The Voice of Podiatrists

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February 11, 2008 #3,164 Editor-Barry Block, DPM, JD

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Demand For Podiatrists to Surge in Next Decade: Study

For young Americans looking for job security in a lagging economy, entering the field of podiatric medicine -- which currently boasts 15,000 doctors nationwide -- may be a step in the right direction. A recent workforce study indicates that the nation's eight colleges of podiatric medicine would have to triple their graduates between now and 2014 in order to meet growing population demands.

Dr. Christian Robertozzi

The study, conducted by the Center for Health Workforce Studies at the School of Public Health, University at Albany, attributes an increase in foot problems as a result of growing obesity, diabetes and aging rates to have a direct impact on the profession. In 2002, podiatrists provided close to 40 percent of all foot care services in the United States, compared to 13 percent for orthopedic physicians and 37 percent for all other physicians, including primary care doctors. Podiatrists are medically and surgically trained to diagnose and treat disorders, diseases, and injuries of the foot, ankle and lower extremity.

"The field of podiatry is really one of the most specialized in all of medicine. And anyone who has become a podiatrist knows that the payoffs associated with becoming a Doctor of Podiatric Medicine (DPM) are priceless," said Dr. Christian Robertozzi, APMA president. "But when it all boils down to it, most medical students are concerned about what their salaries will be once they enter the workforce. Because the supply is less than the demand for podiatrists at the moment, the median income for our profession is at an all-time high."

Source: Fox News Business [2/8/09]

BUSPM Hosts FIP Conference

Barry University was the site of a Feb. 5-6 meeting of the International Research and Education Committee of the International Federation of Podiatrists (FIP). The Federation was founded in 1947 and consists of podiatry organizations and individuals from 22 countries and 5 continents around the world. Its mission is to ensure access to high-quality foot and ankle care for all people, through collaboration with national and international organizations.

(Back row) David Ashcroft, co-chair FIP United Kingdom; Dr. Chet Evans, Dean of BUSPM, Vincent Hetherington, DPM, Dean, OCPM (front row) Anthony McNevin, CAE, FIP; and Leonard Levy, DPM, MPH, Associate Dean, Nova Southeastern University.

The purpose of the meeting was to two-fold: 1) to develop a core competency doctrine that is applicable to the practice of podiatric medicine internationally, and 2) to recommend a body of rules and regulations for the creation of an international council of podiatric educators. “The practice of podiatric medicine is uneven; unlike the M.D. there are different educational programs and different scopes of practice. Some countries like the United States allow podiatric physicians to do surgery, others like France do not,” said conference participant Anthony J. McNevin, FIP director of global education and special projects.

OR Podiatrist Builds World-Class Golf Course

Bandon, Oregon, has emerged as the new Mecca for golf aficionados. When Mike Keiser hired architects David McLay Kidd and Tom Doak to build the first two Bandon Dunes Resort courses, both were relative unknowns. Now both are now considered leaders in their field.

Bandon Crossings Golf Course

Among the many golfers who found inspiration at Bandon Dunes was Rex Smith, a podiatrist from Eugene. But Dr. Smith’s passion transcended that of the typical resort visitor. It served as a catalyst to pursue his own dream of building a golf course. Down the coast from the resort, Rex and his wife, Carla, gave promising local architect Dan Hixson an opportunity to the way Keiser opened doors for Kidd and Doak. The result is Bandon Crossings.

Dr. Rex Smith with wife Carla on 7th hole at Bandon Crossings

The Smiths purchased a 340-acre ranch adjacent to highway 101, about a mile from the Pacific shore and three miles south of the town of Bandon. Within an hour of their first meeting, Rex and Carla gave Hixson his first chance to both design and build a golf course. For a public facility, the course feels very private. A day at Bandon Crossings feels like playing golf in a good friend’s backyard.

Source: John Kirk, Links Magazine [2/7/08]

Query: Botox for Tarsal Tunnel

I recently read a pain management journal (Practical Pain Management Jan/Feb 2008 issue: Outpatient Interventional Treatments for Migraines and Pain Flare-ups) where Botox A and B were being experimentally used for carpal tunnel and diabetic neuropathy with success. The theory is that the intradermal injection inhibits substance P and glutamine. Has anyone used this method for tarsal tunnel or diabetic neuropathy?

Eugene A. Batelli, DPM, Clifton, NJ

Query: Secondary Wound Closure

A diabetic patient was taken to the operating room for an amputation of his hallux at the metatarsal-phalangeal joint for a septic joint and osteomyelitis of the hallux (proximal phalanx) and first metatarsal. The wound site was left open.

Five days later, he was taken back to the operating room for additional resection of the infected distal portion 1st metatarsal. At the same time, the distal 1/2 of the 2nd metatarsal shaft was excised, but the 2nd toe was not amputated. The wound site was closed.

How would the second stage of the surgery be coded? My thoughts were either: (1) Resection of 1st metatarsal, separately coding delayed primary wound closure - complex (CPT 13160) to include the 2nd metatarsal bone resection; or (2) Resection of metatarsals 1 and 2 with delayed primary closure - simple.

Daniel Cohen, DPM, Melbourne, FL

Response: I believe both coding scenarios are fine, but remember to add a "-58" modifier to the code because this is a staged procedure, necessitated by the underlying disease, and you will not get trapped in the previous global period.

Walter Pedowitz, MD, Linden, NJ

Codingline subscription information can be found at:
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RE: Recurring Metatarsal Fractures in Healthy Adult (Jeffrey Bean, DPM)
From: Multiple Respondents

I once had a patient who had a similar problem. I sent her to her PCP who sent her to an endocrinologist who discovered a primary pituitary tumor.

Mark Stempler, DPM, Staten Island, NY, drmstempler@verizon.net

First, I would try to get more of a study of the bone density in the foot itself. Most bone density studies just study the hip and spine. While there may be some correlation between what is happening in the bones of the foot and the spine and hip, we have all had cases where we see radiographs of feet with frank osteopenea and the patient tells you that she recently had a bone density study of the back and hip which was normal.

There are some abnormalities which can lead to bone fractures. Two immediately come to mind. One obvious one is hyperparathyroidism. I had one patient with painful osteoporosis of the feet and when we evaluated her blood serum studies found high calcium levels and subsequently after ordering further parathyroid hormone studies I referred her to an endocrinologist who ultimately with further testing found a benign tumor of one of the four parathyroid glands which was causing the problem.

Another disorder which can be a culprit in stress fractures is elevated homocysteine. This too can be tested for with a simple blood test and the condition can be easily be treated. There is literature to support this correlation and we did have a patient who sustained multiple stress fractures of the foot and high serum homocysteine levels turned out to be the cause. Its been many years since he began treatment to lower these elevated blood levels and he has not sustained another stress fracture to date.

Osteitis deformans or Pagets disease is another potential cause of stress fractures. Check the serum alkaline phosphatase Once again, it is rare for this to initially present with a pedal fracture but if you practice long enough you might see a case or two.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

I had a young healthy female patient in my practice many years ago. She was in her early thirties and was into active Greek dancing. She came in my office with spontaneous neck fractures of two metatarsals. I just made the diagnosis of "stress fracture" put her in a surgical shoe and watched healing occur uneventfully. Approximately one year later she returned to the office again with pain and swelling of her foot (I do not recall if it was the same) and low and behold had two new spontaneous fractures. Three months later developed another. I referred her for a complete work-up and it did not produce any positive results. Approximately one year later she called and told me that she was diagnosed with MS. These bizarre findings and the patient came to mind reading Dr. Bean’s post.

Barry A. Wertheimer, DPM, Redondo Beach, CA,

RE: Large-Sized Orthotic Sandals (John Hester, DPM)
From: Rich Bouche’, DPM

There is a shoe company in Portland, OR called the Oddball Shoe Company (www.oddballshoe.com) that caters to be individuals with shoe sizes larger than 13. Many of their clients are professional basketball players.

Rich Bouche’, DPM, Seattle, WA, spmrtb@earthlink.net

ASSOCIATE POSITION - VIRGINIA (NORTHERN)

Excellent opportunity to join a multi-office practice. In search of a well-trained, hard-working, ethical podiatrist to take this well established full scope practice to the next level. Competitive salary and benefits package. Looking for a long-term relationship with potential for partnership. Reply to: footdocva@cox.net

OFFICE TO SUBLET – SUFFOLK COUNTY, NY

Podiatrist needed in busy medical office building, sublet space Tuesdays, Thursdays and Saturdays. 1,000 square feet. Electric, garbage, taxes, all inclusive fully furnished, absolutely beautiful three treatment rooms, complete waiting room and consultation room. Asking $1,200, call (631) 981-1334 or Fax: (631) 981-6766. Building has internist, psychologist and chiropractor.

EQUIPMENT FOR SALE - BIDIRECTIONAL DOPPLER

KOVEN SMART-DOP 45 Performs arterial & venous studies on its LCD screen or on a computer (software included). Unit & accessories in excellent condition. Unit is 1 year old and has been used about 3 times. Asking $2,800. New unit is $5,000. Doppler specifications: http://www.koven.com/products/SD45.pdf Email nefootandankle@optonline.net

PRACTICE FOR SALE – PHILADELPHIA, PA

Six year-old well established practice averaging 300K over the past three years. Suitable for surgical podiatrist. Large referral base and surgical care. I am looking to relocate. I will stay during transitional period. Excellent Philadelphia location. Practice is still growing, allowing instant and increasing income. Hospital and Surgical Center privileges. Equipment included. Fax 215-665-9242 for details.

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

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

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

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.

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