The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

March 05, 2011 #4,100 Publisher-Barry Block, DPM, JD

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We've just posted the following CPME-Approved CME.

By Mark A. Caselli, DPM

You can Earn 50 CPME-Approved CME Contact Hours Online

FL Podiatrist Cautions Against Going Barefoot Outside of Home

Dr. Dennis Frisch, a podiatrist in Boca Raton, FL, a trustee of the American Podiatric Medical Association, doesn't believe going barefoot is a safe practice. "The risks of what could happen when you're barefoot significantly outweigh the risks of what could happen when you're wearing shoes," Frisch said. For example, he said that a blister or corn caused by wearing an uncomfortable shoe will take a couple of days to heal on its own. But a cut caused by stepping on undesirable material while barefoot could potentially become infected and be a severe medical problem.

Dr. Dennis Frisch

Frisch said that he isn't "anti-barefoot," and he even advises some of his patients to kick off their shoes while they're at home. Being barefoot for some period of each day is especially important for women who wear constrictive high-heeled shoes, he said.

Source: KGO Newstalk (ABC) [3/3/11]

Worn Shoes Exaggerate Your Biomechanical Faults: MN Podiatrist

From the faithful running shoe to the whimsical sandal, from the sensible work loafer to the sexy stiletto, all shoes reach a point at which they have outlived their usefulness, and we must let them go. "The shoe wears out in the area where we overload it, so the part where you need the most support isn't there," said Minneapolis podiatrist Dr. Paul Langer, clinical professor at the University of Minnesota. "A worn shoe can exaggerate the biomechanical faults you already have." 

Dr. Paul Langer

A loss of support and cushioning can cause shin splints, Achilles tendinitis, knee pain, and plantar fasciitis. As a shoe's sole and heel wear down unevenly, the likelihood of twisting an ankle increases. In severe cases, old shoes can cause stress fractures, Langer said.

Source: Alexia Elejalde-Ruiz, Tribune Newspapers [3/3/11]

CA Podiatrist Authors Textbook on Orthotic Therapy

Lower Extremity Review (LER) has announced the publication of Recent Advances in Orthotic Therapy by Paul R. Scherer, DPM, MS, with an introduction by Kevin A. Kirby, DPM. The text is intended for the advanced student and the clinician who uses orthoses to treat mechanically-induced pathology. The author has endeavored to make Recent Advances in Orthotic Therapy a step beyond what is currently being taught in the classroom, and create a compilation of documented and anecdotal evidence regarding orthotic decision-making. 

(L-R) Dr. Lori Waters, Rich Dubin, Drs. Paul Scherer and Lawrence Huppin

The text is constructed in a manner to provide a logical approach to orthotic therapy, and therein establish the concept of pathology-specific orthotic therapy in the professions that prescribe orthoses for adults and children. Additional contributions to the medical text were made by Cherri Choate, DPM, MS; Lawrence Z. Huppin, DPM; and Lori L. Waters, BSc, BEd.

Improve Your Ability to Work Together With Your Staff

You can improve your one-on-one relationships with every staff member. Put these suggestions to use:

• Appreciate others’ depth. You may find it easy to pigeonhole them as “staffers” or “subordinates.” However, they have many roles, including some you may know nothing about, such as parent, volunteer, caregiver, and the like. None of those roles can excuse on-the-job irritability or distractions, but sometimes they explain them. When others do not behave as you think they should, ask about the reason instead of silently giving up on the relationship. Occasionally inform others about your multiple roles, too, so they can appreciate your depth in turn.
   
• Don’t talk down to them. When a team member approaches you to explain a problem with a project, it’s easy to respond in a way that sounds harsh: “Things look bad. I can’t believe you let this happen. Why weren’t you paying attention?” You may hear a denial or an excuse in response. But the conversation does not have to go that way.

Two angry or defensive people cannot expect to have a productive conversation. Deal with any immediate decisions, and then cool down before you discuss the matter further.

Source: Adapted from The Agile Manager’s Guide to Influencing People, John Hook,Velocity Business Publishing via Communication Briefings

Query: Acute Charcot Foot

My patient is a 63 year old Type-2 DM female with painful neuropathy, whom I originally saw in December for a very painful right 5th MT. Her past medical history also includes: polymyalgia rheumatica and a rare sweat gland disease. X-rays did not reveal any abnormality, but one week later there was evidence on x-ray of a stress fracture at the shaft of the 5th MT. I put her into a surgical shoe and advised her to limit her weight-bearing as much as possible. She came back two weeks later, but her right forefoot was now extremely painful, swollen, and warm to the touch. She was now painful at the 1st MTPJ with palpation and ROM. X-rays showed very mild arthritic changes of the 1st MTPJ. I performed an arthrocentesis, which was negative for any organism or crystals. Blood cultures were negative, and a full comprehensive panel was all normal, except a blood glucose of 153, and CRP of 1.7. 

Three days later, her 1st MTPJ was not painful anymore, but she had extreme pain in her right midfoot and heel. The entire foot and ankle were now swollen and warm to the touch. Assuming Charcot, I put her in a BK NWB with cast changes every two weeks. Her pain and swelling has been decreasing slowly. An orthopedic surgeon told her that it could have been Charcot, but it is done by now, and that she now needs to be weight-bearing. Suggestions?   

Andrea Simons, DPM, DeWitt, MI

Query:  Billing for Diabetic Shoes if the Patient Dies

How do you code for diabetic shoes and insoles when the patient has died?

Paul Gill, DPM, Severna Park, MD

Response: If the patient has died prior to the dispensing of extra depth (diabetic therapeutic) shoes and heat moldable insoles, simply return items back to your supplier for credit.

If, however, either the shoes and/or insoles were custom made, then you, most likely, cannot return them. You would bill your DME carrier (DMAC) for only your cost for the custom shoes and/or insoles. File the claim on paper. Mark the claim as "salvage". And attach a copy of the invoice from the company that provided you the shoes and/or insoles. You cannot make any profit on salvage claims.

Paul Kinberg, DPM, Dallas, TX

Codingline subscription information can be found here APMA Members: Click here for your free Codingline Silver subscription

RE: Twitter (Charles R. Oehrlein, DPM)
From: Alec Hochstein, DPM

I find that the social network (Twitter, Facebook, Linkedin, etc.), is a great way to educate the public what we, as podiatrists, are passionate about.  The public is, of course, our patients and potential patients, but even more importantly, it is  other medical specialties, as well as vendors, researchers, entrepreneurs, and future entrepreneurs. It is  through following their Twitter feeds, BLOGs, Facebook notes, online profiles, as well as  through the direct interactions that can be had within the framework of these tools, that we put ourselves in a position to be heard daily and often times multiple times a day.

To my fellow podiatrists who enjoy the daily interaction that we have here at PM News, I can only say that this is only the "tip of tip" of the networking that is available to you.  Let me ask a question: "when was the last time you spoke to 100 people in a day?"  That would be a busy day by anyone's standards, but "do-able." How about 10,000 or more people all over the world with one click of a mouse? That is the kind of impact we are talking about, not just the ability to have a patient make an appointment. I implore you to explore these networks, reach outside of the brick and mortar of your hospitals and offices, and when you do, look me up. I'd be honored to be your first "follow, friend, or contact"

Alec Hochstein, DPM , Great Neck, NY, ahochstein@aol.com Twitter - @iPodiatrist

RE: Fraud and Abuse (David Gurvis, DPM)
From: Richard A. Simmons, DPM

Perhaps, the greatest problem with routine foot care is the inconsistency of rules from region to region. In Florida, we cannot use ICD- 9 code 443.9; 440.20 has to be diagnosed by the primary care physician. That said, we (podiatrists) can diagnose peripheral neuropathy if two of five spots test negative on either foot when performing the 5.07 Semmes-Weinstein test. Then, we get into realm of defining the class findings. What exactly does "absent posterior pulse" mean? Absent to the practitioner's ability to palpate, or absent to Doppler exam? What is thickening of the toenails, reduced hair growth, or thin and/shiny skin? What are cold feet? I am sure podiatrists in Maine see more cold feet than I do in Florida.

Exactly what are the clinical findings one uses to substantiate 443.9 and how are those different from 440.20? As given to us by Medicare, the class findings are objective findings noticed by the practitioner at a particular time. My office has a one-hundred question review of systems that the patient fills out and signs before I see the patient. This gives me an excellent idea if the patient meets eligibility.

Richard A. Simmons, DPM  Rockledge, FL  RASDPM32955@gmail.com

RE: Request for Medical Records by Next of Kin (Tony Esposito, DPM)
From: Michael Brody, DPM

If a patient (or authorized party) requests an ELECTRONIC copy of the records, they must be provided within three business days for 50% of the requests. Failure to meet this threshold will result in not meeting the criteria for "Meaningful Use."

If the request did not specify electronic format, then the records should be processed in paper form, since it is not appropriate to assume that the patient has the ability to view electronic records.

Michael Brody, DPM, Commack, NY, mbrody@tldsystems.com

RE: Michael Faraldi Memorial Scholarship Fund Established (Bud Walker)
From: Brian Fanno, DPM

I was saddened when I read about the crash of a plane in the Hudson this weekend which took the life of Dr. Mike Faraldi (NYCPM,'01). My immediate response was to call Dr. Arthur Gudeon from NYCPM's Alumni Association to orchestrate a fund of sorts, which I read in PM News has already been arranged. Whether you knew Michael on a personal level, or begged him for OTQ's, he was a "hands down" nice guy. I encourage anyone and everyone in the class of 2001, and surrounding classes (that I'm sure he helped), to contribute whatever they can to the fund for his family. I know he would do the same.

Brian Fanno, DPM, Selden, NY, BEFoo7@aol.com

RE: Bakotic to Be Inducted into the PM Podiatry Hall of Fame
From: Paula Pitts, Shawna Shapero

We are elated to be affiliated with someone who works selflessly to enhance the podiatric community. His dedication to podiatric clinicians and the future of podiatric medicine is first and foremost on his mind. At this point in our careers and unexpectedly, Dr. Bakotic has inspired us and brought us to a new and ever-challenging  place that we only dreamed about. 

It is so gratifying to work with our clients and see the positive results of his efforts to elevate the profession. Not only has he changed the lives of countless podiatric physicians, he has also made a tremendous impact on our professional lives, and we are so very honored to represent Dr. Bakotic. From the bottom of our hearts, and on behalf of the Bako Sales Team, we congratulate Dr. Bakotic on this distinguished honor.

Bako Pathology Services employees Paula Pitts, National Sales Manager, and Shawna Shapero, Director of Marketing

RE: Dog Eats Diabetic Man's Three Toes 

A Roseburg, OR man is recovering after police say he woke up to find his dog had eaten a part of his foot.Officers say 61-year-old James Little was sleeping on his couch when his dog ate three of his toes and a portion of his right foot. They say Little has neuropathy due to being diabetic and recently had surgery on that foot, which left an open wound.

Police say it's a case unlike anything they've seen before. "After 25 years, I'm still shocked once in a while, and this was a little bit shocking," says Aaron Dunbar, Roseburg police. Little is in stable condition at Mercy Medical Center. The dog is under quarantine with animal control.

Source: Sharon Ko, WEKZ News [3/3/11]

ASSOCIATE POSITION - MARYLAND

IMMEDIATE Associate needed to join a multi-office podiatry practice in the Baltimore MD Region. Desired candidate should be surgically trained with Board Eligible/Certification. You must be hard-working, ethical, compassionate and confident in your abilities to deal with pathology, patients, staff and fellow physicians. Patient base is already established. Excellent income and growth potential for the right associate. Please forward a cover letter, resume, and surgical log (if a current resident) and availability to FootDocMaryland@Gmail.com

PART-TIME / FULL-TIME PODIATRIST NEEDED ASAP - CHICAGO

Part-time full-time podiatrist needed for our Indiana offices. Must have Indiana license. Must have completed two years of surgical residency. If qualified email to                             f-massuda@footexperts.com

ASSOCIATE OPPORTUNITY - FREDERICKSBURG, VA

Progressive, busy practice seeks personable, ethical, confident associate interested in future partnership. Lucrative opportunity for self-starter with strong work ethic. State-of-the-art office in rapidly growing community with two new hospitals and new surgery center. Practice has excellent reputation with well established referral base. Cover letter/CV to: fredfeet@verizon.net

ASSOCIATE POSITION - NE GEORGIA SUBURB

Immediate opening for PSR24/36, ABPS Qualified or Certified individual. Hosp/Amb. Surg. Ctn privileges available. Good chance of partnership or practice purchase in foreseeable future. Send resume/CV to gramps395@yahoo.com

ASSOCIATE POSITION - SOUTH/CENTRAL PENNSYLVANIA

PSR-24/36 trained individual for busy practice in family-friendly college town. Seeking personable, ethical, motivated individual to join our well established practice providing all aspects of podiatric care. Competitive salary and benefits package. Reply with letter and CV to Jagerone@aol.com

ASSOCIATE POSITION AVAILABLE - NY

Busy Midtown Manhattan state-of-the-art practice with 2 locations seeking part time/full time associate. Must be in-network Empire BC/BS. Looking for a personable doctor with immediate availability. Residents Need not apply. DrB@myfcny.com

ASSOCIATE POSITION - WEST CENTRAL FLORIDA

A great opportunity to join a very busy, well-established, diversified practice in Clearwater, FL. Seeking an associate who has the drive and desire to work hard, has strong work ethics, and is very personable. BC/BE and minimum PSR24 +. We offer competitive salary and benefits. Send resume to Jaye@fdn.com

TWO ASSOCIATE POSITIONS - WEST CENTRAL FLORIDA

One in general podiatry, second with surgical residency. Good diagnostician, compassionate, hard-working individuals needed for high-tech group practice. flpodiatrist@tampabay.rr.com

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION - DAYTON, OHIO

Join a well-established modern practice with an excellent reputation and referral base. Base salary $100,000 and benefits with a bonus structure. EMR, diagnostic ultrasound, all aspects of DME, Padnet vascular studies, and CO2 lasers. We seek a surgeon that is well trained, personable and motivated to join our group of 3 Podiatric Surgeons. Would like this individual to buy in the practice eventually. Please send resume to ohiodoctors@aol.com

ASSOCIATE POSITION/PARTNERSHIP - CHICAGO

Chicago Podiatric Surgeons, one of Chicago’s leading podiatric practices, is searching for a FT podiatric surgeon. Applicant must be a personable and confident surgeon with ability to manage surgical patients independently and be at least board qualified. High compensation. Will be working in new 7000 sf state of the art office in AN upscale Chicago neighborhood. Ownership/partnership opportunities. Send letter of intent and CV to drcarr@chicagopodiaty.com

PART-TIME/FULL-TIME PODIATRIST NEEDED - INDIANA

Part-time podiatrist needed for 2 offices in Chicago with an average of 20 hours/week. Must have Illinois license. Must have completed 2 years of surgical residency. If qualified, email to:     A-Storjohann@footexperts.com

EQUIPMENT FOR SALE

Hausted 825 GMCOO Unicare III stretcher. Approximately 7 yrs old, but rarely used. Great condition. Excellent condition, no rips or tears. $250 PDM J120B Podiatry chair-Used. Navy blue upholstery with some wear. Has Lift, Tilt and Back functions. Foot pedal. Screen and doctor’s stool included. $1,750. Photos on request. 410-768-5800 jferris@chesapeakefootandankle.com

FELLOWSHIP OPPORTUNITY
 
Applications are being accepted for the Central Kentucky Diabetes Management Fellowship. Dr. Jonathan Moore, former UTHSC Diabetes Fellow, OCPM adjunct faculty, AAPPM board member and national lecturer and author on diabetes and practice management related topics is director and founder. Don't miss out on the most unique, dynamic fellowship in Podiatric medicine. Learn latest advances in Diabetes management/surgery along with knowledge to run and grow a successful practice. Generous stipend, full benefits and free housing in resort setting. Email CV and letter of interest to: jmoore@aappm.org  Visit our website

PRACTICE FOR SALE - MARYLAND, DC SUBURBS

Great opportunity. Well established and equipped practice for sale. Office includes state licensed Ambulatory Surgical Center. Present owner is retiring but will stay on as needed for smooth transition. Average gross over past 3 years is $575 K. dpmpracticeforsale@yahoo.com

PRACTICE FOR SALE - BOSTON SUBURB

A 12+ year practice, including all equipment is for immediate sale. Average gross is $100K while being open only one day weekly. The ability for increased growth potential is obviously excellent with increased hours. Doctor is looking for serious offers only. Reply to shop@thefootdoctor.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. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

PM News Classified Ads Reach over 12,500 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $109 for a 50-word ad THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

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