The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

February 05, 2010 #3,772 Publisher-Barry Block, DPM, JD

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Barefoot Running Okay, But Carries Inherent Risks: TX Podiatrist

Runners all over North Texas are trying different techniques to help maximize their workout, including jogging without footwear. This shoeless movement has a growing following of supporters who feel that barefoot running makes their form better and keeps them injury-free."You have to pay attention to shock absorbing because you don't have big foam cushions," said Dr. Brett Gabriel, a local podiatrist. He said that a barefoot runner can sacrifice speed for the sake of form. "The tradeoff is the intensity you're able to run with and the speed overall, in terms of time it takes to cover a distance."

Dr. Brett Gabriel

But perhaps the biggest concern while running without shoes is what you might step on while exercising outdoors. "There are inherent risks, probably not least of which is risk of wound and infection," Gabriel said. "To me, that's probably the greatest argument against it." Still, doctors and advocates all agree that barefoot running can be an effective training tool as part of an overall workout program. "In the right situation, it's okay," Gabriel said. "Athletes need to consider it an alternative. In small doses, it's probably something some could embrace."

Source: Gina Miller, CBS-TV 11 [2/4/10]

GA Podiatrist Collects Shoes for Haitian Earthquake Victims

The waiting room at the foot doctor’s office looked a little like the shoe section of a department store. There were no salespeople, though. Just bins of shoes. Dozens of pairs. More footwear than a podiatrist sees in a week, maybe two. Sandals, loafers, sneakers, new and used — even socks — all for the earthquake relief effort in Haiti.

Dr. Rondrick Williamson (Photo: Woody Marshall)

Dr. Rondrick Williamson’s lobby has, in recent days, become shoe central after his office manager, Yolanda Parker, struck on an idea she thought made perfect sense. “I just said, ‘Podiatry, shoes, that’d be a good idea,’ ” Parker said. “Some people maybe can’t afford to give $10, but everybody has shoes.” Donations will be collected through the end of the month and then shipped to Haiti through a Tennessee-based nonprofit called Soles4Souls.

Source: Joe Kovac Jr., The Telegraph (Macon.com) [2/4/10]

More EMRs are in Physician Offices, But Use Still Lags

Physicians increasingly are adopting electronic medical records systems, even before government economic incentives for doing so have kicked in. But a survey by the Centers for Disease Control and Prevention also found those doctors weren't yet doing a whole lot with the technology.

The CDC's National Center for Health Statistics said an estimated 43.9% of doctors are using full or partial EMRs, up from 34.8% in 2007 and 41.3% in 2008. The use of what was described as "fully functional" systems also went up from 3.8% in 2007 and 4.4% in 2008, to 6.3% in 2009. The survey did not include systems used for billing.

Experts don't expect the numbers found in the CDC study to accelerate significantly, despite the presence of a maximum $44,000-per-physician tax incentive through the American Recovery and Reinvestment Act, and other incentives from Medicare and Medicaid set to begin in 2011.

Source: Pamela Lewis Dolan, AM News [2/1/10]

Query: Jones Fracture Healing

A 13 year old has a classic avulsion fracture of the styloid process inversion injury suffered in phys. ed. class. After 35 days in a CAM walker, there is no pain, edema, or loss of strength. However, there are no signs of fracture healing on x-ray. Should I be concerned?

Bill Zaccardelli, DPM, Parma, OH

Query: EMR Change-Over

I have been using Medinotes and Lytec for several years. Now that Medinotes is not considered compliant and will be phased out by 2011, I was curious as to what products others in my situation are considering. Since Eclipsys/Peak Practice took over Medinotes, it seems logical to stay in-house. We could remain with Lytec, or go with their medical management system that would sync the two together. Gateway is our current clearinghouse and they will be brought on-board in the second quarter of 2010. 

Harry Cotler, DPM, Soldotna, AK

RE: Poor Surgical Result (Tip Sullivan, DPM)
From: Multiple Respondents

I think this can be approached two different ways: 1) Use an Akin-type osteotomy on the phalanges to "cheat" the toes rectus. 2) Do a Weil osteotomy and shift the heads, and reef redundant tissue, and pin it after for 3 weeks. This is a bit difficult, but possible, when fixation is in the way.

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

These results are unfortunate but also common. Might I suggest Weil-type osteotomies of the 2nd, 3rd and 4th metatarsals. Start with the 4th, and use a small 2.4 mm cannulated screw. (I prefer the Osteomed 2.0/2.4mm system.) Then remove the previously-placed K-wire. Using the Osteomed “head-less” 2.4 cannulated system, drive a guide pin from the middle phalanx out of the toe, and then retrograde to the base of the proximal phalanx. Squeeze the PIPJ together to facilitate arthrodesis.

Make a stab incision at the tip of the 4th toe and measure the appropriate size 2.4 head-less, lesser digital arthrodesis screw (it’s an intramedullary screw). Back off your measurement by 2-4mm, so that the screw does not enter the MTPJ. Place the screw from distal to proximal over the guide pin. Then, drive the guide pin retrograde into the metatarsal just off to the side of the MT screw (it acts as a K-wire). Check for a straight position with a C-arm. Repeat these steps for the 3rd, and then the 2nd rays, in an effort to keep the parabola anatomic. I have had excellent success with this combination of procedures.

Godfrey Viegas, DPM, Crystal Lake, IL, gviegas1234@sbcglobal.net

In order to "stabilize the transverse plane of the lesser MTPJs", I would simply perform mini-Akins at the base of phalanges 2 and 3. Osseous procedures always produce a more stable and definitive correction as compared to a soft tissue attempt. Next time, use a threaded K-wire to reduce the chance of proximal migration. I don't understand why you did not use the MMI smart toe implants on all of the hammertoes.

It appears as if she has a clinical hallux varus. If not, and the patient is pleased with the result, leave it alone.  Otherwise, consider a reverse Akin there as well. The 5th toe is a tough call. You may need to consider a re-do, combined with a syndactylization. Leave the broken implant alone and try to remove the broken K-wire. If it has already migrated as far as it has, and if you are taking her back to the O.R. anyway, get it out of there (and do another Akin if needed). It may migrate even more as she continues to weight-bear. Dr. Sullivan said it is "plantar to the joint" which does not sound good. I don’t see how that would not be symptomatic. 

Charles Morelli, DPM, Mamaroneck, NY,  podiodoc@gmail.com

RE: Derm Condition in Diabetic Patient (David Sands, DPM, Bret Ribotsky, DPM)
From: Tom Silver, DPM, Jeffrey Kass, DPM

I have seen this a lot over the years: one foot normal, the other with dry, scaly derm.  Are the toenails on the affected foot mycotic? I don't understand the reluctance to use an oral antifungal on an 83 year old unless he can't tolerate it or has liver problems. You would only need to put him on terbinafine qd x 4-6 weeks. 

Dr. Sands also mentions his reluctance to put his patient through a painful skin biopsy with a resultant hole in his foot. When done properly, 2-2mm punch biopsies are not a painful procedure, heal quite uneventfully, and it is surprising how helpful this can be in making your diagnosis. 

I suspect he needs an oral antifungal and/or a Class-1 (super potent) cortisone cream such as clobetasol propionate ointment 0.05%.

Tom Silver, DPM, Minneapolis, MN, tsilver01@juno.com

"Add topical steroids, if needed." I am not sure what Dr. Ribotsky meant by that. How is one to determine if they are needed? If the keratolytics don't work? If the patient complains of pruritis? What determines that? Again, I think a prudent starting point as Dr. Brent points out, would be a biopsy. This may or may not help in terms of treatment, but at least you know you’re not dealing with any malignancy. And you may be surprised it may come back warty tissue, in which case it may help alter your treatment regimen. If it turns out to be mere "severe plantar keratoderma," block out a 30-minute appointment and take out your trusty #10 blade, and go to town. Then you can choose your favorite urea cream.
 
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

RE: From Evidence-Based Medicine to Marketing-Based Medicine
From: Michael Turlik, DPM

A recently published article¹ discusses how the pharmaceutical industry manipulates journal publications to demonstrate pro-industry results. The article is based upon internal industry documents reviewed as a result of a lawsuit. Although this article is focused on medications utilized in the mental health industry, similar publications have reviewed related issues regarding NSAIDs and medications used in the treatment of osteoporosis. The authors suggest that the subject matter discussed in this article can be generalized to the larger medical community.

Is it possible that drug and device manufacturers manipulate podiatric publications?

1. Glen I. Spielmans & Peter I. Parry.  From Evidence-based Medicine to Marketing-based Medicine: Evidence from Internal Industry Documents
J Bioethical Inquiry 7: online publication, 2010

Michael Turlik, DPM, Cleveland, OH, mturlik@aol.com

RE: Liability for Recommending Barefoot Running (Kevin A. Kirby, DPM)
From: Arnold B. Wolf, DPM

In this day and age of "evidence-based medicine", I would personally be careful of what source I use as an authority on a certain topic. Regarding the comments of "it makes the foot stronger," "it's more natural," and "it’s what our ancestors did and (they) had fewer injuries," I would submit the following:
-What biomechanical/kinesiologic/physiologic science is there behind their opinions?
-What is the definition of "natural"?
-Just because our "ancestors" (dare I say, Cro-magnun man) ran barefoot, should  (we) blindly assume that modern man is at the same point on the evolution time line that would facilitate more "barefoot" activities?

We have to fall back on the "community standard" concept. As such, I think to professionally recommend this type of activity is dangerous not only to the patient, but to the individual providing the recommendation. 
 
Arnold B. Wolf, DPM, Sterling Heights, MI, omnifootcare@prodigy.net

RE: The Passing of Gary Jolly, DPM
From: Lawrence Oloff, DPM

It was with great sadness that I read about the untimely passing of Dr. Jolly. I remember him mostly as a student, a year ahead of me in class at what was then known as the Pennsylvania College of Podiatric Medicine. He clearly targeted excellence, even at that early stage of his career. Metropolitan Hospital rapidly grew to pre-eminence because of the stellar students such as Dr. Jolly, who flocked to that residency program at that time. I remember him always aiming high, a habit he demonstrated throughout his professional career. He will be sorely missed.

Lawrence Oloff, DPM, Redwood City, CA

EQUIPMENT FOR SALE – MICROVAS

Microvas Unit for sale in good condition, 1 year old. Works well for various conditions we treat.Joining multispecialty group and unable to bring unit. Best offer. Please e-mail inquiries to footdoctor@verizon.net

ASSOCIATE  POSITION - MONTANA

Great opportunity for a PSR 24 or 36 residency trained individual to join a dynamic two doctor group with physical therapy.  Needs good FF surgical skills, RF a bonus.  Beautiful office and great area of the country for outdoor recreation-minded individuals. Opportunity for partnership after employment. Please reply to: jclough@bridgemail.com

PRACTICE FOR SALE – WASHINGTON STATE 

Kent (20 miles South of Seattle) 15 year part time practice. Share office with two MD’s. Midmark 417, ExCel X-ray and processor Ritter M9 autoclave, instruments. Owner retiring. VERY REASONABLE PRICE. Call Martin Lynn @ 206.355.3701 Leave Message; or Email at mlynn@wport.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

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

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

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