The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

January 30, 2010 #3,767 Publisher-Barry Block, DPM, JD

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Botox May Help People Walk: TX Podiatrist

You've heard of Botox to reduce the appearance of fine lines and wrinkles. Some doctors are using it on the feet now to help patients get up and walk. These are patients with damage to the brain or spinal cord, either from an injury or stroke, or multiple sclerosis or cerebral palsy. Since spastic muscles can cause the feet to contract in a way that makes it difficult or impossible to walk, Botox may instead relax those muscles.

Dr. Tyson Green

"That's when the Botox will come into play to relax a contracture, so that we can either brace the foot or provide casting to provide stability and flexibility within that foot," said Dr. Tyson Green, a podiatrist.

Source: Kristin Beerman, KCBD NewsChannel 11 [1/26/10]

DC Podiatrist Debunks Ionic Foot Bath

The claim: An electric current in the bath water helps detoxify the body and restore pH balance.

Dr. Arnold Ravick

The shame: It's scientifically impossible for ions to rid the body of bad chemicals, says Arnold Ravick, DPM, a podiatrist at Capital Podiatry Associates in Washington, DC. Further, no studies exist to prove that the machine's ultrasound wave will help ions transfer toxins to the surface. The only thing it may release is iron, which turns the water a "detoxifying" brown.

Source: Cristina Goyanes, Womens Health Magazine [1/29/10]

AMA, Others Challenge FTC on 'Red Flags' Rule

The American Medical Association has again asked the Federal Trade Commission to abandon its position on what's known as the “red flags” rule, which targets identity theft in credit transactions. FTC wants this rule to apply to physicians and their practices because they bill patients.

In a new letter to FTC chairman Jon Leibowitz, the AMA, the American Dental Association, the American Osteopathic Association and the American Veterinary Medical Association point to a recent court decision they say supports their complaint that the FTC has overstepped what Congress intended with the Fair and Accurate Credit Transactions Act of 2003.

The FTC, in part, in response to vigorous resistance from the AMA, has delayed enforcement of the rule, most recently pushing it back to June 1. The rule calls for organizations that extend credit to have written plans describing how they will watch for and respond to identity theft “red flags” in their billing operations. The original enforcement date was Nov. 1, 2008 but has been extended several times, the latest enforcement date set for June 1, 2010.

Source: Gregg Blesch, Health IT Strategist [1/29/10]

Organize by Using your Head First

In organizing, the biggest skill is keeping your HEAD in the game.  The mental part of being organized has to come before the physical part. Get it in your head that you are going to do whatever it takes to get and stay organized to increase your daily productivity and up your game when it comes to efficiency. That means make the decision, visualize the outcome, and follow through to reap the benefits.

Source: Wendy Ellin, President, Momentum. For further infomation about the American Academy of Podiatric Practice Management (AAPPM) click here.

Query: Benchmark for Patients Seen

Does anyone have a suggestion for obtaining benchmarks for podiatry practices? For example, how many patients does the average podiatrist see in a day? I am eager to know if there is some sort of national guideline for this.

Priti Lakhani, DPM, Topeka, KS

Editor's Comment: Podiatry Management's Annual Practice Management Survey appears in the February 2010 issue, and provides this type of information. This year's results show that podiatrists averages  92.6  patients per week.

RE: Botox as Adjunctive Treatment in Jones Fractures? (Bret Ribotsky, DPM)
From: Multiple Respondents

I would assume that the unopposed action of posterior tibialis would bring the foot into a strong inverted position, placing a strain at the insertion of the peroneus brevis, resulting in more problems than you started with.
 
David Secord, DPM, Corpus Christi, TX, david5603@pol.net

Although the use of Botox to paralyze the muscle causing the avulsion in a Jones fracture seems like a novel way of improving healing outcomes, issues of long-term use and toxicity have to be evaluated. Botox which is derived from the toxins which cause botulism is highly toxic in large quantities. How much would be needed and over what length of time to achieve the required result? Would you need more than is normally used to relax muscles in the skin?  It would seem that prior to trying this on humans, animal studies should be done first.
 
In our practice, we have been very successful in preventing non-unions of all fifth met base avulsion fractures with the early use of Exogen bone stimulators. To date, we have not had a non-union. Prior to the use of stimulators, we had our share of Jones and similar fractures go on to non-union. The only problem is that most insurance companies will not cover bone stimulators for early fractures, so it becomes a battle between the manufacturer, patient, insurance carrier,  and our office staff in order to get a unit for everyone who needs it. The good outcomes we see justify our battles. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

While I applaud Dr. Ribotsky’s out of the "BotOX" thinking, remember where the peroneus brevis inserts, on the styloid process of the 5th met. Fractures of the true base or styloid heal quite well, even in a CAM Walker boot. So, Dr. Ribotsky’s hypothesis about the Jones fracture being difficult to heal is not primarily due to the pull of the peroneus brevis. It is primarily due to lack of vascularity, which is why we use bone stims to increase healing potential.

Peter Bregman, DPM, Tewksbury, MA, footguru@comcast.net

RE: Palpable Mass in Dancer (Michael Rosenblatt, DPM)
From: Barrett Sachs, DPM

In response to Dr. Rosenblatt's comments, I want to make it clear that both the patient and her parents are opposed to any treatment will keep her from dancing competitively. All of Dr. Rosenblatt's concerns are certainly shared by me, and believe me, I have considered all the alternatives.

Barrett Sachs, DPM, Plantation, FL, uncletenose@aol.com

RE: Time to Act: (Robert Bijak, DPM)
From: Multiple Respondents

Dr. Bijak writes: "Podiatrists are a small step above nurse practitioners and a mile away from MD's and will stay that way without a degree and attitude change by the majority of the profession."
 
This type of thinking has indeed been present for the 30+ years that I have been a podiatrist. It’s rooted in the unfair and disempowering way we compare ourselves to other medical professionals. Let’s give up, once and for all, saying to ourselves: "podiatrists are better, worse, superior or inferior to other professionals." We are different and we provide a service that most other medical professionals are not well trained to do.

Last night, I attended a lecture on new treatments for gout. It was attended by MD's and podiatrists. We got to mingling after the lecture and it became clear that the MD's in the room had no concept of how to give a periarticular injection or posterior tibial block to treat a case of acute gout. My explanations of these treatments were way over their heads. On the other hand, the management of complex hypertension and other systemic medical disorders would be over my head. I'm proud and happy to be a podiatrist, and part of a community of colleagues that addresses human pain and suffering and increases the quality of life for people, every day of the week. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

I applaud Dr. Bijak for his enthusiasm. Without people who are passionate and get hot under the collar at times, our profession would never progress.
 
That being said, I would like to ask Dr. Bijak what he has been doing about our profession? Before he started putting down the people in our profession, I would have suggested that he thank them for getting us where we are today in such a short time historically.  I would invite him to be the one to come on down here to Mississippi and do surgery on the ankle. It is real easy to make some inflammatory statements - I know because I have done it - but much more difficult to back them up with action.
 
Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

I barely have enough time to send this correspondence as I was woken up last night by the local ER. One of my patients presented with a foreign body abscess with rapid onset ascending cellulitis. Although I was not on ER call last night, since she is my patient, I was notified. I recommended admission to initiate IV antibiotics and to schedule her for the OR for I&D abscess and removal of the FB. I was informed that the "hospitalist" would not do podiatry admissions, and that I needed to admit, order the consults, schedule the OR, and do the admission H&P.

Although the media would simply state that this situation cost the public over $20,000, I expect to receive under $300 of that. Recently, a patient with post-op total knee replacement was sent to me for a post-op physical therapy-induced, full-thickness ulcer with cellulitis. On examination, a Charcot calcaneal fracture was noted with an MRSA infection. When consulting the out-of-town orthopedic surgeon regarding this potentially devastating complication, he calmly asked, "what kind of physician are you?" After responding, "a podiatrist" he stated, "Great...whatever you think she needs...you handle it."
 
Hmmm... let's not confuse these issues. Under the current system of medicine, and especially under the apparent future system, physicians should understand that we are expected to be solidly in the "middle class"...at least we won't be the much talked about "working poor."

Peter Wiggin, DPM, Mansfield, OH, wigone@aol.com

ASSOCIATE POSITION – ILLINOIS

Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings are available. If interested, fax curriculum vitae to 847-674-2113 or e-mail to feetwork@aol.com

ASSOCIATE POSITION - MASSACHUSSETTS

Full-time/Part-time podiatrist needed for a busy nursing home practice. Please send inquiries to debbierobertsm4@hotmail.com

ASSOCIATE POSITION – MISSOURI

Expanding multi-location practice seeks motivated individual to contribute to growth. Practice enjoys strong reputation and name recognition. Prefer candidates with interest in partnership opportunity. Established locations available for PSR 24+ and includes incentive comp with benefits/coverage. Please send CV to jmurray@foothealers.com or call John Murray at 314.842.3875

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes. Top hospitals. Fax CV with references to 703-491-9994

ASSOCIATE POSITION – TEXAS

Dynamic, growing practice in Dallas/Fort Worth area, seeking surgically trained, Board Certified/Board Qualified Podiatrist. Excellent salary and benefits compensation package, for the right candidate, with partnership/buyout opportunity. Contact/Send resume to: jmh6122@yahoo.com

ASSOCIATE POSITION IN WESTERN NORTH CAROLINA

Well diversified growing podiatry practice with good mix of office, surgery center and hospital procedures seeking a full-time associate. Must have NC license or taking state exam this year. Candidates should have excellent bedside manner equal to their medical skills. E-mail a cover letter and CV to DPMCAREER@AOL.COM

ASSOCIATE POSITION - TEXAS

Wonderful opportunity! Successful multi-office, multi-professional practice seeks well-trained new and established podiatric physicians with expertise in sports medicine, podopediatrics, rearfoot/ankle surgery, or hospital podiatry. A must to be outgoing, motivated, and personable with a dedicated hard-working ethical desire to become a winner. Send resume, current photo and letter of interest to sierrajip@gmail.com

PRACTICE FOR SALE - TENNESSEE

Well established practice for sale. Full scope medical and surgical practice including DME. Exceptional practice with a high volume of new patients. Excellent hospital and surgical center privileges with investment opportunity. Great area for a family and the outdoorsman. 731-446-7285/E-mail nraines@charter.net

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

ASSOCIATE POSITION - MARYLAND

Associate needed to join a multi-office podiatry practice in the Baltimore MD Region. Desired candidate should be surgically trained with Board Eligible / Certification. You must be hard-working, ethical, compassionate and confident in your abilities to deal with pathology, patients, staff and fellow physicians. Patient base is already established. Excellent income and growth potential for the right associate. Please forward a cover letter and resume and availability to FootDocMaryland@Gmail.com

SPORTS MEDICINE FELLOWSHIP

The Palo Alto Medical Foundation Surgical/Sports Fellowship Aug 1, 2010 -  July 31, 2011. Applicants must be able to obtain a California license. Responsibilities include assisting in all types of foot and ankle surgery, (approximately 500 cases), seeing patients in the sports clinic and must complete 2 papers/research projects. Benefits include salary of $56K/yr, medical, dental, malpractice, and CME allowance. Interviews will be at the Midwest Podiatry Conference March 11-13, 2010, but on-site visit is preferred. Minimum 24-month surgical residency training pre-requisite. Applicants should send a letter of interest, CV and three letters of recommendation to: Amol Saxena, DPM,  650/853-2927 HeySax@AOL.com

ASSOCIATE POSITION – CINCINNATI, OHIO

This is your once in a lifetime opportunity to join one of the most successful practices in the United States. We do not have a seniority system. If you are motivated and have completed a PSR 24-36 residency, your income is limited only by your enthusiasm and desire to achieve. Email resume to khart@cincinnatifootcare.com

PRACTICE FOR SALE - CENTRAL FL 

Practice and medical building for sale, in beautiful, high quality of life, growing area, Central Fl.; 2000 sf bldg. fully equipped/ designed for podiatry; excellent location, features & exposure; near hospital, wound and HBO center. Great opportunity for expansion & investment; good insurance climate. 352-223-2713 / E-mail: windnwave@earthlink.net

ASSOCIATE POSITION FULL-TIME - SUBURBS OF CHICAGO

PSR 36 - month-trained podiatrist needed for busy suburban Chicago practice. Full benefit package included. If interested, please email your curriculum vitae to foot1st@yahoo.com

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