The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

April 10, 2012 #4,432 Publisher-Barry Block, DPM, JD

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Regular Foot Exam for Diabetics is Cost-Effective: NJ Podiatrist

Feet are the furthest thing from our minds when it comes to health concerns. People don’t get routine foot exams, but that is changing for a growing group of Americans who have diabetes. Standard care for diabetes recommends regular foot exams as a cost-effective way to help prevent serious conditions that can lead to amputation and even death.

Dr. James Walsh (Photo: Dale Gerhard)

Dr. James Walsh, 58, of Palermo, Upper Township, typically gives patients with diabetic or peripheral artery issues vascular exams and sensory tests to see if they’re losing sensation anywhere on the foot. “That can be correlated with a recommendation for shoes and gear to help prevent those ulcers,” he said. People meeting the diabetic and loss-of-sensation criteria of the Centers for Medicare & Medicaid Services are eligible for a pair of shoes and three pairs of inserts a year, he said.

Source: Kevin Post, Press of Atlantic City [4/7/12]

Prolonged Standing Also Presents Risks: NY Podiatrist

­Research shows that being sedentary is bad for you. If you’re chair-bound for more than 23 hours a week, you can be 64 percent more likely to develop heart disease. Sitting may raise blood pressure and blood sugar levels. And it places you at risk for various cancers. But there are also risks of prolonged standing. 

Dr. Krista Archer

According to Dr. Krista Archer, a New York foot ­surgeon, “The main worry with prolonged standing is overuse injuries, ­including tendinitis, inflam­mation, and muscle spasm,” she says. “Wear sneakers with orthotics.” She has another tip: “Walking keeps the blood circulating.”

Source:  A.J. Jacobs, Parade [4/8/12]

Pedicures for Athletes are Medical, Not Cosmetic: DC Podiatrist

For those who play sports and have an active lifestyle, a pedicure is less a luxury and more about keeping their feet in great shape. The Wall Street Journal recently reported that Dwyane Wade, the Miami Heat shooting guard, gets "sports pedicures," which is what some salons call a no-frills foot treatment designed for the pedi-hesitant man or woman. And this week, photos surfaced online suggesting that quarterback Tim Tebow occasionally indulges, too. 

Dr. Howard Osterman

According to Dr. Howard Osterman, the team podiatrist for the Washington Wizards basketball team, a handful of his team's players get pedicures every six weeks during the season. Players consider it necessary in terms of foot health and reducing their risk of injury, he suggests. "They're not the least bit embarrassed, and they see it as part of their training program," Osterman says. "It's as much medical as it is cosmetic."

Source: Cari Nierenberg, msnbc.com [4/8/12]

NJ Podiatrist Sees Disproportional Share of Overuse Injuries

Dr. Greg Mowen sees a disproportionate share of overuse injuries such as strains, stress fractures, pinched nerves, and tendonitis. “Our population has so many casino workers who, because of the nature of their work, tend to be standing on their feet every day,” he said. “That’s very problematic, from the foot all the way up.” 

Dr. Greg Mowen (Photo: Edward Lea )

Typical treatments, he said, involve reducing the stress that caused the condition — “We try to get them off their feet for a few weeks” — adding support with shoe inserts or some type of brace, or in some cases injecting medicine or performing surgery.

Source: Kevin Post, Press of Atlantic City [4/7/12]

MD Podiatry Office is Latest in a String of Burglaries

Baltimore County police announced Wednesday that the Tuesday burglary of an office building in downtown Catonsville is linked to a string of similar incidents in Towson, Owings Mills, and Reisterstown dating back to early December. Shortly after midnight on Tuesday, Baltimore County police responded to a call of multiple burglaries at an office building at 405 Frederick Road, according to a release from police. The windows at both Step Well Podiatry and at Advanced Hearing Centers were broken and electronic equipment, money, and postage stamps had been stolen, police said.

Source: Brian Conlin, Northeast Booster [4/5/12]

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky: What's your take on a push now to make a change in the name of the American Board of Podiatric Surgery to the American Board of Foot and Ankle Surgeons?

Dr. D. Scot Malay

D. Scot Malay: I’m for it because just saying "foot and ankle" is probably more widely understood across the population than "podiatric". It is what we do as podiatrists. We’re trained in foot and ankle, so I think that having a more generally understood terminology is a better definition. I think that if you selected 100 people randomly out of the population and asked them if they knew what the foot and ankle was versus if they know what podiatric meant, you’d probably get a higher proportion of them knowing what foot and ankle meant. 

Dr. Douglas Stoker

Meet the Masters is broadcast each Tuesday night at 9 PM (EST). This week's guest is podiatric coding expert, Dr. Douglas Stoker. You can register for future events by clicking here

Query: Metatarsus Adductus in 14 Month Old

I have a 14 month old patient who has a moderate to severe metatarsus adductus who started walking about 1–2 months ago. The mother had been told that the child would most likely have the problem resolve on its own. It has not. 1) At this age, is casting still appropriate because she is walking? 2) It has been a long time since I did this form of casting. Could someone advise me on the correct technique? 3) Would a Wheaton Brace be appropriate for this age, especially with the patient walking? 4) Because the patient is walking, what alternative treatments would be best for this patient? 

Edmond F. Mertzenich, DPM, Rockford, IL

Query: Elderserve Health

My office has recently been approached by Elderserve Health to join their network. Has anyone contracted with them and how has your experience been? 

Justin Sussner, DPM, Suffern, NY

RE: Bunionectomy Complication (Alan Berman, DPM)
From: Alireza Khosroabadi, DPM

First, you need to get more x-rays. I would get a sesamoidal axial to see where the sesamoids are. I always get maximum dorsiflexion x-rays to see what is causing the limited ROM. On your lateral view, measure the medial column angle (Meary's angle). I have fluoro in my office, so I do an ROM study which gives you more info on the ROM of the 1st MPJ just by looking at the x-rays. I have a feeling that she has a hypermobile first ray.

As far as her limited ROM, what I do is take at least 1/3 of the dorsal aspect of the hallux. I take any and all exostosis off on both phalanx and head of the first met. You will not get anywhere with just taking down the scarred capsule, trust me. When you are done in the OR, there should be at least 90 degrees of motion. That should be your goal. Another tip is after you take 1/3 of the head out, use bone wax so the area has less chance of adhesion. I have not examined the patient, but I don't think you need to do anything with the sesamoids, but check them intra-op.

Alireza Khosroabadi, DPM, Arcadia, CA, drk@fixmyfoot.com

Editor's note: To view the original note and x-rays for this thread, simply click on the underlined subject heading.

RE: Diabetic Ulcers With Verrucae (Jordon Sheff, DPM)
From: Gino Scartozzi, DPM
 
The fact that the patient apparently has an ulceration with a concomitant "verruca" present would lead one to suspect certain issues with this patient. These issues can impact on your treatment and prognosis for resolution. I would be suspect of the pathological diagnosis of "verruca" that is concomitant with this ulceration. Biopsy at SEVERAL sites of the ulceration should be retaken to determine the etiology of this "ulceration" if it has not been done already. I have treated long-standing ulcerations of other physicians that have turned out to be carcinomas of squamous cell and basal cell varieties.
 
If the diagnosis is "verruca," your patient is in an immunosuppressed health state. One would have to be suspect of the patient's diabetic control and any other co-existing medical issues that can impede the patient's ability to heal the ulceration and develop a cell-mediated response to resolve his/her "verruca." The ulceration with a diabetic in such a state, even with "good pulses," places a higher priority in their treatment over any verruca treatment regimen, since an ulceration with concomitant infection places higher morbidity/mortality risks on your patient.
 
Treatment that should be considered would include vascular assessment; bacterial cultures post-debridement; determination of the patient's hemoglobin A1c levels, albumin and pre-albumin levels; radiographs to exclude osseous pathology/infection; diminishment of weight-bearing stresses on the ulceration site during and after wound care healing, and appropriate wound care for this patient. Surgical intervention of the ulcer may be considered if the ulceration recurs with proper pre-surgical evaluation/planning.
 
Gino Scartozzi, DPM, New Hyde Park, NY, Gsdpm@aol.com

RE: S/P Fracture Left Ankle (Philip Graham, DPM)
From: Roody Samimi, DPM

As long as she's not tender medially, she has a stable relatively non-displaced injury, and it is okay to weight-bear her in a CAM boot as long as you trust her to use it. The cast may increase the risk for DVT if she is overweight. Being a smoker, it can take 8 to 10 weeks to heal, but it depends on how much her healing is slowed by her tobacco use.

Follow up with 4 and 6 week serial x-rays (or at 7 and 10 weeks if she is in a CAM boot). I don't have an oblique view to further evaluate the medial gutter, but just push under the malleolus for a deltoid injury. Otherwise, she looks stable. She's only 2 weeks out, so of course it hurts. Make sure she's elevating and icing. If she wants to be completely pain-free, have her non-weight-bear w/crutches.

Roody Samimi, DPM, Flushing, NY, roody.samimi@gmail.com

RE: Hyperkeratotic Tinea (Name Withheld)
From: Barry Mullen, DPM

Iccthyosis and thyroid acropachy remain in the differential diagnosis; the former is associated with certain cancers and renal disease, the latter, hypothyroidism. It would be prudent to obtain a skin biopsy as well as check renal and thyroid function to ensure an occult, associated metabolic disorder hasn't been missed.
 
Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

RE: Recommendations for EMR/EHR (Robert Wunderlich, DPM)
From: Joshua Kaye, DPM

Let’s keep in mind the letter “E” in EMR – electronic.  I agree that CMS does not care if you keep paper copies of all your medical records, but that process is certainly time-consuming, a waste of paper, requires filing, and really is not the goal of the program. If my office computer failed one Monday morning, I would simply install the Amazing Charts program on any laptop PC, restore my backup copy of the data, and in less than 30 minutes, I would be treating patients like nothing happened.
 
I believe the big picture is being missed with those who use Practice Fusion (PF). It took consciousness to not allow for a back-up when they initially designed the software, and they continued to make a conscious decisions not to update their software with a back-up provision. Ask yourself why. I cannot think of any good software that does not allow a back-up. Why was PF so adamant about that choice? Maybe, like many other start-up companies, they plan on selling their book of business in the future to a third party for a huge amount of money, which may then decide to charge a large monthly fee. And who are you going to go call without a back-up, GhostBusters?
 
Joshua Kaye, DPM, Los Angeles, CA, jk@joshuakaye.com

SPACE AVAILABLE - NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview, Long Island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

PRACTICE FOR SALE - AUSTIN TEXAS

Great opportunity for new practitioner or an additional office. 18 year practice with large patient base. Current physician transitioning to part time then retiring to pursue another business opportunity. Start turn-key without need for a bank loan. Great area to live and work.  Susieintx@aol.com (512) 565-6634

ASSOCIATE POSITION - TENNESSEE/NORTH GEORGIA

Multi-physician, Multi-office practice looking for motivated new associate leading to partnership. We are a busy practice with state of the art technology: EHR, Digital X-ray, Diagnostic Ultrasound, PADnet, EPAT machine. Applicant should be PMS 36/Board Qualified/Certified. Applicant should be ethical, personable, hard working and interested in providing all aspects of podiatric care to our patients. Competitive Salary and benefits. All interested candidates please send a CV with two letters of reference to mybestnewjob@gmail.com

ASSOCIATE POSITION - PART TIME - OCEAN COUNTY, NEW JERSEY

Looking for PSR 24/36, board eligible preferred. Busy podiatric practice with up to date EMR & practice management program. Practice currently offers digital x-rays, ultrasounds, vascular studies and laser treatment. Good mix of general podiatry, wound care and surgery. Must be ethical, hardworking and committed to quality patient care. NJ license needed. Competitive salary and benefits. Send cover letter and resume to: AOKNDPM@gmail.com

ASSOCIATE POSITION - UPSTATE NEW YORK

Surgical based, multi-office practice in Upstate New York looking for a highly motivated podiatrist to join our group. Base salary plus incentive. Opportunity for growth. Email resume and cover letter to: professionalfootcare@live.com

ASSOCIATE POSITION - SEATTLE, WA AREA

Established podiatric clinic looking for an associate to join our team, 5 offices located around the greater Seattle, WA area. Great base salary, benefits and friendly work environment. Please send resume to: seattlefootdoctor@yahoo.com

ASSOCIATE POSITION - MARYLAND

Looking for 3rd associate. Must be personable, well trained and highly motivated. Great locations in Southern Maryland, including an Ambulatory Surgical Center. We currently have EHR, digital radiography, dispensing center and PADNet. Looking for immediate hire! Please send CV to: myfeetfeet@aol.com

ASSOCIATE POSITION - KANSAS CITY, MISSOURI

Kansas City may be the perfect move for you and your family. I am looking for an entrepreneurial minded associate who wants to grow and then own part of an already successful practice. If you are the right candidate for this associate position, you will enjoy a competitive compensation package and you will be working with a doctor who is as committed to your success as he is his own. Go to:  www.YourFutureInPodiatry.com for full details.

ASSOCIATE - ST. LOUIS, MO

Multi-location group practice seeks motivated DPM with initiative and leadership skills to contribute to our growing group practice. Foot Healers Podiatry Group enjoys a strong reputation within St. Louis and looking for the right individual to complement our team. Must have the confidence to lead you own clinic and the willingness to draw on the expertise that exists within our group. Starting salary ($100k), plus incentive comp plan, malpractice coverage, health insurance, 401k, group bonus/profit sharing. Please send CV to jmurray@foothealers.com and visit our website www.foothealers.com

ASSOCIATE POSITIONS - MULTIPLE STATES

Podiatrist Needed in Missouri, Nebraska, Iowa, Minnesota, North Dakota, South Dakota, Texas, Colorado, Wisconsin, Indiana, and Oklahoma. Expanding multi-state medical practice seeking podiatrists to service long-term care community residing in nursing homes and assisted living facilities. We offer an established patient base, scheduling, equipment allowance and cover travel expenses. Provide generous compensation, bonus opportunities, disability, health insurance benefits, malpractice coverage and flexible scheduling. Looking for a Podiatrist with excellent skills, able to provide expert and compassionate care to patients. Email CV to: careers@aggeus.org or call 773-770-0140 x300/x305. www.aggeus.org

ASSOCIATE POSITION - MANHATTAN

Podiatrist needed for busy state-of-the-art offices in Manhattan. Offices are located near Penn and Grand Central Station. Along with CV, please provide medical plans that you are currently participating in. Please forward your information to roni@myfcny.com

ASSOCIATE POSITION – FLORIDA

Emerald Coast on the North Shore of the Gulf of Mexico, a well-established group practice with multi-offices, seeking an associate with opportunity for partnership for a PSR-24/36 Doctor well-trained in foot/ankle/diabetic problems/wound care/surgical and medical podiatric care, covering 3 area hospitals, NO nursing homes. e-mail letter of interest, CV, and references to basewedge@yahoo.com

PRACTICE FOR SALE - SOUTH NEW JERSEY

Great practice for sale, lease it, work in practice, rent-free first year, associateship possible. Must have NJ licensure have own TIN participation for Horizon, Cigna, Aetna, etc. Retiring. Anyone is welcome to make offer or come up with other ideas. Contact footcare@comcast.net

PRACTICE FOR SALE- MARYLAND, DC SUBURBS

Be an owner not a worker. Well established and equipped practice for sale. Office includes state licensed Ambulatory Surgical Center. Present owner is retiring but will stay on as needed for smooth transition. Average gross over past 3 years is $575 K. dpmpracticeforsale@yahoo.com

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