The Voice of Podiatrists

Serving Over 10,800 Podiatrists Daily

March 27, 2008 #3,204 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2008- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Don’t Blame Everything on Killer Shoes: NC Podiatrist

Don’t blame everything on those killer shoes. “Foot problems don’t come from the footgear; they come from the mechanics of your foot type,” said Sandra Sheehan, a podiatrist at Cape Fear Podiatry Associates in Fayetteville. “Let’s say you have a developing bunion concern, or an irritation on the top of your toe where it is starting to rub; now the style shoes that you wear can aggravate that condition,” Sheehan said.

Dr. Sandra Sheehan

There’s also the risk of inflammation of the joint, Sheehan said. The symptom is pain across the ball of the foot under the second toe. “The majority of body weight is pivoting on that one spot, and the foot is not designed for that,” Sheehan said.

Calluses and corns aside, Sheehan said, injuries are a bigger concern. “If you come off the curb the wrong way, not only are you going down, but you can snap your ankle like there’s no tomorrow, not to mention your knee, your hip or your shoulder,” Sheehan said. “I don’t care how sexy your outfit was that day with those platform shoes; when you go down, it’s going to be ugly.”

Source: Hilary Kraus, Fayetteville Observer [3/24/08]

Two GA Podiatric Surgeons Internationally Recognized

For over 30 years, Alan Banks, DPM and John Ruch, DPM have been devoted to excellence in patient care and advancing podiatric medicine and surgery. As teachers, surgical innovators and medical authors, Dr. Banks and Dr. Ruch have been involved in training thousands of podiatric surgeons. Their practice in Tucker, GA is an international referral center attracting the most complex foot and ankle cases for evaluation and treatment. “The unmatched talent and dedication of these two surgeons has established them as respected icons in the podiatric profession,” says Dr. David Helfman, CEO of Village Podiatry Group.

Dr. Alan Banks

Dr. Banks has lectured extensively in the United States and Europe . He has published over two dozen chapters for medical textbooks, as well as, articles for medical journals. Dr. Banks was chief editor of the third edition of McGlamry’s Comprehensive Textbook of Foot and Ankle Surgery, the standard reference text in the profession. He has served as an editorial advisor to the Journal of the American Podiatric Medical Association and is currently a member of the manuscript review panel of the Journal of the American Podiatric Medical Association and the Journal of Foot and Ankle Surgery. Dr. Banks is Director of Residency Training at DeKalb Medical Center.

Dr. John Ruch

Dr. Ruch has authored numerous medical articles, textbooks and been a major contributor to McGlamry’s Comprehensive Textbook of Foot and Ankle Surgery. He has served as an educator and lecturer for hundreds of medical courses throughout the U.S. and Europe. Dr. Ruch pioneered the application of AO Screw Fixation in the foot in 1976, techniques that are taught to virtually all podiatric surgical residents across the country. Dr. Ruch previously served as Director of Residency Training at Northlake Medical Center. He is Director of Medical Education for The Podiatry Institute, an internationally recognized teaching foundation for reconstructive foot and ankle surgery in Atlanta. Both Dr. Ruch and Dr. Banks are senior faculty members of the Institute.

Source: Atlanta Hospital News [March 2008]

Foot Care for Children is Theme for April Foot Health Awareness Month

April is Foot Health Awareness Month and podiatrists across New York are making pediatric podiatry the focus of their public outreach activities. “As early as birth, foot complications can present themselves in children,” remarks Dr. Robert Rampino, president of the New York State Podiatric Medical Association, the largest statewide component of the American Podiatric Medical Association.

Dr. Robert Rampino

Some complications, such as flatfoot and ingrown toenails, can be inherited or caused in the womb. Others can occur as children begin their walk through life, from the occasional fall to an injury suffered playing a sport. “No matter the cause or severity of the problem, the health of a child’s feet should not be taken for granted, he says.” However, according to an American Podiatric Medical Association (APMA) survey of parents with children under the age of 18, only 35 percent said that they would not be motivated to take their child to a doctor’s office for foot or leg pain treatment. Furthermore, only 25 percent of those surveyed would take their child to see a podiatrist—a foot and ankle specialist.

Query: Collagen Fillers

Can anyone share information on your experiences with collagen fillers, such as Restylane, etc. From my understanding, these products are not being marketed to podiatrists, nor are they FDA-approved for our use of these products. How are podiatrists buying these fillers? How often are the injections given and what complications have occurred?

Liana Seldin, DPM, Homestead, FL

RE: Is Penlac the Standard of Care? (Jeffrey Kass, DPM)
From: George Jacobson, DPM, Steven H. Goldstein, DPM

I hate to open up this "can of fungi", but my opinion is that no topical antifungal should be the standard of care. I believe that the success rate with home remedies, OTC and Rx products is so poor (exception white superficial onychomycosis) that the standard of care is to educate the patient. Debridment so that the patient can wear closed shoes without pain is the standard of care. Topicals are ancillary and required for regulatory compliance. I prefer total matrixectomies.

George Jacobson, DPM, Hollywood, FL, fl1sun@msn.com

My opinion is that Penlac is not the standard of care as it certainly has very little effect if any on a thickened hallux toenail even if onychomycosis is present. Many insurance companies will not cover Penlac under their formulary guidelines. Does anyone remember that when it first came out it was advertised as for treatment of onychomycosis then somewhere along the line the advertising changed to mild to moderate cases with a minimum of 48 weeks worth of therapy. Most patients are somewhat non-compliant and will never treat that long. Again the issue becomes are we talking about a clinical or mycological cure? In my practice, taking a fungus culture initially and then taking one further down the line 6-9 months never produced a mycological cure. You are probably better off using a rotary drill and grinding the thick nail down to help your patient.

Steven H. Goldstein, DPM, Royal Palm Beach, FL, stevefootdr1@cs.com

RE: Chronic Severe Pain Left Hallux (Bruce Krell, DPM)
From: Peter J. Bregman, DPM, Steven H. Goldstein, DPM,

This is most certainly nerve pain. It is possible it was exacerabated with the surgery. Is there a Tinel's sign with percussion of the anterior tarsal tunnel? Perhaps years of wearing tight hiking boots caused damage to the nerve via chronic compression. Try and do a good isolated block of the deep peroneal nerve at the base of the second metatarsal. If you find good relief then you have your answer. If it is the deep peroneal nerve then you are better off cutting it in the distal leg where it can safely retract in muscle. You have to approach it where it lies adajent to the anterial tibial artery.

You can also approach the superficial nerve in the same area if needed. It might be helpful to also block the nerves above the ankle if the foot block is not successful. You should also look for proximal radiculopathy. I am still surprised at how much "RSD" is used as a diagnosis in people with simple nerve entrapments. Hope this helps. I am not a big fan of chemical neurolysis. I think it can be inaccurate and usually only temporizing depending on where it is being done. This is not to say that I do not think it has applications in the foot.

Peter J. Bregman, DPM, Tewksbury, MA, Footdoc@PAINFREEFEET.COM

The case scenario presented here would make cryosurgery/cryoablation a logical choice to help alleviate the patient's painful hallux. If one were to freeze the deep peroneal nerve in the first interspace, this may in fact resolve the problem. If you send me an email and let me know where you are located, I may be able to refer you to a cryosurgeon in your area.

Steven H. Goldstein, DPM, Royal Palm Beach, FL, stevefootdr1@cs.com

RE: ICD-9 Coding for Total Contact Cast (Harry Goldsmith, DPM)
From: Robert Wunderlich, DPM

I've billed for, and have been reimbursed for, total contact casting for: all foot ulcer codes (707.14, 707.15, etc.), foot fracture codes (825.xx), and Charcot arthropathy (713.5). I use TCCs for any patients with these diagnoses who also have sensory neuropathy, but as Dr. Goldsmith mentioned, there are no guidelines for utilization (and my personal experience suggests that this applies to both Medicare and other insurers).

As a side note, make sure you bill for your materials for total contact casting. I use CPT 29445, Q4037, and Q4038 for each total contact cast...Medicare and others will pay for all 3 of those codes on the same date of service, and there is NO global. But...do NOT bill an ulcer debridement code on the same date of service as a total contact cast! If you do, Medicare will bundle the cast with the debridement code, and the reimbursement won't even cover the cost of the casting materials. They make the rules, we just have to know how to play.

Robert Wunderlich, DPM, San Antonio, TX, rwunder@gmail.com

RE: Value of APMA Membership (Bryan C. Markinson, DPM)
From: Michael A. Conway DPM, Jeff Merrill

With all due respect to Dr. Markinson, finances are not a factor (in New York State, anyway). The NYSPMA has had a confidential committee of only a few members that review financial hardship cases (that are brought to their attention). Any members that can document a "true" hardship, maintain their membership by paying reduced dues as their means allows. I have never served in this capacity, but my understanding is that over the years there are at least a few members that paid almost nothing.

In the past, our association has had programs where non-members can join for a reduced fee. The feeling was once they get exposed to our organization and see what we are trying to accomplish, they would later stay on and pay their full share.

The truth of the matter is that it is not a priority for some. $2,000 a year, buys a lot of dinners out, or a decent vacation. Many dues payers think the money is better spent reinvesting in our profession. How many times have I been annoyed by patients wearing fur coats, and driving a Lexus, telling me they can't afford their co-payment. In my mind, it is the same thing.

Michael A. Conway DPM, Massapequa, NY, mikeswae@optonline.net

I recently read a comment that the APMA membership dues cost too much. As a student, the schools simply take a couple hundred from our tuition and apply it to APMSA/APMA. I think I understand the importance of unity as a community of podiatrist and so I don't let that worry me, despite being married with a child. May I ask a few questions? As a practicing podiatric physician does it cost $2,000/year to be a member of APMA? If yes, is my future as a podiatrist going to be so tight, money wise, that I will not be able to pay $2,000 to the organization that gives us a unified voice? Your comments are appreciated.

Jeff Merrill, TUSPM Class of 2010, teflon@temple.edu

Editor’s Response: APMA currently has 21 different membership categories. First year residents pay no dues, after which they pay $66 per year during additional years of residency. Once in practice, new podiatrists pay $206 in their 1st year, $271 in their 2nd year, $578 in their 3rd year, and $701 in their 4th year. Dues are fixed at $825 for those in practice for five or more years, but APMA has a financial hardship category for those who cannot afford to pay.

APMA state components generally have dues policies which mirror that of APMA. In many states dues include free tuition to CME seminars. Dues are generally 95% tax-deductible. Given the relatively small size of our profession, it is incumbent on every podiatrist to be a member of APMA.

Additionally, a large part of why podiatrists have a median net income of $116,000 is attributed to APMA’s role in fighting for appropriate reimbursement for the procedures we perform. Given that PM’s Annual Survey shows that APMA members earn $121,900 versus $112,190 for non-members, $2,000 for dues works out to a very sound investment!

RE: Outside Payroll Services (Bob Levoy)
From: Bruce N. Block, DPM, Sam Bell, DPM

We use PBI payroll services, Mineola, NY. We fax them the weekly payroll hours and they deduct from my checking account all taxes. They messenger the paychecks, file all quarterly taxes and are very reasonable for the services they provide.

Bruce N. Block, DPM, Kew Gardens, NY, footfxr@pol.net

In addition to EFTPS.gov, there is also www.officialpayment.com - you can use a credit card to pay quarterly federal and state taxes. There is a small "convenience fee" but hey you get mileage points.

Sam Bell, DPM, Schenectady, NY, dpmbell@aol.com

PRACTICE FOR SALE -ORANGE COUNTY, NEW YORK

Busy, part-time, twenty-two year old practice for sale. Easily expandable to full time. Grossing over $225,000 on three days a week. Great potential for growth. Price negotiable for immediate sale. Please reply to ASB310924@aol.com

PRACTICE FOR SALE - LAWRENCE, KANSAS

Great place to live and raise a family (college town). 250+ K yearly gross with good potential for growth. Good mix of general podiatry, sports medicine, and surgery. Hospital privileges available. 4 treatment/procedure rooms and well-equipped. Fully computerized. Partnership in a 4-office medical building. Partnership is for sale. Inquires to foothlr@sunflower.com 785-841-4225.

ASSOCIATE POSITION – CENTRAL NEW JERSEY

Multi-office practice located in Ocean and Monmouth counties. Lokking for a well-trained PSR 24-36 individual. Must be personable and ethical. Excellent opportunity to join a well-established diverse practice. Please fax resume to (732) 255-9364.

SEEKING RESIDENT FOR PSR-24 - BALT, MD (MERCY MC)

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 2008. Includes competitive salary/benefits. Send inquiries to rsher18@yahoo.com

ASSOCIATE POSITION - FT. MYERS/CAPE CORAL FL

Great opportunity for BE/BC established DPM or podiatric surgical resident with strong surgical skills. Well-established podiatric practice offering high surgical volume, advanced wound care, PT, vascular diagnostics and large diabetic population. Exceptional pay with incentives for high performers. Generous benefit package. Relaxed lifestyle, golfing, boating, fishing, close to beautiful SW FL beaches. Please send CV with references to janekelly331@msn.com

EXPANDING IN SOUTH-WEST FLORIDA

Seeking an associate for a well-established, busy, multiple-office practice. All aspects of podiatric medicine and surgery. Must have completed a 24-36 month residency and at least board eligible in forefoot surgery, preferably in forefoot and rearfoot surgery. Competitive salary with excellent benefit package. If interested, please fax CV to 941-639-0026 or e-mail it to Awilliam33@aol.com

ASSOCIATE POSITIONS – MARYLAND

Are you motivated, personable and enjoy working with the elderly? We are offering full or part-time positions in Maryland. Our group, Podiatry Management Services, provides care to the elderly in Nursing Homes, Assisted Living, Senior Homes, Adult Daycare and other similar facilities. Please e-mail your c.v. to drhprosen@comcast.net or fax to 410-486-2049 or call Dr. Herbert Rosen at 410-580-0255

FULL-TIME ASSOCIATE WANTED - CHATTANOOGA,TN

Well established, well-respected surgical/medical practice seeking full time associate. Send CV/ inquiries to: chattfootdoc@yahoo.com

ASSOCIATE POSITION - CHANDLER/GILBERT/PHOENIX, AZ

Multi-location office and soon to start a wound care office in a local hospital. Seeking a well-trained graduate of a PSR 24+/36 Residency. This is a practice with a nice mix of 35% surgery/trauma, 20% diabetic/wounds, 25% biomechanics, 20% pediatric. ER Call for 2 hospitals. Opportunity for partnership at 2 surgery centers. Very modern office with EMR, U/S, Digital X-Ray, Vascular Testing /Nerve Testing Machines and our own ESWT. Excellent referral base, and a well-trained certified staff. Board eligible/certified a plus. Competitive salary, bonus structure, benefits. Please e-mail CV and references to main@footanklespecialtycenters.com

ASSOCIATE POSITION – CONNECTICUT

Connecticut Surgical Group, one of the largest multi-specialty surgical group practices in New England, is seeking a Podiatrist to add to our three-physician Podiatry division based in Hartford. Provide all aspects of Podiatric care with a focus on wound and surgical care to a well-established patient base. PSR-36 training and board certification or eligibility and excellent surgical and wound care skills required. We offer competitive salary and productivity bonus, partnership opportunities, excellent benefits, and reasonable overhead. Apply online at https://home.eease.com/recruit/?id=21426 or via our website or fax your CV to 860-524-2653. No phone calls. EOE

ASSOCIATE POSITION NYC AND STATEN ISLAND

Associate needed for NYC and Staten Island. Spanish speaking a plus. Must have 2 years training . Growing practice with possibility of partnership. Please Send CV to Staff@nynjfoot.com

ASSOCIATE POSITION - NEW YORK CITY

Excellent opportunity for foot/ankle surgeon, Manhattan and Brooklyn Associate position leading to possible partnership. Requirements: Two years enrollment in a surgical residency program Qualities of self-motivation and impeccable skills in forefoot and rear-foot surgery. Package Includes: Malpractice insurance, Health Insurance plus salary, Incentives. Terms negotiable Email CV to Manfootcare@aol.com 212-349-7676

PART TIME PRACTICE W/ PROPERTY FOR SALE, BLOOMFIELD, NJ

Very busy 3 days/week. All modern equipment including digital x-ray and recently remodeled office suite. Office over 1300sf with 3 treatment rooms, large consultation room and second private office suite with full bathroom. Located in a professional building with plenty of parking on a main road. Bus stop in front. 2 blocks off Garden State Parkway. Please contact doccapo@yahoo.com

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.