The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

April 12, 2010 #3,829 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2010- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Extreme Heels Extremely Bad for Feet - MO Podiatrist

In the music video for “Bad Romance,” Lady Gaga dances in 10-inch super high Alexander McQueen heels, but podiatrists say young women trying to emulate that look risk painful foot strain and injury. Bunions, corns, calluses, toe stress, even sprained ankles, can result from heels that are too high, according to the American Podiatric Medical Association.

Dr. Anna C. DeSaix

“The greater the [heel] incline, the more pressure that will be on the balls of the feet,” APMA podiatrist Dr. Anna DeSaix, of Bridgeton, MO, says on the APMA’s website. Wearing heels is okay, as long as the height is not too extreme, and moderation is the key, she says. The podiatrist added several important tips on high heel safety, including limiting wear when walking long distances and ensuring that all footwear has an appropriate heel height of two inches or less.

Source: Ted Webb, Indyposted [4/9/10]

4 Podiatrists Inducted into NAP, Evans Honored

The recent National Academies of Practice (NAP) induction ceremony in the Washington, DC area saw five podiatrists receive recognition for their outstanding achievements to the profession. Receiving NAP Medallions as distinguished practitioners and scholars were  Kimberly Eickmeier, DPM, of Champaign, IL;  V. Kathleen Satterfield, DPM, of Boerne, TX; Arnold V. Signer, DPM, of Jacksonville, FL; Thomas F. Weidner, DPM of Gaithersburg, MD.

(L-r) Drs. Arnold Signer, Harold Glickman, V. Kathleen Satterfield, Chet Evans, Christian Robertozzi, and Kimberly Eickmeier

A current NAP distinguished practitioner, Chet Evans, DPM was further honored with the designation of becoming a National Academies of Practice Fellow by virtue of providing “loyal, consistent and unusually energetic service and support to the organization…”

MO Podiatrist to Compete in No-Holds-Barred Art Debate

This isn't your father's art debate. The second Art Slam at the Crisp Museum will unfold as a no-holds-barred verbal cage match of sorts to entertain and provoke the audience. Art Slam pits two individuals in a debate-style atmosphere discussing a particular exhibit. In this case, Dr. Christopher Rieger of Southeast Missouri State University's English Department will be debating Dr. Zenon Duda, a podiatrist and sculptor.

Dr. Zenon Duda

The exhibit that will be caught in the middle is "Ansel Adams: Masterworks," currently on display in the Crisp Museum. Audience participation during the debate is encouraged. People can shout responses to arguments or questions to the debaters.

Source: Darren Burgfeld, Southeast Missourian [4/9/10]

MO Podiatrist Sentenced to Jail for Medicare Fraud   

A St. Louis podiatrist has been sentenced to five months of prison and five months of home confinement for falsely billing Medicare and Medicaid, and must repay the government $250,000. Dr. David Quang Pham pleaded guilty to obstruction of justice in January. He was sentenced Friday in U.S. District Court in St. Louis.

Pham served patients at nursing homes and residences for older adults in Missouri and Illinois. Federal prosecutors say he submitted false claims and medical records. In some cases, Pham submitted claims for treating the feet of patients whose feet had been amputated. Pham also agreed to pay restitution of $70,000 in the criminal case. In addition, he settled a civil case with the government in January and agreed to pay $180,000.

Source: The Associated Press [4/9/10]

Health Reform Law Raises Geographic Payments from Medicare

Among the Medicare program changes made by the new health system reform law were revisions to the geographic adjustments made in calculating payments for physician services. The AMA has developed preliminary estimates of the impact these provisions will have on average payment rates in each of the states, and concluded that physicians in 42 states and territories will benefit from these changes in 2010 and 2011.

The impact of the revised geographic adjustments on individual physicians will vary by state and by service. But, starting at the beginning of the alphabet to illustrate, the AMA estimates the following increase provided by physicians in Alabama (assuming no change in the fee schedule conversion factor):

•Payment for a mid-level established patient office visit (CPT 99213) will increase by 4.6 percent, from $59.89 to $62.66. 

Sour ce: AMA Health System Reform Insight [4/9/10]

Query: Metallic/Rubbery Taste From Lamisil

I have a 45 year old female patient who completed a three-month course of oral Lamisil for fungal nails about seven months ago and complains of a constant metallic/rubbery taste in her mouth which started around the time she stopped the Lamisil. She is otherwise healthy and takes no other medications.
 
The Lamisil package insert says 2.8% of patients get taste disturbance which usually recovers within a few weeks of discontinuance of therapy, but there are cases where it lasts longer than a year, and is severe enough to result in decreased food intake and results in unwanted weight loss. Is there any treatment? For these cases that last longer than a year, do they ever resolve or is it permanent? 
 
Al Musella, DPM, Hewlett, NY  

Query: Orthotics for Ice Skates

What is the best type of orthotics to use in ice skates? 
 
Joel Morse, DPM, Washington,  DC

Editor’s Note: The June issue of PM will feature an article on this topic by Robert Weil, DPM, podiatrist to Olympic gold medalist Evan Lysacek.

RE: Piezogenic Papules  (Bryan Markinson, DPM)
From: Multiple Respondents

Dr. Bryan Markinson asks if piezogenic papules are easily identifiable on film, and/or under surgical exposure. These fatty papules will show on imaging, but they are not generally symptomatic unless there is an underlying lesion causing their protrusion, and/or a ruptured muscle belly and/or torn tendon.  Based on the large size of this patient, I would think the issue is a ruptured muscle and one would see that on surgical exposure. I would consider an MRI prior to surgery. 

Steve  Berlin, DPM, Baltimore, MD, drstevenberlin@yahoo.com

These lesions are easy to locate. That being said, they are not effectively resected. The fascia is not easily repaired. In my experience, you cannot remove the herniated papules. They are not localized and the result is lobulated fat continuing to be removed. You can try to close the defect but I believe you will end up at the same point prior to surgery, if not worse.  You now may be dealing with painful papules with a possible symptomatic scar. Imaging is a waste of time and money. I have used ultrasound on these lesions to confirm they were fat. This did not change the treatment options.

Carlo Messina, DPM, Weston, FL, cmacna@yahoo.com

I have used the Topaz co-ablator for piezogenic papules with really good results. I use an 18 gauge needle to penetrate the skin, insert the Topaz and ablate say 7 times for 3-4 pulses. You will actually see them shrink in front of your eyes.  My longest patient is two years out now and he has no pain. There is a slight recurrence but he is pain-free.  For a simple procedure with no sutures and a relatively short post-op course, I think it’s worth a shot. On the negative end, I had to use an unlisted code and got paid pretty poorly. I think of it as free advertising.
 
Eugene A. Batelli, DPM, Clifton, NJ, eabdpm@gmail.com

RE: Stiff Joint, Post-op Bunion Surgery (Alan Mauser, DPM)
From: Mathew M. John, DPM

Ever since residency, I have been allowing my patients to walk immediately after surgery following a distal metatarsal and/or hallux proximal phalanx osteotomy type bunionectomy (Kalish, Scarf, Akin, etc.). Knowing that my screw fixation of the osteotomy is solid, I don’t treat  bunionectomy patients as if they had an unstable fracture. I have utilized a post-op shoe and also the pneumatic boot; both work well for my patients. But since surgery is more of an art form than simply fixing a car, I know each surgeon develops an individual protocol post-operatively. Two weeks following a bunionectomy, I fit the patient with a dynamic toe splint to increase the range of motion to a stiff first MTP joint.

My office is part of a multicenter study on the use of a dynamic toe splint post-operatively.  I find that patients are more compliant with a daily routine of using the splint than going to physical therapy three times a week (and I still use physical therapy post-operatively for many patients). Early range of motion and allowing the patient to bear full weight in a running shoe has been working for many surgeons for many years, including myself. If I find that the patient has full range of motion on the OR table, then I know that patient is able to achieve the same range of motion post-operatively. Early range of motion and the use of a dynamic toe splint is a great way of avoiding and treating a stiff joint post-bunionectomy.

Mathew M. John, DPM, Marietta, GA, footdoc@afcenters.com

RE: MASS Theory  (Tyler Brahm, DPM)
From: Kevin A. Kirby, DPM

The repackaging of the century-old ideas from the Whitman Brace type high-arched orthosis, which Dr. Glaser calls his "MASS Theory", is truly an interesting phenomenon within the podiatric profession.  Here, we have an orthosis lab owner who travels around the country lecturing on "biomechanics theory" and suggesting that the best orthoses for all patients should be made around a foam-box, semi-weight-bearing cast of a foot held in the supinated position.  Of course, this orthosis can be best ordered only from the orthosis lab he owns.

Regarding the idea of varying the medial longitudinal arch height in orthoses, when I was taught by Drs. John Weed, Ronald Valmassy, Chris Smith, and Richard Blake, while I was a podiatry student and Biomechanics Fellow at the California College of Podiatric Medicine in the early 1980s, we frequently varied the medial arch height of the orthosis in order to try to achieve more control over excessive pronation motion of the foot.  Certainly, there is definitely a time and place for higher arched orthoses and I have been using higher arched orthoses for selected patients since my biomechanics fellowship in 1984.

My biggest concern is that these types of orthoses are not the optimum orthoses for all patients.  In my community, I have seen patients develop peroneal tendonitis, medial arch pain, and lateral plantar compression neuropathy when these types of high-arched foot orthoses are used indiscriminately on the wrong patients. Please, doctors, be wary of anyone who tries to tell you that one type of orthosis is the best orthosis for all patients. The human locomotor system is exceedingly complex, and the mechanical foot therapy methods we choose for our patients deserves a more rational scientific approach than the ones being promoted by certain individuals within our profession.
 
Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net

RE: Metanx and Folast (Alan MacGill, DPM)
From: Gino Scartozzi, DPM

In regard to the substitution of Folast for Metanx, I explain to the patient with diabetic neuropathy ahead of time that the Metanx, although more costly than Folast, is the activated form of vitamin B (L-methylfolate 2.8 mg, pyridoxyl-5-P 25 mg and methylcobalamin 2 mg.) The L-metylfolate is the active form of folate, the pyridoxyl-5-P is the active form of B6 and the methylcocalamin is the active form of B12.  As such, there is NO substitution for this supplement. This is explained as such to any pharmacist who attempts to substitute my script. Dr. Allen Jacobs advocates this supplement's use since diabetic and elderly patients have malabsorption issues with intestinal uptake and enzymatic conversion of inactivated forms of vitamin B seen with Folast over Metanx.
 
Gino Scartozzi, DPM, New Hyde Park, NY, Gsdpm@aol.com

RE: Accountability of Expert Witnesses  (Adam Cirlincione, DPM)
From:  Multiple Respondents

APMA does not handle ethics issues directly. Complaints regarding ethical behavior are the responsibility of our state components. APMA only acts on an appeal of a state decision. I am unaware of any request for an appeal in the past 20 years. APMA, however, has been very proactive on the issue of expert testimony. The following expert testimony language was added to the APMA Code of Ethics not too long ago:
 
ME5.2 Accountability in Providing Expert Testimony
ME5.21 The podiatrist providing expert testimony is expected to have relevant experience, training, and knowledge in the area in which the podiatrist has agreed to testify. Testimony must be objective and be limited to the area of expertise held by the podiatrist. Expert testimony should be based upon recognized medical and scientific principles, theories, facts, and standard of care.
ME5.22 The podiatrist serving as an expert witness shall offer testimony that is honest and truthful. A breach of these ethics would exist if a podiatrist knowingly provides false or misleading testimony.
ME5.23 The podiatrist may accept compensation for testimony offered but such compensation should not in any way be related to or based upon the outcome of the litigation.

Glenn Gastwirth, DPM, Executive Director, APMA, gbgastwirth@apma.org

The American College of Foot and Ankle Surgeons adopted Expert Witness Testimony Standards in 2005. These standards apply to all ACFAS Fellows and Members who provide expert opinion services to attorneys, litigants, or the judiciary in the context of civil or criminal legal matters, and include written expert opinions as well as sworn testimony. ACFAS members are encouraged to sign a voluntary affirmation statement of these standards.

While this is a voluntary program, if an ACFAS member who serves as an expert witness does not sign the statement, that fact could (and has in the past) be subject to cross-examination by defense counsel. To our knowledge, ACFAS is the only podiatric organization that has adopted such standards. ACFAS members may access the standards and affirmation statement at acfas.org/expertwitness. 

Chris Mahaffey, MS, CAE, Executive Director, ACFAS, Mahaffey@acfas.org

Editor’s Note: Dr. Bryan Markinson’s extended-length letter can be read here.

ASSOCIATE POSITION - TEXAS

Dynamic, growing practice in Dallas/Fort Worth area, seeking surgically trained, Board Certified/Board Qualified Podiatrist. Excellent salary and benefits compensation package, for the right candidate, with partnership/buyout opportunity. Contact/Send resume to: jmh6122@yahoo.com Texas Podiatry License Required.

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.

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 FOR SALE - MAINE

20+ year full scope turn-key practice in the same medical building, podiatrist-friendly hospitals nearby, appreciative and cooperative patients, excellent expansion potential. Retiring seller will stay for transition. mainefootdoc@yahoo.com

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.

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.

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 – 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.

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

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

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,000 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.