The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

April 09, 2010 #3,827 Publisher-Barry Block, DPM, JD

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Foot Pain is Often Indicator of Other Health Problems: NJ Podiatrist

Plantar fasciitis is common in middle-aged people, but it also occurs in younger people such as athletes who stand for long periods or overuse their legs, ankles, and feet. Data shows that each year an estimated two million Americans develop plantar fasciitis and approximately 10% of the population experiences it during a lifetime.

Dr. Marco Ucciferri

"Painful feet can make it difficult to get around, enjoy your day, and be productive at work and play," notes Summit Medical Group podiatrist Marco Ucciferri, DPM. "In addition," says Dr. Ucciferri, "foot pain can be a marker of other health problems such as arthritis, diabetes, high blood pressure, heart disease, and kidney disease."

Source: The Alternate Press [4/5/10]

NY Podiatrist Appointed as HHS Region II Director

HHS Secretary Kathleen Sebelius today announced the appointment of  Jamie R. Torres, DPM, MS as one of five new regional directors of the U.S. Department of Health and Human Services. As a HHS regional director for Region II – New York City (NY, NJ, NY, PR, VI), he will serve as a key representative of Secretary Sebelius in working with federal, state, local, and tribal officials on a wide range of health and social service issues.
 

Dr. Jamie R. Torres

Dr. Torres received his Doctorate of Podiatric Medicine from the New York College of Podiatric Medicine and a master’s degree in Community Health from Long Island University. He is currently Associate Director of Consultative Services at Coler-Goldwater Specialty Hospital, part of New York City’s Health and Hospital Corporation--the nation’s largest public hospital system. He is the founder and President of Latinos for National Health Insurance, a national coalition working for equality in healthcare.

Source: PYMNTS.com [4/6/10]

CA Podiatrist Donates Shoes to the Homeless

The Los Angeles County Sheriff's Department recently organized an event as a way to give free aid to the local homeless, Deputy Paul Archambault said.  It also gave local U.S. Census Bureau officials a chance to count the area's homeless, he said. "These homeless are the hard-to-count ones," Archambault said. "You have to give them a nice carrot to get them out here."

Dr. Michele Summers Colon

Michele Colon, an El Monte podiatrist, took a day off from work to check the feet of the homeless. She also brought eight bags of donated shoes to give to the homeless, who she said often have worn and sprained feet and ankles from living on the streets. "I wanted to do it," she said. "I felt the calling to."

Source: James Wagner, Press-Telegram [3/31/10]

EHRs Improve Patient Contact, Distract Docs: Study

Electronic health-record systems can be a boon and a bane to physician-patient communications, according to a new report by the Center for Studying Health System Change, Washington, with support from the Commonwealth Fund, New York.

On the positive side, the study found that an EHR helps improve physician-patient interaction because it provides quicker access to patient information, affording physicians time to spend with patients that they might otherwise lose hunting for information through paper records that are less organized.

On the other hand, for some physicians, simply using an EHR can pose a distraction. It may also lead physicians to rely on EHRs for information gathering “at the expense of real-time communication with patients and other clinicians,” according to a news release.

Source: Joseph Conn, Health IT Strategist, [4/7/10]

Alleged Failure To Minimize RSD (NY)

Facts: The plaintiff airport baggage handler, then 34, contended that after he sustained a non-fracture crush injury at work, and complained of symptoms that included tingling over an approximate one and a-half-year period, the defendant podiatrist negligently failed to refer him to a neurologist. The plaintiff contended that a referral would have permitted the earlier diagnosis of RSD and more effective treatment. The defendant contended that the reports of tingling were consistent with the soft tissue injury that was diagnosed and that there were inadequate signs or symptoms of impending RSD to mandate such a referral.

The plaintiff maintained that the records reflected that the defendant had made differential diagnoses which included neurological conditions, contended that he was considering surgery and argued that the failure to refer was inappropriate. The plaintiff has undergone placement of a spinal cord stimulator, but maintained that the disabling pain has continued.

Result: The jury found for the defendant.

Plaintiff's Experts: Lawrence M. Kamhi MD Brooklyn, NY, Gary Saphire, DPM, Brooklyn, NY
Defendant's Experts: Roger A. Bonomo, MD New York, NY, Michael Trepal, DPM, New York, NY

Source: New York Jury Verdict Review & Analysis

Two Responses Better Than ‘No’

In an ideal world, you would never have to say “No” to your patients, or employees. In reality, however, you cannot always say “Yes.” But that doesn’t mean you need to actually utter that dreaded two-letter word “No.”

Use these two phrases instead, to move people beyond your refusal and toward satisfaction: “I wish …” and “Even though …” You turn a negative into a positive response when you say “I wish I could do X, but I can do Y” and “Even though I cannot do X, I am happy to do Y.” Here are some examples:

•  “I wish that I could approve your vacation request for this week. However, I can approve time off for you next week.”
•  “Even though we cannot give you a refund for your othotics, I would like to see if we could arrange for credit towards future treatments.”

Note: Those types of responses make clear that you are on the other person’s side and indicate that you want to find a way to reach satisfaction.

Source:  Adapted from Great Customer Connections: Simple Psychological Techniques That Guarantee Exceptional Service, Richard Gallagher, via Communication Briefings

Query: Possible Tear of Lateral Plantar Plate and Lateral Collateral Ligament

I have a 60 YO female who presented with swelling in the 1st interspace, no significant trauma. Plain x-rays didn't show any significant osseous pathology (mild bunion, mild met primus varus). There was soft tissue swelling in the 1st interspace. I had MRI performed and results are: “Thickening of the lateral joint capsule with increased signal of the 1st MTPJ lateral collateral ligament. Suspicious for a tear of the lateral plantar plate and lateral collateral ligament." 

I ask my colleagues if they would open the area to repair this damage or just treat the area as a soft tissue injury with CAM walker, rest, ice, and NSAID's.

Alan Berman, DPM, Carmel, NY

Query: Metanx and Folast

Recently, I had a patient return to my office stating that the vitamins I had prescribed for her were significantly helping her peripheral neuropathy. "So the Metanx is working?" I said to her.  She replied, "No, the pharmacy gave me something called Folast."  I thought this had to be a mistake since I had not heard of a pharmacy substituting a generic for Metanx. 

After searching the Internet for information, it seems that some pharmacies are offering this as a lower cost, generic for Metanx.  The Metanx website states that Folast is not the same. If it's not the same, why is it being offered as a substitution? I have been very happy with the results of Metanx, but I'd like to hear other opinions on this topic.

Alan MacGill, DPM, Boca Raton, FL

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

I published a paper with Mike Cohen, DPM evaluating our hypothesis that 1st MTPJ stiffness post-bunionectomy is related to alterations in crista orientation. As foot surgeons, we tend to focus on the IM angle, HA angle, etc., but forget that we are also altering the underside (plantar surface) of the 1st MTPJ. Specifically, we can inadvertently create an oblique orientation to the sesamoid crista while addressing the IM angle and PASA. Post-operatively, the sesamoids cannot glide as intended and become fibrosed. Effect of PASA - Correcting Osteotomies on the Hallucal Sesamoid Apparatus. Journal of Foot and Ankle Surgery. November/December 2001

As far as treatment, I agree with manipulation under anesthesia. If that fails, I suggest an arthrotomy and liberal use of a McGlamry elevator. I routinely inject 1 cc Decadron 4mg/cc into the 1st innerspace prior to the post-op bandage. I also instruct the patient on proper 1st MPJ passive ROM on the 1st post-op visit.

Craig Breslauer, DPM, Palm City, FL,  cbdpm@bellsouth.net

RE: MASS Theory  (Doug Richie, DPM)
From: Tyler Brahm, DPM

I have used the new type of functional biomechanical orthotics for the past nine years. I was educated by Ed Glaser, DPM.  My patient satisfaction from the use of these orthotics increased tremendously. I changed to a very similar, but smaller lab about five years ago, Icon Orthotics, which is  owned by Robert  Levine, DPM and John Fulner, DPM. Dr. Fulner  makes the orthotics from the beginning to the end; therefore quality control is almost perfect. 

Many of my patients with foot and lower leg problems are amazed that often their sciatica, lower back pain, and hip pain coincidentally decrease or are totally relieved by the use of functional  orthotics. The Root theory of biomechanics was the best in the last century, but these orthotics are far superior. I was deeply offended by Dr. Ritchie’s remark that Dr. Glaser did not have the credentials to teach or develop new techniques. I believe that if Dr. Ritchie was trained with these new  orthotics, they would be the only orthotics he would ever use. Just because Dr. Glaser is not board certified does not mean he cannot invent new and better techniques. Remember that stents were named after a dentist, and not a board-certified interventional cardiologist. Dr. Levine and Fulner’s orthotic lab in Florida has made orthotic therapy much more predictable and almost problem-free. I have been to many of their lectures and weekend 16-hour workshops, and I am still learning.

Tyler Brahm, DPM, Clearwater, FL, Buckeyes72@aol.com

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

In regard to Dr. Bijak’s response to my post about the comparison of the PADnet and Revo units, I have found that the PADnet is a better device. I did not state that the only reason for this was the interpretation by the MD. My point is that we may be the first physician to see the patient. I do not feel that I am a technician or a handmaiden for the MD. I do not need anyone to hold my hand when treating a patient. I do feel that when I have a vascular specialist interpret the study, in addition to myself, I am forming a collaborative effort to treat the patient.

While I am performing a technical exam, and I can interpret the results, I do not feel that I need to be the only one on “the team.” If the patient requires intervention from another specialty, I feel comfortable referring to my colleagues. I hope that nothing I have stated can be interpreted as I believe that we as podiatrists are a quasi-medical specialty. We are the specialists in the treatment of the foot, ankle, and lower extremity.

Disclaimer: I am a consultant to Biomedix, the manufacturers of PADnet.

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

PRACTICES FOR SALE – BOSTON SUBURBS

Two established part-time practices. 2009 Gross 150K. Turn-key opportunity with low overhead. Diverse payer mix & loyal patient base. Currently open 2 days a week, but can expand to increase revenues. Personnel to remain, seller will assist transition. Asking 65K for both offices. Contact david@transitionconsultants.com (800) 416-2055.

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.

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

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.

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.

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