The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

March 22, 2007 #2,840 Editor-Barry Block, DPM, JD

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NY Podiatrists Keep Rockettes Kicking

If getting in shape is your New Year’s resolution, take it from the pros. “Start with your feet,” says Manhattan-based Dr. Louis Galli, Jr., a podiatrist for Madison Square Garden/Rockefeller Center’s Rockettes.

Dr. Louis Galli, Jr

Dr. Galli believes many back, hip and knee problems can develop from faulty foot function. “The lower extremities act like a chain. If the first links—your feet and ankles--are unstable, chances are the other links—your knees, hip and back—may become unstable.

Dr. Galli and his associate Dr. Elisa Kavanagh begin the grueling show season with the Rockettes with an assessment of their feet. The assessment includes an analysis of gait. “Something as simple as how a person walks can reveal biomechanical difficulties,” says Dr. Galli. “When a dancer stresses her body, she often can’t afford to be sidelined.” According to Galli, a podiatrist can minimize pain and damage by changing the way a dancer’s foot moves. Dr. Galli often bandages, uses in-shoe supports and sometimes even casts a foot injury so a Rockette can keep performing.

Source: Gloria Smith

Patient Care Drives Location of Service: CO Podiatrist

Peter D. Schultz, a podiatrist with A Step Ahead Foot and Ankle Center in Loveland and Fort Collins who's had privileges at McKee Medical Center for 22 years, said it's patient care that drives where a physician ultimately requests privileges. "I do most of my cases in the surgery center in Fort Collins or at McKee if the patient has a condition that requires hospitalization or if their insurance requires it. Bottom line, it's usually cheaper (for the patient) at a surgery center than a hospital."

Dr. Peter Schultz

Making the procedure as convenient as possible for the patient also factors into the equation. What it boils down to, he said, is that the physician be available to his or her patients. "It might be more convenient for the patient to drive a quarter mile to a facility rather than 15 miles."

Without privileges at multiple sites, Schultz said, a physician might have to refer a patient to a physician who does have privileges if insurance requires that it be done at one center over another. "That's not economical for a patient who will have to start from scratch and get a whole new workup with X-rays."

Source: Luanne Kadlub, Northern Colorado Business Report [3/16/07]

Duct Tape Not Effective For Treatment of Warts: Study

Rachel Wenner, MD; Sharone K. Askari, MD; Peter M. H. Cham, MD; Deborah A. Kedrowski, RN; An Liu, MS; Erin M. Warshaw, MD, MS

Objective To evaluate the efficacy of duct tape occlusion therapy for the treatment of common warts in adults via a double-blind controlled clinical intervention trial.

Participants: A total of 90 immunocompetent adult volunteers with at least 1 wart measuring 2 to 15 mm were enrolled between October 1, 2004, and July 31, 2005. Eighty patients completed the study.

Intervention: Patients were randomized by a computer-generated code to receive pads consisting of either moleskin with transparent duct tape (treatment group) or moleskin alone (control group). Patients were instructed to wear the pads for 7 consecutive days and leave the pad off on the seventh evening. This process was repeated for 2 months or until the wart resolved, whichever occurred first. Follow-up visits occurred at 1 and 2 months.

Results: There were no statistically significant differences in the proportions of patients with resolution of the target wart (8 [21%] of 39 patients in the treatment group vs 9 [22%] of 41 in the control group).

Conclusion: No statistically significant difference between duct tape and moleskin for the treatment of warts in an adult population.

Source: Arch Dermatol. 2007;143:309-313. Submitted by Peta Minerof, DPM

Query: Walking Irons

Does anyone know how to get walking irons to incorporate in casts to off-load diabetic ulcers. We have used this in the past several times with decent success. Our one remaining walking iron is just about worn out.

Dan Greenan, DPM, Burien, WA

RE: Microvas (Chuck Langman, DPM)
From: Palmer Branch, DPM

Our group was also visited by a Microvas rep recently. He gave a similar glossy picture of the success rate of the product and a few anecdotal letters of good results in a few patients. I directly asked if there were any quality double-blinded, placebo controlled trials for the product and he admitted that there had not been any. The lease terms were a little expensive in my opinion as well for this type of product. The product only carries a one-year warranty, so if it breaks down you would have to pay a 3-year lease on a device that may not keep working three years.

With the Medicare cap on physical therapy, be sure that you are not exhausting a patients physical therapy allowance on a treatment of questionable benefit. There were also claims made that it treats a very wide range of problems of unrelated causes from PVD to neuropathy to non-healing ulcers. I am always somewhat skeptical of a product that claims to "cure all ills" like the classic "snake oils." I usually find it more of a miracle if these "miracle products" work. One note I would make is that there have been some promising studies on wound healing with other electrical stimulation products, but I personally find other treatments more beneficial in difficult wounds.

Palmer Branch, DPM, Chattanooga, TN, drcuboid@aol.com

RE: Neuroma Injection Denial (Lisa Maynard)
From: Michael M. Rosenblatt, DPM, David Secord, DPM,

Empire Medicare's refusal to allow CPT 64640 for neurolytic injection of Morton's neuroma and other forefoot conditions is a classic case of the insurer, whether it is Medicare or another, refusing to pay a fully legitimate, correct code, because they don't feel that podiatrists should be "earning" that kind of money for an injection.

This, to my way of thinking is simply "gaming" by the insurer in order to penalize doctors of podiatric medicine for their degree, and is therefore improper and despicable.

I believe that this should be fought by every legal means possible.

Michael M. Rosenblatt, DPM, San Jose, CA, ROSEY1@prodigy.net

I find it interesting that we re-invent this wheel every couple of months or so. The most succinct answer as to whether CPT 64640 should be used for prolotherapy injections to intermetatarsal neuromas is from Codingline (although it deals with BCBS of Michigan):
“Codingline Responses: Blue Cross and Blue Shield of Michigan is not denying payment for CPT 64640 (destruction by neurolytic agent; other peripheral nerve or branch), but has issued a policy whereby the service is only paid once.

The explanation was the service destroyed the nerve, and, therefore, subsequent nerve destructions were not needed.”

So, following this vein of thought, if dilute absolute alcohol injections are given as a series, is it not the case that the dilution is therefore not sclerosing the nerve and doesn’t meet the criteria for CPT 64640?

David Secord, DPM, Corpus Christi, TX, David5603@pol.net

Woman Grows Nipple on Foot

A 22-year-old woman sought medical care for a lesion in the plantar region of her left foot, a well-formed nipple surrounded by areola and hair. Microscopic examination of the dermis showed hair follicles, eccrine glands, and sebaceous glands. Fat tissue was noted at the base of the lesion. Clinical and histopathologic findings were consistent with the diagnosis of supernumerary breast tissue, also known as pseudomamma. To our knowledge, this is the first report of supernumerary breast tissue on the foot.

Nipple on Foot

These supernumerary breasts can pop up all over the place, including the face, back, and thigh (and foot, obviously). They can be functionally complete, and can even lactate. The authors report some weak and sometimes contradicted associations with other oddities, but no causal mechanism is known. These cases of autonomous self-organization and recruitment of organs are extremely interesting—it suggests that a breast would be a fairly easy tissue to grow in a dish.

Source: Dermatology Online Journal via HealthRelatedInfos, Submitted by Richard Rettig, DPM

ASSOCIATE POSITION – CENTRAL NEW JERSEY

Associate Wanted....For well established Central Jersey practice, diversified in all aspects of podiatric medicine and surgery. I am looking for a highly motivated, conscientious, individual with strong work ethics. My practice may offer great potential for the right person. Minimum PSR 24. Please reply to Jerseypod@gmail.com

ASSOCIATE POSITION – HOUSTON, TEXAS

Lepow Podiatric Medical Associates looking for board certified podiatrist to join their six location group practice in Houston. Competitive salary and benefits. Email CV to lepowft@cs.com

SEEKING RESIDENT FOR PSR-24 POSITION: BALTIMORE, MD

Mercy Medical Center Position for a highly motivated individual with completed non-surgical residency or one desiring additional surgical training in well-established Podiatric Residency Program. Busy metropolitan hospital with high surgical numbers and inpatient care. Resident is integral member of multidisciplinary team. Begins mid June 2007. Includes competitive salary/benefits. Send inquiries to rsher18@yahoo.com

ASSOCIATE POSITION AVAILABLE - OCEAN COUNTY, NEW JERSEY

Immediate position available. Desiring a hardworking, ethical, motivated and well trained individual. Minimum PSR 24. State of the art practice offering EMR, digital xrays, ultrasounds. Must be willing to do all aspects of podiatry. Competitive salary and benefits package. E-mail CV to NJFEET@aol.com

PRACTICE FOR SALE SAN DIEGO, CALIFORNIA

5 y/o LaJolla Ca (San Diego) office collecting $289.5K with mostly soft tissue office procedures, biomechanics, general care, and no HMOs. Affluent community with great schools. Major opportunity for growth. Selling due to age and health. Call 858-405-4780 before 8PM PDT. Serious only, please.

ASSOCIATE POSITION - SANTA FE, NM

Established, 30 year practice with multiple office locations looking for a PSR 24/36 trained, hardworking, personable, ethical, highly motivated individual for associate position with immediate partnership available. E-mail CV and reference letters to sfpodiatry@aol.com

ASSOCIATE POSITION- MINEOLA, NY

Excellent opportunity in fast-paced well-established podiatry practice for full time associate, all phases of podiatry including surgery, biomechanics, orthotics and routine foot care. Begins July 2007. Includes competitive salary and benefits. Please send CV and letter of interest to: cfcsteve@optonline.net

WELL ESTABLISHED PODIATRY PRACTICE IN MT. AIRY, NC

Dr. John H. Hodges had a well established practice in Mt. Airy, NC that is either for sale or in need of an associate/partner to take over patient care. Dr. Hodges unexpectedly passed away, leaving approximately 3,500 patients. This is a unique opportunity to be able to begin work in a busy podiatric practice. If interested, contact Carolyn McMackin at (336)577-2886 or cmcmackin@triad.rr.com

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

PRACTICE FOR SALE MICHIGAN-DETROIT AREA

Michigan practice Detroit western suburbs for sale. 3 offices, great locations & high gross, buy outright or over time. Call 561-213-9400 after 7:00 p.m.

ASSOCIATE POSITION SE MICHIGAN DETROIT SUBURBAN PRACTICE

Busy podiatry group looking for associate interested in future partnership. We have a progressive team-orientated practice. Well-established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a surgical center. New third office being developed on hospital campus. Must be BQ/BC. Minimum PSR/24. Competitive salary and benefits. E-mail CV to jeffsz@msn.com

PODIATRY OFFICE FOR RENT – TUCSON, AZ

Shared space with podiatrist signage already in place for ten years. X-ray, processor, and all furnishings in place. Put your chair in and open for business. Contact Dr. Parks at 520-544-2445 or e-mail parksovc@aol.com

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

ASSOCIATE POSITION - NORTHERN VIRGINIA

Well-established, busy, diversified, multioffice/multidoctor practice seeking associate with opportunity for partnership. Must be highly motivated and ethical with strong interpersonal and patient skills. Excellent opportunity for PSR 24 or higher trained DPM to complement a full-scope podiatric medical and surgical practice. Competitive salary and benefits package. Please send CV and references to saglag2@aol.com or fax to (703) 368-5103.

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City. Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

ASSOCIATE POSITION - VICTORIA, B.C. CANADA

On beautiful Vancouver Island, 3 office practice. Full scope practice, owner near retirement. Future buy-in Exams for B.C. given in June. Willing to sponsor for immigration. Dr.Cole@shaw.ca 1-250-516-7440

PODIATRY PRACTICE FOR SALE - PRIME LAKES AREA, MN

Great place to live and raise a family. 400+K yearly gross with continued growth and potential. Good mix of general podiatry and surgery. Hospital privileges available. Fully computerized, electronic notes with capability to go completely paperless. Recently remodeled office, 5 tx/procedure rooms, well equipped in owner occupied building (for sale or lease). lakespod@charter.net

ASSOCIATE POSITIONS - VIRGINIA

Immediate/July full time associate positions available. Unlimited income potential. Busy, diverse, 40+yr Hampton Roads practice. Must be compassionate; energetic; and motivated; PSR24/36. Looking for long term arrangement. Please send letter and CV to fixafoot@cox.net or fax to 757-397-5889; www.podiatryltd.com

ASSOCIATE PODIATRIC SURGEON POSITION - TEXAS

We are looking for an exceptionally trained podiatric surgeon to work in the Houston, Texas area. Candidates seeking this opportunity need to be dynamic, people friendly, and have current licensure in Texas. Future licensure in Arizona will be required. Exceptional opportunity, with attractive benefits, and excellent starting salary. The successful candidate will find a rare opportunity to integrate into a specialized lower extremity practice with emphasis on peripheral nerve surgery, endoscopic and arthroscopic surgery, and other special surgery of the foot and ankle. Please submit a cover letter with current curriculum vitae via email to: Slb99@pdq.net Stephen L. Barrett, D.P.M., MBA

PRACTICE FOR SALE - BUFFALO, NY

Part Time Practice with full growth potential. Mi of conservative, biomechanics and diabetic foot care. Great surgical potential. Gross 180K. Willing to stay through transition. Call 716-836-8123.

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