The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

March 15, 2010 #3,804 Publisher-Barry Block, DPM, JD

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IN Podiatrist Performs Custom Fit Ankle Replacement

If you've ever twisted or sprained your ankle, you know how painful it can be, but imagine breaking it and needing plates and screws put in just so you can walk. That happens to millions of people across the country who often end up having surgery that leaves them with a limp. Now, there’s new technology that's giving people back the spring in their step -- literally.

Dr. Jeffrey Niespodziany

Fusing ankles can limit motion, so Dr. Jeffrey Niespodziany now performs what's called "INBONE Total Ankle System." He's the only doctor in the area using the technology, which basically has two main pieces and can be custom fit to the patient, mimicking a real ankle. “This type of implant is the third generation. It has been the most advantageous to ankle joint replacement and it’s pretty new,” says Dr. Niespodziany.

Source: Maureen McFadden, WNDU.com [3/11/10]

TX Podiatrist to Present Talk on Foot Health

Board certified foot surgeon Dr. Nora Zoe Ramos-Carthew of Neville & Associates will step into Shoecolate/Foot Solutions, the concept fashion shoe store in The Woodlands, to present a special talk on Thursday, March 25. Ramos-Carthew will discuss common, as well as more complicated painful foot issues that many people struggle with, and the importance of the proper foundation for shoe support.

Dr. Nora Zoe Ramos-Carthew

Dr. Ramos-Carthew is a graduate of Barry University School of Podiatric Medicine in Miami, FL. She is board certified in foot surgery by ABPS, and is a Fellow of the American College of Foot and Ankle Surgeons, as well as the American Professional Wound Care Association. She is a Diplomate of the American Board of Podiatric Surgery, and became the medical director of the Podiatry Section of the Surgery Department at Larkin Community Hospital in South Miami. 

Source: Woodlands Online (TX) [3/12/10]

CO Podiatrist Organizes 9.12 Group

The Tea Party Express, the Tea Party Patriots, the 9.12 Patriots and dozens of related groups first drew attention during their angry, sign-waving protests over taxes and healthcare reform a year ago. Since then, these conservative groups, or "pro-patriots" as they prefer to be called, have been busy in church halls and in coffee shops from Greeley to Bayfield.

Dr. Michael Schneider

"A lot of people say we are fearmongers and naysayers. We are not," said Dr. Michael Schneider, a Vail podiatrist who organized a 9.12 group in the Vail, Eagle and Roaring Fork valleys. "I think Glenn Beck is the Paul Revere of the 21st century."

Source: Nancy Lofholm, The Denver Post  [3/13/10]

Query: Osseous Metaplasia

I have a female patient with a neoplasm on the 4th toe that came back osseous metaplasia. She has a lengthened toe. I would appreciate possible treatment regimens from someone who has treated this. 

Dennis Hershey, DPM, Brooklyn, NY

Query: Accuracy of the Aetrex I-Step

I am interested in knowing how accurate the Aetrex I-Step system is in fitting patients with their shoes.

Sam Rosen, DPM, NY, NY

RE: Recurrent Inferior Calcaneal Ulceration (Tony Quinton, DPM)
From: Robert Bondi, DPM, Richard Benjamin, DPM

I would try a single upright brace with a SACH heel and a silicone heel cushion to prevent further breakdown of the heel. Try this with or without a partial calcanectomy, if indicated.

Robert Bondi, DPM, Lee’s Summit, MO, Robert.Bondi@foot-docs.com

I have had great success (over 100 cases) with restoration of the forefoot and heel fat pads through the use of GraftJacket and Bio Tape (Wright Medical). I insert the material sub-cutaneously and then anchor it into place. Within three weeks, there is a noticeable difference in the thickness of the fat pad. Growth continues for about 6 months, resulting in a thicker pad that allows the patient to resume normal activities such as golf, tennis, and jogging within a month after the procedure. My patient satisfaction rate is 95%+ with respect to their having the same procedure performed on the other foot. We hope to have a paper out in the next few months describing our technique and results.
 
Richard Benjamin, DPM, Summerfield, FL, RSBenjamin@aol.com

RE: CPME Document 320
From: Tilden H. Sokoloff, DPM, MD

I am perplexed by the impending changes in the CPME document 320. We have always talked parity with the MD and DO degrees, and at the same time, we are contemplating limiting the number of core medical rotations required for a DPM graduate. Medical school has core rotations in family practice, pediatrics, psychiatry, and ObGyn. These are eight weeks each. The rest are elective. If parity is the question, then how can we, if we are going toward a surgical subspecialty, limit our core rotations?

When you sit across from an orthopod, what is the constant mantra? I went through medical school and I was trained in medicine before specializing. Aren't we the same? Don't we too want to maintain our medical training in all areas? California allows a resident four graduate years to practice and learn medicine in all of its forms. That makes for competently trained podiatric physicians who represent us well. It certainly bodes well for us when we want to earn a medical degree (MD), take the USMLE, and become part of the greater whole of the medical profession. Less is not more. Some hard thought needs to be given to this before we make any changes.

Tilden H. Sokoloff, DPM, MD, Alamo, CA, docsok@healthsearches.com

RE: Unscrupulous Billing of Routine Care (Dan Klein, DPM)
From: Allen Mark Jacobs, DPM, Mak Yousefpour, DPM

The ongoing debate regarding "unscrupulous billing" is easily stated in summary.

The federal False Claims Act is very clear. This act prohibits the knowing submission, or causing of a submission, of a false claim to the federal government by individuals, corporations, companies, associations, firms, partnerships, or societies. The government need not prove intent to defraud under the FCA. Any person acting with actual knowledge that the information is false, or with deliberate ignorance or reckless disregard of the truth or falsity of the information, can be found guilty under the FCA ( Steven Kern JD;  Medical Economics pp 48, March 5, 2010).
 
Both the general populous and the medical community (not just podiatrists) need to accept the fact that toenail care and skin care is not an entitlement of aging. If not a covered service, it is not a covered service.
 
Allen Mark Jacobs, DPM, St. Louis, MO, allenthepod@sbcglobal.net

Although I do agree with the doctors who responded to this topic, I would like to point out that the root of the problem is not with the treating physician or the patient. No matter how you spin it, we should get paid for what we do. I read in a recent issue of PM News that a DPM took his/her kid for ear wax removal and the insurance company paid the treating physician $300. Really? Removing ear wax with saline is a lot easier than cutting an inch thick mycotic nail. I have recently gone to my PCP for a throat ache. He took a swab of my throat for strep infection. This is a one second procedure. He billed my insurance $300 and got paid $116 and change.

So, why is cutting nails and trimming calluses (which most of the time are painful) labeled as routine care? Now, two wrongs do not make a right, but we did spend a considerable amount of time training to be foot doctors. Seven years post-undergrad, and Medicare decides what we should get paid for. I do blame the docs for billing for these services, but I really blame all of us for not correcting what needs to be corrected. Yes, amendments need to be made in the House and Senate, and it is not as easy as it sounds, but believe me, with the stroke of a pen by our elected officials or the insurance companies, we may not have anything in the near future as DPMs. Case in point: NJ DPMs are not reimbursed for ultrasound, NY DPMs are not allowed to do ankle surgery. The system is broken.

Mak Yousefpour, DPM, Los Angeles, CA, makdpm@yahoo.com  

RE:  Defeat of Podiatry in NJ Diagnostic Ultrasound Case (Larry Cohen, DPM)
From: Henry Slomowitz, DPM, John Tasone, DPM)

I am very pleased to see that there are others who agree with me as to this defeat of podiatry by Blue Cross Blue Shield of New Jersey. I do, however, disagree with Dr. Cohen that the Society should not be blamed because the policy is not discriminatory. The defeat of the action by BCBS should have been based on our training and expertise, not that of orthopedic surgeons.
 
The argument that orthopedists are not allowed to do them either is immaterial. For years, we have been trying to distinguish ourselves as specialists, not under the wings of a specialty that does not treat the foot and ankle in the same way as we do. To say that we should be able to take x-rays or perform ultrasound because another specialty can is a step backwards. I think that BCBS could not care in the least that we were taking ankle x-rays. They did not want podiatry to perform ultrasound, period! The society fell into their trap of us comparing ourselves to orthopedists, who I don’t think were utilizing this technology to the extent we were.
 
To summarize, I have to give kudos to BCBS for a job well done. To our society, I will continue to pay my dues and hope you understand what a terrible mistake you made.
 
Henry Slomowitz, DPM, Paterson, NJ, minggao@optonline.net 
 
Editor's Note: Dr. John Tassone's extended-length letter can be read here.

RE: Laser Holds Hope for Treating Onychomycosis: (Michael Uro, DPM)
From: Andrew Shapiro, DPM, Stanton C. Southward, DPM

Regarding recurring onychomycosis, many fungi (and other micro-organisms) harbor in the materials of the inside of shoes, and need to be eradicated effectively to prevent re-infection.

An effective adjunctive measure is the SteriShoe ultraviolet shoe sanitizer, a new product, designed as a shoetree, that safely sanitizes the inside of shoes using germicidal ultraviolet (UVC) light. A 45-minute treatment kills 99.9 % of bacteria, fungi and viruses. This is especially effective in chronic fungal infections, including onychomycosis.

Disclaimer: I am an advisor to Shoe Care Innovations, makers of the SteriShoe ultraviolet shoe sanitizer.
 
Andrew Shapiro, DPM, Valley Stream, NY, Drshapbark@aol.com

I currently remain skeptical of using a laser for treatment of fungal nails. I concede it is a marketing tool and brings a common foot problem front row and center, however, in my opinion, patients should receive informed consent regarding this experimental and FDA unapproved treatment. I'm all for studies to validate laser efficacy. Perhaps our schools could undertake this clinical research funded by the laser manufacturers.

Mycotic nails are always a favorite podiatric topic, much like the verruca and result in a myriad of opinionated therapies. So I'll throw my hat in the ring based on 40 years experience. The protocol for onychomycosis in my office is treatment with power and manual nail debridements regular vinegar [acetic acid]-H₂O foot soaks, and topical full-strength liquid tincture of green soap applied h.s.to the nails. This safe, low-cost, effective treatment requires a few months and may need to be repeated.

Since there is no universally accepted "sure cure' for these problematic nails and no accepted published "standard of care,"  why not simplify and practice "prima non nochere" - Hoodwinking the trusting public is just not acceptable!

Stanton C. Southward, DPM,  Colorado Springs, CO, sbsouthie@comcast.net

RE: $1,475,000 Settlement for MD's Failure to Diagnose Charcot Foot 
From: Michael M. Rosenblatt, DPM, Stanton C. Southward, DPM

An excellent study done by Gayle E. Reiber, MPH, PhD; Edward J. Boyko, MD, MPH; and Douglas G. Smith, MD reported that mortality after amputation is as follows: 1 year mortality was 11-41%, 3 year mortality was 20-50%, and 5 year mortality was 39-68%. These are alarming statistics. They also reported that foot ulcers preceded amputation in 84% and 85% of patients…in two separate studies.
 
Of the total number of diabetics who are diagnosed with Charcot disease, their study revealed the obvious, that Charcot join disease is a “rare” complication of diabetes. Ulceration, however, is not. It is very prevalent in neuropathic diabetes with what these researchers describe as “foot pressure.” I think that every podiatrist would reasonably conclude that Charcot joint disease pre-disposes neuropathic patients to ulcerations due to improper off-loading and destruction of the normal gait cycle.  Of course, other bony deformities will also “ruin” gait cycle.
 
No matter which side of the argument on this verdict you take (excessive or justified), we all agree that prevention of amputation is the gold standard of podiatric care. I reasonably conclude that "you must be aware of Charcot joint disease" in order to properly treat off-loading and interruptions of normal gait cycle that pre-dispose diabetic patients to ulcers. 
 
Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

In my experience, amputation or major reconstructive surgery for Charcot’s would  indeed rarely be indicated. Treatment for these patients should include medical management of the diabetes mellitus, preventive maintenance and palliative foot care, custom-molded rubber butter orthoses, and fitted supportive footwear. For those intractable digital or plantar ulcerations, I've managed these with percutaneous toe procedures and/or metatarsal osteotomies.

The Charcot foot is characterized by stages of bone and joint changes proceeding to a reconstructive phase.  I'm reminded of patients that years ago had undergone surgery for healing stress fractures when the normal bone callus was misdiagnosed as osteogenic sarcoma. I do concur that the differential diagnosis of Charcot, osteomyeltis, and gout can be challenging.

Ref. Southward, S.C. :Neurogenic Arthropathy Due to Diabetes Mellitus.....JAPMA  Vol 61-9, 1971.
 
Stanton C. Southward, DPM, Colorado Springs, CO, sbsouthie@comcast.net

Smelly Feet at FL Airport May Prompt Security Change

Something stinks at Palm Beach International Airport. And apparently it's the no-shoes rule through security gates. The county airport's director said at an advisory board meeting Wednesday that security personnel "are complaining of odor" in the area. A new carpet might be a better, more feasible idea than a good shampooing. The county is already replacing much of the terminal tile and carpet, but nothing was immediately promised for the stinky security area.

Source: AP via Lee Rogers, DPM [3/12/10]

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

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

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.comASSOCIATE POSITION - CONNECTICUT

Associate needed full or part-time for Nursing homes in Connecticut. Need hard-working, ethical individual. Must have CT license. Excellent salary. Please call Zina (347)307-4333 for additional information.

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 - SAN FRANCISCO, CALIFORNIA

We’re seeking an energetic and enthusiastic Associate to help our thriving non-surgical practice grow. We provide state-of-the-art sports medicine, trauma and lower extremity care. Excellent compensation package. Visit  our website to apply.

HOME FOOT CARE PHYSICIAN NEEDED - LOS ANGELES, CALIFORNIA

Honest, caring, hard-working podiatrist needed to make visits to homebound patients, facilities, etc. for Home Foot Care, Inc. Part time position, flexible hours, independence and excellent compensation. If interested email CV to homefootcare@hotmail.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 (PART–TIME) WHITE PLAINS, NY

Part-time associate wanted for busy 22 year old White Plains office. Call 914-325-9198 for further details.

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

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