The Voice of Podiatrists

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January 06, 2010 #3,746 Publisher-Barry Block, DPM, JD

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ND Podiatrist Concerned About Unstable "Toning" Shoes 

Dr. Timothy Uglem, a podiatrist with MeritCare in Fargo, ND says that walking in an unstable shoe can improve balance, but said he would be concerned if someone with balance issues, such as an elderly person, wore them. “It certainly could lead to issues such as falling,” he says.

Dr. Timothy Uglem

Overall, though, Uglem doesn’t have a strong opinion about the shoes. “I don’t think they’re necessarily good. I don’t think they’re bad. I don’t think we know,” he says. “Certainly I have had numerous patients come into my office and say it’s the greatest thing.”

Theoretically, taking the weight off of the heel if somebody is having heel pain makes sense, Uglem says. But he isn’t sure whether putting more weight toward the toes would necessarily help. The toning results touted by the companies come from studies funded by the shoe companies, Uglem says. Independent, peer-reviewed studies that Uglem researched did not find the same results.

Source: Sherri Richards, INFORUM [1/4/10]

Deadline Approaches for World Congress of Podiatry Abstracts

January 15, 2010 is the deadline for submitting abstracts for the the XXth World Congress will take place from May 13-15 at the RAI Convention Centre in Amsterdam, The Netherlands. Every three years FIP, the Fédération Internationale des Podologues (the International Federation of Podiatrists) together with a member country organize this event which showcases the state-of-the-art in foot care, treatment of foot problems, and evidence-based podiatry. 

The FIP World Congress is by far the most important meeting of its kind. The Dutch Podiatry Association (NVvP) and the board of FIP expect to welcome not only many podiatrists from all 27 member countries, but also doctors, nurses, and other professionals interested in the field of feet and shoes.

Query: Covered, Then Non-Covered Orthotics

We have a 14 year old patient with a number of biomechanical problems resulting in a gait disturbance. I felt that she would benefit from custom foot orthotic devices. The office staff called her insurance company, and documented on the patient chart that she was told that the orthotic devices were covered items. The insurance rep additionally gave us the deductible information.

The orthotics were fabricated and dispensed to the patient. We billed the insurance company who promptly declined payment based on a "non-covered service." We appealed the decision, and, again, were turned down for payment. We reported the incident to the State Department of Insurance. We received no satisfaction, so we then billed the patient. The patient's father, upon receipt of the bill, told me that he was told that orthotic devices were a covered service. So here we are with quite a bit of time spent on this case plus material and orthotic lab costs with no reimbursement. I was thinking of taking this claim to small claims court. Any suggestions?

Michael Forman, DPM, Cleveland, OH

Response: The patient/parent should sign a form that clearly states that they will be responsible for payment if their insurance company does not pay. This does not have to be a form with tons of legalese. I tell patients that the fact that their insurance company has a custom foot orthotic benefit does not guarantee they will approve the claim and reimburse it. I also ask, as long as my contract with the payer does not prohibit it, for a deposit which is refundable if payment is made by the payer. If the patient balks at accepting financial responsibility or leaving a deposit, then no orthotic. This is a patient education issue. Patients must understand the value of an orthotic device toward their overall treatment. We also give the patient options of a payment plan for any balance on the charge, or credit card payment should their insurance company deny the claim.

When dealing with the payer, you do have some recourse to denied claims for custom foot orthotics. While it is true that an authorization does not guarantee payment, getting or attempting to get a authorization is important. You need to record the name of the person you spoke with, phone number, extension, date/time. etc. As the telephone prompt states, some conversations are taped so that they can be retrieved and used as the basis of your appeal. Ask the rep about any identifying number assigned to the conversation, and write it down, just in case you need to prove you spoke to a rep and what they said to you. All payers have written appeal processes. If you are not familiar with a particular plan's policies, request a copy...and follow it. I have found that the first level of appeal often times doesn't get me anywhere - regurgitates policy - but I have better results deeper into the appeals process. Persistence can make a difference.

Tony Poggio, DPM, Alameda, CA

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RE: Surgery Cancellation Due To Prior MRSA Infection (Tom Silver, DPM)
From: Pete Harvey, DPM
 
Dr. Silver’s surgery center is probably a partner in SCIP or Surgical Care Improvement Project. Most U.S. hospitals are participating.

Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com

RE: Importance of Doppler Studies (Michael M. Rosenblatt, DPM)
From: Robert Bijak, DPM

While I agree in spirit with Dr. Rosenblatt, I might remind him that podiatrists are not recognized as competent to interpret vascular results and are not allowed to comment above the ankle in most of the United States. As such, until we get a degree change, we should do what podiatrists do best; refer these patients to a vascular doctor.

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

RE: Bunion in 14 Year Old (Chris Browning, DPM)
From: Philip Demp, DPM

In this case, a single open mathematical curve passes through the positions of the five metatarsal heads. This indicates a smooth movement for force and pressure from the fifth metatarsal to the first  metatarsal. I believe that one would be at risk performing surgery. However, if surgery is performed and a pathomechanical configuration occurred, then one could probably produce a non-pathomechanical configuration using an appropriate osteotomy of one or more of the lesser metatarsals.

Philip Demp, DPM, Cinnaminson, NJ, pdemp@dca.net

RE: Hiring People with Disabilities (Bob Levoy)
From: Paul Stepanczuk, DPM

My son, Aaron, was born with Norrie Disease. You never heard of it, even in pathology class. He is totally blind from birth, requires hearing aids (hearing ability continues to decrease, though not on a regular basis) and has significant cognitive problems (though he can read Braille, at least at high school level). He has been doing my dictation for at least 9 years. When he lived with us, he was doing it 4 nights/week. Now that he is in a group home, he...

Editor's note: Dr. Stepanczuk's extended-length letter can be read by clicking here:

RE: My New Career as an Orthotist (Name Withheld)
From: Ira M. Baum, DPM

Dear Name Withheld and other podiatrists who feel that they are in the same predicament: Our profession has changed or is changing to be solely a surgical specialty. I personally always enjoyed the challenge of our specialty providing both non-operative and operative treatments for my patients. Unfortunately, due to lack of uniformity in post-graduate training programs, our profession is attacked by other specialties who would like to see our profession disappear. Therefore, it appears that the Council on Podiatric Medical Education has been indirectly forced to direct post-graduate training in a single direction.

I feel very sad reading a posting like this, because I love my profession, and I feel strongly that many members who are not surgeons or limited surgeons need training to satisfy disparity and recognition by members of our profession. It should not be beneath anyone's dignity to help a patient in need, regardless of the method of treatment. I'm not sure if there is a solution to this problem because of the hybrid nature of our profession. Orthopedists generally delegate non-operative treatments to PA's. I would not encourage our profession to consider this option if we are to remain a separate profession. If on the other hand, the public would be better served if podiatry became a surgical specialty, then by all means, we should be consolidating into an MD, orthopedic foot and ankle subspecialty. Is there another way?
 
Ira M. Baum, DPM, Miami, FL, ibaumdpm@bellsouth.net

RE: TX Podiatrist Discusses Pregnancy and Foot Health
From: Cam White

This has been a subject that I have been interested in for some time. As the owner of a comfort shoe store, we frequently see women who argue about their shoe size. "There's no way I'm a size 9. I've always been a 7 1/2." My answer usually is, "How many children do you have?" They will usually tell me they have between 2-3 children.

I had an interesting discussion with a podiatrist a few years ago about this subject. I asked him if it made sense to recommend dispensing OTC or custom orthoses to women entering their 3rd trimester of pregnancy. Since the ligaments in the foot are under the greatest amount of stress in the body, the idea was to introduce orthoses before her body starts producing relaxin to soften her ligaments in advance of childbirth.

The result could be that she has far less pain and discomfort during her pregnancy, the original shape of her feet is retained, which could also prevent excessive flattening of the foot due to ligament laxity. The added benefit would be that her original shoes might still fit after she gives birth. I would be interested in feedback, since my research hasn't turned up much on this subject.

Cam White, Total Relief Footwear, Austin, TX, camwhite.shoes@gmail.com

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ASSOCIATE POSITION – ILLINOIS

Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings are available. If interested, fax curriculum vitae to 847-674-2113 or e-mail to feetwork@aol.com

ASSOCIATE POSITION - MASSACHUSETTS

PSR-24 trained podiatrist for busy multi location practice, high volume and high-tech. Seeking energetic individual for high volume of patients with multiple needs. Orthopedic, sports medicine, wound care, pediatric orthopedics and surgery skills required. Looking for immediate hire for the right candidate with possibilities for partnership. Contact Debbie Roberts debbierobertsm4@hotmail.com

ASSOCIATE POSITION – NORTH AND CENTRAL FLORIDA

Quality Podiatry Group of Florida provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists.  Immediate openings are available. If interested, fax curriculum vitae to 847-674-2113 or e-mail to feetwork@aol.com

PRACTICE FOR SALE - ALABAMA, GULF COAST

Established 26 year old practice for sale. Owner desires to sell and relocate. Practice operated 25 hours per week. Mixture of surgery and general podiatry. MD referrals. Surgery center and hospitals in close proximity. Highly profitable. Priced to sell. Seller will lease office to buyer. Call Mike Crosby at 1-888-776-2430 or email at mcrosby@providerresources.com

ASSOCIATE POSITION - BROOKLYN, NY 
 
Full or part-time position available for a busy well-established podiatry practice in downtown Brooklyn. All phase of podiatry. Modern office with EMR, Ultrasound, digital x-rays with a great support staff. Must be highly motivated, ethical, with good communication and clinical skills. please email resume to tkd@gishpuppy.com

ASSOCIATE POSITION - HUDSON VALLEY, NY

Excellent opportunity for a three-year surgically trained foot and ankle physician. We are a high-volume, diversified, multi-office practice utilizing state-of-the-art modalities. Ample growth opportunities for a personable and highly-motivated DPM with ability, and a desire to teach and take ER call. If interested, please forward CV to: healthyfeet4ever@yahoo.com

ASSOCIATE POSITION-CHICAGO AREA

Medical-surgical podiatry practice seeking full-time associate, future partnership opportunity. Start with full schedule. In Elgin, IL 45 minutes from downtown Chicago. Established 75+ years, new state of the art facility. 5 minutes from new, high-tech hospitals. Excellent relationship with other specialties, high physician referral base. PSR-24/36. Email resume to kenjacoby18@gmail.com

ASSOCIATE POSITION – CINCINNATI, OHIO

This is your once in a lifetime opportunity to join one of the most successful practices in the United States. We do not have a seniority system. If you are motivated and have completed a PSR 24-36 residency, your income is limited only by your enthusiasm and desire to achieve. Email resume to khart@cincinnatifootcare.com

ASSOCIATE POSITION - MINEOLA, NEW YORK

Full-time associate position with future partnership potential available with busy multi-office practices on Long Island. Must be proficient in all phases of podiatry with emphasis on surgery, biomechanics and RFC. Minimum standards include either a three-year PSR, or board qualified/certified status with ABPS. Existing hospital privileges with a NY based facility helpful. Interested doctors are encouraged to e-mail their CV to mets724@gmail.com

PRACTICE FOR SALE - TENNESSEE

Well established practice for sale. Full scope medical and surgical practice including DME. Exceptional practice with a high volume of new patients. Excellent hospital and surgical center privileges with investment opportunity. Great area for a family and the outdoorsman. 731-446-7285/E-mail nraines@charter.net

PRACTICE FOR SALE - CENTRAL FL

Practice and medical building for sale, in beautiful, high quality of life, growing area, Central Fl.; 2000 sf bldg. fully equipped/ designed for podiatry; excellent location, features & exposure; near hospital, wound and HBO center. Great opportunity for expansion & investment; good insurance climate. 352-223-2713 / E-mail: windnwave@earthlink.net

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

ASSOCIATE POSITION - MICHIGAN 

Seeking high quality, RPR, PSR1, PSR2, or PSR3-trained associate for a fast-paced, established group practice in Southeast Michigan. This is a secure, long-term position. Emphasis on diabetic foot and wound care. Our outstanding staff allows you to concentrate on optimal patient care without the responsibilities of practice management. MUST have a Michigan license. Partnership possibility for the right individual. If you are highly motivated, ethical, and have good communication and clinical skills, please email your C.V. to mbell6@msn.com

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

PRACTICE FOR SALE - MAINE

20+ year, full scope, turn-key practice. Retiring seller will assist in transition. Excellent expansion potential, superb place to raise a family. mainefootdoc@yahoo.com

DREAM PRACTICE OPPORTUNITY - OKLAHOMA

Use forefoot, rearfoot, wound skills in ideal small city with nearby lake. No buy-in costs. No limit on income. EMR. Act fast. OK State License deadline is 1-30-10 and test is comprehensive. Personality preferred over ego. Email julietburk@gmail.com or call 918-931-1425 for details.

ASSOCIATE POSITION - FREDERICK, MD

Well-established and growing 2 office state-of-the-art practice located in medical/professional buildings. EMR, Digital X-ray, Ultrasound, DME provider, etc. Competitive Base Salary plus bonus, malpractice, health insurance, etc. PSR 24 minimum/Board Qualified or Certified with ability and desire to take ER call. If interested, forward CV to DOCSBNB@aol.com

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