The Voice of Podiatrists

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March 27, 2007 #2,844 Editor-Barry Block, DPM, JD

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PM News would like to clarify our description of the reason stated for the withdrawal of APMA Resolution 13-07 (Single Certifying Board). The accurate statement is that representatives of APBS and ABPOPPM expressed a willingness to discuss board certification issues related to Vision 2015.

NY Podiatrist Offers Injury Prevention Advice

When a person walks, the foot absorbs more than one times the body's weight with each step. But during the regular pounding of running, the foot absorbs much more weight.
"You put two or three times your body weight on your foot," said Dr. Robert DiCaprio, a local podiatrist who is a member of the American Association of Podiatric Sports Medicine. "Sometimes, all that weight turns up on the ball of your foot."

DiCaprio said the first place to start when trying to avoid injury is to purchase sneakers with proper support, specifically strong arch support -- that, in turn, can ensure that joggers run with proper posture. Arch support helps align the body when running, he said. "Orthotics helps to not only align the bones in your foot, but the whole lower extremities," he said.

DiCaprio said runners can use a number of strengthening exercises for their muscles and ligaments. Toe lifts, he said, strengthen the calf, but also bolster the muscles in the feet. "You're in turn, strengthening the foot," he said. DiCaprio also suggested jumping rope to help strengthen the feet and legs.

Source: Mike Goodwin, Albany Times Union [3/25/07]

APMA HOD Day 1 -AM Highlights

The 87th Annual American Podiatric Medical Association’s House of Delegates (HOD) began with outgoing APMA president Dr. David Schofield presenting a State of the Association address. Schofield stated that the state of the association was excellent, and enumerated the many accomplishments of the association over the past year. One of the most significant achievements of Schofield’s administration was the historic meeting he arranged with the American Medical Association (AMA) and related organizations to discuss how podiatry could obtain parity with allopathic medicine.

Dr. David Schofield presenting the State of the Association address

The next speaker, William Hazlet, M.D., and orthopedist and board member of the AMA, clearly demonstrated the success of this monumental meeting by stating that podiatrists could achieve parity by demonstrating equivalent and measurable competence. Later in the afternoon, John Strosnider, D.O., president of the American Osteopathic Association addressed the HOD. Strosnider recounted the struggles which his profession went through to achieve parity with allopathic medicine, and offered to provide whatever help podiatry needed to achieve its goals.

Bylaws and Resolutions

The HOD voted to approve several bylaws, some of which modified the definitions and qualifications for the dues structure of podiatrists in the federal service, as well as those holding faculty positions. The HOD also approved a new 3-tiered structure for APMA organizations. A proposed revision to bylaws which would have allowed each specialty organization to have one vote at the HOD failed to achieve the two-thirds majority necessary for passage.

Dr. Harry Goldsmith presenting resolutions

Several resolutions, including 11-07 (Ethics in CME Programs) were passed. The remaining resolutions will be considered on Day 2 of the proceedings.

The following awards were presented during the first day of the APMA House of Delegates:

President’s Award – Andrew Feldman, Esq., General Counsel of the New York Podiatric Medical Association

Distinguished Service Medallion of the Federation of International Podiatrists- Glenn Gastwirth, DPM, Executive Director of APMA

The Distinguished Service Citations – Charles Bradley, DPM and Sheldon Willens, DPM, previous APMA presidents.

Query: Agent Orange Exposure and Peripheral Neuropathy

Has anyone out there had any experience with patients that were exposed to Agent Orange while serving in Vietnam that, years later, developed peripheral neuropathic symptoms?

I currently have a patient who served several terms in Vietnam as a medic, came home and slowly developed several signs of Agent Orange exposure (including two children with severe birth defects). He now comes to me with a history of approx. two years of neuropathic pain in all digits of his feet, with no history of systemic disorder or trauma. I am curious if this can be attributed to effects from the Agent Orange.

David Alper, DPM, Belmont, MA

RE: DFCon ‘07
From: Bret Ribotsky, DPM

I attended the DFCon '07 meeting in Hollywood, CA this weekend and thought I would offer my two cents. What a beautiful event, Dave Armstrong, arranged for the Miss USA pageant to occur at the same hotel, but even this distraction could not pull the full house away from the lecture hall. True leading experts with firsthand research offered in a friendly peer-to-peer format. MD's and DPM's demonstrated admirationand respect for each other throughout the event. Armstrong was a gifted moderator, truly cutting to the point and making this meeting on my never miss list for the future. Dave, brought up an interesting point during one of the sessions, "Maybe Osteomyletis is a mechanical disease (in the diabetic foot), cause by poor biomechanics" This was discussed and debated. Bravo to Dr. Armstrong - Podiatry's superstar !!

Bret Ribotsky, DPM, Boca Raton, FL, Ribotsky@doctorbret.com

RE: Acral Melanoma (Michael Vito, DPM)
From: Multiple Respondents

Dr. DeVito is asking what his level of involvement should be since he has done an incisional biopsy that established a diagnosis of melanoma, and he has set the patient up with an oncologist and surgeon. Most importantly, he may have saved the patient's life by doing what he has already done, even though the lesion is deep and has a poor prognosis. If he is hospital-based, there is no reason why he himself could not do the amputation while the general surgeon does the sentinel node biopsy. If he is not hospital-based, and can coordinate rapidly with the general surgeon, the same applies. If he is not part of the everyday hospital community, he should simply request operative reports and medical reports from the oncologist.

He should make sure that the patient will be getting total body skin exams. I have reviewed this subject extensively in the print edition of Podiatry Management in the Issues In Podiatric Dermatology Section in the January edition. It is entitled, Is Everyone on the Multi-specialty Team Doing Their Part?

Bryan C. Markinson, DPM, New York, NY, bryan.markinson@mountsinai.org

You did right by this patient. Malignant melanoma might start as a localized form of skin cancer but can rapidly become a systemic disease with consequences we are all aware of. Referring her to a surgeon who specializes in melanoma along with a referral to an oncologist is almost all you can do. The only thing remaining is to publish your findings in a peer reviewed journal along with a thorough history of the patient. That way anyone in the world doing research on this dreaded form of cancer can contact you for further information.

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

Recently I had a patient referred to me at our Wound Institute by his PCP for evaluation of a "blood blister / wound" to the plantar aspect of the right hallux at the level just distal to the IPJ. Aside from being mentally challenged the patient had an absolutely negative medical history.

I treated the area with a minor debridement, followed by Bactroban cream. I saw the patient back in one week and the area was absolutely no better and even looked mildly more erythematous. I then did an incisional biopsy too which returned "malignant melanoma, Clark's level 4 and Breslow's 2.4. I referred the patient to a foot and ankle oncological surgeon at MSK in NYC. We discussed the case and he recommended our general surgeon do a sentinel node biopsy as well as a complete 1st ray resection. The general surgeon and I performed the surgeries on the same day under the same general anesthetic. He injected the material the found the "hottest" inguinal lymph node and then took a few more for study. After he closed the groin area I then did the 1st ray resection. We followed the patient together weekly for about 4-6 weeks, then referred back to MSK for further treatment.

I would imagine that your treatment would be similar. I suggest that you all work very carefully together as a team with constant communication. According to the experts at MSK, 1st ray resection was the standard of care.

Frank Lattarulo, DPM, New York, NY, DOCLATT@aol.com

RE: Give Them A Taste of Their Own Medicine

Aetna has just asked me to refund forty dollars on a patient for an overpayment in September of 2006. They had increased the patient's co-pay, but paid us at the previous level. I wrote them the following letter.

Dear Sir/Madam:

I am receipt of your request for payment. Unfortunately, your request was received after my 90-day deadline for filing refund requests.

Thank you,

David Gutierrez, D.P.M.

You may not bill the patient.

I will probably still have to pay it at some time, but I sure feel better.

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 sher18@yahoo.com

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

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

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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