The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

January 27, 2012 #4,369 Publisher-Barry Block, DPM, JD

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GA Podiatrist Uses Sculptra to Treat Metatarsalgia

Anyone who consistently wears heels can experience more severe problems over time, said Dr. Jason Morris, of Primera Podiatry, a new practice opening in February that offers advanced podiatry services such as a laser center and medical foot spa. “The most common problem for patients who wear high heels daily or more than two to three times per week is thinning of the fat pad at the ball of the foot,” Morris said.

Dr. Jason Morris

The abnormal positioning of the foot in high heels creates pressure on the ball of the foot, which thins the protective layer of fat and leads to a painful condition called metatarsalgia, he said. Morris uses a new treatment — an injection of the filler Sculptra — to replace the fat pad and plump the area. The treatment can last 12 to 18 months, he said. Morris also has treated heel wearers for stress fractures and another problem, bunions, which are caused by weakening of ligaments that hold the foot bones together. Bunions are genetic, but wearing heels can speed their development, Morris said.

Source: Nedra Rhone, Thwe Atlanta Constitution [1/20/12]

Winter Running Increases Chance of Slip and Fall Injuries: IL Podiatrist

The winter creates obstacles for runners—preparing for extreme wind and cold, keeping a firm footing on icy and snowy surfaces, and staying mentally determined to head outdoors.

Dr. Charlotte Covello

“The most common runner-related injury we see this time of year is a slip and fall,” said Dr. Charlotte Covello, a podiatrist at Michigan Avenue Podiatry. “If it’s a slippery surface, you do put more stress on the Achilles tendon because you take shorter strides.”

Source: Katy Nielsen, Medill Reports [1/24/12]

FL Podiatrists Face Proposed Elimination of Medicaid Coverage

Gov. Rick Scott's plan to cut about $2 billion in public funding to hospitals that care for the poor is devastating and even ridiculous, say hospital leaders who predict patient care will suffer if it is enacted. Scott's fellow Republicans in the Legislature say they don't like his plan, either. But they admit that the hospitals - which took a considerable hit last year - will face another swipe of the ax.

The Florida House's Health Care Appropriations Subcommittee's budget proposes cutting reimbursement rates by 7 percent across the board for all hospitals except those that serve children or rural areas. It also reduces nursing home payments by 2.5 percent, creates new restrictions for general care and eliminates reimbursements for podiatrists and chiropractors.

Source: Richard Martin and Tia Mitchell, Tampa Bay Times [1/24/12]

SOS Staff Training and Office Workshop Featured at NEOAPM Meeting

The Northeast Ohio Academy of Podiatric Medicine (NEOAPM) invited SOS Healthcare Management Solutions to conduct their notable staff training and office productivity workshop this past weekend at the Cleveland Marriott Hotel. Judging by the smiles, members of NEOAPM and their staff attended an exceptional day of fun, interaction, and learning as a team. 

Attendees at SOS Staff Training and Office Workshop at NEOAPM Meeting

The workshop offered practice building strategies, hands-on training, revenue opportunities, communication, and effective leadership skills. “This comprehensive workshop definitely crosses all boundaries and offers what we need to run a healthy office,” stated Dr. Richard Berkowitz, program chair, continuing education of NEOAPM. “There’s not another program like it!”

Amputations Due To Diabetes Fell More Than Half Since Mid 1990s

The AP (1/25) reports, "Foot and leg amputations were once a fairly common fate for diabetics, but new government research found that the rate has fallen by more than half since the mid-1990s, decreasing from more than 11 to about 4 per 1,000 people, the Centers for Disease Control and Prevention reported Tuesday."

In the study, investigators "checked national hospital discharge records for 1988 through 2008, looking for patients aged 40 and older who had lost a toe, foot, or leg to diabetes." The AP adds, "While diabetes has been growing more common in the United States - driven by obesity-related Type 2 - researchers have noted recent declines in some of the other most dreaded complications, including blindness and kidney failure." The study was published in Diabetes Care.

Source: Dermatology Daily [1/25/12] via AP, submitted by  Dr. Leonard Levy

Query: Finding a Practice Associate

I wanted to get the opinion of other podiatrists on the best way to find a long-term associate who can eventually share in my practice.  I'm only looking for one person long-term and currently have no plans to form a larger group.

Name Withheld (FL)

RE: Red Spot on Foot and Calves?
From: Stephen Musser, DPM

First, the quality of the photo needs to be more in focus . Second, Dr. Klein didn't provide any detailed history about his patient's skin problem, i.e.:  were there new shoes, a new soap used, was it previously treated with anything? He should resubmit his query with a better photo and with more detailed information. The top clinical suspicions to rule out are tinea, eczema, and contact dermatitis.

Stephen Musser, DPM, Cleveland, OH, ly2drmusser@gmail.com

RE: Achilles Tendon Problem (Geoffrey Bricker, DPM)
From: David Zuckerman, DPM, Todd Lamster, DPM

Achilles tendinois proximal to the insertion into the posterior calcaneus (watershed area) can be safety treated with ESWT. I have  treated this very painful problem many times over a 12-year period. The results of this type of treatment were published by John Furia, MD "High-Energy Extracorporeal Shock Wave Therapy as a Treatment for Chronic Noninsertional Achilles Tendinopathy" Am J Sports Med  March 2008 (36) 502-508. 

If is very effective when the proper case is selected. If there is  a tear, it must be elevated to see if treatment is possible. A tear isn't an automatic exclusion with ESWT. The degree,length of time present, as well as MRI evaluation must be taken into account. It is non-invasive, painless, and requires a single treatment in an office setting without the need for any local anesthetic.

David Zuckerman, DPM, Cherry Hill, NJ, footcare@comcast.net

I have recently treated a few patients successfully with platelet-rich plasma injections. My protocol was as follows: a PRP injection, followed by partial NWB and immobilization using a CAM walker, followed then with 2 weeks of PT. This cycle would be repeated a total of three times. I had one patient in his middle forties who gave up basketball entirely due to chronic Achilles tendinosis. I had to perform three injections in his left Achilles and one in his right. He also followed my protocol to the letter. Now, he is back to participating in tournaments and coaching a youth league. I strongly recommend PRP injection therapy.

Todd Lamster, DPM, Gilbert, AZ, tlamster@gmail.com

RE: Exparel Extended-Release Anesthetic (Tip Sullivan, DPM)
From: Sloan Gordon, DPM

I don't know about Exparel (extended release bupivicaine), however, when I am looking for a long-acting local anesthetic, I give a pre-emptive block. I mix 10 mL of Marcaine 0.5% plain with 10 mcg of clonidine  (Duraclon). Anectodally, this lasts 12-18 hours. Substituting a longer-acting local like ropivacaine (Naropin) lasts even longer.

Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net

RE: The Use of Uloric vs. Allopurinol in the Management of Gout (Elliot Udell, DPM)
From: David J. Kaplan, DPM

I have always treated the acute phase of gout, but it has taken me many years to make the decision to treat gout as a chronic condition. My early protocol was to treat the acute phase and refer the patient back to the PCP for chronic management. But after being told by countless PCPs that they don't treat first attacks, (and usually not second or third attacks), I thought how ridiculous!

Although the attack happens suddenly, the hyperuricemia that produced the attack has been brewing for years, perhaps as long as 20 years. I learned in first year pathology that gout affects 3 organs, joints, kidneys, and heart! Rheumatologists are now saying that first attacks should definitely be treated. I think that any time a basic metabolic profile is done, a serum uruc acid should be included. I have seen gout attacks in males as early as their 20s. This is a very common and complex medical issue, but I just wanted to start the ball rolling and hear from my colleagues about this matter.

David J. Kaplan, DPM, San Mateo, CA, kaplanfootcare@gmail.com

RE: Barefoot Running Benefits Can be Achieved Without Ditching Shoes: NZ Podiatrist
From: Barbara Hirsch, DPM

Here's my response to "(Podiatrist Bruce) Baxter concedes that many podiatrists reject the barefoot movement because it threatens their orthotics business." Is that really why he thinks many podiatrists would reject the idea of running barefoot? What about the possibility of: broken glass, sharp objects, live bees? These are just a few reasons I would have some concerns. Certainly not because it threatens the orthotics business. If runners have such biomechanical issues, they will need orthotics MORE due to the lack of support from a running shoe. Runners will also need more podiatric services due to foreign objects in their feet.

Barbara Hirsch, DPM, Chevy Chase, MD, davis44@gmail.com

RE: PM Celebrates 30th Anniversary
From: Lynn Homisak

To Barry, Hermine, David, and everyone I’ve had the pleasure of working with at PM, I’d like to add my congratulations along with all the others for reaching this exciting and accomplished milestone. Everyone knows that the PM team has been consistent in providing us with a professional and respected venue that is “second to none” in our profession.

As subscribers, we have the privilege of not only looking to it to gain knowledge and perspective, but to freely participate in healthy communication by sharing our ideas, concerns, news, best wishes, and services. It is truly a resource we have all benefitted from and have appreciated for the past 30 years! Stick around ANOTHER 30, please! Thank you!

Lynn Homisak, Renton, WA, lynn@soshms.com

RE: Mrs. Malaprops Returns

A patient recently presented with a painful, red, swollen, first MPJ on the left foot. Her chief complaint was, "I think I have the "gouch" again.
 
Rich Hofacker, DPM, Akron, OH

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