The Voice of Podiatrists

Serving Over 10,800 Podiatrists Daily

March 18, 2008 #3,196 Editor-Barry Block, DPM, JD

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NY Podiatrist Provides Advice for Toddler Shoe Buying

"Toddlers grow so rapidly, you have to have a shoe that fits properly, has room for growth and is very flexible,"said Dr. Michael Pliskin, chief of podiatry at North Shore University Hospital in Manhasset. "The most important thing initially is that there is no irritating factor. The shoe shouldn't be too tight or rub anywhere," he said.

Dr. Michael Pliskin

If you think you can properly size a shoe yourself, adhere to the following guidelines, Pliskin said. Take the shoe in your hand and bend it -- it should bend right at the ball of the foot, Pliskin said. "If you can't bend it in your hand, you should not buy the toddler that shoe," Pliskin said. Then put the shoe on the child and be sure that when the child walks or runs, the shoe is bending at the ball of his foot. That would ensure the best fit, Pliskin said.

Pliskin recommends a canvas or leather shoe, rather than synthetic material that doesn't breathe well. He also recommends a rubber or leather sole. "My rule of thumb is the earlier the stage of walking, the thinner and more flexible the sole should be."

Source: Erie-Times News [3/16/08]

Texas Appeals Court Overturns Scope of Practice Definition

Although the Texas Podiatric Medical Association (TPMA) and the Texas State Board of Podiatric Medical Examiners were initially successful in defending the ankle as being within the scope of practice, they were handed a setback on Friday as the Texas Court of Appeals reversed the lower court’s decision.

In their decision the Court said “The statutory authority currently in place limits podiatrists to the treatment of ‘the foot.’ While it may be difficult to define that term for purposes of treatment, whatever the term means, it is clear that "the foot" does not include the full portion of the body included within the definition in the Rule. Compelling arguments might be made as to whether--from a medical standpoint--it is reasonable to allow a practitioner treating the foot to consider and treat other anatomical systems that interact with and affect the foot. This is a debate to be had at the legislature.”

A gloating Texas Medical Association (TMA) President William W. Hinchey, MD commented “I’m glad the appeals court recognizes that the proper medical care of patients is too important to be left to people who are not adequately trained to perform certain medical procedures. If people wish to practice medicine, they should attend and complete medical school.”

Read the decision at: http://www.3rdcoa.courts.state.tx.us/opinions/HTMLopinion.asp?OpinionID=16620

Many Ankle Complaints are Actually Foot Problems: GA Podiatrist

Dr. Alan S. Rothstein says that when folks complain about their ankles, he usually suspects something else. “Usually people are talking about joints that roll when they stand. That’s not ankle, that’s foot,” he says. And that could call for a stronger heel counter, [a device in the heel area of the shoe which minimizes pronation] or a different wedge that better supports the foot.”

Dr. Alan S. Rothstein

Tendinitis sufferers sometimes use an elastic ankle support that wraps or slips over socks and helps to avoid pressure from the top of the ankle. If it truly is an ankle problem, an orthotic insert may be necessary. It’s made from an impression of the foot and gives flexible support.

Source: Adrianne Murchison, The Atlanta Journal-Constitution [3/13/08]

Senate Bill Aims to Stop Scheduled Doc-Payment Decrease

Sen. Debbie Stabenow (D-MI) has introduced legislation that would halt any cuts to Medicare physician payments over the next 18 months. The measure would begin on July 1, staving off a scheduled 10% cut to physician reimbursement. Instead, physician payments would remain at their current level for the rest of 2008, and in 2009 see a 1.8% increase. Temporary halts to these types of payment reductions—triggered by Medicare’s sustainable growth rate formula—have been implemented frequently by Congress over the past five years.

The forthcoming 10% cut “will be a disaster for Medicare patients as 60% of physicians say it will force them to limit the number of new Medicare patients they can treat,” said Nancy Nielsen, president-elect of the American Medical Association, in a written statement. According to Nielsen, the proposed payment increases in the Stabenow bill adequately reflect medical-practice cost increases. In addition, the 18-month time frame “will inject some stability into the system for seniors and physicians forced to make difficult practice decisions because of planned payment cuts.”

Source: Jennifer Lubel, Modern Healthcare, [3/14/08]

Query: EMR/Digital X-rays

I enjoyed the article about Dr. Girvan and his success with the use of an EMR tablet and digital x-ray in his office. I was wondering if Dr. Girvan would like to comment on the name of the EMR and digital X-ray companies he is now working with and his experiences and costs associated with the project. The readership would most likely be interested.

Bruce Krell, DPM, Chandler, AZ

Response: We became paperless three years ago. Operating our office electronically has taken a significant commitment from the physicians and my staff.

In 2002, I expanded my office to six treatment rooms with essential wiring to all treatment rooms and workstations for a computer network. Development of our system began in December 2004 when I purchased a server, several computer terminals and Tigerview software for digital x-rays. In April 2005, we implemented Nterprise a scheduling, and billing software from Allscripts. A month later we started using TouchChart, an EMR that integrates with Nterprise. I now have twelve computer terminals in my office, a server, two high speed scanners and two tablet pc’s. I can access my server from home or any computer with Windows XP. In a two-year period I spent $77,000. With two doctors we had 5 employees. I estimate the system saves us $45,000 per year in employee costs. Financing this system for 5 years costs about $1,500 per month. Significant cost savings would be seen in an office of 3 or 4 doctors.

Being computer literate or having an employee who is, makes this transition easier. This has been a great investment in my practice. I admit that implementation was not easy but 3 years into this, I would never go back to a paper chart. I sold my last of 7 chart racks last month!

Ross J. Girvan, DPM, Fredericksburg VA, ross.girvan@verizon.net

RE: Alleged Failure to Order Bone Density Test
From: Kenneth Meisler, DPM

Editor’s note: Read this extended-length letter at: http://www.podiatrym.com/letters2.cfm?id=18488&start=1

RE: APMSA Silent Auction
From: Dorothy Cahill McDonald

The American Podiatric Medical Students' Association (APMSA) seeks prize donations to benefit the APMSA Scholarship Endowment Fund within the APMA Educational Foundation. The 16th Annual APMSA Silent Auction will be held in Hawaii, July 24-28 in conjunction with the APMA Annual Scientific Meeting.

The APMSA Silent Auction features items such as office equipment, podiatric medical supplies, vacation trips and homes, educational materials, sports and entertainment tickets or memorabilia, professional services, gift certificates, seminar registrations, and many other items and services.

Auction donations made prior to June 1 will be publicized in APMA News and Silent Auction promotions so that donors receive maximum recognition.

Donations are tax-deductible to the extent permitted by law. Proceeds will provide scholarships for podiatric medical students. For more information or to donate a prize, please contact APMSA Executive Director Dorothy Cahill McDonald at apmsadcm@apma.org or (800) 275-2762 x263

RE: Painful Nails in Patient With Raynaud's Disease (Barry Wertheimer, DPM)
From: Bryan C. Markinson, DPM

Editor’s Note: This extended-length letter appears at:
http://www.podiatrym.com/letters2.cfm?id=18497&start=1

PART TIME PRACTICE W/ PROPERTY FOR SALE, BLOOMFIELD, NJ

Very busy 3 days/week. All modern equipment including digital x-ray and recently remodeled office suite. Office over 1300sf with 3 treatment rooms, large consultation room and second private office suite with full bathroom. Located in a professional building with plenty of parking on a main road. Bus stop in front. 2 blocks off Garden State Parkway. Please contact doccapo@yahoo.com

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