The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

January 22, 2007 #2, 789 Editor-Barry Block, DPM, JD

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Barry Breaks Ground on Center for Community Health and Minority Medicine

Barry University broke ground Thursday, Jan. 18 on the long anticipated Center for Community Health and Minority Medicine. Many community officials and major donors were present, in addition to students, faculty and staff representing the Schools of Graduate Medical Sciences, Podiatric Medicine, Nursing and various other schools and divisions.

Barry University officials break ground on the new Center. Pictured L-R: Bill Heffernan, Sister Jeanne O'Laughlin, OP, PhD, Pegge Bell, PhD, Dr. Chet Evans, Cyrus Jollivette and Sister Linda Bevilacqua, OP, PhD

Barry’s School of Podiatric Medicine graduates more Hispanic podiatrists than any other school in the country. In the last 10 years, Barry’s doctors have treated and operated on nearly 50,000 crippled indigent children in the Yucatan Peninsula. Barry’s five Foot and Ankle Institutes are unique to the podiatric colleges and provide nearly $ 1-million a year in charitable care.”

NY Clinical Conference Becomes Largest Podiatry Meeting Ever

This weekend's New York State Podiatric Medical Association (NYSPMA) Clinical Conference was attended by more than 1,500 DPMs and nearly 200 podiatric students, making it the largest podiatric meeting ever. "Records are made to be broken and we couldn't be more pleased," said Len Thaler, NYSPMA's Executive Director. Thaler humbly declined taking credit for this year's success, instead citing Foundation President Lawrence Santi, DPM and his Committee, NYSPMA President Scott Altman, DPM and his board, as well as Thaler's own devoted staff for this smoothly run meeting.

In addition to packed lecture hall and workshops, the exhibit hall, which this year rose to a record 252 exhibitors, also experienced high traffic.

Honored at NYPMSA's General Meeting were:

Dr. David Schofield

Lifetime Achievement Award--Dr. David Schofield, Current APMA President and former NYSPMSA president

Dr. Joseph Cavuoto

Meritorious Service Award--Dr. Joseph Cavuoto - Longtime advocate for PPAC (NYSPMA Led the nation in contributions in 2006)

Dr. Benjamin Kauth

Pioneer in Podiatry Award--Dr. Benjamin Kauth (First podiatrist to publish book in the lay press)

Wyden Introduces Universal-Care Bill

All employers would contribute up to 25% of the average premium for essential care in their area. New state agencies would provide information about the private insurance plans available to residents and would connect individuals and families with sliding-scale premium reductions. According to the Lewin Group, the plan would cost the federal government $812.9 billion, but that would be offset by about $814 billion in premium revenue, savings to other programs and the elimination of certain business tax credits. Overall, the bill would save $1.48 trillion over 10 years, according to the consulting firm. A Wyden aide said the bill will be referred to the Finance Committee.

Sen. Ron Wyden (D-OR.), who sits on the influential Senate Budget and Finance committees, introduced a healthcare reform bill that he said would guarantee 99% of Americans healthcare coverage equivalent to that now offered to federal employees. Under Wyden’s Healthy Americans Act, all individuals would be required to buy insurance -- a mandate that over the course of two years would replace the current employer-based insurance system.

Source: Jennifer Lubell, Modern Healthcare [1/19/07]

Query: Plantar-flexion of Hallux S/P Fibromas Excision

Five to six weeks post excision of plantar fibromas, my patient has developed a plantar-flexion spasm of the hallux. After doing a posterior tibial nerve block along with a mayo-type block, the spasm relaxed a lot. I am assuming this is due to scaring around the flexor hallux brevis as the IPJ was not flexed. I injected some Kenalog 10 around a knot at the scar area and sent the patient to therapy for muscle stim. and deep massage, etc. Any other comments or recommendations?

Thomas R. Brant DPM, Columbia, MO

RE: Peroneal Spasms (Mark Wolpa, DPM)
From: Steve Gershman, Jeffrey A. Root

Dr. Wolpa inquired about surgical and conservative treatment options for a 52 y/o marathon runner who has developed a peroneal spasm associated with osteochondral defects in the sinus tarsi area. My father, Merton L. Root, DPM developed a highly successful, conservative method for treating peroneal spasm with functional orthoses that most podiatrists are unaware of.

First, evaluate the open chain range of motion (ROM) of the subtalar joint. You may find little to no STJ ROM on initial exam. If so, apply a continuous supination force to the subtalar joint for several minutes in order to stretch out the spasm. After stretching out the spasm, you should see an increased ROM at the subtalar joint. Again, move the STJ through its full open chain ROM. You will likely induce the peroneal spasm with non-weight-bearing supination of the STJ. If so, note the point in the range of motion that seems to trigger the spasm. Again stretch out the spasm and cast the foot with the STJ slightly pronated of the spasm trigger point.

The cast for this orthosis should be corrected to the same pronated position in which the foot was casted (i.e., heel everted to the floor by the same angle as it was casted). The orthosis should have a very deep heel cup (23 to 25 millimeters) and should have no motion in the rearfoot post with medial and lateral post flares. The goal is to prevent the pathological forces (motion) that induces a spastic response from the peroneals. This treatment may require a second, less pronated orthoses in order to get this foot to function closer the neutral position without spasm. In this case, I would recommend a temporary restriction on running so that the therapy has a greater opportunity to work.

Jeffrey A. Root, jroot@root-lab.com

My first comment is that Dr. Wolpa left out the most important clinical info especially in a runner. He failed to give any relevant biomechanical info. Most runners experience pain when long-term uncontrolled faulty biomechanics causes excess motion or motion in faulty dominant planes or unequal physical stresses to certain areas of the foot or ankle. You cant even begin to ask about surgery vs. conservative care or ANY treatment until you look for the underlying causes, especially in a runner.

Based on the info Dr. Wolpa did give, my guess is that his patient has either excess sub-talar motion, causing long-term irritation in the sinus tarsi (especially during the many miles of pounding needed to train for a marathon), or a planal dominance problem in the sub-talar joint with transverse motion or frontal plane dominance.
Excess motion or dominant plane motion abnormalities can irritate the joint causing triggering of the protective splinting the peroneus brevis can cause when in spasm. You need to determine if this is occurring and if so, control the motion with orthotics appropriate to the cause. You can also calm it down initially by use of a CAM-walker to completely immobilize the ankle/foot for three weeks.

Steve Gershman, DPM, Obsidianom@aol.com

RE: Unethical Practices and a New Associate (Name Withheld)
From: Shay Fish, DPM

When interviewing for employment, take advantage of the opportunity to inquire about the potential employer's policies. Are there written policies about the practice in general, OSHA, HIPAA, Medicare compliance, etc. Ask who the officers are for those various roles and try to talk with them. Consider talking with other podiatrists and hospitals in the community regarding the reputation of your potential employer. But remember that rumors may just be rumors. Some coding issues may not apply to your employer's situation, until there is a renovation.

After employment you have two options: leave; or take the initiative to bring the practice "up to date," especially if it has potential. This demonstrates that you have a vested interest in the long term health of the practice. Everyone wins.

Shay Fish, DPM, San Antonio, TX, fishdpm@aol.com

RE: State of Hospitals in the US
From: Neil A Burrell, DPM, David Secord, DPM

One problem that we see is the increase of uninsured patients. Our hospital is a 500 bed facility with a trauma center. Only 33% of the ER patients have insurance. The avg ER wait is 8 hours. People do not go to the doctor until they are so sick they have to be hospitalized. One of our associates had to cancel two days in the office to operate on ER patients, which only 30 % had insurance. Hospitals are losing money but surgical centers should not be punished. Unfortunately I don't think there is an easy answer.

Neil A Burrell, DPM, nburrell@gt.rr.com

Hospital profitability is an odd issue at best. They have to provide uncompensated care and write off the loss, but pay outlandish salaries to people. An example of absurdity is a recent administrative decision at my local hospital. When I do an Evans or a TN fusion, I like to use a cannulated screw with a compressible staple. I just like doing it that way. My hospital recently decided to stop allowing the OSS staple in the O.R. to reduce vendors. They have no problem with me using the EBI VueLock plate for the same TN fusion, however. The OSS staple is a couple of hundred dollars to the best of my knowledge. The VueLock plate and screws runs several thousand (or so I'm told).

So.....to save money by reducing vendors, I can increase the cost of my procedure hardware usage 10X fold, without a problem? What possible sense does this make. I've appealed it directly to the suits in charge and they don't see the problem, as the VueLock is already used by the spinal surgeons and so it is an approved vendor. These guys must be working for the government.

David Secord, DPM, Corpus Christi, TX, David5603@pol.net

OFFICE SPACE TO SHARE – MANHATTAN / PLAINVIEW, NY

East 60th and or East 22nd in Manhattan and on South Oyster Bay Road Plainview. Turnkey operation, all equipment needed is available as well as an extremity MRI, fluoroscopy, x-ray and surgical equipment. Each office has an operating room with anesthesiologist available for iv sedation. Call 516 476-1815 or email to
podo2345@aol.com include a phone #

ASSOCIATE POSITION—NORTH COASTAL CALIFORNIA

Two fully staffed rural offices with continually growing patient load. We take care of all aspects of podiatry: assisted-living centers, palliative care, wound care, biomechanics, surgery, diabetic care. Hospital privileges are available to those properly qualified. If you are interested in challenging and hard work leading to partnership, send your CV to jimf@humboldt1.com

POSITION AVAILABLE – SOUTHERN CALIFORNIA

Los Angeles and/or San Fernando Valley. House Call Practice, Doctor on maternity leave needs Podiatrist to assist with housecalls in San Fernando Valley and Los Angeles (310, 323 and 818 area codes). Must have own car and malpractice insurance. E-mail responses to Docrandi@sbcglobal.net

ASSOCIATE POSITION--PHOENIX SUBURB

Attractive opportunity for enthusiastic, proficient, and personable associate. Well-established modern practice with multiple newer spacious offices, technology and equipment. Solid referral base, close to hospitals, knowledgeable certified staff. 22% MCR. Practice and surgical center partnership potential opportunity. Prefer 24-36+ PSR. Send CV: AZpodassociate@aol.com

ASSOCIATE POSITION – ST. LOUIS, MISSOURI

Immediate Opening. Busy practice in prime suburban St. Louis location looking for a surgically trained associate, possible partner. Must be honest, ethical and hardworking. ABPS preferred, but not required. Please reply with CV and requirements to mdwrtw@aol.com

EQUIPMENT FOR SALE

1 Whitehall whirlpool JO 140, 1 Whitehall whirlpool P 15 M, 3 Bailey physiotherapy stools. Would prefer to sell as package, but will sell separately. Please respond to Bob Kornfeld, DPM at Holfoot153@aol.com or call 516-869-3338.

ASSOCIATE POSITION - MID-EASTERN, NORTH CAROLINA

Potential partnership - Well-established and extremely respected single location practice. Small city east of Raleigh near coast with excellent fishing, hunting, and outdoor activities. Must be personable & motivated with strong surgical and medical skills. Prefer PSR-24/36 training with active (or in process of obtaining NC license). Send CV to ncfootankle@aol.com

ASSOCIATE POSITION – MISSISSIPPI

Well established, busy, 3-doctor practice seeks PSR 12 or 24 trained podiatrist for associate position to fill vacancy of retiring member. East central location is a great area to raise a family and is a prime location for accessibility to several major cities. Competitive salary, benefits, and incentives. Partnership possible in 2 years to right individual. June - July start date. Applicant must be ethical, personable, and motivated. Please E-mail CV and letter of intent to shanegan@bellsouth.net

ASSOCIATE POSITION - LOS ANGELES/SOUTH BAY AREA

Multi-office, multi-doctor, well-established practice near the beach cities. Seeking a board eligible/certified PSR-24 or PSR-36 trained foot and ankle surgeon. Well-rounded practice requiring knowledge in biomechanics, pediatrics, sports medicine, diabetic wound care, trauma, and reconstructive foot and ankle surgery. Full-time position available immediately with generous compensation and benefits, including malpractice, and health insurance. Two-year commitment required with partnership opportunity. Send CV to akemfoot@sbcglobal.net or fax to (310) 838-0227

POSITION AVAILABLE-SOUTH FLORIDA/BROWARD COUNTY

Needs 2 or 3-year post surgical training in forefoot and rearfoot
Salary plus incentives Email responses to office email: advfoot@bellsouth.net

EQUIPMENT FOR SALE - METTLER SONICATOR 715 ULTRASOUND

Mettler Sonicator 715 Ultrasound with 5cm2 with delivery head, great in any podiatry office for multiple uses. The cheapest I am able to price this machine new, is on Esurg at $1396.77. My unit was used about 20 times, and is about 2 years old. I will let it go for $650.00 plus shipping. Like new condition. If interested, write deg1@comcast.net

EXCELLENT ASSOCIATE OPPORTUNITY – SOUTHERN CALIFORNIA

Established 25 year well-rounded biomechanical and surgical practice seeking energetic, enthusiastic, personable and proficiently-trained PSR-24 or PSR-36 foot and ankle surgeon for associate with ultimate partnership opportunity in LA area. Excellent position for an individual interested in all aspects of podiatric medicine with emphasis on reconstructive foot and ankle surgery. Only 8% Medicare with No HMO. Email CV to dr4feet@sbcglobal.net

ASSOCIATE POSITION - CINCINNATI, OHIO

One of the largest podiatry practices in the United States is again in need of a PSR 24-36 Associate. All present doctors are in their thirties with similar training. Everyone is treated equally and there is definitely no limit to your success. Please submit resume or contact Karen Roesch via email or phone. Kroesch4poh@aol.com (513) 729-4455

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

ASSOCIATE POSITION - CENTRAL CALIFORNIA

Central California multi-location practice looking for PSR-36 associate leading to partnership. PSR-36 trained podiatrist with great opportunity for reconstructive surgical practice. Practice has Medicare-approved surgery center. Must have excellent interpersonal skills. Excellent salary and incentive. Respond to: westsidefoot@yahoo.com

ASSOCIATE WANTED FOR SOUTH MIAMI AREA

Large group, busy, multi-office, partner potential. Motivated applicants only. Mail resumes and letters of intent to 999 N. Krome Avenue, Homestead, FL 33030. July start time OK, sooner preferable. E-mail lianadpm2@aol.com. I can also be reached at 305-331-4501.

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

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