The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

March 17, 2011 #4,110 Publisher-Barry Block, DPM, JD

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SC Podiatrist Discusses Causes and Treatments for Heel Pain

Heel pain is one of the most common complaints in a podiatry practice. Approximately 3 million people seek treatment for heel pain. Dr. Scott Werter of Coastal Podiatry says there are multiple causes. The most common cause is plantar fasciitis or heel spur syndrome.

Dr. Scott Werter

Conservative care includes anti-inflammatory injection or oral medication, stretching exercises, orthotics, night splints and not going barefoot which is effective in about 85% of heel pain cases.  Approximately 10-15% of patients require surgery to allieviate this condition.

Source: Chasity Pendergrass, SCNow.com [3/16/11]

Scholl College Alumni Association Announces 2011-2013 Board of Directors

The Scholl College Alumni Association, which represents 5,000 podiatric physicians in the United States, recently announced its 2011–2013 Board of Directors:

Dr. HF "Bunny" Brown

President - H.F. Brown, III, DPM ’74
President-Elect - Richard C. Wilson, DPM ’80
Treasurer - Cynthia Cernak, DPM ’89
Secretary - Kathleen Neuhoff, DPM ’93
Immediate Past President - Jack W. Hutter, DPM ’81

Members-At-Large: Matthew Garoufalis, DPM ’82, Brandon Hawkins, DPM ’01, Joseph Kiefer, DPM ’87, Marlene Reid, DPM ’89, Mark F. Rogers, DPM ’77, and Corbett Toussaint, DPM ’04

Faculty Representative- David Kibrit, DPM ’81

TX Podiatrist Named Top Doc in Houston Magazine

Jeffrey N. Bowman, DPM, MS, of Houston, TX was named a Top Doctor in Houston for 2011 for “The Best in Houston Medicine.” Fellow doctors voted on the top physicians in various specialties in the Houston area. Dr. Bowman was voted one of the top podiatrists to be published in Houston Magazine in their Top Doctors Issue. 

Dr. Jeffrey Bowman

Dr. Bowman is a past president of the Texas Podiatric Medical Association and is still on their board of directors. He also serves on the House of Delegates for the APMA and on two of their committees. He is to receive this award for his continuous commitment to providing the best quality in podiatric care for his patients.

Single Podiatrist Visit: Would Save $3.5 Billion in U.S. Healthcare Savings Per Year

If every American at risk for developing a diabetic foot ulcer visited a podiatrist once before complications set in, the US healthcare system could save $3.5 billion in one year. Closing this gap in podiatric care would reduce healthcare waste on preventable conditions (which reportedly starts at $25 billion) by 14 percent. This estimation is a projection based on findings from a Thomson Reuters study published in the March/April 2011 issue of the Journal of the American Podiatric Medical Association (JAPMA).

The study's numbers were based upon the American population that has either commercial insurance (116 million) or Medicare (46 million) according to the Thomson Reuters MarketScan Research Database. Sponsored by APMA and independently conducted by Thomson Reuters, the study measured the healthcare records of nearly 500,000 patients with commercial insurance and/or Medicare.

Source: U.S. Politics Today [3/16/11]

Query: Hearing-Impaired Patients and the ADA

I have a deaf patient referred from a PCP in an HMO program who is requesting an interpreter. Can I write questions to the patient and have the patient respond in writing rather than having a certified interpreter for whom I have to pay?  

James E. Miller, DPM, San Antonio, TX

Editor's comment: PM News does not provide legal advice. Under the Americans with Disabilities Act (ADA), the answer depends on whether the patient agrees to this practice, the extent of the deafness, and the complexity of what needs to be explained to the patient. If the patient voluntarily agrees to notes instead of an interpreter, you're probably okay, but be sure to get the patient's consent to this practice in writing. If the patient insists on an interpreter, be prepared to provide one at your expense.

RE: Central Hypotonia (Tip Sullivan, DPM)
From: Philip McKinney, DPM

Dr. Sullivan mentions that this is a case of idiopathic central hypotonia. Is there a neurology report demonstrating that? Prior to even placing anything on a surgical table, I would want to know whether this is to be a progressive condition or is it static? X-rays? EMG studies?

If this individual is having difficulty ambulating with braces, and you are confident that the bracing is well-composed, what makes you think that any surgery would alter her gait if she does not have control of her musculature? If there is no conscious control, and the muscle function cannot follow any reproducible gait pattern, surgery in the form of tendon lengthening or repositioning cannot produce a uniform outcome. From the information we have been given so far, surgery cannot be approached.

Philip McKinney, DPM, Eugene, OR, opodiatry@oregonpodiatry.net

RE: Comminuted Fracture S/P Ex-Fix  (Name Withheld)
From: Sloan Gordon, DPM, Simon Young, DPM

Were elective procedures, i.e., the hammertoe repairs done at the same time as the fracture repair? In any case, the hallux needs to be fused with a single or double cannulated lag screw. The first metatarsal fracture needs to be reduced after removal of the ex-fix, likely with a locking plate. The 2nd hammertoe implant needs to be removed and the digit fused. 
 
You can place a medial ex-fix over the plate at the 1st metatarsal, and if the patient weight-bears AMA, likely the fracture won't dislocate.

Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net

This patient seems osteoporitic or osteopenic to me. X-rays show PIPJ fusions 2-5, and a Weil osteotomy to boot. Is it an ORIF fractured 1st met. vs. unstable surgical osteotomy? It seems that the ex-fix loosened with weight-bearing or wasn't stabilized properly during OR.  Remove or replace interfrag. screw or consider a buried K-wire. The osteotomy fracture should be reducible with ex-fix, then cast with complete off-weight-bearing. Call me old fashioned, but  why was so much work needed in one session?

Simon Young, DPM, NY, NY, simonyoung@juno.com

RE: Painful Hyperkeratosis in 87 Year Old (Multiple Respondents)
From: Jeff Root

I believe that Drs. Scartozzi and Meltzer have both made some excellent orthotic device recommendations concerning Dr. Udell’s 87 y.o. patient who suffers with pain-related to plantar displacement of her medial cuneiform at the base of her 1st metatarsal. Dr. Scartozzi recommended a hybrid (semi- functional/accommodative) type orthosis, while Dr. Meltzer has suggested that a Richie Brace might be appropriate if a plantar orthosis doesn’t provide sufficient control for this patient.

If Dr. Udell is considering either of these devices, I recommend further evaluation of the patient to help determine the most appropriate orthosis. In looking at the photograph of the foot, it appears that the lateral column is not structurally compromised, and the patient doesn’t appear to have a complete rocker-bottom foot type. What can’t be determined from the picture is how the patient functions and how she might be compensating during gait.

If her deformity and compensation occur primarily in the sagittal plane, then...

Editor's note: Mr. Root's extended-length letter can be read here.

RE: Choosing a Medical Billing Clearinghouse (Lori Weisenthal, DPM)
From: Marc Garfield, DPM

The questions to consider in choosing a clearing house are:

1. Is it compatible with your likely choices or present billing program?
2. Monthly fees
3. Ancillary services such as patient statements, credit card services
4. The most important consideration is whether or not the clearinghouse is compatible with ALL or MOST of...

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

RE: HIPAA Manuals (Ron Werter, DPM)
From: Raymond F. Posa, MBA 

The HIPAA manuals consist of two major parts: privacy and security. There are many “canned" manuals available, but at best, they can only be templates to work from. The privacy manual is easier to use because there is much less customization required. Security, however, is very technical and very specific to your practice, your building, your computers, your Internet, and your network. In my experience, this task is well beyond what any of the staff can do.

My recommendation is to always use a consultant to do your initial manual. This way, it is documented correctly and your compliance officer can be trained one on one. Going forward, it is then a matter of maintaining the manuals and logs, and you now have a relationship with a consultant who can be an ongoing resource. With mandatory fines for all violations, is it worth taking the chance? Just as with any other professional service, you wouldn’t get rid of your CPA or attorney and do all their work yourself, would you?

Raymond F. Posa, MBA, President, The Manta Group, rposa@themantagroup.com

RE: Sending Patients' Accounts to Collections (David Weiss, DPM)
From:  Robert Scott Steinberg, DPM

In so much as our fees are already deeply discounted, for the first time in my 34 years of practice, I am sending past-due bills to collection. Deciding factors: 1. Has the patient made any effort to respond to statements? 2. Was there any discussion with the patient as to problems the patient might have in paying the bill?

We wait 90 days, and if there is no response to our notice, we send the account to collection. This serves two purposes: 1. We do not have to send any more monthly statements. 2. I stop thinking about it, and when I do get money from the collection agency, it's like a present!

Robert Scott Steinberg, DPM, Schaumburg, IL, Doc@FootSportsDoc.com

RE: Homeopathy is a Safe Way to Complement Treatment Choices: IL Podiatrist (Al Musella, DPM)
From: Marc Katz, DPM

I don't really find the need to hate anything. That's counter-productive. You certainly have the right to practice with what you believe to be superior. And the physician in the article has the same right.  You are so correct when you state that podiatry is on the fringe. This is the only profession not embracing alternative and functional medicine. So, as with many other treatments, we will be left behind once again, and it will kick us in the behind one day. 

Notice how everyone is whining that we are no longer seen as the experts on orthotics.  So we missed that boat. Let's not miss the next big boat and watch the MDs, DOs, DCs, NPs, PAs, etc. run the show.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

Editor's note: The results of our poll (based on 167 responses) are as follows: 

Is homeopathy a legitimate treatment option for podiatrists? Yes 19%,  No 74%, Not Sure 7%

RE: The Affordable Healthcare Act of 2010 /Obamacare (Robert Bijak, DPM)
From: Jerry Falke, DPM

I hate to burst Dr. Bijak's bubble, but the United States Constitution contains two references to "the General Welfare", one occurring in the Preamble and the other in the Taxing and Spending Clause. It is this latter one that is generally referred to as the "General Welfare Clause."
 
While I agree wholeheartedly with his sentiments on this specific issue, i.e. ObamaCare, let's not cloud the issue by obscuring the facts.
 
Jerry Falke, DPM (retired), Hagerstown, MD, falkeg@hotmail.com

ASSOCIATE POSITION - ST. LOUIS

Multi-location group practice seeks motivated DPM with initiative and leadership skills to contribute to our growth.  Must be board eligible/certified. Practice enjoys strong reputation and name recognition. Established location available for PSR 36+ with incentive comp, benefits, coverage. Please send CV to jmurray@foothealers.com and visit  www.foothealers.com.

PODIATRISTS NEEDED - TEXAS, EASTERN, PENNSYLVANIA

Looking for podiatrists to cover three or four nursing homes in Eastern Texas (Rusk & Tyler). Also in Upstate New York (Syracuse and Buffalo) and Pennsylvania (Meadville, Hillsdale, and State College). AVAILABLE IMMEDIATELY. E-mail doconcall02@aol.com  

ASSOCIATE POSITIONS - NW INDIANA, CHICAGO AREA

2 Full-Time positions open - One for Northwest Indiana and one for the Chicagoland area. Must have 2-year surgical residency. Must be motivated and a self-starter. State License required. If interested email: f-massuda@footexperts.com

ASSOCIATE POSITION - MARYLAND

IMMEDIATE Associate needed to join a multi-office podiatry practice in the Baltimore MD Region. Desired candidate should be surgically trained with Board Eligible/Certification. You must be hard-working, ethical, compassionate and confident in your abilities to deal with pathology, patients, staff and fellow physicians. Patient base is already established. Excellent income and growth potential for the right associate. Please forward a cover letter, resume, and surgical log (if a current resident) and availability to FootDocMaryland@Gmail.com

ASSOCIATE POSITION - NYC, NY

ASSOCIATE OPPORTUNITY - FREDERICKSBURG, VA

Progressive, busy practice seeks personable, ethical, confident associate interested in future partnership. Lucrative opportunity for self-starter with strong work ethic. State-of-the-art office in rapidly growing community with two new hospitals and new surgery center. Practice has excellent reputation with well established referral base. Cover letter/CV to: fredfeet@verizon.net

ASSOCIATE POSITION AVAILABLE - NY

Busy Midtown Manhattan state-of-the-art practice with 2 locations seeking part time/full time associate. Must be in-network Empire BC/BS. Looking for a personable doctor with immediate availability. Residents Need not apply. DrB@myfcny.com

ASSOCIATE POSITION – PHILADELPHIA, PA

Philadelphia surgical podiatrist, seeking surgical or non-surgical trained podiatrist to help expand practice hours. Located in a busy medical building. Clinic area is multi-specialty. Looking for someone to work expanded hours, days and some Saturdays. Call 215-665-9225 Dr. Smith, fax CV 215-665-9242 or email mybadfeet1@yahoo.com
 

ASSOCIATE POSITION - KENTUCKY
 
Very well-established podiatry practice in Louisville, KY seeks a motivated, ethical practitioner trained in all phases of podiatry including routine care, surgery and wound care to join 2 other podiatrists. By joining our practice you will receive a competitive salary with a bonus structure and benefits. Our practice is equipped with DME, PadNet, Gait Scanner and on site retail store. There is a huge potential to grow your practice with our ideally located facility that has strong affiliation with leading area hospitals as well as 2 local residency programs. For immediate consideration, please forward CV to Samuel10530@yahoo.com

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION - DAYTON, OHIO

Join a well-established modern practice with an excellent reputation and referral base. Base salary $100,000 and benefits with a bonus structure. EMR, diagnostic ultrasound, all aspects of DME, Padnet vascular studies, and CO2 lasers. We seek a surgeon that is well trained, personable and motivated to join our group of 3 Podiatric Surgeons. Would like this individual to buy in the practice eventually. Please send resume to ohiodoctors@aol.com

EQUIPMENT FOR SALE - COOL TOUCH LASER
 
Cool Breeze Cool Touch CT3 plus laser used for ugly, unsightly, toe nail infections. Less than six months old. Great price won't last long. Considering a laser? We also have the Q- Clear Q- switch laser too. This laser is perfect for you. Dr. Zuckerman is in the Fort Lauderdale area and will demo this lasers on your patients. E-mail footcare@comcast.net

PRACTICE FOR SALE - NORTH DALLAS, TX

Reasonably priced. 26 year old solo practice, centrally located. Includes 1 Ritter & 1 Midmark chairs, Excel x-ray, electronic claims submission, website, all supplies and instruments. Retiring owner will stay for transition. Will consider owner finance. dallasfootdr@yahoo.com

PRACTICE FOR SALE - WASHINGTON STATE - SUBURBAN SEATTLE

16 year established part time practice. Includes Midmark 417 (4 position keypad), Excel X-ray, processor, Ritter M9, instruments, bandaids, etc. 1 Day/week $50K gross. Professional Business appraisal at $48K. Asking $35K. Shared office with 2 FP's. Easily expandable. Reply: practiceforsale18@yahoo.com

PRACTICE FOR SALE - MARYLAND, DC SUBURBS

Great opportunity. Well established and equipped practice for sale. Office includes state licensed Ambulatory Surgical Center. Present owner is retiring but will stay on as needed for smooth transition. Average gross over past 3 years is $575 K. dpmpracticeforsale@yahoo.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. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

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