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Serving Over 14,000 Podiatrists Daily

March 13, 2013 #4,714 Publisher-Barry Block, DPM, JD

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NY Podiatrist Discusses Stress Fractures

Stress fractures feel like a tender area, often on the front part of the foot, at the second or third metatarsals. These are caused by repetitive stress on a bone, like walking or running on hard surfaces, especially in shoes that aren’t designed to absorb shocks. “Every summer, I see fractures in women who walk the city sidewalks all day in flip-flops,” says Dr. Jacqueline Sutera, a podiatric surgeon in New York City.

Dr. Jacqueline Sutera

High heels can also make you more susceptible to stress fractures, because the heel’s tilt distributes your weight over your foot unevenly. For treatment, a podiatrist will give you a surgical shoe to wear as you heal (it has a hard bottom that doesn’t allow the affected bones to bend) or advise you to wear some other kind of rigid shoes.

Source: Sally Wadyka, Realsimple.com

PM News has begun a new weekly feature called Quick Poll. Each week, we will post a new poll based on some of the controversial issues discussed in our Comments/Responses section. 

Quick Poll
If you use a laser to treat fungus nails, compared to oral terbinafine, do you think the laser is:

AAPPM Sponsors Family Night at KSUCPM

On March 7th, 2013, The American Academy of Podiatric Practice Management (AAPPM) sponsored the 1st Annual “Family Night” at Kent State University College of Podiatric Medicine (KSUCPM). In attendance were approximately 40 people, including KSUCPM students and their loved ones looking for support and direction to face the challenges in the lives of podiatric students.

Family Night Attendees at KSUCPM

“The evening was extremely beneficial on several levels, ranging from how to create systems and structures to support my family while simultaneously focusing on school, to the reinforcement of the basic essentials of a marriage such as doing the small things to show your love in the midst of a busy schedule”, says KSUCPM student Nicole Claessens. Presenters for the evening were Dr. Hal Ornstein, Chairman of the AAPPM, and national speakers for the organization, Chad Schwarz and Cindy Pezza, PMAC. 

NYSPMA Trustees Show Support at Haitian Fundraising Dinner

Three years ago, an earthquake rocked Haiti leaving more than 220,00 people dead and millions homeless. This tragedy devastated a country where the basics of life - food, shelter from the rain, and a way to earn a living - were just not available to many. The Kindest Hearts Foundation held its third annual fundraising dinner dance on Sunday, March 10 in Melville, NY. Its partners and supporters joined to raise funds for its ongoing school building construction in the small town of O’Rouck (Anse-aVeau), Haiti. To date, $20,800 has been raised with a goal of $100,000 more to complete construction not only for the school but its medical clinic as well.

(L-R) Drs. Vito Rizzo, Patricia Nicholas, Andrew Shapiro, and Paul Liswood

Drs. Vito Rizzo, Immediate Past President of NYSPMA, Andrew Shapiro, Treasurer of NYSPMA, Paul Liswood, Trustee of NYSPMA and Patricia Nicholas, Trustee of NYSPMA and founder/President of Kindest Hearts Foundation attended this event.

Some Distance Runners Opt for Nail Avusions: Canadian Podiatrist

All runners endure beat-up toenails. They’re marks of distinction, reminders of races run and kilometers travelled. Runners who don’t want to contend with constantly bruised, ingrown and lost toenails sometimes have them removed permanently. “We try not to have patients watch,” echoes Dr. Joseph Stern, a sports medicine podiatrist in Vancouver. “There’s a rule: The bigger the guy, the faster he passes out.”

Dr. Joseph Stern

Aesthetically, the lack of nail is barely discernible. A hard callus forms in the nail’s place. Few runners opt to undergo permanent surgery, though. Stern only performs a couple of procedures a year on runners’ feet. Before they take the plunge, he encourages patients to try less drastic solutions, explaining that toenail troubles can often be controlled with proper shoes and foot care: “The right shoe size is key. It’s important to cut nails straight across, so they don’t grow into the sides of the nail bed. Nails shouldn’t be too short or too long.”

Source: Amy Stupavasky, The Globe and Mail [3/11/13]

Maryland Podiatrist Honored for Pro-Bono Work

On March 10, 2013 the John Carroll Society recognized three physicians for their outstanding dedication and pro-bono work. Edward J. Bieber, MD, Nancy Ripp Clark, MD, and Jean-Jacques Kassis, DPM received their awards during the 2013 Rose Mass. As a foot and ankle surgeon in Montgomery County, Maryland, Dr. Kassis helps the less fortunate and has provided reconstructive podiatric surgical care to patients through the Archdiocesan Health Care Network.

(L-R) Nancy Ripp Clark, MD, Rev John McKay, Edmund Pellegrino, MD, Thomas Winkler, MD, Jean-Jacques Kassis, DPM, and Edward Biber, MD

Founded in 1951, the John Carroll Society promotes the enhancement of spiritual, intellectual, and social fellowship among its members—in service to the Archbishop of Washington. The Society is named after the first Catholic bishop in the United States. The Society furthers this mission principally through a series of yearly events, most prominently the well known annual Red Mass, which is offered in support of the legal community, and the Rose Mass, offered in support of our healthcare community.

Query: Pneumatic Walking Boot

How would you bill L4360? Specifically, what modifiers would you apply? Typically, what diagnoses/ICD-9 codes would you use with L4360? I know Medicare does not allow reimbursement for an ulcer diagnosis.

Barbara Mitchell Office Manager, Office of R. Bruce Franz, DPM, Arcata, CA

Response: Walking boots, as with all AFOs, require a minimum of two modifiers for Medicare. The first is the "KX" modifier. It is the payment modifier, and it stipulates that your chart documentation (and the patient's condition) meet the requirements of the AFO Local Coverage Determination (LCD). For example, a patient with a foot fracture would certainly meet the requirements of the LCD, but a diabetic patient with a foot ulcer with no orthopedic/neurological deformity, where the walking boot is only being used to off-load the ulcer, would not meet the requirements and would not be covered.

The second modifier required is the anatomical modifier. You would be required to use either the "RT" or "LT" modifier, so as to stipulate on which limb this boot is being applied.

As for the diagnosis, I suggest you read the LCD. It is open to interpretation as to what/which diagnosis would be appropriate. Another point to consider is documentation regarding the medical necessity for pneumatic vs. non-pneumatic boot dispensing. The clinical symptoms presented by the patient should be documented to support your choice of the more expensive pneumatic boot. Payers are beginning to take notice of the significant numbers of pneumatic walking boots billed.

Paul Kesselman, DPM, Woodside, NY

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RE: Macrodactyly (Philip Graham, DPM)
From: Robert Bijak, DPM

Macrodactyly may be associated with neurofibromatosis. The fibromas may be occult at this age but should be looked for assiduously so future complications can be mitigated. Carefully look for "cafe au lait" spots. DON'T just look at the foot and ankle. A pediatric neurology consultation should be considered. 

Robert Bijak, DPM, Clarence Center, NY rbijak@aol.com

I suggest sending this to someone who has experience treating it. If you feel comfortable then I suggest a staged approach.

Macrodactaly Pre- and Post-op

The youngest that I have done is after skeletal maturity.

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

RE: Efficacy of Lasers for Onychomycosis
From: Robert Kornfeld, DPM

The obsession with therapeutics, whether laser or not, obscures a more important issue that is getting no attention here...i.e. WHY do patients have onychomycosis? What are the underlying mechanisms? I think we can all agree that even post-avulsion, most toenails will grow back with fungus. The purely local application of therapy is not reliable. Oral drug therapy is not reliable. What does this tell us? No amount of "evidence-based" trials are going to reveal the reasons why focusing on the symptom alone fail most of the time.

Suffice it to say that identifying the reasons why patients are prone to parasitic infections, have misdirected immune systems or burdens on their physiology should be the focus of our attention. I will say that the combination of local laser therapy along with a functional medicine approach to the patient-specific mechanisms (causes) of fungal disease nets the best rational and proactive approach. I have observed the efficacy of these protocols for years with long-term improvement.

Robert Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com

RE: Efficacy of Lasers for Onychomycosis
From: Scott Nelson, DPM

In my two-year experience with using lasers for onychomycosis, I have found that the largest underlying reason the laser may not get the desired results is under-treatment of the nails. Patient compliance remains another challenge. For instance, if you treat the nails and the patient still wears that favorite pair of shoes without attempting to eradicate the dermatophytes from these same shoes, then the results may be less than desirable.

To avoid under-treatment, choosing the right laser for your practice is paramount in your success rate. If you choose lasers with lower wattage output (i.e., 4 watt), then you need to be prepared to treat the patient for a full hour or more to get effective results. If the laser is too powerful (60 watts), you...

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

If Feet Could Talk

Source: Freaking news,com via Dr. Ed Bruno

PODIATRIC SPORTS MEDICINE FELLOWSHIP - ORANGE COUNTY CA

July 1, 2013 and ending July 31, 2014. $60,000/year, medical, dental, malpractice, and CME allowance. APPLICANTS MUST BE ABLE TO OBTAIN A CALIFORNIA LICENSE. Letter of interest, and CV to: Philip Radovic, DPM, Fellowship Director, Email: Info@feetfixer.com

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 PODO2345@AOL.COM 516-476-1815

EQUIPMENT FOR SALE - COMPLETE AMFIT ORTHOTIC FABRICATION SYSTEM

Complete Amfit Orthotic Fabrication System with Footfax SL Contact digitizer-3 years old. System includes milling machine, 2 PCs, all cords, parts, hardware and assorted insole blanks. $45K New, Asking $10K. E-mail inquiries to: sportsmed@fdfac.com

EQUIPMENT FOR SALE - USED Q-CLEAR LASER

Still under warranty. New laser head just added. First Best Offer. Marketing and training included. Dr. Zuckerman will train you. e-mail with questions to mook863@comcast.net

PRACTICE FOR SALE - LOS ANGELES, CA

Practice is in Boyle Heights area since 1998. 70%MM the rest consist of Cash/PPO/HMOs. Last 4 years grossed between 200-350k in a down economy. Constant referrals from PCPs in the area. Includes Padnet, and all podiatry equipments. Asking 130k. Please email me only footdoc525@yahoo.comPRACTICE FOR SALE - MISSION VIEJO, CA

Relocating to Tulsa. Great opportunity to buy my office. Located at Mission Hospital. Gross income 2012 was $560,000. Approximately 1300sqft with 3 treatment rooms, digital x-ray and fully computerized. Will consider all offers. Call David at 949-702-1052 or david@missionviejofootcare.com

PRACTICE FOR SALE - SOUTHWEST FL

Multilocation multidoctor practice in beautiful Southwest Florida . Practice has grossed over seven figures consistently and currently shows 10-15% growth in revenues with increase in new patients and patient visits. EHR is already implemented with meaningful use criteria met. Practice has been professionally evaluated by Provider Resources. Only serious inquiries to this email address. This is a great practice in Paradise and a good opportunity for the right doctor or doctors. Email to: practiceforsaleswfla@gmail.com

PRACTICE FOR SALE - WEST PALM BEACH FLORIDA

Well established successful West Palm Beach practice grossing $475K with excellent reputation and good referral base. Consistent new patient growth, great opportunity with increased gross revenue and surgical growth potential. EHR implemented with meaningful use criteria met. Great area to live and work. Serious inquires E-mail wpbfootdrs@gmail.com

ASSOCIATE POSITION NEEDED FOR CENTRAL FLORIDA

FT/PT associate needed for nursing home work. Great compensation and a great way to supplement your income. Must be willing to travel. Contact us at (786) 975-2090 or fax to (847) 674-2113 you may also email to feetwork@aol.com.

ASSOCIATE POSITION - CENTRAL FLORIDA

Associate position for busy practice in Central Florida. Competitive salary with complete benefit package available. Please send resume to cmedders@atlanticpodiatry.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Requiring full-time podiatrist (PSR-24 or greater) in established Practice situated in a foothill community of Southern California. There is an existing patient base and a strong support team. Compensation is performance based with practically an unlimited earning capability. A possible buy-in is negotiable. Send resume to office@uplandpodiatry.com , titled, "Podiatrist".

POSITION AVAILABLE - WEIL FOOT ANKLE & ORTHOPEDIC INSTITUTE- CHICAGO

Weil Foot Ankle & Orthopedic Institute is expanding their presence in the Chicago metropolitan area and suburbs and is recruiting qualified podiatric surgeons. A three-year residency is required and a podiatric fellowship is preferable. Current practicing podiatric practitioners in Chicago and surrounding area are also welcome to join our rapidly expanding practice that currently numbers 16 DPMs, a neurologist, an orthopedic surgeon, and a primary care sports medicine physician. For more information contact: info@weil4feet.com or call Stephanie Spiegel, COO at 847-390-7666.

ASSOCIATE POSITION - NY AND NJ

Highly ethical, motivated self starter wanted. Must be willing to work hard. Must have excellent people skills. There is partnership opportunity if you are willing to work for it. This is not for everyone. No whiners, and no slackers. Send C.V. to ddfcfootdoc@gmail.com

ASSOCIATE POSITION - EASTERN SHORE OF MARYLAND

Seeking highly motivated, ethical, enthusiastic associate to join successful, well-established practice located in close proximity to Maryland and Delaware beaches. Certified/qualified by ABPS with rearfoot experience preferred. The practice incorporates surgery, wound care, sports medicine and general podiatry. Fully equipped office with diagnostic ultrasound, fluoroscopy, vascular testing, radio frequency ablation, six treatment rooms and three satellite offices. Main office has accredited ambulatory surgery center. This opportunity has excellent salary potential with benefits for the right individual. Send CV to dpmkthomas@gmail.com.

ASSOCIATE POSITION - NORTHWEST IOWA

A well-established, midwest multi-physician practice with strong hospital affiliations seeking FT podiatrist. Applicant should be well trained surgical physician, completed a 12/24 month residency, & board eligible. Practice offers high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume: 712-258-9977.

ASSOCIATE POSITION - HOUSTON, TEXAS

PSR 24+/ Equiv. DPM, Texas license, Busy diverse practice. Greater Houston Area, Guaranteed Salary and benefits All Aspects of Podiatric Medicine and Surgery. Board eligibilty, Bilingual A Plus. Send CV to Randal Lepow at rmldpm1@att.net

ASSOCIATE POSITION - DAYTON, OH

Join a well-established modern practice in Dayton, Ohio. Excellent reputation and referral base. Base salary $120,000, benefits and bonus structure. EMR, diagnostic ultrasound, Padnet vascular studies, CO2 lasers, all aspects of DME. We seek a surgeon that is well-trained and personable to join our group of 4 podiatric surgeons. Would like to have this individual buy in to the practice eventually. Please send CV and to Ohiodoctors@aol.com

ASSOCIATE POSITION - WASHINGTON, DC/ MD SUBURBS

Prominent, established two office practice seeking well rounded, personable, ethical individual with sharp medical and surgical skills. Must be 24/36 month trained, ABPS qualified or certified. Partnership opportunity with ownership potential. Competitive salary with benefits package. Please send CV to ponyrunner66@gmail.com

ASSOCIATE POSITION - 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 call. 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

PM News Classified Ads Reach over 14,000 DPMs 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 14,000 DPMs. Write to:bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $115 for a 50-word ad. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451

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