The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

January 15, 2011 #4,064 Publisher-Barry Block, DPM, JD

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Onychomycosis Affects 6 to 8% of the Adult Population: FL Podiatrist

About 6 percent to 8 percent of American adults battle toenail fungus, a stubborn condition that causes discoloration, cracking and thickening of the toenails – and in some cases, loss of the toenail. And people will do just about anything to get rid of it. "I've had patients tell me they've tried bleach, Listerine, Vick's VapoRub … just about anything to get rid of nail fungus," Tampa Bay podiatrist Dr. Stephen Levin says. "I don't recommend any of those things."

Dr. Stephen Levin

Fungus can enter the nail through trauma. It can spread through the use of wet towels, walking on contaminated surfaces, improper foot hygiene and pedicures. And it can lead to serious infections for people with diabetes and immune disorders, Levin says. "(Nail fungus) is opportunistic and likes dark, moist environments," Levin says. "Over time, it travels into the nail, and attaches to the nail, and lives and eats the nail. Anybody can get it. I see teenagers who have it. And it's very hard to kill, because the infection is embedded within the nail."

Source: Cloe Cabrera, The Tampa Tribune [1/13/11]

Midwestern Professor Studies Effects of Rocker-Bottom Shoes

Soon, podiatrist Dr. Kelley Gillroy, a professor at Midwestern University's Glendale campus, expects to be better able to answer patients' questions about the specialty footwear. She's leading a study to assess the effects of MBT-brand shoes on chronic plantar fasciitis. "I have a lot of patients who really like (various brands of) the toning shoes," Gillroy says, "and a lot who have asked me about them." Not having worn them, she examined the manufacturers' claims, including that the shoes engage muscles in the legs, burn extra calories, and help tone the butt - "fair claims," Gillroy says.

Dr. Kelley Gillroy

The rocker-bottom soles, for example, keep wearers at midstance a little longer, engaging deeper musculature in the lower legs. She says podiatrists long have recommended early versions of today's toning shoes to improve the gait of patients with foot ailments. "But I wouldn't recommend them for patients with acute tendinitis, balance problems, or a history of ankle sprains," Gillroy says.

Source: Connie Midey, Arizona Republic [1/13/11]

Barry Dean Elected NAP Distinguished Practitioner

Dr. John Nelson, professor and dean of clinics at Barry University’s School of Podiatric Medicine, has been elected to the National Academies of Practice (NAP) as a Distinguished Practitioner in Podiatric Medicine. NAP is an organization of distinguished practitioners representing 10 different healthcare professions, working together to advance delivery of healthcare. The NAP recognition is awarded to inductees who have been judged by their peers and have made enduring contributions in their profession. Nelson will receive the award on May 25, 2011 in Arlington, Virginia.

Dr. John Nelson

Nelson achieved this recognition in part for his 22 years of professional service in the practice and direct delivery of podiatric care. His patients include those at Barry’s four University Foot and Ankle Institutes in which he serves as clinical dean, as well as in the five affiliated teaching hospitals in Miami-Dade County where he directs the clinical training of podiatric medical students.

Retired CA Podiatrist Finds Volunteer Police Work Rewarding

 Volunteers in Police Service -- VIPS -- receive training, wear a uniform, drive a specially marked car and learn to operate the police radio and mobile computer. Benicia, CA has 11 VIPS on patrol, seven in clerical positions and the remainder serve as chaplains, mentors and explorers (a youth-oriented category). Retired podiatrist, Dr. Ron "Doc" Uhlman says Benicia VIPS has been a rewarding experience for him because he can contribute to the safety of the community.

"I enjoy learning something new, and the work is interesting. We get to respond to emergencies and relieve the regular patrol officers so they can do something other than stand by a road for a couple of hours," he said. "When we first started with the department, I think the officers were concerned we would cause more troubles. Now they rely on us quite heavily."

Source: Dana Guzzetti, Contra Costa Times [1/4/11]

Four in 10 Docs Plan to Seek EHR Money

Forty-one percent of physicians plan to seek federal incentive payments for the meaningful use of electronic health-record systems, according to a National Center for Health Statistics survey.

HHS cited the survey, which was conducted between April and July 2010, in a news release issued in advance of a briefing by Dr. David Blumenthal, head of HHS' Office of the National Coordinator for Health Information Technology, on EHR use. The survey also noted that not quite one-third (32.4%) of office-based physicians reported that they planned to seek EHR reimbursements during the Stage 1 period of meaningful use, which began Jan. 1 for physicians and other "eligible providers" and will run through 2012.

Source: Joseph Conn, modernphysician.com [1/13/11]

Dramatically Increase the Effectiveness of Your Website Through Lead Capture

One of the most significant shortcomings of many websites is that they lack a mechanism to capture the contact info of people who visit the site that do not submit a "contact us" or "appointment request" form. No matter how much time and effort you put into the design and search engine optimization of your website, you can only expect a very small percent of visitors to contact you after visiting your site (usually less than 2%). Most visitors will only check out your website that one time and never return.

You can dramatically increase your ability to capture prospective patient contact info by offering valuable footcare information for free, in the form of a downloadable ebook or an actual book that is mailed out. This book or ebook could be a general footcare overview or about a specific footcare topic. In exchange for the free info, the prospective patient is required to submit their contact info which will allow you to assemble a database of "warm leads" to be used to for future email campaigns. Be sure to place a promotional graphic on your homepage that links to a submit form that will allow you to capture prospective patient contact info. You can super-charge a call-to-action for your ebook/book giveaway by producing a 30-second video promo with your personal endorsement.  

Source: Gary Ignotofsky

Query: Coding a Winograd Procedure

What is the best way to code a Winograd procedure on both great toes, all borders, to eliminate 'inclusive' deductions?

Edward Nieuwenhuis, DPM, Wyckoff, NJ
 
Response: A Winograd is a matrixectomy technique. The performance would be coded CPT 11750 (excision of nail and nail matrix, partial or complete, [e.g., ingrown or deformed nail] for permanent removal.

Depending on the payer, you may or may not be allowed to bill both borders on the same great toe (definitely not with Medicare). You would bill, for example, partial matrixectomies of the medial and lateral margin of the two great toenails as:

CPT 11750-TA
CPT 11750-59-TA
CPT 11750-59-T5
CPT 11750-59-T5

Unless you have successfully pre-authorized the procedures or know that the payer allows two borders of the same great toe to be billed, you most likely may find that only one margin per toe is reimbursed.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription

RE: Recurrent Neuroma Pain (Randy Lisch, DPM)
From: Multiple Respondents

Consider injecting the second intermetatarsal space to see if a communicating branch is causing a problem.

Philbert Kuo, DPM, Chesapeake, VA, philbear@pol.net

I would perform diagnostic ultrasound to evaluate the involved and adjacent interspaces for neuroma. I would then perform a diagnostic anesthetic injection. These injections are useless if you don't just deposit 1 cc or less around the nerve with US guidance. Otherwise, you are just flooding the plantar surface and the anesthetic will spread to adjacent nerves.

I would not open this foot again for a second surgery. I would perform cryosurgery under ultrasound guidance. This is minimally invasive and should be performed before considering more invasive surgeries. I personally get better results with cryosurgery compared to traditional excision with implantation of the nerve into muscle.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

Dr. Lisch's case of a patient who failed two surgical interventions for "neuroma pain" begs consideration if this is the correct pathology/diagnosis. This is especially true if the patient has had a convention neuroma excision with revision of "stump" neuroma through a plantar incision (in my opinion, usually best exposure to elicit and remedy such a complication.)

The patient should be evaluated and questioned regarding a tarsal tunnel syndrome or lower back radiculopathy at the L4-5 spinal level that can, at times, masquerade as "neuroma" pain. Nerve conduction studies and/or consultation with a neurologist may be helpful in eliciting the etiology of the patient's pain. If an MRI is ordered, especially with post-revision neuroma excision, that scan should be ordered WITH contrast.
 
I have treated patients for past "neuroma" pain that was really metatarsalgia with secondary "neuritis" especially with prolonged periods of walking/standing. Diagnosis is established with complete and comprehensive patient history and radiographic/clinical examination. If the palpation submetatarsal head elicits greater pain than in the intermetatarsal space, metatarsalgia should be considered as a first-line diagnosis. 
 
Gino Scartozzi, DPM, New Hyde Park, NY, Gsdpm@aol.com

RE: Recalcitrant Verraca (Robert Bijak, DPM)
From: Simon Young, DPM

No one is trying to mislead the PM News community. This is a blog for inter-professional communication, not personal assaults. I never stated that the immune system does not play a role. Unless we can stimulate the immune system to respond to the warts and change the clinical course, we still need to treat the clinical entity. Although there are viral antibodies, how do we know they are viral antibodies to this virus(es). If the body does recognize the HPV virus, why aren't these antibodies mobilized? Performing expensive tests doesn't change the clinical course. Granted, looking for underlying disease is important, but it is important for all diagnoses.

The verrucae reside in the epidermis, and although there are vascular elements, it doesn't change the fact that the body doesn't recognize the wart virus(es). Clinically, the vast majority of my patients with verrucae are young, and healthy. I haven't seen a wart in a diabetic patient in the past two years of clinical observation. Rarely do I see a wart in senior patients - clinical observation.

If what Dr. Bijak says is true, warts should be self-limiting like the common cold. Clinically, we find that not to be the case. We do know that warts can spontaneously resolve, but it usually it takes many years. Occasionally, I see dormant warts which don't change for years. In rare cases (twice in my career), I did see an immune response, and multiple warts resolved in two to three weeks. The question is how did this happen? What can we do to make it happen?

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

RE: Call for Help for Flood-Effected Australian Podiatrists

I want to let PM News readers know about the situation here in Australia. I don’t know if it’s made the news in the States, but we’ve got our own version of Katrina here in Queensland and Northern New South Wales. Many towns have been decimated, and we still don’t know how many pods have been affected. At the very least, we can imagine their practices and homes have been destroyed.

We’ve set up an appeal, inviting podiatry interested people (or anyone really) to donate to getting our guys on their feet (no pun intended!) ASAP. Use this link for donations.

Kylie Johnson, Communications Director, Australasian Podiatry Council

RE: Blue Goo Orthotic (Francois Harton, DPM)
From: Multiple Respondents

Riecken’s lab (footcomfortworld.net) in Evansville, Indiana produces custom orthotic insoles for rheumatoid patients that is soft and cushiony.

Robert Schwartz, CPed, NY, NY, rss@eneslow.com

I believe that Marathon Orthotics in Minneapolis, MN is fusing a gel top cover on orthotics for rheumatoid patients.

Scott E Torness, DPM, Yankton, SD, Scott.E.Torness@dmu.edu

We believe that this orthotic product is no longer in existence. We have found, what we think is, an acceptable alternative. It is a formable, custom foot orthosis blank, made of four layers of Microcell Puff and Poron. RA patients do very well with this product, as do other at-risk patients. You should consult your orthotic lab to see if they offer something similar.
 
Susan L. Bartos, President, Earthwalk Orthotics, Inc., eworthotics@neo.rr.com

RE: Expensive Office Modalities And "Possibility" Of Insurance Reimbursement
From: Michael M. Rosenblatt, DPM

There is a "technology" war between insurers and healthcare providers. It is tempting to join in. But careful analysis is critical. There is a long list of "new" technology that was covered by insurers, but no longer is. Or, they never were, despite what the company that sold them said. I have a ...

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

ASSOCIATE POSITION - TEXAS

Associate position leading to partnership available for motivated, surgically skilled, personable podiatric physician. Good compensation and benefits. Respond to footcenter1@sbcglobal.net with a cc: to lisa.schulze@yahoo.com

POSITION AVAILABLE - NEW YORK

Well-established, multi-doctor podiatry practice with offices in Putnam and Westchester counties.Compensation based on productivity. Excellent opportunity for recent or June 2011 residency graduate to build skills and learn practice management. Full-time preferred but right part-time candidate will be considered. Email cover letter and CV to: podiatry2011@gmail.com

ASSOCIATE POSITION - NASSAU COUNTY, NY

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 - 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

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 - OHIO/INDIANA

PrimeSource Healthcare, a leading provider of mobile, on-site healthcare services at long-term and skilled nursing facilities. Our exceptional growth has created a need for traveling, independent contractors of podiatry services in Ohio/Indiana. Earn between $175k and $225k per year. E-mail CV to Kris Wright, kwright@pshcs.com. 847-580-5960. Visit us at pshcs.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

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

SHOCKWAVE MACHINE FOR SALE

D-Actor 200 by Storz Medical. High Frequency Extracorporeal Pulse Activation Treatment (EPAT) System. A little over a year old, excellent results for plantar fasciitis and Achilles tendonitis. Must sell;  practice merger. Selling for $18,000 (new machine >30K) Will include onsite training if necessary. Email footdoc21@gmail.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 - 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

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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