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March 07, 2008 #3,187 Editor-Barry Block, DPM, JD

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Scholl Student Honored at AMA's Student Research Symposium

Laura Shin, a second-year podiatric medical student received the third-place award for her paper "Mesenchymal Stem Cells in Wound Healing" in the American Medical Association Midwest Research Symposium in Omaha, Nebraska this past weekend. Laura was the only podiatric medical student at this regional symposium.

Laura Shin

"We are very proud of the impact that our students are having at research symposia both in the USA and throughout the world", noted Dr. Terence Albright, Dean of the Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science. He continued that this student interest in high-powered research is a relatively recent phenomenon. "Three years ago, we only had a handful of students interested in research at Scholl,” Dr. Albright said. “Now the applicants into the Center for Lower Extremity Ambulatory Research (CLEAR) program amounts to over 40 students of our first-year class."

CT Podiatrist Charged With Drug Procurement and Insurance Fraud

A podiatrist from Burlington faces multiple counts of illegal drug procurement and possession and insurance fraud for allegedly illegally filling prescriptions at a Simsbury pharmacy and then trying to pay for them using insurance, police said Wednesday. Dr. Robert Januska, 65, who police said is not licensed to prescribe drugs in Connecticut, turned himself in March 3 after police issued a warrant for his arrest, according to Sgt. Fred Sifodaskalakis, head of the detective division of the Simsbury police.

Januska is accused of making repeated visits to the CVS Pharmacy in Simsbury to have the prescriptions filled, the sergeant said. A pharmacist who suspected the transactions were fraudulent alerted drug control agents at the state Dept. of Consumer Protection in late January, Sifodaskalakis said. Those agents then notified Simsbury police, he said. Charges against Januska include 25 counts of obtaining or attempting to obtain controlled drugs by fraud or forgery, 17 counts of illegally possessing prescription narcotics, eight counts of illegally possessing a level four controlled drug, and 23 counts of insurance fraud.

Source: Loretta Waldman, The Hartford Courant [3/5/08]

Query: New Topical Anti-fungal AN2690

About one year ago, there were newspaper articles about AN2690, a promising topical anti-fungal which was in Phase 2 trials and heading for FDA approval. It appeared to be as effective as oral Lamisil for treating onychomycosis. Does anyone know what has become of this medication or the approval process?

Bruce Lebowitz, DPM Baltimore, MD

Query: Non-Compliant, Drunk Patient

I operated on a 65 year old patient with hallux limitus The procedure went as scheduled and the patient received post-op instructions, analgesics, anti-inflammatories, and antibiotics. She was given crutches with instructions as well as my cell phone and told to call if there are any problems. The next day my staff calls to check on her and schedule her next appointment. During the call, she seems to be a little out of it. She is a no-show, so she is called, but there is no answer. That evening, I get a call from an ER doctor from a hospital saying that she has severe infection in her surgery foot, and she has a blood alcohol level of 0.37, more than four times the legal limit.

She came in with her bandage off, with dehiscence in the surgical site, with her mutilated posterior splint in her hand, and without crutches. The ER doctor pulled a few sutures, cleaned it well, and put her on IV antibiotics, and hospitalized her until she became sober. The next day, her friend calls me yelling that I botched up her surgery. I had no idea this patient was like this. What do we do now?

Name Withheld

Editor’s comment: PM News does not provide legal advice. In cases like this, documentation is paramount. As long as your records reflect everything you did, it is doubtful that your patient would have any success in a lawsuit. Given the patient’s blood alcohol, most attorneys wouldn’t touch this case. Contacting your malpractice carrier and putting them on notice is your safest option.

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

I am familiar with some of the details of this case and it had nothing to do with a neuroma and failure to perform pre-op MRI. The summary of the case was very misleading. In fact, the original surgery was for a surgical excision of a plantarfibroma, which resulted in inadvertent damage to nerve tissue and two subsequent surgeries resulting in significant permanent injury to the patient.

Name Withheld By Request

First and foremost, the diagnosis of an inter metatarsal neuroma is a clinical diagnosis. Usually a history and a positive Mulder's sign is conclusive. Additional confirmation may be obtained with a block through the web space with local anesthesia. Imaging provides invaluable information, but for this diagnosis it is academic hubris. I have seen many so called "2nd space" neuromas diagnosed with ultrasound and false negatives with MRI. Remember the old science adage: Believe none of what you read and half of what you see.

Frederic C. Spector, DPM, Savannah, GA, spec18608@aol.com

I do not think that an MRI is standard of care for treatment of a patient with "classic" symptoms for a Third interspace neuroma. I personally have always been suspicious of neuromas in the other interspaces. Many of the patients I have seen who had complications from neuroma surgery done by someone else were frequently surgeries performed in the second interspace. I personally will not even start injection therapy for a second interspace neuroma without confirming it on ultrasound or MRI. In our office we have performed many hundreds of ultraounds for neuromas. I have found that a well-performed ultrasound is an excellent way to diagnose a neuroma, if you are good at it. There are times when I have followed up an ultrasound with an MRI and found little or no difference in the readings.

Although I cannot say that an ultrasound or MRI is currently the standard of care for neuromas of interspaces other than the third, I think it will become standard of care as more doctors are comfortable doing ultrasounds in their office. Too frequently a plantar plate tear of the 2nd MPJ is misdiagnosed as a neuroma. Frequently we will even perform an ultrasound even if we do not get paid for it, I thnk it helps me treat the patient better.

Ken Meisler, DPM, NY, NY, kennethmeislerdpm@aol.com

RE: Pain Sub 2nd & 3rd Mets (Matthew Etheridge, DPM)
From: Simon Young, DPM, Tip Sullivan, DPM

This is not an MPJ problem, but a tarso-metatarsal problem. I see evidence of a Lis Franc ligament tear. This is either an iatrogenic metatarsus adductus foot or a failed metatarsus adductus repair. Any metatarsal procedure will deal in a severe failure.

If you attempt anything, consider abductory base osteotmies or fusion of tarso-metatarsal joint 1-3 leaving base 4th and base 5th-cuboid flexible. Consider the mal united or non-union base 4th met, and repair Lis Franc ligament. Lis Franc injuries treated after 6 weeks have poor outcomes.

Simon Young, DPM, NY, NY, Simonyoung@juno.com

In a 30 y/o, I would not piecemeal this. I would not simply address current symptoms. I would strongly consider doing the best that I could to come up with the most “normal” foot possible realizing and relaying to the patient the old adage “you can’t make chicken salad out of chicken poop”. Making specific suggestions is not realistic given a simple AP XR. I would fully evaluate gait, STJ/MTJ complex, equinus as well as the sagittal plane deformity of the forefoot. Speaking simply from the AP XR I would address the met adductus component and consider using the bone from that to correct the nonunion. Fixation options that I would consider would be external fixation but I have found that I have to be real particular about patient choice (compliance) when using xfix techniques to avoid some of the common post op problems.

I believe that a simple Weil osteotomy approach would be addressing the symptom and with a young active guy I would address the deformity at the level of the deformity which in this case is at the level of the previous failed surgery or perhaps even more proximal. I would also respectfully suggest that if you have not done any of this “humpty dumpty” type of reconstruction then ask someone who has to help. With feet like this experience is the best teacher.

Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

RE: Repair of Ritter 8800 Treatment Tables (Michael Saginaw, DPM)
From: Stephen H. Zimmerman, DPM

I cannot provide you any local repair personnel, however, I have dealt with Mark Hayes, DPM on many occasions and he knows just about everything there is to know about equipment that DPM's use. I have bought chairs from him, and he has helped me with several repair issues, including obtaining parts. He can be reached at parkhaven@hotmail.com , he often has ads in some of our journals. As far as the recovering, a local upholstery shop (furniture or automotive) can do it. I recently had a Midmark (all the pads come off and I took them to the shop) recovered for $150, and it looks as good as new.

Stephen H. Zimmerman, DPM Memphis, TN, drzimmerman@poplarpodiatry.com

RE: Storing Records (Elliot Udell, DPM)
From: Joseph Menn, DPM

We have had a similar problem in our office. We have begun to "fix" it this way. We currently store the last 4 years (2005- 08) of active charts in our office. We hired a bonded storage company to store the other six (10 yrs in SC) years off-site. They handle medical and legal documents regularly, and really were not too expensive to hire. If an old patient from say six years ago makes a new appt. , we call for delivery of their chart from storage. If they happen to be coming in before the chart can get here (i.e., emergency) then our staff makes a color-coded temporary chart to merge with the old one when it arrives.

Next year we plan on scanning the 2005 charts instead of cold storing them. We'll then have the storage company destroy the 11 year old charts. They will then have five years in storage, we'll have one on disk and four in the office, (converting current charts to paperless is a whole other subject). The next year - four years in storage, two on disk, four in the office. This will gradually get us to 100% digital old chart storage with little fuss and less up-front cost (it's quite expensive to scan six years of charts at once!).

Joseph Menn, DPM, Myrtle Beach, SC, jmenn@coastalpodiatry.com

RE: Podiatric Assistants Performing Routine Foot Care (Michael Forman, DPM)
From: Daniel Mendoza, DPM

I would be cautious about pushing for schools to train Podiatric MAs. This sounds great to have a person to do all of your RFC, Maybe even ingrowns, warts, injections, etc., but don’t think that for one minute that that primary care physician won't just bypass the referral to podiatry and have his new "MA" now trained in podiatric care, do most of these treatments in house. I think I would rather do the training myself and hopefully retain the employee for myself.

Daniel Mendoza, DPM, Nashville, TN, mendozadpm@comcast.net

RE: Are Those Orthotics Really Custom-Made? (Susan Boren)
From: Susan L. Boren From: David J. Marko, President, DPM Orthotics

Editor’s note: This extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=18310&start=1

TEXAS - SEEKING ASSOCIATE TO FULL PARTNER

Busy multi-physician podiatric group with 2 locations seeking BQ/BC surgically trained doctor. Applicant should be well-trained in all aspects of surgical and conservative care. Seeking ethical, hard working and outgoing physician to join our 4-physician group. Excellent quality of life in suburban Houston, near NASA and the Gulf of Mexico. Email CV and cover letter to Dr. M. Rockett at Mrockettman@comcast.net

ASSOCIATE POSITION – SEATTLE, WA

Seattle area podiatric medical practice established and growing - needs associate. Great partnership potential for well-trained podiatric physician. Costco - Corporate Headquarters + Microsoft & Boeing. 386 597-5766

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 - EASTERN WASHINGTON

Magnificent natural scenery in unique area of Washington state. Seller owns condo with ASC built for podiatry practice. The layout was designed to provide maximum efficiency for patient, doctor, and staff. Located within sight of hospital and medical community. Over 25 years established podiatric medical practice with potential to grow beyond $400K gross. 386 597-5766

ASSOCIATE 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

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 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.

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

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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