The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

March 07, 2009 #3,487 Publisher-Barry Block, DPM, JD

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FL Podiatrist Discusses Dangers of Constant Wearing of High Heels

Medical experts say that constant high heel wear can cause serious problems for the wearer's feet. "Wearing high heels for a long period of time can cause your heel to adapt to the position of the shoe," said Dr. George M. Merritt, a podiatric surgeon from Tallahassee Podiatric Associates. "The constant wear can cause hammertoe, bunions, pinched nerves in the feet and can result in hard or soft corns." 

Dr. George M. Merritt

Merritt said the higher and pointier the heel, the more problems the shoes could cause for the foot. "Feet are in their most comfortable position when body weight is evenly distributed," he said. "When that weight is unevenly distributed, it allows one section of your foot to bear excess pressure." 

Another medical myth that some women believe is that a wider heel is better. This is not the case. A wider heel can create the perception that less weight and strain is being placed on the foot, so women wear them for long periods of time because they feel more comfortable and stable. "The fact is it's important to switch between flats and heels. If high heels are to be worn, it's really important that the shoes fit," Merritt said.

Source: Brittany Donald, The Famuan

TX Podiatrist Participates in Diabetic Foot Care Study

A physician on the medical staff at Methodist Dallas is part of an international study on the treatment of diabetic foot infections. Methodist is the only site chosen in Texas for this study, the first of its kind offered through the hospital. The continuing study involves multiple departments, including radiology, laboratory and microbiology.

Dr. Richard C. Galperin

“We are proud and excited to participate in this worthwhile and most beneficial study,” says Richard C. Galperin, DPM, who is conducting the research. Dr. Galperin is a podiatrist certified in wound care by the American Professional Wound Care Association. He has been an independently practicing physician with Methodist for 15 years.

This study which involves cellulitis is now in a Phase 3, multi-center, worldwide, double-blind, randomized study with about 180 sites in 37 countries. It will compare safety and effectiveness of two medications in the treatment of diabetic foot infections. About 781 patients will be enrolled, to participate for 3 to 7 weeks.

Source: Spirit [2/27/09]
 

Status Quo is Not an Option, Obama Says 

A White House official described President Barack Obama as being in “listening mode” as he convenes his second healthcare policy workshop, adding that the more than 100 lawmakers, interest groups and everyday citizens in attendance would help shape the Obama administration’s approach to the  healthcare system. Melody Barnes, director of the White House’s Domestic Policy Council, called the meeting “the first step towards getting healthcare reform done.”

In remarks made to open the event, Obama pledged not to let special-interest groups derail the process. “I want to be very clear at the outset that while everyone has a right to take part in this discussion, nobody has the right to take it over and dominate,” he said. “The status quo is the one option that is not on the table.” The president again tied reform efforts to broader work to turn around the ailing economy. He said that rising healthcare costs have pushed up the number of bankruptcies and foreclosures across the country.

Source: Matthew DoBias, Modern Healthcare [3/5/09]
 

How to Start a Difficult Conversation

Instead of waiting for the perfect time and setting to broach a sensitive topic, use a statement like the following to create the conditions that you need.

• “I have something I would like to discuss with you that I think will allow us to work together more effectively.”
• “I would like to talk about _____ with you, and first I would like your point of view.”
• “I need your help with what just happened. Do you have a few minutes to talk?”
• “I need your help with something. Can we talk about it now?”
• “I think we have different perceptions of _____. I would like to hear your thoughts on that.”
• “We should talk about _____. I think we may have different ideas about how to _____.”
• “I would like to see if we could reach a better understanding on _____. I want to hear your feelings about that and to share my perspective as well.”

Source: Adapted from “We Have to Talk: A Step-By-Step Checklist for Difficult Conversations via Communication Briefings.

Query: Coding for Tendon Transfer

How would you code for transfer of a single flexor tendon (e.g., flexor digitorum longus) into the fourth digit, plantar, left foot.

Sue Graff CPC, Munster, IN

Response: Usually a flexor tendon transfer is not done as the only procedure to correct a digital deformity. It is usually performed in conjunction with and as a part of a hammertoe correction, CPT 28285, which involves some type of phalangeal bone work (e.g., partial bone resection or fusion of the interphalangeal joint), and may involve a tenectomy, capsulotomy, digital tendon transfer, fixation, IPJ implant, etc.

If you actually only performed a digital flexor tendon transfer, you would bill the procedure as CPT 28899, unlisted foot or toe procedure. If you perform it with other component procedures to correct a hammertoe, you would bill CPT 28285.

Harry Goldsmith, DPM, Cerritos, CA

Codingline subscription information can be found at:
http://www.codingline.com/subscribe.htm

RE: Bunion Deformity with Severe Contracted Digital Deformities (Jim Giannakaros, DPM)
From: Multiple Respondents

Bunion Deformity with Severe Contracted Digital Deformities

There is no easy way to approach this case. The cosmetic result will never be ideal but pain relief and reduction of pressure points should be the ultimate goal. Metatarsal base osteotomies across the board would be what she really needs, but obviously, due to age and diabetes, not really indicated. I would perform an Austin/Keller and MT head resections 2-5. Fuse the toes as well. I have performed Lapidus fusions in patients similar to this, but it wasn't worth the headaches. The cosmetic results were not that much better.

Eugene A. Batelli, DPM, Clifton, NJ, ebatelli2001@yahoo.com

I had a similar problem with a diabetic patient who had a chronic non-healing ulcer sub 3 after a 4th ray resection. I elected to remove the metatarsal heads and do PIPJ fusion/arthroplasties.

Post-op x-rays (Cal Britton, DPM)

The toes were pinned for about 6 weeks. She is doing very well; she had a good functional and cosmetic result. 
 
Cal Britton, DPM, Little Rock, AR, foot.doctor@yahoo.com

My recommendation for this patient's foot (assuming good health, bone stock and vascularity) would be a fusion of the 1st MPJ, with arthroplasties and a pan metatarsal head resection with k-wires to all toes for splintage. If the patient was against this plan, then another option is to perform a base bunion procedure and address the 2nd and 3rd toes and metatarsals with arthroplasties, MPJ capsule releases, possible tendon transfers of the toes and shortening metatarsal osteotomies (which seems like a lot more work and risk to me). 

All of this may seem daunting to the patient, but how many 70 and 80 year olds do we see in practice with similar horrific feet who opted for non-surgical intervention but suffer from continuous pain and pre-ulcerative lesions. The fact that she is a diabetic makes the need for correction only more urgent.

E. Kim, DPM, Astoria, NY, eugenyc@yahoo.com

RE: PT Blocks for Ulcers? (Daniel Chaskin, DPM)
From: Michael M. Rosenblatt, DPM

Several writers have written about "local" symptomatic treatment of ulcers, non-healing wounds and other PAD issues, suggesting nitrogylcerine paste and peripheral nerve blocks, among others, in an effort to "improve" vascular dilitation and possibilities for healing. Unfortunately, there are no data to substantiate the effects, if any, of these modalities. While it might be possible to construct double-blind studies to test them, such options ignore a more available, proven choice.
 
There are new surgical treatments by vascular surgeons that have utilized microvascular surgical equipment, often for even small vessel disease. Rather than "wasting" valuable time and effort at local treatments that may be doomed to failure, it makes better sense to refer these patients for vascular surgery analysis.
 
These new vascular surgery techniques are often viable for significantly debilitated patients, and are a vast improvement over "previous" attempts at large vessel reconstruction and replacement. You are not doing PAD patients any good by delaying these referrals in favor of untested local techniques. 
 
Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

RE: Intra-op Use of Kenalog 40 (James Hetfield, DPM)
From: Michael Turlik, DPM

It is refreshing to read Dr. Hetfield’s post on PM news regarding the intra-operative use of Kenalog 40. Dr. Hetfield uses a rigorous study to answer a clinical question, in contrast to the majority of other posters on this subject who use unsystematic observations from anecdotal experiences to justify their point of view. One method is anchored in the past, the other is the future of the profession.

Michael Turlik, DPM, Cleveland, OH, mmturlik@aol.com

RE: What to do in the Face of the Projected Medicare Cuts?
From: Neal Frankel, DPM

It has just been reported that this year Congress has to vote on the proposed 21% cut in the Medicare rate. I don't know about you guys, but based on the rhetoric coming out of Obama's administration, I wouldn't count on us getting a reprieve this year. What this means is that all of your private payers basing your contracts on the percentage of current Medicare RVRBS values will also be cut by 21%. So what can we do?

My advice is to look at your private pay contracts and see when they expire. Most of you may have “evergreen” clauses which state that each year your contract renews at the same percentage, unless you re-negotiate your contracts. What you really need to do is see whether your contracts may be based on this or a previous year's Medicare rate and re-negotiate for a three-year contract. What this will do is lock you in to this year's rate. Even if Medicare drops 21%, your rates would not change on your fee-for-service contracts. In three years, when it is time to look at the contract again, the environment may change or be more favorable. My guess is even if Congress does not reduce the Medicare rate by 21%, I highly doubt the rate would increase based on the 4 trillion dollar deficit this "splendorous" package is causing.

Neal Frankel, DPM, Chicago, IL, drnrf@aol.com
 

ASSOCIATE POSITION- CALIFORNIA

Associate needed for coverage in the office, nursing homes and facilities in Orange County Southern California. Surgical as well as C&C. Will help to get on staff at St. Jude Medical Center. Please contact Dr. Lee for more information at (714) 333-5837 or by e-mail to chinuklee@yahoo.com

ASSOCIATE POSITIONS – CALIFORNIA

PRACTICE FOR SALE-SOUTHEAST MICHIGAN-BRIGHTON
 
Outstanding opportunity. Eleven year established. Excellent location in mid to high income growth area. Must sell due to illness. Turn-key, all equipment and furniture included. Beautiful 1,350 sf build-out. Great visibility and parking. Priced low to sell immediately. Call (248) 565-5266. Docpod@aol.com 

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

PRACTICE FOR SALE - CENTRAL FL

Practice sale, in beautiful, high quality of life, growing area; 2000 sf bldg. fully equipped/ designed for podiatry; excellent location, features & exposure; near hospital, wound and HBO center. Great opportunity for expansion; good insurance climate. 352-357-7499 / E-mail: windnwave@earthlink.net

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

SPORTS MEDICINE/ PODIATRY FELLOWSHIP

The Palo Alto Medical Foundation has a 12-month Fellowship beginning Aug 1, 2009 and ending July 31, 2010. APPLICANTS MUST BE ABLE TO OBTAIN A CALIFORNIA LICENSE.  Interviews will be at the American College of Foot & Ankle Surgeons Annual Meeting and Midwest Podiatry Conference. Candidates will be chosen by mid-April. 24-month surgical residency training is a pre-requisite .Send a letter of interest, CV and three letters of recommendation to: Amol Saxena, DPM, FACFAS, Fellowship Director, Dept. of Sports Medicine, PAMF, Clark Bldg. 795 El Camino Real, Palo Alto, CA 94301 Ph: 650/853-2927 Email: HeySax@AOL.com

OFFICE SPACE/ MRI RENTAL – NYC, LI   
 
Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, and Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

I’m looking for podiatrist who wants additional practice hours. Perfect for combining your own practice with an additional income. Must be on Aetna Insurance, Horizon Blue Shield, Medicare, and most commercial carriers. I am looking for someone who has a desire to learn how a very successful practice is run, so that I will be able to have time away from my practice. Payscale to be discussed. Could lead to partnership or sale. E-mail contact information, CV, and why you would be perfect for this opportunity. Contact foot.care@verizon.net

ASSOCIATE POSITIONS – MARYLAND

Are you motivated, personable and enjoy working with the elderly? We are offering full or part-time positions in Maryland. Our group, Podiatry Management Services, provides care to the elderly in Nursing Homes, Assisted Living, Senior Homes, Adult Daycare and other similar facilities. Please e-mail your c.v. to drhprosen@comcast.net, fax to 410-486-2049, call  Herbert Rosen 410-580-0255

PRACTICE FOR SALE or ASSOCIATE WANTED – SOUTHEAST OHIO 

Well-established, two-office practice in Southeast Ohio for sale. Seller currently works 3.5 days per week. Gross >$300K, Net ~$140K.  Excellent locations and growth potential. All equipment and furniture included. Seller is willing to help with transition, Ohio Licensure. Contact seller at bjadpm@hotmail.com for more information.

PRACTICE FOR SALE – ANDERSON, INDIANA

Well established office in Anderson Indiana for sale. Seller currently works 3 half-days per week and gross over $200K. Excellent locations and growth potential. Very podiatry-friendly community. All equipment and furniture included. Seller is willing to help with transition. Contact seller at mddpm@sbcglobal.net for more information.
 

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