoe program and DME in general. My participation in the Medicare diabetic shoe program ended abruptly after a very short time when the third patient complained about "rubbing me here," after the first said the "shoe is too heavy" and the second had a complaint I can't recall. It was over for me then, gladly.


I hear from the industry that many DPMs are not "taking advantage of this wonderful opportunity."  After reading his latest explanation of the singular issue of code A5513, and what I am hearing from some who have had audits, I strongly urge any DPM on the fence about participating to NOT participate. It's the smart move. 


Bryan C. Markinson, DPM, NY, NY



RE: Update on HCPCS A5513 Insole Code

From: Paul Kesselman, DPM


Here are some additional details regarding the A5513 posted in PM News and the APMA Weekly Focus: In mid-July 2017, the DME MAC and PDAC issued a joint bulletin concerning A5513 (custom inserts for patients with diabetes only). This bulletin stipulated that only those custom inserts  manufactured with raw materials using either a physical positive mold or those molded directly against the patient's foot are the only accepted methods for fabrication. 


It further went on to say that those manufactured in any other fashion (e.g. custom milling via the use of virtual positive images) were unacceptable. Lastly, the bulletin indicated suppliers would be held responsible and have to...


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



From: Sang Hyub Kim 


Thank you, Dr. Barney,  for the constructive feedback. I was not aware of specific opportunities and venues available in the U.S. for current podiatry students to participate and to learn about MIS-style procedures.


The two-week exchange was not only limited to observing surgeries, but also exploring Polish culture and their medical system. You can find the full article here


Sang Hyub Kim (NYCPM Podiatry Student, Class of 2018)



From: Michael Schneider, DPM


It has been my understanding that the discomfort of plantar fasciitis is caused by a dynamic and not by the heel spur. The heel spur may be a result of the dynamic causing the plantar fasciitis but not the cause. If the heel spur was the cause, then the discomfort would increase on ambulation. As most of us know, the symptoms of plantar fasciitis diminish on ambulation, diminish on rest, and intensify on initial ambulation. 


Michael Schneider, DPM, Denver, CO


Editor’s comment: Because of space limitations, PM News only excerpted a small part of Dr. Sutera’s interview in which she said, "Some people can have heel spurs without heel pain, some people have heel pain without heel spurs… it’s an individual thing and it should be really checked out." 



From: Neil Barney, DPM


It was interesting reading this article stating that this student went to Poland to see an orthopedic surgeon performing a "percutaneous Scarf bunionectomy". He and other students or residents don't have to travel to Poland to see these MIS-style procedures, only to New Orleans and the Academy of Ambulatory Foot and Ankle Surgery's bi-annual seminar where similar procedures are taught by world class MIS podiatrists and orthopedists with hands-on cadaver lab practice.


In many cases, these techniques were taught here by the Academy to these other doctors and brought back to their country. More students/residents could be well served by being exposed to these techniques to incorporate them into real life practice. It is very nice to see that a Dr. Semla-Pulaski is exposing students to these well established surgical procedures. 


Neil Barney, DPM, Brewster, MA



From: Brad Bakatoic, DPM, DO 


It is always an honor to support the Podiatry Management Podiatry Hall of Fame Luncheon with proceeds benefiting the APMA Educational Foundation Student Scholarship Fund. This year’s luncheon was exceptional for us. The honorees, Dr. G. “Dock” Dockery and Ben Wallner, embody BAKO’s mission to advance the profession in general terms, and advance the role of dermatology within it. Congratulations to both Dock and Ben. We appreciate your efforts on behalf of the entire profession! 


Brad Bakatoic, DPM, DO,  Alpharetta, GA



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



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



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



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



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