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April 13, 2009 #3,518 Publisher-Barry Block, DPM, JD

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We’ve just posted the April 2009 CME titled:

By Desmond Bell, DPM

You can Earn 30 CPME-Approved CME Contact Hours Online

 Earn 15 Contact Hours for only $139

Ugg-Style Boots Lack Necessary Support: NY Podiatrist 

Were your boots really made for walking? If they're Ugg-style boots, it turns out the answer may be no. They may feel incredibly comfortable, but despite their popularity, podiatrists warn Ugg lovers to watch their step.

Dr. Rock Positano

"It may feel cushiony, it may feel comfortable, but it doesn't mean they're getting the necessary arch support that a foot needs to function effectively," said Dr. Rock Positano, of the Hospital for Special Surgery. Dr. Positano says arch support is important for helping the foot to absorb shock. Lack of support in your shoe means trouble for your foot.

"What that leads to is overuse, meaning the muscles, the tendons, the ligaments and the bones in the foot and the ankle overwork," Dr. Positano said. "A recent study just came out that showed the correlation between a flat arch and problems with the knee, the hip and the back."

Source: WABC-TV [4/9/09]

AAPPM Chairman is Keynote Speaker to CPMS Practice Management Club

Energy, optimism, humor, and candor - no doubt a recipe for a memorable talk. On April 8, 2009, Dr. Hal Ornstein spoke to students at CPMS at Des Moines University on the incredibly bright future that is in store for future generations of podiatrists. “You are part of one of the greatest professions out there. You will be the all-around go-to person for all foot care problems.” Dr. Ornstein touched upon his experience —the ups and downs— but most importantly, he shared his keys to working through the “downs” and gaining more of the “ups.”

Dr. Hal Ornstein (center) with students of CPMS's Practice Management Club

“He instilled in many of us  (awareness) of our potential to succeed in whatever way we decide to define it,” adds Tea Nguyen, President of the Practice Management Club at CPMS. “He truly has the compassion to help others succeed and perhaps this is why it makes him the richest person I know and had the honor of meeting. He is the Dalai Lama of practice management!”

MI Podiatrist to Sponsor Sisters’ 3-Day Breast Cancer Walk

Sisterhood is about more than just sharing the same parent or parents. It's a bond that carries one through life, and one that four local women are using to help fight cancer. Sisters Jan and Judi Connelly of Northville; Joan Connelly of West Bloomfield; and Joyce Fennell of White Lake will walk in this year's 60-mile Breast Cancer 3-Day Walk in Southeast Michigan Aug. 14-16.

Dr. Harvey Lefkowitz

In addition, since three of the four sisters have had foot surgeries performed by Dr. Harvey Lefkowitz, a podiatric surgeon with an office in Milford, he has agreed to sponsor the team with a significant donation. The four will wear T-shirts that read, “These Feet Were Fixed for Walking by Dr. Lefkowitz.”

Source: Pam Fleming,  Northville Record (MI) [4/9/09]

RE: Aldara  for Plantar Verruca (Gary Kantrowitz, DPM)
From:  Multiple Respondents

Aldara can be applied qd or qod. Have the patient poke a hole in the packet. This can be used until the packet is empty. You must tell the patient that it is an off-label use and warn about the pictures the box comes with. Aldara is very expensive, but it is quite effective. Allow up to 4-6 weeks for results.

Subodh Choudhary, DPM, Greenville, SC, ppodiatry@gmail.com
 
I have used Aldara for several years with good success. The patient applies the cream 3x/wk (M,W,F) hs under occlusion. In the morning, they remove the dressing and can shower. I have them use the Aldara 3-4 weeks before I recheck them and debride any necrotic tissue. I use Aldara for verrucae types that may not have responded to other treatments or mosaic types that involve a large area. It is also useful in children over age 12. The longest tx time I have used it on a single patient (associated with continued improvement) is 3 months. If there is little to no improvement in 4-6 weeks, I change tx.

Greg Aposperis, DPM, Santa Barbara, CA, santabarbarafootclinic@yahoo.com

I use Aldara, but only after sal acid fails. The patient applies Aldara qod. I see them monthly. If there is no improvement after 2-3 months, I excise the verruca. 
 
Doug Dickson, DPM, Syracuse, NY, podocny@hotmail.com

RE: Re-injury of Ruptured Tendons (Kevin Lam, DPM)
From: Multiple Respondents

In this situation, I would consider a lateral displacement along with a varus reducing calcaneal osteotomy, vs a subtalar fusion. In addition, assess for a plantar-flexed 1st Met & consider using an elevating 1st met osteotomy. A Coleman block test should reveal this and the MRI should show the degree of calc varus vs STJ DJD.
 
Amol Saxena, DPM, Palo Alto, CA, Heysax@aol.com

In an obese patient, re-injury of ruptured tendons via a lateral ankle sprain may be accompanied by a partial or total rupture of the lateral ankle ligaments, and if there is a widening of the lateral gutter, it is possible that the tibiofibular syndesmosis has been ruptured as well.

If the ruptured tendons cannot be salvaged and repaired, your best approach should be to repair the tibiofibular syndesmosis and the lateral ankle ligament complex.

Last, but not least, this patient  has to be placed in a custom-made AFO in neutral position to achieve foot and ankle stability in order to be able to have her total knee replacement at a later date.

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com

In my experience, isolated tendon transfers don't usually hold up in obese patients. Many times, peroneal tendon pathology is associated with pes cavus/calcaneal varus deformities. In these cases, a Dwyer osteotomy is required to realign the hindfoot, and protect the lateral tendon repair or transfer. This may need to be accompanied by a dorsiflexory 1st metatarsal osteotomy and plantar soft tissue release if the deformity is that significant.  When the peroneal tendons are able to be salvaged either from extensive degenerative tendinosis or from traumatic injury, consideration should be given to tenodesis above and below the fibular malleolus, with or without additional grafting. If the patient is that obese, sometimes a hindfoot arthrodesis procedure is needed.

Daniel J. Tucker, DPM, Orange, CA, reekat@aol.com

RE: Scanners for Orthotic Fabrication (Bruce Williams, DPM)
From: Larry Huppin, DPM

In response to Dr. Williams statement that there is no evidence to my claims that an orthotic must be captured in a non-weight-bearing neutral position so as to allow for plantar-flexion of the 1st ray, he is correct. There are, however, studies by Ron Valmassy, Tom McPoil, and Irene McClay that have all showed greater amounts of varus captured in the negative cast in semi-weightbearing casts as compared to non-weight-bearing ones.

Our experience in the orthotic lab where I work as medical director is that there is far greater varus found in those casts that are semi-weight-bearing. For this reason, we no longer accept foam boxes or other semi-weightbearing casts for production of functional orthoses. Dr. Williams, who is an exceptionally skilled biomechanist, is the exception that proves the rule. He is extremely careful to avoid the dorsi-flexory effects of ground-reactive forces on the first ray. In general, we find that the majority of podiatrists can provide us with a far superior cast using the non-weight-bearing suspension technique.  
 
Larry Huppin, DPM, Seattle, WA, lhuppin@gmail.com

RE: Diabetic Shoes from a Drug Store (Robert M. Gaynor, DPM, Richard Young, C.Ped)
From: James Korponay, DPM, Paul Kesselman, DPM
 
Dr. Gaynor states " ...you are the expert in managing your patients' diabetic feet. From a practice management standpoint, dispensing is an excellent source of revenue for your practice." 

There is practice management, which translates into maximizing income, and there is patient management, which is doing what is best for the patient.  Yes, there should be a balance between the two but practice mgmt should never overshadow patient mgmt. For the record, I do have a DME provider number.

Just as there are some patients who require surgical procedures that one may not have the skills to provide and are therefore referred out,  there are some "at-risk" diabetic patients who have shoe/insert requirements that are better served by a C.Ped /CO/CP. If the drug store employed a C.Ped, it would not be an issue. The issue here, as Mr. Young realizes, is the danger to those patients who are improperly fit for and dispensed shoes / inserts by a drug store clerk who received maybe an hour of training and what can be done about it. 
 
James Korponay, DPM, NY, NY, JKorponay@aol.com 

Editor’s note: An extended-length letter by Dr. Kesselman appears at: http://www.podiatrym.com/letters2.cfm?id=25723&start=1

SEEKING ASSOCIATE POSITION - NEW JERSEY

Hard-working, compassionate, highly-trained and motivated podiatrist interested in a full-time or part-time position. Graduated from a PM&S-36 residency program. Extensive training focused on wound care, limb salvage, reconstruction, trauma and elective procedures.  Currently hold an active NJ license. Email: ft.n.ankle.dr@gmail.com

TWO YEAR FELLOWSHIP IN RECONSTRUCTIVE FOOT SURGERY AND RESEARCH

2-year fellowship at Beth Israel Deaconess Medical Center, a primary teaching hospital for Harvard Medical School. Fellows have clinic, perform complex reconstructive procedures (external fixation, flaps, Charcot reconstruction), and conduct clinical research (20%). Fellows train residents and receive appointment at Harvard Medical School faculty. Excellent salary/benefits. Program begins SEPTEMBER, 2009. Must have completed PSR-36 or similar. Submit applications to: Adam Landsman, DPM, PhD alandsma@bidmc.harvard.edu Include CV, letter describing goals and any research interests. Deadline: May 1, 2009.  Beth Israel Deaconess Medical Center and Harvard Medical School are Equal Opportunity Employers. Women and minorities are particularly encouraged to apply.

PODIATRIST NEEDED FOR MIAMI-DADE COUNTY

Multi office practice needs doctor of podiatry for full time and/or part time for private office, clinics, and nursing homes. Great opportunity to grow with and unlimited income potential. Offices in Miami, Hialeah, Westchester, and Cutler Ridge. Email to feetdoctor@aol.com

ASSOCIATE POSITION - CENTRAL VIRGINIA

Join a solo surgeon in a two office private practice, modern facilities with EMR and digital x-ray, reconstructive and trauma surgery.  Excellent starting salary and benefits. Position leads to partnership. Submit letter of introduction and CV to jdisabato@vfasa.com

ASSOCIATE POSITION - ILLINOIS
 
Podiatrist needed to provide care for elderly population in Long-Term Care and Assisted Living Facilities. Must be ethical, hard-working, interested in geriatric care and willing to travel. e-mail resume to poddoc2328@hotmail.com

LOOKING FOR FINANCIAL SECURITY?

Our practice continues to grow and we are in search of a motivated, well-trained DPM who is great with patients. Our multi-office practice is located in the scenic Hudson Valley region of New York State. This is a great career opportunity for the right person(s), with an excellent compensation package available. Please reply to Hudson Valley Foot Associates, PO Box 3300, Kingston, NY 12402-3300; or email CV and cover letter to: jobs@hvfa.com

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

PART-TIME NON-SURGICAL PRACTICE FOR SALE - NORTH JERSEY    
 
23 yo practice recently relocated to a spectacular newly-constructed and equipped storefront next to a busy supermarket with ample parking and senior citizens in vibrant downtown. Accepting Medicare and Blues only with great potential. Perfect for expanding to full-time, a second office or new practitioner with means and office experience.  Priced to sell. Financing possible. E-mail interest with contact to Mikedup1215@yahoo.com 

PRACTICE FOR SALE - CENTRAL FLPractice and medical building for sale, in beautiful, high quality of life, growing area, Central Fl.; 2000 sf bldg. fully equipped/ designed for podiatry; excellent location, features & exposure; near hospital, wound and HBO center. Great opportunity for expansion & investment; good insurance climate. 352-223-2713 / E-mail: windnwave@earthlink.net

ASSOCIATE WANTED - FLORIDA

Associate needed for a dynamic multi-doctor practice in the Tampa Bay area. Partnership opportunity for the right candidate. Preference given to a PSR 24+ resident completing their education this spring/summer, and must have a Florida license. Well-established practice, high tech with EMR and digital x-rays, with specialties in sports medicine, surgery and wound care. No nursing homes or HMO's. Excellent hospital privileges available. Choose an area of practice concentration that you are passionate about and enjoy a lifestyle for yourself and your family that is second to none. E-mail: kimvelez@tampabay.rr.com

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. 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 Visit our website

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