The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

January 13, 2011 #4,062 Publisher-Barry Block, DPM, JD

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Wearing UGGs Without Socks Leads to Fungal Infections: NY Podiatrist

There's a fungus among us. And it could be growing in your favorite fuzzy pair of boots. UGGs, the trendy, flat-booted suede boots beloved by celebs and comfort-craving pedestrians alike make a happy home for fungus -- and can increase your chances of a getting fungal infection, especially if you wear the boots or their lower-priced knockoffs without socks.

Dr. Mitchell Greenbaum

A fungal infection can result from any shoe that doesn't "breathe," said Dr. Mitchell Greenbaum, chief of podiatry at St. Francis Hospital. He told the Daily News, "There are a lot of boots that create warmth but make your feet sweat." Without socks, there's nothing to absorb the sweat. "It can definitely be a breeding ground for fungus," said Greenbaum.

Source: Rosemary Black, New York Daily News [1/11/11]

Barry Student Named APMSA's Student of the Year  

The President’s Committee for the American Podiatric Medical Student Association (APMSA) named Barry University podiatry student, Annabelle Santos, APMSA Student of the Year and awarded her a $1,000 scholarship to use for her studies. The committee, comprised of student body presidents from the nine colleges of podiatric medicine across the nation, began their selection process by choosing nominees. These students were selected by their schools for exemplifying professionalism in medicine. Nominees also submitted an essay on the challenges faced by medical students. 

Annabelle Santos poses with associate professor Dr. Albert Armstrong, (L) Barry School of Podiatric Medicine dean Dr. Jeffery Jensen (M), and professor Dr. Sanjay Sesodia (R).

Santos' essay focused on the difficulty of balancing school and personal activities while striving to be well rounded and have a strong sense of self. Her impressive curriculum vitae as well as her long and distinguished list of achievements ultimately won Santos the honor of being named APMSA Student of the Year.

FL Podiatrist Participates in Neuropathy Association's Summit

Dr. Richard Mann a Delray Beach podiatrist, recently participated in the Neuropathy Association's Inaugural Neuropathy Summit in Washington, D.C. The Summit brought together an international array of some of the top researchers and clinicians in the field of peripheral neuropathy.

Ms. Tina Tockarshewsky, President and CEO,The Neuropathy Association with Dr. Richard Mann

"This conference was a great success. It provided a much needed forum for the exchange of new and innovative ideas about the etiology and treatment of peripheral neuropathy. The Summit allowed for the interaction of ideas among many disciplines, including basic science and clinical researchers, neurologists, immunologists, podiatrists, and other healthcare workers and policy makers. I am certain that this kind of interaction will increase our understanding of peripheral neuropathy and facilitate the implementation of new and effective treatments for this epidemic," said Mann.

Medical Residents Must Pay Social Security Taxes: Supreme Court 

The U.S. Supreme Court ruled that full-time medical residents should pay Social Security taxes because they are workers who happen to be studying, upholding Internal Revenue Service rules that have been in litigation since they were published in 2004. Mayo Clinic in Rochester, MN, lost the case.

The clinic had argued that the IRS regulations requiring students to pay Social Security taxes contradicted congressional intent to exempt full-time students from the Federal Insurance Contributions Act, or FICA. Mayo medical residents work between 50 and 80 hours a week and earn stipends of as much as $56,000 a year plus benefits. Mayo argued that residents have not yet begun their "working lives" because they are not fully trained.

Source: Joe Carlson, Modern Healthcare [1/11/11]

Query: Recurrent Neuroma Pain
 
I have a patient who had a neuroma removed from his right 3rd innerspace by another physician from a dorsal approach approximately two years ago. He continued to complain of pain and subsequently underwent a second procedure with a long hockey stick incision over the plantar aspect of the same foot by the same physician. He continues to have pain. He was treated with cortisone injections, a denatured alcohol series, and Neurontin, all with no relief. Does anyone have any suggestions on how to ablate or completely destroy the nerve, as he would prefer a numb area vs. the constant pain.
 
Randy Lisch, DPM, Austin, TX

Query: Phreesia

Does anyone use the free patient check-in software Phreesia? It looks interesting, as it verifies patients' insurance coverage and co-pays, and swipes credit cards. Any experiences with this service would be greatly appreciated.

Joe Gonzalez, DPM, East Lansing, MI

RE: Verruca Needling Technique (John Moglia, DPM)
From: Laurence Rogers, DPM

I have performed needling for verrucae for 30 years. My success rate is 95%, and I follow up on my patients to resolution. I have found that the larger the wart or the greater the number of verrucae, the greater the response to needling. The site(s) are blocked with 2% Xylocaine, 1:100,000 epi, and the verruca is debrided to the level of the good skin on each side of the wart. The site is scrubbed with Betadine scrub for 6-minutes and then I take a 20 gauge needle and pierce the wart to the level of the fat beneath the wart.

You puncture the wart(s) until most of the wart has been pierced. I apply povidine iodine ointment and any non-stick dressing and usually give them Fioricet for any post-op pain. I have been pleasantly surprised how little pain these patients have. They have pain for no more than two days. I see them weekly until the scab falls off; usually three weeks post-op. I prevent them from soaking their foot for the first week. 

Laurence Rogers, DPM, Rochester IN,larrydpm@rtcol.com

RE: Bunion in RA Patient (Mario Dickens, DPM)
From: Ken Jacoby, DPM , Gino Scartozzi, DPM

I feel that the patient would do well with a Keller bunionectomy and a partial second met head resection and possible joint resurfacing at the second MPJ. 

Ken Jacoby, DPM, Elgin IL, kenjacoby18@gmail.com

I read with a certain degree of discomfort some of the surgical recommendations for a 53 year old patient in an interim Stage I-II progression (based on radiographic assessments) of his rheumatoid arthritis with an incomplete history and limited x-ray view. I would like to offer a different perspective of surgical thought and concerns.

The limited history presented does not detail what medications that the patient currently is taking (ie, prednisone or other immunosuppresive therapies) that can impact post-operative healing. In addition, is the patient...

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

RE: Recalcitrant Verraca (Ken Meisler, DPM)
From: Jeffrey Kass, DPM, Simon Young, DPM

Dr. Meisler beat me to the punch as I was going to recommend pulse-dye treatments for this case, as the size of the lesion is rather large. From what I can make out in the photo, it appears that there is a lot of hyperkeratosis around the verrucae. If this is the case, I would make sure to debride and or use 50% urea in between visits, as I don't think the laser would be as effective penetrating the callus tissue as opposed to a direct hit to the verrucae. 
 
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

Verrucae reside in the epidermis, and your body doesn't recognize their existence. We know verrucae do affect immuno-compromised people, e.g.: HIV, RA with TNF, or people on prednisone. Verracae don't involve many diabetics or senior citizens. Recalcitrant verrucae involve normal healthy patients.

Understanding the immune status doesn't change our problem, which is treating a recalcitrant verruca, unless we can improve the patient's immune deficiency or status. Immuno-compromise is certainly a cause, but we must recognize that there are different viruses causing this problem, and some are more difficult to treat than others.

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

RE: Vibram Five Fingers Should Not be Marketed to Runners: CA Podiatrist
From: Multiple Respondents

A piece of factual trivia. While the controversy as to the efficacy and suitability of the Vibram Five Fingers concept for runners continues, interestingly, (and much to my surprise also) the Five Fingers shoe concept was designed originally in Italy as a rock climbing shoe - not as an aqua shoe as we thought. I spoke directly with the Italian designer from Vibram. Regardless, it was definitively not designed as a running shoe.

Mel Cheskin MBS, C.Ped, Boca Raton, FL, Melcheskin@aol.com

If Dr. Kirby gets his wish for Vibram Five Fingers shoes to be banned from being promoted to runners, there will be a lot of unhappy ones in Portland, Oregon, myself included. We are using them for running as they were intended, but we are doing it in a safe progressive manner, so that our feet can get strong enough to function naturally, without the over-structuring and over-cushioning of conventional running shoes. And, we are succeeding.

Dr. Kirby misinformed the listserve when he stated, “The Vibram Five Fingers are boat shoes, they were never meant for running…” Please visit the website of the company for yourself...   

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

I couldn't agree more with Dr. Kirby's comments regarding the correlation between stress fractures and "minimal" running shoes. This is despite the ridiculous assertions I've read on  Internet forums dedicated to running. They blame stress fractures on everything from "improper training that results in poor forefoot strike" to "minimalist shoes reducing the foot's ability to perceive the ground" and they suggest total barefoot running.

Even in PM News there has been discussion on...

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

RE: EHR Recommendations
From: Marc Garfield, DPM

Saying that your system cost $600 month is like saying your airline ticket cost $600. How much are the baggage fees, parking costs, and peanuts? If individuals are going to post reviews and costs for their EHR, I would like to suggest the following:

1. List or explain if your costs cover two-way or one-way lab connectivity, eRX, eRx with formulary, patient portal, document management services and any other “modules” that might carry a surcharge.

2. If possible, separate the...

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

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

ASSOCIATE WANTED - CENTRAL FLORIDA

Well-established Multi-practice Central Florida Office is seeking an associate. Look for a personable, energetic individual who is self-motivated and conscientious. We offer a Competitive salary with full complement of benefits. Excellent opportunity for a promising future. Please submit CV to cmedders@atlanticpodiatry.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

Board certified podiatrist (ABPS, ABPOPPM) 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

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

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 - 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

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

EQUIPMENT FOR SALE - MICROVAS UNITS

Two lightly-used microvas units , 16-lead machines (included) , $7,000 each or best offer for both. Great therapy modality: edema, neuropathy pain, increases peripheral flow, increase soft tissue healing. Great practice from vascular surgeons sending patients for treatment, pays for itself. Unit comes with the charger and 16 leads. jhalvorsen@familyfootandlegcenter.com 

EQUIPMENT FOR SALE - COOL TOUCH LASER 

Cool Breeze Cool Touch CT3 plus laser used for fungus toe nail infections Less than six months old. Great price won't last  long. Considering a laser? This laser is perfect for you. E-mail footcare@comcast.net

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- 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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