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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:


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

02/15/2018    

RESPONSES/COMMENTS (NEWS STORIES)



From: Richard G. Macdonald, DPM


 


It truly warms my heart to see a podiatrist, Dr. Hall IV, reach the status he has accomplished in Lake Charles LA. I had the great honor of being a close friend of another Lake Charles LA native - Nathan Le Doux. Nat was the first black man hired as executive in a local bank and eventually became head of HR for the local Central Illinois utility company. His life story was unbelievable, with stories of segregation growing up in Lake Charles. I congratulate Dr. Hall on his success after knowing the previous history of Lake Charles through the words and eyes of Nathan Le Doux.


 


Richard G. Macdonald, DPM, Tremont, IL 

01/30/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1



From: Robert Creighton, DPM


 


"Bunions aren’t genetic, but they may be common among members of the same family because people get their foot structure from their parents."  Wait...what?


 


Robert Creighton, DPM, St. Petersburg, FL

01/30/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 2



From: S. Jeffrey Ali, DPM


 


Amen to Dr. Bryan Markinson's observation that doctors were blamed for under-treating pain just about a decade ago. In fact, in my residency and in our hospital (2004-2007), we were instructed that pain was "the 5th vital sign". 


 


Now, we are being blamed by opportunistic politicians as the cause of the opioid crisis. In Ohio, opioid prescriptions are now limited to 7 days, and additional orders require charted justification. Any of you ever see an ankle fracture heal in 7 days? I know my own didn't.


 


For months, I have felt like a lone voice for our position on this. The colleagues with whom I have spoken seem to be resigned to accepting the situation. It is re-assuring to hear such a respected spokesman in our field defend us against such unreasonable accusations.


 


S. Jeffrey Ali, DPM, Broadview Heights, OH

01/29/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1B



From: Connie Lee Bills, DPM


 



I agree 100% with Dr. Jacobs. I also think there isn’t 50 hours of new podiatry material to  “learn” each year. Why can’t Michigan and other states reduce the number of live hours needed in order to stop this corrupt behavior?


 


Connie Lee Bills, DPM, Mount Pleasant, MI


01/29/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1A



From:  Dennis R. Frisch, DPM


 


The American Podiatric Medical Association strongly supports any policy that helps to eliminate undue corporate influence over continuing medical education. APMA is extremely transparent in its relationships with industry, and as a past chair of the Annual Meeting Committee, I can confidently assure PM News readers that the generous support our corporate partners provide for our education has never interfered with APMA’s ability to provide high-quality, unbiased education. 


 


Dr. Jacobs makes numerous assertions without providing any factual data. First and foremost, the New Jersey regulation does not apply to educational programs. The Council on Podiatric Medical Education (CPME) in its document 720 has very clear guidelines regarding unrestricted educational grants for...


 


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

01/26/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1B



From: Allen Jacobs, DPM


 


Dr. Udell has suggested that without pharmaceutical support, seminars would cease to exist as the cost for running such seminars would be passed on to those attending the meeting. I could not disagree more strongly. 


 


There are some seminars such as the annual meeting of the APMA which generate well over $1 million in exhibitor fees. I highly suspect the cost of supporting unbiased speakers to present scientific material would result in a negative cash flow to the meeting. 


 


Corporate influence over podiatry education has resulted in...


 


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

01/26/2018    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1A



From: Bryan C. Markinson, DPM


 


I have been a paid speaker/consultant for pharma companies and pathology labs for over 20 years. I leave it up to my audience to decide if I am polluted or not. My deluge of e-mails every month from all over the country from colleagues who ask my opinion on their cases suggests otherwise. I am aware of studies indicating physicians are influenced by steak dinners to choose a certain product and would be foolish to reject it out of hand. However, the assumption that a physician would then prescribe based solely on the promotion without regard to appropriate indication and clinical findings is insulting and outrageous. The total lack of pushback on this by organized medicine is distressing and makes me glad I am in the twilight of my career.


 


New Jersey in particular is a very hostile state to doctors. Gov. Christie in public forums laid the opioid epidemic directly at the feet of doctors. (INCLUDING WHEN JOHHNNY STEALS HIS MOM'S CANCER PAIN MEDICINE OUT OF THE MEDICINE CABINET). In New York and New Jersey, and probably many other states, it was just a few years ago when doctors were threatened with sanctions on their license for INADEQUATE treatment of pain. Now, we are the culprits in the crisis!! Medicine stands by and does nothing. Hospitals make us look at videos so we can stop our drug pedaling. OUTRAGEOUS.


 


Bryan C. Markinson, DPM, NY, NY

01/25/2018    

RESPONSES/COMMENTS (NEWS STORIES)



From Elliot Udell, DPM


 


I have mixed feelings about government putting caps on what pharmaceutical companies can spend on doctors. What is happening in NJ is just the beginning. I just heard on the news that New York City is suing Big Pharma for causing the opioid crisis. There is a growing public sense that pharmaceutical companies are bribing physicians into prescribing all of their products. They do it by giving gifts, sponsoring speakers at conventions, advertising in all medical journals, sponsoring dinners, etc. 


 


On one hand, I wonder if when we go to our respective doctors, are we being prescribed medications that are best for us, or were our doctors enticed into prescribing them because of gifts given to them directly or indirectly? On the other hand, as a person involved in both lecturing at seminars and organizing seminars, I realize that if Big Pharma did not subsidize some of the speakers, sponsor booths or give grants, many of our seminars would either cease to exist or the cost would be passed on to participants, making attendance at these events unaffordable for many practitioners.


 


 Elliot Udell, DPM, Hicksville, NY

01/24/2018    

RESPONSES/COMMENTS (NEWS STORIES)



From: Ron Werter, DPM


 


"In an unusual administrative move – without passing any new laws – on December 22, 2017, the Attorney General of New Jersey finalized new rules governing physician interactions with pharmaceutical companies. In addition, physicians will be subject to a $15 dollar meal cap, for meals related to all activities."


 


So, the Bergen County Division, NJ Podiatric Medical Association will have their next meeting at the Engelwood McDonalds. I just wonder how those foot ulcer pictures will go over with the regular customers.


 


Ron Werter, DPM, NY, NY

01/19/2018    

RESPONSES/COMMENTS (NEWS STORIES)



From: Dennis Shavelson, DPM


 


Peg Swisher is a board-certified pedorthist or CPed and stating that her CPed certification makes her “an expert in biomechanical evaluation and gait analysis” is a claim undeserved of that profession. I have known and worked with CPeds who are in fact experts in biomechanical evaluation and gait evaluation, but they are exceptions and not the rule. Most CPeds are not exceptionally educated, trained, or experienced in advanced biomechanics.


 


Being a board-certified pedorthist makes you a board certified pedorthist and nothing more.


 


Dennis Shavelson, DPM, NY, NY
Bako 214