The Voice of Podiatrists

Serving Over 10,600 Podiatrists Daily

January 17, 2008 #3,143 Editor-Barry Block, DPM, JD

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Edward Gellenbeck, DPM

Edward Gellenbeck died on January 10, 2008. Dr. Gellenbeck was a Life Member of APMA and served as President of the Ohio Podiatric Medical association in 1966. He was 87 and suffered from macular degeneration, prostate cancer and diabetes.

Dr. Edward Gellenbeck

Dr. Gellenbeck's moved to Cincinnati at a young age and decided his career during a visit with his mother to her podiatrist. He entered an accelerated year-round curriculum at the Ohio College of Podiatric Medicine. A week after graduation he went into the Army. Dr. Gellenbeck participated in the D-Day landing on June 6, 1944, during World War II. He was initially a grave registrar, identifying fallen soldiers, and later served as a medic throughout the Allied invasion of Europe.

Upon his return to Cincinnati, he met his first wife, Harriette, a fellow podiatrist. He chose podiatry because he wanted to give back to the community without being on call all the time like a regular doctor. After his wife's death in 1990, Dr. Gellenbeck met Janice Witt, and they married in 1992. He sold his practice in the mid-1990s, but continued as a podiatrist in nursing homes until his retirement in 1999.

PM News policy is to recommend that memorial donations be made to the APMA Educational Foundation’s Student Endowment Program, 9312 Old Georgetown Rd., Bethesda, MD 20814

Sources: Mike McQueary, Cincinnati Enquirer [1/14/08], OPMA

HI Podiatrist Discusses Plantar Fasciitis

“The foot is very dynamic, so it changes a lot,” says Honolulu podiatrist Ricky Sukita. “It gets weaker if we gain weight or do different types of activities. If that happens, the foot becomes unstable and can cause the foot to collapse. It hurts like a son of a gun.”

Sukita treats about three to five patients a day with plantar fasciitis. Although common, he warns that serious problems can occur if it’s not treated quickly. People with plantar fasciitis can compensate for the pain by walking differently. That shift in weight can cause problems to other parts of the body, including the back, hip, knees or ankles. “It’s also a prelude to a heel spur,” Sukita says. “When the fascia is inflamed for a very long period of time, calcium deposits start forming at the heel.”

Other methods of treatment include wearing splints when you sleep to keep the foot at 90 degrees so the band of tissue doesn’t contract. Over-the-counter orthotics, or shoe inserts, also help support the arch. Cortisone shots, icing the foot, and physical therapy to stretch out and strengthen the foot and leg muscles can also help reduce the pain. But these treatments are sometimes temporary. In severe cases, surgery is performed to release the fascia from the heel bone and to scrape calcium deposits off the spur.

Source: Craig DeSilva, Island Scene [1/16/08]

High-Tech Glasses Improve Walking For Podiatrist With Parkinson’s Disease

More than one million people in the U.S. have Parkinson's disease, which robs the body of muscle control. There is a simple pair of new hi-tech eye glasses on the way that could change the way Parkinson's patients live their everyday lives. One foot in front of the other used to be so simple for Tom Reiss, a retired podiatrist. That was before he was diagnosed with Parkinson's. He says he had difficulty walking. As he began to lose mobility, Tom had a vision, literally, of a new invention that could help Parkinson's sufferers walk with ease.

Dr. Tom Reiss wearing hi-tech glasses

He says he would fall up to 12 times a day and had bruises to show for it. But with a special pair of glasses, he says he won't fall. When patients look through the goggles, they see a checkerboard grid in front of them and step over the patterns. Tom likens the effect to dropping cards on the floor as markers. These new glasses use the science of optics to shine lines of light inside the lenses to form visual cues.

Electrical engineer Yves Vaillant says they take the well known concept that physical cues may help a Parkinson's patient walk again. Now, Tom walks around a chair with no problem. He says without the glasses he feels very constrained, like walking under water, and with them he says it feels close to normal. Normal for Tom, takes work, but he says he faces every day one step at a time. Tom is also thrilled that this is a device and not a drug to help fight the impacts of Parkinson's; he tries to remain as drug-free as possible.

Source: Bay News 9 (FL) [1/16/08]

Query: Functional Compartment Syndrome?

I recently saw an 11 y.o. girl, with a complaint for two years of pain in her leg and ankle whenever she runs. This has caused her to stop all sports activities, except swimming. She was diagnosed with a stress fx of the tibia 2 years ago, and told it was due to her "severe flat feet." She has been put in several orthotics, none of which have relieved her symptoms. Her static biomechanical exam is generally normal, with no equinus. On stance and gait, her foot seems to pronate normally, with no medial talar bulge, and only slight eversion of the heel. She admitted that she sometimes gets numb and cold in the leg when the pain starts.

CT and MRI ordered about 6 months ago are normal. I want to rule out some kind of "functional" compartment syndrome. I suspect that I need compartment pressure analysis both before and after running, but I have no idea how to order this test, or even where or who to send the patient to to do it. Does anyone have any suggestions?

Peter Smith, DPM, Stony Brook, NY

Query: Renting Treatment Rooms to Physicians

I own an office building that is not yet built out. We are thinking about building an office with common waiting room and front desk (including front office staff) and several treatment rooms. The treatment rooms would be rented on a part-time basis for any type of physician who needs space for a few shifts a week. If anyone rents in a scenario such as this or owns please let me know your experiences with this (good and bad), including what you pay/charge rent per half day or day? If you were considering this lease option, what questions would you ask?

Hal Ornstein, DPM, Howell, NJ

RE: Width of Margins For Excision of Malignant Lesions (Brent Rubin, DPM)
From: Brad Bakotic, DPM, DO, Jon Purdy, DPM

For basal cell and squamous cell carcinoma, narrow margins are used. In most instances 2-3 mm. will suffice. For melanoma in-situ of the acral surfaces 5 mm. is recommended (NIH). For melanoma away from acral surface 3-5 mm. are standard.

Invasive melanoma less than 1 mm. in thickness require 1cm margins; while melanomas over 2mm require 2 cm. margins. Those between 1 and 2 mm. in thickness may be excised with 1-2 cm. margins. The only way to excise less than these standards is by using Moh's micrographic surgery. This technique allows for the excision of invasive melanoma with an average of 6-7 mm. margins.

Brad Bakotic, DPM, DO, BBakotic@ameripath.com

It can be up to 3 cm. margins depending upon the depth and location. I recently excised a 1.5 x 7cm. melanoma from the plantar surface of a gentleman. I first performed a punch to determine depth and later went in with the surgeon who performed node biopsy at the same time to determine if further resection was necessary. There are some pathology lab policies regarding melanoma handling. One of those is that no frozen section will be performed, so you might want to find this out in advance as you will not be able to rely on it for information. Below is a great article for reference.

http://www.emedicine.com/DERM/topic257.htm

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

RE: Sweaty Feet & Cotton Socks (Robert Scott Steinberg, DPM)
From: Multiple Respondents

Supporting Dr. Steinberg's comments - it has been well established and accepted for years that synthetic fibers such as acrylic are better at wicking moisture away from the foot than cotton. Cotton is a great absorber but does not release moisture efficiently. This causes sweat to cool and dry next to the skin instead to transporting the moisture away into other layers of the sock or shoe lining. Cotton socks also tend to 'roll and pill' thus causing wrinkles which may cause blisters. There is even a coating process for natural cotton fibers to help the material's moisture management. With today's miracle fibers such as CoolMax on the market very few athletes, if any, wear cotton next to the foot - and who sweats more than an athlete?

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

I must agree with Dr. Steinberg. For those interested, some of the most extensive research has been done on Thorlo socks, which are padded and composed of synthetic fibers. This peer-reviewed, published research can be found at the Institute for Preventive Foot Health Web Site at: www.ipfh.org/research/summary_peer_research.php

Gene Ulishney, C.Ped, Parkland, FL, GUlishney@aol.com

APMA Responds: The APMA Marketing and Career Development Committee regrets the error that was printed in the sample edition of the Winter Footprints newsletter. The information about cotton socks was an oversight that was detected by one of our alert APMA members when the online draft came out. Unfortunately, the sample copies had already been printed and could not be recalled.

In the article in the APMA News on page 25 (January 2008) regarding the “Footprints” newsletter, there is a note at the bottom that indicates that there is an error in the article on socks. We have made a correction to the article on the PDF that can be downloaded from the website. However, since the “sample” newsletter was already printed before we could make that change, we wanted to still include the sample edition of the newsletter and let DPMs know that we’d made an error. The sample edition that was included in the APMA News was designed as a sample only, and we felt that our making the notation would allow doctors to know that we had corrected our mistake.

There is a wealth of foot health information both on APMA’s website and from other sources. APMA is diligently working to update and ensure that all of their publications are accurate and consistent in message. We are happy to receive feedback from our members and will respond accordingly.

Thomas C. Melillo, DPM, Chair APMA Marketing and Career Development Committee

RE: Congenital Overlapping 5th Toe (Neil Levin, DPM)
From: Eckart Pape, DPM, Ray McClanahan, DPM, BS Ed

With all Dr. Levin has tried so far without success, he could consider an extensor tendon release proximally and then transferring the tendon under the proximal phalanx. The tendon is then sutured into the lateral aspect of the MPJ complex and soft tissue. This has proven to be effective for me with cock-up 5th toe deformities and my be what is needed with this recurring deformity. Consider Betadine splinting or short-term K-wire fixation for 3-5 weeks post-op, followed by 3-4 weeks of taping to maintain the correction while everything heals up.

Eckart Pape, DPM, Waco, TX, EPAPE@swmail.sw.org

Dr. Greenberg is correct in suggesting there is an ongoing deforming force, and I believe it to be the tapered toe boxes of the patient's shoes that she has been wearing since she got out of the post op shoe. Again the same simple tests apply. We do ourselves a service when we help the patient to understand that their long-term success is as intimately related to their footwear choices, as it is to our best surgical efforts.

Because of this problem, and the need to address overlapping toes, conservatively in non-surgical candidates, and post-operatively in patients undergoing surgery, I developed a silicone product that lines up all of the toes in the sagittal and transverse planes. I would be happy to send a set of these toe spacers to Dr. Levin or others with similar patients, as a courtesy to see if it helps.

Ray McClanahan, DPM, BS Ed, Longview, WA, footdr@nwfootankle.com

RE: Office Attire (Alan Mauser DPM)
From: Multiple Respondents

155 patients were questioned by Drs. Adam Bundy, Lee Rogers, Vincent Mandracchia, and Steven Lascher. See their excellent article: (J Am Podiatr Med Assoc 96(2): 132–138, 2006)http://www.japmaonline.org/cgi/content/abstract/96/2/132

Patients who were questioned about this very subject stated that a dress shirt, tie and white coat rated first. Last came in with scrubs and no coat.

David L. Nielson, DPM, Fellow CLEAR North Chicago, IL, pampantla@hotmail.com

There are many published studies (Am J Med. 2005 Nov;118(11):1279-86 for example) that clearly demonstrate that patients overwhelmingly prefer male doctors to be dressed in a shirt and tie with a white lab coat (They prefer female doctors in dressier attire with a white lab coat).

In our practice of 10 doctors, the majority wear scrubs and a white coat but admittedly will dress up if they are knowingly going to the hospital, to visit another doctor in the area, or are working at an office in a more affluent area of the city.

W. Kevin Pearson, DPM, Stockbridge, GA, pearsondpm@bellsouth.net

Office attire has always been an interesting subject. In my opinion, whatever attire you think is appropriate for your practice setting and environment, will be sufficient. The “old school” of thought that a shirt, tie and a coat, or even a suit, is the most professional attire to wear, is a matter of personal opinion or particular institutional rule.

You can be the best dressed doctor in town, but if your practice looks sloppy, unclean, run-down, and unattended for, that is the way a patient will feel his or her care will be. So keep both you and your practice neat, clean, tidy and updated, and you will do fine with whatever attire you choose. I do not have a closet full of ties every time one gets stained with a chemical or other types of fluids. After all, most of us are hands-on physicians.

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com

ASSOCIATE POSITION – VIRGINIA

Must have Virginia license. Requires 24 to 36 month Residency. Permanent position with potential buy in. Includes all phases of Practice excluding nursing homes. Competitive Salary and Benefit package. Please send Resume including salary requirements and availability date to needpodjob@yahoo.com

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