The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

April 08, 2010 #3,826 Publisher-Barry Block, DPM, JD

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Hygenic Performance Health Products had a great response to the recent podiatry practice survey and wishes to thank those who participated. All participants were entered in a drawing for a new iPad. Congratulations to the winner - Dr. Richard Berliner of Mount Kisco, NY.

We’ve just posted the April 2010 CME titled:

By Tracey C. Vlahovic, DPM

You can Earn 30 CPME-Approved CME Contact Hours Online

 Earn 15 Contact Hours for only $139

Onychomycosis Needs More Than Topical Treatments: MA Podiatrist

According to Dr. John Giurini, head of podiatry at Beth Israel Deaconess Medical Center, it usually takes more than a topical treatment to clear these tenacious infections. Different types of fungi can infect toenails, and some are worse than others. Giurini says that occasionally someone experiences a superficial infection on the surface of the nail, which might respond to a topical treatment. But the majority of infections occur underneath the cuticle and affect the root of the nail.

Dr. John Giurini

The typical signs are discolored nails that become thickened or brittle; the nail may break off or begin to grow in a different shape or angle. Sometimes a thicker nail can cause pain while wearing shoes or if an ingrown nail develops. "But in the vast majority of cases, it is asymptomatic and it becomes more of a cosmetic issue," Giurini says.

For these deeper infections, "the only recourse is to go to an oral medication" he says. Treatment usually involves taking prescription antifungal medications for three to four months, or until the nail has a chance to grow out. After a round of oral medication, Giurini sometimes prescribes a topical medication to help prevent reinfection.

Source: Courtney Humphries, Boston Globe [4/5/10]

NY Podiatrists Receive APMAPAC Chairman's Award 

At the recent APMA House of Delegates, Joseph W. Cavuoto, DPM and Michael Conway, DPM, both of New York were presented with the The 2010 APMAPAC Chairman's Award.

APMAPAC Chairman (L) Dr. Gerald Peterson presents awards to Drs. Joseph Cavouto and Michael Conway

This award recognizes outstanding members of the profession for their success in raising money for APMAPAC. These DPMs faced a unique challenge in soliciting funds due to the large number of podiatrists in New York.

Source: APMA eDaily News

Current EHRs Have Limited Quality, Efficiency Effect: Study

In spite of the ever-increasing push to implement electronic health records, the link between EHR adoption and subsequent improvements in quality of care and efficiency is weak, according to a recently published study in Health Affairs.

Researchers, led by Catherine DesRoches, assistant professor at the Institute for Health Policy at Massachusetts General Hospital, Boston, examined data from more than 2,900 hospitals and found no significant relationship between EHR adoption and performance on quality measures related to myocardial infarction, congestive heart failure or pneumonia, and found only some improvement in prevention of surgical complications.

In addition, they determined EHR adoption did not significantly reduce length of patient stay, readmission rates or total inpatient costs. The availability of computerized physician order-entry systems for medication ordering and clinical decision support did, however, lead to marginally better outcomes, the study found.

Source: Maureen McKinney, Health IT Strategist [4/6/10]

Prepare to Persuade Your Listeners

Persuasive presentations start with a powerful purpose. Identify—and solidify—your purpose when you answer these two questions:

•  “What single idea do I want my audience repeating as they leave the room?”
•  “What single idea do I want them repeating to their friends and colleagues the next day?”

Note: Limit your purpose to one idea, so that you leave listeners with no doubt about the point of your presentation. Although your topic may be complex, your job is to make it easy for your audience to understand and care about it.

Source: Adapted from Presentation S.O.S.: From Perspiration to Persuasion in 9 Easy Steps, Mark Wiskup, Warner Business Books via Communication Briefings.

Query: CryoPen

Does anyone have any experience with the CryoPen system? I currently use the CryoProbe-X and would like to know any advantages/disadvantages to the CryoPen system over the CryoProbe.
 
Anas Khoury, DPM, Passaic NJ

RE: Calcaneal Tumor Treatment (Mark Aldrich, DPM)
From: Bruce Pinker, DPM, Alec Hochstein, DPM

Order an MRI. It may be an intra-osseous lipoma which may need to be removed and packed with bone graft. Keep us posted as to the MRI report.

Bruce Pinker, DPM, White Plains, NY,  docpinker@yahoo.com

These lesions are often found on "routine" radiograph as these benign lesions are non-reactive, and do not cause the patient any pain, until such  time when a pathologic fracture should occur, a real risk in a lesion this large. A CT scan to evaluate the thickness of the cortices as well as any fluid levels within the calcaneus would be very helpful.

The differential for this lesion is solitary bone cyst (SBC) {note fallen fragment sign}, aneurysmal bone cyst, intraosseous lipoma, and giant cell tumor of bone.

Treatment is quite straightforward in, lateral exposure of the calcaneus, windowing the cortex, aspiration and curettage of the cyst, flush of interior calcaneus (many options from saline to dilute phenol), fenestration of bone, packing of defect with bone chips, and/or other bone replacement, 4 weeks non-weight-bearing, 4 weeks of protected weight-bearing. Others may suggest percutaneous aspiration of lesion, but with appropriate imaging, I do not feel this is necessary, assuming  all studies point to benign lesion.

Alec Hochstein, DPM, Great Neck, NY, ahochstein@aol.com

RE: Stiff Joint, Post-op Bunion Surgery (Alan Mauser, DPM)
From:  Jefferson J. Mennuti, DPM

I think that podiatrists are cavalier about letting our patients ambulate in a post-op shoe immediately after a bunionectomy (not including bump-ectomies). I am dealing with such a case where the young gentleman was quite active in the post-op period. He was tolerating manipulation in the office, so I was able to apply traction at the MTPJ and apply ROM to patient tolerance. In the past week, using this physical modality, I have increased his ROM by at least double. Bottom line, I think all my bunions are getting boots from the get-go!

Jefferson J. Mennuti, DPM, Louisville, KY, dr.mennuti@gmail.com

RE: Dorsally Contracted 5th Toe (Alan Berman, DPM)
From: Jeff Kittay, DPM

I asked our chief of plastic surgery for a suggestion about reducing this deformity and informed him that DPMs generally used a V-to-Y lengthening. He advised a Z-plasty instead as it left the dorsal skin with less tension. The center leg of the Z MUST be parallel to the extensor tendon, with the remaining two legs at 60 degrees to the center (use a marker to make sure the end legs are the same length).

When the all three incisions are joined, and with minimal undermining, the two triangles created will almost jump by themselves in to each other’s position, effecting complete relaxation of the contracted skin. Z-plasty or tenotomy, your choice, of the extensor tendon and a standard PIPJ arthroplasty, with or without K-wire, (I prefer the stability of the wire) should get you the results you want. Tell the patients beforehand that you will be signing their foot with a "Z" and they will be happy.

Jeff Kittay, DPM, Dedham, MA twindragons2@verizon.net

RE: PadNet vs. Revo System (Alan L. Bass, DPM)
From: Robert Bijak, DPM

Dr. Bass stated the Revo system did not provide an MD to interpret the results but PADNet did. So, he feels the PadNet is the better system. If podiatrists are performing a procedure they cannot interpret themselves, aren't we acting as a type of technician for the MD? How can we ask for anything besides a technician’s fee for simply mechanically running the test that requires an MD to interpret? Are we duplicating a medical service that would have been more efficiently run by an MD in the first place? 

Are we the specialists in the lower extremity we claim to be or handmaidens for the MDs? If we are the true specialists, shouldn't the MD's be asking for our interpretation? Please note, I didn't bring up the subject of needing an MD to hold our hand. I'm just commenting that we shouldn't need it. Podiatry needs to stop straddling the line of a quasi-medical specialty.

Robert Bijak, DPM, Clarence Center, NY, rbijak@aol.com

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

I do not see how one could not justify the cost of using digital x-rays. We did the figures and found that with the cost of x-rays, solutions, and maintenance, it cost us $900-$1,000 per month. We bought a digital system that cost approximately $22,000. In 22 months, the cost was recouped and there were no ongoing costs. This is especially true if your processor is ready to be replaced. The advantages of a digital system are too numerous to list here, but it is wonderful to have. 
 
Brian Kiel, DPM, Memphis, TN, footdok4@gmail.com

RE: Attracting New Podiatric Students (Bryan Markinson, DPM)
From: Michael Krischer, DPM

I have to agree with Dr. Markinson regarding non-parity and its effect on graduating podiatrists. When I graduated in 1999 in the top ten percent of my class, I did not match with a surgical residency. I swallowed my pride and made the most of my one year, non-surgical PPMR. I had favorable reviews and recommendations from my attending, but it was one of those "boom years." There were significantly more applicants than surgical spots available. The second year, I again did not match. Again, I swallowed my pride and made the most of it. It meant working harder as a lot of doors were closed to me. It meant struggling.

If you look at the ads for associates and group practices, almost all of them request PSR 24 or above training. Most private insurance carriers expect/demand surgical training. This is not sour grapes on my part; I love being a podiatrist and I was very fortunate to obtain a great non-surgical position. However, Dr. Markinson is absolutely correct that some students will spend eight years and over two hundred thousand dollars to obtain a degree and a deck stacked against them.

Michael Krischer, DPM, Cooper City, FL, mskrischer@cnhsa.com

PRACTICE FOR SALE IN HOFFMAN ESTATES, IL NEXT TO SCHAUMBURG

Established 16 year old practice, great Payer mix, no HMO. Fully equipped, updated 1253 ft2, Class A space. Excellent Suburban location just west of Chicago. Great Start-up opportunity - Tremendous expansion potential! Email to: ILDPMpractice@aol.com for more information.

PRACTICE FOR SALE - MAINE

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: robertnunberg@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

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

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