The Voice of Podiatrists

Serving Over 10,800 Podiatrists Daily

April 02, 2008 #3,209 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.

Sport-Specific Footwear Gives Kids a Boost: NYSPMA Podiatrist

Kids who are properly outfitted for the specific sport they’re playing have an edge, says Westchester-based podiatrist Dr. Charles Morelli, president of the Tappan Zee Division of the New York State Podiatric Medical Association. Dr. Morelli says picking the right shoe goes above and beyond just heading to the “athletics” section of the shoe store.

Dr. Charles Morelli

“Buying a sport-specific shoe – a shoe designed for the exact sport your child will be participating in – not only improves your child’s performance on the court or field, but also helps keeps him or her free from serious foot and ankle injuries,” he says.

Scholl's Armstrong Gives Keynote for First Pan-Hellenic Diabetic Foot Symposium

David G. Armstrong, DPM, PhD, Professor of Surgery and Associate Dean at the Dr. William M. Scholl's Center for Lower Extremity Ambulatory Research at Rosalind Franklin University of Medicine and Science was the first keynote speaker at the March 27-29 Pan-Hellenic Diabetic Foot Symposium in Athens, Greece.

From Left: Profs. JM Boulton, David G Armstrong, Dr. Christos Manes, and Prof. Sir Karel Bakker

The meeting, which brought together several hundred clinicians from more than a dozen countries around the Mediterranean, highlighted the importance of foot care in persons with diabetes. Standardizing training for various levels of foot specialists worldwide is critically important as we move forward," noted Dr. Armstrong.

The meeting featured two subsequent keynote addresses by Professor Andrew J.M. Boulton of the University of Manchester and Professor Sir Karel Bakker of the International Working Group on the Diabetic Foot. The key role of the podiatrist echoed throughout these sessions. "The most critical person on the team is the podiatrist", noted Dr. Bakker. "Yet podiatric physicians exist in only one country and podiatry as a field exists in less than two dozen of the more than 200 nations."

Vaginal/Rectal Exams Within Podiatric Scope: CA Podiatrist

A podiatrist who massaged the breasts of an elderly patient, then inserted his finger into her vagina and her rectum, was following proper procedure in treating her for a sprained ankle, another foot doctor claimed in court Monday. Olympia Fields' physician Anthony Overton, 63, lost his license to practice last year after a string of women alleged he had subjected them to improper "physical exams."

Dr. Ivar Roth

Testifying on Overton's behalf Monday, California-based podiatrist Ivar Roth told Judge Michael Toomin that podiatrists had been encouraged during the past decade to carry out full physical exams, rather than referring the patient to another doctor. A full physical exam included tests on the rectum and genitals, he said, and could be helpful in diagnosing several conditions. Podiatrists needed to practice often to keep their skills up-to-date, he said.

"There was a reluctance on the part of many podiatrists to carry out full physical exams," he said. "Clearly, this is a charged issue. "It will have its supporters and its detractors."

Source: Kim Janssen, Southtown Star [4/1/08]

Query: Great Toe Fracture

This is a 15 year old pt that came into the office yesterday. He has a 5-month old fracture that has never been treated. The toe is red and swollen, but not painful. He injured it playing soccer and is concerned that it may affect his playing in the future. He plans on a college scholarship in soccer.

5 Months Status Post Hallux Fracture

Would you leave it alone or perform surgery. If surgery is done would you simply remove the fracture fragment or try to reduce it and fixate it?

Rick Burnell, DPM, Camden, SC

Quey: Bilateral Injection Coding

I have a patient that I did bilateral injections for tarsal tunnel syndrome (confirmed by EMG). I billed diagnosis code, ICD-9 355.5 (tarsal tunnel syndrome) with the injections billed out as CPT 64450-RT and CPT 64450-50-LT (peripheral nerve block, therapeutic).

United Healthcare rejected the second injection, and stated that "this procedure code is not considered reimbursable as bilateral." What do I need to do to correct this?

Bob Kornfeld, DPM, Lake Success, NY

Response: Many injections codes do not allow the "-50" (bilateral procedures) modifier.

I would suggest coding the bilateral CPT 64450 codes, adding "LT" and "RT", respectively.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found at:
http://www.codingline.com/subscribe.htm

Chronic Sub 2nd Met Head Ulcer (Judd Davis, DPM)
From: Multiple Respondents

I think consideration could be made for a plantar condylectomy of the 2nd metatarsal head instead of complete excision. Your concern about transfer lesions is valid. By removing only part of the 2nd metatarsal head, you decrease the likelihood of a transfer lesion (as well as subsequent digital deformities). There will be some concern, however, for continuation of the ulceration. I have used plantar condylectomies for sub metatarsal lesions with good success.

Michael J. Hodos, DPM, Augusta, GA, mike@mikehodos.com

Dr. Davis’ patient has had loss of hallux purchase, and has transferred increased pressure to the second met. He has to get aggressive, and the ulcer will most definitely heal with metatarsal head resection. I cannot give you a percentage, other than you are 100% right to remove the 2nd metatarsal head, and control the foot post-operatively. Just debride the ulcer, teardrop the wound proximally slightly, and remove the met head with bone cutters from a plantar approach...very little additional surgical trauma, with minimal disruption of tissue.

Carl Ganio, DPM, Vero Beach, FL, drcarlganio@bellsouth.net

I think it is important to make sure that the neuropathy is not a result of nerve entrapment which can be rectified by nerve decompression. This can prevent future breakdown. I also think you should not let a patient dictate the proper surgical course. A Weil osteotomy or something similar may be the best choice. The down-time is a few days off the foot. I think you run the risk of transfer lesion to the third especially given the 1st mpj is not working as it should. It looks like something was done there already so I am not sure how that may affect your choice.

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

I’m confused as to the choice of a Weil or a resection. I only keep my patients non-weight-bearing for a week after the Weil and would probably do the same or a little longer after a met head resection. What are your plans after resection of the met head and subsequent sub-sesamoid or sub-3rd met head ulceration. I’m assuming this will follow, as resection of the 2nd met head will make the sesamoid and/or 3rd met head most prominent.

David Secord, DPM, Corpus Christi, TX, David5603@pol.net

RE: Patient with Decreased Sub-Q tissue from Repeated Steroid Injections
From: Bret M. Ribotsky, DPM

I have been doing this and testing products for PSTTA (pedal soft tissue temporary augmentation) for over two years. This is not a technique that is easy to learn on one's own. Depth, volume amount, pressure reduction and product are all variables. There is over 120 different fillers available with only a few (~6) with FDA approval. There are different chemical products, different physical shapes and different mediums that these particles float travel in. Once you add weight-bearing, the factors change. Each product reacts differently.

At the APMA annual meeting in Las Vegas in'06, I presented early data on using PSTTA. I have a research paper being finalized with case studies and two-year follow-ups. I will be sharing my learning curve with these products and I will be presenting some of this data at the Cherry Blossom Dermatology conference in Washington in May. I would be also very careful about importing a medical product for patient use that does not have FDA approval without an approved research project and an IRB approval.

Bret M. Ribotsky, DPM, Boca Raton, FL, Ribotsky@Doctorbret.com

RE: PM News’ April Fools Story
From: John S. Steinberg, DPM

I congratulate Barry Block, DPM, JD on a well-orchestrated April Fool’s piece for PM News. I/Georgetown certainly got quite a laugh out of the creative writing and editorial liberty you took with it. How in the world you came up with that You Tube Jell-O video is equally impressive.

To answer the many emails I have already received, NO, those are not my feet in the video. Was the video perhaps produced in David Armstrong’s lab? Or perhaps this is what he does on those long plane rides to Dubai and Beijing... I guess we will find out all the truths in Hawaii at the PM Podiatry Hall of Fame Luncheon!

With a start like this, it’s clearly going to be a great April!

John S. Steinberg, DPM, Washington, DC, steinberg@usa.net

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

Let me add my endorsement to Dr. Kanat's remarks. I have attached a file for your readers (http://www.podiatrym.com/letters2.cfm?id=18764&start=1) that documents the Federal Legislation developed by the American Podiatric Medical Association over the last four decades. Where would we be without this significant and continuing effort? What other group can match this effort?

Clearly the healthcare system will change after next November. We shall either be united an at the table to help develop the solution or we shall be divided and perhaps become part of the problem.

Arthur E. Helfand, DPM, Narberth, PA, Aehelfand@aol.com

As a former board member of ACFAS, the subject of separation of ACFAS from APMA was discussed at least twice between 1990 and 1997. After long discussions, each time calmer, cooler heads prevailed. Each time, it was felt the wisest result was to work together for the common good of the profession. To my recollection, APMA never seemed to communicate in a genuine fashion. It was the board of ACFAS that brought to light the insurance crisis of 1990 -91. It was the ACFAS that got APMA involved on the national level.

Having said this, I believed then and I believe now that the best solution is for the continuation of the ACFAS/APMA affiliation. I feel it is totally abhorrent that the ACFAS continue to send out propaganda to press their agenda.

If finances are an individual problems, then it is incumbent for both organizations to make some accommodations for those affected members.

Maybe some of those expensive "perks" that go along with board membership, in either organization, should be eliminated since it is the member who pays the freight. Are these individuals supposedly doing good of the profession? Power on either side is a dangerous thing. No matter the outcome of this anticipated ACFAS membership vote, I strongly suggest that every member vote and maintain his or her membership in both organizations.

Then, when the next election of officers is near find a slate of write-in candidates and elect them. You, the members, can elect the board members that will represent you in the manner you desire. Write-in candidates have won in the past and they can again.

D. Steven Ostendorf, DPM, Fort Meyers, FL, DSOSTEN@aol.com

I propose a solution to the ACFAS / APMA Membership Vote situation: The issues, as I see it are, APMA wants and needs the income ($$) that each member pays in order to provide the needed services that our profession must have. ACFAS wants to provide a mechanism for its members that are disenfranchised with either the local, state or nation APMA group. My solution is that ACFAS charge an additional $ 1,000 fee to anyone who wants to join ACFAS without joining APMA and send at least 90% this amount ($900) to APMA. This way, those members who for whatever reason do not want to join APMA, do not have too; and APMA does not suffer financially.

Bret M. Ribotsky, DPM, Boca Raton, FL, Ribotsky@Doctorbret.com

Editor’s note: An extended-length letter from Dr. Kesselman appears at: http://www.podiatrym.com/letters2.cfm?id=18763&start=1

ASSOCIATE POSITION – GREATER MILWAUKEE, WI

Great opportunity: our busy multi-physician, podiatric group practice, with multiple locations, strong hospital affiliations and faculty positions with PM&S-36 residency program, is seeking a full-time RRA BQ/BC, PM&S-36 surgically trained doctor. Applicant should be well trained in all aspects of surgical and conservative care. Candidate should be ethical, hard working and outgoing physician to join our practice. Commensurate pay with incentives and benefit package. Definitive plan leading to partnership tract. Contact: Daniel Hellman, M.D. @ 414.831.0512 or by e.mail @ hellmandr@gmail.com

EQUIPMENT FOR SALE- OSTEOPOWER2 SAW, ETC.

I have a Osteomed saw with many accessories! This is in Immaculate condition asking $15,000 or best offer. Medical office notepads x2 with docking station and keyboard. 3 docking stations and keyboards for other rooms, $1500.00 each. $75.00 each for the the docking stations. OBO email Harbor_Foot_and_Ankle_clinic@msn.com Call 360-533-7388

ASSOCIATE POSITION - NORTHWEST INDIANA

Full-time podiatrist wanted for Northwest Indiana (4 offices) 30-40 minutes away from downtown Chicago. Busy hospital and office based practice. Must have 3 year surgical residency. For more information please email footdocml@gmail.com

PRACTICE FOR SALE - MINNESOTA: PRIME LAKES AREA

Great place to live and raise a family. $400+K yearly gross with continued growth and potential. Good mix of general podiatry & surgery. Hospital privileges available. Fully computerized, electronic notes, with capability to go completely paperless. Recently remodeled office, 5 tx/procedure rooms, well-equipped in owner-occupied building (for sale or lease). 260 402-7490

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.

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

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- 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.

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 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 - 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

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

WEEKLY SPECIAL - One week of ads (5x) for only $85

PM Classified Ads Reach over 10,800 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 10,800 DPM's. Write bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451 Ext 110.

• 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.