The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

March 16, 2013 #4,717 Publisher-Barry Block, DPM, JD

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Unsupportive Shoes Can Cause Plantar Fasciitis: IL Podiatrist

If your plantar fascia gets inflamed, you'll probably feel knife-like heel pain as soon as your feet hit the floor in the morning. The pain generally eases throughout the day, but some people wince with practically every step. Dr. Elizabeth Kurtz, a podiatrist who practices in Chicago, says that many people punish their feet with flat, flimsy shoes that don't support the arch.

Dr. Elizabeth Kurtz

"Flip-flops seem to be a major source of foot pain," she says. Worn-out shoes that have lost their cushioning are another culprit. "People walk into the office wearing shoes that they should have replaced months ago," she says.

Source: Chris Woolston, Chicago Tribune [3/13/13]

PM News 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.  This is the last day to vote.

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

Podiatry Students from Three Countries Hold Meeting at NYCPM

At a recent breakfast meeting held at the New York College of Podiatric Medicine, students rotating from National University of Ireland, students from the University of Quebec at Three Rivers, and the student leadership at NYCPM discussed the similarities between podiatric medical education at their respective institutions, as well as scope of practice in the U.S., Canada, and Ireland. 

Front (L-R) Drs. Robert Eckles, Laurence Lowy, and Michael Trepal with students

Also discussed were areas of collaboration between the student bodies, including research. Also participating were Robert A. Eckles, DPM, Associate Professor of Orthopedic Sciences & Dean of Clinical Education and Graduate Medical Education, Laurence J. Lowy, DPM, Professor of Pediatrics & Dean for Student Services, and Michael J. Trepal, DPM, VP for Academic Affairs and Dean, and Professor of Surgical Sciences.

Query: Mycotic Nails in a 5 Year-Old

My patient is a five year-old female with a moderate toenail infection, which has tested positive for Trichophyton spp. She has been treated with Formula 3 for a year with little or no improvement. What medicines or treatment should now be used?

Billie Bondar, DPM, Rochester, NH

Query: Derotational Hammertoe Surgery Coding

Is there another code to use for "derotational" hammertoe surgery other than 28285? The main goal of surgery was not a correction of sagittal plane contracture ("hammertoe"), but primarily to correct frontal and transverse plane ("adducto-varus") deformity within the toe.

The procedures included wedge/teardrop transverse skinplasty, wedge resection of head of phalanx, transposition of extensor repair to more lateral distal point, and flexor Z-plasty to reduce medial plantar "rotating" force on distal digit (done just distal to plantar metatarsal-phalangeal joint)

Lynn Faulk, Office of Howard Horowitz, DPM, Bowie, MD

Response: If a hammertoe deformity is being corrected with bone and soft tissue work, then CPT 28285 is the code that represents what is being done.

If only soft tissue (capsule, tendon, skin, etc.) surgery was performed to correct an angular digital deformity, then CPT 28313 could be billed.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found here

APMA Members: Click here for your free Codingline Silver subscription

RE: Suggestions for Painful Bunion (Tip Sullivan, DPM)
From: Barry Mullen, DPM, Philip McKinney, DPM

The co-existent metatarsus adductus increases the effective IM angle to an extent where a basilar 1st metatarsal angular correction is warranted. Pending the extent of met cuneiform joint hypermobility, a Lapidus fusion seems like a logical choice. I've seen much worse obliquities in that articulation, so another viable option is a closing base wedge osteotomy, but good post-op orthotic management is a necessity if one eschews the MCJ fusion.
 
Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

I have not been one for performing a Lapidus procedure if there is no indication of pain or degenerative changes in the 1st MCJ. From what you describe here though, I think I would be all for it. The most motivating factor that I see for leaning towards a Lapidus is that apparent medial shift of the 1st metatarsal on the cuneiform. I had a very similar case where I preformed a base wedge osteotomy on a 1st ray that for the most part looked fine at the 1st MCJ.

A year after the surgery, I saw the patient for another unrelated problem, x-rays demonstrated that the 1st metatarsal had shifted about 1.5-2.0 cm medially on the cuneiform, and this was a patient that I did not perceive had any marked laxity in that joint. I feel from your description and the appearance of that 1st MCJ, that a Lapidus would be a good consideration.
 
Philip McKinney, DPM, Eugene, OR, opodiatry@oregonpodiatry.net

RE: Refusing Routine Care to a Compromised Diabetic Patient
From: Michael J. Schneider, DPM

I received a call from a podiatrist who asked if I would see one of his patients who is in a hospital here in Denver. The patient and his podiatrist live over 100 miles away. The referring podiatrist explained that the 88 year-old patient was a diabetic with a history of unresolved ulcers and needed to be examined and to have his toenails debrided. I asked if he had seen a podiatrist with staff privileges at the hospital and was told that the podiatrist was called in. When the podiatrist arrived and was informed that the reason was to do a nail debridement, he turned and left the room stating that he was a “podiatric surgeon and did not cut toenails.“

I understand that there are many podiatrists who limit their practice to surgery and do not accept routine care patients. My issue here is that the podiatrist was in the patient’s room in the hospital and refused care. We are podiatrists. To my knowledge, there is no distinction in disciplines. We have been trained to treat all aspects of pedal issues from routine care to surgical intervention. We podiatrists should be doing everything in our power to project that we care about all of our patients' needs, not just the lucrative ones. Someone should read (or re-read) the Hippocratic Oath.

Michael J. Schneider, DPM, Denver, CA, podiatristoncall@gmail.com

RE: The Passing of Charles Bradley, DPM, MA

The late Charles Bradley, DPM was President of APMA from 1983-1984. He followed me to the Chair. The profession has lost a great leader and one of the finest individuals to ever walk the face of this earth. His humility, integrity, knowledge, and ability to communicate were superior. His dedication and concern for all were as fine as one can remember. If you had the opportunity to know and work with "Brad", you were a very lucky person.
 
Arthur Helfand, DPM

The profession has lost a true giant. Charles was a graduate of CCPM and served on its board for many years, as well as serving as president of the APMA and CPMA. He was a member of the Council of Education at the time when the profession needed his strong leadership. Charles was also a founder and board member of PICA. His spirit and many accomplishments, that were unselfishly achieved for the profession, will last on through the students, residents, and colleagues whom he touched. Rest well Brad, you did good.
 
Paul R. Scherer, DPM

RE: The Passing of Charles Bradley, DPM, MA

Sadly, another good man leaves us. May he rest in peace.

H. F. "Bunny" Brown, III

 "Brad" was a giant in our profession. His work at PICA and APMA is memorable to me personally and has had historic value to our profession.  I will miss his warmth, his smile, and his leadership. As we start the annual APMA House of Delegates, his presence will be sorely missed. 

Lloyd S. Smith, DPM

I just learned of "Uncle Brad's" passing. I had the pleasure to literally grow up running around his ankles at CPMA and APMA meetings. It is hard to actually accept that he's gone. His quiet service over two generations in no small part shaped our profession. His smiling countenance and enthusiasm were consistent, unchanging forces over the years. I type this note in an academic office waiting for a case to start in an operating room three floors below. It is not at all lost on me that I would never have been able to enter either of these rooms were it not for this great and good man.  

May he rest in peace and may everyone take a minute to remember him and the great generation of docs that he joins in that placid podiatric Elysian field up there... RIP, Charles Bradley.

David G. Armstrong, DPM, MD, PhD

RE: PA Podiatrist Among Highest Paid by Big Pharma (Eric M. Hart, DPM)
From: Jesse Riley, DPM, Pete Smith, DPM

I agree with Dr. Hart. I feel that Dr. Joseph is to be commended for his achievements and for his positive representation of our profession within the medical community. I too have had the pleasure of hearing Dr. Joseph lecture in the past and his insights are timely, insightful, and void of any bias. Good for him for making a good living while doing it.

Jesse Riley, DPM, Evansville, IN, dr.jesseriley@gmail.com

Congratulations to Dr. Joseph for working his butt off and becoming one of, if not, the leading expert in the treatment of lower extremity infectious diseases. This is an exceptional accomplishment and could not have been made possible without outside funding. Dr. Joseph is an exceptional lecturer, author, and is about as unbiased an individual as I know. He is an advocate for podiatry, and the knowledge I/we have gained from him is invaluable in treatment of lower extremity infections. He is a credit to podiatry!

Pete Smith, DPM, Lancaster, PA, petesmithdpm@comcast.net

RE: PA Podiatrist Among Highest Paid by Big Pharma
From: Elliot Udell, DPM

In an ideal world, Dr. Joseph would be able to fly every weekend and midweek to another city and lecture on infections of the lower extremity without getting paid. We don't live in a fantasy world.  Speakers have to eat, drink, and support their families. Hence, if we want highly specialized speakers to devote their lives to teaching and coaching, they need to get paid.

Many conferences can afford to subsidize a speaker's expenses and give him or her an honorarium. That is the best scenario, however not every hospital, or small conference can afford to do this for every speaker, hence the medical profession has become dependant upon corporations to bankroll many of their invited lecturers. Dr. Joseph  deserves special praise. His lectures, while subsidized by companies that manufacture antibiotics, are unbiased. Many of his presentations are totally devoted to fielding clinical questions from participants and have nothing to do with the companies that subsidize him.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Oddly Specific ICD-10 Codes

Healthcare IT News recently asked its readers to submit the most outlandish ICD-10 codes they knew of. Here are some of our favorites from the article:

V9542XA: Spacecraft crash injuring occupant, initial encounter.
Y92250: Injury received while in an art gallery.
T7501XD: Shock due to being struck by lightning, subsequent encounter. (A useful code when lightning strikes twice.)
W5922XA: Struck by a turtle.
V0001XD: Pedestrian on foot injured in collision with roller-skater, subsequent encounter.
V91.07XA: Burn due to water-skis on fire, initial encounter.

Source: Healthcare IT News via Dr. Paul Busman

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 footcare@comcast.net

ACADEMIC POSITIONS - SCHOLL COLLEGE

The Dr. William M. Scholl College Podiatric Medicine is seeking up to three full-time academic podiatrists to train and lead the next generation of podiatrists in an interprofessional, multicultural learning environment. Applicants must be board qualified with preference for board certification in foot surgery and reconstructive rearfoot/ankle surgery. Salary and academic rank will be commensurate with scholarly credentials. Contact Robert Joseph DPM, PhD at Robert.joseph@rosalindfranklin.edu or (937) 479-1793. Rosalind Franklin University of Medicine and Health Science is an Equal Opportunity/Affirmative Action Employer. The administration, faculty and staff embrace diversity and are committed to attracting qualified candidates from historically underrepresented groups.

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

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.com

PRACTICE 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

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

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- SUBURBAN PHILADELPHIA

Full time, PSR 24-36 month trained podiatrist needed for busy suburban Philadelphia group practice. Multidimensional, multi-office group treating a wide range of patients including forefoot, rearfoot & ankle surgery, diabetic wound care, sports medicine, and workrelated injuries. Office & diagnostic equipment state-of-the-art. Full benefit package included with bonus incentive. Position available starting July, 2013 excellent opportunity leading to partnership. Please email to: bailliemw@gmail

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 - 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

ASSOCIATE/PARTNERSHIP MIAMI/KENDALL FLORIDA

Podiatrist with interest in foot and ankle surgery and comprehensive foot and ankle care. Pathway to partnership/ownership available. Send CV and information: ibaumdpm@bellsouth.net

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".

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

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

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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