The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

January 22, 2011 #4,070 Publisher-Barry Block, DPM, JD

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VA Podiatrist Reports 50% Cure Rate with PRP Injections

Ida Thornton has been having pain in both her feet for about a year. She's had several treatments, even surgery. While her right foot is cured, the left one is still causing her pain. That's why she's seeing Martha Jefferson Hospital podiatrist and surgeon Dr. Jimmy Downing. He's getting her ready for a new procedure called Platelet Rich Plasma Injection. “You draw the blood, spin it down, take off the top layer, which is rich with platelets that have healing factors and growth factors, and inject it into the site of injury or chronic inflammation,” said Dr. Downing.

Dr. Jimmy Downing

Dr. Downing says this therapy allows patients to get all the bleeding and other factors which are good for healing just in a more concentrated solution. “We've had a 50 percent cure rate of the patient's pain and probably 25 percent to 50 percent success rate,” said Downing.

Source: Stephanie Sachell, CBS Healthwise [1/19/11]

IPMA to Answer Calls, Tweets, and Posts on "Talk to a Podiatrist Day"  

Volunteers from the Illinois Podiatric Medical Association will answer calls, tweets, and posts on Wednesday, Jan. 26. According to IPMA President Marlene Reid, DPM, the call-in event helps provide useful information from physicians to consumers. “Many doctors have treated patients who search the Internet for information about their conditions and come into the office with a self-diagnosis,” Reid said. “Our Talk to a Podiatrist Day seeks to provide a filter on this process as well as answer any questions a caller might have about foot care.”

Dr. Marlene Reid

Reid said it’s a positive step that patients are involved with their care and some reputable Web sites do provide a valuable service to these patients, but nothing replaces a direct source of reliable information.

Source: Associated Press [1/19/11]

Court Rules UK Podiatrist's Forensic Testimony is Valid

A murderer who said he was unfairly convicted because of the way he walks has failed in an Appeal Court bid to clear his name. Elroy Otway was jailed in 2009 for the murder of Mark Daniels, 25, who was shot dead in Wythenshawe in August 2006. The testimony of podiatrist, David Blake, who has years of experience in analyzing people’s gait, was instrumental in bringing Otway to justice.

Podiatrist David Blake

At London’s Appeal Court, Otway’s legal team argued that Mr. Blake ‘could not be considered an expert’ and that podiatry is ‘not sufficiently recognized or advanced’ as a forensic science to justify its use in court. However, three top judges ruled that the jury in Manchester Crown Court had rightly been allowed to hear Mr. Blake’s opinion that the way Otway walked had ‘a significant correlation’ to the gait of a man captured on CCTV who drove the getaway car.

Source: Manchester Evening News [1/20/11]

FPMA's SAM Meeting Off to a Hot Start

While most of the country endured snow and sub-freezing temperatures, 800 lucky podiatrists and 300 podiatric assistants enjoyed near 80 degrees under sunny skies on the opening day of the 2011 Scientific and Management Meeting (SAM).

(L-R) Drs. Brad Bakotic, Robert Iannacone, Terence McDonald, and Jeffrey Jensen at Barry University Alumni reception.

Lecture halls were packed, and a large room of 200 exhibitors remained busy during lecture breaks. During the evening, attendees enjoyed a Barry University Alumni Association reception sponsored by Bako Pathology Services.

National Health Spending Growth Held to Record-Breaking Low

The most recent economic recession slowed the growth of national health spending to 4% in 2009 -- the slowest rate since at least 1960. Patients delayed elective care and limited out-of-pocket spending, in part because millions of people lost private health coverage.

However, the percentage of the nation's gross domestic product devoted to health care increased to 17.6% in 2009, a full percentage point higher than in 2008, because health spending grew at a faster pace than the economy as a whole. Overall health spending reached $2.49 trillion, according to an annual report on national health spending by the Centers for Medicare & Medicaid Services Office of the Actuary, published the journal Health Affairs.

Source: Doug Trapp, AMNews [1/17/11]

A Good Rule of Thumb for Maintaining Peace

Keep peace in the office by following this rule: Never complain to others about anything that cannot change or improve in the next five minutes.

Source: Communication Briefings [January 2011]

Query: Sclerosing Code

What is the correct CPT code to use for sclerosing of a nerve for an intermetatarsal neuroma: CPT 64632 or CPT 64640? Would someone kindly explain the difference in these codes?

Howard Dinowitz, DPM, Brooklyn, NY

Response: Sclosering is a term that implies a change to the tissue, in this case, nerve. It is not necessarily associated with destruction. Typically, your alcohol product package insert will note that 40% or greater alcohol solutions are destructive to peripheral nerves. If you are sclerosing a nerve using less than 40% alcohol solution, you are not destroying it, and you cannot use either CPT 64632 or CPT 64640. In all likelihood, because a number of doctors report improvement in symptoms ranging from little/no to complete resolution, the effect is therapeutic. I would tell you that you would code that injection as CPT 64450 - peripheral nerve block, therapeutic - regardless of the nerve injected. Having said that, I would caution you to check with the particular payer to see if they have any written policies limiting your coding or directing you to "its preferred" code.

If your alcohol solution is 40% or greater (you'd better be sure you've read the literature studies on those concentrations), then if you are injecting an intermetatarsal neuroma, you would code the injection as CPT 64632. A peripheral nerve elsewhere on the foot, CPT 64640. You would not bill CPT 64455 - injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (e.g., Morton's neuroma) - because you are not injecting cortisone as your therapeutic agent.

Harry Goldsmith, DPM, Cerritos, CA  

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RE: Homeopathic Injections? (Robert Bijak, DPM)
From: Randall Brower, DPM, Jonathan Purdy, DPM

I have asked PICA and my attorney regarding this very issue. Homeopathy is not allopathic, proven by scientific method or FDA standards. While treatments may work, they are indefensible in court. We live in a litigious world. My attorney will refuse to represent me if I use unapproved remedies or therapies with no scientific backing. Yes, some homeopathic remedies work well...but we, as a profession, must hold our specialty to a higher scientific standard. Otherwise, we risk not only appearing as "foot chiropractors" by mainstream medicine, but risk legal challenges that will not be defensible in court.

Read the bottom of every homeopathic medication, "not intended to diagnose, treat, cure, or prevent any disease." In my state,...

Editor's note: Dr. Brower's extended-length letter can be read here.

In my opinion, “alternative” medicine or homeopathy does not adhere to current scientific medical principles, and as such, does not uphold the Hippocratic Oath to which we all have pledged ourselves. It states “…I will respect the hard-won scientific gains of those physicians in whose steps I walk,…avoiding those twin traps of overtreatment and therapeutic nihilism.”

Homeopathy is not being used based upon compelling scientifically evidenced research, FDA regulated or not. At best, it employs the placebo effect as an aid which,...

Editor's note: Dr. Purdy's extended-length letter can be read here.

RE: Scarf Complication (Name Withheld)
From: Gino Scartozzi, DPM

Removal of the remaining screw is indicated since it complicates reduction of the post-operative fracture. Based on the radiographic view, it appears that the dorsal extent of the Scarf osteotomy is split along a fracture stress line from the screw heads. Re-approximation of the medial and lateral dorsal fragments and placement of a mini external fixator (to prevent shortening) with a bone stimulator should be considered. The patient should remain non-weight-bearing for a minimum of two months.
 
Gino Scartozzi, DPM, New Hyde Park, NY, Gsdpm@aol.com

RE: Article in New York Times about Orthotics (Daniel Tellum, DPM)
From:  Kevin A. Kirby, DPM

Even though the recent New York Times article, "Close Look at Orthotics Raises a Welter of Doubts", did not give a good account of the many positive therapeutic effects of foot orthoses that podiatric physicians are very familiar with, I do believe that the article accurately represented many researchers' view of foot orthoses.
 
The two biomechanics researchers interviewed for the article, Dr. Benno Nigg and Dr. Joe Hamill, are two of the world's leading researchers in foot and lower extremity biomechanics. When Dr. Hamill claims, “I guess the main thing to note is that, as biomechanists, we really do not know how orthotics work,” I would have to agree with him, from a research scientist's view. Research scientists need good, hard data from multiple studies to be able to form conclusions to how a process works within the human body. 
 
I believe that the critical missing part from the NY Times article is that the author under-emphasized the valuable role that custom foot orthoses have for patients with painful pathologies of the foot and lower extremity. The article would have been much more accurate and evenly balanced if it had reviewed even a few of the 30+ published scientific studies that I reviewed for a recently published chapter that demonstrate the positive therapeutic, kinetic, and kinematic effects of foot orthoses (Kirby KA: "Evolution of Foot Orthoses in Sports", in Werd MB and Knight EL (eds), Athletic Footwear and Orthoses in Sports Medicine. Springer, NY, 2010).

Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net

RE: Expensive Office Modalities and Reimbursement (Ken Meisler, DPM)
From: Michael Schneider, DPM

Dr. Meisler applauds those who are confident enough in their diagnosis of plantar fasciitis to  feel that not taking an x-ray is appropriate. Tell that to our patient who presented with classic plantar fasciitis symptoms as a referral from an orthopod. Had my partner not ordered x-rays, the lobulated cyst in her calcaneus that was diagnosed as multiple myeloma would not have been discovered.

In this practice, we x-ray everyone who presents with heel pain.

Michael Schneider, DPM, Avon, CO, vailfootdoc@aol.com

ASSOCIATE POSITION - CONNECTICUT 

Well-established, well-rounded, busy practice seeking part-time or full-time associate. Excellent opportunity for a highly motivated and ethical professional. Must have good patient skills. PSR-12 or higher with excellent skills required. Please fax resumes to 203-439-7916.

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 - 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.

TEXAS- WONDERFUL OPPORTUNITY!

Successful multi-office, multi-professional practice seeks well-trained new and established Podiatric Physicians with expertise in one of these areas: 1. Sports Medicine/Biomechanics/Gait Analysis, 2. Podopediatrics, 3. Diabetic Specialist, 4. Ankle & Rearfoot Surgery/Ankle Arthroscopy. A must to be really good in this niche, be outgoing, motivated, and personable with a dedicated hard working ethical desire to become successful. Send resume and letter of intent to sierrajip@gmail.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

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

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

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 

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

PRACTICE FOR SALE - SOUTHERN CALIFORNIA

Strong & diverse local economy, in a beautiful beach community. Well-rounded, established since 1983, fully equipped. Grossing over $600K, with continued yearly growth. Many types of insurance, reimbursement, and revenue sources. Local hospitals allow full scope of podiatric care. Terms available.  mcrosby@providerresources.com

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

SPACE AVAILABLE- NYC & LI

Office to sublet and share with DPM and chiropractor, East 60th Manhattan, and Plainview long island.  access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.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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