The Voice of Podiatrists

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February 19, 2008 #3,171 Editor-Barry Block, DPM, JD

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ToeNail Fungus is Hereditary: MO Podiatrist

Toenail fungus is more hereditary than anything. It causes a thickening and discoloration of the nail and is commonly treated for cosmetic reasons or if there's pain caused by the thickness of the nail.

Dr. John Holtzman

We're more susceptible to it as we age, but if there is pain, Dr. John Holtzman, a podiatrist at St. John's Mercy Medical Center, says a doctor can prescribe oral medication, such as Lamisil, to get rid of toenail fungus. Penlac is a topical treatment, but Holtzman says it is less effective than oral medication.

"The fungus will cause a thickening of the nail and then the nail usually falls off," Holtzman said. "It can occur in fingernails, too, but it's easier to clear."And the fungus usually returns when the nail grows back. "It's the same fungus that causes athlete's foot," he said. "It can be passed on from person to person, but it's not that common. You're more susceptible to it genetically."

Source: Jackie Hutcherson, St. Louis Post-Dispatch [2/18/08]

CA Podiatrist Travels to Daytona 500 to Cheer on Driver

The Daytona 500 has a history of a famous fight (1979) but Jimmie Johnson, the two-time defending champion, who drives the No. 48 Lowe’s Chevrolet.said Wednesday that he had not thrown a punch since high school. Still, at least one Johnson fan seems happy to see it.

Jimmie Johnson

The hard-working, beer-drinking fans, that’s what they want to see,” said Neil Kelley, 54, a podiatrist from Fortuna, CA., who attended Thursday’s Gatorade 150 qualifying races at Daytona. Kelley, bedecked in Johnson gear from T-shirt to jacket, is a longtime fan of the sport who happily calls himself a “redneck.”

“They want to see guys show emotion,” he said of his friends who have lost interest in Nascar. “They want to see some fistfights occasionally. They want to see a little cursing and a guy wearing grubby Levi’s and a T-shirt and growing a scruffy beard when he’s not in the car.”

Source: Viv Bernstein, New York Times [2/17/08]

Podiatrist Negligently Performed Surgery To Correct Nerve Damage In Foot (Iowa)

Facts: Susan Gerard, in her middle 50s, underwent surgery on her right foot in early September 2002. Defendant podiatrist, performed the operation after diagnosing Morton's Neuroma, generally characterized by an enlarged nerve between the third and fourth toes.

Gerard saw Defendant again Oct. 31, 2002. She told the doctor she was still in pain, and said she noticed swelling on her right foot and a raised scar along the area of the surgery. Defendant reportedly told her she had a “nerve block” and gave her a cortisone shot. He also told her to put lifts in her shoe, which she did. After that visit Gerard reportedly did not return to Defendant.

She next visited another podiatrist, in September 2004, still complaining of pain in her foot despite receiving steroid injections. Gerard told doctor #2 that her toes on her right foot had contracted and that she was having chronic pain in the ball of her foot. Doctor #2 reportedly responded that the pain in her foot was caused by the removal of fat padding during the September 2002 surgery and that the curling of her toes was possibly caused by an improper incision of the tendon. Doctor #2 tried adding extra padding to the top cover of her arch support and a pad on the foot to reduce pressure on the front part of the foot. According to Gerald, this failed to stop the pain.

The plaintiff alleged defendant removed excessive tissue from her foot in the area of the surgery, failed to inform her that any symptoms she experienced after the surgery and the subsequent cortisone injection were known risks of the surgery, and led her to believe her foot pain would eventually subside so she could walk normally. The plaintiff claimed she sustained severe and permanent damage to her right foot and sought medical expenses and relief for permanent disability.

Defendant denied liability and claimed the patient signed a consent form that stated swelling and delayed healing were possible. He also asserted, as affirmative defenses, the plaintiff's lawsuit had no basis due to a statute of limitations, and he acted within the medical standards for his specialty. Defendant was initially represented by counsel, but his counsel withdrew. Defendant remained unrepresented.

According to court filings Defendant failed to respond to the plaintiff's discovery attempts or the court's orders requiring discovery. An order was entered Jan. 26, 2007, in which it was determined the defendant was in default on all issues of liability and that any defenses claimed by the defendant would be disallowed. Judgment was entered against defendant as to liability. A hearing on Gerard's claimed damages was scheduled and subsequently took place March 6, 2007.

Result: Judgment to Plaintiff, $78,487.02

Plaintiff’s Experts:: Eric M. Goldenberg, DPM, Daytona Beach, FL; Mark Beers, MD, Oskaloosa, IA
Defendant’s Experts:: Brian L. Hamm, DPM, Fort Dodge, IA; Charles D. Joiner, DPM

Source: West's Jury Verdicts - Iowa Reports

Query: Recurrent Enesthopathy of Heel

Approx. 6 months ago, I performed a resection of a large, symptomatic posterior heel enesthopathy (retro calcaneal spur) on a 46 year old male. He healed uneventfully with 4 weeks of NWB followed by off-loading with a CAM walker and physical therapy. He presented to the office last week with a large, painful "lump" in the posterior aspect of the heel. X rays revealed no bone re-growth with adequate resection of the original complaint. On palpation the area feels like a recurrent enesthopathy, even though the x-rays are negative.

The patient has a history of essential thrombocytosis which is a non-reactive, chronic myeloproliferative disorder. ET is associated with sustained megarkaryocyte proliferation and increases the number of circulating platelets, causing thrombocytosis. What treatment would be considered appropriate at this time to resolve the podiatric complaint? I will be referring the patient to a hematologist for cytoreductive therapy.

David Wolf, DPM, Houston, TX

Query: Accepting Credit Cards

My office manager has asked me numerous times about accepting credit/debit cards, as she feels it will increase the number of payments made at the time of visits. My feeling is that I could barely afford to survive on the constantly reduced reimbursements, and I could not afford to give up another few percents to the credit card company. What have others found?

Peter Smith, DPM, Stony Brook, NY

RE: Lateral Cuboid Syndrome S/P EPF (John Levin, DPM)
From: Multiple Respondents

This is a common sequelae of the EPF procedure when more than the medial band is released. I have found a semi-rigid orthotic with the rearfoot posted at zero degrees (extrinsic post) and a lateral flange stabilizes this joint and can be quite helpful

Steven H. Goldstein, DPM, Royal Palm Beach, FL, stevefootdr1@cs.com

The CC joint syndrome could be a stress fracture. I had a patient with one of these several years ago, post EPF. We ended up doing both a bone scan and An MRI, both showing uptake in the cuboid. We casted him for 6 weeks, then used a CAM walker for a few weeks, which did the job.

David E. Samuel, DPM, Chester, PA, desamuel@pol.net

Lateral calcaneal cuboid syndrome will occur post EPF if the lateral band of the plantar fascia is cut during the procedure. It is for that reason that I have always inserted the blade medially, so that I never approach the lateral band. Orthotics with a calcaneal cuboid bar or pad will help this condition over time. I once discussed this with the trainer of the NY Jets and he would strap the player in such a way as to support the calcaneal cuboid joint. He would follow up with orthotics.

Barrett E Sachs, DPM, Plantation, FL, uncletenose@aol.com

RE: NY Podiatrist to Appear on Today as “Big Loser”
From: Steven H. Goldstein, DPM

Congrats to Dr. Dinowitz. This is a great accomplishment. Losing that amount of weight without surgery is commendable. After struggling with my weight since childhood, I understand how hard it is to accomplish such a feat! Kudos to him and I wish him continued success at keeping the weight off.

Steven H. Goldstein, DPM, Royal Palm Beach, FL, stevefootdr1@cs.com

RE: Non-Paying Cash Patient (Michael J. Schneider, DPM)
From: Sloan Gordon, DPM, Joel Lang, DPM

Simple solution. While the patient is checking in, simply have your staff say, "Sir (or Madam) may we have your credit card or check to verify it before you go back, so we can save you a lot of time checking out."

Sloan Gordon, DPM Houston, TX, sgordondoc@sbcglobal.net

I am in total agreement with those who feel that we need to put the practice of podiatry on a real business basis, without accompanying loss of professionalism. A nurse or assistant can approach the patient prior to treatment and actually thank the patient for being a cash patient. Emphasize how much not having to deal with insurance claims makes the process so much easier.

"And by the way, as long as we are waiting for the doctor, perhaps we can take care of the initial office visit right now. Will that be cash, check or credit card?" Since those are the only three options, one has to be chosen. I have never gotten the response of "I left my wallet home".

However, my suggested response would be that "we would be glad to reappoint you at a time that you were prepared to pay for the visit at the time the service is rendered - which is our policy. What day would be convenient for you?" Pleasant, business-like, professional and eliminate any mis-understandings.

One last suggestion . . . All new patients were given a "financial policy statement" clearly (but professionally) stating office policies about payments, insurance, missed visits, billing, etc. The patient signs the statement indicating that he/she understands it and it is a permanent part of the patient record.

Joel Lang, DPM, Cheverly, MD, langfinancial@verizon.net

RE: Number of Podiatrists Needs to Triple by 2014 (From: Bryan Markinson, DPM)
From: Jon Hultman, DPM, MBA

I echo Bryan Markinson's comments regarding the need to use this SUNY data to, "Get funds for scholarships and grants or incentives to the best and brightest in our undergraduate colleges to consider podiatry as a career." However, I wanted to clarify his comment stating that, "This effort should be prioritized over Project 2015." In reality, increasing the quality and quantity of the applicant pool is at the foundation of Project 2015.

While every entity within the profession (such as APMA, ACFAS, ACFOAM, licensing boards, Colleges of Podiatric Medicine, Certifying Boards, Residency programs, etc.) has a role in making Project 2015 a reality, every podiatric physician must play a role in recruiting the best and brightest to the profession and in developing scholarships to help our podiatric medical schools compete with other allopathic medical schools for these students.

Jon Hultman, DPM, MBA, Los Angeles, CA, jonhultman@verizon.net

ASSOCIATE POSITION - FLORIDA , NAPLES

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Candidate should have the skills and desire to perform rearfoot surgery including Charcot reconstruction and ankle surgery. Florida has a great scope of practice law and we rotate for ER call at all 4 hospitals. Candidate needs to be ethical and motivated. Established practitioner or new practitioner OK. Base salary, percentage, benefits including 401K. Fax CV to (239)566-8778 or Email CV to Drgordon@gulfcoastfootcare.com

PRACTICE FOR SALE - MINNESOTA: PRIME LAKES AREA

Great place to live and raise a family. $400+K yearly gross with continued growth and potential. Good mix of general podiatry & surgery. Hospital privileges available. Fully computerized, electronic notes, with capability to go completely paperless. Recently remodeled office, 5 tx/procedure rooms, well-equipped in owner-occupied building (for sale or lease). 260 402-7490

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com -- www.homephysicians.com

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City . Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

PRACTICE FOR SALE -AUSTIN, TEXAS

15 year established practice with good mix of surgery and clinical patients. Nice office condo for sale with practice or lease. Current female Podiatrist will transition the practice. 300-400K yearly gross. Flexible payment options

ASSOCIATE POSITION – RICHMOND VIRGINIA

Hospital-Based Practice with Tremendous Growth Potential and a Fantastic Opportunity for the Right Doctor. I am looking for someone who will be an associate for a couple of years, then discuss Partnership Buy-In. ABPS Certified/Qualified candidate DOES NOT need significant rearfoot experience, but arthroscopy skills appreciated. Need strong surgery and people skills, with emphasis on wound care, forefoot surgery, diabetic problems, etc. No nursing homes. My office is an extremely busy brand new state-of the-art facility with digital x-rays, computerized EMR, etc. Immediate start available, SALARY commensurate with experience. Please send resume to: podmed@mac.com

Great opportunity-must be hard-working, reliable, Responsible and good with patients & staff-surgical Training a plus-partnership after 1yr. Florida License required fax resume to 561-865-2225.

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