The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

January 05, 2012 #4,350 Publisher-Barry Block, DPM, JD

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Post-Op Patients Should Avoid the Ocean: CA Podiatrist

California podiatrist Dr. Lyle Nalli warns post-op patients to avoid swimming in the ocean. "The salt water is a living estuary of bacteria. I tell my patients NOT to get in the water after surgery. And ocean water is the last resort. A typical pool has chlorine and other elements that make the environment for bacteria difficult."

Dr. Lyle Nalli

Nalli is a graduate of the California College of Podiatric Medicine, and his interests include long board surfing and swimming.

Source: Swimming World [1/4/12] 

OK Podiatrist Joins Utica Park Clinic

Jerry Maxwell, DPM, a foot and ankle physician and surgeon joined Utica Park Clinic in Cushing January 3, 2012. Dr. Maxwell graduated from the Ohio College of Podiatric Medicine in 1978 and completed his residency in 1982 at Northlake Regional Hospital in Tucker, GA.

Dr. Jerry Maxwell

He is board certified by the American Board of Podiatric Surgery and is a fellow of the American College of Foot and Ankle Surgeons. Dr. Maxwell is an active member of the Oklahoma State Podiatry Association, American Podiatric Medical Association, and is certified by the American Board of Podiatric Surgery. He has also contributed to a number of professional journals and education textbooks throughout his career.
 
Source: Cushing Regional Hospital

NY Podiatrist Continues Tradition With Annual Holiday Shoe Drive 

Following four years of tradition, Dr. Bruce Pinker, owner of Progressive Foot Care in White Plains, joined ranks with the Westchester/Putnam Central Labor Body AFL-CIO and its affiliates in a “Holiday Shoe Drive” to collect shoes for the homeless. 

Dr. Bruce Pinker (L) (Photo Chris Schwartz)

Footwear in all shapes and sizes was collected over a two-month period and donated to Grace Church Community Center (GCCC) for distribution at the agency’s Open Arms Men’s Shelter and Samaritan House Women’s Shelter and Soup Kitchen. Over 1,000 pairs of shoes were collected.
 
Source: Chris Schwartz, White Plains Patch [12/22/11]

Final Notice Issued on Medicaid Quality Measures

HHS has issued a final notice containing an initial set of 26 quality measures for Medicaid-eligible adults. The measures, which cover areas such as prevention, care coordination, and chronic disease management will be used for quality reporting.

The healthcare reform law required HHS to post the core set of measures by Jan. 1, 2012. Additionally, the law mandates that HHS must develop a standardized quality reporting format by Jan. 1, 2013, and also publish any changes to the measures on a yearly basis.

Source: Maureen McKinney, Modern Healthcare [1/3/12]

Query: Special Needs Rotation
 
Where would one find a list of podiatrists, who see a high number and variety of patients with special needs, who could offer an opportunity to allow podiatric students to shadow and/or do a month-long private practice rotation? 
 
Ashley Mychak, 3rd Year Student, Des Moines, IA

RE: Osteonecrosis of the Posterior Process of the Talus (Jim Fisher, DPM)
From: Paul Clint Jones, DPM

This malady is more common than I thought. Because of the nutcracker effect between the posterior tibia and superior cortex of the calcaneus, the problem can be both acute or insidious in onset. The presenting symptoms can range from referred anterior ankle pain to pain of the posterior ankle. This occurs with either forced plantarflexion at the ankle, or direct pressure to the area.

Diagnostic injections of anesthetic would include the intra-articular ankle to determine if the pain is coming from within the ankle. Next, the anesthetic is injected directly...

Editor's Note: Dr. Jones' extended-length letter can be read here.

RE: Orthotic Therapy for Hallux Rigidus (Arthur Lukoff, DPM)
From: James Clough, DPM

I have seen no credible evidence that using a first ray cut-out in any form works.  Whenever we do a forefoot cut-out, we do a cut-out to off-weight the metatarsal, not to promote plantarflexion. I find that a cut-out here, under the first metatarsal, destabilizes the foot, as the medial forefoot tripod arm is not stable and the foot pronates excessively through midstance and into active propulsion. The only two studies that I am aware of looking at this issue are from Canada. "Effectiveness of the Kinetic Wedge Foot Orthosis Modification to Reduce Relative Plantar Pressure", Rambarran, K.K., et al.,* showed a decrease in pressures under the first metatarsal head, not an increase. The same author, looking at gait posture, showed no improvements. The most reliable way to plantarflex the first metatarsal is to dorsiflex the hallux, via the Cluffy Wedge.

As far as shortening metatarsal osteotomies are concerned, I do not do these, as I believe they interfere with the function of the first ray.  A cheilectomy will not adversely affect first ray function, and I believe is a better solution. After surgery, if the first MTPJ functions normally, the joint should be fine long-term, but re-establishing normal function of the joint, surgically or non-surgically, I believe, is critical to the success of any surgical intervention.

Disclaimer: I am the inventor of the Cluffy Wedge.

James Clough, DPM, Great Fall, MT, jclough@bridgemail.com

RE: Source for Cantharone Plus (Brent Rubin, DPM)
From: Fred Birnbaum, DPM, Frank Lattarulo, DPM

I used to get Cantharone Plus from Canada, but now I get it from a local pharmacist compounder. I use a 30% sal acid in cantharone preparation, but you can vary the strength any way you wish. Not every pharmacist who does compounding can obtain cantharone however. If you need my pharmacist's info, e-mail me.
 
Fred Birnbaum, DPM, Fairless Hills, PA, themick8@comcast.net

I use Cantharone/Cantharone Plus almost exclusively on all my veruucae. In 25 years, I have found nothing beats it. I know of no place in the U.S. where you can purchase it. If you are interested in purchasing outside the U.S., please contact me.

Frank Lattarulo, DPM, NY, NY, doclatt@aol.com

RE: Bone Mineral Density Testing (Joe Agostinelli, DPM)
From: Robert Bijak, DPM

Recollection of first year physiology will remind one of the multiple systemic influences on bone such as parathormone from the parathyroid gland, calcium and phosphate exchange via the kidneys, testosterone and estrogen effects on matrix formation, etc. As limited license practitioners, we are not recognized to treat systemic disease.

I know very few podiatrists who need to do density testing prior to surgery. For decades, x-rays have been quite good and cost-effective in making surgical decisions. Also, before "giving supplements, consider referring to someone who actually knows why the density is decreased and actually treats the etiology, like an endocrinologist. The insurance companies are correct not to pay podiatrists for this test. 

Robert Bijak, DPM, Clarence Center, NY, rbijak@aol.com

RE: Insurance Company Controls (Robert Kornfeld, DPM)
From: Larry Lavery, DPM, MPH

The problem is simply that we have not done extensive research to demonstrate the benefit of orthotics. If there were better clinical evidence and gait lab evidence, there would probably be better reimbursement, or at least you would be able to approach BCBS with randomized clinical trials that were peer-reviewed and published in high level journals to argue your case. Even though podiatry schools all have 'experts in biomechanics', the schools collectively publish very little. There will be a growing emphasis on evidence for what we do or we will not get paid.

Larry Lavery, DPM, MPH, Dallas, TX, lklavery@yahoo.com

RE: Medicaid Change for Orthotics in NY (Alan Silverstein, DPM)
From: Lloyd Nesbitt, DPM

The NY State Podiatry Association has to fight this one! Medicaid has to be made to understand the importance of the podiatrist being the provider of orthotics. Podiatrists are not “vendors” -- they are not selling “insoles.” When orthotics are required, it is in the best interest of all patients that podiatrists diagnose the foot problem, write the biomechanical prescription, perform the proper neutral position casting technique, use a proper orthotics lab, and then subsequently dispense the devices, plus provide follow-up visits.

DPM are the most qualified providers; plus they can evaluate the efficacy of the devices to assure that they are working properly and that the patient is comfortable. If the orthotics are problematic in any way, the podiatrist is again the best person qualified to rectify the problem and make adjustments or modifications.

This problem occasionally had surfaced in Canada, yet insurers came to realize that it is in their clients’ best interests that when it comes to orthotics, that they should have the gold standard of foot care (podiatry). As a result, many major national carriers such as Manulife Financial (who bought John Hancock in the U.S.) now stipulate that they will cover orthotics only when prescribed and dispensed by DPMs (and chiropodists in Ontario), and not retailers and other providers. As a result, several insurers have saved millions of dollars over the years by avoiding repeat claims that followed orthotic failures by unqualified providers.
 
Lloyd Nesbitt, DPM, Toronto, ONT, lloydn@rogers.com

ASSOCIATE POSITION - LAS VEGAS/HENDERSON, NV

Well-established 22 year practice in   Las Vegas/Henderson, Nevada seeking full-time associate. General podiatric care with moderate amount of surgery to be done in local hospital or surgery center. Competitive salary and benefits. Modern office in new area. Please respond by email to lvfootandankle@gmail.com

ASSOCIATE POSITION - TAMPA BAY
 
Well-established, dynamic multi-doctor practice in the Tampa Bay, high-tech with EMR and digital x-rays. Sports medicine, surgery and potential partnership. No NH/ HMOs. Excellent hospital privileges. Choose an area of practice concentration that you are passionate about and enjoy a lifestyle second to none. C.V. to  flpodiatrist@tampabay.rr.com

ASSOCIATE NEEDED - NORTHERN CINCINNATI, OHIO (FAIRFIELD)

Lead to partnership &/or buy practice. Well-established, reputable & successful (700K collection annual) 25+ year practice. Newer 2k sq.ft office condo & w/5 tx rooms, Aver.80 new patients monthly, full hospital privileges, DME, Padnet, digital x-rays. Inquires to email: gsherwood1@cinci.rr.com

ASSOCIATE POSITION - ALBANY/CAPITAL DISTRICT AREA

Immediate position available with generous salary, fringe benefits and percentage. All phases of Podiatry. For more information please contact Dawn at (518) 828-6516 or fax your resume to(518) 828-9510.

ASSOCIATE POSITION - EAST TENNESSEE

30 year old practice with 5 offices in greater Knoxville area seeking ethical, personable, hardworking, team player. $160,000 base salary with bonus incentives and benefits. Post-residency experience a plus. Please send resume to ddavidphawk@yahoo.com
 

ASSOCIATE POSITION - NAPLES, FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Candidate should have the skills and desire to perform rearfoot/ankle surgery. Florida has a great scope of practice law and we rotate for ER call. Candidate needs to be ethical and motivated. Established practitioner or new practitioner. In a cover letter tell me why you should be selected for the team. Email cover letter and CV with subject line "I am your new team member." to:   Drgordon@gulfcoastfootcare.com

ASSOCIATE POSITION - CENTRAL VALLEY/SOUTHERN CA

Seeking associate with partnership availability. Must be highly motivated and have good patient skills and personality. Salary excellent with all paid benefits/incentives including malpractice/401k and profit sharing. Compassionate and well-trained for immediate position. Surgery Center and hospital-based with no HMOs/no rest homes. Bilingual in English and Spanish preferred. Offering a permanent position/partnership in a multi-million dollar hi-tech practice with Partnership also in Surgery center. Please e-mail CV and short bio to: Tonya@wetreatyourfeet.com

ASSOCIATE POSITION - LONG ISLAND, NY

Full time associate position available with well rounded multi-office group on Long Island. Ideal position for July 2012 graduating third year resident who wants to practice and live on Long Island. Candidates must be board qualified or board certified, and well trained in all phases of podiatry including surgery, biomechanics, wound care and palliative care. Compensation includes salary,malpractice insurance, paid vacations and surgical incentives, with a future partnership opportunity available for the right candidate. Interested doctors are encouraged to submit their CV's in response to:  mets724@gmail.com.

ASSOCIATE POSITION - CHICAGO, IL

Established, progressive, busy Chicago practice seeking PSR 24/36 individual with good people skills to join 2 man group. Senior associate retiring. Excellent opportunity leading to partnership for energetic, motivated, ethical professional. Submit CV to JAF@APLfeet.com

ASSOCIATE POSITION - NC PIEDMONT

Excellent opportunity for highly motivated, ethical, and personable PSR 24/36. This well established, 3-physician practice has excellent rapport with physician community,multiple office locations, and hospital privileges. Intent is an associate leading to partnership for the right individual. Competitive salary & benefits. Email CV to dpmassociatenc@gmail.com.

ASSOCIATE POSITION - HAWAII (OAHU)

Full-time position available. Join this fantastic practice in paradise. Diagnostic ultrasound, Digital X-Ray, EHR, Surgical Privileges, Competitive Salary plus benefits package. Send CV to:  yoleven316@yahoo.com.

ASSOCIATE POSITION - NAPLES, FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Candidate should have the skills and desire to perform rearfoot/ankle surgery. Florida has a great scope of practice law and we rotate for ER call. Candidate needs to be ethical and motivated. Established practitioner or new practitioner. In a cover letter tell me why you should be selected for the team. Email cover letter and CV with subject line "I am your new team member." to   Drgordon@gulfcoastfootcare.com

PART-TIME PODIATRIST NEEDED - LOS ANGELES, CALIFORNIA 

ASSOCIATE POSITION - CENTRAL VALLEY/SOUTHERN CA

Seeking associate with partnership availability. Must be highly motivated and have good patient skills and personality. Salary excellent with all paid benefits/incentives including malpractice/401k and profit sharing. Compassionate and well-trained for immediate position. Surgery Center and hospital-based with no HMOs/no rest homes. Bilingual in English and Spanish preferred. Offering a permanent position/partnership in a multi-million dollar hi-tech practice with Partnership also in Surgery center. Please e-mail CV and short bio to: Tonya@wetreatyourfeet.com

SPACE AVAILABLE - NYC & LI

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