The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

March 31, 2010 #3,819 Publisher-Barry Block, DPM, JD

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IL Podiatrist Provides Advice for Distance Runners

Marathon runners need to pamper their feet before, during and after competitions, podiatrists advise. "There has been a huge growth in marathon running in the past several years and as it has gone up in popularity; we've seen an increase in foot injuries," said Dr. Bryan Hersh, a podiatrist at the Center for Podiatric Medicine. "Runners need to do research and take steps in advance to prevent injuries," Hersh said.

Dr. Bryan Hersh

For example, Hersh said it's important to get the right type of shoe and have a proper fit. "A bad shoe can cause big problems," Hersh said. To determine what shoe type to wear, visit a podiatrist or find a running shoe store that can test biomechanics and recommend proper shoes. "It's also important to change your running shoes," Hersh said. "I recommend changing shoes every 300 to 500 miles."

Source: Celeste Busk, Chicago Sun-Times {3/17/10]

Sen. Brown and Other Federal Lawmakers Asked to Support Title XIX Legislation

Massachusetts Podiatric Medical Society trustee and APMAPAC coordinator, Dr. Louis DeCaro, pictured on the left, and Massachusetts executive director, Gary Adams, on the right, recently met with Senator Scott Brown (R-MA) and his legislative staff urging support for APMA’s bill to define podiatrists as physicians under Medicaid, as they are under Medicare.

(L-R) Dr. Louis DeCaro, Sen. Scott, Brown, Gary Adams

Dr. DeCaro and Mr. Adams represented Massachusetts at the 25th annual APMA Podiatric Medical Legislative Conference and made visits to their congressional delegation asking for their co-sponsorship support of the bill, as did their colleagues from around the country and scores of students representing all 9 colleges.

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky: How can podiatrists increase the applicant pool at podiatric colleges?

Dr. Michael Trepal

Michael Trepal: Clearly everybody needs to be an ambassador for their profession and recruit good qualified students to come into podiatry.  We all come across, in our offices and practices, people who are friends. We have relatives. We encounter people in our churches, in our synagogues, local areas, civic clubs, and PTAs. We see hundreds of patients a week, and they all have friends. So, when you see a patient,  say, "hey! Mrs. Jones, what is your son Johnny doing and has he thought about being a podiatrist? Maybe have him come here and spend a day with me. I will be happy to have him shadow me if he is interested."
 

Dr. Lowell Weil, Jr, Jeffrey Toobin

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's show features  Dr. Lowell Weil, Jr., president of International Society of Medical Shockwave Treatment” (ISMST) and team physician for the Chicago White Sox. Additionally, you'll hear a pre-recorded interview of Jeffrey Toobin, writer for The New Yorker. You can register for this event by clicking here

Query: Metatarsal Neck Fractures

My patient is a 60 years old female with a medical history of rheumatoid arthritis, cervical cancer history, hypertension, and a failed left hip surgery that resulted in left lower leg inversion. She fell at home two weeks ago while standing, and had sudden foot pain. She also has a grade-3 ulcer, non-diabetic, plantar 1st metatarsal head left foot, probably due to the way she walks after hip surgery. Her left foot was severely edematous with severe erythema and increased warmth around the ulcer. The left foot was almost 3x the size of right due to fractures or infection or both. She had non-palpable pedal pulses bilaterally. Osteoporosis is evident on x-ray, which is my guess for the cause of the fractures. 

Metatarsal Neck Fractures (AP & Medial Oblique Views)

I'm going to obtain vascular testing and attempt vascular clearance before any surgery. I placed her in an Unna boot and surgical shoe on Friday, took a wound culture, and prescribed antibiotics. She could not dorsiflex her ankle enough to get into a CAM walker due to edema. If I were to attempt surgery after vascular clearance, what would be the best way to go about it? I was thinking of K-wires driven distally through base of proximal phalanx 2-5, retrograded proximally through met. heads 2-5 into the met. shafts. Then, another K-wire horizontally through met. heads 2-5 from the lateral direction. Her bone stock may be too weak for screw fixation. Any other fixation ideas? 

Robert A. Dale, DPM, Clarksburg, WV

Query: VOIP Phone Service

I am considering giving up my landline telephone service for a broadband-based Voice Over IP service. The features offered (mailboxes, virtual PBX, call hunting groups, etc.) and price seem to be what I am looking for, but I am concerned with call quality, reliability, and customer service. I will have broadband service of 50 mbps down/5 mbps up. I am interested to know the experiences of my colleagues who have gone this route before me. Suggestions on service companies and hardware will be appreciated.

Michael Loshigian, DPM, NYC, NY

RE: MASS Theory (Calvin Britton, DPM, Robert Bijak, DPM)
From: Michael Turlik, DPM, Kevin A. Kirby, DPM

I agree with Dr. Richie that the podiatric biomechanics community faces a challenge to its pre-eminent position in the treatment of mechanical foot conditions by experts with commercial interests. Do patients with mechanical foot and ankle conditions have better clinical outcomes using the MASS theory than patients treated with conventional podiatric biomechanical theory? For the last 10 years, medicine has moved away from expert opinion and towards data-driven decisions to answer clinical questions for patients. I believe this will accelerate in the future and encompass the majority of the healthcare decisions made for patients. Where is your data to support your theory and how good is that data?
 
In the same issue, there is a post regarding Dr. Armstrong. I think most people would agree that Dr. Armstrong and his colleagues are recognized experts in the field of diabetic foot care; not only in podiatry, but internationally. The difference between Dr. Armstrong and colleagues, and other podiatric experts is that Dr. Armstrong has consistently produced useful data on the diagnosis and treatment of diabetic foot conditions, which is better than the majority of publications on the subject regardless of experience, training, and degree level - not only data, but quality data.
 
The podiatric biomechanics community needs a Dr. Armstrong in order to further the acceptance and credibility of contemporary podiatric biomechanical theory.
 
Michael Turlik, DPM, Cleveland, OH, Mturlik@aol.com

Custom foot orthoses have been used for over a century by physicians as a way to treat mechanical problems of the foot and lower extremity. In fact, over 120 years ago, in 1888, Royal Whitman reported on a high-arched orthosis design for the treatment of "flatfoot" that quite closely contoured to the medial arch of the foot (Whitman, R: Observations of forty-five cases of flat-foot with particular reference to etiology and treatment. Boston Med. and Surg. Jour. 118:598, 1888).

In the same era as Whitman, P.W. Roberts developed a high-arched orthosis like Whitman's orthosis, but the orthosis of Roberts had the additional anti-pronation design of an inverted heel cup. Then in the 1920s, a podiatrist, Otto F. Schuster, combined the designs of the Whitman and Roberts orthoses, the Roberts-Whitman orthosis, to create an inverted heel cup orthosis that reduced the medial arch irritation problems that had been so common in the Whitman design (Schuster RO: A history of orthopedics in podiatry. JAPA 64:332-345, 1974).

Now, over 120 years after the invention of the high-arched orthosis, we have an orthosis lab owner who is traveling around the country proclaiming that his high arched orthoses are "revolutionary" and are the "only true functional foot orthoses" because they are made around foam-bed molds of semi-weight-bearing supinated feet. Those who are students of the history of foot orthoses will clearly see that in the case of the high-arched, non-rearfoot posted MASS orthosis, there is truly nothing new under the sun.

Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net

RE: Scanning vs. Casting for Orthoses (Robert Bijak, DPM)
From: Multiple Respondents

Dr Bijack's statement: "...one can understand why insurance companies question the efficacy of such devices..." does not mean that orthotics do not help people with foot problems. Our problem with orthotics is that the theories that were developed to substantiate the use of functional foot orthoses were not backed up with unbiased research studies. These theories, many of which are in conflict with each other, were sold to our profession and accepted lock, stock, and barrel, not because there was decisive, well-funded, research, but because well-respected men in our profession espoused these theories. In the era of evidence-based medicine, this type of acceptance without question is no longer an accepted way of dispensing medical care. Insurance companies are aware of this.
 
There is another reason why insurance companies stopped paying for orthotics. The treatment was abused. When I graduated from school over 30 years ago, carriers paid handsomely for orthotics, but when every podiatrist started prescribing them for every patient who walked in the door, companies stopped paying for them entirely or severely limited what they would cover. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

I finally get Dr. Bijak. Following his last post, it seems to me that he is yanking the collective podiatric chain. We respond to him and his rantings like they are serious, but in reality they are just trying to get a response - or he is just so far behind the rest of us that he doesn't understand the present. It has been over 50 years since chiropody, the treatment of hands and feet, has been used to describe our profession. Dr. Bijak, we welcome you back to the future.

Secondly, I use a lab for my orthotics and have done so for 35 years, and by the way, I don’t use rohadur. It’s way too rigid for most cases.

Thirdly, if you think that the future of our profession is surgical, you haven’t been paying much attention to the changes in medicine over the past few years. Primary care is "primary", and if you think that you will be able to make a good living doing only surgery, then thanks for all the rest of the patients who will come to the rest of us for care. Lastly, even though I responded to you, I think that we owe you a thank-you for your attempts to make us laugh, because your idea of our profession is quite humorous, and I look forward to more of your comical insights.
 
Brian Kiel, DPM, Memphis, TN, footdok4@gmail.com

As always, I enjoy Dr. Bijak's letters, right or wrong. In his last letter, he mentions failure rates of non-DPM orthotic devices. The point is we don't know what the failure rate is for anyone's orthotic devices. I am not even sure we could measure failure rates. Isn't that what determines if the orthoses is successful or not?  In the words of the current owner of the Cleveland Cavaliers, "not everything that counts can be counted."
 
I believe that is the reason we have  not  had significant articles dealing with which type of orthotic is best for each condition. We haven't yet figured out how to count. How about getting a representative from the department of orthopedics/biomechanics from each of the colleges of podiatric medicine to attend a "summit" on orthotic devices to figure out a method to determine what is successful and then institute a multi-center study with  our best biomechanical minds?
 
Michael Forman, DPM, Cleveland, OH, IM4MAN@aol.com

RE: Digital X-Ray System (Michael J Marcus, DPM)
From: Jeffrey Kass, DPM, Charles Spatz, DPM

I have the ICRCO 3600. It utilizes true flat scan technology. I like the fact that I do not have to remove the "film" from the plate, but rather insert the cassette into the unit, and the unit does the rest. I have the unit for over a year, and for the most part, the unit has been trouble-free.  If you contact me , I'd be more than happy to share my experience. 
 
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

I just recently purchased the Kodak POC 120 unit, and I am quite pleased with it. It is a CR unit as opposed to the more pricier DR type units. Although the price point was a little higher than the predominant podiatry market unit ScanX, I thought several features of the Kodak unit was more desirable, such as not having to handle the phosphor plates when developing. You just insert the cassette into the machine which extracts the plate and scans it.

I also thought it was aesthetically more appealing than the ScanX, as the unit is in a patient area. I think speed-wise, they are about the same. Kodak does make a faster unit, the POC 140. The downside was the software that came with my unit was unable to calculate IM angles, although angular measurements and other measurements can be performed. I had a radiologist friend see the images, and he was quite impressed, considering the cost. I think that with a decent resolution monitor, the images should be very capable of capturing soft and skeletal images of the ankle/foot.
 
Charles Spatz, DPM, Middletown, NJ, drcharles57@aol.com

RE: Changing to Billing Service (Marc Garfield, DPM)
From: Sara Tradup, CPODCS, CMRS

For the last seven years, I have owned a billing service that services podiatrists only. I can tell you from my own experience in my office and my knowledge of others, that the billing service that Dr. Garfield describes is rare. Most are reputable services honestly trying to do a good job in a difficult profession.

First, the start-up fee was mentioned. I know of no one who has charged over...

Editor's Note: Sara Tradup's extended-length letter can be read here.

RE: Alleged Improper Treatment of Foot Fracture (MI)
From: Douglas Pacaccio, DPM

I cannot believe what I read in PM News about this alleged "permanent Achilles shortening." Again, I ask, "who is the lawyer who actually took this case?" But even worse, what doctor would actually try to make any sane argument that he is such an expert in casting that he can tell after the fact that another physician's cast caused permanent shortening of an Achilles tendon? We are clearly not talking about a neglected cast that caused ulcers, infection and amputation; especially when there are descriptions in our literature and textbooks of situations when one would want to cast plantarflexed. We all know that the Achilles and ankle get tight, but guess what?....send the patient to physical therapy. This is ridiculous!

Dr. Touchton should write a letter of apology to the defendant podiatrists for not telling the attorney to pound sand! Can we get his testimony? Unbelievable, truly unbelievable!

Douglas Pacaccio, DPM Yorkville, IL, pacman25@hotmail.com

RE: GA Podiatrist Haunted By Nightmares From His Haiti Experience
From: Shari Lee, PMAC

I want to take a moment to  thank Dr. Spencer Misner and all those who went to Haiti to help. I am truly sorry Dr. Misner still has nightmares. I do not know his religious beliefs, however, in my background, God will only put us through what we can handle. Also, we are spoken to in detail before any mission trips because all are not fit for missions. If nothing else, I hope Dr. Misner finds peace in knowing he helped this young man. No, not with medicine, but with your love and company during his last minutes. He was not alone as he had Dr. Misner by his side.  He was lost over the loss of his loved ones, and Dr. Misner gave him peace.

Dr. Misner, again, you have my thanks and I am sure many others for all your help while you were there. The next time you have a nightmare, you have the ability to change it. Think of this young man in a reunion with his family with smiles on their faces. When you awake, feel good about what you did, and ask yourself, “how many people can I help today?”

Shari Lee, PMAC, Columbia, SC, midlandspodiatry@bellsouth.net

ASSOCIATE POSITION - SOUTHWESTERN PA

Suburban Pittsburgh. To work in an established practice and also a new office scheduled to open in  August 2010. Future partnership buy-in possibilities. Rearfoot credentials needed to expand the established practice, and to maximize the potential in the new practice. Competitive salary, benefits. 724-337-4433.

ASSOCIATE POSITION – CALIFORNIA

Looking for a motivated podiatrist to join a rapidly growing practice in Los Angeles. Will hire immediately. Excellent compensation. Please fax CV to: 310-652-3669.

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 - 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 – 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.

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

PM News Classified Ads Reach over 12,000 DPM's and Students

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