The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

March 01, 2012 #4,398 Publisher-Barry Block, DPM, JD

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TX Podiatrist Discusses How to Prevent Running Injuries

According to podiatrist Dr. Ana Urukalo of the Austin Diagnostic Clinic, the most common running injuries are of the overuse type. "Common conditions include plantar fasciitis, tendinitis, capsulitis, ligament injuries, sprains, and stress fractures," say Urukalo.

Dr. Ana Urukalo

"Prevention is a mental attitude," says Urukalo. "It means not trying to do too much, too soon. Try to pace yourself, respecting the fact that some days are better than others." Urukalo recommends that runners invest in good running shoes.

Source: KXAN (NBC) [2/26/12}

Feet, Like Cars, Needs Regular Servicing: AU Podiatrist

As a podiatrist, Alice Linklater admits to being “totally biased” about the notion that it's a wise move to look after feet from beginning to end. From toddlers to teens to seniors, Alice, who has just opened Healesville Podiatry, said feet are the most basic form of transport and whether it's preventative maintenance or identifying and working on a problem, seeing a podiatrist is one way to ensure healthy and happy feet.

Linklater

“People service their cars quite regularly,” she said. “But most people don't think to service their own feet.” With older people, it is common to blame painful or sore feet on old age. “That's a cop-out,” Alice said. “It is always good to get things investigated and while it may not always be possible to completely eradicate pain, we can often make things more comfortable.”

Source: Mountain Views Mail [2/28/12]

TX Podiatrist Named 'Physician of the Year'

Dr. Jose Ayala was named the “Physician of the Year” for 2011 by the Valley Baptist Medical Center in Brownsville. Ayala is a podiatrist and director of the hospital’s Foot Care Institute, which is helping fight the epidemic of diabetes in the Brownsville area. Ayala offers specialized care for foot and ankle problems that can prevent disabilities and amputations stemming from diabetes.

Dr. Jose Ayala

Valley Baptist’s Physicians of the Year are selected based on input from hospital staff about which physicians stand out in terms of patient care, professionalism and courtesy to patients, their families and hospital employees. Ayala was cited for his dedication to patient care and his efforts to improve safety throughout the hospital.

Source: The Brownsville Herald [2/23/12]

NJ Podiatrist Offers Pro Bono Day for Uninsured

Family Foot & Ankle Specialists, a podiatrist office in Piscataway and Hillsborough, NJ is setting aside a day to treat patients without insurance at no cost. On Saturday, March 24, 2012,  Dr. Peter Wishnie, owner of Family Foot & Ankle Specialists will treat any person without insurance at no cost. 

Dr. Peter Wishnie

Many people have lost their jobs, have been laid off or are unable to find employment; without employment, people rarely have insurance. Family Foot & Ankle Specialists believes people should not suffer through pain or possible infections simply because they do not have insurance. We want people to come in and get taken care of.
   
Source: Jessica Gleason, mycentraljersey.com [2/27/12]

Query: Painful, Discolored Toe

A 62 year old, Caucasian female in apparent good health presented with a chief complaint of a painful second right toe, of several weeks duration. There is no history of trauma. Physical exam was unremarkable other than a Morton's foot with a significantly elongated second digit which is longer on the right foot than on the left. There is a bulbous appearance with a purple/red discoloration. The contralateral toe is normal. Radiographs display soft tissue edema, but no bony abnormalities and no evidence of gas or osteomyelitis. Could this be a bizarre presentation of Raynaud's or secondary trauma from distal shoe irritation due to the length of the toe?

Chuck Ross, DPM, Pittsfield, MA

RE: Plating Choices (Mario Dickens, DPM)
From: Scott Schonfeld, DPM, Joshua S. Faley, DPM

After careful scrutiny of your x-rays, it appears that the fracture is healing beautifully. If there is no pain, then continue your conservative treatment plan. After 3 months of conservative therapy, I would advance the patient to a sneaker and see how s(he) feels. If you plan to do an ORIF, the Osteomed FPS (Foot Plating System) would provide you with all of the different plate configurations you would need. However, you would probably not require any internal fixation after you visualize the healing fracture, flush out the wound, and re-approximate the skin.

Scott Schonfeld, DPM, Baldwin, NY, ScottSchonfeld@aol.com

In regard to a non-displaced metatarsal fracture (non-union) there are many options. If you choose ORIF, I suggest the Synthes Hand Modular set. You can pick between 1.0/1.3/1.5/2.0/2.4 screws and plates that are amenable to met fractures. They also have a titanium set. The stainless steel hand modular system is very inexpensive vs. alternative systems. If the patient is high-risk, I would consider a mini-rail. Use the rail system to distract the fracture. A small incision can be used to curette the non-union site, followed by compression with the mini-rail. 

Joshua S. Faley, DPM, Detroit, MI, faleyjos@hotmail.com

RE: Large Verruca at the Heel (Bruce Krell, DPM)
From: Pete Harvey, DPM, Jeffrey Kass, DPM,

I had a very similar verruca presentation about four years ago. She had been seen and treated by multiple other doctors for verruca that looked exactly like the one shown. I did a 2 mm biopsy on her first visit which came back as melanoma. I referred her to oncology and plastic surgery. She followed up with her M.D. She is still under care, and is doing well.
 
Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com

1. Biopsy the lesion. 2. There is likely a problem with the patient's immune system, if indeed, the lesion is a wart. This should be looked into. I have read anecdotal reports regarding resistant veruccae and Vitamin D deficiency/insufficiency so this may be a place to start. 3. For larger size warts, I like a pulse-dye laser as a treatment, and I have found success  with multiple treatments.
 
Jeffrey Kass, DPM, Forest Hills, NY jeffckass@aol.com

RE: Do Runners Need Orthotics? (Robert Bijak, DPM)
From: Gino Scartozzi, DPM

The question as to whether custom orthotics are necessary to treat foot problems is based upon the activity level of the patient and whether activity levels predispose the patient to larger stresses than that of a more sedentary patient. The decision to proceed with a custom orthotic is also dependent as to the amount of symptomatic relief they obtain with other conservative management treatments used.

Certainly, patients who are sedentary and/or respond quickly from other conversative treatments may benefit from, as Dr. Bijak states, an over-the-counter insole since their activity stresses are not the same of those of athletes. However, I believe that Dr. Bijak may be short-sighted when he states there is a "profit motive" with most practitioners using custom orthotics and their "inconveniences."

Gino Scartozzi, DPM, New Hyde Park, NY, Gsdpm@aol.com

RE: The Technological Imperative: A Warning
From: Martin M Pressman, DPM

Dr. Jacobs makes an important point in his letter. Those of us who are "early adapters" of technology should be purchasing new computers and gadgets for personal use to satisfy our craving to be on the cutting edge.

As an experienced surgeon, I have, over the years, fallen victim to the T.I. and have had my patients pay the price. Both times involved new orthobiologics supposedly non-immunogenic and used off-label. I have learned this lesson well... and Dr. Jacobs has warned us all again! My advice is to heed his warning. If you must implant tissue for augmentation, borrow it from the patient. 

Martin M Pressman, DPM, Milford, CT, pressmandpm@gmail.com

RE: Pre-Payment Audits for Therapeutic Shoes (David Dowell, DPM)
From: R. Alex Dellinger, DPM

We also have had our share of pre-paid audits. Each time a person is fitted for diabetic shoes, I complete a "comprehensive diabetic foot exam" form. There are many available. I believe this is good for our diabetic patients (so it's at least getting done once a year). I have a sentence at the bottom of that form that reads something similar to:

"I have reviewed the above findings and I agree with them." I print the PCPs name and have a line for his signature. I also sign the form myself and date it. Just like the certification statement they must sign, we DO NOT dispense shoes until we get the CDFE back. One other note, even though our chart notes says, "I recommend diabetic shoes for this patient" (thus functioning as an order), I now physically write a prescription on our prescription pad and sign it the day the patient is measured. It just makes it easier for the auditor to "appreciate" an order. 

Since instituting the above two items, we have NEVER been denied a pre-paid audit. We also have not had any PCP rebuff our request for the CDFE. They find it to be "good" documentation, and they enjoy having it for their records. I would be happy to share my form(s) with anyone who would like them. 

R. Alex Dellinger, DPM, Little Rock, AR, raddpm@yahoo.com

RE: Pre-Payment Audits for Therapeutic Shoes (David Dowell, DPM)
From: Greg Karian, CPed

As a DPM, Medicare allows you to make the diagnosis of the qualifying condition (non-DPM providers cannot). When you make the diagnosis, the PCP does not have to examine the patient’s feet. Sending a copy of your diagnosis notes to the PCP is the right first step.  Next, you need to have the PCP initial, date, and indicate agreement with your diagnosis. If you don’t do this, you’re relying on the PCPs to make adequate notes, and all you can do is keep your fingers crossed that they’ll be able to provide those to you when your claim gets audited. You should send this acknowledgement request along with your initial request for the Certifying Statement, and ask them to return both to you at the same time. Dr. Comfort’s “Check 7” system gives you simple instructions for this step of the process, as well as customizable forms you may choose to use (download at drcomfort.com/MedicareHandbook.doc).

Greg Karian, CPed, Manager Customer Service, greg@drcomfort.com

RE: Podiatric Physicians Practice Podiatric Medicine: RIP Podiatry (Leonard Levy, DPM)
From: Vincent Gramuglia, DPM

I too am disgusted by the term podiatrist. It is antiquated, degrading, and does not really describe who I am as a professional in the current healthcare arena. It is for this reason that I have decided to refer to what I am in a more fitting and descriptive way. From this day forward, I will forever call myself and expect to be called by all physicians, nurses, and patients the following: "His Excellency; Master Surgeon and All Knowing Healer." If time permits, one should add..."and the most good looking physician of all time who would be great at anything he decided to do"! It has a nice ring to it, I think.

Vincent Gramuglia, DPM, Bronx, NY, a2onpar3@optonline.net

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

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

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

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

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 – BROOKLYN NY

Busy multi-specialty Medical office in Brooklyn, NY is seeking an experienced podiatrist. We are offering great compensation, flexible schedule and great office environment. Our Requirements: Must have Experience Must have Medicaid & Medicare provider. Please respond by email to: ddpropertymgmt@gmail.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

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 toejema@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: tolisa.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

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