The Voice of Podiatrists

Serving Over 10,700 Podiatrists Daily

March 11, 2008 #3,190 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2008- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Armstrong, Frankfort to Be Inducted into Podiatric Hall of Fame

David Armstrong, DPM, PhD and Faye Frankfort have been elected to receive the 2008 PM Lifetime Achievement Awards and will be inducted into the PM Podiatry Hall of Fame. The awards ceremony will take place at a special luncheon on July 25, 2008 as part of the APMA Scientific Meeting in Hawaii. All profits from this fundraising event go to the APMA Educational Foundation’s Student Endowment Fund.

Dr. David G. Armstrong

Dr. Armstrong, the 25th podiatrist to receive this honor is the Director of Scholl’s Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University of Medicine and Science in North Chicago, IL.

Faye Frankfort

Faye Frankfort, the 2nd non-podiatrist to inducted into the Podiatry Hall of Fame, is APMA’s Director of Legislative Advocacy.

Biographies of both honorees can be found in the March Issue of Podiatry Management. A list of the members of the PM Podiatry Hall of Fame and those receiving Honorable Mention appears at: http://www.podiatrym.com/pmarticle.cfm?id=115

Tickets for the Hall of Fame Luncheon can be ordered through the APMA Scientific Meeting Registration Form or by contacting APMA at (800) ASK-APMA. This year’s luncheon is sponsored by: Merck & Co., Nexa, a Tornier Company, Ossur, SANUWAVE,Inc., Spenco Medical Corp. and Vasyli, Inc.

AAPPM Inducts Officers and Trustees

During the American Academy of Podiatric Practice Management's Midwinter Seminar the follow Officers and Trustees were inducted:

Dr. Frederick (L) receives gavel from Dr. McCann

Dr. Hal Ornstein, Chairman
Dr. Bill McCann, Past-Pres
Dr. Jeff Frederick, President
Dr. Charley Greiner, Vice-Pres
Dr. Harvey Lederman, Treasurer
Dr. Ben Weaver, Secretary
Trustee: Dr. Jonathan Moore, Dr. Craig Conti, Dr. Marybeth Crane, Dr. Jon Purdy

Dr. Harvey Lederman, received the AAPPM President’s Award for recognition of his outstanding leadership in podiatric medicine.

40% of My Patients With Foot Pain Receive Orthotics: GA Podiatrist

John Jacobs was diagnosed with a bone spur and plantar fasciitis - a strain in the band of tissues that helps support the arch in the foot. When stretching, icing and cortisone injections didn't relieve the pain, podiatrist Perry Julien recommended orthotics. "What I'm going to be doing is applying the plaster to the foot and placing your foot in the neutral corrective position."

Dr. Perry Julien

The plaster mold is then sent to a lab to be made into a shoe insert. A custom orthotic is a mold designed to place the foot in a more mechanically correct position and in doing so, help relieve pain. Dr. Julien claims that 40% of his patients with foot pain are fitted with orthotics.

Source: Kellene Stockwell, KTVN Reno[3/8/08]

Query: NaOH Matrixectomy Protocol

Would anyone please provide their protocol for NaOH matrixectomies, i.e., how long is the NaOH applied, post-op care, length of time to heal, success rates, etc.?

Christopher A. Pensiero, DPM, Bellevue, OH

Query: ABPS Qualifying Examination

I am looking for study recommendations for the ABPS qualification examinations in foot surgery, and rearfoot/ankle surgery. I have been using the Boards by the Numbers computer program and, of course, McGlamry's surgical text, however I was wondering if anybody could recommend any additional helpful review materials.

Jeremy M. Mason, DPM, Tulsa, OK

RE: Amerigel S/P NaOH Matrixectomies (Greg Caringi, DPM)
From: Multiple Respondents

We have used Amerigel for about 2 years now and still cannot believe the difference it makes in the healing process. It cuts the healing time in half. We now use the Amerigel kits and 95 % of our nail patients purchase it without batting an eye. We sell it for $35.00. We even have patients drop in to buy Amerigel to keep on hand for cuts, scrapes and burns. We highly recommend it.

Neil A Burrell, DPM, nburrell@gt.rr.com

We have been using Amerigel for NaOH matrixectomies for several years. This has helped significantly reduce healing time, pain and infection rate. Our patients are receptive to purchasing the wound care kit because we present this as part of our protocols and emphasize that with use of the Amerigel they only have to apply once a day and soaking is not necessary. If they ask if there is a less expensive alternative we simply say “Yes there are other options but our experience has been that with all the other options it takes longer to heal with a higher chance of complications.” This typically quickly closes tthe door in considering other options.

If you send you business card to Amerigel, they will merge this onto a post-op matrixectomy instruction sheet and provide you with customized post-op instructions sheets at no charge. As a side note, it is great to support a company who does so much to support our profession.

Hal Ornstein , DPM, Howell , NJ, hornstein@aappm.org

I have recently switched to the Amerigel post-operative kit for post-operative care of matrixectomies. I believe this option works just as well as soaking for post-operative results. There have been no patient complaints and many patients have stated they like the convenience of not having to make an extra trip to the pharmacy. We charge $30 for the kit and make just under $10 profit. This greatly improves my bottom line at the end of the year. My staff does have to track sales tax in the state of Minnesota. If the patient refuses to pay for the kit, then I write a prescription for a tube of Amerigel.

Michael B. DeBrule, DPM, Marshall, MN, drdebrule@starpoint.net

RE: Staff Bonuses (Joey Resnick)
From: Steven H. Goldstein, DPM

This can present as a difficult situation to come up with the right formula. When presenting employees with a bonus that is structured based on the office generating a certain amount of revenue and that is not achieved, does that mean no bonuses are given? If so this can lead to an unhappy employee.

I feel that EACH employee should be judged independent of one another. Those that meet or beat your expectations should get a higher percentage of bonus than someone who does their job but shows no extra effort. If you allocate a certain amount for bonuses to all, then figure out by percentage from that total allocation who deserves the biggest piece of the pie. In addition to bonuses I took the staff out to lunch once per week, just to keep moral high.

Steven H. Goldstein, DPM, Royal Palm Beach, FL, stevefootdr1@cs.com

RE: Tighter Standards For DME Suppliers
From: Paul Kesselman, DPM

If anyone has any doubt why CMS wants tighter standards for DME suppliers, one should read two studies conducted by the Office of Inspector General on suppliers in the L.A. area. These studies reveal a shocking number of suppliers who were either totally non- operational with no inventory or there were other businesses operating at these locations.

Physician suppliers certainly do not appear to be the target of this investigation. Unfortunately, because we are also suppliers we are affected by the conclusion of the investigation, which is tighter standards and with it accreditation.

Every physician supplier should be beating down the doors of their congressional delegation demanding that physician suppliers be treated differently than the untrained, non-credentialed non professional supplier. The studies may be found at: http://www.oig.hhs.gov/publications/docs/press/2008/la_dme022508.pdf and http://intranet/oiginternet/oei/reports/oei-09-07-00550.pdf

Paul Kesselman DPM, Woodside, NY, pkesselman@pol.net

RE: Podiatric Assistants Performing Routine Foot Care (Michael Forman, DPM)
From: Allen Mark Jacobs DPM, Simon Young

Marvin Levin, MD ("The Diabetic Foot") started the training of nurses to care for feet some years ago at Washington University in St. Louis. The result is a foot clinic, including a diabetic foot clinic at Washington University at which site patients are evaluated and cared for by "nurse podiatrists." That is exactly what they are identified as by Washington University School of Medicine and Barnes Hospital, institutions where podiatry as a profession has been and remains totally excluded.

The fact is that these nurse podiatrists function without any direct supervision while Washington University charges Medicare for the services provided by them. Needless to say our spineless local and Missouri state societies have never sought to remedy this problem. St. Louis University maintains a "foot room" where one of the nurse trainees functions and provides foot evaluation and care without direct supervision.

The reality is that the evaluation and care of patients with significant disorders and at-risk feet occurs with these "assistants", not just toenail and callus or skin care. This hardly represents quality proactive preventive care for the patient; unless you believe that a nurse or other individual briefly trained can assess a patient as you can.

This weekend, at the American Professional Wound Care Association annual meeting, no lesser light than Dr. Andrew Boulton attributed part of the continuing high amputation rates in other countries to a lack of podiatrists in those countries. I believe that we already dropped the biomechanical/orthotic ball with pedorthotists. Let's not drop another one.

Allen Mark Jacobs DPM, St. Louis, MO, allenthepod@sbcglobal.net

I am sick and tired of minimizing our profession by hospital-based and salaried practitioners. Ideally, HMO's should disappear and I will win Mega Millions. This position is voiced by the few who are hospital salaried employees, but not for average DPM. Nevertheless you still treat these patients. ENT 's clear ear wax, we can provide a beneficial service for select high-risk patient.

Simon Young DPM, NYC, NY, simonyoung@juno.com

RE: Are Those Orthotics Really Custom-Made? (Jeff Root)
From: Multiple Respondnets

What some practitioners don't realize is that they won't be able to get away with substituting pre-fabs for the real things.. Not only do I give patients letters stating that their DC's or PT's device was only an OTC device, and the insurance company was being mis-billed, but I will, by necessity, have to tell them the truth if a colleague did the same. I hate to do this, but what choice am I being given?

Robert Steinberg, DPM, Schaumburg, IL, doc@footsportsdoc.com

In my experience, most graduating residents have very little interest in biomechanics nor an understanding of it. Residents in clinics generally do nothing to discuss or evaluate gait with their attendings. We must understand that most of our surgical procedures have a biomechanical etiology and therefore, post-operatively, biomechanics still needs to be addressed.

We need to understand orthotics have a real benefit in certain conditions such as: PTTD, Pl. fascits/heel pains, tendonitis and some forefoot deformities. They don't really work well, in my experiences, with hyperkeratotic forefoot lesions. We need to understand orthotics are only as good as the hand that makes them. Biomechanical understanding, proper casting, and gait evaluation are all components necessary to fabricate a good device.

Biomechanics distinguishes DPM's from all other medical practitioners and gives us a distinct edge in properly diagnosing and treating pedal deformities, either surgically or conservatively. Proper evaluations during office evaluation and "routine foot care" can expose these biomechanical addreessable faults. Proper evaluations during office evaluation and "routine foot care" can help at-risk patients avoid dangerous pedal problems from forming or progressing.

Simon Young, DPM, NYC, simonyoung@juno.com

Editor’s Note: An extended-length note by Dr. Gurnick appears at: http://www.podiatrym.com/letters2.cfm?id=18368&start=1

COLORADO PRACTICE OPPORTUNITY

inquiry@axint.net This is an auto response. Thank you.

FULL-TIME ASSOCIATE WANTED - CHATTANOOGA,TN

Well established, well-respected surgical/medical practice seeking full time associate. Send CV/ inquiries to: chattfootdoc@yahoo.com

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 - 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

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

WEEKLY SPECIAL - One week of ads (5x) for only $85

PM Classified Ads Reach over 10,800 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 10,800 DPM's. Write 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 Ext 110.

• 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.