The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

February 16, 2012 #4,386 Publisher-Barry Block, DPM, JD

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It's Possible to Find Killer Shoes That Won't Ruin Your Feet: DC Podiatrist

If you wear ill-fitting heels, says local podiatrist Dr. Saylee Tulpule, you could experience unstable gait, joint pain, bunions, hammertoes, corns, ankle sprains, ingrown toenails—even tumors of the nerve tissue. Tulpule says the problem is that often women choose what looks good over what feels good. The problems are exacerbated by purchasing heels that are more than two inches high or are too small or narrow through the toe box, which leads to a “compression of the forefoot” and all of the painful injuries already mentioned. 

Dr. Saylee Tulpule

Dr. Tulpule says that for the most stability, women should look for a pump or dress shoe with a wide toe box, preferably round, and a one- or one-and-a-half-inch kitten or platform heel. If you opt for flats, make sure the shoe has some arch support and heel cushion. Remember, she adds, “There is no right or wrong shoe.” As long as you make sure they fit properly and have a wide toe box and a small heel, you’ll surely be able to find killer shoes that fit your personality and style—and won’t ruin your feet.

Source: Stephanie Early, Washiontonian [2/14/12]

NYCPM Faculty Member Participates in CME Conference in Gijon, Spain

Russell G. Volpe, DPM, Professor and Past-Chair of the Department of Orthopedics and Pediatrics at the New York College of Podiatric Medicine, recently participated on the faculty of a CME conference sponsored by the College of Podologists of Asturias, Spain. The conference was held in Gijon, Spain.

Dr. Russell Volpe

The conference on “The Child’s Foot: from Birth to Adolescence” was attended by over 100 podologists and other health practitioners from around Spain.  Dr. Volpe was joined by podologists, surgeons and radiologists on the conference faculty.  Dr. Volpe lectured on “Torsional problems of the lower extremity: Evaluation and Treatment”, “Congenital deformities of the rearfoot: Talipes Equino varus, Calcaneo Valgus and Convex Pes Plano Valgus”, “Etiology of flexible flatfoot in children – assessment and non-operative treatment” and “Criteria for inclusion and procedure selection for flatfoot surgery in children."

CMS Will Re-examine ICD-10 Timeline

The acting head of the CMS on Tuesday signaled that the agency will extend the timeline on ICD-10 implementation. After speaking to attendees at the American Medical Association Advocacy Conference in Washington, acting CMS Administrator Marilyn Tavenner told reporters that the CMS will "re-examine the timeframe" through a rule-making process.

Tanner did not say when that rule-making process will begin but said the CMS would send details about the process in the coming days. "There’s concern that folks cannot get their work done around meaningful use, their work around ICD-10 implementation, and be ready for exchanges," Tavenner said. "So we’re trying to listen to that and be responsive."

Source: Jessica Zigmond, Modern Healthcare [2/14/12]

New Overpayment Rules Proposed

The same day that federal officials unveiled record-breaking statistics on healthcare fraud enforcement, regulators announced the publication of new proposed rules designed to force doctors, hospitals, and suppliers to voluntarily return overpayments within 60 days of discovering them.

In a Tuesday news conference, HHS Secretary Kathleen Sebelius noted that the rules were intended to cut down on improper payments without the need for criminal or civil investigations. The proposed rule requires healthcare providers to return any overpayments within 60 days of when the erroneous payments were detected.

Source: Joe Carlson, Modern Healthcare [2/14/12]

Query: Complete Tear of Peroneus Longus

A 52 year old female suffered an inversion injury laterally, and heard a "pop." An MRI revealed a complete tear of the peroneus longus (PL) tendon from its insertion point at the first TMT joint with retraction 3.5 cm proximal to the cuboid notch. I know that the PL plays a role in stability of the first ray, however, re-attaching the PL to its original insertion after debridement will be logistically difficult. Will a simple tenodesis of the PL to the peroneal brevis tendon at the cuboid notch suffice? The patient is by no means athletic and works on her feet as a greeter at Sam's Club.

David Taylor, DPM, Flint, MI

Query: Kickback or Legal?

Today, a rep from a vascular surgeon stopped by to suggest that I have them come in to do various vascular evaluations for which they would pay to "rent" the room. I know this was common 20-25 years ago. Then it became illegal. Has something changed to make it legal again? He had what appeared to be letters from several NY law firms saying it was legal in their opinion; but I live in Florida, and have no idea if it would vary state-by-state. I am certainly not inclined to do this, but thought I should at least check.

Larry Aronberg, DPM, Lake Worth, FL

Editor's Comment: PM News does provide legal advice. The issue of whether it is legal generally depends on whether the "rent" charged is the fair market value or whether it is based on the number of evaluations performed. Don't count on a lawyer's letter from another state to make this determination. To protect yourself, hire a healthcare lawyer in your state who is well-versed in the Stark laws .

Query: Billing Component for MDLogic
 
I have been using MDLogic for years and have been happy with it, but there is no billing component with it. In the past, this was only an inconvenience, but as we have gotten busier and with the demands from insurance and compliance issues, it has become necessary to have a “married” system with integrated front and back data. Does anyone have any suggestions to resolve this problem?

Scott Shields, DPM, Enid, OK

RE: Hyperhidrosis (Mark Birmingham, DPM)
From: Richard E. Ehle, DPM
 
I have had several young female patients with severe hyperhidrosis of both hands and feet to the degree that while sitting in the exam chair, puddles of sweat would collect in the foot tray. They were all embarrassed by this condition, which, as you stated, only exacerbated their condition. All were recalcitrant to Drysol and Laserformalyde. I referred them to a thoracic surgeon on staff, who performed an endoscopic sympathectomy. They all had an extremely good result as far as their hands were concerned, with less significant results for their feet. However, all patients were pleased with their results.
 
Richard E. Ehle, DPM, Bristol, CT, LT6161@aol.com

Editor's Note: To see the original note, simply click on the underlined subject heading of any message.

RE: Gouty Tophi, 3rd Digit (Charles Baik, DPM)
From: Jay D Helman, DPM, Gino Scartozzi, DPM

When the uric acid is not properly controlled, tophi will form. I would order a uric acid test. I would bet it's over 6.0. If so, I would call his PCP and discuss more aggressive dosing assuming he's already on either allopurinol or Uloric. Once you get his uric acid below 6.0, in time you will probably see a reduction and/or elimination of the tophi.

Jay D Helman, DPM, Suffern, NY, footdr80@hotmail.com

This is certainly an extreme case of tophaceous gouty arthropathy. This can contribute to potential future events of ulceration and infection due to the underlying deformation pressures within the footgear, and underlying diabetes mellitus. Despite the suggestion to provide radical exostectomy and debridement of tophi from the peripheral aspects of the joint (with its inherent risks of poor skin coverage and propensity for non-healing), the patient's suggestion of amputation to the joint just proximal to the arthropathic involvement is a good surgical treatment. Complete amputation of the digit should be avoided, so as to not induce future corresponding digital deformities and metatarsalgias.

The main concerns prior to such surgical treatment should involve arterial assessments and stabilization of hemoglobin A1c levels pre-operatively. It is also important to maintain uric acid levels peri-operatively, since patients with "borderline" hyperuricemia can have a risk of a gout attack being induced by the surgical intervention itself.
 
Gino Scartozzi, DPM, New Hyde Park, NY, Gsdpm@aol.com

Editor's Note: To see the original note and photo, simply click on the underlined subject heading of any message. 

RE: Nail Dystrophy (Tip Sullivan, DPM)
From: David J. Kaplan, DPM

This condition is "green nail syndrome" and is caused by Aspergillus or Pseudomonas. The right great toe looks red, proximal to the nailplate.  The nails are pretty ugly looking; I'd remove both of them, check the nail beds for erosive changes, and get bacterial cultures of the nail beds and bacterial and fungus cultures of the the nail plates. I would also call the lab where you will send the nails. Advise them that these specimens are coming, ask them to check the nail closely and to comment on the discoloration. A great treatment for Pseudomonas is vinegar soaks, but if that right toe has cellulitis, systemic treatment might be warranted, and you must know what the infecting organism is.

David J. Kaplan, DPM, Half Moon Bay, CA, kaplanfootcare@gmail.com

RE: Insurance Card Scanner?
From: Marc S. Glovinsky, DPM

I recommend the Ambir DocketPort 665 (older) or 667 (newer). If you spend more, you can get one that does both sides of the card in one pass.  Many of the Fujitsu sheet-fed scanners will double as ID scanners and document scanners, but the DocketPorts handle the different thicknesses of various IDs better.
 
Marc Garfield, DPM, Williamsburg, VA, mgarfield1@cox.net

RE: Outrageous Shoe of the Day

And she wants to know why she has a heel spur?

Source: Submitted by Dr. Eric Weinstein, Westin, FL

EQUIPMENT FOR SALE

Koven Doppler, Synthes Titanium Mini Frag screw set, Zimmer & Hall Micro 100 set (all 5 heads including wire driver), Two full major surgical instrument sets, miscellaneous surgical tools including osteotome set (curved & straight). All German stainless steel. Best offer. Retired due to illness. Call 586-675-4311 or 440-285-2827. Dr. Gary Docks.

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

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

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 – 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 - SOUTHERN CALIFORNIA

Full-Time Associate needed for busy multi-office locations in LA, Orange, San Bernardino and Riverside counties. SIX FIGURE SALARY PLUS BENEFITS!! Knowledge of Spanish is helpful. Good mix of office patients, house calls, some surgery, etc. NO NURSING HOMES!! Needed in July, 2012 or sooner. If interested, please send contact information and CV to scpodgroup@yahoo.com

ASSOCIATE POSITION - MIAMI, FLORIDA  

well established modern practice all phases of podiatric medicine/surgery needs associate. Respond with CV and cover letter. podistristinsouthflorida@aol.com 

ASSOCIATE WANTED - MANHATTAN

Park Avenue office seeks personable, capable and experienced podiatrist, part-time. Office needs coverage March 21 until May 2, possibly longer, with one day a week position available after May 2 .Growth potential. Please fax CV to 212-889-6150 or email info@healthyfeetny.net

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 

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

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