The Voice of Podiatrists

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February 16, 2007 #2,811 Editor-Barry Block, DPM, JD

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Implantable Arch Support is Treatment of Last Resort: IL Podiatrist

Dr. Joseph Borreggine, a central Illinois podiatrist, said that 80% of Americans will experience a foot problem in their lifetime. One of the most common foot ailments, the hyperpronated or flat foot, can lead to discomfort all the way up the head (jaw and neck)." Borreggine says, "90 percent of people who suffer with flat-footedness can get relief from their symptoms without surgery (including taping, orthotics, cortisone injections, and oral medication)."

Joseph S Borreggine

"...for the other 10% who are not helped with those (non-surgical) treatments...(there is) an implantable arch support (subtalar joint arthroereisis) that can be inserted into the foot...it is designed to open up the abnormally closed space between the ankle and heel bones...(once) inserted... the incision (is) closed with a couple of stitches." According to Borreggine, "This is not a utopia. Not everyone is going to be able to have this done... (it is) an 'all else fails option'...Should it prove to be the best option to eliminate your own symptoms of flat-footedness, (then) you have nothing to lose but your foot pain."

Source: Meredith Jackson, HealthIllinois Magazine (Feb/Mar 2007]

Restaino Joins Burg Simpsom Law Firm

Dr. John M. Restaino, Jr. a podiatric surgeon, has joined the law firm of Burg Simpson Eldredge Hersh & Jardine PC as a shareholder, practicing in the areas of medical malpractice and mass tort litigation.

Dr. John M. Restaino, Jr.

Restaino practiced reconstructive surgery of the foot and ankle in Orange County, CA before getting his law degree in 1986. John earned a Bachelor of Science Degree from Farleigh Dickinson University in New Jersey, where he graduated cum laude in 1974. He then earned a medical degree in podiatric medicine (D.P.M.) in 1978 from California College of Podiatric Medicine in San Francisco, CA, and a Juris Doctorate in 1986 from Western State University in Fullerton, CA.

John holds a black belt in Kenpo Karate and placed 1st for his age division in Black Belt Heavyweight Division, Continuous Sparring at both the 2004 and 2005 Kenpo Karate Long Beach Internationals. He is also a member of the National Association of Underwater Instructors (NAUI) and an instructor in Diving Medicine at NAUI College.

Source: Denver Post [2/15/07]

Medicare to Provide Beneficiaries with Information on Physician Performance

The Centers for Medicare & Medicaid Services (CMS) today announced that the Delmarva Foundation for Medical Care (Delmarva), one of its quality improvement organizations, has entered into subcontracts with four regional collaboratives, as part of the Better Quality Information to Improve Care for Medicare Beneficiaries (BQI) Project. These regional collaboratives will combine Medicare data with data from other insurers to produce information on the performance of health care providers for the benefit of Medicare beneficiaries.

The results of the BQI Project will be used for two primary purposes: first, to provide performance information to physicians that will assist them in improving the quality of care they are delivering to Medicare beneficiaries; and second, to give physician performance information to Medicare beneficiaries in order to help them with physician selection.

The objective of the Initiative is to provide the public and providers with reliable and consistent measures of quality care. The quality measures to be used in the BQI project are national consensus-based measures that have been adopted by AQA (an alliance of health care providers, health plans, senior groups, employers and unions that also played a role in the establishment of the subcontracting collaboratives). For example, all people with Type-2 diabetes should have a simple lab test twice per year that shows the average amount of sugar in the blood over the last two to three months. Running this measure will show how many of a physician’s diabetic patients received this test and allow a physician to improve his or her performance if the test is not being conducted as indicated.

Source: CMS

Query: Compression Neuropathy while Skiiing

I saw a new patient recently with a high arch foot type. He is an avid snow skier who gets a compression neuropathy to his dorsal cutaneous nerves over the midfoot after anywhere between 10-30 minutes of skiing. He's been to all the "boot doctors" at various ski resorts around the country. He's bought at least 10 pairs of different boots and nothing has worked. We talked about custom-fabricated ski boots, but I don't know where he could get these. Does anyone have any suggestions?

Alex Dellinger, DPM, Little Rock, AR

RE: Post-op Allergic Reaction? (David Gutierrez, DPM)
From: Godfrey Viegas, DPM

I have had similar experiences. Short of blocking the toe and digging around for the remnant Vicryl suture, try a course of broad-spectrum antibiotics. I have had success with Bactrim DS BID for 10 days.

Godfrey Viegas, DPM, Crystal Lake, IL, gviegas1234@sbcglobal.net

RE: Refractory Hyperhidrosis (Evan Meltzer, DPM)
From: Eugene A. Batelli, DPM, Don Blum, DPM

Botox injections work well for refractory hyperhydrosis. Keep in mind, once you paralyze the autonomics to stop sweating in the foot, the autonomics in other places of the body might become overactive. In my experience with Botox, it is not uncommon to see increased sweating in the palms, arm pits, or small of the back. The treatment usually works for six months to a year the first round. The successive rounds last longer.

Soaks with dilute tea solutions or white vinegar work as well. It’s a good alternative. I have heard of psychiatrists using anti-anxiolytics as well.

Eugene A. Batelli, DPM, Naples, FL, ebatelli2001@yahoo.com

I have been using BenzaClin Gel for patients with hyperhidroses. Please note that this off-label use.

Don Blum, DPM, Dallas, TX, donrblum@sbcglobal.net

RE: Retrocalcaneal Pain and ESWT (clarification)
From: David Zuckerman, DPM

In my response concerning the use of ESWT and metal hardware I want to clarify my comments. There are no studies that show that it is dangerous to use ESWT where a metal anchor or hardware is present. I have used ESWT personally with a metal anchor attached to the Achilles tendon without any negative effects. We avoid direct focusing of the shockwave into the metal hardware which is very easily done with the Dornier epos ultra and its ultrasound coupling.

In addition, there are studies by Dr. Schaden from Austria treating pseudoarthrosis with hardware and infection being treated effectively with high-energy ESWT. So my point is to avoid the hardware but don't avoid using ESWT for failed Achilles tendinosis surgery. You will make many patients happy and avoid additional surgery.

David Zuckerman DPM, Woodbury, NJ, foot.care@verizon.net

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