The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

January 11, 2011 #4,060 Publisher-Barry Block, DPM, JD

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Most People Still Need Support Which Shoes Provide: CO Podiatrist    

The shoeless craze captivated the marathon crowd first, with books promoting barefoot running and even “shoes” that fit the foot — toes and all — like a glove. And now, the trend is stepping into the land of the rest of us — the walking crowd. Podiatrists aren’t thrilled with this celebration of shoelessness. People wear shoes, they say, because in modern society, we need them.

Dr. Brett Sachs

Few people have an ideal foot type that doesn’t require support, said Brett Sachs, a Wheat Ridge podiatrist. “Most people I see are the ones who have flat feet or high arches, or are getting other types of symptoms. This is related to the fact that patients don’t have the support their feet should provide them, and stress is getting redistributed to other parts of the body.”

Source: Douglas Brown, The Denver Post [1/6/11]

We’ve just posted the January 2011 CME titled:

By Peter Vannucchi, DPM

You can Earn 50 CPME-Approved CME Contact Hours Online

APMWA Announces 25th Annual Student Writing Competition

The American Podiatric Medical Writers Association has announced its 25th Annual Student Writing Competition.

• All papers MUST be non-technical in nature. Appropriate subjects include practice management, ethics,or any topic that would be suitable for a lay publication.
• There is no word limitation. Papers will be graded for content, style, grammar, neatness, and overall impact.
• First prize will be one thousand dollars ($1,000.00), sponsored by an APMA Educational Foundation endowment from Dr. and Mrs. Steven Berlin, and recognition in the APMA NEWS and the APMWA Newsletter. Honorable Mention Certificates may also be awarded.
• This competition is open to ANY enrolled podiatric student.
• Entries must be received by 4/1/11 via e-mail at bblock@podiatrym.com
• Entries become the property of APMWA, which may arrange publication of the entry.

MO Podiatrist Lectures in Germany

Dr. H.J. Visser, podiatrist, recently lectured at the 17th Lubeck Wet-Lab Seminar on Foot Surgery in Lubeck, Germany. Dr. Visser presented two lectures: Surgical Reconstruction of Cavus Foot Deformity and Diagnosis and Surgical Management of Tarsal Coalitions. The Wet-Lab Seminar was attended by more than 100 trauma and orthopedic surgeons throughout Germany and Europe. Dr. Visser  also served as surgical instructor. This involved performance of surgical procedures on cadaver specimens.

Dr. H. J. Visser

Dr. Visser has practiced in the Farmington area since 1979. He is on staff at Mineral Area Regional Medical Center in Farmington where he also serves as Podiatric Residency Director. He also currently serves as President of the State Board of Podiatric Medicine.

Source: Park Hills Daily Journal [1/8/11]

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky: Tell us about the education at Midwestern College of Podiatric Medicine. 

Dr. Stephen Barrett

 

Stephen Barrett: Their education is combined with the DO program. The podiatric medical students are a little bit hamstrung in the standpoint that in the first two years, they have to take all of the DO medical classes in addition to the podiatric classes. They actually have a bigger load than the medical students, but they are getting some really good training. The graduates who are coming out of the residencies now are just world-class, fantastic, and very bright. Compared to when I was at that level, there’s a world of difference.

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). The next segment  will feature a dermatology roundtable with Drs. Tracey Vlahovic, Marc Brenner, and Bryan Markinson. You can register for this event by clicking here

RE: Bunion in RA Patient (Mario Dickens, DPM)
From: Keith Gurnick, DPM, Roody Samimi, DPM

This patient appears to have a dorsally dislocated 2nd metatarsal phalangeal joint. Currently, the best procedure for long-term success would be a 1st MPJ fusion after a lateral release. After a fibular sesamoidectomy, the IM angle should come down nicely. Then, perform a distal 2nd metatarsal shortening osteotomy with extensor tendon lengthening and a dorsal capsulotomy at the 2nd MPJ, plus a hammertoe repair via arthroplasty and fusion at the PIPJ. If you can do a flexor tendon transfer dorsally, it will help to prevent a straight, but dorsally elevated second floating toe.

It is very challenging to maintain these 2nd toes in an anatomic down position. Inform and educate the patient that she could need additional or staged foot surgery later in life should synovitis and deformity of the lesser metatarsal phalangeal joints or hammertoes develop. This is likely due to the RA effects on her feet.

Keith Gurnick, DPM,  Los Angeles, CA,  keithgrnk@aol.com

Is this patient on prednisone, and if so, how much? If 5 mg or less daily, I would not hesitate to do as on any other patient; Reverdin-Green (PASA correction, with lengthening) vs lengthening Austin (may need plantarflexion, depending on lateral view) with a shortening osteotomy of the 2nd (i.e., Weil procedure). I would imagine there is a painful sub second met callus. Also consider (proximal) Akin in conjunction, if needed. Also, depending on flexibility, I would determine how aggressive I would be with a first interspace soft tissue release.

Roody Samimi, DPM, Cincinnati, OH, roody.samimi@gmail.com

RE: Chronic Verrucae (Michael J. Ryan, DPM)
From: Multiple Respondents

I have treated thousands of veruccae patients with a pulsed-dye laser. I own my own laser and treat these lesions every two weeks. I receive many referrals from podiatrists and dermatologists of patients they have given up on. Almost always, I am able to resolve the lesion if the patient is willing to stick with the program. You might consider finding  podiatrists or dermatologists who have their own pulsed-dye laser. Some doctors use a surgery center's unit, and they are only able to do one or two treatments, I find that is rarely successful. I do not bill the insurance company any differently than I do for a topical acid treatment, codes CPT 17110 or 17111.
 
Obviously, that is a very unusual verucca, and you have to rule out any systemic diseases that are making the verucca more resistant to treatment. You also might consider taking another biopsy or two  in various locations just to confirm it is a verucca. I have had two cases of veruccous carcinoma that were referred to my office as "resistant warts." If they look atypical or have been present and resistant to treatment for a significant period of time, I take one or more biopsies before starting pulsed-dye laser treatment.
 
Kenneth Meisler, DPM, NY, NY, kenmeisler@aol.com

After years of using a CO2 laser for verrucae and seeing more recurrences than I would like, I started using Aldara (Imiquimod) post-operatively, and it worked well. Then, I tried using Aldara with no laser and was getting some excellent results. We are told that the patient has to apply it q.d. for four months, but sometimes it would require a few months beyond  that.

Lloyd Nesbitt, DPM, Toronto, Canada, lloydn@rogers.com

The failure of this patient to elicit a resolution from the verrucoid infection reveals that he/she, no doubt, has an immuno-compromised state. This can lead to frustration on behalf of both the patient and physician at times. The size of the lesion presented is not amenable to surgical excision, laser ablation, or other single-stage curative procedure. One option may be staged partial excisions of the larger lesion after evaluation of the immunological state of the patient.

A resolution from a verrucoid infection is due to...

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

RE: Chronic  Verrucae (Michael J. Ryan, DPM)
From: Multiple Respondents

Since a biopsy has confirmed  this as a verruca, has excision been considered? A lesion of that size will require advanced closure such as VAC or adjacent tissue transfer.

Michael Piccarelli, DPM, Staten Island, NY, mcpdpm@verizon.net

Initially, a biopsy should be done to confirm it is a verruca, especially if it is present for greater than six months. In fact, any skin lesion not responding to your treatment within several weeks should be biopsied. Verrucae are great masqueraders, and you need to make sure it is not a  skin carcinoma.

There are many different viruses causing verrucae, and some are more recalcitrant than others. These patients need frequent follow-up and treatment. I have had great success (>90%) treating verrucae via 3x/weeks OTC liquid freeze, BID 17% or 24% liquid salacylic acid,  Carac cream (off-label - and I tell patients) or 5FU (also off-label), and 40% Mediplast. I see patients every 10 days to evaluate progress and patient compliance. Occasionally, you need to hypercate (biopsy before performing) or laser (biopsy before performing) the lesions.

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

Bleomycin injections, candida injections, cimetidine, sal acid - treatments in search of a cause. Before you go through all this treatment protocol, how about running a serum immuno electrophoresis to check the IGg ,IgM, and IgE's to see if this person has the immunoglobulin ability to fight this? What is the patient's total protein and immunglobuin (A/G) ratio? Something's wrong with the immune system. How about a white count with differential to evaluate the granulocytes to see why the patient is apparently compromised? Serum viral antibody screening would provide a window into the recalcitrant nature of this patient also.

Does this patient have phagocyte inhibition secondary to an early occult diabetic condition? What's the family history re: diabetes, immuno-deficiency, slow healing, etc. A tincture of science may be more helpful to the patient's long-term health than just clearing the verrucae, which may just be a dermatologic manifestation of an underlying systemic condition.

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

RE: Volunteering Abroad in the Summer (Rashad Sayeed)
From: Wenjay Sung, DPM, David L. Nielson, DPM

It's great to hear that you're interested in going abroad to serve and learn, especially this early in your career.  At Scholl, I documented our trip to Ghana as part of the International Federation of Medical Students Association. We were led by our team leader, Fui Dawson, a native of Ghana, and the rest of our team, Sarah Naglich, Susan King, and Brittany Crowhurst, sacrificed their summer (and a LOT of money) to serve the under-privileged in Ho, Ghana, (West Africa).

Luckily, I was able to convince our visionary dean at the time, Dr. Terence Albright, to allow my quick documentary to be in the admissions video on the Scholl website. I believe there are plenty of organizations that will take doctors overseas, but finding ones that will take students is tough. Here is the resource website that I used a number of years ago: ifmsa.org/. 

Wenjay Sung, DPM, Des Plaines, IL, wenjay.sung@gmail.com
 
1) IMVA.org has general information on all the volunteer positions around the world.
2) Ligainternational.org - Mexico weekend to 10-day trips
3) Docareintl.org - services Guatemala
4) Enapha.org - Ethiopia
 
A student from your school, Farrah Alani, just returned from Mexico with me. She got to see a lot of patients and perform surgery.

David L. Nielson, DPM, Roanoke, VA, pampantla@hotmail.com

RE: In-Office Fluoroscopy
From: Kathleen Neuhoff, DPM, DVM, Tip Sullivan, DPM 

I have used in-office flouroscopy in my podiatric office for 16 years. It has paid its way many times and has multiple uses. It allows me to place K-wires in digital fractures, perform guided joint aspirates or injection, perform exostectomies with minimal incision techniques, place X fixators percutaneously, etc. I cannot imagine functioning without it.

I also have an in-office diagnostic ultrasound. This was much more expensive than the flouroscope, but I happened to have a...

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

I am an avid proponent of multidimensional viewing of the foot! I guess that with standard x-rays, you can get multiple dimensions but in my experience, it is just not the same, it takes longer to get all the images. I agree with the use of standard weight-bearing images for planning standard and routine surgeries, but a functional radiographic view of the foot adds another dimension.

I have had a mini "C" arm which I've used daily in my office for >10 years. I am not sure if we get paid more or less for...

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

RE: Practice Fusion (Elliot Udell, DPM)
From: Charles Morelli, DPM, Joshua Kaye, DPM

My comments about Practice Fusion have generated a few e-mails from the company directly to me. It is only fair to them that I inform you of their comments, as it is not my intention to hurt any specific company with my comments that may be misunderstood.
 
Practice Fusion is currently certified as an EHR module, but they guarantee complete certification in early 2011 and their customers will be eligible for the incentive once completely certified.  A "Bridge" will not be required (according to them). The way they are able to provide the software for free is that they "run one ad at a time along the bottom of the EHR. The ads are targeted for medical professionals and never pop-up or interrupt the workflow. Support is also free and unlimited."
 
If you want a web-based program that is free, and if you don't mind having advertisements running along the bottom of your screen, then this program might be perfect for you.  
 
Charles Morelli, DPM, Mamaroneck, NY, Podiodoc@gmail.com

As Dr. Udell related, there is a good likelihood of the demise of at least some of the EMR companies. Many of these software companies are considered start-ups, and as such, their future will be dependent upon their future economic stability and funding. Would it not be a better choice to select an EMR company that allows for automatic back-ups, both in the clouds and on a personal office hard drive, rather than being burdened with the need to make paper copies of all the medical records? With paper records, you would then have the laborious task of re-inputing all the data into another EMR system. From an appropriate data back-up, that job would take a few minutes.
 
I can understand the attraction to Practice Fusion - it's free software. However, I suggest that "free" has its cost. Would you feel comfortable flying on an airplane knowing that it was built by the lowest bidder?

Joshua Kaye, DPM, Los Angeles, CA, jk@joshuakaye.com

ASSOCIATE POSITION - SOUTH CENTRAL PENNSYLVANIA

Eight-physician podiatry group with six locations in South Central Pennsylvania looking for a ninth full-time associate with a minimum of a three-year surgical residency and interest in future partnership. We offer a very busy, fast paced environment with an excellent support team. State-of-the-art practice with our own physical therapy department and surgical center. We offer a six figure salary with competitive bonus incentives, CME allowance, 401K, paid malpractice insurance, as well as established patient base. Persons interested in pursuing this opportunity, email CV to: MFATRANS@AOL.COM

ASSOCIATE POSITION – CENTRAL VIRGINIA

Immediate opening. Multi-office practice, completely automated, hospital and surgery center privileges available, ED call, full service foot and ankle practice. Competitive salary/incentive structure and full benefits. Investment opportunities include practice partnership and two surgery centers. Submit letter of interest and CV to Rex Wilson, Practice Administrator at www.silverjet21@hotmail.com

ASSOCIATE POSITION - WISCONSIN

Seeking a surgical podiatrist in Central Wisconsin. Great salary and benefits. Potential for partnership. Busy, well-balanced practice in a rapidly growing area. Email interest to ftsurg@yahoo.com or fax resume and cover letter to 715-241-8102.

ASSOCIATE POSITION - PHILADELPHIA, SOUTHERN NEW JERSEY 

  Seeking motivated, independent foot & ankle surgeon to join large practice. Our multi-office practice covers all aspects of foot and ankle pathology, including heavy hospital volume. Offering competitive salary and benefit package. Send CV and two references to bleich5252@yahoo.com

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 - TAMPA BAY AREA

Excellent opportunity to join a well established multi-office group practice in the Tampa Bay area starting July 1, 2011. We are seeking a hard working, ethical and outgoing physician with Florida license.  Salary commensurate with training plus benefits. Please email or fax CV. podiatryfl@yahoo.com 813-254-8262.

TEXAS- WONDERFUL OPPORTUNITY! 

Successful multi-office, multi-professional practice seeks well-trained new and established Podiatric Physicians with expertise in one of these areas: 1. Sports Medicine/Biomechanics/Gait Analysis, 2. Podopediatrics, 3. Diabetic Specialist, 4. Ankle & Rearfoot Surgery/Ankle Arthroscopy. A must to be really good in this niche, be outgoing, motivated, and personable with a dedicated hard working ethical desire to become successful. Send resume and letter of intent to sierrajip@gmail.com

ASSOCIATE POSITIONS – TEXAS

Looking for podiatrists to join group to work in nursing facilities in Texas (Ft. Worth, Dallas, and Houston) Please respond to: doconcall02@aol.com

ASSOCIATE POSITION - FLORIDA

Three physicians providing comprehensive podiatry services to Jacksonville, FL. Senior partner retiring after 37 years is seeking associate with 3-year residency trained in reconstructive foot and ankle surgery. Salaried position leading to buy-in. Send letter of interest and CV to padler@adlerpodiaty.com

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

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

BOSTON UNIVERSITY LIMB PRESERVATION FELLOWSHIP PROGRAM

Boston University Medical Center has a accredited fellowship position. Become an expert in Limb Preservation, Tissue Repair and Regeneration. Be part of this unique Fellowship at a major teaching facility. During this time, you would be expected to become a knowledgeable expert who will contribute significantly to research, surgical procedures, teaching, and innovation. Requirements: Completion of a two or three year surgical residency; Candidate must possess a commitment to an academic career in Podiatric Medicine and Surgery. Submit a CV and letter of interest to: Erin Springhetti erin.springhetti@bmc.org and Dr. Vickie Driver Vickie.driver@bmc.org or if questions call 617-414 6821.

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

PODIATRY PRACTICE FOR SALE - DENVER, COLORADO 

Turn-key operation with very low overhead in a multi-disciplinary office. Young patient population. Physician’s office building affiliated with a prestigious hospital. Very low buy-in/buyout. Expected transition of about two years. Perfect for family. Contact podpracsale@hotmail.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

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

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

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