The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

February 14, 2013 #4,691 Publisher-Barry Block, DPM, JD

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Lisfranc Injury: Easy to Miss, Hard to Get Over- OH Podiatrist

Elite athletes like NFL quarterback Matt Schaub and wide receiver Santonio Holmes had productive seasons ended by the little-known and often overlooked Lisfranc injury, a serious foot injury that few have heard of and no one wants. But foot and ankle surgeons at the Annual Scientific Conference of the American College of Foot and Ankle Surgeons (ACFAS) this week are evaluating how to effectively diagnose and treat this injury, which can result in severe long-term complications like chronic pain, osteoarthritis and even foot deformities.

Dr. Mark Hardy

Relatively uncommon, found in only 1 of every 55,000-60,000 people annually, Lisfranc injuries occur in the midfoot – where the long bones leading up to the toes (metatarsals) connect to the bones in the arch (tarsals). “The Lisfranc complex is a critical joint in propulsion during walking and running. Unfortunately, injuries there are easily overlooked. As many as thirty percent of Lisfranc injuries are missed at initial diagnosis by providers who are not foot and ankle specialists. The long-term effects can be debilitating,” observes Cleveland, OH foot and ankle surgeon Mark Hardy, DPM, FACFAS, and a conference presenter.

NYCPM ACFAS Student Chapter Wins First Place in Poster Competition

The NYCPM Student Chapter of the American College of Foot and Ankle Surgeons, one of two student surgery clubs at NYCPM, has won first place for the second year in a row in the Poster Competition at the ACFAS Annual Scientific Conference in Las Vegas, Nevada. 

First Place Winning ACFAS Student Club Poster

The poster, titled “Presentation and Treatment of a Fibrocartilaginous Navicular-Medial Cuneiform Coalition: A Case Report”, was researched and written by NYCPM students Todd M. Chappell, Prakash N. Panchani, Heidi M. Godoy, Sarah Daigle, Adisa Mujkic, and Christopher L. Lovell, mentored by Faculty Advisor Johanna Godoy, DPM, Instructor of Surgical Sciences at NYCPM.

ACFAS Installs New President

Jordan P. Grossman, DPM, FACFAS, has become 62nd president of the American College of Foot and Ankle Surgeons (ACFAS), a national association of over 6,800 foot and ankle surgeons. Dr. Grossman was installed as president at the ACFAS 71st Annual Scientific Conference in Las Vegas.

Immediate ACFAS Past President Dr. Michelle Butterworth Passes Gavel to Dr. Jordan Grossman

Dr. Grossman practices in Akron, Ohio with the Northeast Ohio Orthopaedic Associates and is board certified in both foot surgery and reconstructive rearfoot and ankle surgery by the American Board of Podiatric Surgery. He serves as teaching faculty for the Orthopaedic Surgery Residency Program at Akron General Medical Center and the Podiatric Surgical Residency Program at Kaiser Permanente/Cleveland Clinic.

ACFAS Presents Special Awards

One of the highlights of the ACFAS Annual Scientific Meeting was the presentation of special awards for outstanding contributions to the College and the profession. The Champion Award was presented to Douglas Stoker, DPM, ACFAS and the Distinguished Service Award was presented to John Stienstra, DPM, ACFAS.

(L-R) Drs. Michelle Butterworth,  Douglas Stoker, John Stienstra, and Jordan Grossman

ACFAS also surprised Chris Mahaffey its Executive Director with a special award in recognition of 10 years of service to the College. 

(L-R) Dr. Michelle Butterworth, Chris Mahaffey, Dr. Jordan Grossman

Excellagen® Receives APMA Seal of Approval

Cardium Therapeutics has announced  that the American Podiatric Medical Association (APMA) has granted its prestigious Seal of Approval to the Company's innovative Excellagen® advanced wound care product for its contributions to better foot health and mobility. 

Excellagen is a syringe-based, professional-use, pharmaceutically-formulated 2.6% fibrillar Type I bovine collagen gel that functions to activate the wound healing process and accelerate the growth of granulation tissue.  Excellagen is FDA-cleared for the treatment of neuropathic and diabetic foot ulcers, pressure ulcers, venous ulcers, surgical wounds and other dermal wounds.

Query: Video Consent

Is anyone using a video program to reinforce written surgical consents? Several years ago, I saw an animated program for forefoot surgical procedures, but I have not seen anything advertised recently. If anyone is using a program like this, where did you get it, and what do you like/dislike about it?
 
William Duke, DPM, Jefferson City, MO

Query: Cryoprobe or Alternative

I bought a Cryoprobe in 2007. The company either went out of business or sold out to someone else. Is anyone else having trouble with their Cryoprobe, and if so, what are you doing about it?  Does anyone know of a reasonably-priced instrument which can supply enough cold to use for superficial skin lesions. Liquid nitrogen, while relatively inexpensive, lasts less than two weeks.
 
Michael Forman, DPM, Cleveland, OH

RE: Etiology of Hallux Varus (Jordan Sheff, DPM)
From: Eric Fuller, DPM

Hallux varus and hallux valgus have the same reverse buckling mechanism described by McGlamry. I described this reverse buckling mechanism and its relationship to the plantar fascia in my JAPMA article: Fuller, E.A. The Windlass Mechanism Of The Foot: A Mechanical Model To Explain Pathology, J Am Podiatr Med Assoc, 2000 Jan; 90(1) p 35-46.

The hallux can "buckle" either way. Tension in the fascia will compress the hallux into the 1st met. If the MC joint allows little transverse plane motion, there will be a tendency toward hallux limitus rigidus problems. If the MC joint is mobile, there is a greater liklihood of transverse plane motion of the metatarsal, which is what the "buckling" is. The vast majority of the time it moves toward the second toe because a shoe will help push it that way. 

An orthosis designed to reduce tension in the plantar fascia should help prevent further development of the deformity. An equinus can increase tension in the plantar fascia.

Eric Fuller, DPM, Berkeley, CA, fullerpod@gmail.com

Query: Source for Custom Dress Shoes (Charles Morelli, DPM)

Try Oliver Moore (bootmaker.com). They are located on the Upper East Side, Manhattan.  

Joan E. Schiller, DPM, Euclid, OH, Joan.Schiller@UHhospitals.org

RE: DME and Diabetic Shoe Payment Problems (Michael Rosenblatt, DPM)
From: George Jacobson, DPM

There has never been a serious push to correct the inherent problem.  Podiatrists are the only doctors who have been trained to assess whether a patient qualifies for the Diabetic Therapeutic Shoe Program. Whether we get our forms signed by an MD or DO, or not, PCPs do not assess the foot and are not  trained to (and hate doing it). When I was at CCPM, my brother was finishing UF medical school. He looked at my texts and course work and joked that he had completed the lower extremity in one week (vs. 4 years). That's the extent of their training.
 
We should be the gaitkeepers for this program. CMS could easily check our ICD-9-CM claims data against that of the patient's MD or DO data to verify that a patient is diabetic, and verify that they have been seen within the last 6 months for diabetes. 
 
The MDs and DOs would be happy to rid themselves of this wasteful paperwork that they don't have a clue about. This takes time away from actually treating patients. The APMA and AMA should jointly protest this wasted of time, efficiency, and money wasted by both the practitioners and government in administering this program and its bogus wasteful utilization standards. They should be rewritten. I am willing to stand by my assessment and certification, yet the MD and DO isn't, hence the denial of claims for patients that rightly should have received the benefit and disregards their well-being. 
 
George Jacobson, DPM, Hollywood, FL, fl1sun@msn.com

RE: CA Podiatrist Discusses Treatment of Plantar Tears
From: Jeffrey Kass, DPM

I am curious about what surgical procedure would be performed when talking about a plantar fascial tear. I do not think PRP or amniotic membrane injections should be considered surgical procedures (Though insurance companies classify them as such, at times).

I find these PRP injections to be an ideal treatment for this condition. I have had a dozen such patients over the years, all of whom needed one PRP injection for an MRI positive partial tear. My protocol consisted of a CAM walker boot for 3 weeks after injection, with no NSAIDs allowed during the post-injection period. The patient was then allowed to walk normally for 3 weeks and then was allowed to slowly get back into physical activity with the help of an orthotic which, in my mind, supported the fascia. I imagine the amniotic membrane would work as well, if not better.

While some may say in the studies quoted that the return to activity is about the same as what I report, I argue that the advantage of the injection is that patients reported  immediate pain relief to me. The plantar fascial tears that I have treated are often very painful.

Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

PRACTICE FOR SALE - WEST PALM BEACH FLORIDA

Well established successful West Palm Beach practice grossing $ 475 with excellent reputation and good referral base. Consistent new patient growth, great opportunity with increased gross revenue and surgical growth potential. EHR implemented with meaningful use criteria met. Great area to live and work. Serious inquires E- mail wpbfootdrs@gmail.com

PRACTICE FOR SALE - SOUTHWEST FL

Multilocation multidoctor practice in beautiful Southwest Florida . Practice has grossed over seven figures consistently and currently shows 10-15% growth in revenues with increase in new patients and patient visits. EHR is already implemented with meaningful use criteria met. Practice has been professionally evaluated by Provider Resources. Only serious inquiries to this email address. This is a great practice in Paradise and a good opportunity for the right doctor or doctors. Email to: practiceforsaleswfla@gmail.com

PRACTICE FOR SALE - MISSION VIEJO, CA

Relocating to Tulsa. Great opportunity to buy my office. Located at Mission Hospital. Gross income 2012 was $560,000. Approximately 1300sqft with 3 treatment rooms, digital x-ray and fully computerized. Will consider all offers. Call David at 949-702-1052 or david@missionviejofootcare.com

PRACTICE FOR SALE - MARYLAND

Established 1974 treating routine, diabetic, wound care, trauma, workman's comp and surgery. Attached accredited and certified surgery center. High volume with new patients with opportunity for expansion. Long established multiple primary care referral basis including University of Maryland health center. All financial information available. e-mail Msugar8364@aol.com.

ASSOCIATE POSITION – NORTH CAROLINA

New associate position available that may lead to partnership. We are a very busy practice providing care in both office and hospital settings. EHR, arterial vascular testing, and ESWT in the office. We are fully integrated in a large tertiary teaching hospital. We are located in the beautiful mountains of western North Carolina. Research opportunities are available. Applicant should be ethical, personable, hard-working, and committed to quality in patient care. We are offering a competitive compensation package and a wide range of benefits. All interested candidates should send a CV to MFAS828@aol.com

ASSOCIATE POSITIONS - NY, TX, PA, and IL

Looking for podiatrists to see patients in nursing facilities in New York, Texas, Pennsylvania, and Illinois. Please contact me at doconcall02@aol.com.

ASSOCIATE POSITION - NEW YORK

Looking for a once in a lifetime opportunity to join a state-of-the-art well rounded Long Island practice with hospital privileges? Then our office is what you're looking for. Located 20 miles from NYC, LI offers great schools and lifestyle. Perfect for an experienced practitioner or 2013 residency graduate who is ethical, productive, and board certified/qualified looking to be part of a winning team now and in the future. Want to be a partner in a successful practice or own your own office? Serious motivated practitioners only invited to send their CV and personalized cover letter to: mets724@gmail.com.

ASSOCIATE POSITION - MARYLAND

Join our 19-doctor group, with 13 locations, in MD and VA. EMR, digital x-rays, ultrasound, computerized scheduling, certified ambulatory surgical centers, hospital and physician referral base. Please send cover letter and resume to: newdpm@footandankle-usa.com. We look forward to hearing from you. We are www.footandankle-usa.com

PODIATRIC PHYSICIAN/SURGEON - CHICAGO AND SUBURBS

Chicago Podiatric Surgeons is searching for a full-time podiatric physician/surgeon. Prefer ABPS qualified/certified with experience in private practice. Great benefit package and partnership opportunities. Please send letter of interest, CV to dr.tcarr@gmail.com

POSITION AVAILABLE - BALTIMORE MARYLAND

Confident, surgically trained associate position available to join well-established practice locations. Leading to ownership within 3 years! Great salary and benefits. Will train on practice management, business management, and billing. Call 301-514-9781

ASSOCIATE POSITION - NORTHWEST IOWA

A well-established, midwest multi-physician practice with strong hospital affiliations seeking FT podiatrist. Applicant should be well trained surgical physician, completed a 12/24 month residency, & board eligible. Practice offers high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume: 712-258-9977.

ASSOCIATE POSITION - ORANGE COUNTY, NY

Looking for a highly motivated surgical trained podiatrist in the Orange County, NY (West Point area). Hospital, wound center and surgical center affiliated. It is a busy practice that covers hospital inpatients, Wound Center, and takes ER call. The applicant has to be trained in all foot surgery and be able to handle advanced diabetic wound care. The practice is a 1 hour car ride from NYC and is close to hiking ,fishing ,skiing and state parks. Please Email a CV and contact info to clsp4@yahoo.com

ASSOCIATE POSITION - WASHINGTON, DC/ MD SUBURBS

Prominent, established two office practice seeking well rounded, personable, ethical individual with sharp medical and surgical skills. Must be 24/36 month trained, ABPS qualified or certified. Partnership opportunity with ownership potential. Competitive salary with benefits package. Please send CV to ponyrunner66@gmail.com

ASSOCIATE POSITION - SOUTH/CENTRAL PENNSYLVANIA

PSR-24/36 trained individual for busy practice in family-friendly college town. Seeking personable, ethical, motivated individual to join our well established practice providing all aspects of podiatric care. Competitive salary and benefits package with partnership opportunity. Reply with letter, CV and photo to: Jagerone@aol.com.

ASSOCIATE POSITION - VA (SOUTH CENTRAL)

Thirty year established practice seeking associate. PSR 24/36 training, must be highly motivated, personable, ethical and willing to provide all aspects of podiatric care. Early partnership opportunity with potential ownership. Competitive salary and benefits. Excellent opportunity for a successful career. Please send CV to footcare2020@aol.com or fax to 804 733-5946.

ASSOCIATE POSITION - CENTRAL VALLEY/SOUTHERN CA

Seeking associate with partnership availability. Must be highly motivated and have good patient skills and personality. Salary excellent with all paid benefits/incentives including malpractice/401k and profit sharing. Compassionate and well-trained for immediate position. Surgery Center and hospital. Bilingual in English and Spanish preferred. Offering a permanent position/partnership in a multi-million dollar practice with Partnership also in Surgery center. Please e-mail CV and short bio to: Tonya@wetreatyourfeet.com

ASSOCIATE POSITION - MISSOURI – EAST CENTRAL

Podiatric medical group seeks recent graduate or 2013 graduate who is interested in working with former residency director who can enhance your already strong training Full scope practice with the cases to fast track to board certification. We are located close to St. Louis for day use. Exceptional school system in a low crime, low cost of living area. E-mail resume to: drfootski@hotmail.com

ASSOCIATE POSITION - SOUTHWEST FL

R U a PM&S36 graduate looking for a bright future in podiatry BUT cannot be afraid to work hard to achieve. Complete from nail care to reconstructive ankle/leg trauma. Attitude + god complexes need not apply. Frames, nails, must be comfortable applying. Work hard for a bright future, our group can help you achieve. Send CV, and letter of intent to mny1029@gmail.com

ASSOCIATE POSITION - SOUTH CAROLINA

South Carolina's largest provider of foot care is a multi-doctor, multi-location practice currently seeking a highly skilled, personable, and hardworking physician to join our TEAM. South Carolina License is necessary. Above average salary and benefits. Please send Letter of Interest and CV to scdpmjobs@gmail.com.

ASSOCIATE POSITION - SOUTH CAROLINA

Upstate practice seeking PSR-24/36 trained associate. Full-time position with partnership opportunity. Plans include new office and EHR System. Hospital privileges. Near Hartwell Lake and the Blue Ridge Mountains. Please send CV to palpodiatry@att.net. 

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 PODO2345@AOL.COM 516-476-1815

EQUIPMENT FOR SALE - USED Q-CLEAR LASER

Still under warranty. New laser head just added. First Best Offer. Marketing and training included. Dr. Zuckerman will train you. e-mail with questions to mook863@comcast.net

EQUIPMENT FOR SALE - CUTERA GENESIS PLUS

Cutera Genesis Plus. 30 months old, low shot count, sku 022012a 1064 ND:YAG With new handpiece Dec.2011 for 1.5mm adapter go to www.thelasertrader.com Price is $35,000. Save over $29,000. Excellent Condition.

EQUIPMENT FOR SALE - USED PINPOINTE LASER

Used PinPointe Laser for sale! $16,500.00 Firm. Please send email to dman1hansen@gmail.com or call 801-870-4161.

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