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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:


01/18/2017    

RESPONSES/COMMENTS (NEWS STORIES)



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

01/17/2017    

RESPONSES/COMMENTS (NEWS STORIES)



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

01/16/2017    

RESPONSES/COMMENTS (NEWS STORIES)



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.

01/13/2017    

RESPONSES/COMMENTS (NEWS STORIES)



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 

01/12/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1B



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

01/12/2017    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1A



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


01/05/2017    

RESPONSES/COMMENTS (NEWS STORIES)



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 

12/30/2016    

RESPONSES/COMMENTS (NEWS STORIES)



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

12/14/2016    

RESPONSES/COMMENTS (NEWS STORIES)



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

12/07/2016    

RESPONSES/COMMENTS (NEWS STORIES)



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

12/07/2016    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1



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

12/06/2016    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1B



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.

12/06/2016    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1A



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 can....it 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

12/05/2016    

RESPONSES/COMMENTS (NEWS STORIES)



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 (thania.fernandez@nysed.gov) 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

12/02/2016    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1B



From: Jeffrey Kass, DPM


 


PM News yesterday announced that three podiatrists were appointed to the NY Board of Podiatry. In the same issue, a response from Name Withheld read "I was shocked to read that Dr. Pamela Karman was appointed." I am curious how Name Withheld read this and was able to respond in the same posting before all of us were able to read the announcement in PM News. I would ask the editor if Dr. Karman was given the same courtesy of seeing the response against her and given an opportunity to reply before it was printed. I contend anyone publishing negative news about anyone should put their name to it or it not be published. 


 


Having said that, if board certification is not a criteria for appointment to the Board, then this fact is irrelevant. If it is true that Dr. Karman has been an expert plaintiff witness against podiatrists multiple times and has a voice regarding outcomes of professional conduct proceedings, than I too find this problematic. 


 


Jeffrey Kass, DPM, Forest Hills, NY


 


Editor's Response: The information was publicly available, so Name Withheld did not respond to reading it in PM News. We will be happy to post a response from Dr. Karman.

12/02/2016    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1A



From: Joel Lang, DPM, Alicia Lazzara, DPM


 



I am retired and not living or practicing in New York, but I concur with “Name Withheld” regarding Dr. Karman’s appointment to the State Board of Podiatry. Absent any recognized certifications and if she has a history of repetitive testimonies as a plaintiff witness, her appointment seems questionable. She is likely to use her board position to give false gravitas to future testimonies.


 


Joel Lang, DPM (retired), Cheverly, MD


 


I am also concerned about Dr. Karmen’s appointment to the NY board. Who made that appointment? And who is the NY Podiatry Board accountable to?


 


Alicia Lazzara, DPM, Bayside, NY


12/01/2016    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1


RE: Three Podiatrists Appointed to NY Board of Podiatry 


From: Name Withheld


 


I was shocked to read that Dr. Pamela Karman was appointed to the State Board of Podiatry. She has been used multiple times as a plaintiff expert against podiatrists ....at least nine times. She is not board certified by either of the designated boards approved by the Joint Committee on the Recognition of Specialty Boards (JCRSB). I question the vetting process for board members since this appointee will be privy to Office of Professional Conduct proceedings that are confidential, and she may now have access to that information as well as use the title on the stand as part of her "expertise."


 


Name Withheld

12/01/2016    

RESPONSES/COMMENTS (NEWS STORIES) - PART 2



From: Elliot Udell, DPM


 


In his reply, Dr. Richie wrote: “There are no quality studies verifying the efficacy of any of the (physical medical)  modalities Dr. Udell suggests for the treatment of ankle sprains.” This is yet another example of why we often need to read an entire paper and not commentary. In the paper referenced by Dr. Richie in which he was one of nine authors, it states in the NATA guidelines for the treatments of ankle sprains the following: “Electrical stimulation can be used as an adjunct to minimize swelling during the acute phase of injury.” In all fairness, the paper gave this and some other recommendations a C rating.


 


Later in the paper, it said that electrical stimulation was not a recommended modality in the management of lateral collateral ankle sprains; however, the paper by Mendel, et al. in  support of this statement only described one physical medical modality – HVPC, which is a ....


 


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

11/28/2016    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1A



From: Doug Richie, DPM


 


The analysis of the study performed by Brison, et al. (BMJ 2016;355:i5650) posted by Dr. Udell suggests that certain modalities have benefit in the treatment of the acute ankle sprain. He suggests that "most of us" utilize treatments which include interferential therapy, TENS, and "other forms of stimulation" when treating an ankle sprain, and that these therapies "have been shown to be highly effective in controlling the pain and edema associated with ankle sprains."


 


As a co-author of the "National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes" (Journal of Athletic Training 2013; 48(4):528-545), I must clarify to the readers of PM News that there are no quality studies verifying the efficacy of any of the modalities Dr. Udell suggests for the treatment of ankle sprains. On the other hand, Dr. Udell does point out that the key element of treatment of the ankle sprain was not implemented in the Brison study: proper long-term immobilization.


 


Doug Richie, DPM, Seal Beach, CA

11/28/2016    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1B



From: Dennis Shavelson, DPM


 


This thread and the lack of counterpoint reflects weakness that continues to escalate within the podiatry community when it comes to biomechanics. I have never witnessed a cohort of patients or group of adults that did not own genetic underpinning biomechanical problems and their sequelae. No bunions, heel pain, hammertoes, genu valgum, back problems? No high or low SERM-PERM Intervals, no foot type specific pathology? What biomechanical bubble are we living in? 


 


To state that a population’s “faulty mechanics” has nothing to do with overuse injuries related to any activity including dance does little more than justify podiatry prowess of biomechanics as we degrade and second class it. DPMs specializing in dance medicine have been making orthotics for ballet and shod ballroom and modern dancers for 40-50 years +. There are labs that share their interest in dance that are becoming vestigial too. The only realm where orthotics are not applicable to dance are when dancers are training and performing barefoot.


 


Dennis Shavelson, DPM, NY, NY

11/25/2016    

RESPONSES/COMMENTS (NEWS STORIES) - PART 2



From: Elliot Udell, DPM


 


The above "medical news flash" is a perfect example of why it is imperative to read a research paper before jumping to conclusions based on either the title of the paper or a title given by a journalist who read the paper and added his or her own headline about the study. This practice is very common and even affects major world class newspapers and reports on television. I salute PM News for giving us a link to the actual paper. This is not always provided to the public by other media venues.


 


In the actual paper referenced titled “Effect of early supervised physiotherapy on recovery from acute ankle sprain: randomised controlled trial" by Brison, et al., the authors concluded that physiotherapy following an acute ankle sprain is no more effective than at home rest, ice, compression, etc. What is misleading is that what the authors utilized as physiotherapy in their study was just supervised muscle strengthening and hands-on therapies. This did not include the wide gamut of therapies most of us use, such as interferential therapy, TENS, and other forms of stimulation that have been shown to be highly effective in controlling the pain and edema associated with ankle sprains. They also did not evaluate the different types of immobilization that we all routinely utilize in the management of ankle disorders. 


 


Elliot Udell, DPM, Hicksville, NY

11/25/2016    

RESPONSES/COMMENTS (NEWS STORIES) - PART 1



From: Keith L. Gurnick, DPM


 


I have treated many of the celebrity contestants on Dancing with the Stars including two "Mirror Ball" winners. In response to the post by Dr. Robert Weiss, please note the following: All of the serious injuries that sent these dancers to my office were repetitive stress foot and ankle overuse injuries, however none had to do with faulty foot mechanics. Due to the time constraints and format of the TV show, novice dancers (even celebrities) train daily for 3-4 hours in order to be prepared for the first episode. Most of the overuse injuries occur very early in the season, or sometimes before the first show is televised.


 


The "wearing of proper footgear and use of orthotics" is an unrealistic treatment suggestion. Dance shoes for men and women are non-supportive and thin-soled. The use of specific padding and taping is much more likely as a treatment than shoe changes or orthotics in this group of patients.


 


Keith L. Gurnick, DPM, Los Angeles, CA

11/23/2016    

RESPONSES/COMMENTS (NEWS STORIES)


RE: Major Trial Casts Doubt on Leading Device to Heal Bone Fractures


From: Thomas Hill


 


The November 2, 2016 issue of PM News included an item from Statnews.com related to a published study by Canadian researchers and their work on reviewing the effects of low intensity pulsed ultrasound (LIPUS) on fresh fractures of the tibia. It’s important to note that the patients in this study were only approximately 43% compliant and used the LIPUS device, known as EXOGEN, on average approximately only 14 minutes per day. EXOGEN should be used 20 minutes per day to ensure effectiveness.


 


Other published studies have much higher compliance (greater than 80%), which in turn led to successful outcomes. EXOGEN is an FDA-approved product with demonstrated safety that has been on the market for more than 20 years, and there are many studies showing its positive effect on fracture healing. Our rebuttal letter about this study in the journal it was published in can be found here.


 


Thomas Hill, Director of Corporate Communications, Bioventus

11/22/2016    

RESPONSES/COMMENTS (NEWS STORIES)



From: Elliot Udell, DPM


 


Dr. Kass is 100% correct. There are many other reasons in addition to stress fractures and incidental findings of osteopenea where ordering a test for vitamin D would be in the patients' best interest. The problem is that insurance companies which always take the route of least payment, may not approve of the blood test unless the patient has an established diagnosis of osteopenea. It may sound absurd, but many carriers will not allow a patient to be tested for vitamin D deficiency unless the patient has a vitamin D deficiency. The problem is that if the patient gets the bill for this costly blood test, they will come back at us with "a bow and arrow in their hands" demanding reasons why we ordered the test.


 


Elliot Udell, DPM, Hicksville, NY

11/19/2016    

RESPONSES/COMMENTS (NEWS STORIES)



From: Jeffrey Kass, DPM


 


I would like to add to Dr. Udell's post that Vit D3 is now available in once-weekly dosing as well. He uses 30,000 units once weekly. I opt for 50,000. D2 and D3 are both available in the 50,000 unit dosage, and from what I read, the D3 is the preferred form. I would not only look for vitamin D deficiency when presented with a pedal fracture. I strongly urge anyone attempting any bone fusion procedure, no matter the age of the patient to make Vit D testing part of their pre-surgical testing. 


 


Jeffrey Kass, DPM, Forest Hills, NY
Gilden 314