The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

January 04, 2013 #4,656 Publisher-Barry Block, DPM, JD

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NY Podiatrist Advises Against Cosmetic Foot Surgery

Except in summer sandals, the foot is rarely on public display—but that doesn't mean vanity stops above the ankle. Foot surgery is available to make pointy shoes fit better and to shorten second toes that extend beyond big ones; there's lipo for the little toe in cases where it's not little enough, and injections of hyaluronic acid to add padding to the balls of the feet (dubbed the "Loub job," after Christian Louboutin).

Dr. Rock Positano

The complications, however, can be brutal. It took one New York City socialite more than three years to recover from shots in her soles that caused nerve injury and forced her to wear sneakers. "When patients ask to alter the architecture of a foot that has no real disabilities, I advise against it," says Dr. Rock Positano, a New York City podiatrist and director of the non-­operative foot and ankle service at the Hospital for Special Surgery.

Source: Joan Kron, Allure [1/2/13]

NJ Podiatrist Named as Silver Level Consultant of the Year

Dr. Lawrence Levine, podiatrist and founder of Foot Health Centers, P.A., based in Cherry Hill, and a Cherry Hill resident, was recently named a Silver Level recipient in the Consultant of the Year category of the 2012 Health Care Innovation Awards from the Philadelphia Business Journal and United Healthcare.

Dr. Lawrence Levine

The category honors an external consultant who had a major impact on the operations of a hospital or health center. Dr. Levine was recognized for developing the first podiatry program in the country for five Federally Qualified Health Center locations throughout Southern New Jersey.

Source: The Cherry Hill Sun [1/2/13]

ProLab Orthotics Acquires FootStride Technology

ProLab Orthotics has announced the acquisition of FootStride Technology, a leading manufacturer of high-quality custom foot orthotics in the Pacific Northwestern United States. FootStride, headquartered in Snohomish, WA, is recognized for their superior custom foot orthoses and consultation expertise. Originally founded in 1985 by Don Greiert, CPed, FootStride is highly regarded by both podiatrists and physical therapists, with the FootStride brand being synonymous with exceptional quality and service.

Dr. Paul Scherer

“The addition of FootStride to ProLab allows us to continue our leadership role in the orthotic industry. We believe the addition of Don Greiert’s experience and expertise to ProLab’s team will continue to improve our products, services and reputation” said Paul R. Scherer, DPM and CEO of ProLab Orthotics. This action continues ProLab’s strategy of increasing their value through expansion and value enhancement by acquiring high quality orthotic companies.

HHS Targeting Smaller Data Breaches

In less than three years, around 60,500 "smaller" healthcare data breaches—each affecting the records of fewer than 500 individuals—occurred across the country, and the federal government is setting its sights on providers implicated in these incidents. HHS' Office for Civil Rights has reached a $50,000 settlement agreement with Hospice of North Idaho, based in Hayden, a suburb of Coeur D'Alene, pertaining to the hospice's 2010 loss of a laptop computer that contained the records of 441 patients. The Civil Rights Office described the settlement as the first stemming from a Health Insurance Portability and Accountability Act security-rule violation for a breach affecting fewer than 500 individuals.

"This action sends a strong message to the healthcare industry that, regardless of size, covered entities must take action and will be held accountable for safeguarding their patients' health information," said Leon Rodriguez, director of the Civil Rights Office, in a news release. "Encryption is an easy method for making lost information unusable, unreadable and undecipherable."

Source: Joseph Conn, Modern Healthcare [1/2/13]

Query: Periungual Fibromas

I have a 56 year old female with a history of tuberous sclerosis who presented to the office with multiple periungual fibromas on her toes. She just had several removed from her fingers with avulsions of her nails by a hand specialist. She would like her toes done as well.

Periungual Fibromas

I was planning on avulsing the nails along with removal of the fibromas and then doing chemical matrixectomies on the more severe deformed nails. Does anyone have any other suggestions or pearls on treatment?

Steven F. Levin, DPM, Wesley Chapel, FL

RE: Lesions in Feet of Diabetic with Pancreatic CA (Larry Aronberg, DPM)
From: Brian Kiel, DPM, Elliot Udell, DPM

It appears that this patient might have larva migrans, which is most commonly found on beaches where there is animal fecal contamination. Since you are in Florida, this is a distinct possibility.
 
Brian Kiel, DPM, Memphis, TN, Footdok4@gmail.com
 
The serpinginous type of lesions described could be cutaneous migrans larvae or some other parasitic infection. It also could be ringworm which is a fungal infection. Immunosupression from chemotherapy can open a patient up to a wide range of infections and infestations which could affect the skin. Contact your dermatopathology lab, show them the photos, and ask what type of biopsy they would recommend in order to make a definitive diagnosis. If it is cutaneous migrans larvae, there are some very good treatments, but it would be prudent to consult with the patient's oncologist before administering it.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: The Self-Esteem of Podiatry 2013
From: Robert Kornfeld, DPM

It is a new year, 2013. We have much to be grateful for. But so much, in my humble opinion, is going backwards that I think it is appropriate for us to look at what is happening and what we are willing to accept as podiatrists. For starters, we have the Medicare issue which seems to recur every year with threats of large cutbacks. Then, at the last minute, fees are "frozen" and everyone breathes a big sigh of relief. Thank the Lord, no cuts this year.

So the government sets you up, puts fear into your hearts, then comes along at the last minute to "save" you. Does anyone see the...

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

RE: Strapping Denial When Injection Given (Charles Morelli, DPM)
From: Jeffrey Kass, DPM

I think the majority of the readers would agree with Dr. Morelli, and likely practice in a similiar fashion. However, Dr. Forman's point SHOULD be addressed. The fact is when a podiatrist fabricates a foot strapping for say plantar fascitiis - a procedure is being performed that deserves reimbursement. The fact that it may take 90 seconds is completely irrelevant, as many procedures are not necessarily time-consuming.

The insurance company is bundling two distinct services with no justifiable reason except that "they can", and we can't do a thing about it. Dr. Forman, I believe, is merely asking "can we?", "why haven't we?" To discuss other ways to stream revenue or talk about dropping out of plans, etc. is diverging from the topic at hand. Why avoid the issue? Why can't the issue itself be addressed? What will stop insurance companies from proposing equally ridiculous "bundling of service" edits if we don't speak up?

Jeffrey Kass, DPM, Forest Hills, NY jeffckass@aol.com

RE: Rising Patient Deductibles Spell Trouble for Doctors
From: Jon Purdy, DPM
 
I find the term “elective” to be a bit misleading. To the patient with a painful deformity that does not allow them to wear most shoes or perform activities of daily living (ADLs) without pain, corrective surgery is anything but “elective.” What might fit better into this category are the conditions that primary care doctors treat such as high blood pressure, high cholesterol, and a myriad of other conditions that do not limit ADLs. When one sees their primary care doctor to diagnose and treat these conditions, they are doing so “electively.”
 
The primary care doctor has the unfortunate burden of having to educate patients about significant, non-symptomatic conditions, that may lead to future morbidity. It seems to me that high out-of-pocket costs for doctor visits and medications would most likely cause the population to discontinue the diagnosis and treatment of conditions that do not present an immediate concern, and steer them to prioritize treatment of their painful conditions. This certainly positions podiatry to do very well in the future.
 
It’s actually rather sad that doctors who do not practice comprehensive foot care go a step further and make fun of those who do. The public is spending billions of their hard-earned dollars blindly purchasing multiple over-the-counter products to try to alleviate their foot conditions. Doctors who provide patients with products that are time-tested to alleviate their discomfort certainly help them use their co-pay wisely. I don’t think anyone is going to provide a strong argument that a moisturizer, a desiccant, a compression stocking, or an arch support is an “unproven” therapy.  
 
Jon Purdy, DPM, New Iberia, LA, jpurdy@mindspring.com

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Still under warranty. New laser head just added. First Best Offer. Marketing and training included. Dr. Zuckerman will train you. e-mail with questions to mook863@comcast.net

ASSOCIATE POSITION – NORTHWEST INDIANA  
 
Looking for a well-trained, entrepreneurial-minded podiatrist to compliment a busy modern (EHR, Digital X-ray, Diagnostic US, etc.) practice. Highly competitive compensation package. Great area to work, live and raise a family. Send resume/CV to: Pjames@cffaac.com

ASSOCIATE POSITION - GRAPEVINE, TEXAS

Do you want to practice in a fast paced office environment? Do you like all aspects of podiatric medicine? Very busy 2 office practice looking for associate to add to our group of 5. If you are a forward thinking, surgically trained podiatrist send your CV to giacalone@faant.com

ASSOCIATE POSITION - DAYTON, OH

Join a well-established modern practice in Dayton, Ohio. Excellent reputation and referral base. Base salary $120,000, benefits and bonus structure. EMR, diagnostic ultrasound, Padnet vascular studies, CO2 lasers, all aspects of DME. We seek a surgeon that is well-trained and personable to join our group of 4 podiatric surgeons. Would like to have this individual buy in to the practice eventually. Please send CV and to Ohiodoctors@aol.com

ASSOCIATE POSITION - NASSAU COUNTY, NEW YORK

Exciting Opportunity! Associate position. Must be Board Qualified. Joining all Board Certified Doctors in foot surgery and reconstructive rear-foot and ankle surgery. Respond to: Podiatryoffice@doctor.com

ASSOCIATE POSITION - NORTHWEST IOWA

A well-established, midwest multi-physician practice with strong hospital affiliations seeking FT podiatrist. Applicant should be well trained surgical physician, completed a 12/24 month residency, & board eligible. Practice offers high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume: 712-258-9977.

ASSOCIATE POSITION - FLORIDA

ASSOCIATE POSITION – NORTHERN CALIFORNIA/SF BAY AREA

We’re looking for someone entrepreneurial to join our growing practice. Must have great people skills, clinical/surgical skills, and positive demeanor. California license required. No nursing home visits. Send your CV and cover letter to: cvpodiatrist@gmail.com

ASSOCIATE POSITION - KANSAS CITY

Kansas City may be the perfect move for you and your family. I am looking for an entrepreneurial minded associate who wants to grow and then own part of an already successful practice. If you are the right candidate for this associate position, you will enjoy a competitive compensation package and you will be working with a doctor who is as committed to your success as he is to his own. Go to: www.YourFutureInPodiatry.com for full details.

ASSOCIATE POSITION - ORANGE COUNTY, NY

Full-Time or part-time. Looking for a highly motivated, surgical trained podiatrist in Orange County, NY (West Point). Hospital, wound center and surgical center affiliated. A busy practice that covers hospital in-patients, wound center, and ER calls. Must be trained in all foot surgery and be able to handle advanced diabetic wound care. 1 hour car ride from NYC and close to hiking, fishing, skiing and state parks. Email CV and contact info to: clsp4@yahoo.com

ASSOCIATE POSITION - NEW YORK

Established and modern podiatry practice seeking well trained podiatrist for our two offices located in the Hudson Valley. Individuals must be highly motivated, ethical, and have PM & S-36 training. Partnership potential! Please see our recruitment video (845) 471-2243, esims@simspodiatry.com

ASSOCIATE POSITION - CT - (FAIRFIELD AND NORTH HAVEN)

Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices, including EMR, digital x-ray, vascular and NCV studies, Pinpointe and CO2 lasers, diagnostic ultrasound and electrical stimulation therapy. You can expect a full schedule of patients the day you start, and a very competitive salary. For more info www.greatfootcare.com. Send resume to Dr.Kassaris@yahoo.com

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