The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

January 26, 2007 #2,794 Editor-Barry Block, DPM, JD

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GA Podiatrist Winning Battle to Save Student’s Backs

Clarke County school officials apparently have changed their minds that locker-less hallways at Hilsman Middle School are worth students' aching backs. Some Hilsman parents claimed the lack of lockers made the school a dangerous place - for their students' backs, said Todd Herron, an area podiatrist whose daughter is an eighth-grader at the school.

Dr. Todd Herron

"We're tired of our kids coming home and complaining about back pain," said Herron, who has spoken at previous board meetings and requested new lockers. "I had, at least calling me, 30 (parents). It's an issue."

Herron has said his older daughter, who attended W.R. Coile Middle School in the late 1990s and now attends the University of Georgia, still experiences back pain from carrying her book bag around Coile. All Coile students now use lockers, school administrators said last year

Source: Jeffery Whitfield, Athens Banner-Herald [1/24/07]

CT Podiatrist Testifies in Death Penalty Case

Prosecutors in the death penalty phase of Michael Kendall's triple murder trial sought to show Wednesday that the fires Kendall set when he shot his wife and daughters to death in 2003 could have killed others, too.

The first person to testify was Dr. Samuel Berkowitz, a podiatrist, who said he examined Adam Alston, Ramona's Kendall’s father, on Jan. 2, 2004, a few weeks after the triple homicide. Alston, who had escaped the fire, complained of foot pain.

Dr. Samuel Berkowitz

Berkowitz testified that Alston had a lack of blood flow in his legs, which "makes sustained movement painful."

The circulation problems were so bad that Alston later had to have his legs amputated. He has since died. Michael Kendall had testified during the guilt phase of his trial that he didn't know his father-in-law had bad circulation.

Source: Christine Dempsey, Hartfort Courant [1/25/07]

AAPSM Publishes 2007 Running Shoe List

When the list of nominees came out this week, there were a few surprises. Some of the best-known performers were passed over, with some new stars stealing a bit of the spotlight. No, not the Oscars — the American Academy of Podiatric Sports Medicine released its 2007 running shoe list. This academy, comprised of people who see and treat sports injuries every day, analyzes and recommends the year’s best shoes.

The academy evaluates shoes based on seven criteria, including durability, wide availability, quality control and stability. It also considers price, noting: “As we all know, not every recommendation works out and this occurrence is easier to accept with a $75 shoe than with a $150 shoe.”

The academy has a slightly different classification system, paying special attention to pronation, the foot’s tendency to roll inward. “The current commonly used terms of stability and motion control are poorly chosen,” it says. “The way these terms are used in shoe descriptions does not reflect biomechanical function. We choose to define shoes by degrees of protection from overpronation.”

Source: Bernice Torregrossa, The Daily News (Galveston, TX) 1/15/07

More Providers Adopt 'Disclosure and Apology' Policy

A growing number of healthcare providers are adopting "disclosure and apology" policies for dealing with patients who have experienced a medical error, the Wall Street Journal reports. Several states have passed laws protecting doctors' apologies from being used at trial, and more hospitals are implementing policies requiring that doctors and nurses quickly reveal errors to patients and families when warranted.

Hospital risk managers and insurers in previous years generally recommended "defend and deny" policies for dealing with errors. The stance of risk managers and insurers has changed in "part because of mounting evidence that disclosure and apology programs, which often include an upfront offer of a financial settlement, can sharply reduce malpractice costs," the Journal reports.

The University of Michigan Health System has seen its number of malpractice lawsuits decline from 260 to 100 since it adopted an apology program in 2001. The average legal expense per case has declined more than 50%, according to UMHS Chief Risk Officer Richard Boothman. Boothman said, "Many doctors really want to be open and apologize to patients but are led to believe it can end up in financial disaster, when the truth is quite the opposite" (Landro, Wall Street Journal, 1/24)

Source: Wall Street Journal Via American Health Line [1/24/07]

Query: Kick Boxing Injury

I have a patient, diagnosed with an intermetatarsal neuroma that has responded well to injection therapy until he began kickboxing. This requires his being on the balls of his feet on a wrestling mat or other less yielding surface. As a result, he is experiencing a recurrence of symptoms. He has indicated that he will be purchasing a special pair of kick boxing shoes. My question is has anyone had experience with kick boxers and what suggestions would you have for a possible orthoses in the presence of the neuroma?

This is my first such encounter and hope that there are others who have had more experience in this venue.

Chuck Ross, DPM, Pittsfield, MA

Query: Cryotherapy S/P Hammertoe Surgery

A 59 year old African American is to undergo a bunionectomy and hammertoe repair. She is a diabetic, a smoker, hypertensive, has elevated cholesterol. Vascular studies demonstrate slightly elevated ABI's.

Is the use of a cryotherapy (ice water unit) appropriate for home use following surgery in such a patient? Is the use of such a device appropriate for continuing care for 8 days following surgery? Would you allow this patient to sleep with such a device applied?

Allen Jacobs, DPM, St. Louis, MO

RE: Fused Bilateral Calcaneal Growth Plates in 9 Year Old (Mark Goldberg, DPM)
From: H. David Gottlieb, DPM

Without knowing a diagnosis this sounds like a condition that can be treated via distraction osteoneogenisis. There are also probably differences in the rate of growth of other growth plates in the affected limb with a resultant limb lenght difference that will only increase over time. Your patient needs to have a radiographic survey of at least both legs to rule out any other affected areas.

Treatment would most likely entail use of a Taylor Spatial Frame to distract the calcaneous, lengthening of the gastroc-soleal complex as well as addressing any limb length developmental discrepancies. Your patient is in luck because several of the world experts in treating these kinds of condition are nearby in Baltimore, MD at the Rubin Institute for Advanced Orthopedics. They are very podiatry-friendly and in fact have a podiatrist on staff and 4 or 5 podiatry residents rotate through their practice at any one time.

H. David Gottlieb, DPM, Baltimore, MD, hdavidgottliebdpm@gmail.com

RE: Subtalar Arthroresis (Subtalar Arthroresis)
From: Timothy Vogler, DPM, Randall Brower, DPM

Examine the child for equinus (note the foot should be fully supinated when testing for this or it is easily missed).

Timothy Vogler, DPM, High Poiunt, NC Timothy.Vogler@cornerstonehealthcare.com

Off the cuff, it sounds like you may have a forefoot supinatus/varus deformity that is partiall if not totally uncompensated on tghe rearfoot. In other words, when you effectively supinated the rearfoot with a ST implant, if the forefoot varus/supinatus is not a result of the prior rearfoot pathology but a primary deformity, the forefoot varus will be accentuated. With the forefoot in varus, the FHL tendon has a much more effective pull on the distal phalanx of the hallux, hammering the IPJ. I'd place the patient back into an orthotic with a valgus forefoot wedge/post to pronate the forefoot on the rearfoot.

Randall Brower, DPM , Roswell, NM, randoman33@yahoo.com

RE: Removing Granulation Tissue (Bryan C. Markinson, DPM)
From: Mark Schilansky, DPM

Dr. Markinson is 100% correct in that sending the "granuloma" to a pathologist would have allowed the treating doctor to bill for, and be reimbursed for a biopsy. More importantly, by following Dr. Markinson's advice you can save your patient's life. Acral-lentiginous melanoma is frequently misdiagnosed until the melanoma has spread beyond the foot.

Mark Schilansky, DPM, Catskill NY, schilansky@mhcable.com

RE: Hereditary Neuropathy With Liability To Pressure Palsies
From: Bryan C. Markinson, DPM

I recently had involvement of a case of a unilateral drop foot in a 13 year old male. His initial complaints were numbness on the dorsum of the foot as well as lateral leg, then the foot drop. NCV testing revealed complete conduction block at the fibular neck. The initial evaluation was done at another hospital. I was ready to refer for decompression when I discussed the patient with a neurologist I work with. She told me to hold off on any surgery until genetic testing was done, specifically to rule out a genetic disease called "hereditary neuropathy with liability to pressure palsies." I had never heard of this. Apparently, the disease causes a type of hypersensitive response to otherwise trivial pressure on a nerve, such as might occur while wearing a backpack, sitting for long periods, minor trauma to the extremities, etc. There is no impact on life expectancy. I recommend review of the following web link for more information:

http://ghr.nlm.nih.gov/condition=hereditaryneuropathywithliabilitytopressurepalsies;jsessionid= C305B5D8FA9AF296E4A24071CC9FF6CA

If any one out there has information or seen such a case with lower extremity manifestations, I would love to hear about it.

ASSOCIATE POSITION -WASHINGTON - SEATTLE AREA

Two-location practice looking for long-term commitment leading to partnership. Medicare certified surgicenter each location. Must be highly motivated, ethical & have good patient skills. Competitive salary & benefits package available. Excellent opportunity for the right candidate. Send CV to fax 425-775-9078, e-mail to nwfootandankle@yahoo.com or call 425-775-1505.

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 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 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

ASSOCIATE WANTED - NORTH CAROLINA, CHARLOTTE AREA

Incredible opportunity to join a busy, well-established group practice. Looking for a self-motivated, hard-working individual seeking to become a partner. Hospital and surgery center privileges. Salary plus percentage, 401k and real estate opportunities. Send CV to universityoffice@ bellsouth.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

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

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

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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