The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

February 21, 2009 #3,475 Publisher-Barry Block, DPM, JD

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Uggs are Fine If You Add Orthotics: PA Podiatrist

The minute it gets cold outside...the rubber hits the road. The popular UGG is everywhere. Local podiatrist Edward Chairman says that women looking for relief by pouring their dogs into a pair of UGG boots are in for a surprise.  So what's the problem? "After a few hours, their feet are tired they're aching, and they don't know why. The reason is  because there is zero support in the arch area," said Chairman.

Dr. Edward Chairman

Dr. Chairman says that lack of support flattens the arch and puts stress on the foot. He says even women with healthy feet complain of pain if they wear their UGGs too long.  But don't think Dr. Chairman wants you to toss your UGG boots aside. "Absolutely not! I think they're wonderful. You should wear them with orthotics," Chairman said.  He says put them in your UGG and the problem is solved. "It’s as if someone is helping you lift your foot while you walk." Chairman says that you can either buy expensive custom orthotics or ready-made cheaper ones you can find in any drugstore.

Source: Kathie McDermott, NBC-TV (Philadelphia, PA) [2/19/09]
 

FAPA – Fun, Sun, and Learning in Paradise

FAPA’s 14th annual meeting was held at the all-inclusive, luxury Iberostar Paraiso Maya Hotel on the  Riviera Maya, South of Cancun during Presidents’ Week.  The meeting provided a welcome respite from the cold weather up North and a stimulating and enjoyable podiatric seminar.

Dr. Daniel Tucker discusses surgical case at FAPA Seminar

Attendees were treated to a dual program of : medical/legal practice management and ethics workshop given by Dr. Barry H. Block and a clinical and surgical presentation given by Dr. Dan Tucker.  After the morning sessions, participants enjoyed the glorious weather, the abundant fine food and drink, the multitude of family activities and shows, and the beach and pools.

FAPA Seminar Organizers (L-R) Drs. Gary Stones and Al Kanegis

Kudos go to event organizers, Drs. Al Kanegis and Gary Stones, who saw to all the needs of attendees, and created an exciting program and unparalleled camaraderie among participants. FAPA is a fraternal organization of podiatrists which donates all proceeds to the colleges of podiatric medicine.

Increase Delegation

Increase delegation when you ask this question before you begin any task: “Why me?”

Delegate anything that does not require your personal attention.

Source: Adapted from Commonsense Time Management by Roy Alexander via Communication Briefings [Mar 09]

Query: Chloro-preps and Infections
 
Local hospitals and surgery centers in my area have switched to these new one-step chlorohexidine preps in the OR and the rationale is that there are less infections in open heart surgery with them vs. Betadine. My observation is that I have had more post-op infections and contact dermatitis since using them. I went back to the old fashioned Betadine scrub and paint, and my infection and dermatitis rate is back to zero. Has anyone else noticed a similar reaction?
 
Eugene A. Batelli, DPM, Clifton, NJ

Query: Nail Dust Extractor

Does anyone know of a nail dust extractor system that is reasonably priced and effective?

Robert Charnam, DPM, Deerfield Beach, FL
 

RE: RSD Post-Neuroma Surgery (Tip Sullivan, DPM)
From: Douglas Pacaccio, DPM

Editor’s note: Dr. Pacaccio’s extended-length note appears at: http://www.podiatrym.com/letters2.cfm?id=24702&start=1

RE: Mucoid Cyst (Mike Boxer, DPM)
From: Multiple Respondents

I treat digital mucoid cysts by doing a 3:1 excision and cauterizing the stalk, usually into the IPJ, with CO2 laser, and harvesting a matching pinch graft from the dorsum of the foot, easily closed there. 

Lancing Malusky, DPM, Dayton, OH, lmalusky@woh.rr.com

Dr. Boxer states "Puncture the lesion by making a few needle holes subcutaneously. This will allow the gelatinous fluid that is in these lesions to escape. Then deposit 0.25 cc of lidocaine with 2 mg. of triamcinolone. An insoluble steroid will stay in the cyst and prevent refilling.”

If you puncture the cyst "a few times" to allow a thick gelatinous substance to escape, why would anyone think a watery fluid would stay in the space, especially after applying a compression bandage. I am not saying it doesn't work, just that the reasoning doesn't make any sense to me.

Art Hatfield, DPM, Long Beach, CA, afootjob@juno.com

If you are convinced that the lesion is a mucoid cyst and you have exhausted conservative measures and its symptomatic, then it’s time for surgical excision. I would start with a 1.5 cm. dorsal converging semi-elliptical skin incision and since these cysts usually arise from the joint level, I would do a standard PIPJ arthroplasty and close with 4.0 nylon.

Ben Dimichino, DPM, E. Setauket, NY drdfoot@aol.com

RE: Heel Spurs Don’t Cause Pain (Robert Steinberg, DPM)
From: Gerald Mauriello, Jr., DPM, MA, Barry Mullen, DPM

I cannot disagree with Dr. Steinberg more. Many patients seek medical attention for so called "heel spurs" after receiving inaccurate information concerning the pathology. This is often via the Internet by explaining  the correct disease process in everyday language and not perpetuating an antiquated and false, albeit easy explanation. This allows me to not only educate my patients but to allow them to take an active role in their recovery. Most patients with heel spurs, plantar fasciitis, heel spur syndrome do quite well with conservative treatment modalities. 

I cannot tell you how many patients have come to my office after having heel spur surgery only to tell me that the previous physician did not complete the procedure because the spur is still there. Now, not only do I have to explain this true disease process to the patient, I have to work twice as hard to gain their trust.

I believe the correct way to address this common and often debilitating pathology is through proper patient education and treatment based on evidence-based medicine. Our patients may not know the technical terms associated with their disease process, but they are savvy and not stupid. It is our job, as physicians, to educate them. I have found that my patients appreciate the time I take and my honesty.

Gerald Mauriello, Jr., DPM, MA, Philadelphia, PA, drmauriello@gmail.com

Editor's note: An extended-length letter by Dr. Mullen appears at:http://www.podiatrym.com/letters2.cfm?id=24701&start=1
 

RE: Reason to Dismiss?
From: Murray J. Findel, DPM, Barry Mullen, DPM

When faced with a similar scenario as Dr. Khoury, I told the patient that he was welcome here, and in the future please call and tell me when you are in the parking lot and I will gladly escort you to the office..... BUT, then directed the following statement to the spouse: Just know, in the future, we shall not accept any phone calls from you, and under no circumstance will you be allowed in our office.  That was 10 years ago and the husband comes regularly WITHOUT his wife. 

Murray J. Findel, DPM, Glendale, CA

As physicians, we have rights...You are under no obligation to continue to care for a patient who is rude and belligerent to you, or your staff; the lone exceptions being the provision of any emergent care requirements during the patient's transition to another health care provider and/or completion of care associated with a surgical procedure until they may be safely discharged for that care. In New Jersey, that is 30 days. I suggest you check your own state regulations. Dismissal guidelines exist, but are generally regulated by state law.

I would respectively disagree with Dr. Gosnay's comments regarding how one approaches a belligerent patient. I'd avoid mudslinging and derogatory statements that bring one down to the level of behavior being admonished. As such, I recommend simply stating you are aware of their behavior, that it is unprovoked, unacceptable and not tolerated. Due to the irreparable damage their behavior has created to the doctor-patient relationship, you have no option but to terminate the relationship, effective immediately (within the aforementioned parameters).

Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com
 

RE: Dan Glassman
From: Richard Mann, DPM

It was with great sadness that I learned about the passing of, my friend, Dan Glassman. Dan was a charismatic, generous man with an endearing quality about him. He was a brilliant businessman, a loving family man and a true friend of our profession. His passing was much too early. He will be missed by all those who knew him.

Richard Mann, DPM, Delray Beach, FL

 IMMEDIATE OPENING – MIAMI, FL 
 
Part-time and Full-time position available now. Massive growth potential present in an expanding group practice. June graduates are welcome to apply. Send CV and LOI to qvan@aol.com

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. 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 Visit our website

ASSOCIATE POSITION -SOUTHERN NEW JERSEY 

I’m looking for podiatrist who wants additional practice hours. Perfect for combining your own practice with an additional income. Must be on Aetna Insurance, Horizon Blue Shield, Medicare, and most commercial carriers. I am looking for someone who has a desire to learn how a very successful practice is run, so that I will be able to have time away from my practice. Payscale to be discussed. Could lead to partnership or sale. E-mail contact information, CV, and why you would be perfect for this opportunity. Contact foot.care@verizon.net

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

GREAT OPPORTUNITY- ATLANTA, GEORGIA

Forget getting paid by percentage or a salary, be your own boss. Great opportunity to have your own office with patients without major financial burden. Well-established practice/ office, fully equipped, five treatment rooms, x-ray room, lab, kitchen, doctor’s office, large street sign on a main road, office location and doctor's name is well-known in the community, lease or lease to buy. The doctor is cutting back on this location to become semi-retired. E-mail superrang@bellsouth.net

PRACTICE FOR SALE – ANDERSON, INDIANA

Well established office in Anderson Indiana for sale. Seller currently works 3 half-days per week and gross over $200K. Excellent locations and growth potential. Very podiatry-friendly community. All equipment and furniture included. Seller is willing to help with transition. Contact seller at mddpm@sbcglobal.net for more information.

PODIATRY ASSOCIATE WANTED – NJ

Northern NJ. Bergen County Must be well-trained. No nursing homes or house calls. Modern well-equipped office. Digital x-ray and ultrasound. Excellent pay and opportunity. Must have NJ license. Call 973-472-4700.

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 NORTHERN CALIFORNIA

Need associate in busy office in two locations. Hospital privileges
available. Emphasis on wound care. All aspects of Podiatric Medicine and Surgery. Associate position to lead to partnership and buyout. Please contact jimf@humboldt1.com

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.

  
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