The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

April 07, 2010 #3,825 Publisher-Barry Block, DPM, JD

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Structural Foot Flaws Often Affect Weekend Warriors: MO Podiatrist

Cooped up in the office during the work week, golfers, cyclists, tennis players, softball enthusiasts and other amateur athletes push hard come Saturday and Sunday. “‘Weekend warrior’ injuries are especially common during spring and summer,” says Dr. John Dailey, medical director of The Missouri Foot & Ankle Institute, an outpatient facility in Washington, Mo. “So many people sit on their butts the entire winter, then end up in my office with an overuse injury as soon as the weather turns warm.”

Dr. John Dailey

Injuries are sometimes symptoms of underlying structural weaknesses that were there all along. “Problems in the feet and lower extremities can cause pain throughout the body, even when there’s no pain in the foot itself,” Dailey explains. “People who go to the chiropractor for knee, back or hip pain might feel fine for a day or two, only to have the pain return because it’s caused by a structural flaw in the foot.”

Source: Tony Martino, Ladue News [4/1/10]

More Emphasis on Quality While Reducing Costs if New CMS Head is Confirmed

Although no official announcement has been made, the White House press office has confirmed that Donald Berwick, MD, president of the Institute for Healthcare Improvement (IHI) and a Harvard Medical School professor, will be Obama’s pick to head the agency. Berwick, a pediatrician by training, served on an advisory commission for patients rights during the Clinton administration and on an Institute of Medicine panel focused on the reduction of medical errors and improved patient safety.

Boosting quality while reducing costs will be the next administrator’s top priority as the Medicare program is scaled back by more than $400 billion over the next decade, and enrollment in state-run Medicaid programs explodes as a result of the health reform law and double-digit unemployment rates. As a result, the agency’s strategic focus will need to shift to increased use of chronic care management and quality improvement. Industry observers interviewed by Health Plan Week say that makes Berwick an ideal candidate.

Source: Health Plan Week [4/5/10]

Avoid These Missteps When You Fire

Telling an employee, “We’re letting you go” is never easy. Yet the way you phrase that unwelcome message can make the communication process unnecessarily harder. Avoid these statements:

•  “This has nothing to do with your performance.” It’s tempting to protect a departing employee’s feelings. However, if performance problems led to the decision, be honest.
•  “We have no choice but to terminate your employment.” Be honest: You always have other options; they just are not as appealing as letting the person go. If you start with a blatantly false statement, you distract the employee.
•  “You brought this on yourself. You did not try hard enough.” Hold the employee accountable but don’t be insulting. If the person feels personally attacked, he or she may fight back.
•  “This is as hard on me as it is for you.” Delivering bad news is no picnic, but it is harder to be fired than to fire. Don’t expect a newly unemployed person to care about your discomfort.

Source: Adapted from “10 Things Not to Say When Firing an Employee,” Jonathan Segal, BusinessWeek via Communcation Briefings

Query: Calcaneal Tumor Treatment

While treating this 45 y/o man for hallux limitus and forefoot pain, his radiograph showed a tumor in the distal body of the right calcaneus.

Calcaneal Tumor

His left heel has no such lesion. His heel has never been the source of pain and no history of injury. An orthopedist who previously treated him for the forefoot pain told him to “leave it alone.” This man has HTN, hypothyroidism, and elevated cholesterol. I am concerned that doing nothing leaves him at risk for possible tumor growth and pathologic fracture. I am seeking input on what treatment approach my colleagues would recommend.

Mark Aldrich, DPM, Antigo, WI

Query: Advisory Boards

What are experiences of those who have utilized "Advisory Boards" to fill in the knowledge gaps they might have about managing their practices?

Bob Levoy, Great Neck, NY

Query: Mucoid Cyst ICD-9 Code

Can anyone recommend the ICD-9 code that best describes a mucoid cyst? Is it the ganglion cyst code?

Nicole Hancock, DPM, Denton, TX

Response: Several ICD-9 codes describe a mucoid cyst. Choose the one that most closely resembles the pathology encountered:

ICD-9 727.40 - Synovial cyst, unspecified
ICD-9 727.41 - Ganglion of joint
ICD-9 727.42 - Ganglion of tendon sheath
ICD-9 727.49 - Cyst, other

Barry A. Wertheimer, DPM, Redondo Beach, CA

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

RE: Importance of Biomechanical Measurements
From: Neil L. Horsley, MS, DPM

I am concerned over the current status of biomechanics and how students/residents miss the importance of evaluating the feet during stance or during gait. Students are primarily resistant to taking any kind of measurement except for vital signs, especially if those measurements have anything to do with biomechanics. Hence, that is why I require all students to take the sagittal plane measurements at the ankle joint, 1st ray, and 1st MTPJ. These measurements are taken during each patient encounter. When indicated, the complete biomechanical examination is performed prior to casting for orthoses.

Neil L. Horsley, MS, DPM, N. Chicago, IL, Neil.Horsley@rosalindfranklin.edu

RE: Stiff Joint, Post-op Bunion Surgery (Alan Mauser, DPM)
From: Multiple Respondents

This is personal experience and I really have no scientific explanation for it: I always use a medial incision for a bunionectomy favored by most orthopedic foot and ankle surgeons rather than a dorsal incision favored by most podiatric surgeons. I have found that with a medial incision, post-operative stiffness at the articulation is rarely a problem barring degenerative changes at the joint.

Russell F. Trahan, DPM, NY, NY, dr.trahan@att.net

Dr. Mauser didn't mention the type of procedure he performed on each person or whether they underwent physical therapy. Any bunionectomy patient of  mine goes 3 times a week for at least 3 weeks for physical therapy (whether performed in my office or outside). They are then given at-home exercises to do. They are given very strict do’s and dont's to do after surgery, realistic expectations, etc. Make sure that your 35 year old is following your instructions. At my residency at the original Northlake in Chicago, we were always taught that rehab is just as important as the surgery itself.

Judith E. Rubin, DPM, Cypress, TX,  jrubinfoot@aol.com

Dr. Mauser asks a time worn question, "Why the heck did that first MPJ freeze up after my beautiful surgery?"  Textbooks have been written on this problem and many of our podiatric gurus have tried to answer that question.
 
Not being a guru, but some old guy with a lot of experience, I will list some of the reasons this occurs.
 
1. Not taking off enough...

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

RE: PadNet vs. Revo System (Marc Goldberg, DPM)
From: Alan L. Bass, DPM

I purchased the Revo system last year during the Midwest conference. One of my only criteria at that time was price. Knowing that it was about half the price of PADnet, I bought the Revo unit. I made the wrong choice. When I received the unit, there was really no on-site training or customer service. The one thing that I noticed was there was too much interacting with the unit: too many buttons to press, too much scrolling back and forth on the wave forms.

When I bought the unit, there was no interacting with an MD to interpret results. This may have changed now. After about six months, I investigated the PADnet unit. One of the things that I noticed right way was the ease of using the unit, and that my results were much more reproducible. In addition, the PADnet unit allows you to perform a higher level study that will detect disease more precisely. This will also allow you to bill for a higher level test. Biomedix also provides superior on-site training, and an MD to interpret your studies. Don’t base your decision on price alone. I am glad that I switched. The unit is worth it.

Disclaimer: I am a consultant for Biomedix, the makers of the PADnet device.

Alan L. Bass, DPM, Manalapan, NJ, abassdpm@optonline.net

RE: Digital Imaging Systems/In-office Radiology
From: Kenneth Meisler, DPM

I think all podiatrists should ideally be taking x- rays in their offices. I cannot see how the costs of an x-ray system, traditional or digital, cannot be easily recouped by the number of films taken in the office. In addition, I feel that not having x-rays in your office will negatively affect patient care. Frequently, certain views have to...

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

EQUIPMENT FOR SALE - X-RAY ORTHOPOSER

SXR-15 floor model X-ray Orthoposer unit for Sale. Great unit for primary or second office. $1500.00, shipping not included. Reply to: robert.nunberg@me.com 617-974-3338

ASSOCIATE POSITION – HUDSON VALLEY, NY

Lower Hudson Valley (Carmel area) Tuesday & Wednesday mornings 9-1. Surgical privileges at hospital available for any cases booked. Compensation dependent on experience. 25 year old practice. Podiatric references will be needed. Reply to PodAssociate@aol.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 - 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.

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.

PART-TIME POSITION - CHICAGO AREA 

Immediate opening to provide podiatric services in nursing homes within 30 miles of downtown Chicago 2 to 3 half days a week.  Competitive package and $500 signing bonus paid after 6 months of service. Contact Dr, Brian Aronson at 773-775-0300 or BA@podiatryplus.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.

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

PRACTICE & BUILDING FOR SALE - MIDDLE TENNESSEE

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. Website and marketing material included. Seller happy to assist with transition. Priced to sell with financing available 250k. Call 931-446-5724.

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

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