The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

March 09, 2010 #3,799 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2010- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Foot Care is a Vital Part of Overall Health: MA Podiatrist

“Taking care of your feet is an important part of taking care of your overall health,” says podiatrist Walter Wolf. “The earlier one comes in with pain, the more treatable they usually are,” says Wolf.

Dr. Walter Wolf

“Any episode of pain or loss of sensation should be brought to your doctor’s attention,” says Wolf. In terms of overall health, it’s also necessary to get regular exercise, says Wolf. “Making the right shoe choices is also important”, says Wolf.

Source: Elizabeth Corridan, ABC 40/Fox-TV (Springfield) [3/4/10]

Scholl Students Volunteer at Free Clinic

Free health screenings, hot meals and haircuts attracted more than 1,000 people to the seventh annual Kenosha Touched Twice Free Clinic on Saturday. Sponsored by a partnership of area churches, the five-hour clinic included the distribution of 300 pairs of new shoes.

Dr. Jeremy Fleischmann

A group of students from the Dr. William Scholl College of Podiatric Medicine in North Chicago, IL., provided foot inspections under the supervision of podiatrist Dr. Jeremy Fleischmann.

Source: Bill Robbins, Kenosha News [3/7/10]

FL Podiatrist Says Yoga Benefit is Becoming Aware of Muscle Tightness

Problematic foot mechanics, which create imbalances in muscle strength and flexibility, can affect the alignment of the entire body, Tampa podiatrist Jerry Cosentino says. They also can be the source of many common foot ailments, such as plantar fasciitis and Achilles tendonitis. For example, tight calf muscles are correlated with the heel pain that comes with plantar fasciitis, Cosentino says.

Dr. Jerry Cosentino

Even "runner's knee" has its roots in overpronation of the foot, which causes the lower leg to rotate inward and put more force than necessary on the kneecap. "There's nothing in the gym that exercises your feet in all directions and develops muscle tone," Cosentino says. "I think that's one great benefit about yoga - becoming aware of the tightness in a particular area."  Cosentino instructs some of his patients to stretch their feet in all directions with a Theraband - a rubber band-like piece of equipment that offers resistance.

Source: Daniela Velázquez , TBO.com [3/5/10]

Meaningful Use Will Slow Docs Down: MGMA Survey

Meeting the 25 meaningful-use criteria required to receive the financial incentives contained in the federal stimulus law will result in reduced physician productivity, according to 67.9% of those who responded to a Medical Group Management Association member survey released March 4.

With one being “very easy” and five being “very difficult,” the survey also asked on a one-to-five scale how easy or difficult certain proposed requirements would be to fulfill. According to the 353 respondents (out of 445) who answered the question, the most difficult requirement would be using a certified electronic health record to provide at least 10% of all patients with electronic access to their health information within 96 hours of the information being available. That requirement received a 3.72 difficulty rating with only 14 respondents saying meeting the requirement would be very easy, 90 saying it would be difficult and 99 saying it would be very difficult.

Source: Andis Robeznieks, Health IT Strategist [3/5/10]

Query: Post-op Numbness, Status Post EPF

My patient is a 30 year old female who was treated for four months conservatively for plantar fasciitis. She chose to have an EPF. She did very well for two to three weeks post-op, when she suddenly developed some "numbness" in the distribution of the lateral plantar nerve. This has become more symptomatic as time goes on. An MRI reveals no injury or sign of injury to any specific nerve, especially the lateral plantar nerve. EMG studies show some denervation of the lateral plantar nerve distribution.

I have tried two steroid injections into the porta pedis area without success.  So far, she does well during therapy, but has no prolonged positive results. The fasciitis problem is gone, but I am at a loss now as to what to suggest. I would sure appreciate any advice or suggestions that anyone might have. 

Neal Kramer, DPM, Bethlehem, PA

RE: Defeat of Podiatry in NJ Diagnostic Ultrasound Case
From: Henry Slomowitz, DPM

New Jersey Blue Cross Blue Shield had wanted to stop paying for ankle x-rays and diagnosis or treatment using diagnostic ultrasound. As a result of a legal battle, BCBS conceded to paying podiatrists for ankle x-rays, but did not allow use of ultrasound. This was a major victory for the insurance company and a tragic loss for podiatry. X-rays of the ankle essentially give us the ability to diagnose pathology of three bones. Think about the percentage of time useful information is seen from all the ankle x-rays you take. Now, remove from the mix ankle fractures. The percentage of time that useful information is seen is almost non-existent.

Ultrasound of the foot and ankle can visualize  tendons, soft tissue masses, ligaments, quality of range of motion of joints, subluxation of tendons, nerves, arteries, veins, joint spaces, foreign bodies,  enthesiopathies, location of inflammatory conditions, and guiding injections directly in the area, ankle synovitis, stress fractures before x-rays can see them, plantar lesser MPJs to differentiate between capsulitis, plantar plate tears, and FDL tendinosis, subcutaneous edema, extent of gouty swelling, as well as metatarsal cuneiform joint pathologies, such as third metatarsal cuneiform joint effusions.

The future of diagnostic ultrasound is fascinating. There is work currently being done in areas of elastography which will help differentiate between a malignant and non-malignant subcutaneous mass. There are even specialists with very high resolution machines, differentiating skin lesions as to whether they are cancerous or benign. Don’t we in podiatry want to be part of this evolution of medicine? We should all be mourning this restriction, not celebrating that we can still take ankle x-rays.

Henry Slomowitz, DPM, Paterson, NJ, minggao@optonline.net

RE: The Future of DME in Podiatry (Narmo L. Ortiz, Jr., DPM)
From: Paul Kesselman DPM

Cigna is not the only non-Medicare carrier centralizing their DME services or to reduce reimbursement and restrict DME coverage. This is an attempt to reduce the exponential growth in DME claims seen by all carriers. Measures to reduce this growth have already been taken within Medicare (competitive bidding) and are now being mirrored by the private insurance carriers.

Large expenditures for DME usually not attributed to DPM’s are the primary focus of investigations by...

Editor's Note: Dr. Kesselman's extended-length letter can be read here.

RE: Concerns from a Podiatric Physician (Joseph S. Borreggine, DPM)
From: Michael Cohn, DPM, Joseph S. Borreggine, DPM

My approach to Dr. Borreggine’s problem would be different than in the prior postings that have all been made with the finest of intentions. Rather than a detailed statistical analysis of his current condition, or clamoring for a change to the MD degree, what this fine doctor needs to do now is the following:

1. Close his satellite office that is only a 30 mile drive from his main office. It is only drawing the patients who would come to the main office anyway. Rural patients are willing to drive that distance to see a doctor, so he will keep most of those patients and change his investment to a more profitable location.
2. Find a community farther away, and I find 50 or 60 miles to be ideal, that needs podiatric care and has a stable community with steady sources of income, like retired seniors or government employees, who will not lose their coverage. Move your equipment to that town, and start going at least once a week.
3. Find some nursing home work. The patients are there, but you have to leave your comfort zone to go get them.
 
I hope these are practical ideas that can be done now and don't cost you much, if anything. They should change the equation to profitable in the near future. 
 
Michael Cohn, DPM, Albuquerque, NM, michael_cohn@msn.com

I would like to thank all of my podiatric colleagues and PM News for taking an interest in my concerns. I was not expecting the overwhelming response that I have received so far. It surprised me that there were as many in our profession who shared the same concerns. I am glad that we could have this discussion. It is important to have these types of open and honest dialogues because it helps all of those who are involved. I have  learned much through this process.

I have also enjoyed the candid and heartfelt pearls of advice, wisdom, and opinions from all respondents, and will take them all under consideration. Some, I have already started to implement. I have also started to investigate other opportunities that may be available to rectify my situation. With the pending and sweeping healthcare reforms, all of us need to consider how these matter will affect our future and our ability to make a living.

I do not plan on leaving podiatric medicine any time in the future. This is the profession that I chose to enter over 25 years ago, and I will continue to pursue it and try to excel in it. I appreciate the support and fellowship that has been brought about through this discussion. I look forward to all of your continued suggestions and ideas not only to help me, but also to aid those who are as concerned as I am about the future of the podiatric medical profession.

Joseph S. Borreggine, DPM, President, Illinois Podiatric Medical Association
footfixr@consolidated.net

RE: Laser Holds Hope for Treating Onychomycosis: TX Podiatrist
From: Lowell Scott Weil, Sr., DPM

The interest in laser treatment for onychomycosis has escalated  due to the public outcry for a "cure." Although laser "ablation for cure" of the mycosis has been reported, there have been NO evidenced-based studies to prove that lasers are effective. To that end, the Weil Foot & Ankle Institute has received a grant to perform a randomized, double-blind, placebo-controlled study to evaluate the hypothesis that "laser treatment of culture positive, mycotic toenails is safe and more effective than a placebo treatment."
 
Let me say that I am a skeptic, but the chips will fall where they may. We should have some early results within six months, and will report them in PM News.
 
Lowell Scott Weil, Sr., DPM, Des Plaines, IL, weil4feet@aol.com

RE: Kudos to International Podiatric Ambassadors
From: Leonard A. Levy, DPM, MPH

I applaud the efforts of Dr. Sebastien Demoiny, a fourth year podiatric surgery resident from Temple University who volunteered in Haiti and to Drs. David G Armstrong and David G. Mulder from the University of Arizona and the University of California at San Diego, who were keynote lecturers in Saudi Arabia. More such involvement should be emulated. As the world continues to shrink, podiatric medicine, like other medical disciplines, must become more evident in the international community.

Leonard A. Levy, DPM, MPH, Slovakia, levyleon@nova.edu

RE: $1,475,000 Settlement for MD's Failure to Diagnose Charcot Foot
From: Douglas J. Pacaccio, DPM

I would really like to know more about this case because it severely concerns me that a jury awarded a man, “2.27 million” dollars in damages. How was this number reached? How much does his lawyer get?  I’d love to think that all that money will go to support his family because he was gainfully employed and can no longer work because of his disability. But, we all have patients with diabetes who have their Charcot disease diagnosed correctly and still end up with ulcers, deformity, and who face amputation. Is this opening the door for any patient with Charcot disease to sue the second they get an ulcer and...

Editor's note: Dr. Pacaccio's extended-length letter can be read here.

RE: The Passing of Robert Piccora, DPM
From: Jerry Ciccarello, DPM, Christine Gregorat

It is with sincere sympathy that I extend my condolences to Myrna and family on the passing of a truly good person and fine doctor. I had the pleasure of meeting Bobby while he was still a student at NYCPM. I had just graduated from college and had no idea of what I was going to pursue as a career. Pic had the answer and before you could blink an eye, he had me visit the school with him and showed me around the facility. Six months later, I found myself enrolled at NYCPM. Every year, at the clinical conference, I would always track down Bobby and remind him that he was the one to “blame” for my career choice. He will be truly missed. Thanks Bobby.
 
Jerry Ciccarello, DPM, Wantagh, NY

I was a patient of Dr. Piccora since I was 18 yrs old. I am now 44. He became a friend of the family. When I moved from the Bronx to LI, I traveled to see him every 3 mos to take care of my ingrown nails. I was afraid of surgery, but he always tried to get me to have it done, but I told him then that I wouldn’t have the pleasure of seeing him every 3 mos. He did one side of my big toe, and I almost passed out. We had many, many great laughs and were like family. I am so, so sad about his passing. He was a great doc, a wonderful, funny, kind gentle man. I will miss him terribly. 

Christine Gregorat 

PRACTICE FOR SALE - FLORIDA CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

PRACTICE FOR SALE – CONNECTICUT

Outstanding practice for sale in northern Fairfield county, CT. Shared space with other medical professionals. Very low overhead. Grossing almost $300K on 30 hours per week. Referrals from three different primary care physician offices. If interested e-mail CTPodiatry@gmail.com

FULL-TIME PODIATRY OPPORTUNITY -  BOSTON, MA

HealthDrive is seeking a caring podiatrist to join our group practice. We currently have a FT non-surgical opportunity available in the Boston, MA area. We offer a competitive salary, Paid malpractice Insurance, health and dental Insurance, long & short term disability, flexible schedule (No weekends), established patient base, equipment, supplies and complete office support provided. If interested in this opportunity, please call Maria Kelleher (toll free) at 877-724-4410 or email caring@healthdrive.com
  
OFFICE SPACE TO SHARE - NYC

Wanted- Licensed podiatrist to share space in a State-Of-The-Art medical office in the midtown area. Please call Dr. Robert Singer (212) 921-5775 or e-mail dr.roberth.singer62@netzero.net

ASSOCIATE POSITION - TAMPA BAY

Associate needed for a dynamic multi-doctor practice in the Tampa Bay area. Preference given to a PSR 24+ training and must have a Florida license. Well-established practice, high-tech with EMR and digital x-rays, with specialties in sports medicine, surgery and wound care. No nursing homes or HMOs. Excellent hospital privileges available. Choose an area of practice concentration that you are passionate about and enjoy a lifestyle for yourself and your family second to none. Kindly forward C.V. to e-mail drcosentino@tampabay.rr.com

ASSOCIATE POSITION - DAYTONA BEACH, FLORIDA

Associate position with buy-in potential. Daytona Beach, Florida Great opportunity for PSR 24-36.trained physician to join state-of-the-art practice. Please forward resume to pfk4@yahoo.com

ASSOCIATE POSITION-INLAND EMPIRE, SOUTHERN CALIFORNIA

Associate needed full or part-time for multi office practice. Must be ABPS BC/BQ. Hard working, ethical individual who is looking to a possible partnership opportunity. Looking for current licensed or resident completing program this spring. Email CV to bkatzman2@earthlink.net or call Martha 909 984-5614.

ASSOCIATE POSITION - TEXAS

Dynamic, growing practice in Dallas/Fort Worth area, seeking surgically trained, Board Certified/Board Qualified Podiatrist. Excellent salary and benefits compensation package, for the right candidate, with partnership/buyout opportunity. Contact/Send resume to: jmh6122@yahoo.com

PRACTICE FOR SALE: TENNESSEE

Established 30-year full-scope podiatry practice. Excellent hospital and surgery center privileges with investment opportunities. Fully equipped 2200 sq.ft. office across from hospital. High volume of new patients, DME, and local referral base. Great community for a family and the outdoorsman. Reply to tnfootdr@gmail.com

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes. Top hospitals. Fax CV with references to 703-491-9994

ASSOCIATE POSITION - MICHIGAN - (OAKLAND COUNTY)

outstanding opportunity for associate in well established practice, general & surgical podiatry forefoot, rearfoot & ankle (full or part-time). Well-trained, responsible, motivated with good communication skills, ABPS qualified or better. Send CV & letter of interest to: PodiatristWanted@AOL.COM

PRACTICE FOR SALE - UPPER WEST SIDE NY

Great starter practice or satellite office in NY. Looking for new podiatrist who needs to start on his/her own, enthusiastic and flexible hours. Serious inquires only. Office has been used as satellite office, but can easily be expanded to a primary office if your schedule permits. Call 201-491-2173

POST-GRADUATE PODIATRIC RESEARCH FELLOWSHIP

Boston University Medical Center and Boston University School of Medicine. This unique fellowship at a major teaching facility is a two-year opportunity, during which he/she would be expected to become a knowledge expert who will contribute significantly to research, teaching, and innovations in limb preservation and tissue repair. Requirements: Completion of a two or three year surgical residency; Massachusetts license-eligible, ABPS Board Qualification-eligible. Candidate must possess a commitment to an academic career in podiatric medicine and surgery. Annual Salary: Year-1 $61,000, Year-2 $66,000. Submit a CV and letter of interest to: erin.springhetti@bmc.org

PM News Classified Ads Reach over 12,000 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 12,000 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.