The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

January 18, 2010 #3,756 Publisher-Barry Block, DPM, JD

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PA Podiatrist is Researcher in Gene-Activated Gel for Wounds Study

Researchers are testing a new topical gel for non-healing wounds in patients with diabetic neuropathy, called Excellarate™. The gel is made from bovine collagen and is composed of a gene-activated biocompatible Matrix™. The gel is applied to the wound. Then, Scott Lipkin, DPM, podiatrist/researcher with Lehigh Valley Health Network in Allentown, PA, says cells migrate into the matrix and take up an embedded carrier virus (adenovirus). The adenovirus has been genetically altered to stimulate the cells’ release of platelet-derived growth factor-B (PDGF-B), a key component of wound healing. In turn, that sets off the healing process, stimulating the growth of new blood vessels and tissue.

Dr. Scott Lipkin

In an early phase 1/ 2 study, 10 out of 15 patients (67 percent) had wound closure within 14 weeks of treatment with Excellarate. Seven of the ten had received just one application of the product. A phase 2b study of about 125 participants showed 48 percent of patients had complete wound closure within 12 weeks after a single application of Excellarate (compared to 31 percent wound closure for patients receiving standard care). The company is now in talks with the FDA to initiate Phase 3 trials with the wound-healing drug.
 
Source: WSOCTV.com [1/15/10]

100% of Attendees Donate to APMAPAC at AAPPM Million Dollar Summit

When Dr. Jeff Frederick, president of the American Academy of Podiatric Practice Management (AAPPM), welcomed attendees to the second annual AAPPM Million Dollar Practice Summit on January 8 in Fort Lauderdale , he issued a friendly challenge to all DPM attendees to make a donation to the APMA PAC - at the seminar. “Our goal was to become the first podiatry seminar ever to have 100% participation in making a donation to the APMA PAC at the seminar, and by the end of the weekend we had accomplished our goal and raised over $15,000," said Dr. Frederick.

Dr. Jeffrey Frederick

“This group of highly successful doctors with large practices from all over the country really understands how important it is to support the APMA PAC and appreciates all that has been accomplished to move podiatry forward,” added Dr. Frederick. The AAPPM board designated that the money raised at the seminar be given in honor of Dr. Harvey Lederman for his many years of service on the APMA PAC board, working for the advancement of podiatric medicine

NJ Podiatrists Remain Loyal to their Alma Mater

Put three Rutgers alumni together at a party, and it’s just a matter of time before the talk turns scarlet. A similar conversational hue often rules at Affiliated Foot & Ankle Center in Howell, New Jersey, where three of the doctors are as happy to share their enthusiasm about Rutgers as they are to offer their expertise about feet.

(L-R) Drs. Alison DeWaters, Jasen Langley, and Hal Ornstein (Photo: William Denver)

“We’re rah rah Rutgers,” says Hal Ornstein ’83, managing partner and the self-described “Papa Bear” of the trio. “We make it known to everyone that we are the ‘Real RU,’” agrees Jasen Langley '96. “We all wear Rutgers gear, and we share the sports stories from the weekend, too. We are very proud graduates.”

Alison DeWaters ’00 feels likewise about her alma mater. She always mentions where she went to college when she speaks to civic organizations and other groups about podiatry (education is a major focus at Affiliated Foot & Ankle). “I also offer to all students interested in the medical field to come and spend a day in the office, and I encourage them to apply to RU.”

Source: Kevin Riordan, Rutgers Magazine [January 2010]

Query: Custom Orthoses vs OTC Study
 
In my studies as a podiatric resident, I have yet to encounter a solid, high level of evidence study strongly supporting the use of custom orthoses over pre-fab/OTC orthoses for the treatment of plantar fasciitis. Can anyone shed light on this?
 
Dan Preece DPM, PGY-1, Salt Lake City, UT

Query: Limitation of Privileges

On reapplying for privileges for a local hospital, I was informed that JCAHO said that they wanted documentation on my "competency," i.e., having done certain procedures within the last 8 years. Has anyone else encountered this? What recourse do I have if I get denied privileges? 

James Breedlove, DPM, San Luis Obispo, CA

RE: Ankle Exostosis (Michael Forman, DPM)
From: Arnold B. Wolf, DPM, Robert Scott Steinberg, DPM

It is difficult to analyze the lesion with the x-rays provided as to whether there is an issue with the osseous tissue on the deep surface of the lesion. Are there lytic changes occurring? There appears to be some irregularity in the superficial margins of the lesion. In the absence of a clear trauma history, I would pursue MRI with contrast to rule out a neoplastic process. If benign, I would then consider monitoring for changes in the lesion (re-evaluate after ski season) and modifying the ski boot (the better ski shops should be able to make an accommodation to off-load pressure); resection with excisional biopsy.
 
Arnold B. Wolf, DPM, Sterling Heights, MI, omnifootcare@prodigy.net

Dr. Forman’s patient's complaint is very common. If his patient does not want to miss this ski season, then a good boot fitter should do the following: 1) Mold a custom insole to stabilize the foot and ankle. This will center the ankle and leg in the shell and upper cuff. 2) Grind and "punch out" the upper cuff of the ski boot to create a larger pocket for the malleolus. This area could be directly over the rivet that hinges the upper cuff and lower shell. More modifications might be necessary depending on the model of your patient's boot. 3) Apply appropriate off-loading pads around the newly-created ankle pocket.
 
Robert Scott Steinberg, DPM, Schaumburg, IL, doc@footsportsdoc.com

RE: Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy? (Michael Turlik, DPM)
From: Lloyd S. Smith, DPM

The recent article referenced in JAMA regarding PRP will most likely end any chance of creating a legitimate CPT code and RUC value for this service. Having managed and negotiated the billing and coverage process for many years, it would now take many well-documented studies to undermine these findings. It will also doom the possibility of insurers providing coverage.

Regardless of personal and anecdotal experience on the value of PRP and industry advice on the appropriate code to use, the best option for physicians who provide this service is to tell patients that it is a non-covered service. Collect payment in advance or at the time of service and, if billed, use an unlisted code. There is no CPT code that is legitimate. Coverage will be limited, and if payment is received for an alternate code, be aware of the implication of fraud. 
 
Lloyd S. Smith, DPM, Newton, MA, lloydpod@yahoo.com

RE: Edward L. Tarara, DPM
From: Arthur Helfand, DPM

It is with deep sadness that I report that Dr. Edward L. Tarara passed away on December 27, 2009. Ed was a World War II veteran and was at the Mayo Clinic for many years. He was a former member of the APMA Council on Podiatric Medical Education and a consultant to the Bureau of Health Manpower, PHS, NIH, at a time when the Manpower Act was in place. He served on several committees at NIH and helped our educational institutions in the quest for new facilities and special project grants. Ed was our first representative to the First White House Conference on Aging.
 
Ed was a part of the team, along with Marvin Shapiro and me to be a part of the program to train nurses in long-term care in Lincoln, Toledo, and Philadelphia. It was the program first developed by John Carson. Ed was an Admiral in the in the Navy of the Great State of Nebraska, an honor that we shared thanks to John Carson. His landmark nursing home study (conducted in Minnesota) was published in the Journal of the APMA and set the benchmark for the need for podiatric medicine in long-term care facilities. It was one of the studies that helped us gain entrance to Medicare under Section 1861r of the Social Security Act of Medicare.
 
Ed was a respected member of our profession whose contributions formed our base for the future. He was the epitome of moral and ethical standards, whose word was his bond. He found a way to enjoy every moment of life. He earned a special place in the history of podiatric medicine and the APMA.
 
Arthur Helfand, DPM, Narberth, PA

RE: Surgery and Podiatry
From: Peter Bregman, DPM

I felt compelled to espouse on the subject of surgery as it relates to our profession. I understand completely how and why newly-trained residents are geared up and primed to be “surgeons”, and hopefully get paid a lot of money to use their acquired knowledge and hopeful skill.  This is how I viewed myself when I graduated from podiatry school. I am a believer that...

Editor's Note: Dr. Bregman's Extended-length letter appears here.

RE: New Balance TV Ads (Allen Mark Jacobs, DPM)
From: Multiple Respondents

In my 30+ years in podiatry, I have seen the same issues continually resurface. In my view, orthotics are fabricated from a doctor’s prescription. This is an important distinction between "arch supports" and orthotics. If a non-medical person is promoting the sale of orthotics, I believe they are practicing medicine without a license. The only way to stop this blatant misrepresentation is to file an injunction. This will cost money, but enough is enough! The APMA should look onto this.

Barry Drossner, DPM, Aventura, FL, bdroz50@aol.com

How do shoe stores and pedorthists feel about DPM’s dispensing diabetic shoes and socks? It is not the surgical training of our young DPM’s that is the problem, it is the fact that our elders have relaxed teaching and practicing biomechanics and non-operative podiatry into something that others can and will do competitively!  Root changed arch supports to orthotics and orthopedics to biomechanics. This mandated professional treatment. We need to create new biomechanical language and treatment parameters and a professional presentation and follow-up that once again places “The Foot Specialist” atop the orthotic box, not teetering precariously on a box of foam. We need to set professional goals and standards for our footbeds that others cannot imitate, and then market these upgrades to the foot-suffering community and the medical establishment in the same way Root and his followers did thirty years ago.

The next time you ask your assistant to take a cast or press feet into foam or place them onto a scanning device, ask yourself, “could a Good Feet Store do this just as well?” Use that moment to contemplate change. Our profession has come to a fork in the road that divides surgically or non-operative. To their credit, the surgical road has been well-planned and executed, but currently the other road leads to a downward spiral. Fortunately, DPM leaders are emerging for biomechanics, the diabetic foot, wound care, and dermatopathology to lead us down a thriving non-operative road. Let’s stop blaming the shoe clerk or New Balance and leave them in the dust as we unite to blaze new trails in podiatry.

Dennis Shavelson, DPM , NY, NY, drsha@foothelpers.com

I thought I would step into this discussion on non-podiatry semi-custom orthoses that are made at shoe stores and now Cosco. The Medical Board of the State of California has made a unique effort in this respect in response to podiatrists’ complaints. They have produced a pamphlet directed at consumer protection from these marginal suppliers of what should be medical care. The brochure clearly states that podiatrists and orthopods are the only doctors trained to make orthotics and cautions the consumer to be careful if obtained anywhere else. The brochure clearly says, "be wary of shoe inserts marketed for medical purposes by unlicensed people...orthotics should be prescribed by a doctor" (bpm.ca.gov).

I don't think we can stop people and stores from making insoles or arch supports that they call orthotics, but maybe we can better  educate the consumer into making the right decision. Maybe, we should have been doing this for years. Maybe the APMA can help in this regard.

Paul R. Scherer, DPM, San Francisco, CA, hpoc@aol.com

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes. Top hospitals. Fax CV with references to 703-491-9994

ASSOCIATE POSITION – ILLINOIS

Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings are available. If interested, fax curriculum vitae to 847-674-2113 or e-mail to feetwork@aol.com

ASSOCIATE POSITION - MASSACHUSETTS

PSR-24 trained podiatrist for busy multi location practice, high volume and high-tech. Seeking energetic individual for high volume of patients with multiple needs. Orthopedic, sports medicine, wound care, pediatric orthopedics and surgery skills required. Looking for immediate hire for the right candidate with possibilities for partnership. Contact Debbie Roberts debbierobertsm4@hotmail.com

ASSOCIATE POSITION – NORTH AND CENTRAL FLORIDA

Quality Podiatry Group of Florida provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings are available. If interested, fax curriculum vitae to 847-674-2113 or e-mail to feetwork@aol.com

ASSOCIATE POSITION - SOUTH FLORIDA

Ft. Lauderdale/Miami office locations seeking associate leading to partnership for the right person. Active modern busy practice needs help. Competitive salary + benefits + incentives. Send resume to podiatrydoctor@aol.com

ASSOCIATE POSITION – TEXAS

Dynamic, growing practice in Dallas/Fort Worth area, seeking surgically trained, Board Certified/Board Qualified Podiatrist. Excellent salary and benefits compensation package, for the right candidate, with partnership/buyout opportunity. Contact/Send resume to: jmh6122@yahoo.com

ASSOCIATE POSITION IN WESTERN NORTH CAROLINA
Well diversified growing podiatry practice with good mix of office, surgery center and hospital procedures seeking a full-time associate. Must have NC license or taking state exam this year. Candidates should have excellent bedside manner equal to their medical skills. E-mail a cover letter and CV to DPMCAREER@AOL.COM

PRACTICE FOR SALE - ALABAMA, GULF COAST

26 year old practice for sale. Owner desires to sell. Practice operated 25 hours per week. Surgery and general podiatry. MD referrals. Surgery center and hospitals in close proximity. Highly profitable. Priced to sell. Seller will lease office to buyer. Contact Mike Crosby at 1-888-776-2430 or mcrosby@providerresources.com

ASSOCIATE POSITION – CINCINNATI, OHIO

This is your once in a lifetime opportunity to join one of the most successful practices in the United States. We do not have a seniority system. If you are motivated and have completed a PSR 24-36 residency, your income is limited only by your enthusiasm and desire to achieve. Email resume to khart@cincinnatifootcare.com

PRACTICE FOR SALE - TENNESSEE

Well established practice for sale. Full scope medical and surgical practice including DME. Exceptional practice with a high volume of new patients. Excellent hospital and surgical center privileges with investment opportunity. Great area for a family and the outdoorsman. 731-446-7285/E-mail nraines@charter.net

ASSOCIATE POSITION - MINEOLA, NEW YORK

Full-time associate position with future partnership potential available with busy multi-office practices on Long Island. Must be proficient in all phases of podiatry with emphasis on surgery, biomechanics and RFC. Minimum standards include either a three-year PSR, or board qualified/certified status with ABPS. Existing hospital privileges with a NY based facility helpful. Interested doctors are encouraged to e-mail their CV to mets724@gmail.com

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

PRACTICE FOR SALE - NEW JERSEY
 
Part-time practice for sale. Located in Bloomfield, NJ. Great location in professional building. All modern equipment including digital x-ray. Please contact doccapo@yahoo.com

ASSOCIATE POSITION - HUDSON VALLEY, NY

Recruiting a podiatrist who enjoys doing surgery! We are a seven–doctor podiatry group and we’re great to work with. A residency program is attached to our practice. Interviews will begin shortly for this special position. Please forward CV to: healthyfeet4ever@yahoo.com

PRACTICE FOR SALE - CENTRAL FL

Practice and medical building for sale, in beautiful, high quality of life, growing area, Central Fl.; 2000 sf bldg. fully equipped/ designed for podiatry; excellent location, features & exposure; near hospital, wound and HBO center. Great opportunity for expansion & investment; good insurance climate. 352-223-2713 / E-mail: windnwave@earthlink.net

ASSOCIATE POSITION FULL-TIME - SUBURBS OF CHICAGO

PSR 36 - month-trained podiatrist needed for busy suburban Chicago practice. Full benefit package included. If interested, please email your curriculum vitae to foot1st@yahoo.com

PRACTICE FOR SALE – MAINE

20+ years, full scope, turn-key practice in the same medical building location. Podiatrist-friendly hospitals just down the street, wonderful, appreciative and cooperative patients await. Excellent expansion potential. Maine offers an enjoyable life style, recreation abounds, reasonable housing costs, excellent school systems, low crime rates. Colleges and universities nearby as are cultural opportunities. Retiring seller will stay for transition. Please contact: mainefootdoc@yahoo.com

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

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