The Voice of Podiatrists

Serving Over 10,800 Podiatrists Daily

March 29, 2008 #3,206 Editor-Barry Block, DPM, JD

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PA Podiatrist Provides Advice on Preventing Nail Infections

Infections can happen during toenail care as well and can be prevented if some prudent care is taken, adds Carl Ginsberg, DPM, a podiatrist in private practice in Wyncote. "One of the most common problems that can develop in your toes is fungus, especially among the elderly because their immune system is more compromised than in younger people. Also, their circulation isn't as good, so we may find more fungal infections."

So, just as with your fingernails, proper care and safety precautions should be uppermost in people's minds. For example, Ginsberg continues, regardless of age, many women have developed skin infections after getting pedicures in salons. "Bacteria can be absorbed through tiny cuts or abrasion on your skin, leading to sores and other problems. And if the tubs are not thoroughly cleaned between clients, it's like sitting in the same bath water as everyone else before you."

To prevent problems with toenails, Ginsberg says, you should wear comfortable shoes, clean socks and avoid walking around unprotected in an unclean environment. And always remember that nail tools used by different people may transmit infections like nail fungi, staph bacteria and viruses.

Source: Rita Charleston, Jewish Exponent [3/27/08]

FDA Conducts Safety Review on Regranex

The FDA is conducting a safety review based on study data suggesting there may be an increased risk of death from cancer in diabetic patients using Regranex (becaplermin) Gel, a skin product used to heal leg and foot ulcers. While the review is ongoing, the FDA recommends health care professionals discuss the potential risks and benefits of using Regranex with their patients.

This communication is in keeping with FDA’s commitment to inform the public about its ongoing safety reviews of drugs. As soon as this review is complete, FDA will communicate the conclusions and recommendations to the public.

To Read Communication About an Ongoing Safety Review click here

Source: FDA [March 27, 2008]

Accused IL Podiatrist Claims Vaginal Exam is “Normal Procedure”

A podiatrist from Olympia Fields sexually assaulted a 75-year-old woman during a medical exam then told her he'd done her "a favor," a judge heard in court this week. Dr. Anthony Overton, 63, claims he was following normal procedures for a foot doctor when he touched the woman's breasts and inserted his finger into her vagina and rectum. But as Overton's bench trial began before Judge Michael Toomin at the Cook County Criminal Court on Tuesday morning, Assistant State's Attorney Beth Pfeiffer said, "Those transgressions were a crime."

Dr. Anthony Overton, Jr.

The victim, now 77, testified she had made an appointment with Overton about an ankle injury June 2, 2006, because her regular podiatrist had moved. Though Overton had her strip and change into a gown, violated her and ordered an x-ray, he did not examine the injured foot, she said. But defense attorney William Hooks said Overton "was within the standard of care for podiatric medicine." Overton's license to practice as a podiatrist was suspended in July last year after as many as six other women came forward with similar allegations.

Prosecution expert Dr. Adolph Galinski, a podiatrist for 40 years, testified there was "no reason" for Overton to have conducted a full physical exam on the victim. "A podiatrist is trained to deal with the ankle and the foot. If I started dealing with the elbow, the back and all the other parts of the body, I'd expect to be a defendant in this courtroom pretty soon," he said. Overton is free on $250,000 bail.

Source: Kim Janssen and Eric Herman, Southtown Star [3/27/08]

Query: Patient with Decreased Sub-Q tissue from Repeated Steroid Injections

I have recently seen a patient who was originally diagnosed with "neuroma pain" and received 4 steroid injections in the 2nd and 3rd interspaces along with 5 treatments of iontophoresis. Now she presents herself to me with a decrease in tissue mass at the plantar and dorsal aspect of her foot with significant neuritis from lack of fat padding. Other than orthotics or metatarsal head resections/etc., is anyone familiar with a "filler" that would give greater lasting results than Restyline, etc.?

Neal Frankel, DPM, Chicago, IL

Query: Billing During Another Doctor's Global Period

A patient from another state recently had foot surgery there. She is in town, and would like her foot "looked at." How can one bill for an E/M service on a patient who is in the global period from another doctor?

I don't believe I can bill an E/M service or x-rays during the global period from another doctor, but I would appreciate some clarification.

Thomas Rehm, DPM, Asheville, NC

Response: The global period only applies to the provider who performed the procedure. Any other provider would not be bound to this (unless they are in the same group). In your case, bill for the services you provided. No special modifiers are required. Standard modifiers may be required depending on the specific services you billed.

Tony Poggio, DPM, Alameda, CA

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RE: Forteo Use in a Partially-Fused Lapidus (Nat Chotechuang, DPM)
From: Jonathan Labovitz, DPM, Peter J. Bregman, DPM

I have used Forteo in about 5-6 cases of non-unions effectively. It has taken about 8 weeks on the medication to be beneficial. Forteo patients should not be on bisphosphonates concurrently. Insurance companies in my area called this experimental since it was not being used for a diagnosis of osteoporosis.

There is no evidence this currently works in fracture repair or non-unions, however, it inherently makes sense since it is osteogenic in the osteoporosis patient. Currently there are animal studies regarding fracture management and Thomas Einhorn is working on human clinical trials now.

Jonathan Labovitz, DPM, Torrance, CA , jonathan_labovitz@hotmail.com

Why you would use a staple and a mini rail? I believe that defeats the purpose of the mini rail as it is limited in its ability to compress beyond the staples position? Perhaps this is why it did not fuse?

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

RE: Is Penlac the Standard of Care? (Dan Klein, DPM)
From: Elliot Udell, DPM

Dr. Dan Klein makes a good point when he equates the control of onychomycos with controlling weeds in a garden. As an a avid gardener, I can relate to it. What makes his analogy so significant is that many of us become disappointed when we view onychomycosis in a similar way that we view acute bacterial infections. Once we wipe out the bacterial infection with antimicrobials, unless the patient is immunocompromised, the infection is gone. Onychomycosis is different. The infections come back and they may come back irrespective of whether the patient used an oral antifungal agent or one of the many topicals. Just as we have to use weed killers and physically remove weeds from our gardens regularly, so too, we have to offer ongoing medical and surgical management of mycotic nails.

All too often patients come to my office lamenting that their internist placed them on oral antifungal agents. They paid megadollars for the medication, had to go for blood tests, and six months to a year later, the problem returned. I explain to these patients that the problem may not be that you were re-exposed to fungal spores but that there may be a loss of immunity in the nail bed to the fungi that cause the problem hence opening up the nail to re-infection. I then place the patients on regimens of debridement and ongoing topical antifungals. Dr. Klein gave me a more eloquent way of explaining this to future patients with chronic mycotic nails.

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

RE: Chronic Severe Pain Left Hallux (Simon Young, DPM)
From: Jeffrey Kass, DPM

Dr. Young's response for Chronic severe pain left hallux. While, I do agree M-C exostosis are definitively a possible etiology of nerve compression, so is the EDB muscle belly at the base of the first met region. I would not "severe the nerve" rather release all possible extrinsic pressure such as a possible exostosis or EDB muscle belly. I am not sure if anyone has mentioned yet in these postings, but Dr. Dellon's PSSD machine is sensitive to these types of nerve entrapments when EMG/NCV are negative.

Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

RE: ACFAS / APMA Membership Vote (Irvin Kanat, DPM)
From: Multiple Respondents

The crux of the matter is that we are podiatrists first and ACFAS fellows second. The APMA is the foundation that the ACFAS is built upon. The role of ACFAS is to represent surgical podiatrists, those who have additional issues and needs as surgeons, not to usurp and duplicate the role of the APMA, which represents all podiatrists.

The only reason that I renew my ACFAS membership is for the prestige of having FACFAS behind my name, and my guess is that a majority of their 6,000 members renew for the same reason. I believed that membership in the college was a distinction that meant to be among ‘the best and brightest.’ To be among the best and brightest is a privilege that is earned, and with privilege comes responsibility, a responsibility to do what is best for the good of the whole.

The end result of this is lose-lose because both organizations will be left with less members. Many ACFAS members like me will quit to protest the board’s decision if it isn’t overturned. The APMA/ACFAS members who don’t get the big picture will be happy to quit the APMA because they just got a huge discount on their FACFAS initials. Also, as a member from Michigan with a front row view, let me just add that there were no victims here and for ACFAS to use those events as the catalyst for their decision is disingenuous.

Scott Hughes, DPM, Monroe, MI, dr.hughes@comcast.net

I was shocked to receive an ACFAS advertising campaign in the mail asking me to "support choice" by voting to support the ACFAS Board of Directors decision not to require dual membership in APMA. One of the reasons the ACFAS Board has made this change is save the members money. Yet, they produce these advertisements and mail them to all the members asking them to support the Board decision. At what cost?

I find this propaganda rather insulting. ACFAS is an academic, professional organization. I'm sure the members can make up their own minds. It is also noteworthy that it requires a 2/3 majority of the entire membership to overturn what a board of 12 was able to with a simple majority.

I have seen many letters to PM News commenting on the value of one membership or another. When considering which organization is of most benefit to the profession, it is interesting that ACFAS does not have the word "podiatry" anywhere on the homepage of their website. ACFAS also has a website for patients which does not mention the word "podiatry." This is very divisive and causes confusion among patients and other professionals. APMA has an active lobby that supports all podiatrists by default. Even if you're not a member, the APMA benefits you because they are actively lobbying and bringing the concerns of podiatry to the legislature and policy makers. We are all PODIATRISTS.

Lee C. Rogers, DPM, Des Moines, IA, lee.c.rogers@gmail.com

As I read the "rebuttal" to the ACFAS "FAQs" on the issue of ACFAS/AMA membership/affiliated status (Click here), it seems that since the ACFAS bylaws membership requirement change occurred as a result of a simple majority vote of the ACFAS Board, the "Support Choice" campaign membership vote determination would, likewise, only require a simple majority vote of ACFAS membership to direct the Board to either confirm the decision of the Board to change the membership requirement (effectively rejecting compliance with the APMA bylaws), or reject the Board's membership policy decision which led to a change of the ACFAS bylaws. The wishes of the membership, as demonstrated by a simple majority vote, is all that the ACFAS Board needs to act

Harry Goldsmith, DPM, Cerritos, CA, hgfca@verizon.net

RE: Value of APMA Membership (Simon Young, DPM)
From: Name Withheld

I couldn't disagree with Dr. Young more about applying for hardship status within the NYSPMA. He states that your application is evaluated by a committee and that it can be very embarrassing. He is completely wrong about the process. Speaking from personal experience, your application is reviewed by the Executive director (Len Thaler) and approved by the Treasurer. Other than maybe an office worker, no one else knows you are even applying for special status.

That being said, if a member is embarrassed (or feels guilty) because they have to apply for special status then it becomes very easy for them to make up for a decrease in dues by having a greater participation in and by contributing more to the association in other non-monetary ways. Believe me those other means of participation are appreciated more than the money. Be active in your local, state and national association in any way you can.

Name Withheld (NY)

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 individual 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.

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

ASSOCIATE POSITION - FLORIDA PANHANDLE

We are looking for a hardworking, ethical physician to join our busy practice. We are well-established and looking to expand. Must be a PS24+ with interest in all aspects of podiatric medicine and surgery. Partnership available. Fax resume to (850) 478-5227, call (850) 477-9015 or email PenFootAnk@aol.com

ASSOCIATE POSITION - NEW YORK STATE

ASSOCIATE Wanted To Be fast tracked into PARTNERSHIP. 6 doctor group with one partner anxious to retire. DON'T MISS THIS OPPORTUNITY. Check out our website, then e-mail me to arrange a visit mhudes@footcaregroup.com

ASSOCIATE POSITION – SEATTLE, WA

Seattle area podiatric medical practice established and growing - needs associate. Great partnership potential for well-trained podiatric physician. Costco - Corporate Headquarters + Microsoft & Boeing. 386 597-5766

PRACTICE FOR SALE – WESTERN WASHINGTON

Magnificent natural scenery in unique area of Washington state. Seller owns condo with ASC built for podiatry practice. The layout was designed to provide maximum efficiency for patient, doctor, and staff. Located within sight of hospital and medical community. Over 25 years established podiatric medical practice with potential to grow beyond $400K gross. 386 597-5766

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 - BALTIMORE, 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 WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City . Currently four (4)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

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

PRACTICE FOR SALE - AUSTIN TEXAS

Live and work in the best place in Texas. 14-year established practice which includes beautifully finished office condo. Own a practice AND real estate. Nicest office in town. Located between 2 major hospitals and in the most heavily populated part of town. Major employers including Dell and IBM. Office can support 2 podiatrists easily. Serious inquiries only. mrobsondpm@aol.com 512 585 0242

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.

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