The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

March 26, 2007 #2,843 Editor-Barry Block, DPM, JD

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High Heels Will Always Pose a Problem: Markinson

More women wearing higher heels means more serious foot problems. Just ask podiatrist Dr. Bryan Markinson. "It would be fair to say that we are seeing problems related to this type of footwear on a more frequent basis," he said.

Dr. Bryan Markinson

Dr. Markinson says that while cushioning can take some stress off the front of the foot, heels that high will always pose a problem. "The heel height is really key in terms of the mechanics of the foot and normal walking," he said. "It just wasn't designed for such a high heel."

Source: WABC-TV [3/21/07]

Non-Weight-Bearing Leg Generates Momentum: OH Podiatrist

According to Stacy Osborne, an avid runner and podiatrist in the Cincinnati area, many of us ignore the importance of fine tuning our biomechanics – one of the most controllable aspects of our training and keys to improvement.

Dr. Stacy Osborne

Contrary to popular belief, it is not the leg on the ground that is primarily responsible for generating the power for forward velocity. Rather, it is the non-weight bearing leg (the one in the swing phase), which generates the momentum, by creating a tug on the runner’s center of gravity as it swings forward. The foot on the ground acts as a lever and the runner is thus propelled forward. Those muscles responsible for this “power stroke” are the hip flexors. These are also some of the most important muscles for cyclists, recruited during the pulling up phase.

Source: McCracken and Mike Ricci, Triathlete [3/24/07]

DME MAC C Transition

All podiatrists in DME MAC C (AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, PR, SC, TN, TX, and the U.S. Virgin Islands, should immediately invest some time in reading about your transition from Palmetto to Cigna as your DME MAC carrier. This will also affect those in VA, and WV who will eventually be transitioned from Administar (National Gov't Services) from DME MAC B to DME MAC C.

This information can be found at:https://www.cignamedicare.com/transition/index.html. Look for the link for the newsletters on the right hand margin, and click on the March PDF file.

This newsletter contains information on the transition from Palmetto to Cigna as the DME MAC contractor. One can find information on signing up for electronic fund transfer, electronic claim submission and other extremely important and timely issues. There is also information on upcoming "Ask the contractor" telephone conferences and the ability to sign up for updates via an elist news serve.

For those in VA and WV, while Palmetto will no longer pay your claims they will serve as your electronic gateway to claims submission (at least for now), and the ability to take the opportunity for early testing and transition etc. Further information for VA and WV suppliers may be found at: http://www.adminastar.com/Providers/DMERC/ContractorReform/files/vawvanewsubmitterletterforngs.pdf

Source: Cigna Gov't Services & Administar (National Government Services) via Dr. Paul Kesselman

Query: Enlarging Hallux Lesion

A 60 y.o female was referred by her PCP for enlarging mass on hallux ~1.5cm x 1.0cm. over the last 2 months.

acral lentigious melanoma

I performed an immediate incisional biopsy reported as acral lentigious melanoma, not invading fat, Breslow 2.6 mm., Clark level IV. I then referred her to an oncologist for work-up, who has recommended PET scan and sentinel node biopsy. She is scheduled for a wide excision at the MPJ level by a specialist surgeon, who will perform both at the same time. What level of involvement by me is recommended in this case going forward.

Michael A. DeVito, DPM, Oak Lawn, IL

RE: Post-op Respiratory Depression Following Opiate Administration (David Weiss, DPM)
From: Paul Kesselman, DPM, Elliot Udell, DPM

I asked Dr. Ave Gold whether there is a risk of respiratory depression with post-op Demerol and sleep apnea. He is a critical care and pulmonary specialist at Stony Brook’s teaching hospital and directs all of the sleep study clinics at that institution. Dr. Gold conveyed to me that if you have an obese patient with a bona fide case of sleep apnea, you might opt to exercise caution and use a nasal airway during surgery. This passes the back of the tongue. He also said that if the patient is intubated, make sure the patient is wide awake before taking out the airway.

He did say, however, that there are no hard statistics that show a greater risk for sleep apnea patients with post op medications or even surgery. He said to me that he has treated at least two thousand patients with sleep apnea, and many of them have had major surgery and obviously survived. He also pointed out that sleep apnea is more common than we realize, and it is highly likely that we have all operated ithout sequelae on patients with sleep apnea.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

I agree that asking about respiratory disease especially for patients undergoing surgery or for those we are prescribing narcotics or muscle relaxants is extremely important. I had a very close call last week with a 105 year old mentally astute patient status post a partial foot amputation.

The anesthesiologist and I were quite concerned over a patients regular breathing pattern exhibited regular cessation every 30 or 40 seconds for 2 to 4 seconds. In discussing the appropriate post-operative pain management, we were both reluctant to give the patient the normal dose of narcotics and the patient was adequately treated on pediatric dosages of acetaminophen w/codeine. This was pointed out to the internist and was well documented in the pre and post operative notes, several progress notes, and in the anesthesiologists record of surgery.

My discharge note indicated a similar pediatric dosage of acetaminophen w/codeine was written. The patient was discharged from the hospital by the medical attending, after my discharge note was written on Oxycontin. Both the patient and his daughter were astute enough to contact me about this prior to the patient taking this medication.

Fortunately my instructions to patients upon discharge are very clear: Any medication prescribed by any other doctor having to do with foot pain should be cleared by me.

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

RE: NAOMI Digital Imaging (Wes Daniel, DPM)
From: Palmer Branch, DPM

I also have looked into NAOMI for digital x-rays. I am getting ready to open a solo practice and the cost savings on space and the film, chemicals may offset some of the equipment costs. By no means am I any type of expert on digital x-rays. From what I understand, NAOMI is fairly new to the US market. There are a variety of suppliers of digital x-ray processors (Reina, NAOMI, and another through Gill Podiatry) many of which can work with your present equipment.

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

RE: Massachusetts - Commonwealth Care
From: Lloyd Smith, DPM

It is not yet clear that podiatry services will be fully covered to the limits of our license in the new Commonwealth Plan. The Massachusetts Podiatric Medical Society is working hard to determine the coverage, and insure that all medical and surgical services provided by podiatrists are covered.

There is still ongoing debate on the costs, coverage criteria and implementation timetable of this plan. It certainly seems that something will be implemented but it could be something different than what is being proposed. Attempts to determine a fee schedule for physician services have not been successful.

Lloyd S. Smith, DPM, Newton, MA, lloydpod@yahoo.com

Super Splinter

Adam Landsman, DPM, PhD. Boston, MA

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 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 - 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 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

ASSOCIATE WANTED - BOCA RATON-DELRAY BEACH AREA

Full time for growing practice-surgical training a plus-hard working a real plus-opportunity of a lifetime-partnership after 1yr. Need Florida license. Fax resume to 561-865-2225

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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