The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

February 10, 2009 #3,466 Publisher-Barry Block, DPM, JD

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TX Podiatrist Critiques Trendy Footwear

Weird, wacky and wild — that's the best way to describe these trendy shoes designed to fix your foot problems. It's functional footwear with misshapen soles, individual toe compartments, built-in springs and other out-there features, packaged with lofty claims about their benefits for the body. But do they live up to the hype? We asked Dr. Mark H. Tompkins, a podiatric physician and surgeon with a background in sports medicine, to give his opinion:

Dr. Mark H. Tompkins

MBT Lami ($230)  According to Tompkins, doctors use rocker-bottom shoes and related devices to treat patients with significant foot deformities. Otherwise, the pricey MBT has no significant advantage over a good name-brand athletic shoe, which is also much cheaper.  Vibram FiveFingers Classic ($75)  Tompkins says that they do improve muscle function, especially in the forefoot and toes, but they might not fit well if you have foot anomalies, such as unusual toe lengths. Wear them to run on the beach or play sand volleyball if you'd rather not go barefoot, since they do protect your feet from sharp objects.

Z-Coil Freedom 2000 ($199.95) The coil does lessen pressure on the heel and provide shock absorption, but the height of the heel has led to ankle sprains and other injuries in some of Tompkins' patients. “Heel pain can be treated more efficiently and effectively with supportive shoes, heel or arch supports and stretching exercises,” Tompkins says. CrocsRx Silver Fox ($49.99)  These are a great choice for leisure shoes because they are very supportive and do help with heel and arch pain, as well as most biomechanical foot ailments. They also bear an endorsement by the American Podiatric Medical Association.

Source: Jessica Belasco, Express-News (San Antonio, TX) [2/9/09]

Medicare Advisory Agency to Back 1.1% Physician Pay Raise For 2010

Congress' Medicare advisers will recommend that physicians receive a 1.1% pay increase in 2010 instead of the roughly 21% cut that is currently on tap.

The recommendation will appear in the annual March report to lawmakers from the Medicare Payment Advisory Commission, a congressional agency that counsels lawmakers on how they should set Medicare rates. Commissioners approved the proposal at their January meeting. Lawmakers do not always follow the panel's advice but often use it as a starting point for debate.

Source: By Chris Silva, AMNews [2/9/09]

Take Control of Your Schedule

Remember how busy you were just a few weeks ago, trying to wrap up the year, juggling professional responsibilities and social obligations? Steer clear of similar mayhem in the future by learning to say “No” more often. Here are three nice but no-nonsense ways to turn down a request.

• “I see why that is important to you; however, I am unable to help. What I can do is spend 10 minutes right now brainstorming together to find some other solution that could work for you.”
• “Here are the things on my plate right now. If I were to accommodate your request, I would have to downgrade one of my own top-priority projects, and I am not willing to do that.”
• “I would love to join you, but my schedule is already full for that time. Please keep me in mind for the next time, and know that I will be wishing you nothing but the best.”

Source: Adapted from “How to Say ‘No,’” Nancy Stampahar, Silver Lining Solutions
 

Query: Tendon for Gastrocnemius Paralysis

I have a 46 y/o otherwise healthy lady, who has painful hammering of all toes on the right foot from flexor substitution, secondary to virtually absent gastroc strength, due to a severe herniated disc 13 years ago. To address the shoe irritation of the hammertoes, PIP joint fusions at toes 1,2,3 and arthroplasties/flexor tendon transfers for toes 4 and 5 would seem appropriate. But what would be suggested to address the gastroc paralysis, if anything? Her gait is apropulsive on the right. All other muscle groups have normal strength by manual muscle testing. Has anyone had success with a tendon transfer?

Mark Aldrich, DPM, Antigo, WI

Query: Concierge Podiatry Services

Is anyone offering concierge podiatry services to their patients? If so what do you offer? How much is the service? Are there any concerns with regard to insurance and or Medicare?

Alan Mauser, DPM, Louisville, KY
 

RE: Erythromelalgia (Ken Jacoby, DPM)
From: Myron Boxer, DPM, Elliot Udell, DPM

One dose of 10 grains (2 regular pills) of aspirin at bedtime may offer significant relief of the symptoms, sometimes for several days just with one dose. The mechanism of action is not known. Another drug that has been reported to work is dibenzyline. The dose is 10 to 40 mg per day. Start with 10 mg and increase gradually up to 40 mg.  The mechanism of action is also not known. Also, keep the patient away from heat.

Mike Boxer, DPM, Woodmere, NY, mcbdpm@aol.com

True erythromelalgia is a very rare disease. In my 30+ years of practice, I have only treated  a handful of cases and this is more than many other practitioners who have been in practice equally as long. If you comb the literature, you will see that the treatments given are anecdotal because there aren't huge numbers of cases available that would allow for a major clinical study. I did come across a few anecdotal treatments from a paper published out of Mt Sinai, in NY. This was published many years ago and the authors were successful in using seratonin uptake inhibitors. (anti-depressant class of drugs).

Recently, I saw a paper where the authors were successful in using amitriptiline as part of their regimen. Another paper mentioned success with melixitine which is part of a totally different class of drugs. In the four cases I treated, I was successful with Zoloft which is a seratonin uptake inhibitor. I wonder if Cymbalta would also be helpful.  
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com
 

RE: Healthcare Networks of America, LLC (David Zuckerman, DPM)
From: Paul Kesselman DPM

I signed up with them many years ago when they initially came to NYC and had no sign-up fee.  After one year and not a single patient referral, they began to demand an annual fee. I continue to get letters from them threatening to discontinue my presence on their panel. Of course, I have never sent them a dime, they have never sent me a letter of termination nor have I ever seen a patient referred from them.

HNA and companies like them, thrive on poor unsuspecting physicians. They market the concept that they can provide a huge influx of patients from a wide number of insurance panels into your practices with ease. It simply isn’t that easy. The demographics of many of these insurance companies in your area may not live up to their marketing material. Many of these carriers are small and may not have a large population density in your practice area. If HNA, and other companies like them were successful in getting patients to your practice, they would also get a percentage off the top of your fees and not from the insurance carrier. Nowhere in their brochure or contract do they promise you a higher fee than you could negotiate on your own directly with the carrier.

Other significant issues to consider are: Who pays your claim, HNA or the carrier? What happens if your claim is paid incorrectly, to whom do you appeal the claim, the carrier or HNA? How will ERISA or your state insurance department or attorney general’s office deal with any interruption of payment? Most of the companies advertised by HNA as being on their panels are really providing union welfare benefits as they are not true insurance carriers. Any company who markets themselves in this manner is not worth the time it takes to read their brochure.

Paul Kesselman DPM, Woodside, NY, pkesselman@pol.net
 

RE: Carl Abramson, PhD
From: Joe Agostinelli, DPM, Arthur E. Helfand, DPM

I , too, was saddened to hear of Dr Carl Abramson's recent passing. For several years, Dr Abramson volunteered to lecture at our joint military armed forces symposiums. He was always there when we needed him, sometimes on very short notice. He had one of the most structured comprehensive lecture programs at PCPM and will be missed as an educator and proponent of podiatric medicine.
 
Joe Agostinelli, DPM, Col., USAF, Retired.

Drs. Glickman and Jacobs clearly identified the contributions that Dr. Abramson made to the academic program at the Pennsylvania College of Podiatric Medicine. He began to teach at a time when the basic science curriculum was just being developed as a part of our educational system and he helped enhance the educational system of the profession.
 
But there is more. Dr. Abramson was born and grew up in South Philadelphia. He entered the Army during World War II, served as a part of General Patton's Army, fought his way through France and Germany, and helped liberate one of the concentration camps. That was a life-altering experience. Dr. Abramson’s casket was draped with an American Flag because he was a true hero, the recipient of four bronze stars for his heroic actions during the war.
 
He had been married to Phyllis for almost fifty-nine years, had a wonderful family, including one son who entered our profession. During the time of his education, he supported his family as a stand-up comedian and master of ceremonies under the name of Jerry Young. His sense of humor and his concern for others proved to make him an excellent teacher who cared about his students.
 
He contributed significantly to podiatric and scientific literature and continued to lecture after his formal retirement from the Pennsylvania College of Podiatric Medicine as Professor Emeritus. Dr. Abramson left his mark on the profession, his former students, and his colleagues.
 
Arthur E. Helfand, DPM, Professor Emeritus, Temple University,
Past President, APMA
 

ASSOCIATE POSITION NORTHERN CALIFORNIA

OFFICE SPACE FOR RENT - SEATTLE, WA

Full-service, state-of-the-art podiatry office is offering office space for an independent podiatrist or podiatry group. We have digital X-ray, PADNET, physical therapy equipment, all podiatry equipment and staff to assist you to make the most out of your podiatry practice. Our office is conveniently located close to North West and Stevens Hospital right across from North Gate Mall. You can send your letter of interest to: seattlefootdoctor@yahoo.com or call 425-223-9588

ASSOCIATE POSITION-- METRO NEW YORK AREA

Part-time/Full time. Must be HIP Par Provider. Excellent opportunity for partnership. Must have surgical privileges at area hospitals. E-mail CV to rrranch7@yahoo.com

ASSOCIATE POSITION – CINCINNATI, OHIO

This is your once-in-a-lifetime opportunity to join one of the most successful practices in the United States. No seniority system. If you are motivated and have completed a PSR24-36 residency, your income is limited only by your enthusiasm and desire to achieve. Fax resume to: 513-577-7261 or E-mail resume to Kroesch4poh@aol.com

ASSOCIATE POSITION -SOUTHERN NEW JERSEY

I’m looking for podiatrist who wants additional practice hours. Perfect for combining your own practice with an additional income. Must be on Aetna Insurance, Horizon Blue Shield, Medicare, and most commercial carriers. I am looking for someone who has a desire to learn how a very successful practice is run, so that I will be able to have time away from my practice. Payscale to be discussed. Could lead to partnership or sale. E-mail contact information, CV, and why you would be perfect for this opportunity. Contact foot.care@verizon.net

PODIATRISTS NEEDED  CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC 
 
Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. 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 Visit our website

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 - VIRGINIA IS FOR LOVERS

Immediate full-time amd part-time associate positions available. Unlimited income potential. Busy, diverse, 40+yr Hampton Roads practice. Must be compassionate; energetic; and motivated; PSR24/36. Looking for long-term arrangement. Please send letter and CV tofixafoot@cox.net or fax to 757-397-5889

ASSOCIATE POSITION – ST. LOUIS, MISSOURI

Excellent opportunity for PSR 24-36 foot and ankle surgically-trained physician. Looking for hard-working, personable, highly-motivated individuals to join our group and build their own practice. Position leading to partnership. Great opportunity with excellent salary and benefits. Please e-mail CV and references to cavallinig@foothealers.com

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. Reply to: jclough@sofast.net

PODIATRY ASSOCIATE WANTED – NJ

Northern NJ. Bergen County Must be well-trained. No nursing homes or house calls. Modern well-equipped office. Digital x-ray and ultrasound. Excellent pay and opportunity. Must have NJ license. Call 973-472-4700.

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 - CENTRAL FLORIDA AREA

Exceptional opportunity for qualified candidates. Associate position available in a rapid growing, well-established multi-office practice. Well trained (PSR-24 or more). Compensation includes excellent salary plus incentives and benefits. Please e-Mail CV, letters of reference toCF_resume@hotmail.com

PRACTICE FOR SALE - CENTRAL FL

Practice sale at bargain, in beautiful growing area; 2000 sf building fully equipped/ designed for podiatry; excellent location, exposure; near hospital& wound center. Great opportunity for expansion; good insurance climate. 352-357-7499 / E-mail windnwave@earthlink.net

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