The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

April 03, 2010 #3,822 Publisher-Barry Block, DPM, JD

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ON Podiatrist Joins the Bandwagon of Ugg Boot Critics

We've all seen the Ugg shuffle, usually performed by a young woman in a mall. Hair in a ponytail, she sports sweatpants or jeans with her soft, clunky boots, either true sheepskin Ugg or knock-off. Now podiatrists say walking long distances in Ugg boots or knock-offs can be terrible for your feet, especially if you already have foot problems or if you're young and your feet are still forming.

Dr. Hartley Miltchin with an autographed pair of Pam Anderson's Ugg boots (Photo: Canadian Press) .

Toronto podiatrist and foot specialist Hartley Miltchin of Accent on Feet owns an autographed pair of Anderson's Ugg boots. He, too, is concerned about both the original brand and the many cheaper versions. "Just walk behind a woman who's wearing a pair of Uggs and see how distorted they can be in the heel area," he says. "This is basically a slipper. It shouldn't be used for walking."

Miltchin says many people have problems with overpronation, a genetic trait that causes the heel to roll in toward the centre of the body. Walking in an "unconstructed" shoe like a flimsy boot will not allow overpronation to improve, which could lead to sore feet, sore knees and low-back pain.

Source: Nicole Baute, The Canadian Press [4/2/10]

MN Podiatrist Follows in Family's Footsteps

The St. Peter doctor whose great grandfather was the first licensed physician in Minnesota has been reappointed to the Board of Podiatric Medicine. Dr. Schelli McCabe is the great granddaughter of Dr. Louis Albert Fritsche, a New Ulm doctor whose license was No. 1 in 1887.

Dr. Shelli McCabe with photo of her great grandfather.

McCabe, a podiatrist with the Foot and Ankle Clinic on Third Street in St. Peter, was reappointed last week to the podiatric board for a new four-year term. McCabe said it’s satisfying to serve on the board. “It’s a wonderful way to be able to protect the public; that’s the mission of boards in the first place,” McCabe said.

McCabe’s interest in serving on the board traces to mentor Dr. Ann Rotrammel. “She was one of the first women podiatrists,” McCabe said. “She loved what she did. She was on the board for many years and proud of it. She often spoke of it.” Rotrammel was a lover of life, buying a Cadillac at age 95. She passed away at age 97.

Source: Ed Lee, St. Peter Herald, [4/2/10]

GA Podiatrist Presents at Oglethorpe University

Dr. Dane Ulett, a board certified podiatric surgeon with Village Podiatry Centers presented an educational lecture to Oglethorpe University students at the Emerson Student Center in Atlanta on March 16. The lecture, “Your Foundation for Life: Foot & Ankle Health,” focused on the podiatry profession and lower extremity healthcare.

Dr. Dane Ulett

The event attendees included aspiring medical students and students active in various sports. Dr. Ulett discussed the training of a podiatric surgeon and provided medical information on common foot and ankle ailments and injuries, as well as preventive care. He included a discussion of diabetes, a rapidly growing disease among all ages, which may negatively impact lower extremity health due to peripheral neuropathy.

Dr. Ulett, a practicing physician and surgical instructor, encouraged the students to have an awareness of when to see a doctor and not to take their foot health for granted. “Young adults often ignore foot pain and continue activities despite suffering injuries that can seriously damage joints or tendons. My goal is to use community lectures to educate about the value of good foot health for a lifetime of mobility,” said Dr. Ulett. “I also hope to inspire students to consider the field of podiatry, a vital medical specialty for treating all ages.”

Handle Touchy Feedback Reactions

No matter how tactfully and effectively you deliver criticism, the recipient is likely to feel defensive or even argumentative. Prepare yourself for the following reactions:

•  “Yeah, but …” Suppose that you have informed an employee that her late arrival every day is unacceptable. Her response: “Yeah, but I can’t control what time my bus gets me here.” Your reply: “I hear you, and while I empathize with your transportation problem, that is not the issue. The issue I am addressing is that you are supposed to clock in every morning at 9 a.m. How do we make that happen?”
•  “That’s not fair.” An employee may react to justified criticism by accusing you of being unfair, of playing favorites, or of picking on her. Reply with a simulated role reversal. Say: “I’m sorry you feel that way. Let’s imagine that you are responsible for this office. You have a situation where ringing telephones aren’t answered, and patients' needs aren’t met because the person who should pick up the phone is not there on time. What would you do?”

Note: If the employee responds with an unreasonable suggestion, explain why it is not workable. If you hear a good solution that meets both your needs, consider implementing it.

Source:— Adapted from Power Tools: 33 Management Inventions You Can Use Today, Sam Deep and Lyle Sussman, Addison via Communication Briefings.

Query: Neuropraxia?

I often get some discomfort from my right saphenous nerve when my athletic shoe presses on it. Last week (8:00 PM), I was at a play and my athletic shoe irritated my foot, so I loosened it. The discomfort continued until it hurt over the entire MTJ medial to lateral, and I was not able to put my foot in a comfortable position. At intermission (9:00 PM), I limped to the concession area and removed my shoe, and my foot was slightly purple and a little swollen.  By 10:00 PM, I had to have help walking out of the play. We stopped at my office on the way home and got crutches because I was no longer able to bear any weight on my right foot. I tried on a CAM walker, but it made the pain worse. I went home and rested, iced, elevated it and was able to tolerate an air stirrup ankle support. I had severe pain till about 3:00 AM then finally was able to fall asleep. I got up several times in the night and had to use the crutches, unable to even bear any weight on my foot.

By 10:00 AM when I got up, I could put a little weight on my heel, my foot was still swollen mildly with a slight reddish discoloration with decreased ROM. As the morning went on, I was able to walk with a cane and by the afternoon I was walking almost normal. I stayed off of my feet the rest of the evening and by Sunday I was out mowing my lawn.

I am completely at a loss as to a diagnosis? Severe neuropraxia?  There was no history of trauma. I had some flu symptoms earlier in the week. One of the men at the play in our group had an intestinal flu 1-2 weeks ago, and said his foot had hurt and he was not able to put it in a comfortable position also. Comments please?

Catherine Yack, DPM, Huntsville, AL

Query: Proex Online

I’m currently paying 11 cents per line for transcription, with very few mistakes. I’m thinking of switching to Proex Online since they charge 6.4 cents per line. Does anyone have a good or bad experience with this company?

Joe Borden, DPM, Reseda, CA

Query: Casting Code for a Richie Brace

Is there a separate casting code for the stocking cast applied to get an impression of the patient's leg/ankle/foot for a Richie or Colorado Brace? Or is it included in the fee for the brace?

I am specifically asking for a Medicare payable code.

Karen L. Wrubel, DPM, Hawthorne, CA

Response: There is no code or separate payment for the casting procedure or the casting supplies for any AFO device under Medicare guidelines. These costs are included in the code and payment for the AFO brace itself.

Doug Richie, DPM, Seal Beach, CA

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

RE: Dorsally Contracted 5th Toe (Alan Berman, DPM)
From: Multiple Respondents 

Do a "Y" type incision over the 5th MPJ. Make the top part of the "Y" cut and then a longer bottom portion of the "Y" cut. When you lengthen the tendon, make sure you really lengthen the tendon. Z-plasty should be fine. Do a total 5th MPJ capsular release. I like to use a 0.45 K-wire for 4 weeks and a CAM walker boot. A helpful way to prevent the toe from popping back up is to remove a transverse double elliptical wedge of skin at the plantar aspect of the proximal phalanx to tighten up the skin plantarly. 

Also, take a look at the 4th toe. It also looks dorsally contracted. It might not be an issue now, because the 5th toe is so raised, but after you correct the 5th toe, the adjacent 4th toe might become the next "shoe rubbing" problem.  After the K-wire and stitches are out, I suggest taping the 5th toe down for 2 months afterwards.

Keith Gurnick, DPM, Los Angeles, CA, keithgrnk@aol.com

Dr. Gary L. Dockery and Dr. Mary E. Crawford published an excellent book on plastic and cutaneous surgical techniques: Lower Extremity Soft Tissue and Cutaneous Plastic Surgery, which includes how to repair a contracted 5th toe like the case presented by Dr. Berman. I consider this book a must for any lower extremity physician's library.

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com

I have concerns whether or not the 5th toe can be corrected with soft tissue correction alone. In comparison, the 4th toe would probably respond very well with...

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

RE: 21% Medicare Reduction
From: Dale Smith, DPM
 
Yesterday, the 1st of April,  the official beginning of the reduced payments, until or if they are revised, I took my case to my patients, to get a feel for their potential involvement if additional pressure is needed on legislators to correct the situation!  Surprise, surprise, the response was underwhelming. Maybe, because people don't know how it will impact them exactly yet, they view this as our (the doctors) little contribution to the whole reform process.  It might have been different if I had said, "I'm sorry I can't see you anymore, because of your insurance." All of the patients took the, Oh well that's too bad attitude. This doesn't bode well at all.
 
Dale Smith, DPM Chicago, IL, DMSmithDPM@aol.com

RE: VOIP Phone Service (Michael Loshigian, DPM)
From: Dwight L. Bates, DPM, Dwight L. Bates, DPM

Skype is very good when it is working, but it is not as reliable as traditional telephone service. The version of Skype I use is free, and also allows real-time video as well as telephone. Possibly, their premium version is better.  

Dwight L. Bates, DPM, Athens, TX, dlbates04@yahoo.com

I have a VOIP called "vocalocity" and have had a very good experience with it. The features are numerous and the price is good. I recommend that you contact  Jim Kline @ jkline326@comcast.net. He is very knowledgeable about these systems and really helped us set up the entire system. He can assess what you are currently running and show you how to save money and likely improve your service.

Disclosure:  I am not paid in any way to endorse this product or vendor.

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

RE: Digital X-Ray System (Michael J Marcus, DPM)
From: Ed Davis, DPM, Michael Forman, DPM

I am interested in digital x-rays but do not understand the economics of this service. Currently, I refer patients to a radiology center in proximity to my office (across the street) as opposed to providing in-office x-ray services. Considering the reimbursement rates for foot and ankle radiographs, and comparing that to the costs of purchasing and maintaining such services, I would appreciate advice.

Ed Davis, DPM, San Antonio, TX, ed@sanantoniodoc.net

We like to think that we  have a modern well-run practice. Every expenditure we make is based on
1. how it will affect our patients and
2. how it will affect our bottom line. 
 
I have been writing positively about the benefits of diagnostic ultrasound and vascular testing on both of these issues. I learned this from my AAPPM colleagues.
 
We do not have digital x-rays. I know how convenient they are, and I understand their benefit, and I appreciate that they make things easier and more efficient. However, our practice feels that the cost/benefit ratio of a digital x-ray system does not add up at this time. We don't believe that we would make up the cost for a long time by increasing our efficiency .
 
Michael Forman, DPM, Cleveland, OH, IM4MAN@aol.com

RE: Changing to Billing Service (Peter Smith, DPM)
From: Bruce Fisher, DPM

You've heard the phrase "caveat emptor" or "let the buyer beware." When purchasing any item or service as important as this, I cannot emphasize this more. Without a diatribe detailing my horrific encounter with a so-called billing service that was a "podiatry billing expert," the only question I implore you to ask yourself is...

Editor's Note: Dr. Fisher's extended-length letter can be read here.

RE: Attracting New Podiatric Students (Michael Trepal, DPM)
From: Bryan C. Markinson, DPM, Paul Liswood, DPM

Dr. Rosenblatt paints a rosy picture of how podiatrists thrive in poor economic times. He also encourages us to allow prospective students to shadow us. I have loved my work since day one, and today, I love it more than ever. I have had many prospective students shadow my practice. In fact, I have had some pre-med students shadow me in a special program here at Mount Sinai to encourage people for careers in medicine and have had some switch into podiatry. I have believed in the ethic of this process as a way to attract better students. I am as proud a DPM as could possibly be.

However, at the beginning of this past month, I have decided that I cannot in good faith encourage anyone to consider a profession that does not provide a post-graduate training spot for all of its graduates, when at the same time, the profession now mandates three years of such training. Some 50 graduates will be asked to sit out a year, unless some provision has been made that I am unaware of.

This is tragic, and all resources of the profession should fix it fast before one more high school or college student is encouraged. The days of "we at the schools never promised anyone a residency spot" should be long over. The silence on this has been deafening!

Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org

When Senator Schumer states that doctors are investing in technology for the sole purpose of making a profit, we have to understand there may be some merit to what he is saying. We have seen many doctors try to increase the scope of their services. Primary care doctors are giving heel spur injections, physical therapists are debriding ulcers, and chiropractors are making orthotics. Why is this happening? This may be happening because doctors are looking to increase the scope of services they provide to compensate for inadequate reimbursement rates. At some point, that is the issue that needs to be addressed.
 
I am a third generation podiatrist, and I would love my children to become fourth generation podiatrists. Podiatry has been good to me so far. However, I was told that the average DPM makes about $130,000 a year. The cost of podiatry school is very high. The average residency program is now three years. If you want to recruit more DPM’s, you have to have the average DPM salary go up, and the cost of education go down. Simple economics.

Paul Liswood, DPM, Brooklyn, NY dr.liswood@verizon.net

ASSOCIATE POSITION – NEW YORK

Podiatrist Needed Immediately - RFC only. $45/hr working for the state prison system. Clean and safe. Easy money to help pay the bills. Several shifts available. If interested, E-Mail hansfeet@aol.com.

EQUIPMENT FOR SALE - PADNET+

Padnet+ vascular testing unit Includes Unit, Dell laptop, all cuffs and cart. Pay what I owe on lease ($19,000) + Shipping. Call 856-783-2800 or E-Mail Feet1@comcast.net

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

EQUIPMENT FOR SALE – MICROVAS

Microvas Unit for sale. Less than 1 year old and in perfect working condition. Pads included. Best offer. Please e-mail inquiries to podiodoc@gmail.com

CANADIAN PODIATRISTS COME BACK HOME!

An Edmonton, Alberta group of DPM’s requires an additional Podiatrist. Interest in biomechanics essential. Given Canadian visa restrictions, this position is open only to Canadian Citizens or permanent residents. Very attractive compensation package. Fax C.V. or letter of interest to: (780) 483-5796.

ASSOCIATE POSITION FULL-TIME - SUBURBS OF CHICAGO

PSR 36 - month-trained podiatrist needed for busy suburban Chicago practice. Full benefit package included. If interested, please email your curriculum vitae to foot1st@yahoo.com

ADVANCED RESEARCH AND SURGICAL FELLOWSHIP

Boston University Medical Center has two unique fellowship positions Become an expert in Limb Preservation, Tissue Repair and Regeneration. Be part of this unique Fellowship at a major teaching facility. During this time, he/she would be expected to become a knowledge expert who will contribute significantly to research, surgical procedures, teaching, and innovations in limb preservation and tissue repair. Requirements: Completion of a two or three year surgical residency; Candidate must possess a commitment to an academic career in podiatric medicine and surgery. Annual Salary: Year 1 $61,000, Year 2 $66,000. Submit a CV and letter of interest to: erin.springhetti@bmc.org

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 - 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

PM News Classified Ads Reach over 12,000 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 12,000 DPM's. Write to 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.

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