The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

February 08, 2010 #3,774 Publisher-Barry Block, DPM, JD

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FL Podiatrist Joins Bethesda Wound Care and Hyperbaric Medicine Program

Bethesda Healthcare System has announced that Alan MacGill, DPM, AO Fellow, has been appointed as the new panel physician of the Bethesda Wound Care and Hyperbaric Medicine Program.

Dr. Alan MacGill

Dr. MacGill currently practices at Certified Foot and Ankle Specialists located in Boca Raton. Dr. MacGill is the Research Director of Bethesda’s new Podiatric Medicine and Surgery Residency Program, scheduled to accept its first residents in July 2010.

Source: Paul Kurlansky, South Florida Hospital News [2/5/10]

CT Podiatrist Collects Shoes for Haitian Earthquake Victims

Norwalk podiatrist Dr. Harris Greenberger is taking strides to help those affected by Haiti's 7.0 magnitude earthquake. To help with relief efforts, Sound Foot Care Center of Connecticut is collecting new and gently worn shoes to donate to Haiti in partnership with Soles4Souls. Proceeds from the first phase of the shoe drive will benefit Soles4Souls' "Project Haiti," which will donate more than one million pairs of shoes to areas affected by the 7.0 magnitude earthquake.

Dr. Harris Greenberger

"Since I am unable to travel to Haiti myself and provide assistance, I wanted to find a meaningful way to help those devastated by the earthquake," said Dr. Greenberger. "We are excited to partner with Soles4Souls and look forward to helping them achieve their objective."

Source: Danielle Cyr, Hartfort Courant [2/2/10]

Query: Off-Shore MD Degrees for Podiatrists 

I am interested to know about the Caribbean or Costa Rican medical schools that accept podiatrists to advanced program for the MD degree. Has anybody done any of these programs, and what would the recommendations be?

Hermoz Ayvazian , DPM, Glendale, CA

RE: Dwight Freeney Ankle Injury (R.D. Teitelbaum, DPM)
From: Doug Richie, DPM, Amol Saxena, DPM
 
Dr. Teitelbaum unveils several myths and misconceptions about the management of ankle sprains in the high level athlete:

1. Performing immediate "ORIF" (I assume he is proposing surgical repair of the ruptured ligaments?) is not standard practice in the treatment of any lateral ligament sprain in the competitive athlete.  The literature continues to demonstrate that, regardless of extent of ligament injury, athletes will respond as well or better to a functional rehabilitation program compared to open surgical repair.  In the NFL and the NBA, immediate repair of acute ankle ligament ruptures are never done, period.

2. Data from the NCAA has demonstrated that the average time of return to play after Grade-2 ligament sprain in the ankle is 10 days.

3. The suggestion of performing a local anesthetic block to a sprained ankle prior to return to play would not ever be done by any credible medical team managing a professional athlete. Yes, proprioception would be even further compromised.

4. There is no official word on the true extent of ligament injury sustained by Dwight Freeney. The video tape replay shows a mild plantarflexion-inversion injury with minimal ankle rollover.
 
Notwithstanding, there is no real controversy here and no real medical ethics issues. Dwight Freeney will play on Sunday, just like thousands of other athletes do within days of single or double ligament injuries of the ankle.
 
Doug Richie, DPM, Seal Beach, CA, DRichieJr@aol.com

Grade-III lateral ankle sprains in a professional athlete: Surgery for this acute injury is extremely rare. Drs. Bouche, Richie & I "debated" this at previous ACFAS & Midwest Podiatry Conference Sports Medicine sessions, and we were unanimous that we would NOT operate on a Grade-III lateral ankle sprain (LAS) unless there was a bony intra-articular fragment, displaced OCD lesion, or tendon, syndesmosis, or peroneal retinaculum tear.

In fact, Bouche and I each have children who have sustained this injury, who were treated non-surgically with immobilization followed by physical therapy, and happily both children have stable, fully functional ankles. My son sprained his ankle three years ago playing basketball in college, which he still does, but he also does the triple jump which has amongst the highest impact on the ankle.

I am also fortunate to practice in a sports med group that currently takes care of both an NFL, an NBA team, many high schools, and over the years, has taken care of other NFL, MLB, Pro Soccer, University, and national basketball, soccer, track & field & rugby teams. Our group has never, and I mean NEVER, operated on an acute grade III lateral ankle sprain in 35 +yrs.

In this age of EBM, Cochrane's Reviews has substantiated that non-surgical treatment for Grade-III LAS is best. I realize that "experienced-based medicine" may argue  otherwise, but we also have to balance (no pun intended) the medico-legal based medicine, which does not support immediate surgery unless the other indications listed above are present.

Amol Saxena, DPM, Palo Alto, CA, Heysax@aol.com

RE: Poor Surgical Result (Tip Sullivan, DPM)
From: Robert P. Martin, DPM, Philip Demp, DPM

In response to Dr. Sullivan’s question of how to stabilize the lesser MPJ's in the transverse plane, I suggest that you look into the mini-tightrope by Arthrex. I have used this to correct transverse plane deformities in the lesser digits, utilizing essentially the reverse technique which is described for the tight rope for hallux varus repair. Once you have completed the appropriate capsular work, you can control the desired amount of transverse plane correction by how tight you pull your knot proximally.

In my opinion, this is a more predictable and less traumatic procedure than multiple metatarsal and or phalangeal osteotomies, with a much quicker healing time. Be sure to place your proximal and distal drill holes at the same level in the sagittal plane, with the digit held in a neutral position to avoid any sagittal plane influence of the tightrope, i.e., dorsal or plantar contracture of the digit. A 0.054 K-wire works well as a pre-drill in this indication.

Robert P. Martin, DPM, Manteno, IL  footdocs@sbcglobal.net

Every metatarsal has a variation among the positions of the metatarsal heads. There is a total relationship among the variable positions of the five metatarsal heads so that they affect one another. Some of these relationships (configurations) have been implicated in the pathomechanical etiology of a wide range of clinical chronic conditions.

In this case, the x-ray shows a pathomechanical configuration. This can be changed into a smooth healthy configuration by shortening the second metatarsal two millimeters. This may improve the problem.

Philip H. Demp, DPM, Cinnaminson, NJ, pdemp@dca.net

RE: Jones Fracture Healing (Lowell Weil, Sr., DPM, Steven Goldstein, DPM)
From: Thomas Graziano, DPM, MD, Kenneth Meisler, DPM

Rule out an os vesalianum. Take radiographs of the other foot. In a 13 y/o who is asymptomatic, it may have been an acute flare-up of the accessory bone and its surrounding tendon.
 
Thomas Graziano, DPM, MD, Clifton, NJ, TGrazi6236@aol.com

Editor's Note: Dr. Meisler's extended-length note can be read here.

RE: Billing and Coding Books Specifically for Podiatric Medicine & Surgery (Mark  Lambert, DPM) From: Steven H. Goldstein, DPM

I had used Dr. Taubman's coding set for five years when I was practicing. They are podiatry-specific, so you get the codes that most of us see in day-to-day practice. The CPT-4 codes come with global periods. All the modifiers are included, as well as A-codes and J-codes. I have found his coding set to be the best I have ever used.

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

RE:  EMR Change-Over (Harry Cotler, DPM, David R. Sullivan, DPM)
From: Multiple Respondents

I also am a "satisfied with reservations" Lytec/Medinotes user who must make a switch to become CCHIT-certified. I am looking at my options and came across a web-based blended EMR/Practice Management product called "Office Alley" that claims to have 300,000 medical users nationwide. I like what I see on the demos, but the fee structure seems too good to be true. Does any podiatrist have experience (good or bad) with "Office Alley"?

Note to Dr. David Sullivan: Medinotes was never CCHIT-certified, as the final standards for certification have not even been released yet. Thus, to my knowledge, there are no EMRs that have been certified (only EMRs that are in position to become so - Medinotes is not one of them)

Kevin McDonald, DPM, Kannapolis, NC, mickeyfeets@yahoo.com

Dr. Cotler and others who are Medinotes users are in a unique situation. When a product is scheduled to go off support, a user is often required to purchase a new or different software package. Eclipsys decided to treat the Medinotes to PeakPractice EMR migration as a "software maintenance" issue. Any user who is current on their maintenance and support agreement will receive the PeakPractice EMR without any new licensing costs. You may opt to keep your existing billing/scheduling software or add the PeakPractice PM system to create a single database with the EMR.
 
Anyone who has implemented an EMR knows the real cost is the time it takes to set up your content to fit the way you document patient visits. This has been addressed as well through a conversion wizard. This will allow a user to keep the templates that they have developed to fit their individual podiatry practice. Notes, scanned images, lab results, and other data will convert as well.
 
PeakPractice has been certified for the CCHIT 2008 criteria. This makes their progression to the 2011 certification much easier than if they had never been through this process. Eclipsys is projecting that they will attain their 2011 ARRA full certification in April of this year.
 
Disclaimer: I am a business partner for Eclipsys.

Zac Childress, Oxford, MI, zac@godarwintech.com

Editor's note: Extended-length notes by Drs. Michael Brody and James DiResta can be read here.

RE: Liability for Recommending Barefoot Running (Kevin A. Kirby, DPM)
From: Paul Busman DPM, RN, Doug O'Heir, DPM

I get a real kick out of people who say that running barefoot is the way our ancestors ran 10,000 years ago, so it must be the best, most natural way to run. 10,000 years ago, our ancestors didn't have insulin replacement therapy: why not go back to those natural days? They lived in caves or crude huts, but who would want to do that today? They had to hunt or gather every morsel of food they could find: sound nutritious or appetizing?  We could argue that not everything mankind has achieved is so wonderful, but by and large, I think we've improved our lot and I wouldn't want to live the old "natural" way. 

Paul Busman DPM, RN, Clifton Park, NY, Brewerpaul@aol.com

If anyone is enthusiastic about barefoot running, simply let them try it at their own risk. These things come around in cycles - in the 60's, barefoot running was in vogue because of Abebe Bikila of Ethiopia, who won the 1960 Olympic Marathon running barefoot (his 1964 Olympic victory was done wearing shoes). I was running high school cross-country at the time, and we'd try barefoot running at times for training runs up to 8 miles. 

The only saving grace was that a local golf course let us run around their grassy perimeter, but otherwise barefoot running on rocky trails or pavement was intermittently painful. Once we put aside the adolescent bravado of daring each other to run barefoot, we were all glad to revert to the thinly padded, minimalist shoes that were typical of the time. I've never been tempted since, and I wouldn't recommend it to a patient. 

Doug O'Heir, DPM, Waterville, ME, doheir@gmail.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

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 - TEXAS

Wonderful opportunity! Successful multi-office, multi-professional practice seeks well-trained new and established podiatric physicians with expertise in sports medicine, podopediatrics, rearfoot/ankle surgery, or hospital podiatry. A must to be outgoing, motivated, and personable with a dedicated hard-working ethical desire to become a winner. Send resume, current photo and letter of interest to sierrajip@gmail.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

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 – 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 - 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

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 - W FLORIDA, BEACHES

Well established podiatry practice 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

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