The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

January 19, 2011 #4,067 Publisher-Barry Block, DPM, JD

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AL Podiatrist Killed In Automobile Crash

Lisa Weaver said the deadly crash that happened near her grandparents home on Highway 45 Saturday was the worst she's seen. State troopers said 73-year-old Georgia Pugh and 53-year-old Donna Landi were killed. Landi was ejected from the car. Otto Ludwig, 71, was driving. He was seriously injured.

Dr. Donna Landi at 2010 Christmas Party

Ed Brezniak said Landi was a good neighbor who will be missed. "She just was a sweet lady. We'd see her every morning with her dog walking all the way around the block," he said. Neighbors tell FOX10 News Landi was a local podiatrist. She moved to Mobile from New York a few years ago following the death of her husband.

Source: Renee Dials, Fox 10 News (Alabama) [1/17/11]

NY Podiatrist Elected President Emeritus of NY Clinical Conference

The Foundation for Podiatric Medical Education has unanimously elected NYSPMA Past-President and current APMA Board of Trustee Dr. Frank Spinosa as President Emeritus of the 2011 NYSPMA Clinical Conference! 

Dr. Frank Spinosa

Spinosa will be receiving a plaque to honor this momentous achievement on Saturday, January 29 during the New York Clinical Conference.

90 Year Old Retired MO Podiatrist Has an Emmy to His Credit

If anyone has good reason to assume his life is interesting to others, it’s Dr. Joe Friedman, who was born and raised in St. Joseph by Russian immigrants during the Great Depression. In the time since those early years in poverty — which saw him selling magazines from a cart fashioned from an orange crate and, later, earning $6 a week for 60 hours of work at a drugstore — he became a captain in the Army, a doctor with a successful podiatry practice, a Broadway actor, and an award-winning researcher and writer in Hollywood.

Dr. Joe Friedman, shown here with an Emmy he won (photo Erin Wisdom).

After his time in the Army, Dr. Friedman returned to podiatry school in Chicago and then operated a practice in St. Joseph for 13 years while also doing community theater. Friedman eventually moved to Hollywood, where (using the stage name Joel Frederick) he worked as a researcher and writer for “Ripley’s Believe It or Not.” He also did some work as a researcher for National Geographic, and in 1986 won an Emmy for the documentary “Secrets of the Titanic.”

Source: Erin Wisdom, St. Joseph News-Press [1/16/11]

CA Podiatrists Sues Newspaper for Intentional Infliction of Emotional Distress

The father of a former Cal football player is suing The Daily Californian’s editor-in-chief and president Rajesh Srinivasan in a Fresno County small claims court, charging him with intentional infliction of emotional distress related to one article and two blog posts from 2006 and 2007 that remain in the newspaper’s online archives.

Dr. Harvey Purtz

In a series of e-mail exchanges with Srinivasan, Dr. Harvey Purtz, a Fresno podiatrist, requested that Srinivasan remove articles written about  now-deceased Chris Purtz’s altercation at a San Francisco nightclub – because they “inflict harm” upon his son’s memory. He is asking for $7,500 in damages after Srinivasan’s consistent refusal of his requests, despite the editor’s citations of company policy. Peter Scheer, the executive director of the First Amendment Coalition, said that succeeding in any kind of libel action under United States law is an “uphill battle” against freedom of press.

Source: True Shields, Daily Californian, U. California-Berkeley via UWIRE [1/16/11]

Even a Winter Snowstorm Can't Stop Another Successful Superbones Conference 

The Superbones East 2011 Conference took place this past weekend for the ninth consecutive year at the Atlantis Resort in the Bahamas. The severe snowstorm that ravaged the East Coast created travel challenges, but three-quarters of the attendees arrived safe and sound, and the show went on.

(L-R) Superbones Committee Members Drs. Stan Kalish, Alan Sherman, Michael Shore, Richard Reuter, and Chuck Zelen. (Bottom) Some of the many family members who attended the event.

A remarkable number attend this meeting with their families year after year, enjoying lectures and workshops by the top scientific leadership the conference is known for. Drs. Kalish, Steinberg, Frykberg, Schoenhaus, Jacobs, DiDomenico, Zelen, and Trepal were among the fine teachers presenting new scientific presentations and well-organized clinical reviews. To view photos from the conference, click here.

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

Ribotsky: What are your thoughts on lasers as a treatment for onychomycosis?

Dr. Bryan Markinson

Markinson: There is nothing is better for the treatment of onychomycotic nails than Lamisil. The problem is the doctors don't treat onychomycosis like it's an infection. No one has a problem with osteomyletis or pneumonia re-occurring, but for some reason, podiatrists want a treatment that will cure onychomycosis forever. Unfortunately, this is just not going to happen.  

Dr. Gary Lepow

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). The next segment  will feature Dr. Gary Lepow,  podiatric surgeon and inventor. You can register for this event by clicking here

Query: Homeopathic Injections?

Dr. Kornfeld states he gave a homeopathic injection. Do we as licensed professionals accept homeopathic injections as ethical? Do we think this is doing justice to the patient? Should we take money for this? Podiatry is trying to define itself in the new millineum. Is this something we should advocate?

Robert Bijak, DPM, Clarence Center, NY

Query: Neuroma Excision - Burying Nerve

When billing for excision of neuroma, CPT 28080, can you also bill for CPT 64787 (implantation of nerve end into bone or muscle [list separately in addition to neuroma excision]) if you bury the nerve in muscle? There is a parenthetical instruction following CPT 64787 that says, "Use 64787 in conjunction with codes 64774-64784."

Matt Murphey, DPM, Des Peres, MO

Response: There is no major current peer-reviewed literature that recommends burying the nerve in an initial excision of an intermetatarsal neuroma. It is, however, recommended in revision forefoot neuroma, and in that case, it may be coded.

Walter Pedowitz, MD, Linden, NJ

Codingline subscription information can be found here
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RE: Scarf Complication (Name Witheld)
From: Multiple Respondents

The patient whose x-rays were presented with the complication of the Scarf osteotomy has a lot going on. The loss of length after the loss of the screw will likely cause metatarsalgia of the 2nd MTP and/or the third.
 
Just a hint to the surgeon: The Scarf is not meant to be the length of a chevron osteotomy but rather, it is meant to be a long osteotomy that gives more bone to bone contact and DOES NOT REQUIRE STRICT NON-WEIGHT-BEARING AT ALL. See technique articles on the Scarf or watch it on our website (weil4feet.com).

Options now are to immobilize the patient in a cast (not boot) with the toe splinted in slight varus and keep the patient like that for four weeks. Begin PT for range of motion as soon as the patient is out of the cast. If revision is necessary, an arthrodesis would probably be best.
 
Lowell Scott Weil, Sr., DPM, Des Plaines, IL, WEIL4FEET@aol.com

Name Withheld states that the patient was seen one week after the surgery, and the screw was seen through the incision. The radiographs shown are 16 days post-op. Is the film weight-bearing? Where are the initial radiographs? Also, why is there only one screw? What was the reasoning for fusing the 5th digit? There is obvious shortening of the 1st metatarsal that will lead to sub-2 lesions. Also, the fragments can lead to neurovascular impingement. I think sound surgical principles were not applied during the surgery, and unfortunately the patient was "bad."
 
Jessica R. Brent, DPM, Fremont, OH, jrbdpm@yahoo.com

The view provided is not enough to make a proper recommendation. Could Name Withheld kindly provide the other two views and clinical picture if available? In light of history/xray provided, it sounds like there were two screws initially, and one was taken out in an office setting. Is the wound healing now? If not, there is still contamination and possible deeper infection that is preventing soft tissue healing, which in turn may lead to bone infection if not addressed in time.  The patient needs to be taken back to the OR for wound debridement with removal of the remaining screw (since it appears to be only in the dorsal segment) Name Withheld needs to perform reduction of the first met via external/internal fixation as needed. Please make sure to restore length of the metatarsal as it appears shortened on the view provided. 

Greg Khaimov, DPM, Fort Lee, NJ, gregkhaimov@yahoo.com

RE: Overlapping 2nd Toe (Sean Ravaei, DPM)
From: Richard Gosnay, DPM, Geoffrey Bricker, DPM

The case presented would reasonably be treated with a de-rotational arthroplasty of the 5th toe, arthrodeses of toes 2-4, medial capsulotomies of all the lesser MTPJ's with percutaneous pinning into the metatarsal heads during recovery. A Girdlestone might be required at the second toe, but it is difficult to assess the amount of sagittal plane deformity with these images. However, the most significant medical condition is this patient's 30 year history of smoking. Smoking is likely to cause transient ischemia and incision dehiscence in the extremities, especially in the digits. I would not be surprised to see complications of extraordinary pain, failure to heal, infection, gangrene, and amputation after toe surgery on this patient.

Richard Gosnay, DPM, Danbury, CT glabroushead@gmail.com

This may sound radical but I would do a pan-metatarsal head resection, removing enough to reduce the deformity and reshape the head. It would heal fast in a smoker, whereas the toes probably won't fuse and deformity will be poorly reduced. This also works in isolated second MTP deformity. There is very high patient satisfaction even though it is counter to conventional wisdom.

Geoffrey Bricker, DPM, Springfield, MO, geoffreybricker1@msn.com

RE: Recurrent Neuroma Pain (Michael Forman, DPM)
From: Pete Harvey, DPM

I palpate for a positive Mulder’s sign which I find in approximately 10% of patients who are positive for neuroma at the third space. However, over many years of practice, I have rarely found it necessary to excise a 4th interspace neuroma, probably for the reasons you mentioned. I have personally had a second space neuroma excised about 25 yrs ago with good results.

Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com

RE: Amazing Charts (Arthur Lukoff, DPM)
From: Bob Kuvent, DPM

I have used Amazing Charts for two years. It is a reasonable choice and it works with Dragon. It is not an advanced system and reporting capabilities are very limited. I do not recommend using their MTBC  billing service. In my opinion, they are horrible. They are not patient-friendly and their service to my office was atrocious. Patients and staff were always unhappy, and they did not follow up on unpaid claims. A/R went through the roof until I switched to a local billing service.
 
Bob Kuvent, DPM, Chandler, AZ, FtFixr@gmail.com

RE: Expensive Office Modalities And "Possibility" of Insurance Reimbursement (Robert Kornfeld, DPM)
From: Ken Meisler, DPM

Dr. Kornfeld criticizes the treatment of two podiatrists who saw a patient with plantar fasciitis before he did. He felt the first doctor was wrong by not prescribing orthotics or doing imaging studies. The second he felt was wrong for suggesting the patient should try going without the orthotics for one month, presumably because they weren't covered, and the doctor also didn't do imaging studies.

First, I think that if you see a patient with classic plantar fasciitis symptoms, you should not be criticized for NOT taking an x-ray or performing an ultrasound. In fact, I applaud a doctor who is... 
 
Editor's note: Dr. Meisler'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

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 - 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

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 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 - NASSAU COUNTY, NY

Experienced board certified podiatrist wanted for busy diversified practice located in Nassau County, New York. Energetic DPM, please send CV to JELLA810@GMAIL.COM

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

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.

EQUIPMENT FOR SALE - MICROVAS UNITS 

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

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

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