The Voice of Podiatrists

Serving Over 10,700 Podiatrists Daily

February 06, 2008 #3,160 Editor-Barry Block, DPM, JD

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TUSPM Podiatrist Provides Tips on Buying Athletic Shoes

Although the purchase of athletic shoes may seem a bit involved for many recreational runners, it's still important to buy a shoe that's built for running. "We find a lot of people get hurt because they wear a running shoe to play basketball and [other sports] on," Dr Howard Palamarchuk, director of sports medicine at the Temple University School of Podiatric Medicine says. "People are doing treadmill running in tennis shoes, and there's no padding in them." That's because tennis shoes are made for moving side to side, not for the constant pounding of forward motion.

Dr Howard Palamarchuk

You also need to pay close attention to your arch, because a high arch requires extra support. If you're not sure whether you have a high arch, do the concrete test. "If your foot's wet and you're standing on concrete, is everything flat or is there a tunnel under your arch?" Palamarchuk says. "In a high arch, you're looking for more cushioning."

Also, take a close look at the tread. The most durable material, Palamarchuk says, is carbonized rubber, which is the same material used to make race car tires. And if you're planning to do most of your running on trails, you want a studded tread. "You're better off to have shoes like that for wet surfaces for grip and grab," Palamarchuk says. "Shoes that are too smooth will slip."

Source: 24.com [2/2/08]

Anodyne Light Therapy Does Not Improve Peripheral Neuropathy In Diabetes: Study

Does Anodyne light therapy improve peripheral neuropathy in diabetes? A double-blind, sham-controlled, randomized trial to evaluate monochromatic infrared photoenergy. Lavery LA, Murdoch DP, Williams J, Lavery DC

Objective: The purpose of this study was to determine the efficacy of anodyne monochromatic infrared photo energy (MIRE) in-home treatments over a 90-day period to improve peripheral sensation and self-reported quality of life in individuals with diabetes.

Research Design and Methods: This was a double-blind, randomized, sham-controlled clinical trial. We randomly assigned 69 individuals with diabetes and a vibration perception threshold (VPT) between 20 and 45 V to two treatment groups: active or sham treatment. Sixty patients (120 limbs) completed the study. Anodyne units were used at home every day for 40 min for 90 days. We evaluated nerve conduction velocities, VPT, Semmes-Weinstein monofilaments ( SWM ) (4-, 10-, 26-, and 60-g monofilaments), the Michigan Neuropathy Screening Instrument (MNSI), a 10-cm visual analog pain scale, and a neuropathy-specific quality of life instrument. We used a nested repeated-measures multiple ANOVA design. Two sites (great toe and fifth metatarsal) were tested on both the left and right feet of each patient, so two feet were nested within each patient and two sites were nested within each foot. To analyze the ordinal SWM scores, we used a nonparametric factorial analysis for longitudinal data.

Results: There were no significant differences in measures for quality of life, MNSI, VPT, SWM , or nerve conduction velocities in active or sham treatment groups (P > 0.05).

Conclusions: Anodyne MIRE therapy was no more effective than sham therapy in the treatment of sensory neuropathy in individuals with diabetes.

Source: Diabetes Care. 2008 Feb;31(2):316-21.

FTC Rejects Collective-Bargaining Proposal

The Federal Trade Commission concluded competition would be harmed under a Puerto Rico proposal that would allow collective bargaining among healthcare providers, including doctors, hospitals, diagnostic centers and others.

A bill pending before Puerto Rico's Senate seeks to "create a competitive equilibrium" among providers and payers. But the FTC staff responded that consumers could be "doubly harmed" if they're "forced to bear the brunt of the elevated fees charged by the provider cartel on top of any markup already charged by that health plan because of its market power." The FTC commentary was solicited by the president of the Treasury and Financial Affairs Commission of Puerto Rico's House of Representatives.

Federal antitrust enforcers consistently have taken a dim view of provider alliances that involve setting prices but fail to share financial risk or accomplish clinical integration that benefits consumers. In this and other commentary, the feds also have sought to emphasize their opinion of state laws or regulatory action that grants permission for behavior that violates federal antitrust laws. Quoting the U.S. Supreme Court, the staff notes that the “national policy in favor of competition cannot be thwarted by casting … a gauzy cloak of state involvement over what is essentially a private price-fixing scheme.”

Source: Gregg Blesch, Modern Healthcare [2/4/08

Query: Providing Promotional Gifts

A podiatrist in my area has built a very successful practice in his area by giving expensive gifts to his patients who refer other patients to him. I know that in the past he has given out gift cards to patients, but recently my sister’s next door neighbor, who often refers patients to his practice received an LCD television from him. Is this legal or ethical?

Name Withheld (OH)

Editor's comment: PM News does not provide legal advice. Under the APMA Code of Ethics:

BE1.22 Promotional gifts of nominal value may be offered.

While the APMA Code of Ethics does not define “nominal,” it is clear that giving a patient an LCD TV as a gift is problematic. We believe that giving a small promotional gift, such as a coffee cup with your practice name, along with a thank-you note is both effective and appropriate. A $25 gift card would likely be considered as “nominal.”

RE: VTE Risk/Anti-coagulated Patients
From: Carl Solomon, DPM

A couple of situations that often make me very uneasy include either the patient who is anti-coagulated and needs a procedure, or one who is at high VTE risk and needs peripoerative prophylaxis. Frequently it’s the diabetic with multiple illnesses who’s on an anticoagulant and needs an amputation, debridement or deep space I&D and I’m concerned about control of bleeding. Or else the elective surgery patient who’s at high risk for DVT and will need prophylaxis. There’s a confusing array of issues. What drug to use…Lovenox, Coumadin, heparin, Plavix, aspirin, etc.? What level of INR is therapeutic, vs. what level of INR is optimum for surgery? Is it safe to take an at-risk patient off of their anti-coagulant, and for how long?

Obviously these decisions are left to the internist or other consultant who’s on the scene to “hold our hand” but they are medical specialists not surgeons, and often ask us where we want the INR to be. We’re also still in the loop especially when recovery room nurses look to us, and the hospital requires the surgeon to fill out a VTE risk assessment form and maybe even write orders off of a checklist. I’m not about to consider handling these delicate cases alone, but I found a great article titled “When patients on warfarin need surgery.” To me, it was very practical, informative and hopefully of interest to others in this forum.

http://www.ccjm.org/pdffiles/Jaffer1103.pdf

Carl Solomon, DPM, Dallas TX, cdsol@baylorhealth.edu

RE: Videotaping of Surgery (Nat Chotechuang, DPM)
From: Steven H. Goldstein, DPM

I have done this for educational purposes however you must have the patient sign a separate consent and release should you want to show this to other patient and/or doctors. As far as taping a surgery to keep in a patient's chart, this could be used against you in a court of law should something unexpectedly go wrong. Be very careful what you say as well because a slight "whoops" could be potentially harmful to you.

Steven H. Goldstein, DPM, Royal Palm Beach, FL, stevefootdr1@cs.com

RE: Charging for Copies of Patient Records (Paul Busman DPM,RN)
From: Jon Purdy, DPM

I have to disagree with the statement that copying medical records costs pennies. Some medical records are extensive but for argument's sake we could use a 50 page medical record as an example. The time you pay an employee to speak with the patient, pull the record, disassemble, copy, reassemble and contact the patient to pick it up probably ranges in the area of 30min. For a $10 / hr employee this is about $6.50 when benefits, taxes, workers comp, etc, is taken into consideration.

In a copier lease (which includes rental, taxes, toner and repair/maintenance of the machine) each page costs anywhere from four to eight cents a copy. At 50 pages and an average of $.06 a copy, your cost here is $3.00. Now you need to add in the cost of 50 pieces of paper and an envelope to put them in, so let's say $1.00. The grand total in this scenario is $10.50. Of course that is just the paper record. X-rays are another story.

The reality is that it is expensive to do business in many areas that people don’t consider to be “expensive.” We have no problem charging patients that just “want” a copy of their record. We also have no problem informing them that we will fax their record free of charge to the physician of their choice. The ball is in their court. Also consider that to the lay person, there are many, many opportunities within a medical record for the patient to get the incorrect idea of what has transpired, especially if this patient had documented inappropriate actions during any of their visits.

Jon Purdy, DPM, New Iberia, LA, podiatrist@mindspring.com

PRACTICE FOR SALE - WEST CENTRAL FLORIDA

Twenty year old mobile podiatry practice. Retiring. Alf’s, nursing homes, and Independent living facilities. Excellent location and growth Opportunity. Willing to stay on and introduce new doctor to patients and administrators. Great opportunity for a new graduate. Please contact me at footdoctor87@yahoo.com

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com -- www.homephysicians.com

PODIATRIC CONSULTANT AVAILABLE

Board-certified podiatrist with over 25 years experience available on a consultant or educational basis for health-related agency or corporation. To receive a copy of my resume, e-mail havbil@gmail.com

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

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

MEDICAL SPACE FOR RENT OR SALE - NEW YORK CITY

305 Second Avenue (17-18th Sts), 3 Treatment rooms, Private office, Lab, Separate Receptionist/Business area, waiting room, bathroom w/ stall shower Deluxe/Landmark/Prime Building and Location, 24/7 security. Multi-specialty condominiums originally designed specifically for podiatry has also been upgraded for dentistry. For further details contact Laura Dobrusin, Ny2azld@aol.com or jdobr@arizonamed.com 480-951-2480 602-980-8457.

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

ASSOCIATE POSITION – VIRGINIA

Must have Virginia license. Requires 24 to 36 month Residency. Permanent position with potential buy in. Includes all phases of Practice excluding nursing homes. Competitive Salary and Benefit package. Please send Resume including salary requirements and availability date to needpodjob@yahoo.com

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

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