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March 14, 2008 #3,193 Editor-Barry Block, DPM, JD

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Kosofsky Reappointed to NH Podiatry Board

Podiatrist David R. Kosofsky of Nashua Podiatry Associates has been reappointed to the Board of Registration in Podiatry for the state of New Hampshire. The group ensures that only fully qualified podiatrists are permitted to provide podiatric medicine and surgery services in New Hampshire.

Dr. David R. Kosofsky

Kosofsky earned his undergraduate degree from Fairleigh Dickinson University, and a medical degree from Ohio College of Podiatric Medicine.

Source: LGH Lowell Sun (Massachusetts) [3/13/08]

Rising Rents Force CA Podiatrist to Relocate

For three decades, Dr. Brad Aguirre had a Montrose podiatry office -- until his rent doubled last year and he had to move. Rising rents are forcing out longtime businesses and fueling anxiety among merchants that their mom-and-pop stores will lose out to national chains. That's already happened in recent years in other areas, from Old Town Pasadena to Larchmont Village, said Jack Kyser, chief economist with the Los Angeles County Economic Development Corp.

Dr. Brad Aguirre

Merchants say new landlords are raising rents sky-high, forcing out tenants. Aguirre, the podiatrist who established his office in Montrose in 1977, said he moved last year to another part of Glendale when a new landlord wanted to increase his rent from $4,500 a month to more than $9,000 -- for 2,500 square feet of space.

Source; Daily News (Los Angeles) [3/10/08]

Alleged Failure to Order Bone Density Test (New Jersey)

Facts: The female plaintiff in her late 20s had received overlapping treatment from the three defendants, including an internist, podiatrist and ob/gyn, with the ob/gyn seeing her last. The plaintiff contended that despite the weight of the 5 ft. 5 in. tall plaintiff, which dropped as low as 101 lbs., frequent rigorous exercise, the loss of her period and the suffering of two stress fractures to the feet, the defendants negligently failed to consider that the plaintiff might be suffering from an eating disorder.

The plaintiff further contended that the defendants negligently failed to send her for a bone density study and to institute other measures to correct the bone loss. The plaintiff maintained that after she ultimately suffered an ankle fracture, a non-party orthopedist sent her for a bone density study and that it was determined that the plaintiff suffered severe osteoporosis, which is particularly pronounced in the spine and hip, and that the condition of her bones was similar to that of a woman in her 70s.

The defendants maintained that the care was reasonable. The plaintiff contended that although the condition has stabilized, it will never improve and that she will permanently be very susceptible to compression fractures in the spine.

The defendant podiatrist maintained that he had a right to rely on the physicians and the internist maintained that any fault primarily rest with the ob/gyn.The ob/gyn contended that he acted appropriately, especially since he treated the plaintiff correctly with birth control pills and was able to achieve the return of her menstrual cycle.

Result: The case settled prior to trial for $ 375,000, with the most significant portion paid by the defendant ob/gyn.

Plaintiff Experts: Richard Luciani, M.D., Millburn, NJ, Myron Boxer, D.P.M., Woodmere, NY, Kevin Bell, M.D., Watchung, NJ

Source: Medical Litigation Alert Volume 16, Issue 2

Query: Keloid Scar on Plantar Surface.

I have a patient that had had surgery by another physician who removed the distal 1/3 of the 5th MT for a tailor's bunion. The incision was along the lateral aspect of the foot and she developed a keloid at the plantar aspect of where the 5th MTH would be. I offered the patient an excision with plastic closure but she does not want to be cut again. I also offered intralesional cortione injections. Does anyone have other ideas or has anyone had success with pulse-dye laser?

Mike Carroll, DPM, Crown Point, IN

RE: Unilateral Deep Itching Pain (Alan Mauser, DPM)
From: Greg Mowen, DPM

Often itching without an obvious skin lesion with in a "dermatome" type distribution may be a nerve entrapment. In the location you described there could be a common peroneal entrapment (at the fibular neck) involving thus both the deep and superficial peroneal nerves or just the superficial peroneal (most likely at the ankle or anterior compartment) or possibly a radiculopathy. If you have access to a Pressure Specified Sensory Device (PSSD), the diagnosis may be easier.

Graded monofilaments are also useful in unilateral cases (use contralateral foot as your control). Look for nerve entrapment signs such as tenderness and or Tinels\Villeauxs, on the fibular neck (just below knee), over the anterior ankle, dorsum of foot. I would also do proactive testing for back pain.

Greg Mowen, DPM Margate City, NJ, gregmowen@comcast.net

RE: NV Podiatrists Act to Prevent Needle and Syringe Misuse
From: Elliot Udell, DPM

The Nevada Podiatric Medical Association deserves credit for their initiative in educating doctors on how to not contaminate needles and vials of injectible medications. Their reasoning was the debacle in a local endoscopy center where people contracted hepatitis because of the use of unsterile needles. In my own geographic area, a pain management specialist made headlines because he used unsterile needles and contaminated injectable materials and made people very sick.

What I don't comprehend is that all of us had basic medical education. No one with any basic understanding of microbiology would take a needle used to inject medication into one patient and reinsert that same needle into a 50 cc. vial of lidocaine and then use that same vial to inject into a new patient. That is not a lack of knowledge. It's crude, barbaric, and according to our local district attorney, maybe even criminal. According to today's news, the local pain specialist is being investigated and may be brought up on criminal charges.

Dr. Rubin deserves to be lauded for what he is doing to remind our colleagues about what we learned in medical school. The rest of the medical profession also needs to be reminded about the spread of pathogens in the medical office setting and this should apply not only to needles but to all instruments inserted into people's noses, throats, mouths and other human orifices. Then and only then will we all be safer from the spread of disease.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Tighter Standards For DME Suppliers (Timothy Tillo, DPM)
From: Jeffrey Kass, DPM

I want to thank Dr. Tillo for his informative response. While, I am an active member who looks at APMA's daily "blast emails" and the APMA newsletter, I do not recall reading about this topic. As this topic has been discussed here. Everyone should read Dr. Tillo's response. It is nice to see what the APMA is doing. Perhaps, some non-members will view this as a reason to join.

With regard to Jason Kraus from SOS - I appreciate his response, but we are still in disagreement. I do not believe that the podiatric community will increase dispensing of DME by closing down some of these shady DME places. There are large orthotic prosthetic corporations - they will be the beneficiaries. I believe Dr. Tillo's response explains why there is no reason for physicians to be accredited.

Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

FULL-TIME ASSOCIATE WANTED - CHATTANOOGA,TN

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

PART OR FULL TIME ASSOCIATE POSITION - NEW YORK, NY

Busy, thriving Manhattan Podiatry offices looking to hire part or
full-time in-network Podiatrist for growing private practice. Please, only in-network doctors apply. Send resume and list of in-network plans that you participate in to: Rachel@FootCareofNewYork.com

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