The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

March 18, 2010 #3,807 Publisher-Barry Block, DPM, JD

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Collagen Injections Can Ease Foot Pain: Scholl Podiatrist

Pain often strikes when we cram our feet into ill-fitting shoes, something women do more often than men, according to a survey by the American Podiatric Medical Association. It's also a common complication of a medical condition, such as diabetes, arthritis and obesity. Can collagen injections help foot pain?

Dr. Stephanie Wu

"High-heeled shoes and stilettos tilt up the heel bone (cancaneus) and subject the ball of the foot to support most of the body weight," said Illinois podiatrist Stephanie Wu. After a while, the pressure on the ball of the foot becomes painful. "The injection acts like an internal foot pad that follows the patient everywhere she goes and acts to mitigate pressure 24 hours a day," said Wu.

Source: Julie Deardorff, South Florida Sun-Sentinel via Chicago Tribune, [3/16/10]

WI Podiatrist Appears in Marine Recruiting Film

Appleton podiatrist Barry Erdman understands why an honorably discharged military veteran might have difficulty re-entering civilian life. A former Marine who transitioned from "corporal to doctor," the 48-year-old Erdman said it took him five years to "recivilianize" after a three-year tour with the Marines, including duty in Alaska and deployment in the Mediterranean Sea. Erdman and retired Marine Brig. Gen. Gerald Miller, a highly decorated flier who served two tours in Vietnam, were tapped for their views earlier this month for a recruiting film for the Marines.

Dr. Barry Erdman (Photo: Patrick Ferron)

Erdman said his main advice to returnees is to choose one's friends with care. "The No. 1 thing is to get in with the right group of people," he said. "If you don't get in with the right group of people, your tour in the Marine Corps can go down mighty quick." "And if you get in with the right group of people, even if you're mediocre, they will make you look better and inherently it'll get better." Erdman, who joined the Marines out of high school, said he chose to attend college and then seek a career in podiatric medicine despite a generous offer from the Marines to re-enlist.
 
Source: Pete Bach, Gannett Wisconsin Media [3/16/10]

NJ Podiatric Residents Collect Shoes for Haitian Earthquake Victims

Thanks to the help of the South Jersey community and podiatric residency program at Kennedy Health System, 1,674 pairs of shoes will go to those who need them. The three hospitals within Kennedy Health System participated in a three-week drive with Shoes 2 Share to help collect gently used shoes that will benefit, mostly the victims of the January Haitian earthquake.

Beth Reichman, assistant vice president of medical administration, said she saw a segment about Shoes 2 Share on television and decided to bring the local efforts to the hospital. "I thought it would be a perfect fit for our podiatry residency," Reichman said Tuesday as she stood by a massive pile of shoes. Reichman said the project started out with just the residents bringing in shoes, but then it grew to have other hospital employees bring shoes in, and then even community members who dropped off shoes at the three locations. The residents helped clean the shoes, sort them, bag them up, and deliver them to the Stratford location, Reichman said.

Source: Jessica Beym, Glouster County Times [3/17/10]
 

RE: Moldable AFO for Dropfoot (Ira Meyers, DPM)
From: Stanton C. Southward, DPM, Jeff Root

I advise counseling this patient on the superior benefits of walking. A pair of custom molded foot orthoses may be indicated. Running will probably put him at risk for other medical problems e.g. back pain. In fact, the heavier AFO may be beneficial as an exercise weight during walking.
 
Stanton C. Southward, DPM, Colorado Springs, CO, sbsouthie@comcast.net

Dr. Meyers might want to consider using a Richie Dynamic Assist Ankle Brace™ or the Richie OTC Dynamic Assist Ankle Brace™ for his patient with drop foot due to post-traumatic sciatic nerve damage. Both versions are a lightweight yet durable braces that utilize bilateral Tamarack hinges to provide dorsiflexion assistance at the ankle joint.

One thing that differentiates Richie custom AFO’s from other braces is the manner in which the foot plate is created. Dr. Richie advocates using a neutral position, and a suspension cast rather than a semi-weight-bearing cast of the foot. A non-weight-bearing cast preserves the plantar, non-weight-bearing contour of the foot so that a functional orthotic can be manufactured and attached to a pair of uprights to create a functional ankle brace. If the patient is capable of sustaining a running gait, then a functional type foot plate will act to support the osseous structure of the foot and can be designed to address any other neurological and functional deficits that may exist. 

Disclosure: I own an orthotic laboratory that is one of the Richie Brace™ distributor labs.

Jeff Root, President, Root Laboratory, Inc., jroot@root-lab.com

RE: ADA Comprehensive Diabetic Foot Exam Format (Mark K. Johnson DPM)
From: Stanton C. Southward, DPM

Based on my experience, a podiatric history and physical exam based on the chief complaint is essential. Using mats and sensors is an ADA suggestion and is not required nor a documented standard of care. The podiatrist's training and expert hands-on clinical skills will supersede mats and sensors. Patient compliance with take-home sensors will also be an issue.

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

Post-op Numbness Status Post-EPF (Frederic Schwartz, DPM)
From: Michael Forman, DPM
 
Dr. Frederic Schwartz asks about numbness following endoscopic plantar fasciotomy (EPF). The location of the first branch of the lateral plantar nerve (Baxter's nerve) lies very close to the origin of the plantar fascia at its attachment to the medial calcaneal tubercle. Despite meticulous dissection, this nerve can be damaged. It is my opinion that this is a foreseeable complication from any type of heel surgery such as EPF. Symptoms may include numbness and pain at the surgical site. An MRI can show atrophy of the abductor digiti minimi muscle. The patient may also exhibit an adducto varus fifth toe as a result of this muscle damage. This also is nothing new and is documented in our literature. My suggestion is that you document the position of the fifth toe before surgery as this "syndrome" can be present before surgery.

Michael Forman, DPM, Cleveland, OH, IM4MAN@aol.com

RE: The Passing of Eugene Feinberg, DPM

I learned yesterday of the death of Dr. Gene Feinberg, a man who, in my opinion, was one of the truly great leaders of your profession.  Gene was a stalwart of the Virginia Podiatric Medical Association and served as its Treasurer and Executive Director for many years.
 
Gene passed away on Sunday morning, at home, after a lengthy illness.  He was surrounded by his family and loved ones. There will be a memorial service for Dr. Feinberg at National Funeral Home at 10:00 a.m. on Sunday, March 21, 2010. The Home is at 7482 Lee Highway, Falls Church, VA, followed by a graveside interment at around 11:30 and a reception for those who wish to join us back at the funeral home thereafter.
 
Gene will truly be missed by those of us who had the pleasure to know him. All Honor to His Name!
 
Richard W. Boone, Sr., Fairfax, VA

RE: Volunteers Needed for Boy Scout Jamboree
From: Ed Williams, DPM

The 2010 National Boy Scout Jamboree is in need of volunteer podiatrists. This is the 100th anniversary of Boy Scouts in America. The jamboree will be held at Fort AP Hill in Virginia July 22 until August 4, 2010. Experience as a scouter is needed. 40,000 boys and girls and 6000 volunteers will be in need of podiatric care. This will be a great opportunity to have fun but also make a great PR impact for our profession. For further information call Ed Williams at 505-690-0266 or Neal Frankel at 312-372-3117. 

Ed Williams, DPM, Santa Fe, NM, Edward.d.williams@comcast.net

RE: CPME Document 320 (Tilden H. Sokoloff, DPM, MD)
From: Tim Vogler, DPM

I graduated in the 4th class at Des Moines University. At that time, our basic science curriculum was essentially equivalent to the DO curriculum. I chose my residency based on the large number of "medical/surgical rotations" included in our curriculum. I have never regretted having that broad background.  I have spent my entire career (now 19 yrs) treating diabetic complications, trauma, and complex deformities that I would otherwise not dream of treating without this background.

I do consider our profession a specialty within the broader confines of medicine; anything less does not do our professional knowledge and skills justice. We need to PRESERVE and EXPAND required rotations for students as well as residents. This critically important experience provides:  1) a knowledge base which builds upon their didactic experience 2) cumulative skill sets and, 3) interaction with "other" medical students and residents (need I explain the importance of this in building acceptance?). Our standards must remain incredibly high. Otherwise our profession will surely experience a decline in the skills and competency of new graduates, and our profession will be doomed to mediocracy and never achieve true parity.

Tim Vogler, DPM, Winston-Salem, NC, tav@yadtel.net

RE: Unscrupulous Billing of Routine Care (Brian Kashan, DPM)
From:  Michael Munson, DPM

Nothing amazes me more in my first 10 years as a podiatrist than how long we can talk about trimming toenails. Don't get me wrong, as my residency director once said, "sometimes after a few very tough patients, your are happy to walk in the next room and see an RFC patient!" Indeed, I take these services seriously and patients are thankful. What amazes me is that there is nothing in the practice of podiatry from a coding perspective that's as complicated as trimming a toenail. I love to tell my patients about the 40-page manual Medicare puts out on toenails and calluses. They get a kick out of it. 

I could not disagree more with Dr. Kashan when he states that RFC is "cut and dry." I can think of no better example than a recent posting to Codingline asking whether two absent pulses count as one or two findings. Well, here we are 10-plus years into this Q-modifier stuff, and wouldn't you know it, two well-regarded authorities disagreed on the answer to that question! Nobody knew the answer for sure! There was an article in Podiatry Management years ago about billing for routine care that asked several good questions. What exactly is "decreased hair growth"? Compared to my foot, 9 out of 10 patients qualify there. Is there anyone over 30 who doesn't have "skin discoloration" somewhere?  How could anything be more of a gray area than RFC? Is it illegal to ask the patient without a qualifying diagnosis whether they have "pain?" Is this pain from the ingrown side of the mycotic nail or the thickness, or both? Good grief. 

Michael Munson, DPM, Orangeburg, SC, bigmig19@yahoo.com

RE: Medicare Payment - Subtalar Arthroereisis
From: Lloyd S. Smith, DPM

The procedure has been formally submitted to CPT by APMA on at least one occasion and rejected by the panel. On another occasion, discussion occurred (and the code may have actually been submitted and rejected, I am not certain) and no code was formalized.  Unless there is solid evidence based on published research, AND, support of the AAOS (which has not been forthcoming), the code will have great trouble getting passed. 
 
Lloyd S. Smith, DPM, Newton, MA, lloydpod@yahoo.com

RE: Maryland Podiatrist Opens a New Shoe Store (Robert Bijak, DPM)
From: Multiple Respondents

I couldn't disagree more with the comments from Robert Bijak, DPM in which he states that podiatrists' "association with shoes, arch supports, and business....represents the entire problem with podiatry." In fact, I think the distancing that we have done with these useful services has hurt us as a profession. There is no question that many podiatrists have become the world's most excellent foot surgeons, and that having surgery as a tool at our disposal has contributed to our stature as the "go to" foot specialists in most areas of this country. But I also think that our training has been guilty of over-emphasizing surgery as the  "be all and end all" treatment in podiatric practice. The result of this over-emphasis has been our denigration of other treatment forms that have traditionally contributed so greatly to our value as a profession.

Why shouldn't a podiatrist go on for advanced training as an orthotist? Are these skills somehow beneath us? Baloney! They add to our skills. Why shouldn't a podiatrist offer shoes and arch supports to his/her patients? Frankly, buying such items from a podiatrist designed and supervised facility is an elite service that many patients highly value. If these practices embarrass Dr. Bijak and sicken him to his stomach, I would suggest that he re-examine exactly why his patients are coming to him. Patients come to us to solve their foot problem and relieve their pain...not for surgery.

Alan Sherman, DPM, CEO, PRESENT e-Learning Systems, asherman@presentelearning.com

Dr. Bijak is mostly correct. He and I can thank our college, ICPM, now Scholl, for turning out pedorthists. Further, DPMs thinking that they need to be pedorthists is a huge downgrade to our profession. Selling shoes? Not me. Making biomechanically correcting functional foot orthoses is ours, or was, but can be once again. Scanners and foam boxes allow even children to "take" an impression, as not much training is necessary.
 
Robert Scott Steinberg, DPM, Schaumburg, IL, Doc@FootSportsDoc.com

I could not disagree more with Dr. Bijak's statement about  podiatry's embarrassment from  association with shoes. The ONLY criteria should be if it helps the patient. I fail to see how this is different than my sleep apnea doctor supplying me with the CPAP machine and supplies.       

Dwight L. Bates, DPM,  Dallas, NY,  dlbates04@yahoo.com

Editor's Note: Dr. Ray McClanahan's extended-length letter can be read here. 

RE: $1,475,000 Settlement for MD's Failure to Diagnose Charcot Foot (Allen Jacobs, DPM)
From: Chuck Anderson, DPM

This reminds me of a patient who came in from rural Texas for his swollen foot. He was visiting a family member who was a patient of mine. Two months previous, he was placed in the hospital by his PCP and put on IV antibiotics. The swelling went down but reoccurred when he was discharged home on IV antibiotics. So, the doctor kept switching his antibiotics. When he saw me, I found out he never had an x-ray taken the entire time. I tell PCP's all of the time that x-rays are pretty cheap compared to hospitalization, IV antibiotics, and lawsuits.

Chuck Anderson, DPM, Norman, OK, andersonfoot@msn.com

ASSOCIATE POSITION - FLORIDA

Associate needed for a dynamic practice in the West Palm Beach, Florida  area. Preference given to a PSR 24+ training and must have a Florida license. Well-established practice, specializing in sports medicine, surgery and trauma. Excellent hospital privileges available. Excellent salary and benefits for the right candidate. Contact/Send resume to springwm41@aol.com

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.

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

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.com

ASSOCIATE 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.

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