The Voice of Podiatrists

Serving Over 10,700 Podiatrists Daily

February 01, 2008 #3,156 Editor-Barry Block, DPM, JD

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We’ve just posted the February CME titled “"Developing a Comprehensive Diagnostic and Treatment Plan for Charcot Neuroarthropathy – Part 1" by Brent Bernstein, DPM and John Motko, RN.

Shoes are the Foundation for Good Health in Running: PA Podiatrist

Richboro, PA podiatrist Dr. Michael Greenberg, one of the founders of the Bucks County running movement and an accomplished marathoner, says shoes are the foundation for good health in running. “The key is you have to know what foot type you have,” Greenberg said. “Someone in a store can help you. What I tell people is find the shoe that's right, be it a stability shoe, a motion-control shoe, a cushion shoe. Have them bring out several brands to you, and you choose which of those is best to your foot.”

Dr. Michael Greenberg

Greenberg also points out that wear starts on the inside of the shoe first. So checking the bottom of the shoe for deterioration is sort of after the fact. “That [inside] is where the shock absorption is,” Greenberg said. “I would say no more than 500 miles, that's about the limit. If your back or knees start to ache, usually that means it's time for a new pair of shoes.”

Last but not least, if you have an injury that you suspect might be because of your shoe fit, it's a good idea to visit a podiatrist such as Greenberg. There are a number of options to possibly solve your problem, such as custom-made orthotics. “If you're having a problem that's not being resolved, see a professional,” Greenberg said. “One, to see what the problem is, and two, possibly a shoe recommendation or some simple stretching exercises might help.”

Source: Wayne Fish, Phillyburbs.com [1/31/08]

Israeli Podiatrist Settles 2,000 Year Old Debate

Recently an archeologist came to the office of Richard Jaffe, DPM, Jerusalem podiatrist and asked him to examine a 2,000 year old calcaneus…...with a bent nail running through it. It is the only bone ever found from a crucifixion in Israel. This is interesting because for years crucifixions were a daily event carried out by Roman soldiers. Some experts have claimed that there may have been up to 500 in a single day! So many that the hills around Jerusalem were filled with crosses and bodies.

Dr. Richard Jaffe

The reason that more bones haven’t been found is that the families of the victims would come and collect the bodies for interment, a Jewish, religious obligation. Later, many people would recover the nails from the crosses and wear them on strings around their necks as amulets to ward of the “evil eye.” According to Jaffe the archeologist believes that this bone had not been recovered because the nail got stuck in a knot in the wooden cross. This is evidenced by the bend at the tip of the nail.

2,000 Year Old Calcaneus

Jaffe was asked his opinion about what body structures were injured by the path of the nail. We know that the victims were tied to the crosses and then nails were driven through the hands and feet and sometimes genitalia also. The purpose of the nails was to increase suffering. One theory is that blood vessels were avoided so that the suffering before death could be prolonged. The opposing theory is that nails driven through nerves would increase the suffering but hasten death due to bleeding of vessels which run alongside the nerves. According to Jaffe, the nail ran right through the neurovascular bundle on the medial side of the heel. The debate was settled - more suffering for a shorter time.

Hand Gels Do Not Reduce Hospital Infection Rates: Study

Use of alcohol-based hand gels by hospital personnel might not lead to reduced rates of infections among patients, according to a study published in the January issue of the journal Infection Control and Hospital Epidemiology, the AP/Boston Globe reports. For the study, Mark Rupp, an infectious disease specialist at University of Nebraska Medical Center, and colleagues observed 300 hours of physician and nurse hand hygiene in two comparable intensive care units over a two-year period. Researchers added hand gel dispensers in the ICUs, and usage increased from 37% to 68% in one unit and from 38% to 69% in the other unit, the study found.

The study found that usage of hand gel reduced bacteria on the hands of hospital personnel but did not reduce significantly rates of infections among patients. The results of the study contradict CDC guidelines that recommend improved hand hygiene among hospital personnel to reduce the spread of infections. Rupp said, "There are many factors that influence the development of hospital-acquired infections. It would be naïve to think that a single, simple intervention would fix this problem"). An abstract of the study is available online.

Source: Timberly Ross, AP/Boston Globe via American Health Line [1/31/08]

Query: Pediatric Nail Infection

I have a 4 year-old male who came into my office with a erythema to his proximal nail fold. His parents state that this started in December with the infection being worse at that time extending to his toe. Initially there was drainage and purulence from the proximal nail fold, but no cultures were taken. His pediatrician placed him on Bactrim because he has a hx of MRSA from prior wound on his leg. He has tried Bactrim and then Omnicef with no resolution. His b/l hallux toenails have nail pitting, but show no signs of ingrown borders. No drainage was noted the current visit. He has pain on direct palpation the proximal nail fold, but no pain on ROM at the IPJ. X-rays show no signs of osseous reaction or prior trauma. Any recommendations?

Syed Ahmed, DPM, Louisville, KY

RE: Medial Deviation of 2nd Digit (Wayne C. Gould, DPM)
From: Multiple Respondents

A Weil osteotomy with medial displacement of the capital fragment will relocate the toe nicely in the transverse plane. The procedure is not without its drawbacks, however. A second toe that does not purchase the ground (floating toe) can be a side effect of the Weil osteotomy with or without the medial displacement. The second metatarsal is relatively long, and 2 or 3 mm. of shortening along with the displacement should be ideal. I usually fixate these with a 12 mm. length snap-off screw. The patient is in a post-op shoe for 3 weeks and then tapes the toe down for at least another 6-8 weeks.

Neil Levin, DPM, Sycamore, IL, DRFEET1@aol.com

Have an MRI taken. There is probably plantar plate rupture or attenuation. You may need to shorten the 2nd met with repair of plantar plate.

Greg Amarantos, DPM, Chicago, IL, amogreg@aol.com

If reasonable conservative measures have failed, then give strong consideration to a medial displacement osteotomy of the 2nd metatarsal head. A Weil osteotomy that shortens the met will relieve some of the traction on the extensors and if you also translate (slide, not tilt) the capital fragment several mm medially you will usually get a significant improvement that holds up over time. Make the osteotomy a little more proximal than a regular Weil (where the shaft is a little wider) so that you can have good bone-to-bone apposition for fixation. Two 2.7 mm. cannulated screws will be sufficient. The dorsal pain is from capsular stress as the joint begins to sublux and the plantar pain is from plantar plate stress and overload as the toe displaces dorsally. Moving the met head in the direction of the drift (either medially or laterally) reduces the tension on the collateral ligament and capsular tissues that are tight and tethering the digit thus allowing for some reduction in the drift.

Howard J. Bonenberger, DPM, Nashua, NH, howardbon@aol.com

RE: Reimbursement and Quality of Care (Neil Frankel, DPM)
From: Multiple Respondents

Neil Frankel's words are right on! He and I years ago discussed forming a group right here in NY. When I contacted several practitioners here I got the exact response Neil speaks about. If any podiatrists in the NY area would like to re open this type of discussion, I'm sure Neil would fly here in a heartbeat and we can get the ball rolling again.

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

Note to NYSPMA conference makers next year: Have attorney Mr. Boone and Dr. Frankel lecture. It is becoming pointless to lecture on all these wonderful podiatric topics if we can't get paid for what we do. Lecturing on how we can get paid for what we do and bring respect and dignity back to the profession is becoming increasingly more important. I am envious of Dr. Frankel's group as well as any other state that has brought forth a fight.

Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

An article appeared in the January 30th San Jose Mercury News Business section that gave reference to the above suit. http://www.insurance.ca.gov/0400-news/0100-press-releases/0070-2008/release007-08.cfm

According to the California Government press release, damages of up to 1.3 billion dollars in penalties could be assessed against the insurance providers. The suit alleges damages to both providers and patients, and also is trying to prove that they were “willful violations.”

This is certainly a groundbreaking suit, for the action is the result of a combined effort of two separate California state agencies. You can see the original article by Ms. Barbara Feder Ostrov, an excellent reporter on healthcare issues for Mercury news.
http://www.mercurynews.com/businessheadlines/ci_8116684?nclick_check=1

There have been some recent letters written to PMN ews discussing implications oflawsuits against insurance companies. They CAN be successful. I sued a major insurer and it was settled well in my favor. The consent decree does not allow me to go into detail about it. Sometimes one has to stand up for your rights. It was not nearly as “frightening” as you might think. Because of it, payments for podiatrists who own either Medicare Certified Ambulatory Surgical Centers or non Medicare Certified Surgical Centers in Washington State were allowed. Obviously it was worth the effort.

Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

PRACTICE FOR SALE - MINNESOTA: PRIME LAKES AREA

Great place to live and raise a family. $400+K yearly gross with continued growth and potential. Good mix of general podiatry & surgery. Hospital privileges available. Fully computerized, electronic notes, with capability to go completely paperless. Recently remodeled office, 5 tx/procedure rooms, well-equipped in owner-occupied building (for sale or lease). 260 402-7490

EQUIPMENT FOR SALE – PODIATRY CHAIRS, ETC.

SELLING quality clean, sturdy well padded exam chairs priced at $500 each, waiting room chairs $100 each, and large desks with rolling chairs at $200 each pair. Email: dr.wright@bigfoot.com or call 609 267 7707

ASSOCIATE POSITION – NAPLES, FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Candidate should have the skills and desire to perform rearfoot surgery including Charcot reconstruction and ankle surgery. Florida has a great scope of practice law and we rotate for ER call at all 4 hospitals. Candidate needs to be ethical and motivated. Established practitioner or new practitioner OK. Base salary, percentage, benefits including 401K. Fax CV to (239)566-8778 or Email CV to Drgordon@gulfcoastfootcare.com

ASSOCIATE POSITION - CENTRAL VIRGINIA

Immediate opening. Two office practice, EMR, digital x-rays, sonography. Full scope of foot and ankle care. Candidate needs to be mature, hardworking, and personable. ABPS certified/eligible. Base salary, percentage, and benefits. Submit letter of introduction, CV, and photo to practice administrator at mtrevor41@yahoo.com

SEEKING ASSOCIATE WITH POTENTIAL TO FULL PARTNER

Busy multi-physician podiatric group with 2 locations seeking BQ/BC surgically trained doctor. Applicant should be well-trained in all aspects of surgical and conservative care. Seeking ethical, hard working and outgoing physician to join our 4-physician group. Excellent quality of life in suburban Houston, near NASA and the Gulf of Mexico. Email CV and cover letter to Dr. M. Rockett at Mrockettman@comcast.net

ASSOCIATE POSITION - VIRGINIA (SOUTHERN)

Immediate full-time and part-time associate position available.
Unlimited income potential. Busy, diverse, 40+yr Hampton Roads practice. Must be compassionate; energetic; and motivated; PSR24/36. Looking for long-term arrangement. Please send letter and CV to dcarrone@cox.net

Busy multi-dimensional practice; 70 miles north of New York City . Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

ASSOCIATE POSITION- CONNECTICUT

Established Practice looking for PSR 24/36 trained surgeon. Must have experience and be responsible for all surgical cases for the practice. EMR and digital x-ray in new 6-treatment room office. Hospital privileges available. Connecticut has a new ankle law for the Properly-trained DPM. Competitive salary, benefits, and bonus. Great area to raise a family. Fax resume to 860 243-5790.

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

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