The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

February 15, 2010 #3,780 Publisher-Barry Block, DPM, JD

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Barefoot Running Not For Everyone: MT Podiatrist

Some runners are leaving their shoes at home in the hope of preventing injuries like shin splints and sprains. A Billings podiatrist said losing the shoes changes a runner's step, which can work better with the body's natural rhythms. "You have better natural shock absorption that way," Dr. Scott DeMars of Rimrock Podiatry said, "and there tends to be less injuries overall with barefoot runners because of that, and less chronic injuries."

Dr. Scott DeMars

But before you set out on a barefoot 5K, make sure your feet can handle it. Dr. Demars says not to jump into it too quickly, it is best to ease it into your routine gradually. "There are a lot of different types of feet," DeMars said. "Some foot types should not be barefoot running. They are not going to do well. Like the pronated foot type is not going to do well with barefoot running. They would have perhaps increased injuries, because they need that supportive shoe."

Source: Arianna Bennett, KILR8.com [2/12/10]

Western U Students and Faculty Participate in Second Annual Community Health Fair 

During the recent community health fair, College of Podiatric Medicine students conducted general foot screenings, including neuro, vascular and muscular tests, said Josh Hunt ’13. They also looked for calluses, fungi and nail pathologies. The students performed the examinations and reported their findings to Assistant Professor Bora Rhim, DPM, said Richard Gardner ’13.

Dr. Bora Rhim

“As newbies, Dr. Rhim was very helpful in guiding us through both the exam and in explaining treatment options with the patient,” Gardner said. “What I liked is that she allowed us to do everything, from the exam itself to identifying concerns, to treatment options.  She stood by, making sure that what we did and said were accurate and gave us pointers when we got stuck.”

IL Podiatrist Participates in Shoe Drive for the Homeless

If you think walking a mile in someone else's shoes can make a difference, try letting someone else walk in yours. Throughout February, local podiatrist Dr. Samuel Potts will be participating in a shoe drive in conjunction with the Illinois Podiatric Medical Association's Share Your Soles drive.

Dr. Samuel Potts

Potts' wife and office manager, Valerie Potts, said the office has never participated in a drive before and would like the shoes they collect to benefit local residents. She is working with area service agencies such as The Salvation Army to get shoe donations to those who will receive the biggest benefit. Salvation Army Social Service Director Jeanne Robinson said that with recent cold weather, the men's shelter is averaging 50 people at times, and many of the clients are in need of shoes.

Source: Annie Getsinger, Herald-Review [2/13/10]

KY Podiatrist Settles Fraud Case - Whistleblower Office Manager Benefits

A Lexington podiatrist and his company have agreed to settle allegations that they violated the Federal False Claims Act. Dr. Michael Allen and Lexington Foot and Ankle have agreed to pay $419,330 to settle allegations that they submitted false claims to Medicaid, Medicare and the Office of Personnel Management between January 2002 and February 2007.

According to the settlement agreement, prosecutors contended that Allen and the company billed government programs for orthotic shoes, and the company unbundled follow-up visits for the fitting of orthotics that should have been included in initial consultations. Further, the settlement agreement says that Allen and the company billed Medicare and Medicaid for services performed by a nurse practitioner or physician's assistant at the higher billing rate of a podiatrist.

Robin Rue, who worked as Lexington Foot and Ankle's billing manager, filed a federal whistleblower lawsuit in July 2005. Because of her help, she is entitled to $71,286 of the U.S.' recovery. 

Source: Patrick Sullivan, Herald Leader [2/13/10]

RE: Medicare Advantage Plans
From: Joe Gonzalez, DPM

What are people's thoughts on all these new Medicare Advantage plans? It seems like every week, I get a fax or call from an insurance company to sign on to their latest product, with the claim that they pay "100% of Medicare Fees." Here's my problem with all these plans: they may pay 100% of Medicare fees, but they don't always cover all the services in my office (i.e,. diabetic shoes: they want patients going to their contracted labs). Also, it seems they require more chart audits, which seem to be simply cash-grabs for them, so they can bill Medicare for more diagnoses than listed.

Are most podiatrists signing on with these Medicare Advantage Plans, or are you just staying out-of-network?

Joe Gonzalez, DPM, East Lansing, MI

RE: Plantar/Palmar Keratosis (Misty McNeill, DPM)
From: Chuck Anderson, DPM, Dan Haley, DPM

I have a patient with severe plantar-palmar keratosis. She had a heel ulcer after a hip replacement and was using Panafil for it, when a nurse started putting it on the entire plantar aspect of her feet.  It shouldn't work, but it has made her periodic debridements in the office much easier. It is generic now, so it's a little less costly.

I imagine you could also use a Beta boot (basically a foot-shaped baggie) and some type of urea cream overnight. Have the patient put a sock on to keep the bag on and keep them from slipping if they have to get up in the middle of the night.

Chuck Anderson, DPM, Norman, OK, andersonfoot@msn.com

Assuming that you have cultured to rule out dermatophyte infection and treated appropriately, you may wish to consider a biopsy to aid in the diagnosis. I have had several patients with similar hyperkeratotic lesions unresponsive to debridements as well as oral and topical antifungals. When I developed the same condition several years ago, it became quite painful and debilitating. Moisturizers helped very little, keratolytics and debridements were of little help as well. More than likely, you are dealing with a form of eczematous dermatitis and it may be idiopathic. 

Super high potency topical steroids in ointment form may be the treatment you need to try. Halobetasol proprionate ointment (Ultravate 0.05% ointment) BID, without occlusion and especially before bedtime, is what helped me and my patients. Clobetasol was not strong enough in my case. A Medrol dose pack can also help turn the corner in recalcitrant cases. The topical steroids will be a continuing treatment. This has worked on patients who had failed many treatment regimens from other podiatrists, PCP's, and dermatologists.

Dan Haley, DPM, Reynoldsburg, OH ,  Dhaleyman@aol.com

RE:  PRP (Vincent Marino, DPM)
From: Philip Wrotslavsky, DPM

Below is a recent study on PRP. I am sure some will find faults with the study, but it was a stratified, block-randomized, double-blind, placebo-controlled trial.

Platelet Rich Plasma Injection for Chronic Achilles Tendinopathy JAMA 2010;303(2):144-149.

Tendon disorders comprise 30% to 50% of all activity-related injuries; chronic degenerative tendon disorders (tendinopathy) occur frequently and are difficult to treat. Tendon regeneration might be improved by injecting platelet-rich plasma (PRP), an increasingly used treatment for releasing growth factors into the degenerative tendon.

Objective: To examine whether a PRP injection would improve outcome in chronic midportion Achilles tendinopathy.

Conclusion: Among patients with chronic Achilles tendinopathy who were treated with eccentric exercises, a PRP injection compared with a saline injection did not result in greater improvement in pain and activity.

Philip Wrotslavsky, DPM, San Diego, CA, drphilipw@msn.com

RE: Financial Impact of Pre-Fabs (Michael McCormick, DPM)
From: Multiple Respondents

Dr. McCormick, please step back and look at what you have just written. Where in this is the question, "What does my patient need?" While we all went into medicine to make a good living and provide for our families, our first priority should be the needs of our patients. If your patient doesn’t need a custom orthotic to control biomechanical abnormalities, dispense an OTC device. And if you do not have the "personal biomechanical knowledge" to adequately diagnose biomechanical abnormalities and prescribe the correct orthotic device to correct that pathology, I would suggest refresher courses or seminars to update/enhance your knowledge. Do what the patient needs as your first priority, and the financial remuneration will follow.
 
Robert A. Boudreau, DPM, Tyler, TX, rbftdoc@aol.com

While I have not scientifically tracked sales data, I spoke with my orthotic lab who has order data for my custom-made orthotic devices. My order totals have remained constant over the past 24 months (compared with the 12 months prior to adding pre-fabs).

I incorporated the Aetrex I-Step kiosk into my practice 2 years ago. I dispense Lynco orthotics as a pre-fab device. The recommendation for pre-fabs is certainly not for every patient, just as the need for a custom device is not for every patient. There is a place for each. 

Dr. McCormick mentions human nature’s path to least resistance. Certainly, you will "lose a couple" who take this path, but you will also gain more than a couple who need support and don't need custom devices, not to mention the custom patient who will "buy" the pre-fab while waiting for the custom to return from the lab.

Alan Berman, DPM, Carmel NY, DrBerman@PutnamFootDoc.com

Dr. McCormick, you will definitely be impacted financially by using pre-fabricated inserts more so than you may imagine - all in a positive way. We stock all sizes of the PowerStep product. I have no financial relationship with them. We simply have never found a better product out there for the price. Les Appel, the founder of PowerSteps has done more for the podiatry profession than I can put on this site.

Being able to immediately give your patient a product that will correct deformity and relieve pain is an invaluable tool for both you and the patient. If you do prescribe custom orthotics, you know it takes weeks for those to be processed and dispensed. Your patients need relief now. For the doubting patient, this product is affordable and will prove to them that long-term support is needed and help move them into a custom orthotic.

Our profit margin is approximately $35 per pair and we dispense about 25 pairs a week.

Jon Purdy, DPM, New Iberia, LA, podiatrist@mindspring.com

RE: Financial Impact of Pre-Fabs (Michael McCormick, DPM)
From: Multiple Respondents 

I don’t consider pre-fabs replacements for orthotics. We began using them several years ago for short-term problems that do not require permanent orthotics. Because they are not replacements but adjuncts to treatment, there is no loss of income. Our patients love them and they have been successful in treating biomechanical problems. Just as an aside, we use the Hotshots from Precision Orthotics. I have no interest in Precision other than as a provider.
 
Brian Kiel, DPM, Memphis, TN, footdok4@gmail.com

Our practice has dispensed Spenco products, Powersteps, and more recently Emsold. I believe the answer to whether this impacts custom orthotics volume would depend on your practice area (mine is rural) and socioeconomic patient mix. Generally, pre-fabs are complementary to customs in our office; patients not willing or able to afford custom L3000's often benefit from and purchase prefabricated inserts such as posted Powersteps. As a first-line therapy, our volume of pre-fabs is excellent; patients not responding obviously often opt for custom. Do all patients with biomechanical issues need custom orthotics? Probably not. I usually present both options, if indicated, in my initial discussions.

Mark K. Johnson, DPM, West Plains, MO,  DDR004@centurytel.net
 
I never made a study of the financial impact of pre-fab orthotics, but when I was in practice, I used them quite often. There are a great many people who simply don't need or can't afford the more expensive custom-made orthoses. Heel pain, for example, is not always a chronic condition that needs permanent orthotic control. My practice included a great many senior citizens on fixed incomes who couldn't come close to paying for custom made orthotics. I always felt that having an affordable and effective alternative for those people was an essential part of my day to day armamentarium of treatment modalities. In addition to pre-fab orthoses, I would sometimes alter the insoles of the patient's own shoes with felt padding as a cheap/free treatment.

For patients who are considering "real" orthotics, temporary pre-fabs can be a good confidence-building tool. I could tell the patient in good conscience and with confidence that if the pre-fab orthotics helped their condition, then the custom-made ones would help them even more.

I usually didn't stock the orthotics in my office. I went to a number of local pharmacies, medical supply stores and sporting goods stores, introduced myself and talked to their managers about good OTC orthotics. Then, when I felt a patient needed such a device, I'd write a note on my Rx pad (crossing out Rx) telling that store what I wanted for the patient. It got my name in front of those stores, and I received quite a few referrals from those stores. I didn't have to stock a lot of sizes of orthotics which I could not really make a huge profit on, and I got new patients in the bargain. A win-win situation. 

Paul Busman DPM, RN, Clifton Park, NY, brewerpaul@aol.com

RE: Off-Shore MD Degrees for Podiatrists (Hermoz Ayvazian, DPM)
From: RJ Simms
 
The International University of the Health Sciences (IUHS) is an accredited allopathic medical school which has graduated numerous DPMs and podiatry students with MD degrees. I am pleased to report that our graduates have gone onto MD residency programs and become appropriately licensed in the US as MDs. IUHS recognizes both the need to follow the educational guidelines set out by the various allopathic accreditation and licensing bodies as well as a significant level of interest by podiatrists in adding an MD degree to their existing medical qualifications. My IUHS colleagues and I look forward to working closely with the DPM community in offering this opportunity to earn an MD degree to both podiatrists and podiatry students.
 
RJ Simms, President, International University of the Health Sciences School of Medicine, simms@iuhs.edu

SPACE AVAILABLE With MRI– NYC/LI

Turn-key office space, East 60th and 22nd St. Manhattan and Plainview, Long Island. Available extremity M.R.I and dynamic ultrasound (East 60th St Manhattan and Plainview, LI). Tests are run by DPM and read by board-certified radiologist. Call for rental agreement. Satisfies Stark laws (516) 476-1815.

ASSOCIATE POSITION - W FLORIDA, BEACHES

Well established podiatry practice with excellent mix office/surgery seeking full time associate PSR 12-36. Excellent salary & benefits for the right hardworking, personable candidate. Email resume to capecoralpodiatry@live.com or fax to 239-573-9201

OFFICE SPACE TO SHARE - NYC

Wanted- Licensed podiatrist to share space in a State-Of-The-Art medical office in the midtown area. Please call Dr. Robert Singer (212) 921-5775 or e-mail dr.roberth.singer62@netzero.net

PRACTICE FOR SALE - NORTHWEST CHICAGO SUBURBS

17 year-old surgical practice for sale. Practice sees a wide variety of foot and ankle pathology and is largely referral especially regarding surgical patients. Two offices fully equipped. Lease or purchase of office condo also possible. Doctor willing to stay Please email inquiries to crystallakefootandankle@live.com

PRACTICE 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 FULL-TIME - SUBURBS OF CHICAGO

PSR 36 - month-trained podiatrist needed for busy suburban Chicago practice. Full benefit package included. If interested, please email your curriculum vitae to foot1st@yahoo.com

ASSOCIATE POSITION-INLAND EMPIRE, SOUTHERN CALIFORNIA

Associate needed full or part-time for multi office practice. Must be ABPS BC/BQ. Hard working, ethical individual who is looking to a possible partnership opportunity. Looking for current licensed or resident completing program this spring. Email CV to bkatzman2@earthlink.net

ASSOCIATE POSITION – CINCINNATI, OHIO

This is your once in a lifetime opportunity to join one of the most successful practices in the United States. We do not have a seniority system. If you are motivated and have completed a PSR 24-36 residency, your income is limited only by your enthusiasm and desire to achieve. Email resume to khart@cincinnatifootcare.com

ASSOCIATE POSITION - MARYLAND

Associate needed to join a multi-office podiatry practice in the Baltimore MD Region. Desired candidate should be surgically trained with Board Eligible / Certification. You must be hard-working, ethical, compassionate and confident in your abilities to deal with pathology, patients, staff and fellow physicians. Patient base is already established. Excellent income and growth potential for the right associate. Please forward a cover letter and resume and availability to FootDocMaryland@Gmail.com

PRACTICE FOR SALE - NEW YORK

Dr. Mark Levine's Office in Middle Village, Queens, NY. Dr. Levine passed on several weeks ago BUT practice has been covered and is being actively manned. Call cousin Art Korbel, DPM, MD who is handling the sale, for details. 954 753 7621 or classicboats4425@aol.com

ASSOCIATE POSITION - HUDSON VALLEY, NY

Do you enjoy teaching residents and being in the O.R.? We are seeking a well-trained foot surgeon. Experienced foot surgeons or new graduates with excellent training considered. We are an expanding multi-office group practice with a great group of doctors, located in the scenic Hudson Valley. We also have a Wound Center and Residency Program affiliated with this special opportunity. Please forward CV to: healthyfeet4ever@yahoo.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. Please reply to: jclough@bridgemail.com

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 - MASSACHUSSETTS

Full-time/Part-time podiatrist needed for a busy nursing home practice. Please send inquiries to debbierobertsm4@hotmail.com

ASSOCIATE POSITION – MISSOURI

Expanding multi-location practice seeks motivated individual to contribute to growth. Practice enjoys strong reputation and name recognition. Prefer candidates with interest in partnership opportunity. Established locations available for PSR 24+ and includes incentive comp with benefits/coverage. Please send CV to jmurray@foothealers.com or call John Murray at 314.842.3875

ASSOCIATE POSITION - INDIANAPOLIS, INDIANA 
 
Hospital clinic practice with a large volume of all patient types. In need of 1-2 podiatrists, willing to work as a team and make a career in Indianapolis. One - two year residency training can be medical or surgical. Excellent income and ownership possible. Curriculum vitae to  twz1001@sbcglobal.net

ASSOCIATE POSITION - MARYLAND/D.C AREA

We are looking for an energetic and well-trained podiatrist to join our rapidly growing group; we have offices in Maryland and D.C and are in need of someone who is hard-working and growth-oriented. This candidate must be a graduate of a PM&S 36 residency program or have the equivalent in practice experience. We are looking for the person that wants to make this area their home and become an integral part of our group. If interested, e-mail your CV and cover letter to washingtonpod@aol.com

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes. Top hospitals. Fax CV with references to 703-491-9994

ASSOCIATE POSITION – ILLINOIS

Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings are available. If interested, fax curriculum vitae to 847-674-2113 or e-mail to feetwork@aol.com

PM News Classified Ads Reach over 12,000 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 12,000 DPM's. Write to 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

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