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January 02, 2007 #2,779 Editor-Barry Block, DPM, JD

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New Year’s Resolutions Can Result in Foot Injuries: FL Podiatrist

As people ring in the new year, many will make resolutions to get in better shape, but they need to learn to listen to the bodies they are aiming to improve.

For Dr. Brian Rell, a podiatrist and surgeon at the Center for Foot and Ankle Disorders, the month of February is often a busy one. People who have been sedentary for prolonged periods of time and then decide to jump into a vigorous exercise program as part of their new year's resolution may start to feel aches and pains. One of the most common area affected by the stress is the feet.

Dr. Brian Rell

Stretching and proper shoes are important for everyone, no matter the age. Rell sees quite a few young patients in his office for reasons ranging from failing to stretch to wearing improper shoes to trying to work through an injury. Metatarsal stress fractures are common injuries, especially for those who decide to jump feet first into a running regimen. "They do too much too soon," Rell said.

Source: Melissa Followell, Bradenton Herald [12/30/06]

Congress Sends Health IT Back to Drawing Board

Capitol Hill's leading health information technology legislation for 2006 died a slow death, but lawmakers are hoping for a reincarnation of sorts in 2007.

Congress was unable to come to an agreement on the health IT issue before adjourning in December, despite spending about five months trying to bridge the gap between two significantly different Senate and House bills. The Wired for Health Care Quality Act passed the Senate in November 2005, and the Health Information Technology Promotion Act of 2006 passed the House last July.

In the end, disagreements were too pronounced between House and Senate leaders over setting safe harbors for health IT donations to doctors, providing grants to technology adopters, and updating diagnostic code sets used by hospitals and physicians. This year, lawmakers will go back to the drawing board and craft new legislation rather than reintroduce the same bills that ground to a halt in negotiations between the houses, congressional aides and lobbyists said.

Source: David Glendinning, AMNews [1/1/07]

Query: Plavix Side-Effect

Recently, I saw a patient in her home. I debrided her nails. Then I got a call stating that she has a bruise on her foot and the home attendant panicked and called a social worker. The daughters did not blame me for it. I went over today and saw an area of erythema there. The woman is taking Plavix and one daughter feels that is what did it, as do I. Does anyone have any experience with this side-effect?

John Spina, DPM, Brooklyn, NY

Query: Expert Review Fee

I have been treating a patient who had a bad surgical result from another podiatrist years ago. He has been seeing an attorney and has had depositions from the offending podiatrist. I recently got a letter from the patient’s attorney that he wants to meet with me privately to discuss "issues that are pertinent to this lawsuit." This is not an "expert witness" request as yet. What should my fee be for such a meeting?

Gershon Goldman, DPM, Flushing, NY

Editor’s comment: PM News does not provide legal advice. Generally, such a fee would be based on your hourly rate, which in turn is related to how much you earn per hour and what credentials you have. Most DPM's charge between $250 - $350 per hour for expert review. A retainer of three hours should be collected in advance.

RE: Polypropylene Orthoses
From: Paul Scherer, DPM

Kevin Kirby's photo of the high heels got me to dig out this photo. Sometimes we think our challenges with shoes in our culture are difficult but no where close to the shoe issues in other cultures.

Polyproplylene Orthoses?

This photo is from Northern Ethiopia. I think the man walked into a shoe store and had a computerized scan of his feel, resulting in this pair of polypropylene orthoses.

Paul Scherer, DPM, San Francisco, CA, hpoc@aol.com

RE: Orthotics For Skier with Achilles Tendinitis (Edward Orman, DPM)
From: Robert Scott Steinberg, DPM, Lloyd S. Smith, DPM

Alpine skiing is about medial column support. While it is important to find STJ neutral, of more importance is where the center of knee mass is in relation to the foot. Minus genu varum or valgum, center of knee mass should be over the first interspace. So, how do you get this alignment and get an impression? Not with plaster casting and surely not with a foam box.

There are a number of "fancy" ski boot orthotic systems available to ski shops. Most are too prone to technician error and more often then not create a supinated custom insole. I have found that direct contact molding on a thermoplastic sandwich blank, with the skier standing on specially designed pillows, allows the visual examination of the center of knee mass over the foot by use of a plumb bob. Posting material is then added and ground to the appropriate alignment requirements. The orthotic is then placed into the shell to check its fit to the boot board.

Next, have the skier stand on the orthotics in the shells and visually check for upper cuff alignment. Adjust the cuff alignment, if you have the special tool, so that there is equal spacing medial and lateral. Then place the liner and orthotic into the shell. Further fit issues can be addressed with shell grinding and punching, and heel height adjustments. Keep in mind that the hinge point of the ankle should be aligned with the hinge point of the boot. You don't want off-set hinges.

There is a pronounced heel cup in the boot that can irritate the Achilles. Grinding the shell and off loading padding can help --- after the foot is stabilized on an orthotic. In fact, all boot fitting should be done after the orthotic is made.

Robert Scott Steinberg, DPM, Hoffman Estates, IL, doc@footsportsdoc.com

Having skied more than 50 days a years for many years, I can appreciate all the comments regarding ski orthotics. Making things quite simple, I played around with a personal pair of Rohadur orthotics for several days to get my skis flat, my turns round and my balance perfect.

The old remedy that worked perfectly was a roll of duct tape. I added strips of duct tape in successive runs to each orthotic until I felt comfortable and balanced. I did this on different days to allow for different snow conditions. I found the most consistent way to get the best posting was to do this on days when the snow was firm and fast since this allowed for an accurate feel of a smooth surface.

After several days, and without trying to be too esoteric, I found my ideal posting. I then replaced the duct tape with Korex posting and I was done. I used those orthotics for years and they never failed me. I have used the same strategy for my patients when they are willing to play around and find their ideal balance points.

Simple? You bet. It works!!!

Lloyd S. Smith, DPM, Newton, MA, lloydpod@yahoo.com

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

ASSOCIATE POSITION - CENTRAL CALIFORNIA

Central California multi-location practice looking for PSR-36 associate leading to partnership. PSR-36 trained podiatrist with great opportunity for reconstructive surgical practice. Practice has Medicare-approved surgery center. Must have excellent interpersonal skills. Excellent salary and incentive. Respond to: westsidefoot@yahoo.com

ASSOCIATE WANTED FOR SOUTH MIAMI AREA

Large group, busy, multi-office, partner potential. Motivated applicants only. Mail resumes and letters of intent to 999 N. Krome Avenue, Homestead, FL 33030. July start time OK, sooner preferable. E-mail lianadpm2@aol.com. I can also be reached at 305-331-4501.

ASSOCIATE POSITION - CINCINNATI, OHIO

One of the largest podiatry practices in the United States is again in need of a PSR 24-36 Associate. All present doctors are in their thirties with similar training. Everyone is treated equally and there is definitely no limit to your success. Please submit resume or contact Karen Roesch via email or phone. Kroesch4poh@aol.com (513) 729-4455

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

ASSOCIATE POSITION--PHOENIX SUBURB

Attractive opportunity for enthusiastic, proficient, and personable associate. Well-established modern practice with multiple newer spacious offices, technology and equipment. Solid referral base, close to hospitals, knowledgeable certified staff. 22% MCR. Practice and surgical center partnership potential opportunity. Prefer 24-36+ PSR. Send CV: AZpodassociate@aol.com

ASSOCIATE POSITION - LOS ANGELES/SOUTH BAY AREA

Multi-office, multi-doctor, well-established practice near the beach cities. Seeking a board eligible/certified PSR-24 or PSR-36 trained foot and ankle surgeon. Well-rounded practice requiring knowledge in biomechanics, pediatrics, sports medicine, diabetic wound care, trauma, and reconstructive foot and ankle surgery. Full-time position available immediately with generous compensation and benefits, including malpractice, and health insurance. Two-year commitment required with partnership opportunity. Send CV to akemfoot@sbcglobal.net or fax to (310) 838-0227.

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