The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

February 26, 2009 #3,479 Publisher-Barry Block, DPM, JD

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TX Podiatrist Uses Platelet-Rich Therapy For Torn Ligaments

Doctors with Diagnostic Foot Specialists will be bringing an innovative treatment for soft tissues injuries to the Houston area within the next few weeks - a procedure that they say will offer a safer, cheaper and more effective alternative to invasive foot surgeries. Whereas before, torn and damaged tendons would require as much as $5,000 in surgery and weeks of downtime, the new procedure will offer relief for a fraction of the cost and without painful incisions, said foot specialist Robert Leisten.

Dr. Robert Leisten

The process, called plasma-rich therapy, involves taking a sample of the patient’s blood and placing it into a centrifuge. From the centrifuge the sample is separated into plasma and autologous conditioned blood, or concentrated blood platelets. These platelets contain much of the proteins and other ingredients used by the body to heal itself of injuries, so much that Leisten refers to it as a, “cocktail” that jumpstarts the healing process. The patient’s blood platelets are then injected into the area of injury – such as a torn or inflamed ligament - where they assist in regenerating damaged tissues.

Leisten said the process will be especially effective in helping patients recover from plantar fasciitis, or inflammation of the thick connective tissue that runs the length of the bottom of the foot, which accounts for nearly 40% of foot injuries encountered at his office. “The best thing about this process is it can’t really hurt anyone. There’s no cutting and no worry about infections and diseases because we use the patient’s own blood,” said Leisten. Injections of platelets can be performed as an outpatient procedure for as little as $500, a fraction of the cost of previous surgical solutions.

Source: Josh Hardwick, The Sentinel [2/24/09]
 

Kinesio Tape Increases Blood Flow to Injuries: CA Podiatrist

Gold, silver, and bronze weren't the only colors decorating Beijing Olympians. Some athletes wore Kinesio Tex Tape in strips of pink, blue, and black. This adhesive is popular because it speeds healing without limiting range of motion, says Amol Saxena, D.P.M., a sports podiatrist in Palo Alto, California.

Dr. Amol Saxena

"The tape pulls up the skin slightly, allowing more blood to flow to the injured area," he says. He teaches runners, including bronze medalist Shalane Flanagan, how to put it on themselves. The tape ($14.95 per roll at kinesio-tape.com) can last five days, even in the shower. Saxena thinks black sticks best to sweaty skin.

Source: Beth Dreher, Runner's World [February 2009]

OH Podiatrist Found Guilty of Healthcare Fraud

A Pepper Pike, OH podiatrist has been found guilty in a scheme to defraud Medicare and Medicaid. Dr. Harold M. Jones, 45, went on trial Wednesday in U.S. District Court in Cleveland on 26 counts of mail fraud, 22 counts of healthcare fraud and six counts of aggravated identity theft. After three days of deliberations, the jury found him guilty on three of the counts, and not guilty on the remainder of the charges.

Jones used improper billing codes, billed for services not rendered and billed under a false provider number, according to Assistant U.S. Attorney Justin Roberts. In addition, the doctor was accused of using another person’s name and medicare provider number to submit false claims for reimbursement.

Source: The News-Herald [2/24/09]

Clear Confusion

Resist the urge to tell employees “You are not following me.” If they seem like they are incapable of grasping the point you are trying to make, take on the responsibility for communicating clearly. Say “Based on what I am hearing you say, it seems that perhaps I have not explained myself clearly.” That offers you a chance to clear up the miscommunication without embarrassing or intimidating your staffers.

Source: Adapted from Telesales Tips, Art Sobczak, Business By Phone, Inc. via Communication Briefings

Query: Scalpels and OSHA Compliance

I'd like to get some feedback on OSHA compliance as it relates to scalpel blades. We  were told during an OSHA training session that if a blade is available as a “protected” blade we are obligated to use this type of disposable scalpel. These blades/scalpels are considerably more expensive at approximately $2 for a quality Bard Parker. Are practices utilizing these? If so, are other options available?

Scott D. Gurwin, DPM, Newark, OH

RE: Plantar Fibroma in a Child  (Scott Hanegan, DPM)
From: Joe Agostinelli, DPM

This is a rare presentation in a child this young. In 28 years, I have had one synovial sarcoma present as a plantar fibroma in a 19 year old patient. I would obtain a consult  from an orthopedic oncologist on this patient just to be sure.

Joe Agostinelli, DPM, Niceville, FL, jmpa21@cox.net

RE: EBM to Support “Experimental” Treatments (Jeffrey Kass, DPM)
From: M. Turlik, DPM

1) ESWT for mechanically-induced plantar heel pain

There have been several randomized controlled trials published evaluating this subject with contradictory results. This occurs for a number of reasons; however, the best way to resolve this is to search for a meta-analysis.

The two meta-analyses I am familiar with regarding this subject are:

Thompson CE., et al. The effectiveness of extra corporeal shock wave therapy for plantar heel pain: a systematic review and meta-analysis.

BMC Musculoskelet Disord. 2005 Apr 22; 6:19.  Extra corporeal shock wave therapy for plantar heel pain. California technology assessment forum. ctaf.org/content/assessment/detail/739 (accessed 2/25/09).

Both articles appear to have satisfactory internal validity, neither of which support the use of ESWT in the treatment of mechanical heel pain.  2) After a short search on MEDLINE, I could find no randomized controlled trials, systematic reviews or meta-analysis regarding platelet-rich plasma injections. Given the fact the federal government has allocated $1.1 billion in the most recent economic stimulus package for comparative trials of medical interventions which normally would not be funded by pharmaceutical and device manufacturers, it should be recognized that the choices in healthcare payments in the USA will be driven even more so by EBM in the future.

M. Turlik, DPM, Cleveland OH, mmturlik@aol.com

RE: Made in America?
From: Jack Glick, DPM, MHA

President Obama's speech inspired this thought. Thousands of orthotic devices are sold every day.  They can be custom made to order or mass produced (aka: pre-formed, modified pre-forms or computerized modifications). It is time orthotic devices are properly-labeled with country of origin and materials used and whether those materials are natural or man-made. The consumer and the dispenser (podiatrist, chiropractor, orthotist, pedorthist, shoe salespeople, physical therapists, M.D.s and D.O.s) have a right to know what they are buying and if it is American made.

Jack Glick, DPM, MHA, Beaumont, TX, afolab@att.net

RE: WI Podiatrist Among First to Use PinPointe FootLaser
From: Michael Uro, DPM, Gary Hoberman, DPM

I have performed about 360 cases since the last week of June of 2008. I have seen many 3 and 6- month follow-ups. The majority show clinical improvement. A few have shown little or no improvement. Some may require a second or even a third treatment. I have many before and after pictures that demonstrate these results. The majority of these patients never wanted to take oral Lamisil. Some tried the Lamisil but had adverse reactions. They have been waiting for such a technology to treat their embarrassing, unsightly nails.

The PinPointe FootLaser has shown better efficacy than oral Lamisil without any of the risks of Lamisil. I have seen no adverse effects. As to an 88% success rate, ask me in about 4 to 5 months if my results match up. For now, my patients and I are extremely happy to have this modality available.

Michael Uro, DPM, Sacramento, CA ,michaeluro@aol.com

Editor’s Note: An extended-length note from Dr. Hoberman appears at: http://www.podiatrym.com/letters2.cfm?id=24815&start=1
 

RE:  I Must Be Seeing Things

I recently performed arthroplasties/derotational skin plasties on both 5th toes of a patient whom I have been seeing for many  years for a variety of reasons. Upon the first follow-up, everything looked good and no complications were noted. Upon her return 1.5 weeks later for suture removal, I entered the room to find her sitting in the podiatry chair with bandages off and no sutures in either of the 5th toes. I looked at her and said nothing.

Upon closer look, I could not even find incision lines. The toes were very straight. I asked what happened to her bandages, sutures and incisions? She looked at me and simply replied that she woke up one morning and they were gone, and that she had no recollection of what happened at all. I looked at her closely and confirmed her ss# and chart information. I excused myself from the room scratching my head and wondering if I recently suffered a form fruste TIA. I just didn't get what was going on. 

A moment later, I heard her laughing, as were the secretaries and my medical assistant. In walked the patient to greet her identical twin sister who was sitting in the treatment chair! Chalk one up for the twins!  I was totally fooled.

Maurice W. Aiken, DPM, Baltimore, MD

SPORTS MEDICINE/ PODIATRY FELLOWSHIP

The Palo Alto Medical Foundation has a 12-month Fellowship beginning Aug 1, 2009 and ending July 31, 2010. APPLICANTS MUST BE ABLE TO OBTAIN A CALIFORNIA LICENSE.  Interviews will be at the American College of Foot & Ankle Surgeons Annual Meeting and Midwest Podiatry Conference. Candidates will be chosen by mid-April. 24-month surgical residency training is a pre-requisite .Send a letter of interest, CV and three letters of recommendation to: Amol Saxena, DPM, FACFAS, Fellowship Director, Dept. of Sports Medicine, PAMF, Clark Bldg. 795 El Camino Real, Palo Alto, CA 94301 Ph: 650/853-2927 Email: HeySax@AOL.com

ASSOCIATE POSITION - MICHIGAN  

Seeking quality-oriented, patient-focused RPR-trained associate for a fast-paced, established group practice in Southeast Michigan. Emphasis on diabetic foot and wound care. Gain surgical experience while earning an excellent living. Our outstanding staff allows you to concentrate on optimal patient care without the responsibilities of practice management. If you are highly motivated, ethical, and have good communication and clinical skills, please forward your C.V. cfsdr@yahoo.com

EQUIPMENT FOR SALE

PRACTICE FOR SALE or ASSOCIATE WANTED – SOUTHEAST OHIO 

Well-established, two-office practice in Southeast Ohio for sale. Seller currently works 3.5 days per week. Gross >$300K, Net ~$140K.  Excellent locations and growth potential. All equipment and furniture included. Seller is willing to help with transition, Ohio Licensure. Contact seller at bjadpm@hotmail.com for more information.

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.

PRACTICE FOR SALE – DALLAS, TX

10 year old part-time podiatry practice for sale in North Dallas. Middle to high income area. Could easily be made full-time. Great potential! please reply to: footdoc8390@yahoo.com

ASSOCIATE POSITION - TX

Successful, multi-physician, multi-office practice in The Woodlands, Texas is seeking Podiatric Physician Specialist in Biomechanics, Sports Medicine, Gait Analysis, and Orthotics Laboratory. Please email current CV to kelley.glazier@yahoo.com

OFFICE SPACE/ MRI RENTAL – NYC, LI  

Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, and Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

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

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

  
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