The Voice of Podiatrists

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January 03, 2007 #2,780 Editor-Barry Block, DPM, JD

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Howard Inbody, DPM, 82

Dr. Howard I. Inbody passed away December 21, 2006 in Fort Dodge, Iowa from complications related to illness. He was 82. Howard attended Iowa State University, then served in the U.S. Army as a Master Sergeant with the U.S. Army Medical Corps. He was a veteran of WWII and Korea. Following military service, Howard graduated from the University of Iowa (Class of 1948), and the Illinois College of Podiatric Medicine, where he graduated in 1955.

He was in private medical practice in Fort Dodge from 1955 until his retirement in 2002. During that time, he served on numerous state podiatric medical boards and committees, as well as serving as President of the Iowa Podiatric Medical Society, in 1973. Howard was also a member of the American Podiatric Medical Association, where he was recognized as a 50 Year Life Member.

PM News policy is to recommend that memorial donations be made to the APMA Educational Foundation's Student Endowment Fund, 9312 Old Georgetown Rd., Bethesda, MD 20814.

Regular Exercise Can Reduce Foot Pain: CA Podiatrists

Many podiatrists believe that putting feet through a simple exercise regimen designed to build up foot strength and flexibility can save some folks a world of hurt.

Dr. Noreen Oswell

"A lot of injuries we see can be prevented if you have stronger feet," says Dr. Noreen Oswell, chief of podiatric surgery at Cedars-Sinai Medical Center in Los Angeles. And though podiatrists have many recommendations for preventing injuries (such as wearing proper shoes), only one thing, they say, will directly strengthen the feet — and that's exercise.

Dr. Douglas Richie

Regularly exercising your southernmost appendages can strengthen muscles of the foot and ankle, warding off tendonitis, plantar fasciitis and good old-fashioned foot pain, says Dr. Douglas Richie, a podiatrist in Seal Beach and past president of the American Academy of Podiatric Sports Medicine.

Source: Janet Cromley, Los Angeles Times [1/1/07]

CA Podiatrist Charged With Failing to Adequately Treat Patient

According to The Medical Board of California, Dr. Richard H. Graves, a Los Alamitos podiatrist, is accused of failing to adequately treat a 49-year-old man with foot problems. The board also cites Graves' 2004 criminal indictment for allowing unlicensed employees to treat patients and fraudulently billing Medi-Cal for nearly $600,000. Graves pleaded guilty in September to one felony count of making false statements, was fined $200,000 and placed on two years' probation

Source: Blythe Bernhard, The Orange County Register [1/1/07]

Query: Alternative to Isopropyl Alcohol

Is there a possibility of cross contamination w/ having a jar of sponges soaked in consumer-grade, OTC isopropyl alcohol? I use them mostly as (1) as an initial pre-prep to a surgical scrub prep--according to literature I've read, it provides an bactericidal effect; and (2) for patients to clean/decontaminate their feet before I see them for an exam/treatment. The Infection Control (IC) section at my hospital argues that these sponges could be a source of cross-contamination, and that the lid of the jar--when not cleaned or polished looking--could appear unseemly (to JCAHO inspectors) and perhaps be virulent as well. What other inexpensive, easy, safe, non-allergenic (to their skin & my nose) alternatives are available?

Will Godfrey, DPM, Fort Polk (Leesville), LA

Query: Golfer with Hallux Limitus

My patient is a golfer in his 60’s with hallux limitus with pain is noticeable at end of ROM of plantar-flexion, He has elevated first metatarsal and mild HAV. Over the past several months he has had an escalation foot pain issue mostly with his right foot (he is a right-handed golfer, hence he exerts a lot of pressure/stress to the right foot when he swing sand shift weights to his left side). Any suggestions for golf shoes and orthotics?

Ido Friedman, DPM, Savannah, GA

RE: Expert Review Fee (Gershon Goldman, DPM)
From: Richard W. Boone, Sr

I would recommend that any podiatrist who is thinking about doing so should think long and hard about whether they want to become a standard of care expert on behalf of a patient they are currently treating. This is especially true if they are treating the iatrogenically caused problem which is the subject matter of the suit. In my experience, acting as a standard of care expert in such situations is a very, very bad idea.

You can, and indeed you're probably legally obligated to, serve as an expert consultant on damages issues. Your patient probably cannot prove his or her case without you. And you're entitled to be paid for these services. The editor's fee recommendations seem very reasonable to me.

But you are not obligated to give testimony, and you should not give testimony on standard of care issues against the previous treating podiatrist, no matter how critical you are of his or her care. Never, not ever, never.

The rationale for not testifying on standard of care issues in these cases is complex. Indeed, it is probably too complex to explain in a posting here. All I will say about it is that it's the second best way I know of to get yourself sued for malpractice.

Richard W. Boone, Sr., Fairfax, VA, RWBoone@aol.com

Plavix Side–Effect (John Spina, DPM)
From: Elliot Udell, DPM, Marc Katz, DPM

Plavix (clopidogrel bisulfate) is a platelet inhibitor used to reduce morbidity in patients with severe cardiovascular disease who are at risk for or have had a recent MI or CVA. It functions similar to prophylactic aspirin. Given this, the insert from the manufacturer states: "Plavix prolongs the bleeding time and therefore should be used with caution in patients who may be at risk of increased bleeding from trauma, surgery, or other pathological conditions (particularly gastrointestinal and intraocular)."

It is possible that the condition your patient presented with was due to trauma from tight shoes or an injury that he did not remember. Elderly people often injure themselves getting in and out of bed or going to bathroom at night. They often do not remember the injury because it is not that bad, but if they are taking a medication that prolongs bleeding time they can develop a bruise that will be visible long after the injury. Because podiatrists deal with a large geriatric population, we all see many patients who are either taking or have taken Plavix. In my practice I have not seen any problems with excessive bleeding due to this medication. I've seen more such complications with patients who take Coumadin or prophylactic aspirin.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

Typically you find purpura or bruising with a skin injury and not erythema. Perhaps she had irritation from the debridement or has irritation from the shoe. Plavix usually causes a fairly pronounced purple area. It sounds like the patient’s family is going a bit overboard with their reaction.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

RE: Orthotics For Skier with Achilles Tendinitis (Edward Orman, DPM)
From: Charles Morelli, DPM, Marc Katz, DPM

To simply make an orthotic and throw it in a ski boot is doing your patient a terrible disservice. Dr. Orman tells us nothing more than that this particular skier has a slight forefoot valgus, insertional Achilles tendinitis, and is having a hard time making turns to the left. With this information, many of our colleagues have simply addressed the orthotic issue and, never addressed what might be the most important aspect of this discussion. Do his boots fit?

In many cases, the person for this job is not a podiatrist, but a professional boot fitter. Depending on your foot type and skiing ability, the boot you choose will usually make all the difference in the world, and can make your foot problems simply go away. I suffered for an entire year with insertional Achilles tendinitis bilaterally. Once healed from having ruptured my PL, and after the swelling subsided in my Achilles, I bought a new pair of boots that addressed my problem and my foot type.

As far as having a hard time turning to the left, many skiers have a strong side, and making turns in one direction is usually easier than the other? Once his limb-length, orthotic and boot issues are addressed, tell him to pay $50.00 and take a private lesson.

Charles Morelli, DPM, Mamaroneck, NY, charles@themorellifamily.net

I have found that orthotic devices in cases like this are often an art and less a science. I would simply direct heat mold a pair of thin thermoplastic orthoses with moderate flexibility and add a heel lift or neutral post. All of the the angles, varus etc. seem of little value if you provide the patient with a solid medial arch. The body compensates significantly, especially in skiers. So taking all of these measurements are rarely accurate.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

Editor’s note: This topic is now closed

ASSOCIATE POSITION - MISSISSIPPI

Well established, busy, 3-doctor practice seeks PSR 12 or 24 trained podiatrist for associate position to fill vacancy of retiring member. East central location is a great area to raise a family and is a prime location for accessibility to several major cities. Competitive salary, benefits, and incentives. Partnership possible in 2 years to right individual. June - July start date. Applicant must be ethical, personable, and motivated. Please E-mail CV and letter of intent to shanegan@bellsouth.netASSOCIATE 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.

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

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