The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

February 04, 2010 #3,771 Publisher-Barry Block, DPM, JD

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Runners Need to Avoid the "Terrible Toos" - DC Podiatrist

Runner and sports podiatrist Stephen Pribut, DPM, warns runners to beware the "terrible toos"—doing too much, too soon, too fast. Every research paper and every expert agrees that this—"training errors"—is the number one cause of self-inflicted running injuries.

Dr. Stephen Pribut

The body needs time to adapt from training changes and jumps in mileage or intensity. Muscles and joints need recovery time so they can recover and handle more training demands. If you rush that process, you could break down rather than build up.
 
Source: Amby Burfoot, Runner's World  [March 2010]

WI Podiatrist Named Chair of Diabetes Advisory Group

The Diabetes Prevention and Control Program, a program of the Wisconsin Department of Health Services and a partner of the American Diabetes Association in Wisconsin, has elected new leadership for the next two years.  William Weis, DPM of Wisconsin Foot and Ankle serves as the new chair and Wendy Countryman, RN, of WEA Trust serves as the new co-chair.

Dr. William Weis

The Wisconsin Diabetes Advisory Group, convened by the Wisconsin Diabetes Prevention and Control Program in 1997, provides the foundation for active diabetes programming partnerships across the state. It includes representatives from over 80 key organizations involved in diabetes in Wisconsin. The mission of the Diabetes Advisory Group is to reduce the economic, social, physical, and psychological impact of diabetes in Wisconsin. This is accomplished through the work of the Diabetes Prevention and Control Program, Diabetes Advisory Group and many other statewide partners.

IPMA Members Collect Shoes for Haitian Earthquake Victims

Members of the Illinois Podiatric Medical Association are teaming up with Share Our Soles to collect shoes for victims of the earthquake in Haiti. According to Illinois Podiatric Medical Association President Joseph Borreggine of Charleston, podiatrists have traditionally worked with local charities to provide shoes for the less fortunate.

Dr. Joseph Borreggine

“Our members and their patients, both collectively through the IPMA and individually, have historically been generous with local charities and I’m confident they will contribute in a significant way to the Share Our Soles charity ,” he said.

Source: Journal-Gazette Times-Courier [1/29/10]

AZ Podiatrist Edits New Diabetic Charcot Foot Text

Datatrace has recently published The Diabetic Charcot Foot: Principles and Management edited by Robert G. Frykberg, DPM, MPH. This 300-page text includes 20 chapters written by over 50 nationally and internationally renowned authors, covering every aspect of the diagnosis and treatment of diabetic Charcot foot. 

The Diabetic Charcot Foot: Principles and Management, Edited by Dr. Robert Frykberg

Covered topics range from conservative to surgical management, and feature a virtual who's who of podiatric diabetic experts from Armstrong to Zgonis, as well as a wide variety of podiatrists well-known in the podiatric community. The text also features chapters from prominent endocrinologists, orthopedists, diabetologists, and biomechanics experts. 

Query: Poor Surgical Result

A 50 year old female had surgery on 12/2008 for multiple hammertoes and a bunion. Post-op  x-rays show a poor result. Her current chief complaint is that the 5th toe irritates her in shoes. Note that the transverse plane component of the deformity in the lesser digits has come back. Capsular MTPJ correction was done during the original surgery by reefing up the medial joint and releasing the lateral collateral. The sagittal plane was resolved, except for the 5th digit (where a "V-Y" plasty and arthroplasty were done) with stable arthroplasties/failed fusions. The hallux position has not changed from that shown on immediate post-op x-rays.

Post-op x-rays

Post-op K-wires used to stabilize the MTPJ stayed in for 4 weeks. The wire in the 4th MTPJ has migrated proximally and is plantar to the joint and not symptomatic. Note that the one-week post-op x-ray showed good reduction of the deformity in all planes. The patient has a met adductus foot type, which I think is the main complicating factor. She did not use custom orthoses post-op, but did use OTC pre-fabs with good shoes (SAS). What is the best way to stabilize the transverse plane of the lesser MTPJs in cases like this?
 
Tip Sullivan, DPM, Jackson, MS

Query: Liability for Recommending Barefoot Running

Currently, within the running and scientific research communities, there is considerable discussion regarding the potential benefits of barefoot running. Many barefoot running advocates claim that running without shoes produces fewer injuries than running in shoes since it is "more natural", "makes the foot stronger," and "it is what our ancestors did with fewer injuries." Because of this, there are now some scientists, and even some within the medical profession, who are suggesting that people try barefoot running as a viable treatment option for their running injuries.

What type of liability would a podiatrist be subject to by recommending running without shoes to treat a running injury? For example, if a podiatrist told a patient that their chronic running knee injury was due to running in shoes and then recommended barefoot running as a treatment for this knee pain, what liability would the podiatrist be subjected to if the patient then suffered a serious puncture wound or laceration that subsequently resulted in permanent disability to their performing work and/or recreational activities? In other words, could a podiatrist be successfully sued for medical malpractice by making a barefoot running recommendation if the patient suffers serious foot injuries from doing so?

Kevin A. Kirby, DPM, Sacramento, CA

Editor’s comment: PM News does not provide legal advice. Anytime a physician provides medical advice, s/he is subject to liability if that advice is found to be the proximate causation for an injury. Thus, podiatrists who advise that patients run barefoot should 1) Have adequate literature and documentation to support that recommendation 2) have adequately informed patients of the risks inherent in barefoot running 3) have patients sign an informed consent to this effect.   

RE: Derm Condition in Diabetic Patient (David Sands, DPM)
From: Multiple Respondents

With hyphae in the skin scraping, try the following treatment. Make sure the liver function tests are WNL and prescribe Diflucan 200mg #4 tablets, one tablet, po, each week for 4 weeks. It is a very benign treatment, even in geriatrics.

Paul Krupe,r DPM, Kingsburg, CA, prkruper@yahoo.com

I heard Dr. Bakotic, from Bako labs, lecture on the roles of doing a biopsy.  He said that  he would rather see benign punches than malignant ones, and sometimes those lesions that appear benign can be malignant. Even if you don't suspect it to be "deadly", a biopsy can help rule things out. You should not worry about the slight pain it can cause. Otherwise, if it turns out to be something worse, you’ll kick yourself. I would suggest doing a small punch biopsy of 2-3 mm from different sites and send it out. Dr. Bakotic said that size would be large enough to review and that this size biopsy will not require sutures to heal up.  I’d rather be safe than sorry on the condition. From a practice management standpoint, you can bill for the procedure.
 
Jessica R. Brent, DPM, Middleburg Heights, OH, jrbdpm@yahoo.com

This is a severe plantar keratoderma. There are many causes, psoriasis, eczema, hypothyroidism and it could even be a manifestation of internal malignancy. Start with a trial of  keratolytics, such as urea or Lac-hydrin. Add  topical steroids, if needed.

Bret Ribotsky, DPM, Boca Raton, FL, ribotsky@yahoo.com

RE: EMR Stimulus (Neil Levin, DPM)
From: Michael L. Brody, DPM

The EMR issue is “etched in stone.” The stimulus for implementation is known as Hi-Tech and is part of the American Recovery and Reinvestment Act (ARRA) that was passed into law in January of 2009.

If you adopt qualifying EMR in 2011 and use it in a "Meaningful Manner" for 90 consecutive days in 2011, you will be eligible to receive a stimulus check. If you adopt EMR in 2010, it does NOT decrease the amount you are eligible to receive, and if you participate in E-Prescribing and PQRI in 2010, you could even receive more incentive funds from the federal government.

For further details, you can look at past issues of PM Magazine and watch for future articles in PM News. I encourage everyone to attend upcoming state, regional, and national podiatry meetings to learn more about how to participate in these programs.

Michael L. Brody, DPM, Commack, NY, mbrody@tldsystems.com

RE: PICA Demutualization (Scott Werter, DPM)
From: Barry Block, DPM, JD

The most accurate information that we have to date, is that for PICA shareholders who were stockholders for more than two years, the correct way of handling the PICA demutualization funds is to treat them like a capital gain. This will, in most cases, mean less liability than if this dispersement were treated as ordinary income, as discussed by a podiatrist in a previously posted note. This opinion is not etched in stone and should not be construed as legal advice. Your decision should be discussed with your accountant or tax advisor.

Barry H, Block, DPM, JD, Forest Hills, NY, bblock@podiatrym.com

RE: CPME (Robert Scott Steinberg, DPM)
From: Jonathan Haber, DPM, Patrick J. Nunan, DPM

I read about Dr. Steinberg's comments related to the "arrogance of the CPME" and the inability to get a "straight answer" from CPME.  Having recently completed nine years on the Council, the last two as chair, the comments are totally inconsistent with my experiences. The CPME consists of podiatrists and public members, who are all volunteers, working for the betterment of our profession. The standards, requirements, and procedures for residencies, fellowships, the colleges, the boards, and continuing education in podiatry are well documented and available to all. No changes are made without consideration and input from the "community of interest." The Council has held open forums, and question and answer sessions at the APMA House of Delegates and seminars around the country to answer questions and deal with issues that any individual or institution may have. The Council staff in Bethesda is a well-trained, professional group that is more than willing to deal with "issues" and give "straight" answers that podiatrists may have.

The CPME is an independent accrediting body that functions separately from the APMA, and is regulated by the federal department of education. To suggest that the members, past and present, of the CPME, who have given thousands of hours of their time to the Council and its committees are arrogant or deceitful, is simply untrue. 
 
Jonathan Haber, DPM, Caldwell, NJ,  jhaber4932@aol.com

Once again, it amazes me that people do not understand how the CPME works. This has been explained over and over again in this forum and in other media. According to the U.S. Department of Education, the CPME must remain independent of the profession. So therefore, the APMA has no jurisdiction over the CPME. They can make suggestions, not mandate policies to CPME. So, they are two separate organizations. 

As far as the APMA, while I have not always been happy with their decisions, remember the ones who make the decisions are the Board of Trustees and the House of Delegates. We elect these people to these positions so if we do not like how they run our profession, then vote them out. Each state has practice acts which govern the scope of practice for our profession. The APMA does not always have the ability to influence every state. Remember all politics are local.

Our training, education, and scope have improved over the years. Most of these battles have been won by the local rank and file members.  It is never too little or too late to improve. The AMA does not have the percentage of members that we enjoy. I feel that the APMA has improved and been more responsive to the needs of the membership.  However, each member has the duty and obligation to promote and improve the profession in a positive light. 

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

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

Dr. Bijak wrote: “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. If you disagree, just read the next few months of PM News and see the complaints associated with our limited degree and training continue.”

I believe that Dr. Bijak is half right.  When I first read Dr. Bijak’s letter, I could not help but think of some of the great modern day podiatrists such as David Armstrong who have set high standards and are an inspiration to others in their profession.  Perhaps an attitude change is all that may be required for some podiatrists to recognize the potential of their degree!

Jeffrey A. Root, President, Root Lab, Inc., jroot@root-lab.com

I am sure Dr. Bijak has his reasons for his recent and past rants about our place in medicine, but I completely disagree with him. I have been in practice for 35 years. When I first went into practice in Memphis, we had just recently gotten the right to prescribe narcotics and we had no surgical privileges at any hospitals. My, what a change the years have brought. I am welcomed at multiple facilities and have an ownership position in two general outpatient surgery centers, both associated with major hospitals. I have referrals from multiple M.D.'s for problems, ranging from diabetic nail and wound care to orthotic needs to surgical intervention.

I am sure that the APMA is not the only factor in these changes over the years, but I feel that without it, we would not have progressed as we have. But I have one other thing to say to Dr.Bijak and others who think like him. Who are these people you are trying to impress? I see a full schedule of patients daily. I enjoy treating them and improving their lives. My patients seem to like me as well, since they return for new problems and refer their friends and family for their problems. As I see it, that’s what it is all about. Not impressing "others" to attain their acceptance but to give good foot care to the public. So, my advice is relax, treat your patients to the best of your ability, and that will bring you plenty of rewards - and eventually the acceptance you seem to need so badly.

Brian Kiel, DPM, Memphis, TN, footdok4@gmail.com

Dr. Robert Bijak's comments are not overly critical of where our specialty "has come from" and "where we are now." It is just a simple observation. Remember, we were once known as "chiropodists" and the word chiropodist literally means “medicine of the hand and foot.” Note that according to the dictionary: "A podiatrist is a physician that specializes in the evaluation and treatment of diseases of the foot."

According to Wikipedia, "a podiatrist is a Doctor of Podiatric Medicine (DPM), also known as a podiatric physician or surgeon, qualified by their education and training to diagnose and treat conditions affecting the foot, ankle and related structures of the leg." However, Wikipedia also states, "Foot and ankle surgery is a sub-specialty of orthopedics and podiatry that deals with the treatment, diagnosis and prevention of disorders of the foot and ankle." Note that according to this definition, "foot and ankle surgery" is a sub-specialty of both "podiatric medicine" and "orthopedics."

But also notice in Wikipedia, "Orthopedic surgery or orthopedics (also spelled orthopaedics) is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and non-surgical means to treat musculoskeletal trauma, sports injuries, degenerative diseases, infections, tumors, and congenital disorders."

Eventually, both these competing medical professions may blend into a homeogenic one. There is also the possibility that the "podiatrist" and the "foot and ankle surgeon" may become just as distinguishable the "dentist" and the "oral surgeon." Dentistry did it without any degree change. We will too. Evolution of anything takes time, and during the process, the best attributes usually survive. In the long run, podiatric medicine will find its niche...so let's stop fretting and just keep moving forward.

Joseph Borreggine, DPM, Charleston, IL, footfixr@consolidated.net

Editor’s note: H. David Gottlieb’s extended-length letter can be read here.

RE: The Passing of Gary Jolly, DPM
From: Michael J Marcus, DPM

Gary was a classmate of mine back in Philly from 1971 to 1975. From the very beginning of our professional education, he showed great competence and passion. I remember discussing various didactics with him. Through the years, we would occasionally run into each other at meetings. There, we would catch up on our personal lives and discuss our practices and our current trends. The last time I saw Gary was at an ACFAS meeting. We both admitted how lucky we were to have chosen this wonderful profession. Gary loved podiatry - he was passionate about every aspect of what he did professionally. I am saddened by our loss of him and I will miss seeing him. Our profession will miss him as well, and it rests in our hands to continue to encourage competence and passion in regard to future podiatric foot and ankle surgeons. In such a fashion, Gary’s spirit will always be present.

Michael J Marcus, DPM, Montebello/Irvine CA

OFFICE SPACE TO SHARE - NYC

Wanted- Licensed podiatrist to share space in a State-Of-The-Art medical office in the midtown area. Please call Dr. Robert Singer (212) 921-5775 or e-mail dr.roberth.singer62@netzero.net

ASSOCIATE POSITION - SAN FRANCISCO, CALIFORNIA

We’re seeking an energetic and enthusiastic Associate to help our thriving non-surgical practice grow. Located in the heart of San Francisco, we provide state-of-the-art sports medicine, trauma and lower extremity care. Excellent compensation package. Submit CV with cover letter to: sfsportsmed@yahoo.com

ASSOCIATE POSITION - MARYLAND/D.C AREA

We are looking for an energetic and well-trained podiatrist to join our rapidly growing group; we have offices in Maryland and D.C and are in need of someone who is hard-working and growth-oriented. This candidate must be a graduate of a PM&S 36 residency program or have the equivalent in practice experience. We are looking for the person that wants to make this area their home and become an integral part of our group. If interested, e-mail your CV and cover letter to washingtonpod@aol.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 – 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

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

PRACTICE FOR SALE - NORTHWEST CHICAGO SUBURBS

17 year-old surgical practice for sale. Practice sees a wide variety of foot and ankle pathology and is largely referral especially regarding surgical patients. Two offices fully equipped. Lease or purchase of office condo also possible. Doctor willing to stay Please email inquiries to crystallakefootandankle@live.com

ASSOCIATE POSITION - W FLORIDA, BEACHES

Well established podiatry pPractice with excellent mix office/surgery seeking full time associate PSR 12-36. Excellent salary & benefits for the right hardworking, personable candidate. Email resume to capecoralpodiatry@live.com or fax to 239-573-9201

ASSOCIATE POSITION - VICTORIA, B.C.

Beautiful Victoria, B.C. Canada on the ocean, fast growing area, Associate for multi-office full scope practice. Interviews in Orlando, February 20th and 21st, Reply by email to orthotic4D@shaw.ca

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-INLAND EMPIRE, SOUTHERN CALIFORNIA

Associate needed full or part-time for multi office practice. Must be ABPS BC/BQ. Hard working, ethical individual who is looking to a possible partnership opportunity. Looking for current licensed or resident completing program this spring. Email CV to bkatzman2@earthlink.net

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 - 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 – 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

PM News Classified Ads Reach over 12,000 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,000 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451

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