The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

January 06, 2011 #4,056 Publisher-Barry Block, DPM, JD

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CA Podiatrist Receives Milton Wolfson Award

Dr. Marc A. Benard, Executive Director of the American Board of Podiatric Orthopedics and Primary Podiatric Medicine (ABPOPPM) recently received the Milton Wolfson Award from the California School of Podiatric Medicine. This award is presented to an alumnus who has contributed to the profession of podiatric medicine.

Dr. Marc Benard

Benard, a 1977 graduate of CCPM, has spent a good portion of his career training podiatric residents and colleagues at the Baja Project for Crippled Children, and has distinguished himself through regional and national lecturing in the areas of podopediatrics and biomechanics.   

Source: ABPOPPM Fall 2010 Newsletter

WV Podiatrist Hopes that New Office Will Revitalize Town

A local doctor hopes that his new podiatry office will help kick-start revitalization in the city. Dr. Joseph Goodwin - who lives in Wheeling with his wife, Amy, and their five children - treats ailments of the foot and ankle via medicine and surgery. He hopes construction of his 3,200-square-foot building will lead others to invest in South Wheeling and the city as a whole.

Dr. Joseph Goodwin

Construction of his center began this past spring, about the same time work on a new housing development started across the street. "It has been fun. This is the first building I've built for myself that's new. It's like having another child," Goodwin said. "The people are very friendly here. They kept an eye on the property. It went really well," Goodwin said of the construction. "Hopefully it will start the revitalization of the area - and get some new businesses down here and get Wheeling going again."

Source: Shelloy Hanson, Wheeling News-Register [12/30/10]

OH Podiatrist Won't Run For Cincinnati Seat, But Won't Rule Out Mayoral Bid in 2013

Brad Wenstrup, a podiatrist who catapulted into the Republican limelight when he made a failed bid for mayor in 2009, has decided against running for Chris Monzel’s council seat. He said that was his choice. Wenstrup knows his name was bandied about as a possible replacement, and even told The Enquirer election night that he was interested in discussing the idea with party leaders. “I haven’t done anything since that night,” Wenstrup said Monday.

Dr. Ben Wenstrup

In the end, the council job would have distracted him for his current work, he said. He’s a busy guy: He’s on the Cincinnati Board of Health, a three-year commitment; the director of Podiatric Surgical Residency at Christ Hospital; and still has military duty. He’s a Major in the United States Army Reserve Medical Service Corps. “I feel engaged in public policy right now,” Wenstrup said. “We’ll see what the future brings, but I’m pretty content. So does that mean he’ll run for mayor again in 2013? “A mayoral run is a possibility,” he said. “I can’t say what I’ll be thinking in a year.”

Source: Cincinnati.com [1/3/11]

Increase Your Website Google Ranking with External Links

Search engine optimization experts agree that link popularity is considered by most search engines to be one of, if not, the most important factors that determines a site's ranking in search engines. Since your draw for new patients, for the most part, is geographically dependent upon a 20-mile radius of your office, focus your efforts on exchanging links with your network of referring medical practioners in your area. Offer to put a link to their website on your site in exchange for their doing the same for you.

Expand your efforts to other organizations or businesses that may have some connection or relevance to your practice such as a medical supply company or non-profit charity. Also, consider writing a series of articles on "Good Foot Health" that can be posted to the websites of your local newspapers in exchange for a link back to your website. Another effective means of increasing your link popularity is by uploading your videos to Youtube which allows you to post a link to your website within the description box.

Source: Gary Ignotofsky

Query: Recalcitrant Heel Pain

The attached MRI images are of a 40 y/o F  (5'8" 170lb.). She started jogging two weeks ago. Recalcitrant heel pain continued after classic treatment for plantar fasciitis. There was even pain in a BK boot and pain on medial to lateral compression of the calcaneus. X-rays were negative. Given this info, the radiologists read the MRI as "small bone bruise plantar calcaneus with findings of plantar fasciitis." That is not what I see. The T1 images are very difficult to see, but the fat SAT and STIR images show pathological findings. Tc99 would show up "hot" on a plantar bone bruise just as it does with a case of fasciitis.

MRI of Patient with Recalcitrant Heel Pain

I don't know if a calcaneal stress fracture or stress reaction could easily be differentiated from a small bone bruise on a standard Tc99. Even if, with much scrutiny, one might be able to differentiate a bone bruise from a stress Fx/Rx, is it worth doing, given the MRI scans seen here regardless of the radiology read?  I will send the radiologist a more complete history and LEPE, and I will even cite the images and views where I see the problem. I wonder what approach others would take?

Tip Sullivan, DPM, Jackson, MS

Query: Ultrasound Courses?

Is anyone aware of any ultrasound courses focusing on the foot and ankle?
 
Brian Kiel, DPM, Memphis, TN

RE: Achilles Procedure With Distal Incision (Daniel Chaskin, DPM)
From: Dan Michaels, DPM

Make your incision at talar level over midline of Achilles tendon.  Dissect to tendon, and make a linear incision. Use a meniscotome (used for knees) to insert into the Achilles tendon distally at the level of the talus. Use this to incise the tendon up through the watershed region, dividing the tendon in a medial half and a lateral half. Then it is easy to make a proximal incision and cut half of the tendon medially, and the other half laterally distally.

If you can't make the proximal incision, then you can use an arthroscopic 90 degree knife to cut 1/2 the tendon proximally through your distal incision to complete your z lengthening. You would be going proximal to the talus, but the work would be under the skin, so no incision would be proximal to the talus.

Dan Michaels, DPM, Frederick, MD,  danieldm@pol.net

RE: Undiagnosed Diffuse Skin Lesions (Simon Young, DPM)
From: Robert Bijak, DPM, Joe Agostinelli, DPM

I can't let Dr. Young's statement stand that most of the biopsies we do, do NOT show pathology! What is he biopsing? Even a verruca is pathologic. And, even a general dermatitis will show some pathology of the skin. Perhaps, I'm just not getting his irony. If the insurance carriers read and believe his first sentence, watch how fast we lose the privilege of biopsying! Furthermore, to think that mailing a picture to the pathologist, who amends a potentially pathologic finding based on a clinical photograph, is incredulous at best.. I'd like to be the plaintiff's attorney on that case.

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

Thanks for all the comments on my interesting case. The esophageal mass turned out to be a stricture! The keratotic lesions were verrucous. The other skin lesions were severe tinea corporis. Sometimes you have to look for horses, not zebras.

Our first impressions and the impressions of the PCP and hospital physicians were correct. Three of us were about the same age and had the same amount of total medical experiences. Our youngest consultant, the dermatologist, had suggested some of the rare but plausible differentials that PM News readers commented on.

Joe Agostinelli, DPM, Destin, FL, jmpa21@cox.net

RE: Concrete Floors and Plantar Fasciitis (Name Withheld)
From: Jon Purdy, DPM, Robert Scott Steinberg, DPM

I know of no compelling study that makes any conclusion of working on concrete floors to be the sole cause of any condition in the foot other than direct trauma. There are far too many variables to offer a direct link to a chronic pathologic condition. Factors such as foot type, shoe type, body weight, and a myriad of others, make this a tough cause and effect scenario. 

I do not support a diagnosis of plantar fasciitis as a worker’s comp claim. I’m not saying a practitioner would be wrong in doing so - I just can’t support it.

Jon Purdy, DPM, New Iberia, LA, podiatrist@mindspring.com

It might just be me, but are lawyers getting more desparate?  Now for other causitive factors: "Stupid" shoes, overweight, underweight, lack of stretching, using her feet to get to work, and other lifestyle issues. Things she did to her feet 25 years ago. If the interface between the floor and the foot is the shoe, then the problem is not the floor material.

Robert Scott Steinberg, DPM, Schaumburg, IL, doc@FootSportsDoc.com

RE: Contact Management Software (Ken Meisler, DPM)
From: Charles Morelli, DPM, Dave Rizzo, DPM

Simply open up a Google Gmail account. Its free and they have a fully integrated "contact" list that can be accessed anytime, anywhere, from as many workstations as you like.  And if you have a Verizon wireless smart phone, all of that information will automatically be in the palm of your hand. Oh, did I mention It's free?
 
Charles Morelli, DPM, Mamaroneck, NY, podiodoc@gmail.com

Check out ACT. Sage is the value-added reseller that handles it (ACT.com). I'm not sure how many work stations it will support, but I have used it on and off for 15 years, and have been pretty pleased with it.

Dave Rizzo, DPM, Torrance, CA, droadmap@pacbell.net

RE: Practice Fusion (Steven Frydman, DPM)
From: Craig Aaronson, DPM, Charles Morelli, DPM

My office has converted from paper charts to Practice Fusion over the past 3 months. The company can offer its EMR free by capitalizing on (non-intrusive) banner ads, and by massive volume (similar to Google or Mapquest).  The program is fairly intuitive to use, easy to customize, and simple to learn. A training video is offered on their site (also free), and is very user-friendly. There is a time and hardware commitment needed, but the government incentives to convert to EMR make it a huge financial gain. So far, the staff at Practice Fusion is extremely helpful and easy to reach.

I am phasing in the Practice Fusion system in segments;  1.  Converting all patient demographics, history, and scheduled visits into PF. 2. Putting all new progress notes and initial patient encounters in PF. 3.Initiating the free electronic prescription writing in PF. 4. Adding all labs to PF so the results are received electronically. 5. Scanning all "other" documents into the electronic charts (e.g., MRI's, bone scans, photos, ultrasounds, referrals, etc.)

At this time, I still dictate my initial patient encounters and use my transcriptionist  to transcribe directly into PF which immediately appears on my computer screen for my e-signature.  Follow-up visits are much faster and cheaper for me to chart myself. So far, the transition has gone smoothly. I highly recommend Practice Fusion.

Craig Aaronson, DPM, Fresno, CA, aafoot@comcast.net  

In all of the discussion surrounding Practice Fusion, you all have forgotten to mention one important thing -according to the ONC website, they are only modular certified, and for one-half of the total modules needed for meaningful use. This means that you will NOT qualify for meaningful use and you will not see one dime of the $44,000. I wrote at length last month regarding Internet-based companies vs. program-based, not to mention the bridging programming software you are going to need if you have a modular system. Why?  Because all parts of a program that are required for meaningful use need to integrate with each other; otherwise, you don't meet the standards that have been set.
 
I have no financial or vested interest in ICS software, but the one thing they offer is a complete system, all under one umbrella. There are others out there, and you should look at those too.  In a few weeks, they will all be on display at the New York Cinical Conference where you can do side-by-side analysis. But this is one time where trying to save a few dollars here and there could be counter-productive. Remember, you're going to receive $44,000.00 if you do it right. If you don't, you get NOTHING.
 
Charles Morelli, DPM, Mamaroneck, NY, podiodoc@gmail.com

RE: Digital X-Rays
From: Philip E. Larkins, DPM

I disagree with obtaining digital x-rays in an office. Digital x-ray technology does not produce the same type of image that an analog film produces. Does anyone remember the old tomogram technology? No, not CT. This was an image that was analog x-ray but added a "3-D" component to the image. Ask any digital technology salesperson about the nitty gritty, and if they don't tell you, they are lying or they don't know the truth. The truth is, those "trabeculae" that you see on the digital image are not real for the most part. They are computer-generated. The limiting factor in digital x-ray technology is the pixilation of the x-ray beam. There is currently only so much pixilation that can be done. The rest, in between the pixels, is "fudged" by the computer. 

The computer program gives a "well-polished" image that it thinks will make the viewer happy. I agree, it is cool to and handy to have digital x-ray technology and all the benefits that go along with it, but the technology as it is, should never be thought of as having replaced analog images, as if analog was something wrong or broken.  Analog x-ray is the true WYSIWYG. So, if you think your analog x-rays are poor quality, buy better screens, developers, x-ray generators, and hire an x-ray certified technician. I guarantee you that the images will be superior to digital in diagnostics. It is too bad that the radiology world has gone digital; much will be lost in the future.
 
Philip E. Larkins, DPM, Escondido, CA, larko33139@yahoo.com

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION - DAYTON, OHIO

Join a well-established modern practice with an excellent reputation and referral base. Base salary $100,000 and benefits with a bonus structure. EMR, diagnostic ultrasound, all aspects of DME, Padnet vascular studies, and CO2 lasers. We seek a surgeon that is well trained, personable and motivated to join our group of 3 Podiatric Surgeons. Would like this individual to buy in the practice eventually. Please send resume to ohiodoctors@aol.com
 
ASSOCIATE POSITION - SOUTHWEST FLORIDA

Immediate opening. Well-established podiatric group in Southwest Florida. Multi-office practice with EMR, Digital x-ray, Ultrasound and more. Seeking full-time associate that is PM and S-36 trained, personable, independent and highly motivated. Must be BC/BS in rearfoot and ankle with confidence in complex reconstructive cases. Full benefits package, competitive salary, excellent lifestyle. Email CV to: JLH459@aol.com

PART-TIME/FULL-TIME PODIATRIST NEEDED - INDIANA

Part-time full-time Podiatrist needed for our Indiana offices. Must have Indiana license. Must have completed two years of surgical residency. If qualified email to f-massuda@footexperts.com

ASSOCIATE  POSITION - SOUTHEAST FLORIDA

Southeast Florida practice seeks PMS-36 graduate for associate position. Candidate should posses strong work ethic, motivation and excellent interpersonal skills. He/She should be comfortable in multiple clinical settings and all aspects of foot and ankle surgery. Competitive salary, benefits, incentive structure.
Reply to petaldaisy@gmail.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. Applications due by Jan 31st.

ASSOCIATE POSITION - BOSTON

CPME Board certified podiatrist wanted to join Orthopedic & Arthritis Center at Brigham & Women’s Hospital, Boston, MA. The position is per diem, 2 days/ week. Interested candidates should send their CV to: Brenda Surowiec, Orthopedic & Arthritis Center, 75 Francis Street, Boston, MA 02115. Or email to bsurowiec@partners.org

ASSOCIATE POSITION - NEW YORK CITY
 
One of the fastest growing podiatry practices in New York City and Queens seeks a podiatrist who participates with HealthFirst, Fidelis, and other Medicaid plans. Preferably a Spanish speaking podiatrist. Contact me at Podocare@aol.com

PART-TIME / FULL-TIME PODIATRIST NEEDED ASAP - CHICAGO

Part-time podiatrist needed for 2 offices in Chicago with an average of 20 hours/week. Must have Illinois license. Must have completed 2 years of surgical residency. If qualified, email to: A-Storjohann@footexperts.com

ASSOCIATE POSITION - CHICAGO

Weil Foot & Ankle Institute, Des Plaines, IL (www.weil4feet.com) is seeking associate position in summer 2011. This 15 member podiatric medical and surgical group is internationally acclaimed. Twelve locations throughout Chicagoland, with a 3 operating room surgery center, MRI’s, computerized footprint analysis, orthotic and brace laboratory, radiofrequency coblation technology, extracorporeal shockwave devices, PRP and clinical research program. Successful candidate will have completed a 3-year residency, experience in wound care, trauma, and sports medicine. Competitive salary, bonuses commensurate with experience and training. E-mail letter of interest and CV to Harriet Kass, HR, hkass@weil4feet.com 847-390-7666

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Douglas Richie, DPM is seeking a well-trained, motivated podiatric physician to join his two office practice located in North Orange County, California. Applicants must have completed a 3-year residency program and must have exceptional skills in reconstructive foot and ankle surgery, sports medicine and podiatric biomechanics. This is a salaried position with a goal of long-term buy-in for equity ownership. Send letter of interest and CV to drichiejr@aol.com

PRACTICE FOR SALE- SOUTHERN CALIFORNIA

An extremely well-run, paperless  office on sale.  Owner moving out of state due to family reasons. State-of-art EMR system, trained staff. Office across from main hospital. From 2005-2009, average gross was ~500 K with potential of grossing a lot higher. For more details contact: podiatry-practice4sale@hotmail.com

PRACTICE FOR SALE- MARYLAND, DC SUBURBS 

Be an owner not a worker. Well established and equipped practice for sale. Office includes state licensed Ambulatory Surgical Center. Present owner is retiring but will stay on as needed for smooth transition. Average gross over past 3 years is $575 K. dpmpracticeforsale@yahoo.com

PM News Classified Ads Reach over 12,500 DPM's and Students

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