The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

April 14, 2010 #3, 831 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.

AZ Podiatrist Provides Advice to High Heel Wearers

Dr. Kathleen Stone, president of the American Podiatric Medical Association offers the following advice to those who insist on wearing sky high heels. She suggests not wearing heels that are higher than 2 inches. “It’s very difficult, not only on the foot, but the knees and low back,” she warns. “The way the shoes put pressure on the front part on your feet, it applies compression on your toes and irritation to the nerves in the toes.”

Dr. Kathleen Stone

“The bones in the ball of the feet, called sesamoids, can be damaged or broken,” Stone reports. “Constant pressure on the feet can result in thickening of tissues around the nerves of the toes, called Morton’s neuroma, causing pain, stinging or numbness in the toes.

Source: Madison Park, CNN [4/9/10]

PA Podiatrist Lectures at Infectious Diseases Congress in Turkey

Warren S. Joseph, DPM, FIDSA of Roxborough Memorial Hospital in Philadelphia, PA recently returned from a lecture tour of Turkey.  Dr. Joseph gave five talks on the topic of diabetic foot infections, including one in the Mediterranean resort city of Antalya to the nationwide Hospital Infection Congress. This was followed by four lectures to University Infectious Diseases Departments at various cities throughout the country including Istanbul, Malatya, and Kayseri. 

Dr. Warren Joseph in Turkey

“It is interesting to see both the similarities and differences between Turkey and the United States in our respective approaches to diabetic foot infections (DFI) and, in particular, their approach to forming amputation prevention teams,” stated Dr. Joseph. “There is no equivalent to our U.S. podiatric physicians, so the primary responsibility for identifying at-risk feet is spread between different specialties, with no one taking primary responsibility. At a few of the major hospitals, they have started to form true multi-disciplinary teams to treat DFI with great success.”

FL Podiatrist's License Suspended for Unpaid Student Loans

State officials have suspended indefinitely a Naples podiatrist’s license until he can show he has made arrangements to repay outstanding student loans, according to the Florida Department of Health.

The license of Rasool Shariff, 62, was suspended immediately following a meeting of the Board of Podiatric Medicine in late March, according to an April 8th order from the board. The podiatrist also was ordered to pay an administrative fine of $12,000 and administrative costs of $1,918, according to the order.

Source: Liz Freeman, Naples News [4/12/10]

APWCA Establishes Masters Designation

The American Professional Wound Care Association has established a new masters designation, "MAPWCA."  Individuals earning this prestigious title must have demonstrated extensive authorship of scientific articles, participated in research and teaching, and have demonstrated leadership in the wound care field.

Dr. Steven Kravitz, APWCA Executive Director (center), surrounded by Drs. Diane Krasner, Elizabeth Ayello, Gail Woodbury, and Adrian Smith.

The following individuals are the first to achieve APWCA's highest level: Robert Frykberg, DPM, Elizabeth Ayello, RN, PhD, Adrian Smith, MD, Diane Krasner, RN, PhD, Gail Woodbury, PT, PhD, and Gary Sibbald, MD.

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

Bret Ribotsky: What unique pearls have you brought into your practice, and whom did you learn them from?

Dr. Lowell Weil, Jr.

Lowell Weil, Jr.: I really learned a lot from Louis-Samuel Barouk, who is one of the most dynamic foot and ankle surgeons this world has ever seen. He is from Bordeaux, France. He is truly a Renaissance man. He looks at the foot as an artistic thing and he does not look at just correcting a bunion or correcting the hammertoe. He looks at it as making the foot beautiful and as being able to fit the foot into a beautiful shoe.This means not correcting a toe in isolation, but how it will blend with the entirety of the foot, and function in a beautiful shoe.

As much as we say that we do not do cosmetic surgery, foot surgery has very much a basis of cosmetics. Patients are interested in cosmetics, in beautiful shoes, and things like that, so we have to really be appreciative of that.

Dr. Neal Frankel

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's show features IPA expert Dr. Neal Frankel. Dr. Ribotsky's interview of Jeffrey Toobin can also be heard on the Meet the Masters website. You can register for this event by clicking here

Query: FHL Repair Coding

How do I code a primary repair of a ruptured flexor hallucis longus tendon with use of a bone anchor?

Steve Sheridan, DPM, Sandusky, MI

Response: I am assuming that the repair of the flexor hallucis tendon was performed within the foot, and not at the ankle or lower leg level. This being the case, the proper code would be: CPT 28200 - repair tendon, flexor, foot, primary or secondary without free graft.

If the repair is performed at the ankle or lower leg level, code it as CPT 27658 - repair flexor tendon, leg, primary, without graft.

The use of an anchor in the repair would be included in the surgical allowance.

Howard Zlotoff DPM, Camp Hill, PA

Codingline subscription information can be found at:
http://www.codingline.com/subscribe.htm

RE: Taste Disturbance from Lamisil (Al Musella, DPM)
From: Robert Boudreau, DPM, Marc Sabo, DPM

"Taste disturbance side effect" is reportable as an incident report to both the manufacturing company and the FDA.
 
Robert Boudreau, DPM, Tyler, TX, rbftdoc@aol.com

I have seen this several times. In one case, we did formal taste thresholds. It turned out the disturbance actually was with sense of smell rather than taste. Who really knows how often this is the case, since formal taste testing is rarely performed on these patients. Please see the entire article as listed below.

Lemont, H., Sabo, M.: Terbinafine Associated Taste Disturbance with Normal Taste Threshold Scores. JAPMA 91:540-541, 2001.

Marc Sabo, DPM, Williamston, NC, dmrmas1@juno.com

RE: Stiff Joint, Post-op Bunion Surgery (Barry Mullen, DPM, David Secord, DPM)
From:  Mathew M. John, DPM

In regard to Dr. Mullen’s comments, I respectively disagree that early weight-bearing following a bunionectomy violates standard of care. I do agree that early mobilization does not equate to early unprotected ambulation. But again, as some surgeons may begin early mobilization post-op day 1, I am more comfortable in starting ROM exercises at two weeks once I know that the incision is healed. During this time, I believe that incision healing and avoiding dehiscence is primary to range of motion.

Would starting ROM immediately following surgery be deviating from the standard of care? No, I don’t believe it would be. Let me clarify that following their two weeks in a post-op stiff soled shoe, I allow my post-bunionectomy patients to walk in a supportive running shoe such as an Asics or New Balance. I do not advocate patients wearing anything else non-supportive and still stress that they maintain activity restrictions.

In fact, unlike Dr. Secord, I maintain those activity restrictions for three months post-op. But, I do not believe Dr. Secord is deviating from the standard of care. So, the question for debate is whether the surgeon who keeps his post-bunionectomy patient on crutches for six weeks is more in line with the standard of care than the surgeon who only keeps them NWB for one week or two weeks? Or maybe eight weeks is more in line of standard of care? It is an assumption that every surgeon who allows their patient to bear weight early post-distal metatarsal bunionectomy somehow experiences an unusual amount of complications. I as well as many other podiatrists will agree: this is simply not true.

Returning to the original topic, I believe that the treatment of a stiff joint can be addressed in different ways, but I have found that the use of a dynamic splint post-bunionectomy has provided better compliance.

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

RE: MASS Theory  (Elliot Udell, DPM)
From: Michael Lawrence, DPM, Doug Richie, DPM

The back and forth regarding the MASS theory of Edward Glaser has been most interesting. I met him many years ago and he came across as a bit different, a renegade of sorts. He lost a lot of credibility with me when he bragged about doing television ads for his practice in which he dressed up in all kinds of clown suits, some depicting foot problems like hammertoes. I'm not smart enough in biomechanics to blow his theory out of the water, but with the commercials in mind, I find it hard to take him seriously.

Elliot Udell, DPM brought up another factor regarding the practices of Dr. Glaser, that being heavy marketing to chiropractors. Friends from Nashville, where Dr. Glaser is from, tell me he also does the same with shoe stores, showing them how to cast and get into the custom orthotic business - his lab, of course.

Michael Lawrence, DPM, Chattanooga, TN,  ftdoc@joimail.com

I believe that Dr. Udell provided the best insight into this dilemma facing the podiatric profession with the introduction of "new" theories of lower extremity function and foot orthotic design. Several labs, including Sole Supports have aligned with the chiropractic profession to provide "new" insights into biomechanical theory and foot orthotic design.

As Dr. Udell correctly observes, Sole Supports is a company which has a strong alliance to the chiropractic profession based upon: 1).  Their appointment of a chiropractor as their director of "research and development", 2). Their marketing to the chiropractic profession,  and 3). The requirement for submission of  partial weight-bearing impression casts using foam boxes.
 
Most experienced podiatric physicians have long recognized the pitfalls and fallacy of producing foot orthoses from foam box impressions, which chiropractic practitioners utilize when providing their own brand of foot orthoses. I hope that most of us realize that we have training and expertise in the treatment of lower extremity pathology, which should command a higher level of respect than the chiropractic profession. Why certain colleagues such as Dr. Brahm would buy into the fallacy of foam box impression casting and chiropractic theory of foot function is beyond my comprehension. 
 
Doug Richie, DPM, Seal Beach, CA, DRichieJr@aol.com

RE: Skating Boot Problems (Nancy A. Kaplan, DPM)
From: Lloyd Nesbitt, DPM

Dr Kaplan's patient with the prominent 5th metatarsal head needs to have her leather boot stretched, or if it is made of one of the newer synthetic materials, it can be heat-molded to accommodate the deformity. That is assuming that she has the proper style and size boot for her foot type and skate discipline.

Off ice, this patient should be asked to wear a wooden-soled, post-op shoe or at least a sport sandal while all other  anti-inflammatory measures are taken. Skaters do not like to wear felt or foam accommodative pads, but some can tolerate a thin gel pad in their boots. Over the years I have performed surgery on prominent 5th metatarsal heads which did not respond to non-surgical treatment modalities.
 
The odor from the boots are a common situation. All boots hold moisture, especially at the end of a 2 or 3 hour training session. I ask skaters who want to minimize or eliminate this problem to use a common boot dryer overnight, and if they wear orthotics or any type of removable insole, to take them out and let them dry overnight, as well. Too often, skaters take their wet boots, place them in their skate bag, and do not bother with them again until the next day's skate session.
 
Jonathan P. Contompasis, DPM, Wilmington, DE, Jpcdpm@aol.com

We dispense to hockey players and others  1" x 1" adhesive felt squares. We tell them to simply stick them on their foot in a biplane fashion before putting on the skates. It doesn't get rid of the bone problem, but skaters always ask for more pads as they work well. We buy a roll and use a paper cutter and hand them out for free.

As for the smell, it's probably too late. Moisture/dark/hot environment equals mycosis as we well know. The solution: get new skates and be sure to air them out after every skate.

Lloyd Nesbitt, DPM, Toronto, Canada, lloydn@rogers.com

RE: Orthotics for Ice Skates (Joel Morse, DPM)
From: Multiple Respondents

I agree with Dr. Ross that a skater's orthotics should be a thin, graphite device with a narrow grind. I take a neutral position cast and post the orthotic intrinsically. The graphite shell on my skate orthotic only extends to the sulcus. I add a thin top cover which extends to the toes.  If a leg-length inequality is present, I add the appropriate lift between the blade and sole of the boot, rarely to the orthotic itself since space inside the boot is of such a premium.
 
Jonathan P. Contompasis, DPM, Wilmington, DE, Jpcdpm@aol.com

First, are we referring to figure, speed, or hockey ice skates? Each of these winter Olympic events is sport-specific as to biomechanics and shoe design. Like skiing, ice skating requires specific knowledge and fitting expertise when it comes to orthotic prescription and boot selection. The orthotics lab I use is located in Canada, and fortunately happens to have considerable expertise in orthotic fabrication in these winter sports disciplines. I would not rush into prescribing an orthotic for a skater without first studying the biomechanics of the sport in which the patient is involved in addition to the etiology and correction required in the orthotic.
 
I look forward to the PM article to be published in June written by Robert Weil, DPM, podiatrist to Olympic gold medalist Evan Lysacek, for his insight on the subject.
 
Mel Cheskin MBS, C.Ped., Boca Raton, FL, Melcheskin@aol.com

I have made many orthotics for skaters over the years. I've found that an orthotic like our Fashion Classic Cobra device is consistently the best. It allows for significant control of the rearfoot and midfoot, as well as forefoot to rearfoot alignment. This orthotic design will fit in the most confining footgear. If your lab doesn't make this type of device, have them contact me.

Paul Langer, DPM, President, Footbon Orthotic Laboratory, info@footbon.com

RE: Accountability of Expert Witnesses  (Michael Rosenblatt, DPM)
From: Richard W. Boone, Sr.

As one of those defense lawyers who regularly recommends against pursuing opposing experts, let me suggest to my learned colleague, Dr. Rosenblatt, one other reason why we make the recommendation that we make: It doesn't work.
 
Expert witnesses, no matter how biased or repetitive they might seem from a defendant's viewpoint, are expressing expert opinions. Those opinions, just like Dr. Rosenblatt's opinions about lawyers, are protected by the same Constitutional guarantees of free speech which, as Americans, we all still enjoy. So, unless you can prove that an expert deliberately gave false testimony for the purpose of harming you, you have no legal recourse. Sorry, but the expert's giving testimony just so that he or she can earn the fee probably isn't good enough to support any counter action, no matter how often it occurs.  And proving the existence of a deliberate lie with malicious intent is incredibly hard to do in any case.
 
Nor is any counter action, short of one which results in a license revocation, going to deter these repetitive experts from plying their nefarious trade. Hookers don't cease to ply their trade just because they get arrested every now and then. Frankly, the way to put those folks out of business is to whip them soundly at trial a few times.  Plaintiff attorneys don't hire experts who repeatedly lose the case for them. I occasionally represent my doctor clients for a subsequent case. I've had the same lawyer sue my client more than once, but I've never had the same opposing expert twice when the physician prevailed in the first case. Besides, most of my lawyer colleagues can't even spell “cognitive dissonance,” let alone practice it.
 
Richard W. Boone, Sr., Fairfax, VA, RWBoone@aol.com

HOME FOOT CARE PHYSICIAN NEEDED-LOS ANGELES, CALIFORNIA

Honest, caring, hard-working podiatrist needed to make visits to homebound patients, facilities, etc. for Home Foot Care, Inc. Part-time position, flexible hours, independence and excellent compensation. If interested email CV to homefootcare@hotmail.com or call Terri at 323-353-8103.

ASSOCIATE POSITION – MICHIGAN

Well established practice in Southeast Michigan suburbs seeking full time associate. Must be ethical, personable and professional. This is a solid opportunity for a PSR-36 graduate or experienced practitioner. Must be able to diagnose and treat everything from general podiatry to reconstruction of severe deformities of the foot and ankle. The practice is currently maintained by two board certified surgeons. This practice is residency affiliated. Please forward current location and availability with C. V. to HKANEDPM@gmail.com

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

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 - 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.

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

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.