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March 06, 2008 #3,186 Editor-Barry Block, DPM, JD

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We’ve just posted the March CME titled “"Developing a Comprehensive Diagnostic and Treatment Plan for Charcot Neuroarthropathy – Part 2" by Brent Bernstein, DPM and John Motko, RN.

You can Earn 30 CPME-Approved CME Contact Hours Online

No Need to Rush Babies Into Shoes: NY Podiatrist

When is your baby ready to wear real shoes? As soon as she's standing, but then only outside. She shouldn't wear shoes full-time until she's walking steadily. "Millions of years ago, we weren't taught to walk with shoes," says Jeffrey Falcone, a pediatric podiatrist and clinical assistant professor at the New York College of Podiatric Medicine.

Dr. Jeffrey Falcone

"Kids who are learning to walk need to feel as much with their feet as they do with their hands." says Falcone, so while your baby learns to stand on her own, barefoot is best for the house (socks can be slippery), and a shoe with a flexible sole (it should bend with gentle pressure) and a soft upper part is good for outings to the park. If your baby isn't anywhere near walking, you can still buy adorable footwear. Soft-soled slipper-style shoes like Pedipeds and Robeez are geared to newborns on up.

Source: Jennifer L. Smith, Parenting [March 08]

IPMA Debuts New TV Show “Feet Forward”

This week, the Illinois Podiatric Medical Association debuted its first-ever television show called ‘Feet Forward,’ on Chicago Cable Access Television (www.cantv.org) with IPMA members Ken Jacoby, DPM and Jondelle Jenkins, DPM. The monthly show’s format focuses on one foot health topic each segment with sufficient time to field questions from the audience. The first show, which was run as a test without promotion, resulted in seven calls from viewers about a wide range of foot health topics from orthotics to chronic heel pain.

Dr. Ken Jacoby

The next edition of ‘Feet Forward” is scheduled for March 26th at 8 pm and will be used to roll out the IPMA’s walking campaign to help combat obesity. “The IPMA PR Committee believes a show like Feet Forward is an excellent, and low-cost method to reach a surprisingly large audience,” said Ken Jacoby, DPM, of Elgin, IL. and IPMA PR Committee Chair. CAN-TV reaches 1 million households in the Chicago area.

Footprints More Informative Than Fingerprints: IN Podiatrist

"A footprint tells you more than a fingerprint," said Michael Nirenberg, podiatrist with Friendly Foot Care in Crown Point. "A criminal can wear gloves and hide his fingerprints, but it is rare that they can enter and leave a crime scene without using their feet." Nirenberg is one of few forensic podiatrists in the country. When he was studying to become a podiatrist, Nirenberg became interested in every which way of looking at feet, particularly regarding forensics and the role feet play in a crime scene.

Dr. Michael Nirenberg

While in college, Nirenberg wrote an award-winning paper on forensic podiatry and how this new specialty needed an organization. A few years after his paper was published, the American Society of Forensic Podiatry was formed, of which Nirenberg is among the board of directors. In addition to taking several courses in forensics medicine, Nirenberg has studied forensic analysis of footwear with Bill Bodziak -- one of the FBI's top footwear examiners.

Forensic podiatrists like Nirenberg are able to look at the foot, footwear or footprints and be able to link a suspect to a crime scene. With the help of X-ray records, they've also helped identify remains of deceased by their feet, particularly victims of airplane crashes, especially involving military personal. "Their feet survive because they are in boots -- and nothing else survives," Nirenberg said. "A person can be identified just by the foot in the boot." Nirenberg volunteers his services to law enforcement agencies and so far has been involved with one homicide and consulted on two others.

Source: Rob Earnshaw, Northwest Indiana and Illinois Times [3/3/08]

Query: Pain Sub 2nd & 3rd Mets 10 Years S/P

I have a 30 year old male who presented to me several months ago with a forefoot deformity. His main complaint is pain under the 2nd and 3rd MPJ's. He had previous foot surgery ten years ago by a general orthopedist. The following plain film shows the result of the previous surgery.

Pain Sub 2nd & 3rd Mets 10 Years S/P

His major complaint is not being able to walk without pain and play sports with his son. He wears an Aircast walking boot which offers a little relief when walking and working. He's tried various orthotics in the past, none of which have offered any relief. He now wants to proceed with surgical correction of the deformity. I've contemplated Weil osteotomies of the 2nd and 3rd met heads versus a pan metatarsal head resection with digital stabilization or a Wright lesser MPJ implant arthroplasty. How would others proceed?

Matthew Etheridge, DPM, Pensacola FL

Query: Repair of Ritter 8800 Treatment Tables

I have four circa 1982 Ritter 8800 treatment tables that for the most part have held up well for 26 years. I have one table that needs 3 new or rebuilt compressors. Does anyone have any experience with this or know of any service technicians who can work on these? Is the cost of repair likely to be more than a used replacement? Also, can these chairs be recovered at a reasonable cost?

Michael Saginaw, DPM, Dallas, TX

RE: Alleged Failure To Properly Perform Removal of Neuroma on Foot (NY)
From: Multiple Respondents

The jury award certainly seems excessive, however, I think one has to be very careful when making such strong responses to this. I have to believe there were many more facts that led to such a verdict. I don't know and I wasn't there -- and that's the point. I've given several depositions here and there, and my whole family basically are lawyers (except for me -- thank goodness!) and I CAN tell you, there are many factors that lead to large jury awards. I've actually asked my father and brother (both attorneys) about this case, just based on the info provided, and they both think there had to be more to this case than whether or not an MRI was necessary. In residency, I remember asking our radiologist about MRI and neuromas. He stated that a lot (however many that is) would not be visible on MRI, even when read by true musculoskeletal radiologists.

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

Whether the defendant’s treatment was negligent or not to the standard of care is difficult to say, but what was surprising to me was that the plaintiff’s expert witness needed to rely on an MRI for the exact size and placement of a neuroma (it should be readily visualized upon exposure if an open excision was made), and that the neurological injuries were caused by the original surgery. I am also surprised that the plaintiff required two additional surgeries in order to treat her problem that, apparently, it was still not resolved.

With the poor presentation of more facts, it is difficult to tell who was at fault, but it seems to me that this suit stemmed from a poor patient-physician relationship to begin with.

Narmo L. Ortiz, Jr., DPM, Cape Coral , FL, nlortizdpm@embarqmail.com

Editor's Note: Extended-length letters from Dr. Markinson and Jacobs appear at: www.podiatrym.com/letters2.cfm?id=18280&start=1

RE: Transfer Lesions S/P Bunionectomy (Scott Werter, DPM)
From: Adam Teichman, DPM

I would suggest a Morton’s extension for the short first ray with a metatarsal pad to accommodate for the sub metatarsal pain 2-4, use a full-length FFO. You can try strapping the patient with a temporary metatarsal pad as a trial to see if this will alleviate her symptoms as first line of treatment, or modify an OTC insert with the above as a trial. If this does fail a shortening osteotomy 2-4 is a good option for her symptoms.

Adam Teichman, DPM, Allentown, PA, drteichman@eastpennfoot.com

It is interesting to note that the posting regarding a short first metatarsal after a bunionectomy stated that the patient was extremely happy with her result. That the being the case, I wonder why she went to another podiatrist.

Although much of the history was left out of the original posting, and I am not aware of the specifics of the situation, my recommendation is, whenever possible, to refer the patient back to the original surgeon. Sometimes that is difficult, if the result is not good and the patient is unhappy. However, in this case, the patient is very happy with her result. I believe it is in both the patient and doctors (both the original surgeon and the second consulting podiatrist) best interest, to have the original surgeon treat this sequelae.

That being said, from a practical standpoint, to consider lengthening all of the other metatarsals because of the short first metatarsal, when her only current problem is metatarsalgia, and no other conservative care has been utilized us far, is extremely premature. I have found that these patients respond positively to a regular functional orthotic. At times, a first metatarsal extension can be helpful as well.

Brian Kashan, DPM, Baltimore, MD, drbkas@worldnet.att.net

RE: Podiatric Assistants Performing Routine Foot Care (Michael Forman, DPM)
From: Multiple Respondents

As one who has spent almost 35 years as a podiatric medical assistant and continuously trying to raise the educational bar for assistants nation-wide, I say to Dr. Forman - Yes, go for it and "thank you!" It's people like you who can make the difference, raise the long-ignored educational bar and get "podiatric medical assisting" on the map. My co-worker and I wrote a curriculum to initiate a course for pma's in NJ at a vo-tech/community school there several years back. We taught it for one year, but because of minimal funding and low student enrollment, it fizzled, like so many others. Those of us that entered this profession with a serious focus on making it our careers need the support of doctors with your mindset in order for it to become a viable medical career path. With proper training in place, it's about time that we legally assume duties that can help us grow as individuals, help to increase practice revenue and at the same time add to the professionalism of this profession. If I can help in any way, Doctor Forman, count me in!

Lynn Homisak, PRT, Renton, WA, lynn@soshms.com

My feeling is that it is a shame that some podiatrists are so unhappy being podiatrists, but, if we must delegate clinical duties to lay personnel, and we expect to be safe and sound with our decision to do so, then we must train these people properly. Therefore, they should be trained in a community college or in a podiatry college so that they are aware of the ramifications of cutting nails on patients with ASO and/or diabetes. Their instructors should be as dedicated to the outcome of the course, and their graduates as if they were their own children. Lest we forget, the ultimate responsibility is to our patients.

Jay W. Slepner, DPM, Margate City, NJ, jaymarcia@comcast.net

Editor's Note: An extended-length letter by Dr. Girling appears at:
http://www.podiatrym.com/letters2.cfm?id=18287&start=1

RE: A New Specialty?
From: Paul Kesselman, DPM

A family member recently sent me all his laboratory results and a list of his specialists for my records. One was listed as an endrochronologist (I assume he meant endocrinologist). I performed a word search on wordcentral.com and found nothing for the root “endro.” Of course we all know that “chrono” means time. So we have a new medical specialty, for a doctor who does nothing with your time. So how does this specialty bill? By time of course!

Paul Kesselman, DPM, Woodside, NY

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 POSITION MASSACHUSETTS-BOSTON NORTHERN SHORE AREA

Innovative Practice on Boston’s North shore seeking motivated associate to join high, energy doctor to assist in growing practice. Competitive compensation package and partnership after two years. consulting@providerresources.com

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 - NORTHWEST PENNSYLVANIA

Multi-specialty group is looking to add another Podiatric Surgeon or General Podiatrist to our well-established group. Office locations in northwestern Pennsylvania. Unlimited opportunities exist for the right Associate, wound care experience is a plus. Please forward your CV to adminsec@ips-mso.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

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