The Voice of Podiatrists

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January 11, 2008 #3,138 Editor-Barry Block, DPM, JD

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Diabetics Must Check Feet and Shoes Daily: TN Podiatrist

Wearing good-fitting shoes is an important "step to take" to maintain healthy feet. This is especially true for persons who suffer from diabetes, says Dr. Melissa Gaffney, a foot specialist who is now practicing in Greeneville. Dr. Gaffney is a podiatrist with the East Tennessee State University (ETSU) Foot and Ankle Clinic, which is part of ETSU Physicians and Associates. On Friday, Dr. Gaffney was the guest speaker at this month's "Time Out For Your Health" lecture sponsored by Takoma Regional Hospital.

Dr. Melissa Gaffney

During her talk, the podiatrist focused on steps that persons with diabetes should take to protect their feet from potential complications that can occur due to elevated blood sugar levels. Unless it is properly controlled, the elevated blood sugar levels associated with diabetes can cause numerous health complications. Among those, Dr. Gaffney said, are problems with the feet.

"Make sure you check your feet every day," she said. "Don't hold off seeing a doctor if you think there is a problem," she said. "With diabetics, problems with the feet can get worse - fast." One of the keys to preventing feet problems from occurring is to wear proper-fitting shoes, Dr. Gaffney said. "If you have (diabetic) neuropathy, you should shake your shoes before you put them on and make sure there is nothing inside them," she said.

Source: Lisa Warren, Greeneville Sun, [1/7/08]

D.C. Measure Means Licensing of Drug Reps

After stripping the legislation of its prescription data-mining prohibitions, the District of Columbia Council voted 7-6 to approve the SafeRx Act of 2007, which mirrored the preliminary vote the bill received on first reading Dec. 11.

The bill would still require the licensing of drug company sales representatives, commonly known as “detailers,” and subject them to fines or loss of their license for knowingly providing false information about their products. “Detailers have come to play a huge role in our healthcare system, and it is time to start treating them as healthcare providers,” said the bill's sponsor, Councilman David Catania, in a news release.

Originally, the legislation also called for making it illegal to use, sell, transfer, license or exchange for value any prescription information that identifies a patient or prescriber without the prescriber’s consent. Lee Christy, a staff assistant for the council's committee on health, said that provision was stricken from the final version of the bill "for cautionary reasons" as similar legislation passed by Maine and New Hampshire has been the subject of lawsuits. In fact, the 1st Circuit of the U.S. Court of Appeals will begin hearings today in Boston in a case involving the New Hampshire law.

Source: Andis Robeznieks, Modern Healthcare [1/9/08]

Query: Windswept Toe Deformity

A 54 y/o presented with what appears to be a fairly stable foot except at the lesser MTPJ’s. Radiographic evidence (weight bearing)- is as follows: calcaneal inclination-26, talar declination-21, anterior break in cyma line, Met adductus-16, IM-13, HA-13, cuboid abduction-7, mild/mod medial subluxation at lesser MTPJ 2>3>4 with the 2nd digit overlapping first (reducible).

Biomechanically: there is mild/trace genu varum, max pro STJ in static stance with inverted heel, no significant equinus, resupinatation, appropriately in gait. The mid tarsal joint locks in STJ inversion, and there is ear foot varus with an accommodative forefoot valgus, Push-up test on lesser 2,3,4 MTPJ results in medial deviation easily reducible, non-weight-bearing active flexion by the patient results in increase in digital deformity. Total ROM of rear foot, mid foot and forefoot is basically normal.

This gentleman’s cc: is the painful overlapping second toe in his cowboy boots. I have found this deformity to be an interesting and challenging problem from a surgical, as well as biomechanical standpoint. and hope someone can suggest something different to help decide procedures and post-operative functional control tips.

Tip Sullivan, DPM, Jackson, MS

RE: Prescribing Systemic Drugs (Elliott Udell, DPM, James DiResta, DPM)
From: Simon Young, DPM, Sloan Gordon, DPM

I reviewed the responses of Dr. Udell and Dr. DiResta and tend to agree with Dr. Udell. In reality, it's what your state ed. dep't and state laws that determine what you can and can't do. Neither of these positions has been challenged legally. This further reinforces the need to standardize our post-graduate education and consider conversion to an MD degree.

Simon Young, DPM, NY, NY, Simonyoung@juno.com

I don't agree with the response from Dr. Udell regarding the calcium blocker, nifedipine. In fact, nifedipine does lower blood pressure and so is a systemic treatment, whether he believes the PDR or not. I believe it's fine to use if for Reynauds phenomena once the diagnosis is properly established.

I disagree with the use of the word "scope". I believe when a patient is referred to a podiatrist, e.g. by family practice or internal medicine, the DPM is charged with the duty of taking care of the patient. In the instance of chronic gout, I see nothing wrong with prescribing a uricosuric drug, e.g. allopurinol or probenecid. In fact, I prescribe both and often with small doses of colchicine. Colchicine is a systemic drug that affects the renal system as well as the manifestations of podagra, by the way. My point is that we often treat the pedal manifestations of disease while simultaneously treating a systemic ailment.

The use of insulin is certainly another story. In many states, Insulin is an over-the-counter drug and one simply asks the pharmacist for it, while they may require a prescription for the syringes and/or needed used to administer the drug.

We as DPM's use many systemic drugs with many adverse reactions and I believe as long as we are well-trained and know what we are doing with those medications we are within our practice to do so. When you order IV Cefazolin pre-op you are ordering a systemic drug and some of us do this every day. My advice is do what you are trained for and do the best job for the patient. If you are unsure of a drug to use, call someone who is familiar or refer.

Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net

RE: OCPM’s New Facility
From: Hal Ornstein, DPM

I had the great pleasure of visiting the new home of the Ohio College of Podiatric Medicine (OCPM) this week to speak with the students. As a graduate of OCPM Class of 1987, I was beaming with pride getting a tour of the new facilities. The layout of the school is remarkable, with top technology to help the students maximize their education and the décor is beautiful. This Is another feather in the cap for our profession in the eyes of premed advisors, the allopathic medical world and the community-at-large. I implore all to visit OCPM if you are in the Cleveland area. Congratulations to all who worked to make this a reality.

Hal Ornstein, DPM, Howell, NJ, toetoe@optonline.com

PART-TIME PRACTICE FOR SALE - FLUSHING, NY

40 year old part time practice for sale. Priced for quick sale. Please contact me at footdoc60@gmail.com. Serious inquires only, please

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-TO-PARTNERSHIP OPPORTUNITY NEW HAMPSHIRE

Established practice located 1 hour north of Boston in tax-free New Hampshire is seeking a well-trained graduate of a 24-month surgical/general podiatry residency. This is a practice with a nice mix of surgery, biomechanics, injuries, diabetic and general care. No nursing homes. Very modern office with EMR, US, excellent referral base, and a well-trained staff. E-mail inquiries howardbon@aol.com

ALTERNATIVE PATHWAY TO BOARD CERTIFICATION PETITION

I am seeking to gather the names of my fellow podiatrists who are being denied the opportunity to sit for the board certification exams and would like to join my efforts to petition our leadership for a fair alternative within the system. To join this effort, please email your name and contact information podiatrydoc@gmail.com

Outcome Medical, (see our ad in Podiatry Management) is looking for reps to call on podiatrists and primary care physicians to market our pain program. Our FDA-cleared technology for pain and circulation is currently used by hospitals and doctors throughout the country. We provide training and technical support. On staff, certified billing, coding, and compliance specialist. Attractive commissions and leads furnished Website, www.outcomemedical.com. Request our representative package by email @ don@outcomemedical.com phone, 770-487-0029; Fax 770-692-0116

PRACTICES FOR CANADA - CANADA

2 DPM practices for sale in metro Vancouver and the Fraser Valley in beautiful BC. Both are well established with healthy client bases over a 30 year practice and can be sold separately. Gross revenues are $190.K and $100.K respectfully with an average net profit of 8% with great potential for increases. Priced at $199,000 & $99,000 to a graduate of any of the 8 USA colleges for approval by local licensing requirements. Contact pearsonhome@telus.net or by phone 1-604-986-0809 or fax: 604-986-0870.

ASSOCIATE POSITION - VIRGINIA

Multi-office practice, EMR, digital x-rays, sonography. Great opportunity for hard-working, personable new or established surgeon. Hospital and surgery center privileges available. ABPS eligible/certified. Full scope of foot & ankle care. Base salary, immediate percentage, and benefits. E-mail letter of introduction, CV and photo to practice administrator at: mtrevor41@yahoo.com

MANUFACTURING ORTHOTICS BUSINESS FOR SALE - CANADA

In Vancouver BC with a average client base of 40 with potential to increase to over 60 clients by calling on MD, ND & Chiropractor practices. Gross revenue averages $230.K over the past 2 years with a 5% net profit after taking a management fee of $12,000. Owner is retiring and will sell for $185,000. Contact Milt at marketime@telus.net or tel: 888-359-2202 fax: 888-303-0017.

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com -- www.homephysicians.com

PRACTICE FOR SALE - SOUTH CAROLINA

Upstate SC practice of 25 years. Retiring. High volume, high grossing. 60% routine foot care, 40% surgery. Several nursing homes. Plenty of opportunity for growth. Hospital and Surgery Center privileges. Financials available upon request. Serious inquiries only! Beautiful area. Contact: Carolinafootdoctor@yahoo.com

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City . Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

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