The Voice of Podiatrists

Serving Over 10,800 Podiatrists Daily

April 11, 2008 #3,217 Editor-Barry Block, DPM, JD

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We’ve just posted the April CME titled "The Five Most Common Running Injuries Seen in the Office" by Stephen Pribut, DPM on www.podiatrym.com .

You can Earn 30 CPME-Approved CME Contact Hours Online

Spring Gardening Presents Risk for Foot Injuries: NY Podiatrist

“Plant your feet firmly in solid shoes when you’re digging in the garden or tackling home improvement projects,” says Dr. Craig Herman, president of the Bronx Division of the New York State Podiatric Medical Association. “If you’re not careful, your enthusiasm for do-it-yourself projects can trip you up.”

Dr. Craig Herman

During construction as well as everyday repair and yard-work projects, the risk for injury to the feet can be high. Choose work boots or leather shoes over flip flops and sandals. Mowing the lawn? Don’t let exposed toes anywhere near those blades, Dr. Herman warns.

“Remember that your feet and ankles are the anchors that are holding you up,” adds Dr. Herman. “Stand on a good foundation”. According to Dr. Herman, being on your feet for hours can stress your arches. “Make sure your shoes provide the support your feet and arches need,” he advises.

SOS Healthcare Provides Lectures to Podiatric Students

Lynn Homisak, Jason Kraus, and Dr. John Guiliana have been touring the country delivering important practice management lectures to the students at the colleges of podiatric medicine. SOS Healthcare Management Solutions, LLC, together with PRESENT e-Learning Systems have undertaken this important educational role thanks to generous grants from the grand sponsor, Spenco, and major sponsors DJO, Gill Podiatry, and Merz Pharmaceutical.

SOS (Dr. John Guiliana and Lynn Homisak, front center) with CPMSM students.

Students at a recent program at the California School of Podiatric Medicine at the Samuel Merritt College were given insight on their options after graduation and learned what it takes to become a successful practicing podiatrist.

Investment Advisor Who Defrauded Podiatrists Faces 10 Year Sentence

Former investment adviser Jeffrey Lafferty faces 10 years in prison after pleading guilty to stealing hundreds of thousands of dollars from clients who gave him money to invest. The former Princeton resident, who has been in jail since his September indictment, pleaded guilty last week in state Superior Court in Hackensack to securities fraud and misapplication of entrusted property.

Jeff Lafferty

As part of the plea, prosecutors will recommend a 10-year prison term for Lafferty at his May 2 sentencing. The former co-owner of Lafferty & Partners also agreed to repay about $790,000 to investors and surrender his state insurance producer license, Peter Aseltine, a spokesman for the Attorney General's Office, said yesterday.

A grand jury indicted Lafferty and his companion/business partner, Vincella Ross, on conspiracy, money laundering and other charges. They were accused of taking money from clients -- the firm dealt mostly with podiatrists -- and using it for themselves. In a deposition that Lafferty gave as part of a lawsuit that a podiatrist from Orangeburg, NY, filed against him, Lafferty acknowledged taking the foot doctor's money to buy a house. For years, Lafferty was affiliated with the American Academy of Podiatric Practice Management as a speaker on investment issues, but the association cut ties with him when they learned of his previous securities violations.

Source: Greg Saitz, The Star-Ledger (NJ) [4/10/08]

Query: Easy Billing System EMR/Billing System

I would like anybody's input in regard to EBS (Easy Billing System) based out of Nanuet, NY.

Victor Villagonzalo DPM, Middletown NY

RE: Hallux Varus Repair (Mark Miller, DPM)
From: Multiple Respondents

The Arthrex mini tightrope is an excellent way for correcting hallux varus. The procedure requires only two drill holes with no osteotomy. I will e-mail a PowerPoint presentation which describes the procedure to anyone who requests it.

Denis Russell, DPM, Fountain Valley, CA, rdenisr@sbcglobal.net

I have reaped great success with 1st MTPJ arthrodesis as a definitive treatment for symptomatic hallux varus. If the deformity has been present for years, articular remodeling has likely already occurred, making soft tissue release procedures tenuous at best. Reverse osteotomies will not eliminate the problem of current or future arthritis in the joint, and still could result in recurrent varus. My patients have achieved high levels of satisfaction with fusion. My preferred fixation construct includes a dorsal locking-type plate (Acumed, Nexa, Stryker, and a few others), as well as an interfragmentary cannulated screw from the phalanx base medially to the metatarsal laterally.

Godfrey Viegas, DPM, Crystal Lake, IL, gviegas1234@sbcglobal.net

I recently treated a 68-year-old female patient suffering from hallux varus secondary to overcorrection of an Austin type procedure by another practitioner. The patient was adamantly resistant to the idea of arthrodesis. In this case, I performed a soft tissue correction utilizing extensor hallucis brevis tenodesis secured via an absorbable interference screw placed in the neck of the first metatarsal. With the limited series that has been published patients achieved acceptable correction with a slight trade-off of decreased range of motion. This particular patient is now five months out from surgery and thus far had a great deal of the symptomatic relief and is overall very pleased with the procedure.

For more details regarding surgical technique recommend reviewing Myerson MS, Komenda GA. Results of hallux varus correction using an extensor hallucis brevis tenodesis. Foot Ankle Int. Jan 1996;17(1):21-7

Christopher P. Segler, DPM, Chattanooga, TN, Dr.Segler@anklecenter.com

RE: Injectible Cortisone Dosage
From: Multiple Respondents

I would like to know where does it say in the literature that only 3 steroids injections can be given? Wouldn't it depend on amount, type, location, and frequency?

Robert Frimmel, DPM, Sarasota, FL, rfrimmel@hotmail.com

I've been using DepoMedrol 20mg/ml with 1% Lidocaine with epinephrine, 0.5% Macaine and buffered to physiologic pH with 8.4% Sodium Bicarbonate for about 5 years now. If you leave the syringe in your pocket for 10 minutes or so, you'll see the steroid precipitate with gravity, but once mixed together in the syringe, it stays in solution by my visual examination for at least the several minutes it takes to get from the injection station to the room and into the heel. You will see ready precipitation of the 80mg/ml Depo in the syringe, but I don't see it with the 20mg/ml.

David Secord, DPM,, Corpus Christi, TX, David5603@pol.net

The Depo-Medrol crystalline powder is almost completely insoluble in water-based solutions. Attempts to mix with them results in a highly super-saturated aqueous solution, incompatible with the ability of limited soft-tissue compartments to absorb. Although the package insert does not disclose the exact size of the molecular powder fragments, I believe it is substantially larger than a number of other cortisone derivatives.

In fact, the package insert advises against mixing with saline or water. The medication comes as an aqueous suspension which requires a large muscular substrate site to facilitate systemic absorption.

I think that podiatric physicians who use it (improperly) will find their patient actually develop a slow-healing sinus tract to the site where the molecules have been deposited. It is therefore unsuitable for podiatric medicine, if given directly to contiguous foot or ankle sites.

Michael M. Rosenblatt, DPM, San Jose, CA, rosey1@prodigy.net

The posts regarding the use of soluble versus insoluble steroids has produced quite a varied response. I feel compelled to offer my experience, which does not seem to agree with anyone. The use of soluble preparations such as dexamethasone sodium phosphate in the foot in 1-4 mg. doses makes no sense whatsoever. You may avoid a flare, but that is because the half life of this drug is a little over three hours. That means that it probably flushes away from the area you injected it into in a matter of minutes. If indeed anyone is getting a response, you should get the same response by injecting the preparation into the deltoid or anywhere else in the body.

For years I remember using phosphate solutions injected once weekly into bursal areas and neuromas, mixed with lidocaine, for up to seven weeks. That is what I was taught in podiatry school. Patients would often tell me that they went to an orthopedist and were cured in one injection. Then, during a rheumatology rotation in the early 80's, what I was taught about injectable steroids turned what I had already thought upside down. I now use insoluble preparations exclusively, in 10-20 mg. doses, limiting therapy to three injections maximum in 6 months. Whenever I get a flare reaction, perhaps once a year, it is most often resolved with ice application after a couple of hours, and almost universally is followed by a markedly better therapeutic response to that particular injection. I totally accept the fact that the patient might lie to me to avoid another injection, but the same is true for many of you who use soluble preparations.

Bryan C. Markinson, DPM, New York, NY, bryan.markinson@mountsinai.org

Editor’s note: An extended-length letter from Dr. Zapf appears at: http://www.podiatrym.com/letters2.cfm?id=18909&start=1

RE: AMA’s Scope of Practice Report (Allen Mark Jacobs, DPM)
From: Ross E. Taubman, DPM, Donald Jay Arenson, DPM

I appreciate the postings regarding the AMA Module and the profession's response to that document. The APMA has a master plan that is already being implemented that was presented at the APMA HOD House of Delegates in Executive Session this past week. The plan is a coordinated effort between APMA and all of our affiliates. The plan comprehensively responds to this document. APMA members may obtain more information from their State Components or from the APMA.

Ross E. Taubman, DPM, President, APMA, Clarksville, MD, retaubman@apma.org

I fully agree with Dr. Jacobs that the degree of aggressiveness by the foot & ankle orthopedic surgeons has, of late, been unprecedented in my near 30 year career. It should be no surprise, however, that the audacious contempt on behalf of the AOFAS for podiatry remains inculcated in the fellowship training programs of these folks. Please recall, Circa 1975, the editorial written by the then president of the AOFAS entitled "Wither Podiatry." The only thing that has changed is now these guys are highly organized, backed by the AAOS, AMA- funded, and are dedicated to the insidious, behind the scenes, piece-by-piece dismantlement of our profession. Make no mistake; it is their number one priority. We are fighting a guerilla war.

Donald Jay Arenson, DPM, Elmhurst, IL, darenson@pol.net

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com -- www.homephysicians.com

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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