The Voice of Podiatrists

Serving Over 10,700 Podiatrists Daily

February 13, 2008 #3,166 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2008- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

People Need Not Suffer From Bunions: IL Podiatrist

Most people think they have to live with bunions or go through a very disabling surgical procedure to resolve it. These facts are not true, and therefore, a foot specialist should be consulted if this deformity is present. “The cause the bunion deformity is not the shoes that a person wears. It is actually caused by abnormal foot joint alignments around the great toe.”, says podiatrist Dr. Joseph Borreggine. The large bump around the great toe is usually red, swollen, and painful. The bone sticking out around the great toe actually has not ``grown,' but rather it is the joint that is becoming subluxed or dislocated.

Dr. Joseph Borreggine

“Pain occurs when the shoe presses on the bunion deformity. However, bunions may not always be painful, but asymptomatic bunions can cause debilitating arthritis if left untreated.”, says Borreggine. Bunion deformities are hereditary, usually caused by flat (hyperpronated) feet, and are more prevalent in women (since, statistically, women seek care for foot pain more than men).

Borreggine says bunion pain can be relieved through many treatment regimens, including arthritis medication, steroid injections, wider shoes and arch supports. Bunion surgery could be the best treatment to correct the problem, if all else fails. As always, it's advisable to consult with a podiatrist and see which treatments is available.

Source: Herald Review [2/7/08]

CT Podiatrist to be Inducted into AIC Hall of Fame

American International College Director of Athletics, Robert E. Burke, has announced the inaugural class to be inducted into the AIC Athletic Hall of Fame on Saturday, April 9 at 5:00 pm. Among those to be inducted is Dr. Marcy MacDonald.

Dr. Marcy MacDonald

MacDonald starred for the Yellow Jacket softball team from 1982-85 as a designated hitter and catcher. She served as team captain as a junior and senior, and was a two-time All-Northeast-8 selection, earning NE-8 First Team honors as a junior. As a senior she received the Maloney Award as well as the ECAC Merit Medal and led AIC to the NE-8 regular-season championship.

Among her post-graduation accomplishments, MacDonald has swam across the English Channel a total of eight times, the first coming in 1994. In 2001, she became the first American woman to perform a double crossing, a feat which she duplicated. In 1989, MacDonald became a Doctor of Podiatric Medicine and has operated her own private practice in Manchester, CT since 1992.

Source: American International University [2/11/08]

More Employers Shifting Retiree Coverage to MA Plans

The Los Angeles Times on Monday examined how state and local government agencies, large not-for-profit organizations, and major corporations across the country are shifting the costs of retiree health care to the federal government through Medicare Advantage plans. Payments to private MA plans are on average 113% of the cost of care under traditional Medicare, and the higher payments allow insurers to offer additional benefits not available to other Medicare beneficiaries, according to the Times. About nine million seniors are enrolled in the private MA plans. However, as employers shift retiree coverage to MA plans, the program is "hastening the depletion of the already stressed Medicare trust fund," the Times reports.

In addition, because MA plan premiums are tied to the federal government's overall costs, monthly premiums have increased for all Medicare beneficiaries, including the 80% of seniors enrolled in the traditional program who do not receive the additional benefits and must purchase supplemental coverage. According to the Times, "It didn't take long for employers to see the potential" of MA because the plans are "simple to administer" and "employers who provide retirees with coverage to bridge the gaps in Medicare can score significant savings."

For example, according to John Grosso, a consultant with the benefits firm Hewitt Associates, a traditional Medigap supplementary policy could cost employers $1,000 to $1,500 annually per retiree, while a private fee-for-service MA plan could offer a similar benefit for $300 to $600 annually.

Source: Los Angeles Times via American Health Line [2/11/08]

Query: Aqua Relief System (DME product)

Is anyone familiar with this DME product, its indications, how it is utilized and assessed? From the literature it is a pain management device that can also be used for diabetic neuropathy. This is a brief description: "The ARS (Aqua T pump) is a rehabilitation product that provides safe and effective treatment of pain, arthritis and inflammation. It is water circulating, conductive, localized temperature therapy that provides therapeutic surface warming of the skin and underlying tissue. The ARS (Aqua T pump) maintains a heat temperature range that is within safe clinical parameters (40°C/104°F on low setting) to meet a wide variety of pain conditions. The ARS (Aqua T pump) system has been designed to be used in conjunction with a prescribed rehabilitation program designed by a treating physician."

Richard A. Simmons, DPM, Viera, FL

Query: Outsourcing Appointment Scheduling

Our office consistently fails to schedule appointments during certain time periods such as the last hour of the day, the hour prior to and the hour after lunch and Friday afternoons. We believe that the staff may hold too much "power" over filling these appointment times for personal reasons. Likewise, the front desk is frequently interrupted by telephone calls while checking patients in or out of the office. Needless to say, this is a problem for both the patient in the office as well as on the phone.

We are interested in outsourcing our appointment scheduling and would like to hear from those offices that may already do so. What are the "less obvious" pros and cons? What companies are recommended?

James L. Rose, DPM Anderson, SC

RE: Pruritic Rash [Chris Seuferling, DPM]
From: Multiple Respondents

Pruritic Rash

Your 29-year-old patient who has the chronic puritic rash unilaterally on her foot may have a contact allergic dermatitis or as it is called sometimes, contact eczematous dermatitis. This process usually involves inflammation with intra-epidermal intracellular edema and monocyte infiltration into the dermis. This suggests allergic contact dermatitis.

I would recommend doing a patch test with insole material from the shoes that the patient commonly wears. Since this sensitization is present on every part of the skin, therefore application of the allergen to any area of normal skin will provoke inflammation. A positive patch test will show erythema and papules, as well as possible vesicles on the skin under the test site.

Management of chronic contact dermatitis involves of course removal the etiological agent and then use a short course of one of the potent topical corticosteroid preparations such as betamethasone dipropionate or clobetasol propionate.

John Hahn, DPM, ND, Portland, OR, jmhahn2@verizon.net

Not everything that is pruritic is fungus. Clortrimazole is good but needs to be applied frequently. If in doubt, do a PAS skin culture of the periphery to check for fungal elements. If present, consider Naftin, econozole, Lamisil, Ertazco and other long-acting antifungal topicals.

If not, consider the myriad of dermatoses. Frequently I see neurodermatitis, contact dermatitis, irritant dermatitis. Consider a potency class I i.e., temovate or II Lidex ointment.
If treatments fail, consider biopsy or using orals meds.

Simon Young DPM, NYC, NY, simonyoung@juno.com

Before considering a punch biopsy, there are a couple of questions that should be asked. Is this seasonal? Does the patient report dryness of the skin in any other part of the body? Does the patient have a history of allergy? Does it occur only when certain shoes or sneakers are used? Also examine for limb-length discrepancy. When we were studying all about contact dermatitis, we learned that since the antigen was in the shoe and both shoes are made up of the same materials, any form of contact dermatitis would have to be bilateral and symmetrical in appearance. Having severe allergies, I can vouch that I have had cases of contact dermatitis to certain soaps that only affected one of my arms. So I would not rule out contact dermatitis or drying out of the skin with a secondary dermatitis, even though it is unilateral.

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

RE: Socks (Doug Richie, DPM)
From: Robert Scott Steinberg, DPM

Dr. Richie was quoted in an article, re-published in PM News, as say saying cotton is absorbent and polyester and acrylic are water repellent. Maybe a better way to understand the properties of polyester and acrylic is that they wick and transport (accelerated by heat) moisture off the skin and up and through the sock.

Longer socks have a much stronger wicking capability. Socks need to stick up above the shoes. Another secret is never use fabric softener on performance fibers. Fabric softener is basically wax. Wax does repel water. Fabric softeners will plug the breathable membranes of Gore Tex and Entrant. Most manufacturers even go so far as recommending that only powdered detergent, first dissolved in water, be used on performance fabrics.

Robert Scott Steinberg, Schaumburg, IL, Doc@FootSportsDoc.com

RE: Universal Healthcare (PM Jan 08 Column by Harry Goldsmith, DPM)
From: Michael M. Rosenblatt, DPM

Editor’s note: This extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=17892&start=1

PODIATRIST WANTED – MICHIGAN

Busy 2-Office practice looking for the right podiatrist to take the practice to the next surgical level. Fast track to partnership. PSR 24/36 ABPS qualified/certified. Email resume to drflatfoot@yahoo.com

EQUIPMENT FOR SALE - AUTOMATIC PROCESSOR

AFP Mini-Medical/90 automatic X-ray processor. Excellent condition. Purchased in 2003. Have monthly maintenance records. Location: Pasadena, MD. $1000. View at http://www.afpimaging.com/medmini Contact Jayne at jferris@chesapeakefac.com for details.

PRACTICE FOR SALE - PORT ST LUCIE, FLORIDA

The office is 0.2 miles away from the hospital. Good mix of Medicine, Surgery, Wound care, and general podiatric care. Wound care center privileges available. No HMO's. Please call 1-772-475-7920 or derrico@pol.net for details

PARTNER WANTED FOR GROUP PRACTICE LOCATED 1 1/4 HOURS NORTH OF NYC

BE AT THE RIGHT PLACE AT THE RIGHT TIME. YOU CAN'T BEAT THIS OPPORTUNITY. Respond to: mhudes@footcaregroup.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

ASSOCIATE WANTED -BOCA RATON-DELRAY BEACH AREA

Great opportunity-must be hard-working, reliable, Responsible and good with patients & staff-surgical Training a plus-partnership after 1yr. Florida License required fax resume to 561-865-2225.

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 (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.

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.

WEEKLY SPECIAL - One week of ads (5x) for only $85

PM Classified Ads Reach over 10,700 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 10,700 DPM's. Write bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451 Ext 110.

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.