The Voice of Podiatrists

Serving Over 10,800 Podiatrists Daily

April 10, 2008 #3,216 Editor-Barry Block, DPM, JD

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PA Podiatrist Likes Newly-Invented Alternative to Crutches

Tired of using crutches? A newly invented device called the Cast Skate attaches to the leg with adjustable straps, giving it the appearance of a skate -- without the wheels. Patients then inflate a foam insert in the sole of the cast skate, stabilizing it.

The Cast Skate

Podiatrist Dr. Gregory Parker has had patients grumble when he hands them crutches. He likes the theory behind the cast skate. "Essentially, if you put your foot into a big pillow and plant it on the ground, it's gonna disperse the weight evenly. That's what this looks like it aims to do," says Dr. Parker.

Dr. Gregory Parker

The inventor says the "cast skate" has been issued a patent. He is currently talking to manufacturers who would be willing to produce it.

Source: Steven Selzer, MD, Bay News-9 TV [4/8/08]

IL Sentenced to 6 Years on Drug/Sex Charges

A suburban Chicago podiatrist accused of providing prescription painkillers to two patients in exchange for sex was sentenced Wednesday to 6 years in prison after pleading guilty to drug and eavesdropping charges. Under a deal with prosecutors, Dr. Steven P. Loheide, 64, pleaded guilty in Kane County Circuit Court to one count of illegal delivery of a controlled substance and an illegal eavesdropping charge.

Dr. Steven P. Loheide

"I consider your conduct in this case an enormous betrayal of your trust as a physician," Judge Donald Hudson told Loheide. Loheide also agreed to never again practice medicine. As part of the agreement, Loheide will be on probation for 2 years following his release from prison. Hudson warned Loheide that he would have no qualms about sending him back to prison should he violate his probation.

Source: Clifford Ward, Chicago Tribune, [4/9/08]

Commission Recommends Primary-Care Pay Bump

Congress should establish a budget-neutral adjustment to increase payments for doctors who provide primary-care services, the Medicare Payment Advisory Commission recommended. The payment adjustment would be part of Medicare’s physician fee schedule and would be payable for certain services under the statutory definition of primary care, including office and home visits, and visits to patients in non-acute facilities.

The aim is to “help reward a career in primary care,” which has been suffering from shortages and access problems, said Kevin Hayes, a principal policy analyst with MedPAC, at the commission’s April meeting.

HHS would establish criteria to determine which physicians would be eligible to receive the adjustment. Specialty physicians could stand to lose financially under this proposal, however, and some specialty societies are hoping that Congress will pursue other avenues to improve primary-care payments. In rewarding some physicians under a budget-neutral proposal, “You also have to be careful about who you hurt,” said MedPAC Commissioner Karen Borman, a surgeon who voted against the recommendation.

Source: Jennifer Lubell, Modern Healthcare [4/9/08]

Query: Hallux Varus Repair

A 63 yo healthy female patient presented with a mild, yet symptomatic hallux varus. She had what appeared to be a Silver-type bunionectomy 15 years ago. Over the last year or so, the hallux has started to move medially and rub in her shoes as well as hang over the inside of sandals. The radiograph shows the medial base of the proximal phalanx is 4 mm. medial to the medial side of the first metatarsal head. The IM angle is less than 10 degrees. Any thoughts on soft tissue repair (medial release/lateral pursestringing), bone work, or combination would be appreciated.

Mark Miller, DPM, Bakersfield, CA

RE: Extremity MRI
From: John Etcheverry, DPM

In regards to the extremity MRI we have one in our office. It is made by GE and it came with a computer and monitor to view the images. We had to make some minor improvements in the office to accommodate it. In addition we purchased a printer to print images. We perform the MRI in the office. We then e mail the MRI to a tele-radiology group called Franklin and Seidelmann. They are excellent muskuloskeletal radiologists and their readings are excellent. We then store all of the MRI's on disks. It is a small magnet, but the field of view is small, so proportionately it is similar to a larger magnet with a larger field of view. Excellent images. You can see our exact MRI here It distributed by Hologic. It comes with pre-programmed scan sequences and is very easy to use.

John Etcheverry, DPM, Bakersfield, CA, jetch@footnankle.com

RE: Repair of Kidde Pneumatic Tourniquets (Scot Zindel, DPM)
From: Brian Kiel, DPM

We have used the following company for Kidde Cuff repairs several times over the years.

Medical Product Resources, 1166 East Cliff Rd, Burnsville, MN 55337, 800 524-5194

Brian Kiel, DPM, Memphis, TN, Footdok4@gmail.com

RE: Injectible Cortisone Dosage (Jeff Kass, DPM)
From: Richard Gosnay, DPM, Mike Boxer, DPM

My conclusion with respect to steroid flares is that they are so debilitatingly painful that all large crystal steroids pose an unacceptable risk. I have had flares with Depo-Medrol, Kenalog, Aristospan, and Soluspan. While these flares are rare (Dr. Hall notes 5%.) that is still unacceptable morbidity for me because those few flares are so painful.

I have been using 1 cc. of dexamethasone phosphate in 0.025% bupivicaine for some time now. I have eliminated steroid flares without compromising the therapeutic goal of the steroid injection. My thinking is that long-term steroid therapy is not necessary if the injurious mechanical process that caused the injury in the first place is eliminated as it should be. For example, if a plantar fasciitis patient stretches, stops walking barefoot, and wears arch supports, he is unlikely to become symptomatic after the Decadron stops working. In the worst case scenario, I'd rather give another Decadron injection than risk a steroid flare. But I have not needed to do this yet. I was merely gilding the lily by using large crystal steroids.

Richard Gosnay, DPM, Danbury, CT glabroushead@gmail.com

I was amazed to see the recommendations to mix Depo-Medrol with various solutions including a buffering solution. One should read the literature before using a medication. Depo-Medrol literature clearly states not to mix it with anything. Non-believers should just look at a syringe after something like a local anesthetic is added to Depo-Medrol and one will see that the medications flocculate out. It is just not compatible with anything.

Mike Boxer, DPM, Woodmere, NY, mcbdpm@aol.com

RE: AMA’s Scope of Practice Report (Paul Bishop, DPM)
From: Allen Mark Jacobs, DPM

Dr. Bishop is correct in his position that APMA/ACFAS produce a "white paper" regarding the treatment of foot pathology by non-DPM's, including DO's, MD's, PA's, C.Peds. I for one am tired of having DPM credentials questioned by people who refer me patients with severe PAD diagnosed by them as arch strain, Charcot's joints diagnosed at DVT or treated with diuretics, ruptured ankle ligaments and fractures treated as "simple strains."

It should be clear to any discriminating observer that we will NEVER obtain credibility from the foot and ankle orthopods who are simply in the throws of repeating our professions earlier mistakes. They have become very aggressive toward our profession, and in my opinion generally lack the experience or expertise to critique anyone in my profession.

The potential reversal of practice acts in states such as Texas or Florida are not at the behest of internal medicine, dermatology, or neurology. It is from the bone crushers who would rather willfully or through ignorance mistreat a patient than lose 10 cents by referral of a patient to a podiatrist. Yes, there are SOME exceptions, but they are just that...exceptions.

I have personally not witnessed the current level of orthopedic bigotry since I stared practice in 1975! There is an old adage that the best way to keep a secret from an orthopod is to publish it in a journal. Let's get a white paper together. The crushers will never see it. They don't read. People of reason do.

Allen Mark Jacobs, DPM, St. Louis, MO, allenthepod@sbcglobal.net

ASSOCIATE POSITION – VICTORIA, BC

Beautiful Victoria, B.C. Canada on the ocean, fast growing area. Associate for multi-office full scope practice. Licenser exam to be given in June 2008. Reply to dr.cole@shaw.ca

ASSOCIATE POSITION – NW INDIANA (1 HR FROM CHICAGO)

Caring, hardworking podiatrist needed to join our busy practice. We offer great pay and benefits. Must be highly motivated, have a great bedside manner and superb surgical skills (forefoot and rearfoot surgical training a must). E-mail resume to friendlyfootcare@comcast.net or fax resume to (219)662-7290. Learn about here

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