The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

February 08, 2012 #4,379 Publisher-Barry Block, DPM, JD

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Feet Can Hold Clues to Heart Health: MI Podiatrist

If you’re wondering about the health of your heart, try looking at your feet. The lowly, stepped-on, shoe-squished foot could very well hold clues about the state of your coronary arteries. If your feet show signs of poor circulation – or peripheral arterial disease – your heart could be suffering as well. Dr. Marisha Stawiski, a Grand Rapids podiatrist, says she regularly checks patients for the subtle signs that could indicate PAD. A loss of hair on the feet is one possible sign of poor circulation. 

Dr. Marisha Stawiski checks a patient for PVD (Photo T.J. Hamilton)

That doesn’t mean that people who have always had smooth, rather hairless feet have PAD, she said. “But if you have somebody with a lot of body hair and none on their feet and ankles, it could indicate an arterial issue,” she said. Different pulses, very cold feet, or a change in color also could indicate a problem. If she sees any signs of PAD, Stawiski recommends a simple, non-invasive test called an ankle-brachial index. It compares the blood pressure in the ankles to the blood pressure in the arms.

Source: Sue Thoms,  The Grand Rapids Press - MLive.com [2/6/12]

Feinberg Research Scholarship in ‘Podopediatrics’ Established at Barry

Barry University’s School of Podiatric Medicine announces the establishment of the Dr. Herbert Feinberg Research Scholarship in Podopediatrics through a $30,000 gift by the Feinberg Family. The donation, pledged over three years, will be used to provide research scholarships to Barry podiatric medical students on the prevention, diagnosis, and treatment of children’s foot and ankle problems through the Paul & Margaret Brand Research Center.

(L-R) Dr. Jeffrey Jensen, Dr. Gail Goldman, Carol Feinberg, and Dr. James Losito

The late Dr. Feinberg was instrumental in the founding of the Barry’s School of Podiatric Medicine in 1985. He served as chairman of the Presidential Advisory Council for the school and donated many of the first textbooks, journals, and scholarship funds. Feinberg was president of the Florida Podiatric Medical Association, delegate to the American Podiatric Medical Association, and editor of the Footprints Journal for more than 20 years.

Canadian Podiatrist Skeptical About the Shift Away from Supportive Footwear

For runners, the trend away from tricked-out, uber-supportive shoes and toward minimal footwear has taken off in the past few years, turning a fringe product into a roughly $2-billion annual cash cow. But Michael Mesic, a doctor of podiatric medicine at the Canadian Foot Clinic & Orthotic Centre in St. Catharines, Ont, is skeptical about the shift away from supportive footwear.

Dr. Michael Mesic

“Most of the hype is generated by shoe companies – they’re creating a new market,” Dr. Mesic said. “There is that subset of the population with great mechanics who don’t need that extra support, but the average person needs support.”

Source: David Kumagai, Globe & Mail [2/5/12]

FL Podiatrist Named Chief of Podiatry Staff

Sarasota Memorial Hospital has named Dr. Robert Goecker as chief of podiatric foot and ankle surgery. Goecker, a physician in private practice at the West Coast Podiatry Center, lectures extensively on topics related to foot and ankle surgery for other podiatrists nationwide. He is also on the faculty of the renowned Podiatry Institute in Decatur, GA.

Dr. Robert Goecker

Dr. Goecker graduated from College of Podiatric Medicine and Surgery – University of Osteopathic Medicine and Health Sciences in Des Moines, Iowa as a Doctor of Podiatric Medicine and completed a 3-year Surgical Residency at Northlake Regional Medical Center in Tucker, Georgia. He served as a volunteer in the Baja Crippled Children's Project.

Source: Sarasota Herald-Tribune [2/6/12]

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky: What can DPMs do to drive nail salon clients into podiatric practices?

Dr. Robert Spalding

Robert Spalding: You have to first remember that the salons are in the aesthetic business. Podiatry has typically not embraced aesthetic into our practices like dermatologists and plastic surgeons have; however, many DPMs have recognized this, and have offered sterilized instruments vs. chemically cleaned ones (like in most salons). You can find competent nail technicians and hire them for your practice, thus increasing the value of your practice and your bottom line.

Dr. Jeffrey Jensen

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's guest is coding  expert Dr. Jeffrey Jensen, dean of the Barry University School of Podiatric Medicine.  You can register for future events by clicking here

Query: Source for Medical Nail Technicians

How do we find medical nail technicians? We are interested in expanding our podiatry practice and would love to know how to find these techs.

Tracy Edwards, Office of Daniel Mendoza, DPM, Nashville, TN

Query: Wound Care Coding & Billing Question

A patient with an existing plantar foot wound which was debrided had a new venous leg wound on the same leg which was evaluated and treated at the same visit. Accelacare is stating that because the debridement is a surgical procedure, there can be no billing for the treatment of the venous leg wound because it is on the same side. If it were on the opposite leg, however, then it would be billable.

To my knowledge, the venous leg wound is a separate diagnosis regardless of location and is separately billable with the evaluation of that wound at some level of E/M coding (with a "-25" modifier). Am I wrong?

Kevin Brattain, DPM, Peoria, IL Wound Care Coding & Billing Question

Response: A "-59" modifier should be used to separate the two sites of treatment as long as the level of tissue debridements performed (e.g., foot ulcer - CPT 11043; venous leg ulcer - CPT 11042) are different.

Walter Pedowitz, MD, Linden, NJ

Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription

Query: Atypical Forefoot Pain (Gary Bjarnason, DPM)
From: Michael Forman, DPM, Evan F. Meltzer, DPM

As my former classmate, E.J. Daniels from North Carolina, used to say, "Machk (Mike), don't go lookin' for berries in a pea patch." It smells like a neuroma. My protocol here would be: 1. try 3-7 alcohol injection 2. MRI 3. if the MRI is positive, surgery. 4. If it's negative, write us back.
 
Michael Forman, DPM, Cleveland, OH, IM4MAN@aol.com

Your patient may suffer from pre-dislocation syndrome. The late Dr. Gerard Yu lectured on this extensively. It responds quickly to the application of a hammertoe regulator such as a Budin splint for the second toe; the diagnosis and treatment are complete. If this works, he should wear the splint for 3 months. 

Evan F. Meltzer, DPM, Jackson, MS, Evan.Meltzer@va.gov

RE: Treatment Options Talocalcaneal Coalition (Edmond F. Mertzenich, DPM, MBA)
From: Robert D. Phillips, DPM

Mert Root taught me a good approach to these types of coalitions, which has served me well for a great majority of the tarsal coalitions. Unfortunately, you’re going to have to get out a goniometer to do a good job.

An orthotic that tries to immobilize the joint in its fully pronated state is the object. That means the more rigid, the better it works. Talk to your lab about how to get an orthotic that is very rigid. I have on occasion added up to 1cm thick PMM re-inforcement under an acrylic device to get the rigidity.

If the patient truly has the coalition you described, you should have noticed that...

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

RE: Walk for the Cure...NOT! (Arthur Gudeon, DPM)
From: Elliot Udell, DPM
 
Dr. Gudeon shines a light on a problem with many charitable organizations. The Lustgarten Foundation which was started and is subsidized by Cablevision, sees to it that 100% of donations go toward research on pancreatic cancer. This is one, highly admirable end of the spectrum. On the other end are shady and quasi-shady charities where the executive directors are given the same kinds of bonuses that Wall Street tycoons get, and only a pittance goes to fund the actual charitable work. A close friend of my mom, who was not wealthy, used to give annual contributions to a charity that supposedly supported orphanages and soup kitchens. My friend traveled abroad to observe their work in action  and was shocked to find that the only thing that charity had to its name was an office, where the crooks running it collected checks from unsuspecting American donors.
 
There are two  organizations that monitor charities. One is Charity Navigator and another is called Guidestar. Both have websites, and they evaluate major charities. For small enterprises, it is advisable to speak to people who have intimate knowledge of them, or are recipients of their work before parting with your hard-earned dollars.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Two-Thousand Downloads in 24 hours for Meet the Masters Sets a Record
From: Lee C. Rogers, DPM, Marc A Brenner, DPM

Congratulations to Dr. Ribotsky on a great milestone for Meet the Masters! His dedication and hard work have resulted in a great product, and people respond by tuning in to his weekly interviews which provide a snapshot of current affairs in podiatric medicine, practice management, and politics.

Lee C. Rogers, DPM, Los Angeles, CA, Lee.C.Rogers@gmail.com

Kudos for Meet The Masters. Anytime you get 2,000 DPMs to be on the same page, you are doing something right.

Marc A Brenner, DPM, Glendale, NY, Icare4yourfeet@aol.com

PRACTICE FOR SALE - BALTIMORE, MARYLAND

Established 40+ year old well-rounded practice of both surgical and non-surgical care with special emphasis on sports medicine. Medicare and BS/private insurance base, no Medical assistance. Needs to transition to a confident well trained individual. Purchase can include building. Contact:podiatrypracticesale@gmail.com 

EQUIPMENT FOR SALE

Cosman Radiofrequency Generator for Sale! Model RFG-1B Like New Condition. Comes with Manual, 17 Dispersive Electrodes, 2 CSK-R 10 Kits, 2 CSK-R 5 Kits, 11 CC RF Cannula 10cm/10mm/22G, 4 CC RF Cannula 10cm/5mm/22G, 1 - 5cm RF Cannula/22G (4mm Sharp Curved Tip), & 2 Replacement Fuses. Asking $10,500 OBO Please Contact: nffpbosk@gmail.com

SPACE AVAILABLE - NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview, Long Island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

PART-TIME PODIATRIST NEEDED - LOS ANGELES, CALIFORNIA

Busy podiatrist looking for assistance with patients located in facilities, homes, office, etc. Flexible hours, independence, and great compensation. If interested email CV to  or call Terri at 323-353-8103.homefootcare@hotmail.com

ASSOCIATE POSITION - SOUTHERN KENTUCKY

Available in beautiful southern Kentucky in progressive, multi-office practice with 6 providers. Excellent base salary, malpractice, full benefit package with 2-year track to partnership. Looking for someone that wants to grow with our practice, work hard and develop relationships with local hospitals and surrounding communities. Strong communication skills, bedside manner and willingness to learn a must. Narrow window for interviews: email CV and letter of interest before March 1: footdocky@gmail.com

ASSOCIATE POSITION - KANSAS CITY, MISSOURI

I'm not just looking for an associate. I am looking for a doctor who wants to build a highly successful career with a doctor who is as committed to their success as he is to his own. Go towww.YourFutureInPodiatry.com to find out about this opportunity.

ASSOCIATE POSITION - NEW YORK

WORK SMARTER NOT HARDER. Join a modern, well-established 42-year-old podiatric medical/surgical practice within a multi-specialty office. Located just 20 minutes from NYC. Must be responsible, compassionate, driven, and self-starter. Enjoy cross-referrals from other specialists and support of medical assistants, office managers, and medical billers with over 50 years combined experience. Utilize modern technology: state-of-the-art diagnostic ultrasonography, fluoroscopy, ESWT (machine is owned by practice), physical therapy, x-ray, circulation testing, NCV, and in-office operatory suite. Very strong and effective advertising/marketing program. No nursing homes, No HMOs, No Medicaid, No Medicare. Must be licensed for podiatry in New York. Send cover letter/CV to: linchpindpm@yahoo.com.

ASSOCIATE POSITION - CENTRAL NJ

Looking for a three-year surgically-trained associate who has entrepreneurial spirit. Partnership guaranteed within three years for the right person. Must be very outgoing and personable. Great opportunity for a person who is confident and a go getter. drwfoot@verizon.net

ASSOCIATE POSITION – FLORIDA

Emerald Coast on the North Shore of the Gulf of Mexico, a well-established group practice with multi-offices, seeking an associate with opportunity for partnership for a PSR-24/36 Doctor well-trained in foot/ankle/diabetic problems/wound care/surgical and medical podiatric care, covering 3 area hospitals, NO nursing homes. e-mail letter of interest, CV, and references to basewedge@yahoo.com

ASSOCIATE POSITION - ARIZONA

Podiatrist to joint established practice in the Phoenix, Arizona area. Modern office utilizing EMR, Digital X-Ray, ultrasound, full DME, seeking entrepreneurial, ambitious individual who can provide excellent care and expand already existing patient base. Send CV to ArizonaFeet@gmail.com

ASSOCIATE POSITION - VICTORIA, B.C. CANADA

Beautiful Victoria, B.C. Canada on the ocean fast growing area, Associate for multi-office full scope practice Reply to dr.cole@shaw.ca

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