The Voice of Podiatrists

Serving Over 10,700 Podiatrists Daily

March 03, 2008 #3,183 Editor-Barry Block, DPM, JD

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NJ Podiatrist Explains Connection of High Heels to Corns/Calluses

"Women do love their high heels, but if you wear them all the time, significant foot pain and other problems can ensue, either as a direct result of the heels or exacerbated by them," says Morris Morin, DPM, director of podiatric medicine at the Hackensack University Medical Center.

Dr. Morris Morin

If you're wearing high heels on a daily basis, it's likely you've already experienced two more common problems: corns and calluses. These thickened layers of dead skin usually occur on the toes or sides of the foot and are actually the body's way of defending your feet against assault. Only in this case, says Morin, your shoes are the enemy.

"When you start developing corns and callus, or even ingrown toe nails, pressure from shoes that don't quite fit is often the problem," says Morin. Other times it can be the result of a "hammertoe"—a condition that causes the bone of the affected toe to curl under, leaving the top to rub against the shoe. When that shoe is a high heel, says Morin, problems and pain are intensified.

Source: Colette Bouchez, Oprah.com {3/1/08]

CLEAR Adds Two New Members From UK, Harvard

The Dr. William M. Scholl College’s Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University of Medicine and Science in Chicago has added two new members to its distinguished team.

Dr. Bijan Najafi

Bijan Najafi, PhD, comes to CLEAR from Harvard's renowned Neuromotor Control Laboratory. He is a researcher in bioengineering and motion analysis. Dr. Najafi's pioneering work in this area of medicine and engineering has influenced research ranging from fall prevention in the elderly to alpine skiing and high-performance athletics. He is now assistant professor and director of CLEAR's Human Performance Laboratory.

Manish Bharara, PhD, is a biomedical engineer who received his doctorate from Bournemouth University in the United Kingdom. His work, in thermography and biomedical imaging, has advanced this rapidly expanding field. He is performing a postdoctoral fellowship with Professor David G. Armstrong and is working in the Human Performance Laboratory.

Query: Transfer Lesions S/P Bunionectomy

This new patient was referred to me. She was very happy with her bunionectomy (done by another surgeon). She now has transfer metatarsalgia due to her short first metatarsals. She is 60 years old.

Transfer Lesions

I am seeking opinions on options for orthotics that may help and for surgical options. Do I consider shortening the 2,3,4 metatarsals (Weil osteotomy) or lengthening the first?

Scott Werter, DPM, Myrtle Beach, SC

Query: Medical Director For Tattoo Studio

I have been asked to be a medical director for a tattoo studio and their use of a laser for tattoo removal. The studio carries a 1 million dollar policy aggregate, with Lloyd's of London covering myself, the laser, and the technician. It won't be in my office. It would be in the tattoo studio. The requirements for me to do this are that I have to do an on-site visit once a month to the tattoo parlor and check the laser and the logs. Also, I have to do an 8-hour training session with a doctor and a technician prior to set-up. I have e-mailed the state licensing office and have not heard anything back yet. I have talked to a malpractice attorney who she said she had a case four years ago that ended with a bad burn. Does anyone have any experience or advice?

Ashley Ledger, DPM, Killeen, TX

RE: Post-Op Care For Matrixectomy (Frank DiPalma, DPM)
From: Multiple Respondents

If you were to use electrocautery or a CO2 laser to cauterize the nail matrix there would be almost no need for a dressing beyond the first day.

Eric Edelman, DPM, Syracuse, NY, ericedelman@gmail.com

For thirty years the only reason I apply a post-op dressing following a phenol nail is for hemostasis in the first few hours following the procedure. I have the patient remove the dressing at bedtime and cleanse the area with hibiclens. A few drops of alcohol should be applied bid until the area is healed. I have the patient wear sandals or cut out shoe until healed. Some exceptions are people who must return soon to work in steel toed boots or patients on anti-coagulants. I do not use post-op antibiotics in an otherwise healthy patient.

Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com

What if you put the foot in a Aircast CAM walker after bandaging it? That would be difficult to chew.

Jeffrey Kass, DPM, Forest Hills, NY, Jeffckass@aol.com

RE: Ethical Dilemma (Name Withheld)
From: Michael M. Rosenblatt, DPM

I agree with the editor, who recommended passing-up his “opportunity” for testifying against the MD. Even among fellow MD’s the “small-town syndrome” can be dangerous. If you take this case, orthopedists gunning for you will foment patients to sue you and submit claims to the podiatry board against you. I have helped defend clients who faced this. The legal bills to protect yourself against these baseless allegations could cost in excess of $250,000 dollars! It could take 5-10 years out of your life! It is very unwise to get into a shoving match between MDs. I’m sure that the doctor’s colleagues are embarrassed enough by their fellow orthopedist’s dumb mistake.

When explaining why you are declining this to your patient, you must be careful. While the truth is always the best policy, you need to “present” it with care, always underlining the “dignity” of their claim against the doctor. I see no harm in explaining the “Small-town” syndrome to your patient. It’s the truth after all…You should end the conversation telling the patient that you deeply respect and understand their predicament.

If you were involved in the treatment of this patient, you WILL be called to testify. Keep your testimony to standard of care ONLY. Avoid saying that the doctor made a mistake, but when cornered, say that the standard of care is “contrary” to the orthopedist's approach.

The attorney who represents the orthopedist used despicable tactics. You are within your right to report her to the Bar Association. But unless you have witnesses to her comments, it will be “he said…she said.” I’m sure there were no witnesses. The best policy is to say as little as you can to ANYONE, and try to distance yourself from the entire matter as best you can.

Michael M. Rosenblatt, DPM, San Jose, CA, ROSEY1@prodigy.net

RE: Are Those Orthotics Really Custom-Made? (Susan L. Boren)
From: Multiple Respondents

Dr. Ganio opens up the possibility for an interesting discussion on the quality of orthotics that many chiropractors dispense. All of us have from time to time have encountered patients who come to us with foot problems that are correctable with properly prescribed and well made orthotics and when we suggest this treatment option, the patient says, " Doc I just bought this expensive set of orthotics from my chiropractor" and when we look at them, we want to vomit.

Chiropractors are trained in spinal manipulation. I go to one who has really helps me when I have back problems and he admits that he is not an expert on the biomechanics of the foot. As podiatrists we spend four years plus residency studying every pedal nuisance and when we make a patient a set of orthotics, all of our years of didactic education and clinical training are in some way incorporated into that final product. It shows. Our patients get better.

We cannot tell chiropractors, shoe store attendants or whomever not to make orthotics. The only thing we can do is be true to ourselves and produce quality products for our patients and the proof is in the pudding. If orthotics are indicated and we dispense well-made products their foot problems resolve.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

I would like to offer that 'custom-made' orthotics are not the only medical products that start from stock. As one who wears eyeglasses, I can tell you that my vision can only be corrected in 0.25 diopter increments. For instance, if my eye requires +0.37 diopter of correction, I have to choose between +0.25 or +0.50. Hence the famous question from the eye care specialist: Which is better?: this one or this one (as the choice is made between +0.25 and +0.50). Finding anything 'custom-made' these days is rare. We live in a society of mass production.

Richard A. Simmons, DPM, Viera, FL, RASDPM32822@aol.com

Editor's Note: An extended-length letter by Dr. Shavelson appears at: http://www.podiatrym.com/letters2.cfm?id=18216&start=1

PRACTICE FOR SALE - BUFFALO'S KENSINGTON SECTION

Established satellite practice. In urban metropolitan area on a busy commercial street corner - commercial building with an attached retail store that allows easy advertising of the podiatric medical practice. Gross $170K+ at 2 ½ day per week. Great potential for growth. 260 402-7490

PRACTICE FOR SALE - EASTERN WASHINGTON

Established practice located in the fastest-growing city in the state of Washington. Enjoy the lifestyle available in the area. Practice is directly across the street from the hospital - surgery center located within the hospital, and podiatric surgical privileges are not restricted. Gross $200K+ at 4 days per week. Can easily grow. 260 402-7490

ASSOCIATE POSITION - MONTICELLO, NY

ASSOCIATE Wanted To Be fast tracked into PARTNERSHIP. 6 doctor group with one partner anxious to retire.. DON'T MISS THIS OPPORTUNITY. Check out our website www.footcaregroup.com then e-mail me to arrange a visit mhudes@footcaregroup.com

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. Currently keeping two part-ime podiatrists very busy, Turn-key for one full-time physician. MRobsonDPM@aol.com

EQUIPMENT FOR SALE

Tab type legal size records shelving (5 units) $50 each, MinXray P202 works OK, $1000 2 Wolf xray viewboxes (24x12) $50 each, Walker $15, Star x-ray copier $100, 3 xray Paper safe boxes $20 each, Fisher x-ray processor -will do 10x12 $500, 1.5mm moveable x-ray shield on casters $250 Contact Beth @ 919-850-9111 or btl1963@aol.com

FULL-TIME ASSOCIATE WANTED - CHATTANOOGA,TN

Well established, well-respected surgical/medical practice seeking full time associate. Send CV/ inquiries to: chattfootdoc@yahoo.com

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

ASSOCIATION POSITION - MONTANA

Two Doctor group seeks individual with three years of surgical training with emphasis on the forefoot. Diabetic foot fellowship desirable. Practice includes two physical therapists that work on site. Rural setting with excellent outdoor activities. Competitive salary and benefit packages with opportunity for partnership. Respond to: jclough@sofast.net or Fax to: 406-761-7219

PRACTICE FOR SALE - DALLAS TX

10 year old general podiatry practice, including, geriatric care, diabetic care, surgery, biomechanics, etc. Grossing approximately $185,000 part-time, can be made full-time. Hospital privileges available. Will stay for transition. Please reply to: footdoc8390@yahoo.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 - NEW YORK CITY

Excellent opportunity for foot/ankle surgeon, Manhattan and Brooklyn Associate position leading to possible partnership. Requirements: Two years enrollment in a surgical residency program Qualities of self-motivation and impeccable skills in forefoot and rear-foot surgery. Package Includes: Malpractice insurance, Health Insurance plus salary, Incentives. Terms negotiable Email CV to Manfootcare@aol.com 212-349-7676

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.

ASSOCIATE POSITION - NEW YORK STATE

ASSOCIATE Wanted To Be fast tracked into PARTNERSHIP. 6 doctor group with one partner anxious to retire. DON'T MISS THIS OPPORTUNITY. Check out our website www.footcaregroup.com then e-mail me to arrange a visit mhudes@footcaregroup.com

PRACTICE FOR SALE - PORT ST LUCIE, FLORIDA

The office is 0.2 miles away from the hospital. Good mix of Medicine, Surgery, Wound care, and general podiatric care. Wound care center privileges available. No HMO's. Please call 1-772-475-7920 or derrico@pol.net for details

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