The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

March 22, 2010 #3,811 Publisher-Barry Block, DPM, JD

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Properly Fitted Shoe are Essential to Good Foot Health: MO Podiatrist

Podiatrist John Holtzman of Missouri Foot and Ankle reminds us that happy feet are more important than we might realize. “Say you made a resolution to lose weight and get in shape. If your feet hurt, you can’t exercise,” he points out. “If you can’t exercise, you can’t lose weight. Any problem with the feet, such as heel pain, plantar fasciitis, forefoot pain or bunions, will keep you from exercising comfortably.”

Dr. John Holtzman

He also stresses properly fitted shoes. “I can write a prescription for the type of shoe you need, and if you take that to a store like Laurie’s or Seliga Shoes, they have orthotists on staff who can give you the fit you need,” Holtzman says. As far as sandals, he does not recommend wearing flip-flops for any length of time. Birkenstocks are great, as are FitFlops, which give good arch support in a sandal.

Source: Mary Jo Blackwood, Ladue News

AAPPM Announces 2010 President's Awards

At their recent annual meeting in Pittsburg, the American Academy of Podiatric Practice Management presented the prestigious AAPPM President’s Award for 2010. These awards are presented yearly to individuals that contribute unselfishly to help others improve their practices and their lives.

(L-R) Gary Adams, Drs. Jeffrey Frederick and Ira Kraus

In making the presentation, Dr. Jeffrey Frederick, president of the AAPPM, stated that "Ira. Kraus and Gary Adams have contributed countless hours toward helping others grow and prosper and because of their dedication on behalf of the AAPPM, they have earned this recognition for their tireless efforts.  The entire AAPPM family is extremely proud of both of them for all they have done, and continue to do in elevating the podiatry profession for all of us."

PA Podiatrist Receives Edward James Olmos Award

Warren S. Joseph, DPM, of Philadelphia, editor of the Journal of the American Podiatric Association has been selected as the 2010 honoree for the Edward James Olmos Award for Amputation Prevention.

(L-R)  David Armstrong, DPM, PhD; Edward James Olmos (actor); Warren S. Joseph, DPM; and George Andros, MD

The award was presented during the DFCon2010 Conference, which is attended by about 1,000 delegates from all 50 U.S. states and 40+ foreign countries. This three-day event is being held at the site of the Academy Awards®.

Alleged Failure to Diagnose Charcot Foot (CA)

Facts: In September 2006, plaintiff Kenneth Raymond Austin Jr., 48, a truck driver, was referred to defendant for diabetic ulcerations of his right foot. Austin sued defendant, contending that defendant failed to diagnose Charcot foot. Plaintiff's counsel presented evidence through a forensic document examiner that the defendant altered his records by re-writing the notes of each office visit.

Defendant's failure to make a timely diagnosis allegedly resulted in a poorer outcome than Austin would have obtained otherwise, as surgery could have been avoided if the foot had been placed in a non-weight-bearing status. It was the continued use of his left foot that caused fractures and dislocation, according to plaintiff's counsel. Counsel contended that the left foot condition had started by the time of the initial consultation with defendant on Sept. 20.

Defendant responded that the left foot injury had not occurred before Sept. 20. The defense podiatry expert showed bilateral x-rays taken by defendant on Sept. 20 that the left foot injury had not yet occurred. The tissue envelope evident in the films was normal and equal in both feet, according to defense counsel. Defense counsel asserted that, when the left foot dislocation subsequently developed, defendant immediately diagnosed the condition, immediately immobilized the left foot, and made Austin non-weight-bearing. He also obtained a CT scan and referred Austin to a podiatric surgeon with more experience in surgical treatment of Charcot foot.

Result: The jury found for the defense.

Plaintiff's Expert: Frederick Youngswick DPM, Novato, CA 
Defendant's Expert: Thomas Chang DPM, Santa Rosa, CA

Source: Verdict Source

Query: Plantar Plate Tear

I have a 61 year old female who has complained of chronic 2nd MPJ pain for six months. MRI was confirmatory for a partial lateral plantar plate tear. I have treated her for 8 weeks with splinting, NSAIDs, and OTC orthotics with no substantial improvement. Does anyone have any suggestions for further conservative care that might be successful to avoid surgery. If not, I was planning to perform a plantar plate repair.

Brent Rubin, DPM, Bradenton, FL

Query: One-Day Podiatric Seminars

Does anyone know of any one-day podiatric conference in the mid-Atlantic states area? 

Thomas Tran, DPM, Harrisonburg, VA

Editor’s note: Podiatry Management's website lists a variety of upcoming meeting. Click here to view current availability.

RE: Scanning vs. Casting for Orthoses
From: Paul R. Scherer, DPM

I read with some bewilderment, in the clinical studies section of the March issue of Podiatry Management, the abstract produced at Temple University, comparing scanning vs. casting for orthoses. I believe that the primary purpose and clinical standard for casting or scanning a foot for orthoses intended to restore a more normal foot function, is to capture the forefoot to rearfoot relationship. I was quite surprised this most important criteria for manufacturing functional orthoses was not included in the study comparison, and I question why. 

I am also quite surprised that orthoses in this study were made from a scan that does not capture the posterior surface of the heel. How could a laboratory cast correct or balance the forefoot varus or valgus without this important observation? Obviously, this laboratory skips this part of the orthotic manufacturing process. 

I am further surprised that the dimensions that were compared were only those that could be obtained by a photograph and did not include shape. Would a plantar and lateral photograph sent to their laboratory also produce the same orthoses?

The profession is well aware that there is a business relationship between the company that makes this scanner and the company producing these orthoses. This should have been disclosed in the abstract as well as the financial relationship with Temple University. Who funded the project? Considering the absence of the most important aspect of obtaining a cast for functional orthoses, the inability of the scanner to image the posterior heel, and the concealment of disclosures, I am most surprised that the IRB Committee of Temple University approved this project, or did they? Lastly, what possible value does this “comprehensive study” provide the profession?

Paul R. Scherer, DPM, San Francisco, CA, hpoc@aol.com

RE: Shelf Life of Phenol (Amy Wahl, DPM)
From: Susan Love, DPM,  Michael E. Munson, DPM

I had a large bottle of phenol which I used for my first 12 or so years of practice. I was always careful to close it tightly and never noticed any problem with dilution. All was well until the day one of my assistants dropped it on the floor (carpeted) where, still 3/4 full, it smashed into a thousand pieces. In a nutshell, the embarrassment and loss of revenue due to the evacuation of my ENTIRE medical building for the rest of the day, the men in HAZMAT suits, the hole in my carpet, the expense of hazardous waste removal and the DEP threatening me with severe fines were enough to get me to switch to NaOH!
 
Susan Love, DPM,  Howard Beach, NY, slovedpm@aol.com

I have wondered why we don't utilize compounding pharmacies more often. I'm not sure I even knew they existed when I was a student. Go down to your local compounding pharmacy, tell them you want X% phenol, and they will whip up any amount you desire. I think the bottle I have is 50 ml, about the size of a bottle of local anesthetic.
 
Michael E. Munson, DPM, Columbia, SC, bigmig19@yahoo.com

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

It is very clear to me and many other readers that Dr. Bijak finds himself in a profession that he doesn't want to be in. That is very sad and he should consider a career change rather than to lash out at his colleagues who enjoy treating their patients comprehensively. Podiatrists like Dr. Levine are using all of the tools that will help people to be pain free and enable them to resume their lives in a non-invasive way. Surgery certainly has its place, but as a last option. It turns out that Dr. Levine would have never had to go back and secure a further education and certification had podiatry never given up on footwear in the first place. Therapeutic uses of shoes began in the podiatric profession but as a result of thinking similar to that expressed by Dr. Bijak, podiatrists walked away from it. Of course the patient need never diminished, and the result is that an entire specialty (pedorthics) evolved.
 
The headlong push to make podiatry a surgical specialty will likely cause that to happen again with other podiatric tools. The last time I checked, over 85% of the patients seen by this profession have some biomechanical deficit or deformity. It's confounding to me why any podiatrist would choose not to be the foremost experts in understanding and treating these underlying causes. Dr. Bijak should attend the Orthopedic Foot and Ankle meetings (those laughing MDs), and observe all of the biomechanical content in their programs. Oddly, biomechanics is conspicuously absent from most podiatric conferences and continues to be diminished in the schools and residency programs. We study history to learn from it and not make the same mistakes over again. For those interested in learning more about biomechanics and the non-surgical tools to help your patients, I would strongly recommend Langer's seminar program (advertised above).
 
Jason Kraus, Executive Vice President, Langer Biomechanics, Inc., jkraus@langerinc.com

I was surprised by the "embarrassment" comment, regarding a DPM choosing to further his knowledge by becoming a CPed. 
 
As a point of interest, pedorthics is defined as the "design, manufacture and/or modification of shoes and foot orthoses, to alleviate foot problems caused by disease, overuse or injury".  Because of curriculum requirements, a CPed is the go-to resource for shoe fitting.  This very complex and very important facet of a patient's relief and/or recovery process should be learned from an authority and experienced firsthand, under supervision, until a high level of proficiency is gained.  Shoe fitting is not about a size.  It's about painstakingly matching a foot's three-dimensional shape, with consideration to its inherent function and desired biomechanical outcome, then relating this information to a properly fitting and functioning shoe.  In a perfect world, and the competitive factor being eliminated, a local DPM/CPed team (or individual) can be a tremendous force toward patient well-being in the community.     
  
Gene Ulishney, CPed, Parkland, FL, GUlishney@aol.com

Many of the responses about a  doctor dispensing shoes have been positive and others have been unsupportive.  We, as podiatrists, have  reached a point in the development of our profession where our individual practices are not carbon copies of each other. We all practice in different ways and offer different treatments. What is unproductive is when a colleague who opts to not perform a certain treatment such as  surgery, physical medicine, injection therapy, shoe therapy, etc. knocks those who do opt to render that service. I still remember a discussion I had 30+ years ago with an "about to retire" colleague who knocked all of us who were doing foot surgery. He said, "podiatrists had better send those cases to orthopedists who really know what they are doing."
 
This does not mean that we should refrain from discussing the merits of any particular new or old treatment. PM News serves this function well. What it does mean is that our profession has reached a point in time where not every doctor chooses to render every available service. Medicine and dentistry  has for years had true specialization. Podiatry is also maturing, and eventually we too will have recognized specialty practices within our community. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Let's Not Go There
From: John Purdy, DPM

One of my elderly patients with whom I enjoy talking when she comes for her visits, presented the other day with painful fissures in her fingers from doing dishes. She said she uses Vaseline to moisturize them, but it is not working. I told her she had a similar condition on her feet and that I could prescribe a moisturizer for her to use. 

I then stated, "I only treat the lower extremities, so where you put the lotion is up to you." She then replied, "Oh, Dr. Purdy, I'm way past all that now."  Suspending disbelief, I restated that I was prescribing the lotion for her feet, but if she used it on her hands, that would be of her own choosing. Unfortunately, my disbelief was no longer suspended when she confirmed she now understood what I meant.

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.

ASSOCIATE POSITION-BERKELEY, CALIFORNIA

We are seeking an energetic individual to join our multi-office practice in Northern California. PSR 24+ with a California license is required. Partnership position is possible with an excellent long term business opportunity for an enthusiastic and motivated individual. Please send resume to Mwolpafootdoc@yahoo.com

TWO YEAR FELLOWSHIP IN RECONSTRUCTIVE FOOT SURGERY AND RESEARCH

2-year fellowship at Beth Israel Deaconess Medical Center, a primary teaching hospital for Harvard Medical School. Fellows have clinic, perform complex reconstructive procedures (external fixation, flaps, Charcot reconstruction), and conduct clinical research (20%). Fellows train residents and receive appointment to Harvard Medical School faculty. Excellent salary/benefits. Program begins SEPTEMBER 1st, 2010. Must have completed PSR-36 or similar. Submit applications to: Dafny Suazo at dsuazo@bidmc.harvard.edu Include CV, letter describing goals and any research interests. Deadline: April 30, 2010. Beth Israel Deaconess Medical Center and Harvard Medical School are Equal Opportunity Employers.

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 - 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-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.

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

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