The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

March 02, 2012 #4,399 Publisher-Barry Block, DPM, JD

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Wearing Pointy Shoes Can Lead to Foot Surgery: NY Podiatrist

Dr. Tejas Pandya, a podiatrist at Capital District Podiatry in Troy, knows women love their Jimmy Choos and other designer shoes. He also sees first-hand what these high heels can do to women’s feet and the rest of their bodies. Take your back, for instance. “Women cannot walk with a natural stride when they have high heels on,” Pandya says, noting the curvature in the lumbar changes. “It will eventually affect their knees and back.”

Dr. Tejas Pandya

He recently saw a 37-year-old patient who had a rigid hammertoe with a corn on top of it. She had tried everything, including pads, to help it. She wore a lot of pointy shoes and shoes that were too small through the years. “She has to have it surgically corrected,” he says. “The tight shoes have caused her muscles in her feet to contract. The tendons have gotten weaker.”

Source: Lee Nelson, Albany Times-Union [2/28/12]

APMA Completes Shoot for O₂ Media's Morning Show

The American Podiatric Medical Association, the nation's leading professional organization for today's podiatrists recently completed their shoot for O₂ Media's hit morning TV show "The Balancing Act." The segment, which features Dr. Hillary Brenner, Doctor of Podiatric Medicine, will air as part of the show's "My Family" series in March on Lifetime Television. 

Dr. Hillary Brenner

"The Balancing Act is a great opportunity to teach people about the podiatrist--a surgeon, physician, and specialist who provides expert care for your feet and ankles, as well as plays a vital role in overall health," Dr. Brenner says.
 
Source: RCR Wireless News [2/28/12}

NY Podiatrist Coordinates Heart Weekend

Heart Weekend in the Mohawk Valley is one of Central New York’s greatest events. It’s happening Friday and Saturday and will involve thousands of people who will walk and run toward a goal of $1,119,000. 

Dr. Mark Schug

Dr. Mark Schug, a Utica podiatrist, coordinates the one-day event, held in the Utica College gymnasium on Friday, from 9 a.m. to 9 p.m. The expo grows each year, and features displays, demonstrations and other information to help individuals improve their cardiovascular health.

Source: Utica Observer-Dispatch [2/29/12]

House Subcommittee Votes to Repeal IPAB

Members of the House Energy and Commerce Health Subcommittee approved a bill to repeal the Independent Payment Advisory Board (IPAB) created in the health reform law. In a 17-5 vote, the panel supported the Medicare Decisions Accountability Act of 2011, a bill introduced last year by Rep. Phil Roe (R-TN), a physician. Roe's bill now has 226 co-sponsors, including 17 Democrats.

The House Ways and Means Health Subcommittee will have a hearing to examine IPAB next week. Following the subcommittee vote, Rep. Joe Pitts (R-PA), chairman of the Health Subcommittee, said he did not know for sure when the bill would make it to the full House floor, but that “I'd expect (it will) by the end of March.”

Source Jessica Zigmond, Modern Healthcare [2/29/12]

Query: Plantar Keloid

A 58 year old Haitian female without any significant past medical history presented complaining of a recurrent wart to her foot. In May 2010, another surgeon excised the lesion, roughly the size of a quarter. The path report confirmed verruca. At the same time, he applied an STSG - harvested from her ipsilateral thigh. The area healed initially, but she has noticed progressively increasing size of the borders and thinks that the wart has come back. She is having pain because of the size of the lesion. She also notes a history of keloid formation and the harvest site on the thigh is moderately thickened. 

Plantar Keloid

I strongly recommended a biopsy to rule out malignancy, but she adamantly refused. I haven't seen very many plantar keloids and wanted to get the opinion of others. If a biopsy is done, and this is a keloid, what conservative options are available, aside from an accommodative orthosis?

Alan MacGill, DPM, Boynton Beach, FL

RE: Painful, Discolored Toe (Chuck Ross, DPM)
From: Elliot Udell, DPM, Marc Garfield, DPM

This might be chilblains, which is related to Raynaud's phenomenon in the sense that both are small vessel vasospastic conditions brought on by cold weather. Chilblains can be quite painful. They tend to appear in patients living in cold, damp climates. They present more frequently in places like the English Countryside and even in British cities because of the cold, damp winters. This winter has been quite unusual and the weather pattern in your geographic area might be perfect for producing this condition. Compare photos of your patient with photos of chilblains on the Web. If the clinical presentations match, you might try placing the patient on nifedipine or another calcium channel blocker in the same class, but first make sure the patient does not have a history of cardiac pathology.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

Raynaud’s would be my first suspicion. I recommend having the patient sleep with a heating pad on low or medium heat around the calf, and  keep thick or double socks on, even in the house. Chemical warming packs from a camping store are also useful if the feet are getting cold when she cannot get indoors. If there is no improvement, I would use a calcium channel blocker. At 62, she is likely on other blood pressure meds, so a call to the PCP would be prudent before starting the Ca 2+ CH blocker. Expect 2-3 weeks for the pain to dissipate and the toe to turn pink. If there is still no improvement or if there is any suspicion for PVD, get a non-invasive vascular assessment ASAP. 
 
Marc Garfield, DPM, Williamsburg, VA, mgarfield1@cox.net

RE: Plating Choices (Mario Dickens, DPM)
From: Greg Caringi, DPM, Tip Sullivan, DPM

Before considering which plating system to use, consider the use of a bone growth stimulator. The fracture is reasonably well-aligned and opposed, and the bone callus is a good prognostic sign for healing. I've had very good results with the Exogen Ultrasound Bone Healing System from Smith & Nephew.
 
Greg Caringi, DPM, Lansdale, PA, drgregc@msn.com

Unfortunately, no clinical history was provided, which is extremely important in making these types of decisions. It's not simply whether or not surgery is needed vs. immobilization, nutritional consult, PEMF stimulation, etc. but also the patient's weight, activity, job, health, and foot function should all be used. This is an example of the art we work in — trying to combine the best treatment in the appropriate case.

If this were a healthy compliant person and I could use whatever I wanted from an insurance (cost) standpoint, I would use an autologous graft (easily obtained with a bone dowell) and a small (Wright Medical) locking plate (at least 5 holes). In my hands, this is the most stable construct for an ORIF. You certainly could put an Ex-fix on this, but I have found that the pin care and risk of complications (I have seen stress fractures across the pin holes) just make it easier to use ORIF.
 
Tip Sullivan, DPM, Jackson, MS, tsdefeet@MSfootcenter.net

RE: Large Verruca at the Heel (Bruce Krell, DPM)
From: Philip McKinney, DPM, Robert Kornfeld, DPM

A patient with this lesion came in last week. The patient had noticed it for six months. The primary care physician had made three attempts to remove it using N2. This screamed out for a biopsy. The report received back today is positive for malignant melanoma.

Malignant melanoma, initially misdiagnosed as a verruca

I'm not really sure why this had not been biopsied before the primary care doctor referred the patient to me for treatment of a resistant verruca.
 
Philip McKinney, DPM, Eugene, OR, opodiatry@oregonpodiatry.net

If, in fact, Dr. Krell's patient has a verruca AND the patient has a compromised immune system, the goal of successful treatment should be identifying the reasons why the immune system is over-burdened. Instead of looking at the symptom and trying to eliminate the symptom, looking at causative mechanisms reveals answers to why many patients are recalcitrant to typical therapies.

I have had many patients over the years who suffered from widespread mosaic verrucae as well as very large lesions, such as this one, who failed multiple attempts with topical meds, lasers, and excisions. Once the underlying mechanisms are revealed and addressed, it is possible to treat these lesions, without surgery, to resolution while improving the patient's immune deficits. In this scenario, the lesions do not recur.
 
Robert Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com

RE: DR X-Ray Equipment (Neil H Hecht, DPM)
From: Raymond Posa, MBA

I offer the following suggestions when shopping for a digital x-ray unit. While price is important, do not let it be the be-all, end-all in your decision. Some manufacturers are offering very low prices, but then have hidden mandatory ongoing support costs, or they compromise the quality of the unit in its design.
 
So, what do you look for and what questions should you ask?: Do you have maintenance and/or support fees? Does your unit use direct x-rays on the ccd receptors or indirect? Indirect will significantly increase the life of the unit. How many megapixels is your image? Look for 20 plus megapixels anything less will compromise the quality of your images. Is your unit tailored for podiatry? Many units are scaled down units that are not designed for podiatry or are much bigger units than are required for podiatry.
 
Raymond Posa, MBA, Technology Advisor to the AAPPM, RaymondPosa@themantagroup.com

RE: Podiatric Physicians Practice Podiatric Medicine: RIP Podiatry (Leonard Levy, DPM)
From: Bryan C. Markinson, DPM

I will borrow a line from an old comic strip (Motley’s Crew) that I used to read. In the first frame, a character is frantically looking through the Yellow Pages. He is asked, “what are you looking for?” He replies that he hurt his foot and needs a foot doctor. He is told that, “they call themselves podiatrists.” In exasperation, he replies, “well, the first one who calls himself a “foot doctor” will become a millionaire!
 
That about nails this dilemma perfectly!
 
Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org

RE: The Technological Imperative: A Warning (Allen Jacobs, DPM)
From: Ira Baum, DPM

I’m not sure anyone could argue with the advice Dr. Jacobs has recommended. At times, the difficulty is holding an inquisitive mind from exploring the unknown. As physicians, it is assumed we have inquisitive minds and, in these times, it can be a liability. From my perspective, as in the allopathic and osteopathic fields, let the research centers do their job, and when the experimental study is complete and the object of the study is approved, use it. If not, be prepared for the potential costs of litigation. 

Ira M. Baum, DPM, Miami, FL,ibaumdpm@bellsouth.net

RE: Pre-Payment Audits for Therapeutic Shoes (Cyril M Gostich, DPM)
From: Josh White, DPM, CPed

Medicare's revisions to the Therapeutic Shoe Program speak to a desire to improve quality of care and work very effectively to DPMs' advantage. I think that the main reason why over 90% of suppliers failed post-payment audits for therapeutic shoe claims is that they did not completely understand Medicare documentation requirements nor how to efficiently comply.

Fortunately, compliance need not be onerous using a program developed by SafeStep called "WorryFree DME." By streamlining documentation procurement and guaranteeing Medicare compliance, fitting diabetic shoes should be seen as very worthwhile. An explanation of each of the six required pieces of documentation and...

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

RE: TX Podiatrist Discusses How to Prevent Running Injuries
From: Lou Pack, DPM

We have long been taught that overuse syndromes, like runner’s knee, plantar fasciitis, etc. are the result of doing too much, too soon. I humbly submit that this term is incorrect and really makes no sense when one thinks about it. For example, how is it possible that someone can develop runner’s knee on their right side as a result of overuse if they took their left leg with them for the run? This could only be possible if they hopped or did indeed leave their other leg home.

I do consulting work for the navy SEALs. During training, their third-most common injury is unilateral knee pain, also thought to be due to overuse; especially in lieu of the incredible amount of stress they place on their bodies in training. But here again, if they are running on both feet and legs, there has to be another factor. By correcting their underlying mechanical problems...

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

Codingline & PM News
In conjunction with AAPPM Present
The Greenbrier Coding & Practice Management Workshop - August 20-22
(Following the 2012 APMA Annual Scientific Meeting in Washington, DC)  

The Greenbrier, White Sulphur Springs, WV

Speakers: Harry Goldsmith, John Guiliana, Barry Block, Michael Brody, Paul Kesselman, Jonathan Moore, Rem Jackson, Chad Schwarz, and other nationally-known authorities. 

Earlybird Bonus Until March 1 - Save $50 

Click Here for information or to Register

ASSOCIATE POSITION – PORTLAND, OREGON  

$120K approx. starting salary plus malpractice and benefits! Long-term possibility with a unique buy-in plan. Busy, well-established private practice has an immediate opening with an established patient base for a dynamic, motivated, surgically-trained podiatrist. High volume of primary care referrals. All aspects of podiatric care; surgically-oriented practice. Prefer PSR-24/36 w/ankle training. Call (503) 652-1121 and ask for Dr. John Mozena or email jlmozena@aol.com.

FULL-TIME  PODIATRIST NEEDED - ORANGE COUNTY, NY  

Looking for a highly motivated surgical trained podiatrist in the Orange County NY (West Point) area. Hospital, wound center and surgical center affiliated. It is a busy practice that covers hospital inpatients, Wound Center, and takes ER calls. The applicant has to be trained in all foot surgery and be able to handle advanced Diabetic wound care. The practice is a 1 hour car ride from NYC and is close to hiking,fishing, skiing, and state parks. Please Email a CV and contact info to clsp4@yahoo.com

ASSOCIATE POSITION – SUBURB OF DALLAS, TEXAS

Available in suburb of Dallas 2-office practice. Excellent base salary/ bonus structure, malpractice, full benefit package with 4-5-year track to partnership. Looking for someone that wants to grow with our practice. Must have strong communication skills, excellent bedside manner and be PSR 24-36 trained. Email CV and letter of interest to myfoothurts2@yahoo.com

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 to www.YourFutureInPodiatry.com to find out about this opportunity.

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 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

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 440-285-2827  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

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