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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:



From Ron Werter, DPM, Paul Kanter, DPM


I'll go one or two steps further. Not only should they be excluded from health coverage, but they should also be excluded from receiving any type of disability payments. That also goes for their spouses or family caregivers who have to give up their own jobs to care for the traumatic brain injury patient. No one wants to take away their choice, but let it be their sole responsibility, not their family's or mine.


Ron Werter, DPM, NY, NY


During my years at NYCPM, I always wore a helmet driving my Honda Twinstar to school and would have done so even if it was not a law. However, I disagree about not providing helmetless bikers necessary healthcare just as I would not deny a type 2 diabetic patient or a clinically obese patient with heart disease proper healthcare because they chose a not so healthy lifestyle.


Paul Kanter, DPM, Palmerton, PA



From:  Robert Hilkemann, DPM


Thank you for including the story about the motorcycle helmet bill. I did lead the filibuster to make it mandatory for riders of motorcycles in Nebraska to wear an approved helmet. We kept the helmets in place by ONE vote. One senator who supported repeal was not present at the time of the vote and asked for a reconsideration of the vote. The speaker did not let that happen - effectively keeping the helmets in place for at least one more year.


Robert Hilkemann, DPM, Omaha, NE



From: Justin Sussner, DPM


It is horrible indeed that a repeal of the helmet law is considered. Maybe if those who chose to not wear a helmet also gave up their right to healthcare related to their un-helmeted injuries. Nobody wants to be accountable for their own actions anymore.


Justin Sussner, DPM, Monroe, NY



From: George Jacobson, DPM


It's the dumbest repeal in the world! Florida repealed it several years ago. Not smart. We are dumb. My daughter witnessed a motorcycle accident this past week on I-95. It wasn't a pretty sight. She can't get the images of the motorcycle driver without a helmet out of her mind.


George Jacobson, DPM, Hollywood, FL 



From: Charles D. Clayton, DPM


I agree with Senator Hilkemann. I've had personal experience with the benefits of wearing a motorcycle helmet. In October 2015, I had a motorcycle accident.  Even though I was wearing a helmet, I suffered a traumatic brain injury. Though I don't remember the accident or the next week and a half, I suffered no significant permanent damage. I returned to my normal activities including finishing my sport pilot flying lessons and getting my license. Had I not been wearing a helmet, there is no question that I would not be writing this.


Charles D. Clayton, DPM, Mastic, NY



From: Joel Lang, DPM 


I have only admiration for and congratulations to Dr. Kor, for not only surviving and persevering, but overcoming and thriving. It only validates my philosophy to be kind to “everyone” you meet, because you have no idea what road they have travelled, what challenges they have overcome, or what burdens they still carry. Please share this message.


Joel Lang, DPM (retired) Cheverly, MD



From: Janet McCormick, MS


Dr. Splichal's comments on formaldehyde in polish are true - sort of. The full story is is that only foreign-manufactured polishes, as in a few made-in-wherever ones, purchased by Internet-based companies have "formaldehyde" - as in formaldehyde resin, which is different than formaldehyde - in them now, and that no American-made brand has it. The reputable lines are manufactured here in the U.S. as 3-free or even 5-free, meaning so-called toxic chemicals are no longer in their formulations, and have not been for years. I won't go into the names of the chemicals removed (available all over the Internet) but I will tell you that the U.S. manufacturers have worked very diligently to remove these chemicals while still producing quality products. 


The tests that "proved" these chemicals toxic in polish are rediculously false. They feed the lab rats tablespoons of 100 percent concentrations of the tested ingredient per day, which measures nothing as polish has thousands of times less in applications, even over years of polish changes. The naive legislature falls for it and demands change, so the manufacturers do it becauase it was too much trouble/costly to fight these types of claims by those who make millions on sensationalizing false claims. Consumers fall for it and it is not profitable to fight stupid, for certain! And it has proven to be good business for them to make the changes, of course. If they are 3-free or 5-free, they sell well, simple as that. 


Janet McCormick, MS, Fort Myers FL



From: Andrew Levy, DPM


Congratulations to Dr. Rubin and the entire governing body of the ACFAS. We could not possibly be under a better or more dynamic leadership. I am excited for the future of ACFAS!


Andrew Levy, DPM, Jupiter, FL



From: Robert S. Steinberg, DPM


I tried to find a report linking failed instrument sterilization to a post-op infection, but could not. I found reports on instruments not being properly cleaned to reduce "bio-load", but not that they caused a post-op infection after sterilization.


Someone stands to make  a lot of money, if enough people are frightened into believing that all instruments need to be disposable.


Robert S. Steinberg, DPM, Schaumburg, IL



From: Steven J Berlin, DPM


I want to congratulate our Congressman, Brad Wenstrup of Ohio, for his most recent appointment as the Subcommittee Chairman of the Veterans Hospitals. I am sure he will make a difference in the healthcare delivery for our military veterans.  


Steven J Berlin, DPM, Baltimore, MD



From: Daniel Chaskin, DPM


I agree that it is unfortunate that such a ruling puts board members at risk and I fully agree that they should be immune. They volunteer their time to help others and they try their best. Every podiatrist should be hired as a state employee whenever they sit on a podiatry or medical board. The employer will be responsible to indemnify and pay for all actions of the employee within the scope of their employment as a board member. Every board member will be required to fill out a job application. Every decision involving a loss or denial of license should be forwarded to the state attorney general for an advisory opinion as to if any federal civil rights or antitrust laws has been complied with. 


Daniel Chaskin, DPM, Ridgewood, NY



From Robert Scott Steinberg, DPM


While anecdotal, it is rare that I see a patient with plantar fasciitis who wears a stability or motion control shoe, either all day or for exercise. When I do, more often than not, they slip their shoes on and off without untying them. What I do see are athletic patients wearing low drop flexible/hyperflexible shoes presenting with plantar fasciitis. When they purchase a stability or motion control shoe with 10-12 mm drops, they begin their recovery from plantar fasciitis. 


Robert S. Steinberg, DPM, Schaumburg, IL



From: Bret Ribotsky, DPM


To Dr. Peacock's point that we are genetically made to be barefooted, I’d remind him that before the advent of shoes, humans rarely lived past 40 years of age. There are clues from real life that can add to this discussion. Recall that when you watch the Olympics, you notice that each athlete 's body type seems to look like others within the sport they are competing in. Each of us (maybe via genetic code) are pre-determined to be good at some things and not good at others. 


Case in point: LeBron James is possibly the best basketball player ever, but would be a complete failure as a jockey. When a 250 pound person comes into your office and says that his feet hurt when jogging, I tell him to get in the pool, as his body has selected him for something else to excel at.  


Bret Ribotsky, DPM, Boca Raton, FL



From: Don Peacock, DPM, MS


I would like to weigh in on the comments by both Dr. Shavelson and Dr. Kirby. Both of these men are biomechanics experts and I am not. I am a person that has exercised for years and have done my fair share of running. After numerous and continuous exercise injuries, I became smarter about how to work out. I did this by following many of the recommendations fostered in the paleo community. One of their recommendations is barefoot walking, and I have followed this protocol for 6 years and am injury free. 


The human body is not made for running on the surfaces that most people run on, and it is not genetically made for running in shoes for repetitive bouts of daily pounding, regardless of shoe or surface. The human body is made for walking long distances and for...


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



From: Dieter J Fellner, DPM


I agree with Dr. Kirby's analysis and opinion of the Hoka One One. Comparing the Hoka with the Sketcher's Rocker Shoe is comparing apples with oranges. I am quite confident the people who used Dr. Shavelson's information to sue Sketchers got great advice and good value.


The customers who try Hoka One One leave mostly positive reviews. A few comments on the shoe: the men's shoe tends to be undersized and quite a few runners complain that the shoe perhaps wears out more quickly than other brands. Some do not like the garish color designs. That aside, there are a lot of positive health comments about comfort, and less foot and knee pain too.


Dieter J Fellner, DPM, NY, NY 



From: Elliot Udell, DPM


Dr. Kirby reports that he sees a rise in certain foot injuries as a result of patients jogging with minimalist shoes. In this past issue of the patient flyer put out by the Massachusetts General Hospital, there was an article stating that barefoot running is a treatment for memory loss. If enough people read this article, it would appear that we might be seeing a lot of people who suffer with early dementia presenting with metatarsal fractures.


Elliot Udell, DPM, HIcksville, NY



From:  Kevin A. Kirby, DPM


To clarify, the article in Scientific American in which I was recently quoted on barefoot running, that one in three of my runner-patients now wears Hoka One One shoes. These patients are not injured because of their Hokas, but rather have switched to Hokas in order to try to find a more comfortable running shoe. However, a few years ago, I did see many injuries in runners trying to train in Vibram FiveFinger shoes. Vibram FiveFinger shoes seem to have lost their popularity since they settled out of court for $3.75 million for making repeated unsupported health claims for their five-toed shoes.


Regarding Dr. Shavelson’s comments about “Sketchers Rocker Shoes”, as anyone who has run or walked in Hoka shoes knows, the Hoka One One shoe line is not the “Sketchers Rocker Shoe.” Dr. Shavelson’s comment, “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” is not supported by any medical literature, to my knowledge, and has not, at all, been my clinical experience with Hokas. 


All podiatrists who are interested in treating runner-patients should try on a pair of Hoka shoes to see and feel for themselves how these shoes are very unique in construction and “feel” when compared to other running shoes. I have no financial ties to Hoka One One.


Kevin A. Kirby, DPM, Sacramento, CA



From: Craig Payne


Actually minimalist running is dead. The most recent sales figures have reported that minimalist running shoes sales have fallen to only 0.3% of the running shoe market. If that is not dead, I do not know what is. Runners have voted with their feet.


Craig Payne, Melbourne, Australia 



From: Richard Mann, DPM


What a wonderful story. Although I do not know Dr. Becker personally, I wish to express to her and her family how very happy I am for the miracle of the birth of their beautiful son, Jacob. I would also like to wish her a speedy and complete recovery.


Richard Mann, DPM, Boca Raton, FL



From:Elliot Udell, DPM


To paraphrase the saying: "from Dr. Michaels' mouth to God's ears." It would be a blessing if the Trump administration did away with MACRA, PQRS, Meaningful Use stage 3, and any other costly, time-consuming rules that the federal government has laid on the backs of healthcare providers.


This past week, I went to a physical therapist to get treated for a muscle spasm in my back. Had I not known where he was coming from I would have resented all of the irrelevant questions he had to ask me. He sheepishly apologized by letting me know that it was PQRS. As a patient, I felt that I would have preferred him spending more time evaluating and treating my back than on asking me a whole bunch of silly questions. I experience the same thing when I see my internist.


Many of these regulations were designed as part of the federal stimulus package to create jobs ala paid federal monitors, outside corporations selling us expensive software, etc. The only ones not taken into account with all of these extra tasks are the patients. Hopefully, the next administration will understand this.


Elliot Udell, DPM, Hicksville, NY



From: Evan Meltzer, DPM


As a former proud member of the NYS Podiatry Board prior to moving out-of-state, I recall going to Albany for an interview conducted by the Board Chairman and another Board member. I do not know if this is still a requirement, but if Dr. Karman was interviewed, I wonder how she managed to get past this hurdle. I strenuously oppose her appointment for all the reasons previously discussed.


Evan Meltzer, DPM, San Antonio, TX



From: Dan Michaels, DPM, MS


Recently, the AHA asked President-elect Trump to stop stage III of Meaningless use. How about the APMA joining the AHA in the request to President-elect Trump that Medicare cancel Stage III, MIPS, PQRS all other ridiculous programs which add red tape? In addition, get rid of the last alphanumeric character in ICD-10! We should be leading this charge and getting other organizations to join us in this request.


Dan Michaels, DPM, MS, Frederick, Hagerstown, MD



From: Alison D. Silhanek, DPM


Several respondents have noted concern over the appointment of Dr. Pamela Karman to the NY State Podiatry Board. I think that “concern” is not an adequate response. “Outrage” may be more appropriate. The NY State Department of Education has tasked the NY State Podiatry Board with overseeing my license, making sure that I am in compliance with the various regulations and bylaws. First off, momentarily ignoring this appointee’s seat on the plaintiff’s expert bandwagon, let us look again at her credentials. 


I realize that this forum has had vigorous debates about the fairness of some of the board certification requirements. Let us put that aside and hopefully agree that a person charged with overseeing my (and all NY podiatrists’) license should have successfully undergone the arduous process of...


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



From: Michael M. Rosenblatt, DPM


There is considerable controversy about Dr. Pamela Karman's appointment to the NY State Podiatry Board. She has served in "a number" of expert testimony cases against DPMs. Podiatrists envision themselves as "soft targets" and have an understandable enmity against those who "frequently" align themselves with the plaintiff's bar. There is one obvious conflict of interest: We would automatically assume that she would recuse herself from ANY Board action where she had even a passing contact with a DPM under NY Board focus, even if she didn't testify. This would even include her reading of chart notes. 


Aside from this issue, we wonder about "fairness." Some Board members are tough as nails and some seem fair. This is a moving target and hard to identify in advance. How do you know until they are seated and do some actual Board-issue voting? So far, she has elected not to comment in PM News. That is her privilege. But a brief note from her might help allay NY DPMs' fears, among them some who (someday) might sit under the NY Podiatry Board microscope. Anyone happens all the time. I believe all we ask is that she is "fair" in her new seat of power. So far we don't know. In the minds of those whom she testified against, it is safe to assume what their opinion is. Do you believe she has an unstated obligation to allay their fears? Should she resign?


Michael M. Rosenblatt, DPM, San Jose, CA



From: Donald R Blum, DPM, JD


It appears that the issue is that this one doctor testifies for plaintiffs against DPM defendants, not about the competency of the doctor. In most states, after the Governor (governor's appointment officer) makes an appointment, the appointee must be approved by the state senate. I'm not sure of the appointment process in New York, but podiatrists can express dissatisfaction with the appointment by writing to Thania Fernandez ( of the New York State Education Department. Perhaps if enough DPMs complain and express that it is felt that this appointee would not protect the citizens (not the licensees) of NY, then perhaps her appointment might be rescinded.


The purpose of a licensing board is to protect the citizens of the state and make sure that the practitioners meet minimum standards of competency.


Donald R Blum, DPM, JD, Dallas, TX
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