The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

January 25, 2012 #4,367 Publisher-Barry Block, DPM, JD

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MD Podiatrist Discusses Flatfeet and PAD

If your heels or arches hurt when you walk: You may have flatfeet, which means your arches collapse more than they should when you put weight on them. “Flatfeet can lead to knee and lower-back pain,” says podiatrist Dr. James Christina, the director of scientific affairs for the American Podiatric Medical Association. Try over-the-counter arch support inserts, and if the pain persists, see a podiatrist.

Dr. James Christina

If they cramp up when you walk: This could be a sign of peripheral artery disease, in which blood doesn’t effectively circulate to the extremities. “Poor circulation can lead to lactic acid buildup in the foot muscles, which causes cramps,” says Christina. See a podiatrist right away for an initial diagnosis.

Source: Michele Bender, Fox News [1/20/12]

FL Podiatrist Named Chief of Foot & Ankle Surgery at Sarasota Hospital

Dr. Robert Goecker is passionate about foot and ankle surgery and about using his gifts and talents as a podiatrist to improve the lives of patients. Whether it's in the Baja Project for Crippled Children providing free corrective surgery to children with clubfoot, or right back here in Sarasota, Dr. Goecker comes alive when he has the opportunity to help someone. 

Dr. Robert Goecker

It was in recognition of this passion and his reputation for excellence that Sarasota Memorial Hospital recently announced that Dr. Goecker would take over as Chief of Podiatric Foot and Ankle Surgery. "Dr. Goecker has truly provided some incredible outcomes to patients who otherwise may have progressed towards major lower extremity amputations," says Dr. Michael Lepore, Past Chief of Staff of the Sarasota Memorial Health Care System.

NH Podiatrist Collects Over 1,500 Shoes to Benefit Soles4Souls

Every seven seconds, Soles4Souls Inc. gives away a pair of shoes to someone in need. To help benefit those in need, Core Podiatry in Exeter collected 1,524 pairs of gently worn shoes. Students from Winnacunnet High School dedicated their time and efforts to help box up the footwear, which was then shipped to those in need.

Dr. James Dolan

During the past two years, Core Podiatry has collected more than 2,600 pairs of shoes for the cause. "At Core Podiatry we talk with patients about shoes each day and often have patients bring in multiple pairs of shoes to be evaluated," said Jim Dolan, DPM, of Core Podiatry. 

Source: Foster's Daily Democrat [1/20/12]

Car Crahes into NJ Podiatrist's Office

A car smashed into the waiting room of podiatric surgeon Dr. Brian Gotchel on Kings Highway early Thursday morning, township police Chief Craig Mangano said. Mangano said the driver was traveling south and intended to make a left into the parking lot of the office building that includes Gotchel’s office. 

Worker outside of Dr. Brian Gotchel's office (Photo: Lori M. Nichols)

The vehicle, a 2003 Saturn Ion, then veered back into Gotchel’s office, coming to a stop about half-way into the office, the chief said. The crash ruptured a gas line in the building, he explained, but the driver exited the vehicle and was transported to Underwood Memorial Hospital in Woodbury.

Source: Joe Green, Gloucester County Times [1/19/12]

Doc-Owners Find EHR Adoption More Taxing: Survey

Physicians who own their practices may require more help to implement electronic health records than those who do not, a new study finds.  Using survey data from more than 150 physicians, taken during a Massachusetts eHealth Collaborative pilot, researchers from Boston-based not-for-profit system Partners HealthCare assessed physicians' perceptions about the difficulties associated with EHR implementation.

Of the respondents, more than half said implementation was "somewhat difficult," while 35% called the EHR implementation process "very difficult." Roughly a quarter of responding physicians who did not have any ownership stake in their practices said they considered implementation very difficult. But that share jumped to 38% for physicians with full or partial ownership.

Source: Maureen McKinney, Modern Healthcare [1/20/12]

Query: Painful Piezogenic Papules

I was wondering if anyone has some treatment tips for a patient with painful piezogenic papules (herniations of adipose tissue, typically around the heel rim). Most of them that I see are asymptomatic, but I've seen two symptomatic cases this week. For one patient, I advised ice compresses, compression stockings, and weight loss. Other possibilities I contemplated, but did use, were plastic heel cups and an NSAID (Voltaren) gel. 

Doug O'Heir, DPM, Waterville, ME

Query: The Use of Uloric vs. Allopurinol in the Management of Gout
 
The makers of Uloric, a new uric acid-lowering medication have been directly marketing to patients via television commercials. They are also marketing to podiatry by visiting our offices and even sponsoring dinners where they detail podiatrists on their product. I would like to get feedback from those of you who are using Uloric and who have used allopurinol as to which medication you feel is doing the best job in managing our patients with gout. Another issue is that Uloric, which is a new product with a patent, is significantly more expensive than allopurinol, which is generic.
 
Elliot Udell, DPM, Hickville, NY

Query: Code for Promogran

What is the appropriate code for dispensing Promogran (systagenix.com/lets-heal/lets-promote/promogran-prisma-3)?  Is it A6010 (collagen based wound filler, dry form, per gram of collagen) or A6021 (collagen dressing, sterile, pad size 16 sq in or less, each)?

Thomas Rehm, DPM, Asheville, NC

Response: A6021 - Collagen dressing, sterile, pad size 16 sq in or less, each.

Bryan Blanck, DPM, Ada, OK

Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription

RE: The Passing of Harold Marquit, DPM
From: David M Schofield, DPM

I was sorry to hear of the passing of one of the gentle giants of our profession. Dr. Marquit mentored so many of us. He taught us what it meant to be a professional, to be a podiatrist. His strength and knowledge were there for all to share. Harold stood tall as a kind gentleman. I feel blessed to have been counted among his friends. My condolences to the entire Marquit family and the family of podiatry. Harold will be missed by many. 

David M Schofield, DPM, Past President, APMA, NYSPMA

RE: Red Spots on Foot and Calves? (Daniel Klein, DPM)
From: Shaun Hafner, DPM

Has Dr. Klein ordered bloodwork? I recommend ruling out acute rheumatic fever. I would order an antistreptolysin O (ASO) titer. Also consider performing other tests: CBC w/diff, ESR, CRP, Lyme titer, ANA, uric acid, theumatoid factor or HLA-B27.

Shaun Hafner, DPM, Manassas, VA,shaun24nyc@hotmail.com

RE: Achilles Tendon Problem (Michael J Felicetta, DPM)
From: Geoffrey Bricker, DPM

I would use prolotherapy - an injection of 2 ml. each of Sarapin, 50% dextrose, and 0.5% Marcaine around the swollen area every 2 weeks for up to 7 injections. In my hands, there is a 90% success rate with Achilles problems. Sometimes, it takes 2-3 injections to see improvement.

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

RE: Keeping Toes Warm During Antarctica Marathon (Ayne Furman, DPM)
From: Paul Busman, DPM, RN

I suggest that your patient consider a psych evaluation rather than worry about what socks to wear for the Antarctic Marathon. We're talking about the Ant-freakin'-arctic here! Temperatures, according to the marathon's website, of -21C, plus wind. The cost for this little jaunt in the park (a 5 day package) is 9,900 Euro from Chile (so add airfare to Chile too). As of this morning, that's $12,805 USD. I know, I know, it's a personal challenge, yadda yadda. I still think it's kind of irrational to spend that kind of fortune to run a race that stands a good chance of your leaving frozen bits of yourself behind.

Note: If the marathon isn't insane enough, they run an ultra-marathon in the Antarctic too! 

Paul Busman, DPM, RN, Clifton Park, NY, paul@busmanwhistles.com

RE: Podiatry Management Celebrates 30th Anniversary
From: Howard Dinowitz, DPM

My sincere congratulations for a yeoman's effort in bringing PM to the forefront of podiatric medicine. It has become a mainstay in every podiatrist's daily to-do list. A day doesn't go by without the urge to look for the new edition or review the recent one just released. I'm certain that every podiatrist reading this agrees! Stay well and keep this wonderful blast of daily information coming for many years to come.

Howard Dinowitz, DPM, Brooklyn, NY, drdinowitz@verizon.net

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