The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

March 27, 2010 #3,816 Publisher-Barry Block, DPM, JD

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TX Podiatrist Recommends Exercises to Strengthen Foot Muscles

The weather is warming up, which means that lighter clothing and footwear are on the way! (I already spied a few open-toed shoes on my way to work this morning.) To get your feet in shape for spring and summer, podiatric physician Dr. Robert Klein, a diplomat with the American Board of Podiatric Surgery, offers this suggestion.

Dr. Robert Klein

Strengthen your foot muscles. Since you walk differently in sandals and flip-flops than you do in closed-in shoes, it’s a good idea to exercise your feet a bit by doing “towel curls.” Lay a towel on a floor and with one foot at a time, curl and pull the towel toward you with your toes. Repeat at least 10 times.

Source: Barbara Brody, Women's Day [3/19/10]

Residency is a Win-Win for VT Podiatrist and Resident

Dr. Brandon R. Gumbiner, the hospital’s first resident surgeon, is also the state’s first podiatry resident. Gumbiner, in the process of completing his third year of residency, has been working out of the office of Southwestern Vermont Medical Center (SVMC) surgeon Dr. William J. Sarchino for the past four weeks. Gumbiner is a resident from St. Joseph’s Hospital in Chicago, which has partnered with the University of Illinois and SVMC.

(L-R) Drs. Brandon R. Gumbiner and William J. Sarchino (Photo: Peter Crabtree)

As a third-year resident, Gumbiner is for all intents and purposes a practicing physician, said Sarchino, which makes running his practice a little easier. Sarchino said the residency program will be on-going at his practice and that residents will be on one- to two-month rotations with a slight break in June.

During his time here, Gumbiner has witnessed at least two procedures he has not seen elsewhere, a complete ankle replacement and a double skin graft, which involves skin used to cover a surgery on the foot.  Gumbiner said he has had the opportunity to watch surgeons in action and perform procedures himself. "For example, (Gumbiner) has been able to work with an orthopedic surgeon who is an expert on foot and ankle surgeries, an orthopedist who specializes in a unique ankle repair technique, and with several of our general surgeons who have had cases involving the lower extremities," Sarchino said.

Source: Keith Whitcomb, Jr., Bennington Banner [3/24/10]

Diagnostic Ultrasound Helps MO Podiatrist View Foot Pathology

Dr. Vincent L. Travisano, a podiatrist practicing for 27 years in Webster Groves, MO confesses that he still takes pride in knowing that podiatry is one of the few medical specialties that can alleviate most foot problems on the first visit.

Dr. Vincent L. Travisano

Board certified by the American Board of Podiatric Surgery, Dr. Travisano has now introduced in-office podiatric ultrasound which enables him to accurately view, in real-time, problems of the foot, such as heel pain with plantar fasciitis, bursitis, and heel spurs, as well as tendinitis, ligaments, bones, and other areas of inflammation and pain in the foot. "This allows us to better prescribe and monitor the best treatments for our patients right from the start," he said.

Source: Webster-Kirland Times [3/19/10]

GA Podiatrist Haunted By Nightmares From His Haiti Experience

It’s one of many stories that still gives him nightmares. In Port-au-Prince, Haiti, a 19-year-old “kid” was standing in the doorway of his home talking to his mother and father and brothers and sisters, said Dr. Spencer Misner. “When the earthquake hit, the cement walls collapsed and buried his family,” the Dalton podiatrist said. “He stood there in shock for a moment before the cement roof caved in and killed them all. His leg was cut, but he refused to seek medical help.”

Dr. Spencer Misner in Haiti

The young man got blood poisoning from the open wound and needed an amputation, but declined treatment at the expedient tent hospital where Misner was working. “He said he wanted to be with his brothers and sisters,” Misner said, becoming emotional. “I laid down on a cot beside him and he died right next to me.”

A certified wound specialist, Misner was invited to Haiti by the wounds trauma unit at the University of Miami School of Medicine. He and eight other doctors landed late one night five weeks after the Jan. 12 quake and were given a primer in basic needs early the next morning.

Source: Mark Millican, Dalton Daily Citizen [3/25/10]

NY Podiatrists Arrested for Medicare Fraud 

Three Brooklyn podiatrists charged the government $300 for foot rubs in a half-million-dollar scheme to defraud Medicare, federal prosecutors said yesterday. Investigators yesterday arrested the foot doctors Drs. Vadim Nekritin, Zhanna Glikman and Igor Loshakov, who operated out of clinics in Gravesend and Coney Island, and allegedly submitted Medicare claims over the past five years for chemical cauterization -- a $300 treatment to help heal open wounds.

But according to the feds, the patients only had their toenails cleaned, trimmed and rubbed with lotion. FBI agents yesterday carted off records and computers related to the alleged fraud.

Source: Janon Fisher, New York Post [3/25/10

DEA Issues Interim e-prescribing Rule

The Drug Enforcement Administration has issued an interim final rule regulating electronic prescribing of controlled substances. The 334-page rule also contains a request for comments. The rule affords prescribers the option of writing e-prescriptions for controlled drugs and also applies to pharmacies and hospitals. According to a summary of the rule, it will “reduce paperwork for DEA registrants who dispense controlled substances and have the potential to reduce prescription forgery.”

The effective date of the rule is 60 days from its March 31 publication in the Federal Register, but as a “major rule,” it is subject to congressional review and, consequently, its effective date could be adjusted.

Source: Joseph Conn, Health IT Strategist [3/25/10]

Query: MASS Theory

I have attended lectures by Dr. Ed Glaser, who is also a mechanical engineer. He has a new insight on biomechanics that challenges traditional Root theories, tissue stress/ moment arms, etc. Dr. Glaser advocated the MASS theory and developed a semi-weight-bearing casting technique using a foam box. My question (especially to those DPMs who teach biomechanics): How do other DPMs feel about his theories and orthotics? Is his theory taught in the podiatry colleges? 

Calvin Britton, DPM, North Little Rock, AR

RE: Scanning vs. Casting for Orthoses (Jeff Root)
From: Robert  Bijak, DPM

Mr. Root adds to the increasingly long list of observations elucidating the variability of casting for foot orthoses. Variables include manual plaster casting, foam casting or electronic (scanner) "casting." Further variables are weight-bearing, semi-weight -bearing or non-weight-bearing. Patients can be prone, supine or sitting. "Tractographs" are held in variable positions, calcanei are bisected in variable ways. Gait patterns are observed from platforms, standing position or stooping as a patient walks down a hallway. Surfaces are carpeted, tiled, wooden or paper covered. Was it the orthotic that caused improvement or has the condition self-dissipated, or did an injection or NSAID mitigate the symptomology?  Was it a placebo effect? Was the child afraid to be honest with the white coat Dr. or want to please the parent?

It should be clear to an honest broker that foot orthosis "variability" is such that one can understand why insurance companies question the efficacy of such devices as the "science" stands today. With the increasing number of recognized technologies in medicine (MRI, ultrasound, laser, EMG, NCS, wound care, x-ray interpretation, etc.), I suggest that doctors of podiatric medicine spend their limited time becoming proficient in conditions and technologies where the sequelae of a wrong treatment or diagnosis causes harm to the patient. You can't harm a patient much with a bad orthotic. Referrals to the non-medical providers of orthotics may boomerang into the type of referrals to which our training is more suited. 

Robert Bijak, DPM, Clarence Center, NY, rbijak@aol.com

RE: Safe Guard, LLC  Audit (Name Withheld (California)
From: Paul Baumgarten, DPM, Michael M. Rosenblatt, DPM

I went through one of these audits two years ago. They reviewed 450 charts and they made me go through a prepayment audit where they reviewed EVERY chart before it was authorized to be paid. They found the most nit-picky reasons NOT to pay many claims. They called many of my patients and asked if ...

Editor's note: Dr. Baumgarten's extended-length letter can be read here.

The (name withheld) podiatrist in CA who is being audited for an extended period of time, including a large number of patients is having difficulty in obtaining advice on what to do. The Editor correctly responded that it is well past time to seek the advice of a healthcare attorney familiar with these kinds of audits. This would not be a local family attorney, but someone with experience defending this kind of audit.

The assumption in this kind of situation is that patients are being interviewed, and their testimony taken. In addition, the "defendant" podiatrist may eventually expect to be interviewed by at least one investigator from the insurance company audit representative. The number of investigators present at the "provider interview" is very important to note. If there is more than one, the second one is present to confirm any actionable statements by the audit target. Even if only one is present, you should follow the advice of your attorney and not disclose any comments to the investigators, and neither should your staff. The presence of two may confirm the criminal nature of the audit.

Even Draconian audits can be contested. You should not be tempted to make any changes in your chart notes or billing files. These may only magnify any potential culpability. This is a time to remind all of us that we must keep detailed and excellent chart notes, which are the mainstay of your defense. Your attorney can find out if this is a criminal audit. If it is, you can expect a Miranda letter in some cases. The purpose of this note is not to provide legal advice of any kind, but to simply point out some factors that present themselves in these situations. You have put off hiring an attorney far too long. Now is the time.

Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

RE: The Passing of Mel Carver, DPM
From: Norman Rubin, DPM

It is with great sadness that I heard that Mel Carver had passed away. Mel, along with his lovely wife Carolyn, were a tremendous help to me and my partner, Al Groman, in starting a practice in Langley Park, Maryland in 1974. Even though we practiced in close proximity to one another, Mel and Carolyn were always available to answer questions and to explain the various intricacies of insurance billing. I will always be indebted to Mel and Carolyn for their time, interest and concern for us.

Norman Rubin, DPM, Potomac, MD

RE: GA Podiatrist Worried and Upset by New Healthcare Bill
From: Paul Busman DPM,RN

The upside is that with more people covered by health care insurance, a whole new patient pool could open up. In any event, the status quo was clearly not working. 

Paul Busman DPM,RN, Clifton Park, NY, brewerpaul@aol.com

RE: Johnson Named President of Canadian Federation of Podiatric Medicine
From: Mario G. Turanovic, DPM

Further to a blurb that was posted in PM News a few weeks, ago, I have received e-mails from several colleagues asking about this individual and his relationship to the Canadian Podiatric Medical Association, a professional association that has been in existence for 85 years.  In response to the questions asked, I provide the following response:

Brian Johnson is NOT a Doctor of Podiatric Medicine. He is a foot practitioner, who received his training in chiropody in England. He practices in Prince Edward Island, a province in Canada that currently has no podiatric legislation. The Canadian Federation of Podiatric Medicine is comprised primarily of Ontario-trained chiropodists.

Mario G. Turanovic, DPM, President, Canadian Podiatric Medical Association, mgtdpm@telusplanet.net

RE: Polydactyly Plus

The six-year-old boy, whose name has not been released, has 16 toes and 15 fingers. One of the fingers is incomplete and appears on x-ray photographs as a "fork" sticking out from the right thumb.

Polydactyly (31 digits)

Three fingers on each of the boy's hands are also fused together by skin. The boy, from Shenyang in China's north-eastern Liaoning province, beats the current world record held by Indian boys, Pranamya Menaria and Devendra Harne, who have 12 fingers and 13 toes. Doctors will today attempt to remove the boy's extra digits.

Source:  9MSN News [3/24/10] via Dr. Bret Ribotsky

PRACTICE FOR SALE - MIDDLE TENNESSEE

Turn-key operation ideal for new practitioner. Two locations each with 3 exam rooms, x-ray room, large waiting room, and ample parking.  Excellent locations and growth potential. All equipment and furniture included. Seller happy to discuss extensive financial and professional information. Priced to sell with good reputation, website, and assistance with transition if needed. Call 931-446-5724 for additional information.

ASSOCIATE POSITION - BALTIMORE/WASHINGTON REGIONAL AREA

Multi-faceted practice (routine care to trauma) seeks associate with Maryland and/or Pennsylvania license. Great opportunity for partnership. Looking for pleasant personality. We have multiple offices. Contact butler@qis.net. or call at 410-848-6800 and ask for Dr. Butler.

PRACTICE FOR SALE: TENNESSEE

Established 30-year full-scope podiatry practice. Excellent hospital and surgery center privileges with investment opportunities. Fully equipped 2200 sq.ft. office across from hospital. High volume of new patients, DME, and local referral base. Great community for a family and the outdoorsman. Reply to tnfootdr@gmail.com

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

ASSOCIATE POSITION - SW FLORIDA, BEACHES

Well-established podiatry practice with excellent mix office/surgery seeking full-time associate PSR 12-36. Excellent salary & benefits for the right hardworking, personable candidate. Email resume to capecoralpodiatry@live.com or fax to 239-573-9201

ASSOCIATE POSITION - CONNECTICUT

Associate needed full or part-time for Nursing homes in Connecticut. Need hard-working, ethical individual. Must have CT license. Excellent salary. Please call Zina (347)307-4333 for additional information.

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-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 – LONG ISLAND 
 
Busy Bellmore, NY office. Motivated, board certified, hard-working, experienced in all phases of podiatry. F/T, P/T hours available. excellent salary, call 516 242-7540 or Fax Resume 516 826-9036 or email jobke@aol.com

ASSOCIATE POSITION – CALIFORNIA

Looking for a motivated Podiatrist to join a rapidly growing practice in Los Angeles. Excellent compensation. Please reply to coasttocoastpodiatry@yahoo.com

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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