The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

February 28, 2012 #4,396 Publisher-Barry Block, DPM, JD

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High Heels Are Leading Cause of Ingrown Toenails: IL Podiatrist

High heels can cause a number of foot problems, yet most women aren’t willing to give their shoes the boot, according to podiatrists at Loyola University Health System (LUHS). Ingrown toenails are among the most common problems that result from high heels.

Dr. Rodney Stuck

“Ingrown toenails can be painful, but many women are willing to cope with the discomfort in order to continue wearing their high heels,” said Rodney Stuck, DPM, professor of Podiatric Medicine, LUHS. “However, more serious complications can arise and cause permanent damage to the toenail, if they are left untreated.” Dr. Stuck warns that people with diabetes should be particularly careful of ingrown toenails.

Source: Loyola University Health System [2/24/12]

NZ Podiatrist Discusses Effects of Running in Worn-Out Shoes

Good shoes are an important part of running, says sports podiatrist Rob Dallimore. Dallimore has competed in triathlons since his teens, including completing the Ironman distance multiple times. "Most of the injuries I see are from people who have worn shoes for too long, so the shoe has worn out."

Rob Dallimore

Even though my shoes haven't been worn much, Dallimore says a shoe has a finite lifespan. After two to three years, the material begins to degrade, particularly if you've done a lot of running in the winter, he says. "You draw a lot of moisture into the sole and the shoes start losing a bit of life." Dallimore recommends regularly checking your shoes for signs of wear. Pop them up on the kitchen bench and see that they are sitting up at 90 degrees and not sloping to one side. Also see that the uppers aren't coming apart, particularly around the toe and heel areas.

Source: Helen Twose, NZ Herald.com [2/27/12]

NY Podiatrist to Give Away iPod to a Local Youth For Doing a Good Deed

Dr. Mary Carlson believes that many good deeds done each day are going un-rewarded. “We all know that negativity will not improve a situation, but complimenting or rewarding a job well done will actually prompt more of those good activities,” says Carlson. She launched a Good Deed Contest in January 2012 which ends on May 11, 2012. The contest is open to any youth 18 years of age and under. 

Dr. Mary Carlson

Dr. Carlson will be giving away a brand new Apple iPod to the winner who submits the best essay. According to Carlson, “we all have a vested interest in providing a stable foundation of moral values to our youngsters.”

Medicare Doctor Pay Patch Sets Up 32% Cut for 2013

The 10-month delay of cuts to Medicare physician payment rates leaves Congress in what some see as its toughest spot to date when it comes to preventing deep pay reductions. Physician organizations and other health policy observers said lawmakers missed a major opportunity to pass a long-term solution to the broken Medicare sustainable growth rate formula.

The pursuit of yet another short-term patch makes attaining a permanent fix to the SGR in 2012 significantly more difficult, with the price of a repeal going even higher above the $300 billion mark and the added pressures of competing for legislative attention in a presidential election year.

Source: Charles Feigl, AMNews [2/27/12]

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

Bret Ribotsky: What is the hottest thing in foot surgery now or about to come down the pike?  

Dr. Lowell Weil, Sr.

Lowell Weil, Sr: I would like to think that pyrocarbon is. Recently, I went to France to see the work being done on other joints. They now have a pyrocarbon cue ball that they use for the femoral head. They use it on hand surgery all the time because it is so compatible with cartilage. It has the exact same properties as cartilage. Whether it’s going to work in the foot, I cannot tell yet because the foot is a much different animal than anything else, but I would like to see pyrocarbon coming out for many, many different types of joints in the next five years. 

Dr. Gregg Young

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's guest is podiatric surgeon and residency director Dr. Gregg Young. You can register for future events by clicking here

Query: Plating Choices

I have a 40 year old male patient with a 5th metatarsal shaft fracture that has been treated conservatively for the last three months. Callus formation is noted on x-ray, but the fracture is still present. 

AP, Oblique and Lateral Views of 5th Metatarsal Fracture

Surgical intervention is planned, but with the plethora of hardware systems on the market, I'd like to know which plating system some of my colleagues prefer for this type of fracture.
 
Mario Dickens, DPM, Chattanooga, TN

RE: Large Verruca at the Heel (Bruce Krell, DPM)
From: Barry Mullen, DPM, G. Daniel Shanahan, DPM

Biopsy of recurrent, longstanding skin lesions is warranted. Assuming verruca, try stimulating your patient's immune system: Rx Tagamet 25mg/kg/day in divided doses up to a max of 1,600 mg/day. Response time for adults ranges from 6-14 weeks. Anecdotal adult success rates approach 60%. Review JAPMA (2005) Mullen, et al. - Cimetidine as a first line treatment for pedal verruca.
 
Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

I highly suggest a full thickness wedge biopsy of the lesion that includes a margin of normal skin for comparison. The first thing that comes to mind with your given history of the patient is a verrucous carcinoma. I have seen this same type of lesion in the past that tested positive for the aforementioned pathology.

G. Daniel Shanahan, DPM, Commerce Twp, MI, footdan@comcast.net

RE: Do Runners Need Orthotics? (Kevin Kirby, DPM)
From: Michael B. DeBrule, DPM

I have no problem with Dr. Campitelli advocating for minimalist shoes if that works for his patients, and I won’t speculate on his personal financial motivations with Vibram. I firmly agree with Dr. Kirby that there are a lot of studies justifying the use of orthotics for runners. I would like to see Dr. Kirby, Dr. Campitelli, and other leaders of our profession work together designing some studies looking at injury rates for runners who are unshod, wearing minimalist shoes, wearing running shoes, and wearing foot orthotics.

Personally, I recommend running barefoot or in minimalist shoes for patients who fail to improve with changes in shoes and orthotic therapy, which is not often. It takes at least several months to transition to these and they may introduce new discouraging injuries (Achilles tendonitis, stress fracture, top of the foot pain). Also, before your patients spend a lot of money on Vibrams, Nike Free, etc., consider Huaraches from invisibleshoe.com. They are about 1/3 of the price and last ten times longer. The last issue of Runner’s World forgot to mention invisible shoes in their shoe guide as a low-cost alternative.

Michael B. DeBrule, DPM,  Marshall, MN, Dr.DeBrule@InnovativeFootCare.com

RE: Pre-Payment Audits for Therapeutic Shoes (David Dowell, DPM)
From: Paul Kesselman, DPM

Considerable attention to this issue has been paid by many organizations representing the various suppliers of therapeutic shoes for at least two years. There has been considerable dialog with the DME MAC Carrier Medical Directors (CMD's) on a number of occasions, resulting in some (but not enough) clarification on the required documentation. To my chagrin, none of these communications has resulted in substantive progress in resolving the issues at hand.

I agree with Dr. Dowell that the most difficult documentation for any supplier to obtain is a progress note from any physician which contains the body of evidence required by a DME MAC.

For most DMEs, podiatrists have the ability to...

Editor's note: Dr. Kesselman's extended-length letter can be read here.

RE: Overburdened by Paperwork (Howard Fox, DPM)
From: Frank Lattarulo, DPM

I read with interest the response by Dr Fox. I too, like Dr. Fox, would have a brief patient info sheet, then a privacy policy. I would see the patient in the consultation/treatment room also, and do a more complete H&P. I would document these findings in my chart and then dictate my complete and final note. It's pretty efficient and highly effective. However, now that I have made the jump into EMR, I somewhat feel Dr. Borreggine's pain.

Take medications as an example. To meet meaningful use, it's simply not enough to list medications. You must list the complete list of meds taken by the patient, as well as dosage and frequency. In some patients, that can be quite a list. Once these patients return to the office, it's...

Editor's note: Dr. Lattarulo's extended-length letter can be read here.

RE: Podiatric Physicians Practice Podiatric Medicine: RIP Podiatry (Leonard Levy, DPM)
From: Karen Malley Banks, DPM

I have been a podiatrist for 20 plus years and wear many hats. I go by the following: Christian, wife, mother, Facebook fanatic, encourager, etc. I am sure there are some that I don’t want to admit to. My point is this. Be who you are and love the moment you’re in. It will show. Your business will prosper. I don’t care when someone calls me a foot doctor, toenail clipper, chick with a foot fetish, etc. I think it is funny, and laugh all the way to the bank. I perform surgery, but try to talk folks out of the ones that are more painful than they are worth.

There is a wonderful life out there worth enjoying. Do your version of the foot job thing and go home and play with your kids. Hug your spouse. We have a wonderful profession that is something I am proud to be a part of... but it is WHAT I do.. not WHO I am. When you adapt an attitude of gratitude, it will show. Take the time to look at the pictures of your patients’ grandkids. Tell them they are cute even when they are ugly as dirt. Be kind to the old folks who take forever to get up and down the halls. You will be old soon enough. Join a civic group you like, not just one that would bring you good business. You have a life to live. Live it well.
 
Karen Malley Banks, DPM, Thomasville, GA, kmbwwjd@rose.net

RE: Staple in Diabetic Shoe (Jonathan Michael, DPM)
From: Larry Kansky DPM, JD

As a very aggressive personal injury attorney, my advice to Dr. Jonathan Michael is: relax. A patient finding a staple in his diabetic shoe, without injury, is not entitled to any monetary compensation. Certainly, a replacement pair of diabetic shoes is in order.
 
If the presence of the staple was indeed caused by the diabetic shoe company, their manufacturing process should be reviewed to identify any problems. If a problem is present and not corrected, other future patients may suffer significant harm. If this happens, then attorneys like me will be waiting in line.
 
Larry Kansky DPM, JD, Wilkes-Barre, PA, larry.kansky@gmail.com

RE: Taking Telemedicine to a New Level

As part of our intake history and physical, we ask our patients who their primary care physician is. Normally, it is one of the PCPs who I recognize as local. The other day, I was going over a patient's form and I noticed the section was blank. I asked the patient who her PCP was and she said Dr. Oz: "I follow him everyday and take all his advice." I jokingly asked if this was considered a house call for him. She didn't think that was funny, and I realized that she was not kidding. What's next, Dr. iPhone?

Tim Shea, DPM, Concord, CA

PRACTICE FOR SALE - CALIFORNIA

V.A. podiatrist closing one day a week private practice in Long Beach, CA. Great location in medical building. Reasonable rent. Basic equipment. Good opportunities for growth. Contact Art Hatfield  at
Afootjob@juno.com

ASSOCIATE POSITION - CENTRAL NEW JERSEY

Associate Wanted for Central NJ offices. Looking for highly motivated self starter to build/expand practice locations. Great part-time opportunity for the right candidate. Email your CV with references to ejema@aol.com

ASSOCIATE POSITIONS - TEXAS

TEXAS licensed podiatrists needed in San Antonio and Austin. Great paying positions for full or part-time. Well-established, unique mobile podiatry practice servicing senior living facilities. Business office location with excellent support staff for your assistance and scheduling. Check us out before looking elsewhere. Find us at www.footmobile.com. Reply with cover letter and CV to doctor.cohen@yahoo.com with a cc: to lisa.schulze@yahoo.com or call us at 210-495-6477.

ASSOCIATE POSITION - MANHATTAN

Podiatrist needed for busy state-of-the-art offices in Manhattan. Offices are located near Penn and Grand Central Station. Along with CV, please provide medical plans that you are currently participating in. Please forward your information to roni@myfcny.com

ASSOCIATE POSITION - UPSTATE NEW YORK

Outstanding Opportunity. Our medical surgical group is recruiting a well-trained licensed podiatric physician. Located in Beautiful upstate NY. Full hospital privileges, as well as working with two residency programs. Must be highly motivated and great with patients. Opportunity for growth. Competitive salary and benefit package. Please send CV to associateinfoot@yahoo.com

SOUTHEAST GEORGIA- SAVANNAH & SURROUNDING AREAS

Beautiful weather year round & near the Coast. Opportunity for Early Buy-in. Seeking podiatrist looking to build a career & long-term relationship. Either established practicing physician or new residency graduate. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facilities. E-mail cover letter & CV to melissafoot@pol.net

ASSOCIATE POSITION – ALBANY, NEW YORK

Solo practitioner looking to wind down after 29 years. Immediate position available in a well- established diversified practice. Must be ethical, hardworking and committed to quality patient care. Must have good communication and surgical skills. Patient base established with additional growth present. Excellent salary & benefits. Please send cover letter and resume to McBride719@aol.com

ASSOCIATE POSITION - KANSAS CITY, MISSOURI

I'm not just looking for an associate. I am looking for a doctor who wants to build a highly successful career with a doctor who is as committed to their success as he is to his own. Go towww.YourFutureInPodiatry.com to find out about this opportunity.

ASSOCIATE POSITION - EAST CENTRAL NEW JERSEY

Well established practice needs a career-minded podiatrist for associate position leading to Fast Track Partnership. Competitive salary/benefits. Busy practice. Great location. Board Certification a plus. Part-time or full-time. Immediate availability, but will wait for best candidate. GardenStateDPM@aol.com

ASSOCIATE POSITION - NORTHEAST GA

Well-established 18 year practice in Northeast Georgia seeking full-time associate leading to partnership. General podiatric care with moderate amount of surgery to be done in local hospital or surgery center. Competitive salary and benefits. Please respond by email to: Fivetoes1946@aol.com

ASSOCIATE POSITIONS - MULTIPLE STATES

Podiatrist Needed in Missouri, Nebraska, Iowa, Minnesota, North Dakota, South Dakota, Ohio, Texas, Colorado, Oregon, Washington, Arizona, Massachusetts, Rhode Island, Wisconsin, Indiana, Oklahoma, Connecticut and Vermont. Expanding multi-state medical practice seeking podiatrists to service long-term care community residing in nursing homes and assisted living facilities. We offer an established patient base, scheduling, equipment allowance and cover travel expenses. Provide generous compensation, bonus opportunities, disability, health insurance benefits, malpractice coverage and flexible scheduling. Looking for a Podiatrist with excellent skills, able to provide expert and compassionate care to patients. Email CV to: careers@aggeus.org or call 773-770-0140 x300/x305.www.aggeus.org

ASSOCIATE POSITION - MARYLAND

Looking for 3rd associate. Must be personable, well trained and highly motivated. Great locations in Southern Maryland, including an Ambulatory Surgical Center. We currently have EHR, digital radiography, dispensing center and PADNet. Looking for immediate hire! Please send CV to:myfeetfeet@aol.com

PART-TIME PODIATRIST NEEDED - LOS ANGELES, CALIFORNIA

Busy podiatrist looking for assistance with patients located in facilities, homes, office, etc. Flexible hours, independence, and great compensation. If interested email CV to or call Terri at  323-353-8103  homefootcare@hotmail.com

EQUIPMENT FOR SALE

Summit Doppler, Hall Micro 100 set with 5 heads including burrs, drills, and rasps (pristine condition). Original Hall/Zimmer set (still works), two major podiatry surgical packs; will sell them complete or piecemeal. Titanium Synthes Mini frag set; Osteotome sets, etc. Inventory of all equipment for sale available on request. Best offer. Call 586-675-4311 or email me at gwdocks@aol.com

EQUIPMENT FOR SALE - COOL BREEZE COOT TOUCH VARIA

Cool Breeze Coot Touch Varia. Very low use. You won't find a laser at this price. $39,500. Has about 19 hours of use of it. E-mail for photos, and ask any questions. Will go fast. David Zuckerman DPM 856-229-2939 footcare@comcast.net

SPACE AVAILABLE - NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview, Long Island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

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