The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

February 24, 2010 #3,788 Publisher-Barry Block, DPM, JD

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ACFAOM Installs New Officers and Board Members

Kirk Geter, DPM, FACFAOM, of Washington, DC, has assumed the presidency of the American College of Foot & Ankle Orthopedics & Medicine (ACFAOM). Dr. Geter took over from Dr. Beth Jarrett of North Chicago, IL, who served two one-year terms as president.

Dr. Kirk Geter

Dr. Geter received his DPM degree from the Pennsylvania College of Podiatric Medicine (now Temple University School of Podiatric Medicine) in 1988, and completed a residency at the VA Medical Center in Washington, DC.  He is a past president of the National Podiatric Medical Association.

The other ACFAOM officers for 2010 are Drs. Kathleen Satterfield (President-Elect) (TX), Stephen Albert (Treasurer) (CO), and Robert Marcus (Secretary) (NJ). Drs. Daniel Evans (IL), Jason Harrill (AZ), and Michael Robinson (MA) joined Dr. Denise Freemen (AZ) as new members of the 9-person board of directors. The ACFAOM executive director is Dr. Norman Wallis.

Research Paper by Scholl Student to be Published

A research study titled "Does footwear type impact the number of steps required to reach gait steady-state? performed by Daniel Miller, a Scholl student (Class 2012) has been accepted to be published in the journal Gait & Posture, which is one of the most prestigious journals in the area of movement analysis in humans.

Daniel Miller, Scholl '12

This research was performed during a student summer research program, and focused on the impact of the type of footwear on gait initiation. During this recent study, he demonstrated that foot orthoses help to reduce the number of steps required to reach a gait-steady state, and therefore, offers a better gait initiation, which in turn, helps to improve overall gait performance during activities of daily living.

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky: How do private practitioners get involved in doing clinical research?

Dr. Adam Landsman

Adam Landsman: There are a lot of practitioners out there who have really busy practices. They keep beautiful records and have excellent databases. Those kind of practices are really conducive to clinical trials type of research. The better organized practitioners can develop their own questionnaires, and prospectively collect data. One thing that is new is that now, even the private practitioner really should have Institutional Review Board (IRB) approval if they are going to the prospective studies, even if it is on their own patients.  

Dr. Kevin Kirby

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's show features Kevin Kirby, DPM, noted biomechanics guru. You can register for this event by clicking here

Query: Acivenna Laser

What experiences have any readers had with the Acivenna Laser?

John Swangim, DPM, Michigan City, IN

RE: Smart Toe Implant Complications
From: Multiple Respondents

I have limited experience in using the Smart Toe, but have had two of them break on me. I have included pictures of one of the cases. The first x-ray is about 2 weeks post-op and the second film is 2 weeks later.

(L-R) Smart Toe 2 and 4 weeks post-op

I was able to take this patient back to the OR, remove the broken one, and replace it with a longer Smart Toe with great success. I would like to know what others are experiencing with this implant and what their post-op regimen is, if any different from other hammertoe surgeries.

Jeffrey Kleiman, DPM, Ft. Myers, FL,  footdoc622@aol.com

I have placed 26 Smart Toe implants in the past 12 months. Early in the series, there were two fractures of the proximal phalangeal cortices in toes 3 and 4 in elderly patients. The other cases did well, and I have since tightened my criteria for use of the Smart Toe. The implant looks deceptively easy to insert, but be aware, there is a learning curve. Because of its apparent simplicity, it is tempting to avoid some steps, for example, broaching.

I suggest using transverse elliptical incisions over the proximal interphalangeal joint, wide enough to fully expose the joint. Remove only enough phalangeal head so that distal flaring of the shaft remains. The use of the broaches is not intuitive, but using them will make insertion of the implant easier. Complete reduction of metatarsal phalangeal joint contracture must be accomplished. I do an open tenotomy and capsulotomy. I almost always use the angled Smart Toe implants.
 
Gary Friend, DPM, Glenview, IL  gjfriend@gmail.com 

The obvious but interesting factor behind implants is that they are all subject to failure. Whether it be a tibia-talo-calcaneal nail, a first MTP reconstruction, arthrodesis plate, multiple 6.5 arthrodesis screws for pantalar or triple arthrodesis, they all CAN and DO fail.

I don't find it appropriate to trash a company's product without more evidence than a couple of "referrals" and some banter from several others. We have used the Smart Toe Fusion Implant with great success in more than 75 cases, because the implant allows for fusing in slight flexion, which we like to do. Maybe we have been lucky? I, too, have had referrals for repair or removal of virtually all of these, and there seems to be two common denominators:

1. The learning curve and experience of the surgeon performing the procedure. This is true for most surgical procedures in that the more we do "correctly", the better we get (believe me, after 45 years of foot & ankle surgery, I have had my share of the learning curve).
2. The second most common reason for implant failure is failure of the patient to comply with post-operative instructions, whether it be total non-weight-bearing for X weeks, aggressive PT too soon, or whatever (we all have experienced these events).

The truth of the matter is that a broken implant viewed on a radiograph is USUALLY a benign incident, unless it is in a joint, or painful within the soft tissue. The stress shielding of the implant can be a detriment to fusion, and when it breaks, the part often fuses. Sigvard Hansen, MD, taught me long ago not to be concerned with multiple broken screws in major hindfoot reconstruction or fusion. As long as it fuses and the implant is not prominent, it makes for boring discussions at podiatric meetings.

Lowell Scott Weil, Sr, DPM, Des Plains, IL, weil4feet@aol.com

RE: Osteochondral Defect (Marc S. Greenberg, DPM)
From: Aidan Nguyen, DPM

While there are multiple surgical repair options to consider regarding the OCD lesions of the aforementioned first metatarsal head, i.e. graft, hemi-implant, or even fusion, have you considered the less invasive option: arthrotomy and K-wire drilling?  Based on the lesion size (small), I wonder if grafting is even necessary?

Aidan Nguyen, DPM, Yuba City, CA, nguyena2@sutterhealth.org

RE: An Open Letter to CPME RE: Document 320 (Barry Block, DPM, JD)
From: Rich Hofacker, DPM

Dr. Block’s letter to the CPME was outstanding. The surgical advances in our profession over the last 10 years have been outstanding, and no profession does foot and ankle surgery better than the podiatrist.  However, I too have noticed that today's resident does not have the desire to debride fungal toe nails or a painful corn or callus. The residents do not even want to go to nursing homes. This is bread and butter podiatry! Who is better trained to do the primary care than us? I had the privilege of working with Dr. Ray Suppan, one of the finest podiatric surgeons in our profession's history. He took pride in primary care podiatry, just as much as in the surgical aspects of our profession. We need to be training our new residents as podiatrists, not just ankle surgeons!
 
Rich Hofacker, DPM, Akron, OH, cavsdoc26@att.net

RE: Ask the Specialist Website (Chuck Ross, DPM)
From: Mathew M. John, DPM

I have also been approached by similar marketing ploys. I received a call from a “production assistant” who stated that “Our director Mr. Claire” is producing a show called “Modern Healing” and would like to feature me on it. After a bit of research, I learned that it was simply a marketing gimmick for advertising. Many of the advertisers have started using this type of approach now to lure doctors into a very expensive advertising campaign that may or may not work. Just do a little research, and you’ll know if it is right for you. But don’t be fooled into thinking that you were specially chosen because they know of you, your practice, and what type of doctor you are. They have probably solicited all of your competition as well.

Mathew M. John, DPM, Marietta, GA, footdoc@afcenters.com

RE: Dependence on Medicare Ruined Me (Name Withheld (GA) by Editor)
From: Multiple Respondents

This is a story very similar to mine. I also had a very profitable business with a lot of my income being derived from DME. Medicare then sent a letter to my office billing person stating they had to change my provider number. She filled out the forms, but continued using my established number until she was notified it had been changed. As time went on, Medicare would pay me one month, then ask for all the money back the next. When I inquired why they were taking the money back, they couldn't tell me. When I finally found out what the problem was, Medicare said they had paid me on the obsolete number, so I had to pay back everything and re-bill with the corrected number. The problem arose when I was told that after I paid everything back, the time limit was up, and I could not re-bill with the changed number. This put me into debt, and out of business.

Name Withheld

Something is wrong with this situation. If you are seeing 1,000 patients a month and can't make ends meet, you are a bad business person. Relying on things like blood glucose testing and hyperbaric oxygen therapy is crazy. That should be thought of as extras, not your main income. Get back to your roots - the bread and butter of our profession is routine foot care, much of which is not covered under Medicare, and brings in cash. Sprinkle in a bunch of x-rays, injections, orthotics, and some surgery, and you should be grossing $600,000 a year with that patient load.

Al Musella, DPM, Hewlett, NY, musella@aol.com

If the terrible experience our colleague has endured with Medicare is of any lesson to all of us, I hope that it is a very loud call for alarm when supporting any kind of healthcare reform sponsored by the Federal Government.

When will the medical class in its entirety say enough is enough, and stop the nonsense? Why is medicine the only profession that does the work first, and waits to get paid whenever, and at reduced rates than originally billed? Think about it the next time you are in line to buy a ticket for a concert, amusement park, sporting event, or when changing the oil in your car.

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com

PRACTICE FOR SALE – CONNECTICUT

Outstanding practice for sale in northern Fairfield county, CT. Shared space with other medical professionals. Very low overhead. Grossing almost $300K on 30 hours per week. Referrals from three different primary care physician offices. If interested e-mail CTPodiatry@gmail.com

ASSOCIATE POSITION - TAMPA BAY

Associate needed for a dynamic multi-doctor practice in the Tampa Bay area. Preference given to a PSR 24+ training and must have a Florida license. Well-established practice, high-tech with EMR and digital x-rays, with specialties in sports medicine, surgery and wound care. No nursing homes or HMOs. Excellent hospital privileges available. Choose an area of practice concentration that you are passionate about and enjoy a lifestyle for yourself and your family second to none. E-mail: drcosentino@tampabay.rr.com

ASSOCIATE POSITION - DAYTONA BEACH, FLORIDA

Associate position with buy-in potential. Daytona Beach, Florida Great opportunity for PSR 24-36.trained physician to join state-of-the-art practice. Please forward resume to pfk4@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 or call Martha 909 984-5614. 

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 - TEXAS

Dynamic, growing practice in Dallas/Fort Worth area, seeking surgically trained, Board Certified/Board Qualified Podiatrist. Excellent salary and benefits compensation package, for the right candidate, with partnership/buyout opportunity. Contact/Send resume to: jmh6122@yahoo.com

PRACTICE FOR SALE: TENNESSEE

Established 30-year full-scope podiatry practice. Excellent hospital and surgery center privileges with investment opportunities. Fully equipped 2200 sq.ft. office across from hospital. High volume of new patients, DME, and local referral base. Great community for a family and the outdoorsman. Reply to tnfootdr@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.comASSOCIATE 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 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

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

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 - 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

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.

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

ASSOCIATE POSITION - TEXAS

Wonderful opportunity! Successful multi-office, multi-professional practice seeks well-trained new and established podiatric physicians with expertise in sports medicine, podopediatrics, rearfoot/ankle surgery, or hospital podiatry. A must to be outgoing, motivated, and personable with a dedicated hard-working ethical desire to become a winner. Send resume, current photo and letter of interest to sierrajip@gmail.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.

PM News Classified Ads Reach over 12,000 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,000 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451

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