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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:


05/28/2018    

RESPONSES/COMMENTS (NEWS STORIES)



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

05/22/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1



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  

05/22/2018    

RESPONSES/COMMENTS (NEWS STORIES)



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

05/19/2018    

RESPONSES/COMMENTS (NEWS STORIES)



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

05/17/2018    

RESPONSES/COMMENTS (NEWS STORIES)



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

05/16/2018    

RESPONSES/COMMENTS (NEWS STORIES)



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

05/14/2018    

RESPONSES/COMMENTS (NEWS STORIES)



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

04/28/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 2



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 Prevention.com. 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

04/28/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1



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

04/26/2018    

RESPONSES/COMMENTS (NEWS STORIES)



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

04/17/2018    

RESPONSES/COMMENTS (NEWS STORIES)



From: Ira Baum, DPM


 


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


 


Ira Baum, DPM Naples, FL

04/06/2018    

RESPONSES/COMMENTS (NEWS STORIES)



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 

04/04/2018    

RESPONSES/COMMENTS (NEWS STORIES)



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

03/28/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1



From: Dennis Shavelson, DPM


 


Muscle engine weakness living in the lower extremity originates and depends on the ability of the foot to provide stability and support architecturally. Stresses are produced when running that the body must adapt to in order to perform. When these stresses to the body do not translate into improved performance, they translate into pain, suffering, injury, and poor performance.


 


One needs to consider taking the time, energy, and dedication to examine, diagnose, and treat genetic and epigenetic factors that are precursors/lateral to muscle engine failures in order to establish leverage, healthy engineering, and efficient performance of the myofascia and CNS as underpinnings for the success of strengthening programs.


 


That is in the domain of podiatrists with special interests in sports, performance, and body movement like Dr. Conenello. I wish Dr. Conenello continued success with his health. I’m very proud of him.


 


Dennis Shavelson, DPM, NY, NY  

03/28/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 2



From: Name Withheld 


 


With all respect to Dr. Baum, I have to differ with his opinion about keeping the anonymity of podiatrists involved in legal issues. When I first started reading queries on the PM News, I agreed with Dr. Baum about not reporting podiatrists names associated with unfavorable legal rulings. Dr. Block did give an explanation as to the importance of reporting such instances. Not only did it made a lot of sense to me, it proved invaluable when it came time to sell my practice. 


 


I received an inquiry from a potential buyer wanting to purchase my practice. He seemed very serious and well qualified. After our productive phone call, I Googled him only to find out he was involved in a serious legal issue that, if found guilty, he would receive jail time and potentially have his license revoked permanently. A scenario of him purchasing my practice before his trial was a possibility. 


 


It’s unfortunate that fellow podiatrists can become involved in serious legal issues. I think it’s only fair to be made aware of pertinent information that could be involved in making important decisions, especially if partnerships, practice sales, and more are involved. 


 


Name Withheld

03/27/2018    

RESPONSES/COMMENTS (NEWS STORIES)



From: Ira Baum, DPM


 


Court reporting by PM News can be a good resource to teach podiatrists what not to do and how many of our colleagues fare in court decisions. However, I don't see any value in naming a podiatrist in a DUI incident in sharing it with its readers. 


 


Ira Baum, DPM, Naples, FL

03/24/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1A



From: Elliot Udell, DPM


 


Drs. Young and Schneider question the findings in the recent paper published in a British medical journal which challenged the efficacy of orthotics in the management of heel pain. Most of us would concur with the above doctors that one of the key armaments podiatrists use in combating heel pain are orthotics. We see the results from our daily clinical management of heel pain. 


 


So what is going on here? The authors of the article from Britain cited other studies. They basically "scooped the barrel" for already published studies which showed that orthotics don't help patients with heel pain. This paper and the conclusions of the authors are exactly what a recent thread on PM News was all about. We podiatrists are not doing the research and are not publishing the papers, and if we did, those authors from England may very well have read our papers and come to a different conclusion about the role of orthotics in the management of heel pain. 


 


Elliot Udell, DPM, Hicksville, NY

03/24/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1C



From: Keith L. Gurnick, DPM


 


First let me state that I have not read this specific study, but I would like to state what will be obvious to all of our readers which is that all foot orthotics are not the same, all those who write prescriptions and order foot orthotics do not have the same high level of training and expertise and experience with orthotics, and many similar studies are flawed. 


 


An orthopedic surgeon, who specializes in foot and ankle surgery and now practices in my locality, wrote a similar article many years ago that gave a similar impression as this article. When I questioned him at a hospital staff meeting about foot orthotics, I asked him directly the following 4 questions to...


 


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

03/24/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1B



From: Nicholas A. Ciotola, DPM 


 


What I have found problematic in most studies on the role of various orthotic devices in plantar fasciopathy is that they all treat this disease like it is a homogeneous entity. Future investigations would be more robust by specifying the factors placing the patient at risk for plantar fasciopathy. It seems intuitive to me that plantar fasciopathy secondary to sagittal plane deformities (e.g. equinus) will do fine no matter what you place under the patient's foot, since a heel lift is probably all they needed. On the other hand, I believe heel pain with severe coronal plane deformities will benefit from an appropriately posted customized device. This paper, while limited in its methodology, hints that there may be some substance to this approach.


 


Nicholas A. Ciotola, DPM Methuen, MA

03/23/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1A



From: Simon Young, DPM


 


I don't necessarily disagree with the conclusions (without reading the study), but the study can be misleading. What were the biomechanical and pathophysiologic diagnoses of the PHP, for prescribing the orthotics. Not all PHPs are the same and respond to orthotics.


 


My empirical clinical experience indicates combined therapy treatment seems to be a reliable path to treat PHP - custom-molded orthotics in combination with other modalities i.e.: NSAIDs, physiotherapy, stretching, etc. Unitherapy modalities, in my clinical experiences, are not as effective for treating PHP.   


 


Simon Young, DPM, NY, NY

03/23/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1B



From: Michael J. Schneider, DPM


 



I'm assuming that PHP refers to plantar fasciitis. In 1976, I developed severe “PHP”. I saw a podiatrist who prescribed functional foot orthotics. I walked into his office on my toes to pick up the devices and walked out without heel pain. This actually led to my going back to school to become a podiatrist at the age of 42. In the years since, I have prescribed thousands.... yes thousands of orthotics to treat biomechanical issues... mostly plantar fasciitis.


 


I'm retired now (kind of). I still get positive feedback from patients whom I treated years ago. I am pretty certain that the majority of podiatrists who have treated “PHP” would agree that functional foot orthotics, done by professionals, have produced positive results in many if not most patients. Is it possible that the orthotics used in this “sham study” were not fabricated by true professionals?


 


Michael J. Schneider, DPM, Denver, CO


03/08/2018    

RESPONSES/COMMENTS (NEWS STORIES)



From: Richard G. Macdonald, DPM


 


Dr. Duran is to be honored for her service to podiatry and her country.


 


Richard G. Macdonald, DPM, Tremont, IL 

03/07/2018    

RESPONSES/COMMENTS (NEWS STORIES)



From: James Koon, DPM


 


It is not infrequent anymore to read articles that show higher and higher rates of physician burnout. The thing is this: no one cares. Joe Q Public could not (and does not) concern themselves with your emotions one bit. In their minds, you are still a rich doctor who only cares about making money. Certainly, there is a microcosm of patients that care about you but be assured, 99% couldn’t give a flip about us. 


 


I’ve been practicing for twenty years. The first 18 were in a private practice and the last two in a multi-specialty clinic. There are pros and cons to both, but I must admit that being in a multi- specialty clinic has far more pros than cons. My 80-hour work week is now a 50-hour week. The money is...


 


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

02/27/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 2



From: Amol Saxena, DPM


 


What a classy, original, and great scholarship idea by Dr. Perez! We need more people to do the same.


 


Amol Saxena, DPM, Palo Alto, CA

02/27/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1B


RE: Anthem Agrees to Fully Rescind Proposed Modifier 25 Policy


From: Michael Levi, DPM, Lloyd Smith, DPM


 


Thank you Frank Kase. I've been lucky enough to have known you for over 35 years. It doesn't surprise me that you were able to overturn Blue Cross reimbursements of EM codes. You are  a tenacious negotiator - a credit to our profession. I applaud your hard work. I believe if this problem would not have been overturned, it would have been the beginnings of other reductions in our reimbursements. Thank you Frank and the late Harry Goldsmith. 


 


Michael Levi, DPM, Santa Monica, CA


 


The success of this policy change is hard to appreciate. Dr. Kase is a podiatric legend. He is tenacious and dedicated. He worked with many DPMs from APMA and CPMA to others. He worked with CMA and AMA. He made this happen. Some of us, me included, played a small part in this effort. Harry Goldsmith was an intimate player. His wisdom will be missed.  


 


When I see these kinds of successes, I hope all American DPMs will realize that without APMA, absolutely none of these efforts would ever succeed. Join APMA. Join your state APMA affiliate and realize what your dues dollars pay for.  


 


Lloyd Smith, DPM, Newton, MA
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