The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

February 17, 2010 #3,782 Publisher-Barry Block, DPM, JD

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WA Podiatrist Injects Polylactic Acid to Create "Foot Pillow"

Women have long had a love-hate relationship with high heels. No matter how much they hurt, they won't give them up. But now a local foot doctor is offering a new solution that takes the agony out of wearing heels. Podiatrist Mikhail Burakovskiy said, "No matter how I'm going to try to persuade them, they're still going to do it. So I was looking for a solution to solve that problem." 

Dr. Mikhail Burakovskiy

The solution is an injection called a foot pillow that works like an internal orthotic. "What we do is inject a polylactic acid in the ball of the foot to create an extra padding," said Burakovskiy. It's the same filler used for the face. The injections can last about a year for most patients.

Jean Enerson, KING 5 News [2/15/10]

NC Podiatrist Returns From Haiti

Dr. Rosemay Michel of the Fayetteville Veterans Affairs Medical Center was recently part of a group of 18 doctors, including 5 DPMs, internal medicine docs, and nurses, primarily of Haitian descent in Port-au-Prince for one week.

Dr. Rosemay Michel in Haiti

The group worked in community clinics and the main general hospital, treating acute injuries, podiatric, orthopedic, general medicine, and  counseling in adults and children.

IN Podiatrist to Run for Sheriff

Thomas Philpot entered the race for sheriff Monday in an effort to win a trifecta in Lake County politics. Philpot was county clerk until he resigned at the end of 2009 to become the county coroner. Now, with less than two months in office, he's seeking a post with an even bigger budget and staff than both of the previous positions combined.

Dr. Thomas Philpot

Philpot told listeners of his WJOB radio show last week that his professional training qualifies him to oversee the sheriff's staff of 481 and budget of more than $25.6 million."I think we can do better," he said. "It's a challenge to me. Crime could go down. Your streets could be cleaner. There are a ton of things that could be done. I believe I could do better. You want a professional to run the jail? That is what I'm going to do. I have a legal background, a medical background and that is 90 percent of the problems going on right now in the jail."

Philpot is an attorney and a podiatrist. He won elections for coroner in 1992 and 1996, county clerk in 2002 and 2006, and coroner again in 2008.

Source: Bill Dolan, NWI.com [2/16/10]

IL Podiatrist Named Assistant Medical Director & Podiatry Coordinator

Wake Pharma US, Inc. (Chicago, IL) has announced the appointment of Dr. Milton Kondiles as an Assistant Medical Director & Podiatry Coordinator. Kondiles is a board certified foot and ankle surgeon and a fellow of the American College of Foot and Ankle Surgery. He has been in private practice for over 25 years, and currently is the head podiatrist at Our Lady of Resurrection Hospital and the past chairman of podiatry at Lincoln West Hospital. He has been teaching foot and ankle surgery to residents for over 20 years. He is a board member of several prestigious medical organizations and societies such as Advanced Foot and Ankle.

Dr. Milton Kondiles

Dr. Kondiles has been on the frontline in treating wounds for over twenty years and has vast experience with them. He has developed new innovative techniques in treating peripheral neuropathy, which is often associated with wound ulcers. He is the director for the Clinics of Wellness and Neuropathy which treats neuropathic conditions.

Query: MD Logic EMR

Has anyone used or converted to the MD Logic EMR system? The system seems very impressive (of course, that's based on the representative's demo), but I'm not sure it's the best product for a new, one-doctor practice. I'm also considering Traknet (formerly Podmed), but I want to avoid the need to "upgrade" 2-3 years from now.

Mario Dickens, DPM, Chattanooga, TN

Query: Richie Brace Coding

I researched the Richie Brace on the forums, and found information from December 2008 stating the way to bill:

L1970 (AFO, plastic, with ankle joint, custom fabricated),
L2820 (addition to lower extremity orthosis, soft interface for molded plastic, below knee section), and either
L2275 (addition to lower extremity, varus/valgus correction, plastic modification, padded/lined)  or
L2270 (addition to lower extremity, varus/valgus correction ('T') strap, padded/lined or malleolus pad).

Is this information still valid, and, if so, when would it be appropriate to bill L2275 versus L2270?

Michelle Fultz, Office Manager ,James Adleberg, DPM, White Marsh, MD

Response: The use of a varus/valgus correction when billing for any AFO device should only be applied when such an addition is added to a standard version of that device and when the addition fulfills the description of the code.

The Standard Richie brace does not contain a varus/valgus correction, so only codes L1970 and L2820 are appropriate.

When the Arch Suspender addition to the Standard Richie Brace is added, then code L2270 would be appropriate as an additional code since this device includes a plastic modification as well as a padded correction to improve frontal plane control of the hindfoot.

Doug Richie, DPM, Seal Beach, CA

Codingline subscription information can be found at:
http://www.codingline.com/subscribe.htm

RE: Surgical Options for HAV in 16 Year Old (Richard Frost, DPM)
From: Multiple Respondents

The x-rays submitted are totally inadequate. What is the Met. add. angle, CIA, Kites angle, Meary's angle, etc? The x-rays show long 2nd and 3rd metatarsals with a severely deviated HAA with a rounded head.  The IM angle seems to be within acceptable range. What does gait analysis show?

No one can make a surgical decision based on the information submitted. In my opinion, 10" By 12" plates should be used for all basic foot exams.

Simon Young, DPM, NYC, simonyoung@juno.com

In the patient's brief history, Dr. Frost mentioned that the patient has "flatfeet."  Please note during your examination that a forefoot varus may be masked by his "flatfeet."  This may be more of a global issue than one just localized to a "bunion" procedure.

Wenjay Sung, DPM, Pittsburgh, PA, focker@mac.com

The growth plates appear to be closed, based on the lesser mets. I can't really see the entire 1st met base on your x-rays. You have a few options: 1) Off-set V osteotomy with Akin  2) Scarf osteotomy with Akin. Both of these can give length depending on your axis guide and can be rotated to address PASA as needed. 3) Opening base wedge osteotomy with Akin. 4) Lapidus with graft and Akin. I don't like to do Lapidus procedures that require grafts for length. Just a preference.

I think there are more simple options with less morbidity. With the base procedures, you may need a Reverdin if you think PASA is a problem. I almost always do Akins (midshaft with staple fixation) as a secondary procedure to complement any large bunion correction. I think Akins give you a better correction (radiographically and cosmetically) with large deformities. I also believe that they help restore the soft tissue alignment of the 1st MTPJ. Lastly, in this case, I would also consider a Weil osteotomy of the 2nd met to restore the parabola. I always will do the Weil if there is already a lesion submet 2.  

Robert P. Thiele, DPM, Hillsborough, NJ, drthiele@facnj.com

RE: Plantar/Palmar Keratosis (Misty McNeill, DPM)
From: G Dock Dockery, DPM

There are two very helpful treatments for painful plantar keratotic lesions that should be considered after the normal process of debridement, padding and orthotic devices fail to give relief, and these are:

1. Cryotherapy with the CryoProbe™ (from Cryosurgical Concepts, Inc.) to the most painful lesions. This involves performing a deep debridement of the keratotic center of the lesion, and then a freeze-thaw-freeze of 30 seconds each. The response is very similar to that of cryotherapy for plantar warts.

2. Sub-lesional injection of 4% dilute ethyl alcohol. This frequently reduces the pain significantly, and many times the lesions will resolve following treatment.
 
I can recommend both treatments, and additionally will offer references for the injection therapy.

Disclaimer: I am a consultant for Cryosurgical Concepts.
 
G Dock Dockery, DPM, Seattle, WA, gdockdockery@aol.com

RE: How Long to Keep Charts (Barry Finkelstein, DPM)
From: Jeffrey Kass, DPM

Why don't you scan the charts and save them on a computer with appropriate back-up. Scanned images are just as good as the originals.
 
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

RE: Financial Impact of Pre-Fabs (Michael McCormick, DPM)
From: Dennis Shavelson, DPM

There is an alternative point of view. I believe that biomechanics is the unique quality we offer to patients and the medical community. I am passionate about my ability to diagnose, cast, dispense, and monitor custom orthotics that deliver what no OTC orthotic can.

Biomechanics is an artistic medical science, without much Level-1 EBM, which like foot surgery requires foundational knowledge, a paradigm for practice, and special skills that create a bell curve of outcomes for our practitioners. Would any of us offer second-rate surgery that is cheap and the patient would accept over surgical excellence for profit? That seems to be what I am reading.  

I promise patients performance enhancement, prevention, upgraded quality of life, and a 60-day refund for my orthotics. I utilize Foot Centering Pads ($20 profit) as a test drive for considering my devices on every initial office visit. If the patient has “sticker shock” over my $800 fee, I state that my lab fee is $125 and ask the patient to arrange a payment plan for the balance. I then proceed with the casting or suggest an OTC orthotic in a shoe store because I will not recommend and certainly not sell any OTC device.

Dennis Shavelson, DPM, NYC, NY, drsha@lifestylepodiatry.com

ASSOCIATE POSITION – NEW YORK

Great opportunity to share “state-of-the-art” offices and equipment in mid-town Manhattan and White Plains with Board Certified podiatrist. Out-of-network or participating providers welcome.  Please call 212-704-4310 for additional information and fax your CV to 212-704-4311.

ASSOCIATE POSITION – LONG ISLAND 
 
Busy Bellmore, NY office. Motivated, board certified, hard-working, experienced in all phases of podiatry. F/T, P/T hours available. excellent salary, call 516 242-7540 or Fax Resume 516 826-9036 or email jobke@aol.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 – 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

ASSOCIATE POSITION -  MICHIGAN - (OAKLAND COUNTY)

outstanding opportunity for associate in well established practice, general & surgical podiatry forefoot, rearfoot & ankle (full or part-time). Well-trained, responsible, motivated with good communication skills, ABPS qualified or better. Send CV & letter of interest to: PodiatristWanted@AOL.COM

PRACTICE FOR SALE - MIDDLE TENNESSEE

Practice and building for sale. Two locations each with 3 exam rooms, x-ray room, large waiting room, and ample parking. Excellent locations and growth potential. All equipment and furniture included. Seller happy to discuss extensive financial and professional information.  Priced to sell. Call 931-446-5724 after 5PM CST.

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

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

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

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