The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

February 13, 2012 #4,383 Publisher-Barry Block, DPM, JD

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CA Podiatrist Discusses Plantar Fasciitis

Plantar fasciitis is an inflammation of the fibrous tissue that connects the heel bone to the metatarsal bones on the bottom of the foot. Symptoms can include a burning sensation and aching on the soles, and dull or sharp heel pain. "If, first thing in the morning, your heel is really painful, and then as you walk around it feels better, that is the classic sign," says Sheryl Strich, DPM, president of the American Association for Women Podiatrists.

Dr. Sheryl Strich

Surprise: "High heels are not the evil-doer," says Dr. Strich. The most likely culprits are pancake-soled shoes with zero arch support, such as flip-flops, ballet flats, and some casual sneakers. And standing for long periods of time in any shoe -- say, if you work on your feet -- can also cause this common injury.

Source: Ladies' Home Journal

VA Podiatrist Organizes Shoe Drive

For more than 20 years, local foot doctors have been teaming up with the Salvation Army for a program called Shoes for the Homeless. This year, they've collected more than 5,000 pairs of shoes. All of those shoes were up for grabs -- all for free -- at Charlottesville's Salvation Army center. At the end of the day, the Salvation Army gave away more than 1,000 pairs.

Dr. Bryan Snyder

"Being a podiatrist, being a foot doctor, it's kind of paramount that we know how important a good pair of shoes is for somebody, and we saw it as something the community needed," said Dr. Bryan Snyder, a local podiatrist who helped organize the event.

Source: Chris Stover, Newsplex.com

IN Podiatrist Won't Run for Re-election as Coroner

Lake County Coroner Dr. Thomas Philpot has put his future political career on hold as he awaits trial on federal public corruption charges. Philpot didn't file for re-election before the noon Friday deadline, leaving the May 8 primary race for coroner to seven other Democrats and one Republican. Philpot is scheduled to face a jury in U.S. District Court in Hammond the week of July 9 on charges alleging he illegally enriched himself from federal grants between 2004 and 2009, when he was county clerk. An attorney and a podiatrist, Philpot has been a prominent player on the Lake County political scene for more than two decades. He won elections for coroner in 1992 and 1996, county clerk in 2002 and 2006 and coroner again in 2008.

Source: Bil Dolan, nwitimes.com [2/10/12]

Panel Suggests Health-Worker Vaccine Mandate

HHS' National Vaccine Advisory Committee approved a recommendation that healthcare employers who haven't achieved 90% influenza vaccination compliance after following other recommendations to boost flu vaccination rates “strongly consider” an employee requirement for flu vaccination.

Along with four other related recommendations, the vaccine committee also urged the assistant secretary for health at HHS, Howard Koh, to ensure that the recommendation be implemented in HHS facilities and services, including the Public Health Service, HHS staff who are healthcare employees, and at federally-qualified health centers.

Source: Paul Barr, Modern Healthcare [2/10/12]

Phrases That Can Kill a Proposal

Suppose you want to perform surgery or prescribe othotics. Avoid the following phrases when speaking to prospective patients:
1. “I want to …” That puts the focus on you and what you want. Instead, tell them what you can do for them.
2. “You should …” The phrase can come across as condescending, as if you are lecturing the patient for not doing something the right way. Instead inquire “Have you tried to …?” or “What do you think about …?”
3. “I can’t do that.” You’ll quickly make a patient tune out. Instead say “What I will do …”
4. “You will have to …” That phrase makes patients think they’ll have to jump through hoops. Instead ask “Are you willing to …?”

Source: Adapted from Communication Briefings

Query: Gouty Tophi, 3rd Digit

A 73 year old Asian female presented with a swollen third toe that had a small opening, exuding white, cheese-like material on the lateral aspect. Pain is present with pressure. She has diabetes which is under control. She is not on any gout medications at the moment.  She has had previous debridement of tophi about a year ago; but since then, the tophi have recurred.  

Gouty Tophi, 3rd Digit

X-rays reveal destruction of the majority of the middle phalanx. I gave her a cortisone injection, put her on NSAIDs, and sent her back to her PCP for gout management. As for surgical treatment, I recommended aggressive surgical debridement of the tophi, but due to her gout, age, diabetes, and possible limited amount of good healthy tissue to close, explained to the patient the low success rate. The patient instead prefers distal amputation. Comments?

Charles Baik, DPM, Tustin, CA

Query: Disposing of Old X-Ray Machines

My two old (pre-1990) X-Cel x-ray units cannot be retrofitted. My x-ray vendor will charge me to return the x-ray head portions for appropriate disposal of the hazardous waste oil contained therein. Can anybody give me suggestions related to their experience of legally disposing of older x-ray equipment?
 
Neil H Hecht, DPM, Sherman Oaks, CA

RE: Nail Dystrophy (Tip Sullivan, DPM)
From: Bryan Markinson, DPM

Dr. Sullivan presents a very interesting photo which demonstrates very symmetrical nail lysis changes. The pattern of lysis appears to be proximal to distal and beginning just beyond the level of firmly attached nail which appears to be just at the level of the distal lunula (from what I can see on the left hallux). Interestingly, the distal lysed segments seem to remain adherent to the lysed nail behind it. There is a green tinged discoloration of the left hallux nail plate. At first look, due to the symmetry, I would assume bilateral trauma from some activity or footwear or both together.

I remain curious as to why the distal portions stay attached, but assuming that the entire plate is indeed intact but lysed from the bed, then I would have to assume a matrix issue causing a nail plate alteration, coupled with a separate reason for the lysis. I would debride the lysed portions completely to the firmly adherent proximal nail and send them for culture, and PAS stain. If there are any visible changes in the nail bed/lunula areas, a nail bed biopsy can also be considered and may be helpful in ruling out an inflammatory process. An x-ray of the toes may also be revealing. Occupational history may also be helpful. These nails look like cases of severe water immersion that I have seen, but the patient's other nails are normal.

Bryan Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org

RE: Nail Dystrophy (Tip Sullivan, DPM)
Dennis Shavelson, DPM

In 2006, Brad Bakotic and I published an article in Podiatry Management entitled “The Pathogenesis of Nail Unit Dystrophy” introducing a new classification system for diagnosis dystrophic toenails. This case seems to be the pure repetitive microtrauma version (Class III) requiring more biomechanical and shoe adjustment care than a laser. 

When functional foot typing® is applied, your patient will be diagnosed as a flexible forefoot type which has a primary FHL and a secondary functional hallux extensus as described in the article. Dr Bakotic continues to use this classification system to this day when reading his nail samples. As the biomechanics consultant to his lab, I work with DPMs to apply biomechanics to predominantly 1st and 5th toenail disease as in this classical case.
 
I maintain that more “fungal toenails” need a bunionectomy, an orthotic, or a bigger shoe than they need Lamisil or a laser. I think that EBM and the literature proves me correct long-term. Please email me if you want a copy of the aforementioned article.
 
Dennis Shavelson, DPM, NY, NY, drsha@foothelpers.com

RE: The Use of Uloric vs. Allopurinol in the Management of Gout (Jeffrey Kass, DPM)
From: Elliot Udell, DPM

The problem with colchicine is a loophole in the law that enabled a private drug company to do research and patent a drug that has been on the market for ages. The same law enabled them to take generic colchicine off of the market. Shame on the FDA.
 
Drug plans take the path of least payment. When colchicine went from less than a dime per tablet to close to ten dollars a tablet for brand name Colcrys, the companies started dropping it in favor of uric-acid lowering drugs and NSAIDs. This alone should change the way we as podiatrists view the treatment of acute and chronic pedal gout. We need to revisit our injection techniques as well as the use of newer and less toxic NSAIDs. We need to take a fresh look at the use of allopurinol and Uloric as part of the podiatric armamentarium in the management of this extremely painful and disabling condition that we see so frequently.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Podiatric Physicians Practice Podiatric Medicine: RIP Podiatry (Leonard Levy, DPM)
From: Multiple Respondents

Bravo to Dr. Levy. Podiatric physician sounds great, as well as foot and ankle surgeon. I figure that after doing a three-year surgical residency, we are entitled to call ourselves foot and ankle surgeons. When people ask me what I do, I never say I am a podiatrist. I tell them I am a foot and ankle surgeon. The public gets it.
 
Ivar E. Roth DPM, MPH, Newport Beach, Ca.ifabs@earthlink.net

I am a podiatrist.

Richard Gosnay, DPM, Danbury, CT, glabroushead@gmail.com

I do not know any specialists who call themselves “orthopedic physicians”, “pediatric physicians”, “proctologic physicians”, or even “Internal medicical physicians.” I do hear them call themselves orthopedist, pediatrician, proctologist, and internist. Calling oneself a “podiatric physician” instead of podiatrist sounds pompous at best and, at worst, like we are trying to prove to the world that we really are doctors! Of course, that is just the opinion of this one podiatrist!
 
Peter Smith, DPM, Stony Brook, NY, ps84@bc.edu

RE: Outrageous Shoe of the Day

The latest in self-defense footwear from Urban Outfitters

Source: Submitted by Dr. Joseph Borreggine

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 - COOL BREEZE COOT TOUCH VARIA

Cool Breeze Coot Touch Varia. Very low use. You won't find a laser at this price. $39,500. Has about 19 hours of use of it. E-mail for photos, and ask any questions. Will go fast. David Zuckerman DPM  856-229-2939 footcare@comcast.net

EQUIPMENT FOR SALE - ARE YOU CONSIDERING A PADNET UNIT?

If so save thousands of dollars on a lightly used unit with venous option and laptop. Why pay full price for our unit which is in perfect working order. We also have a SIUI CTS 200 ultrasound with 7 mHz probe and SONY printer. Let's Make a Deal!! Call 516-220-8258 today.

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

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 POSITIONS - MULTIPLE STATES

Podiatrist Needed in Missouri, Nebraska, Iowa, Minnesota, North Dakota, South Dakota, Ohio, Texas, Colorado, Oregon, Washington, Arizona, Massachusetts, Rhode Island, Wisconsin, Indiana, Oklahoma, Connecticut and Vermont. Expanding multi-state medical practice seeking podiatrists to service long-term care community residing in nursing homes and assisted living facilities. We offer an established patient base, scheduling, equipment allowance and cover travel expenses. Provide generous compensation, bonus opportunities, disability, health insurance benefits, malpractice coverage and flexible scheduling. Looking for a Podiatrist with excellent skills, able to provide expert and compassionate care to patients. Email CV  to:  careers@aggeus.org or call 773-770-0140 x300/x305. www.aggeus.org

ASSOCIATE POSITION - MARYLAND

Looking for 3rd associate. Must be personable, well trained and highly motivated. Great locations in Southern Maryland, including an Ambulatory Surgical Center. We currently have EHR, digital radiography, dispensing center and PADNet. Looking for immediate hire! Please send CV to: myfeetfeet@aol.com

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

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 – F/T MARYLAND

Looking for a bright, hard-working, personality plus, extremely well trained podiatrist with both top notch surgical and non-surgical skills. Remarkable opportunity with our busy practice. Excellent salary and benefits. Email CV and salary requirements to Marylandpodiatrist@live.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

PART-TIME PODIATRIST NEEDED - CAPE COD MASSACHUSETTS 

Need assistance with busy office practice. Possible long-term position. Housing can be accommodated. Email interest to Lauren Boudreau, Clinical Manager at ltboudreau@gmail.com or call 1-508-648-7840

ASSOCIATE POSITION - UPSTATE NEW YORK

Outstanding Opportunity. Our medical surgical group is recruiting a well-trained licensed podiatric physician. Located in Beautiful upstate NY. Full hospital privileges, as well as working with two residency programs. Must be highly motivated and great with patients. Opportunity for growth. Competitive salary and benefit package. Please send CV to associateinfoot@yahoo.com

SOUTHEAST GEORGIA- SAVANNAH & SURROUNDING AREAS

Beautiful weather year round & near the Coast. Opportunity for Early Buy-in. Seeking podiatrist looking to build a career & long-term relationship. Either established practicing physician or new residency graduate. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facilities. E-mail cover letter & CV to melissafoot@pol.net 

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.

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