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January 24, 2008 #3,149 Editor-Barry Block, DPM, JD

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Computerized Gait Analysis Can Predict Propensity For Injury: MO Podiatrist

Anyone who has ever experienced foot pain is probably familiar with the adage, "When your feet hurt, you hurt all over." Dr. John Dailey, Washington podiatrist, would likely agree with that assessment, but takes it a step further. He knows that even if a person's feet don't hurt, they can affect the entire body, causing pain in ankles, legs, knees, lower back and beyond.

Dr. John Dailey

"Often problems arise because of the way people walk," said Dr. Dailey, who specializes in providing computerized gait analysis that evaluates the stability of the stance and gait and, in the case of athletes, is able to diagnose if someone has the propensity for an injury.

Although Dailey has only been in Washington for three years, he's been in practice for 25 years, and arrived with a long list of credentials: undergraduate work from the University of Pittsburgh, Medical School in Cleveland, residency in surgery and emergency room training in Cleveland, a fellowship in rheumatology, immunology and vascular disease at the Cleveland Clinic and an MBA from Washington University in St. Louis.

Source: Joan Elliott, The Missourian, [1/22/08]

NY/MA Podiatrists Clash on Significance of Brady’s CAM Walker

The sight of star quarterback Tom Brady wearing a protective boot over his right foot Monday had New York tabloids buzzing and New England Patriots followers fearing the worst, but the injury is not serious.

Dr. Michael A. Robinson

“Since two weeks remain (to the game), the medical/training staff may have determined that using this short leg walker would provide some relief of pressure, and provide support and rest, even if it was a minor injury,” said Dr. Michael A. Robinson, a sports podiatrist and foot surgeon based in Brookline, Mass. “The short leg walker would help promote more rapid recovery.”

Dr. Rock Positano

A New York podiatrist familiar with the boot — known as a CAM walker — told the New York Post that it could be more severe. "When they put you in a CAM walker, that usually means you're hurting," said Dr. Rock Positano, director of the Foot and Ankle Center at the Hospital for Special Surgery. "He's sustained some kind of trauma that requires immobilization. This is not just a simple strain or a sprain."

Source: Mike Reiss, The Boston Globe, David Heuschkel, Hartford Courant [1/23/08]

WA Podiatrist Arrested For Bike Thefts, Rescued From Car

A Longview man was treated Monday at Southwest Washington Medical Center in Vancouver after Cowlitz County sheriff's deputies rescued him Sunday from his car, which nearly went into the Kalama River. Due to federal privacy restrictions, a hospital spokesman could not disclose the condition of Dr. Jacob J. Bos, 35, a Longview podiatrist.

Bos was barely conscious and was bleeding seriously from a 4-inch cut in his forearm when witnesses found his car teetering on the river's edge around 5:30 p.m. near a Weyerhaeuser logging gate, deputies said. Several Weyerhaeuser employees held on to the vehicle to keep it from slipping into the river until deputies and aid crews arrived.

After Bos was rescued, deputies learned that Longview police arrested him Friday in connection with an eight-month investigation by the Seattle Police Department into the theft of bicycles from King County. Police found a stolen bicycle at his office and six or seven more bikes at his residence, Seattle detectives said. Seattle detectives told dispatchers they interviewed Bos in Seattle. He was released Saturday on his personal recognizance.

Source: Leslie Slape, Longview Daily News (WA) [1/22/08]

Query: 20% Sclerosing Alcohol injections for Neuromas

I have a patient who has failed on 4% ETOH injections for a neuroma, had the neuroma excised, and unfortunately has recurrence of the neuroma. I would like to use a stronger concentration of alcohol, say 20%, to try to treat this condition. Has anyone used a stronger concentration of alcohol for neuromas. If so, what was your treatment protocol as far as dose and frequency as well as what were your results?

Dan Methuselah, DPM, Columbia, SC

Query: MediSoft Billing Software

I would like to know your experiences with MediSoft Billing Software and its support team. What other programs do you recommend?

Syed Ahmed, DPM, Louisville, KY

RE: Painful Erythematous Toes (Judd Davis, DPM)
From: Kenneth L. James, DPM, MPA

Given the limited information, I would ask the patient if she tucks her sheets into the bottom of the bed, then tries to kick them out when she gets into the bed. I've seen many cases of distal neuropathy of the great toes B/L from the pressure of doing this(or from the pressure of the sheets themselves); a neuropraxia, but it's possible this could affect the 2nd toes, especially if she has a Morton's toe. If she denies this, I would consider a congenital condition of small arteries to the feet, or severe arteriosclerosis (possible athrosclerosis). Always consider yeast infections of the nails and periungual areas. I dispense more Nystatin cream to patients as the years pass.

Kenneth L. James, DPM, MPA, Ft. Worth, TX, docjammin@sbcglobal.net

RE: Bromidrosis (Melissa Gaffney, DPM)
From: Beth Pearce, DPM

I had a similar 'challenge' with my 18 month old son, now 10years old; I was pregnant with my daughter and had to solve the problem for obvious reasons. I discovered a product "On Your Toes" which worked in 2 applications! I now keep it in stock at the office always, with a complete money-back guarantee. I have never had to refund anyone's money.

Beth Pearce, DPM, St. Augustine, FL, drfootmagic@aol.com

RE: "Every Wound Doesn't Fit Every Algorithm” FL Podiatrist
From: Robert Scott Steinberg, DPM

I could hardly get past the quote from the article in Rehab Management [January/February 2008], "Rather than follow evidence-based protocol, Fishman prefers to rely, first and foremost, on her own judgment."

Of course, we all use our own judgment, but the difference between a physician and a lay person is that our judgment is based on evidence-based medicine. That's why we went to medical school and do CME.

Robert Scott Steinberg, DPM, Schaumburg, IL, Doc@FootSportsDoc.com

RE: Reimbursement for Topaz Procedure (Harry Goldsmith, DPM)
From: Lloyd S. Smith, DPM, Allen Mark Jacobs, DPM

Dr. Goldsmith raises a valid coding issue. There is no exact CPT code for Topaz, and as such, the unlisted code 28899 should be used. The process to attain a new CPT code requires valid evidence that the new technology is effective, safe and being used often enough to justify a code. Recommendations from industry about a specific code to be used should be scrutinized and vetted by an independent coding expert or organization. APMA will often be asked these questions and works hard to create an accurate answer. If you are an APMA member, I recommend you take advantage of that opportunity.

Industry most often presents these new codes to CPT but organizations such as APMA often do as well. If a CPT code is approved, it then will go to AMA's Relative Value Update Committee (RUC) for a value. I currently serve as the first podiatrist to ever have a full voting seat at the RUC and, as a result, have the opportunity to review all of these proposed values.

Lloyd S. Smith, DPM, Newton, MA, lloydpod@yahoo.com

Our hospital and surgery center recently interviewed several podiatrists regarding this matter.The truth is that most insurance plans do not cover the Topaz procedure if ethically and honestly billed.The individuals doing the procedure tell us (and this is advocated by speakers for this procedure at seminars) to bill this as a "partial plantar fasciotomy", "microtenotomy", "partial plantar fascia ablation", " partial plantar fascia release". Some speakers for Topaz (as well as company representatives) proffer a code promising to pay $1,000 for the procedure.

In truth, there is no EBM to support this procedure at this time. All of the literature support for Topaz in the treatment of recalcitrant inferior heel pain remains anecdotal. The billing for this procedure in my opinion borders on fraud using the aforementioned terms for CPT. It is an unlisted procedure unsupported with medical EBM. When I personally asked the podiatrists using these codes where they had gotton these ideas rather than billing as an unlisted procedure, I was told "so and so " (a speaker at some meeting) told us "it was OK to do this".

I do not doubt the speakers who advocate this therapy and report on their personal success with Topaz. Should PM publish this letter, I do not doubt a flurry of letters supporting the procedure will appear. The issue with Topaz and other new modality based therapies is two-fold: EBM for support, and ethical billing for the procedure. Clinical success and financial suce$$ are two oftentimes very different matters.

Allen Mark Jacobs, DPM, St. Louis, MO, allenthepod@sbcglobal.net

ASSOCIATE POSITION - VIRGINIA (SOUTHERN)

Immediate full-time and part-time associate position available. Unlimited income potential. Busy, diverse, 40+ yr Hampton Roads practice. Must be compassionate; energetic; and motivated; PSR24/36. Looking for long-term arrangement. Please send letter and CV to dcarrone@cox.net fax to 757-397-5889

Excellent opportunity for ethical & personable hard-working individuals to join a busy multi-office two physician practice. Looking for one podiatrist with interest in conservative care, including sports medicine and one podiatrist trained in rearfoot surgery. Rearfoot surgeon must be board eligible and working toward board certification. Competitive salaries, 401-K, health insurance, paid vacation and more. Please forward CV with references to nrussell@neondsl.com

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