The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

February 01, 2007 #2,799 Editor-Barry Block, DPM, JD

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Mandracchia Named Chief Medical Officer at IA Center

Vincent Mandracchia, DPM, a nationally respected foot and ankle surgeon, has been named chief medical officer at Broadlawns Medical Center. Mandracchia, who has been with the hospital since 1995, is a major advocate of transforming Broadlawns into the “people’s community hospital” for Polk County. Mandracchia, who practiced in Philadelphia and southern New Jersey before moving to Iowa 12 years ago, accepted the permanent role after serving as interim CMO since August 2006.

Vincent Mandracchia, DPM

In addition to his practice and teaching duties at Broadlawns, Mandracchia holds the position of clinical professor of podiatric medicine at Des Moines University College of Podiatric Medicine and Surgery. A Fellow of the American College of Foot and Ankle Surgeons, he has authored more than 50 publications including book chapters.

Mandracchia is vice president of the Iowa Podiatric Medical Society and the scientific co-chairman of the annual Heartland Podiatric Seminar. He is an adjunct member of the American Association of Family Physicians. He is also a member of the Podiatry Advisory Committee with Ortho-McNeil Pharmaceuticals, Inc., and has served as consulting editor to the Hospital Medicine and American Family Physician journals in the field of podiatric medicine.

Simple Classification Can Help Define and Predict Limb-Threatening Diabetic Infections: Study

Research groups from Texas, Illinois, Washington State, and the Netherlands partnered to publish a landmark study validating the Infectious Disease Society of America’s guidelines for the clinical classification of diabetic foot infections.

Dr. David Armstrong

“We’re all very pleased to see this study in print.” noted co-author David G. Armstrong, DPM, PhD, Professor of Surgery at Scholl’s Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University. “What this provides us now is confirmation that a simple system that labels infections as mild, moderate or severe can have a dramatic impact on predicting hospitalization and amputation. This will go a long way toward helping us to most effectively guide therapy and communicate with our patients.”

The study is published in the February issue of the journal Clinical Infectious Diseases. The classification system itself is freely available at www.diabetic-foot.net.

Two NJ Podiatrists Indicted For Medicare Fraud

A pair of Mercer County podiatrists were indicted by a federal grand jury yesterday for allegedly treating people with poor circulation with a device that didn’t work and wasn’t covered by Medicare. Special agents from the federal department of health arrested Dr. John Cavalli, 36, of Hamilton, yesterday morning, while issuing a warrant for a second doctor, Alan Tuchman, 60, of East Windsor.

U.S. Attorney Christopher J. Christie said the defendants’ alleged fraud led to more than $1 million in losses.President and chief executive officer of the now-defunct Poor Circulation Treatment Center in Hamilton, officials said Cavalli allegedly "submitted fraudulent claims for therapeutic services" to several insurance companies, including Medicare and Aetna. Christie said most of the services rendered to Cavalli’s patients involved non-traditional podiatric services, including the "circulator boot" and electric stimulation. Allegedly the "circulator boot," a non-podiatric procedure, didn’t improve the health of his mostly elderly clientele.

For two years starting in 2001, Cavalli got more than $1 million from Medicare, Horizon and Aetna, the indictment alleges. The indictment says most of the services weren’t provided by the lead doctor or a licensed podiatrist. Instead various unqualified personnel, including technicians and medical interns, who had received little or no training administered the treatment. From January 2003 to January 2005, the duo allegedly scammed health care providers of more than $200,000. Cavalli’s bail of $100,000 was secured by equity in the defendant’s parents’ home.

Source: The Trentonian [1/30/07]

Query: Patient Rejects Potential Surgery

I have a 56 year old nurse who worked 20 years closely for an orthopedic foot and ankle surgeon and has above average knowledge about foot surgery. Her chief complaint is a painful 2nd hammertoe, which is medially dislocated with hallux abductus. She has a long 2nd metatarsal. Her IM angle is 13 degrees and there is an increased DASA.

I had recommended a 1st metatarsal osteotomy with a distal Aiken, then a Weil osteotomy with arthrodesis of the 2nd toe. She refuses the osteotomy of the 1st metatarsal because she has no bunion pain. I do believe I can get the hallux away from the 2nd toe with just the Aiken, but I am worried about long-term reoccurrence. If I do not do the osteotomy now, but if she understands the risk, is this substandard care?

William Axton, DPM, Ludlow, MA

Editor’s Comment: PM News does not provide legal advice. There can only be one foot surgeon, and whoever that is takes full responsibility for both the judgment as to which is the best procedure to perform, as well as the proper execution of that surgery. Because foot surgery is “an art as well as a science,” it’s possible that two different surgeons can perform different procedures on the same foot, and both will have satisfactory results.

When a patient dictates what procedure a surgeon should or should not perform, it’s time to refer that patient to someone else. It’s a clear and obvious “red flag” if ever there is one.

RE: 10 Year Old Toe-Walker (Charles T. Martin, DPM)
From: Multiple Respondents

During my residency I recall 2 brothers (7 and 8 years old) presenting with the same findings. The diagnosis ended up being "Idiopathic Toe Walking." I believe serial casting was used successfully for treatment. The following link to a PubMed article which may be helpful to you...
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9600550&dopt=Abstract

Chris Seuferling, DPM, Portland, OR, cseuferling@comcast.net

I had a similar patient. A 10 year-old autistic male that was an extreme toe-walker. When he stopped walking his returned the heels to the ground. There was no equinus and his hindfoot and ankle were supple. He did not have the mental capacity to understand verbal requests not to walk on his toes. He was only on his toes while he walked.

He responded well to internal thermoplastic AFO's with a plantar flexion stop at zero degrees. His parents admitted that the AFO's were extremely hard to apply but they worked well.

I don't understand if your patient is wearing the AFO's properly how he could possibly be toe walking. I suspect the parents have been having a great deal of trouble putting the AFO's on their child and they want an alternative treatment that is easier to apply. The parents may conclude the AFO's "don't work" based on the effort it takes to put them on their autistic child. Have the parents bring the AFOs to your office, put them on, and observe the gait yourself.

Another option would be an external double-upright AFO. These are cosmetically less appealing but easier to apply.

David T. Taylor, DPM, Flint, MI, dttaylor_19@yahoo.com

It sounds like this might be an issue with the parents and not the child. If he does not have equinus, then what good is a night brace going to do? In my work with the Fit Feet program of Special Olympics, we have seen this problem quite a bit, all over the world. A patient with autism cannot always relate how they are feeling or why they are doing something such as toe walking or other body movements. If it is not impeding them, then why are we treating them? This goes to one of the fundamentals of the Special Olympics movement, that athletes with intellectual disabilities have rights also. If the patient can put his heel down on command then it is habitual. If he toe walks with an AFO, then it is habitual. The only treatment would be with a physical therapist with experience with this population to help with cognitive feedback.

Patrick J. Nunan, DPM, West Chester, OH, PJNDPMRUN@aol.com

Try MBT Physiological footwear. It is easy to dorsi-flex the foot and practice heel chord stretching while wearing them. Years ago we put lead in the heel of the shoe to overcome the practice of toe walking in children. This appears to be a case worth considering that measure. Simply have the pedorthic technician remove the heel; put in a plug of lead and put a lift back on the heel.

Robert Schwartz, C.Ped, NY, NY, rss@eneslow.com

RE: Integrative Medicine
From: Bob Kornfeld, DPM

I would like to laud the New York College of Podiatric Medicine as the first teaching institution of podiatric medicine in this country to form a Department of Integrative Medicine. This is an idea whose time has come. Thanks to the vision and dedication of Stephen Holt, M.D., the Dept. of Integrative Medicine at NYCPM was born. I am proud to count myself as an Adjunct Professor in this department. It is my honest hope that through the efforts of our faculty, we, as a profession, can join the growing movement of integrative medicine in this country which has become well accepted amongst thousands of M.D.'s and D.O.'s.

I encourage every podiatrist out there to open their hearts and minds and decide for themselves, AFTER attending lectures and seminars, how integrative principles might work for them and their patients. I have no doubt that those who refuse to learn will be left standing alone in the near future. The last seminar I attended on integrative medicine had almost 700 M.D. and D.O. attendees and only one D.P.M. I truly think that this is quite unfortunate.

I also want to thank Barry Block at PM Magazine for publishing the topic of holistic podiatry in the last issue. At the very least, this is a paradigm that deserves your attention. And, it is not going to go away. John Hahn, DPM, ND and I have joined together to create the Institute for Integrative Podiatric Medicine and are presently at work on developing a vehicle to present this incredibly dynamic information to the profession.

Bob Kornfeld, DPM, Lake Success, NY, Holfoot153@aol.com

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.

ASSOCIATE POSITION - SOUTH CENTRAL PENNSYLVANIA-PM & S 36

Large, busy podiatry group looking for associate interested in future partnership. Practice facilities and technologies include: Surgical Center, Physical Therapy Department, six appointment locations, EMR, MRI and Digital X-ray. Full compensation and benefit package offered. Mail CV to Martin Foot and Ankle, 1203 S. Queen St. York, PA 17403 or email business administrator, johnreitzel@comcast.net

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 POSITION LEADING TO PARTNERSHIP - TAMPA BAY AREA-FLORIDA

Immediate position available in growing multi-office/multi-physician practice. Looking for a highly motivated psr24/36 trained podiatrist. Must be board qualified/board certified ABPS physician and be highly enthusiastic, motivated, with excellent patient/ social skills. Excellent benefit package including salary/bonus, health ins, paid time off, paid CME, and much more. Please e-mail CV to drdad94@aol.com or contact (727) 944-2522 for more information.

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.

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

PRACTICE FOR SALE -NORTHERN CALIFORNIA

Great opportunity to own a well-established turn-key podiatry practice located in modern medical office building in East Bay; Electronic billing, good payor base, no HMO contracts; biomechanics, general podiatry with great potential for surgery. Please send CV and letter of interest to: norcalpod@hotmail.com

PEDALIGN SCANNER, COMPUTER, MONITOR, AND KIOSK FOR SALE

Considerable savings on 1 year old system. Lease may be assumed. Contact Jeffrie Leibovitz, D.P.M. Office 317-545-0505 ftbenpod@sbcgloabal.net

ASSOCIATE POSITION--PHOENIX SUBURB

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

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