The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

March 12, 2012 #4,407 Publisher-Barry Block, DPM, JD

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Tight Shoes Can Cause Burning, Tingling, or Numbness: FL Podiatrist

Have you ever taken off your heels after dancing the night away and been overcome with what can only be described as an inferno under your feet? If so, you can thank your shoes. “When you squeeze your toes into narrow high heels, you put pressure on the balls and sides of the feet, so the nerves between your toes get compressed, causing a burning, tingling, or numbness between the toes and in the ball of the foot,” says Amber M. Shane, DPM, FACFAS, a reconstructive foot and ankle surgeon in Orlando, FL.

Dr. Amber Shane

Shoes need to accommodate the foot so there’s room for toes to wiggle. The ideal heel height is less than two inches. However, since most women won’t go that low, a platform heel is a good compromise. This stacked heel makes full contact with the ground, which distributes pressure more evenly, says Dr. Shane.

Source: Jennifer Tzeses, Woman's Day

GPMA Elects New Officers

The Georgia Podiatric Medical Association (GPMA) has announced its new officers for 2012. 

Dr. Leonard LaRussa

President - Leonard LaRussa, DPM
Past President - Sarvepalli Jokhai, DPM
Treasurer - Richard Mistretta, DPM
Board of Directors At-Large - Howard Gale, DPM and Henry Taylor, DPM
Young member Representative to BOD - S. Patrick Dunn, DPM

FL Podiatrist Receives ACFAS DSC

Jerome S. Noll, DPM, FACFAS, is the 2012 recipient of the American College of Foot and Ankle Surgeons Distinguished Service Award. This award, presented annually by the American College of Foot and Ankle Surgeons Board of Directors, recognizes long-term, behind-the-scenes volunteerism to the profession and the College.

Dr. Jerome Noll

Noll was selected this year for his countless ongoing hours of research and preservation of the history of the College. He was recognized at a ceremony during the 2012 Annual Scientific Conference in San Antonio last week.

APMWA Announces 26th Annual Student Writing Competition

The American Podiatric Medical Writers Association has announced its 26th Annual Student Writing Competition.

• All papers MUST be non-technical in nature. Appropriate subjects include practice management, ethics, law, education, or any topic that would be suitable for a lay publication.
   
• There is no word limitation. Papers will be graded for content, style, grammar, neatness, and overall impact.
   
• First prize will be one thousand dollars ($1,000), sponsored by an APMA Educational Foundation endowment from Dr. and Mrs. Steven Berlin, and recognition in the APMA NEWS and the APMWA Newsletter. Honorable Mention Certificates may also be awarded.
   
• This competition is open to ANY enrolled podiatric student.
   
• Entries must be received by 4/15/12 via e-mail at bblock@podiatrym.com
   
• Entries become the property of APMWA, which may arrange publication of the entry.

March 2012 CME

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Advancements in Medicine and Patient Outcomes Highlighted at Foot and Ankle Conference

Foot and ankle surgeons from around the globe gathered last week to pave the way for advancing patient outcomes and medicine at the 70th Annual Scientific Conference of the American College of Foot and Ankle Surgeons in San Antonio, Texas. 

Dr. Glenn Weinraub welcomes a crowd of 1,250 DPMs at ACFAS Annual Meeting

Hot topics at the conference were "Advanced Treatments Help Hard-to-Heal Diabetic Foot Ulcers—and Improve Lives," "Ankle Replacement Rapidly on the Rise," and "Sprained Ankles Can Be Complicated — and Misdiagnosed."

Query: Changing Banks for Medicare Direct Deposit

Has anyone changed banks and had to complete a new Medicare form for direct deposit? How big a deal was it? Is it a two-week transition as they say or more like six months? Was it a big cash flow problem or was it simple? Would you do it again? 

Joe Borden, DPM, Reseda, CA

RE: Atypical Forefoot Pain (Gary Bjarnason, DPM)
From: Robert S. Schwartz, C Ped, Barry Mullen, DPM

The positive Mulder’s sign sounds like his shoe may be the culprit. Most neuroma symptoms are relieved with a longer/wider shoe. Often it is advisable to use a more rigid sole shoe to reduce MTPJ motion.
 
Robert S. Schwartz, CPed, NY, NY, rss@eneslow.com

Dr. Bjarnason's patient's pain is actually fairly typical for a neuroma, especially if proximal nerve entrapment has already been ruled out. The key in this case is isolating exactly where the nerve entrapment lies. Have the patient show, with ONE finger, where the most intense pain is experienced when he drives his truck. Have him be very specific.

In your physical assessment, also be very specific, palpating each intermetatarsal space to isolate the locale as accurately as possible since MRI is not 100% corroborative. I have a similar ongoing case. Check your trucker's footwear and his particular company's policy. Experiencing symptoms ONLY in his work environment signifies a combination of shoe style worn at work (many trucking companies require the use of steel-toe safety shoes) in conjunction with the repetitive microtrauma created from long drives and associated gas and brake pedal pressure.

Shoe modification sounds reasonable given the history. Continue to manage the neuroma as you would in any other locale, but ensure you are injecting the correct intermetatarsal space.
 
Barry Mullen, DPM, Hackettstown, NJ yazy630@aol.com

RE: Lapidus or Fusion (Philip Graham, DPM)
From: Marc Garfield, DPM

Dr. Graham did not mention the patient’s weight, activity demands, general health, or limitations. Some 67 year olds are very spry and active while others have had two bad knee replacements and sit and knit. 67 is a very transitional age. Bone mineralization is decreasing and the needs and abilities or self-sufficiency need to be carefully reviewed before casting this woman for 10 weeks.

Is she willing to undergo DVT prophylaxis during that time? Can she be non-weight-bearing for the recovery? Would a Keller help her enough to be worthwhile even if she still has a bunion when you are done? Most people in this age group are scarcely prepared for the type of recovery that you will subject her to. But, if this is painful for her and she is very active and willing to do what it takes to get the most anatomical and stabilizing correction possible, then the Lapidus would likely offer...

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

RE: Topical Antifungals with Colloidal Silver (David L. Kahan, DPM)
From: Robert Kornfeld, DPM

Regardless of the topical you choose to use (and colloidal silver happens to be a really potent anti-fungal, anti-bacterial, anti-viral compound), you are not going to have a reliable cure since the underlying mechanisms that caused the infection are not being addressed by topicals alone. The answers lie in the understanding of each patient's unique epigenetic construct. Once you understand the burdens that the patient's immune system is dealing with and you intervene on behalf of cause and effect, you will then have a protocol that can effect a long-term cure.
 
Robert Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com

RE: Depreciated Value of Equipment (Name Withheld)
From: Robert Wunderlich, DPM, George Jacobson, DPM

Depending on the age of the equipment, it may already be fully depreciated (from a tax standpoint). I suggest making a list of the equipment and the date(s) of purchase, and discuss this with your accountant to see if there would be any additional depreciation deduction(s) available when you assume ownership of the practice. Most office equipment is considered fully depreciated after 5 or 7 years.  Also, see the IRS free Publication 946, How to Depreciate Property at irs.ustreas.gov/pub/irs-pdf/p946.pdf
 
Robert Wunderlich, DPM, San Antonio, TX, rwunder@gmail.com

After I evaluated a practice, I sat down with my CPA and explained why the practice fit my purposes, and he explained any tax benefits or liabilities. I suggest that you do the same.
 
George Jacobson, DPM, Hollywood, FL, fl1sun@msn.com

RE: ICD-10 Preparation (Arthur Lukoff, DPM)
From: Dennis Shavelson, DPM

I agree with Dr. Lukoff that smaller providers will not and should not have to carry that kind of financial burden and put up with that type of payment delay. However, I disagree with his gloom and doom prediction that that will mean adios to personalized medicine. Practitioners who are not insurance-bound will thrive. Practitioners that do not let their treatments be dictated by insurance coverage will need guards at their doors.

Interventional DPMs who offer narrative, experiential diagnosis, and treatment that include prevention, performance enhancement, and quality of life upgrading of all medical professions will form the core of a new alternative to patient care I call “Patient-Based Medicine.” I have and will continue to prepare myself for that time. Any of you wish to join?

Dennis Shavelson, DPM, NY, NY, drsha@lifestylepodiatry.com

RE: ABPS Name Change (M. W. Aiken, DPM)
From: Michael M Cohen, DPM

I admire Dr. Aiken's pride in the podiatry profession as we all should. Those before us have worked tirelessly to ensure that our schools and residency programs produced physicians who provide top-notch foot and ankle care. In just a few decades, we have been elevated from storefront chiropody to a profession treating complex foot and ankle deformities. Dr. Aiken should rest assured, however, that the name change isn’t as much about ego as it is access.
 
Isn’t it a shame that our residents completing excellent programs which provide the skills necessary to perform foot and ankle surgery are unable to harness these skills in their home states and local hospitals? Insurance companies, including Medicare, continually question the competency of a podiatrist to perform these complex procedures, and if approved are reimbursed at an inferior level than their orthopedic counterparts. Some of this is due to the common misconception that podiatric surgery refers to the surgical removal of bunions, corns, and calluses.
 
We have morphed from the American College of “Foot” Surgeons to the American College of “Foot and Ankle” Surgeons and are proud to showcase our achievements in the Journal of “Foot and Ankle” Surgery. Take a look at the surgical textbooks we’re publishing. Isn’t it time to be proud of the fact that we are foot and ankle surgeons?
 
I am in favor of the name change and urge my colleagues to celebrate our achievements and consider doing the same.
 
Michael M Cohen, DPM, Miami, FL, Michael.Cohen1@va.gov

PRACTICE FOR SALE —BROOKLYN, NY

A large, busy practice is for sale in Brooklyn, NY. This practice has been in the same location for over 50 years. Average 150 pts/week, average gross 730K, most surgery is currently being referred out. Financing available. Please call 800-983-4194, or email contactus@podiatrypracticeconsultants.com 

PRACTICE FOR SALE - BALTIMORE, MARYLAND

Established 40+ year old well-rounded practice of both surgical and non-surgical care with special emphasis on sports medicine. Medicare and BS/private insurance base, no Medical assistance. Needs to transition to a confident well trained individual. Purchase can include building. Contact: podiatrypracticesale@gmail.com

EQUIPMENT FOR SALE - SWISS DOLORCLAST ESWT

Swiss DolorClast ESWT. Complete with Cart. Extra hand pieces. Excellent condition. Low hours. Asking $12k. Pictures available upon request. Contact Carol at 708-596-3757 or carol.performance@sbcglobal.net

SPACE AVAILABLE - NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview, Long Island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

POSITION AVAILABLE – CENTRAL WYOMING
 
Well established solo practitioner looking for an associate leading to partnership at a busy, modern practice in a great location. Friendly personality and good communication skills a must. Competitive salary and benefits. Please send letter of introduction and CV to: wyofootdoc@gmail.com

ASSOCIATE POSITION - NEW YORK

WORK SMARTER NOT HARDER. Join a modern, well-established 42-year-old podiatric medical/surgical practice within a multi-specialty office. Located just 20 minutes from NYC. Must be responsible, compassionate, driven, and self-starter. Enjoy cross-referrals from other specialists and support of medical assistants, office managers, and medical billers with over 50 years combined experience. Utilize modern technology: state-of-the-art diagnostic ultrasonography, fluoroscopy, ESWT (machine is owned by practice), physical therapy, x-ray, circulation testing, NCV, and in-office operatory suite. Very strong and effective advertising/marketing program. No nursing homes, No HMOs, No Medicaid, No Medicare. Must be licensed for podiatry in New York. Send cover letter/CV to: linchpindpm@yahoo.com

ASSOCIATE POSITION – BROOKLYN NY

Busy multi-specialty Medical office in Brooklyn, NY is seeking an experienced podiatrist. We are offering great compensation, flexible schedule and great office environment. Our Requirements: Must have Experience Must have Medicaid & Medicare provider. Please respond by email to: ddpropertymgmt@gmail.com

ASSOCIATE POSITION – MIAMI, FLORIDA

Associate with potential for partnership. All phases of foot and ankle care. Bilingual in Spanish helpful. Send Resume and Letter of interest to miamifootandankle@gmail.com

SOUTHEAST GEORGIA- SAVANNAH & SURROUNDING AREAS

Beautiful weather year round & near the Coast. Opportunity for Early Buy-in. Seeking podiatrist looking to build a career & long-term relationship. Either established practicing physician or new residency graduate. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facilities. E-mail cover letter & CV to melissafoot@pol.net

ASSOCIATE POSITION - MANHATTAN

Podiatrist needed for busy state-of-the-art offices in Manhattan. Offices are located near Penn and Grand Central Station. Along with CV, please provide medical plans that you are currently participating in. Please forward your information to roni@myfcny.com

ASSOCIATE POSITION - LOS ANGELES
   
Multi-specialty group seeking part time podiatrist. Opportunity to transition into full time position. Required:  3 years or surgical residency, including Charcot reconstruction, fellowship or interest in biomechanics, and ability to train surgical residents. Send CV to podiatricri@yahoo.com 

ASSOCIATE POSITION - SEATTLE, WA AREA

Established podiatric clinic looking for an associate to join our team, 5 offices located around the greater Seattle, WA area. Great base salary, benefits and friendly work environment. Please send resume to:  seattlefootdoctor@yahoo.com

FULL-TIME PODIATRIST NEEDED - ORANGE COUNTY, NY

Looking for a highly motivated surgical trained podiatrist in the Orange County NY (West Point) area. Hospital, wound center and surgical center affiliated. It is a busy practice that covers hospital inpatients, Wound Center, and takes ER calls. The applicant has to be trained in all foot surgery and be able to handle advanced Diabetic wound care. The practice is a 1 hour car ride from NYC and is close to hiking,fishing, skiing, and state parks. Please Email a CV and contact info to clsp4@yahoo.com

ASSOCIATE POSITION – ALBANY, NEW YORK

Solo practitioner looking to wind down after 29 years. Immediate position available in a well- established diversified practice. Must be ethical, hardworking and committed to quality patient care. Must have good communication and surgical skills. Patient base established with additional growth present. Excellent salary & benefits. Please send cover letter and resume to McBride719@aol.com

ASSOCIATE POSITION - KANSAS CITY, MISSOURI

I'm not just looking for an associate. I am looking for a doctor who wants to build a highly successful career with a doctor who is as committed to their success as he is to his own. Go towww.YourFutureInPodiatry.com to find out about this opportunity.

ASSOCIATE POSITIONS - MULTIPLE STATES

Podiatrist Needed in Missouri, Nebraska, Iowa, Minnesota, North Dakota, South Dakota, Ohio, Texas, Colorado, Oregon, Washington, Arizona, Massachusetts, Rhode Island, Wisconsin, Indiana, Oklahoma, Connecticut and Vermont. Expanding multi-state medical practice seeking podiatrists to service long-term care community residing in nursing homes and assisted living facilities. We offer an established patient base, scheduling, equipment allowance and cover travel expenses. Provide generous compensation, bonus opportunities, disability, health insurance benefits, malpractice coverage and flexible scheduling. Looking for a Podiatrist with excellent skills, able to provide expert and compassionate care to patients. Email CV to: careers@aggeus.org or call 773-770-0140 x300/x305. www.aggeus.org

PM News Classified Ads Reach over 13,500 DPM's and Students
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