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February 25, 2008 #3,177 Editor-Barry Block, DPM, JD

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Surgeons Rethink Approach to Minimal Incision Foot And Ankle Surgery

Many patients who undergo foot and ankle surgery are recovering faster and with smaller surgical scars, thanks to new minimal incision techniques and tools. At the same time, foot and ankle surgeons are questioning whether smaller is always better.

"In the 70s and 80s, there was a trend towards small incisions for the sake of small incisions," says Lawrence Ford, DPM, FACFAS. He presented a lecture on small incisions Thursday at the 66th Annual Scientific Conference of the American College of Foot and Ankle Surgeons (ACFAS). "Surgeons are now recognizing that the incision has to match the procedure and the patient."

Dr. Lawrence Ford

"Depending on the patient and the procedure, a wider exposure may be preferable to a small opening that is made just for the sake of a small scar," says Ford. "More surgeons are embracing an approach that matches the incision size to the individual patient and condition being treated." Ford gives the example of a patient who falls off of a ladder and shatters his or her heel bone, requiring an operation.

For some patients, a small incision technique may be appropriate. It would allow the surgeon, guided by miniature cameras and scopes, to insert metal plates and screws to secure the bones in the correct position without compromising the surrounding delicate soft tissues. Healthy blood flow is important for bone healing. A few, small incisions would disrupt fewer veins and arteries. But Ford points out that every patient's injury or condition is different, so in some cases a larger incision can make repairing a complicated injury easier.

WI Podiatrist Appointed to Affiliated Credentialing Board

Dr. Rene’ Settle-Robinson of Milwaukee, WI has been appointed by Governor Doyle to the Podiatry Affiliated Credentialing Board of the State of Wisconsin. She is double board certified by both the American Board of Podiatric Surgery and the American Board of Podiatric Orthopedics and Primary Podiatric Medicine.

Dr. Rene' Settle-Robinson

Settle-Robinson was formerly president of Cream City Medical Society for seven years. She is the Chair of the Health Committee of the Milwaukee Branch of the NAACP and is a registered nurse. She is recipient of the Interfaith Dignity Award in 1998 from the Central City Interfaith Churches and was named Mrs. Milwaukee County in 1999.

Settle-Robinson is recipient of the Black Excellence Award 2004 from the Milwaukee Times Newspaper and the Legacies in Leadership Award from the Black Women’s Network in Milwaukee, WI.

Free Throws Win or Lose Games: CA Podiatrist

While watching a recent college basketball game on television, an 85-year-old retired foot doctor in Seal Beach, CA noted that some right-handed Memphis players failed to keep in their elbows when releasing their shots, causing some free throws to drift right and clank off the rim.

Dr. Tom Amberry

Even from 1,800 miles away, Tom Amberry knows flawed shooting when he sees it. Fifteen years ago, he made 2,750 consecutive free throws, then a Guinness world record that has since been broken. These days, he has sudden curiosity in a talented team that makes barely more than half its free throws. "Making free throws is really simple," Amberry said. "Just put the ball in the basket."

Amberry, the 85-year-old shooting guru who has appeared on television with David Letterman, believes the woes at the line could lead to Memphis's eventual demise next month. While Amberry enjoys talking about specific keys to the shot that he details in his book, "Free Throw: 7 Steps to Success at the Free Throw Line," he believes it ultimately comes down to focus and concentration. "A lot of players think free throw shooting isn't important," he said. "They practice three hours a day, eight days a week, but they are not thinking about free throws. Free throws win and lose games."

Source: Eric Prisbell, Washington Post, [2/23/08]

Query: Antibiotics for Dialysis Patients

I recently placed one of my dialysis patients on Bactrim D/S for an infected digital ulcer. The nephrologist discontinued the Bactrim and placed the patient on another antibiotic. What oral antibiotcs are safe to use on these patients?

Jim Clark, DPM, Salinas, CA

RE: Tear of Peroneal Longus (Stuart W. Honick, DPM, PT)
From: S. Jeffrey Siegel, DPM

Three years ago, I had a patient with a ruptured/avulsed peroneus longus tendon off the 1st metatarsal/medial cuneiform. I searched the literature and there were plenty of os peroneum/proximal PL rupture cases, but none that described my patient's problem. I re-attached the PL tendon to the 1st met. base in the following manner:

I pulled the tendon out from under the cuboid, debrided it and sutured in fiberwire via Kraco fashion. In anticipation of needing length, a Z-plasty of the tendon was performed just distal to the myotendinous junction and both ends were tagged. Then, an oblique drill hole was placed (started small then enlarging the hole to about 5mm dia.) in the base of the 1st met. base at the approximate orientation and location for the PL insertion site. Next, 28 gauge monofilament wire was inserted from medial to lateral through the drill hole, under the cuboid within the groove for the PL tendon. The fiberwire/PL tendon stump was pulled lateral to medial into the 1st met. hole and the fiberwire sutured into the bone. Following application of physiologic tension, the z-plasty lengthening was repaired and the wound close.

Patient did have sural nerve issues which were addressed and has since done very well. She wears her orthotics and has runs 1/2 marathons since the repair.

S. Jeffrey Siegel, DPM, Philadelphia, PA, heeldoc1@aol.com

RE: ACFAS to Poll Members on Membership Policy
From: Kathleen Toepp Neuhoff, DPM

I am glad the ACFAS has decided to poll its members. This should have been done prior to making such a major decision. When I learned of this decision, I immediately called and resigned my membership in ACFAS. Although I disagree with their decision, my primary reason for resigning was that I did not wish to support any group that made major change without asking for the input of it members. I hope those of us who resigned will be included in the poll!

Kathleen Toepp Neuhoff, DPM, vetpod@aol.com

RE: Discharged Patient Who Refused to Accept Letter (Bruce M. Nigro DPM)
From: Richard W. Boone, Sr.

Ironically, when a certified or a registered letter is sent and returned as undeliverable, as in Dr. Nigro's case, some courts have held that the usual presumption of delivery of mail is destroyed.

That's why most attorneys who need to send an official notice send it two ways: (a) by certified mail or some other form of mail providing proof of delivery and (b) by plain old first class mail.

Even though the certified letter might not be claimed, the fact that the regular mail copy wasn't returned as undeliverable still gives you the usual presumption of delivery.

Richard W. Boone, Sr., Fairfax, VA, RWBoone@aol.com

RE: DME Accreditation (Mark M Levine, DPM)
From: Paul Kesselman DPM, Stephen J. Bennett, DPM

Editor’s notes: Dr. Kesselman’s extended-length letter appears at:
http://www.podiatrym.com/letters2.cfm?id=18075&start=1

Dr. Bennett’s extended-length letter to CMS appears at:
http://www.podiatrym.com/letters2.cfm?id=18091&start=1

PODIATRISTS TO SHARE OFFICE SPACE - BROOKLYN, BRONX

Office space to rent on busy 737 Nostrand Avenue, Brooklyn. New Bronx building and offices at 1250 E 223 St. Bronx. PRIVATE OFFICE, 3-4 treatment rooms, separate receptionist area, waiting room and 2 bathrooms.CALL CRISPIN ADAMS: (917) 301-6284

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

P/T ASSOCIATE POSITION - QUEENS, NY

10 yr old practice seeks motivated, surgically-trained individual. Fax CV with hours available to (718) 458-0053.

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City . Currently four (4)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

ASSOCIATE WANTED -BOCA RATON-DELRAY BEACH AREA

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.

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

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, 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

ASSOCIATE POSITION – CONNECTICUT

Connecticut- Part time or Full time position available for a PSR 24 trained Podiatrist in the New Haven Area. We are seeking a hard working, ethical, charismatic practitioner for a well rounded established office Please email resumes to Surgeonseven@aol.com. Position available ASAP or July.

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 MRobsonDPM@aol.com

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

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