The Voice of Podiatrists

Serving Over 10,800 Podiatrists Daily

April 15, 2008 #3,219 Editor-Barry Block, DPM, JD

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PA Podiatrist Provides Advice on Prevention of Calluses

Particularly bad calluses require a trip to the podiatrist, but Dr. Lee Cohen, podiatric consultant to the Philadelphia Eagles and 76ers, offers these tips to remedy your current callus situation and to keep future problems at bay:

Dr. Lee Cohen

Choose the Correct Athletic Footwear: "Everyone thinks that sneakers will be automatically comfortable because they are, well, sneakers, but even they need to be fitted properly," says Dr. Cohen. "Because I work with professional athletes, I can see how important wearing the right footwear is for athletes of any caliber."

Stay hydrated: "Be sure to drink lots of water because it's important to hydrate yourself internally as well as externally," he says. To eliminate dry feet and calluses, it's important to keep your feet moisturized once you've gotten rid of that thicker, dead skin," Dr. Cohen says. "Apply a thick lotion to your feet a few minutes after filing away excess skin and after showering because these are when the skin is most receptive."

Source: Amber Smith, The Post-Standard [4/14/08]

Spring Runners and Walkers Need to Start Slowly: IL Podiatrist

Doctors typically see more foot problems this time of year – things like Achilles tendon ruptures, ankle sprains, and the pain of plantar fasciitis. Sometimes those problems come from putting on extra pounds over the winter, which puts more strain on the ankles, said Dr. Kimberly Eickmeier, a Christie Clinic podiatrist and spokeswoman for the American Academy of Foot and Ankle Surgeons.

Dr. Kimberly Eickmeier

Sometimes, it's largely a problem of being out of shape after too much inactivity during the winter, causing the muscles and ligaments surrounding the ankle to atrophy, she said. "And the older you get, the quicker it happens," Eickmeier said.

I typically tell patients: Don't exercise every day. Take a day of rest in between when you're first starting out," Eickmeier said. "Remember: The distance you walk away from your house, you have to walk back." For walkers, Eickmeier suggests a mile walk for your first three outings. If you can do that without any problems, every fourth walk increase your total distance by half a mile. If you're a beginning runner, she said, increase your distance more gradually.

Source; Debra Pressey, News Gazette [4/6/08]

Scholl's Armstrong Receives Award of Excellence in Research by VA

David G. Armstrong, DPM, PhD, Professor of Surgery and Director of the Dr. William M. Scholl College’s Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University and the North Chicago Veteran Administration Hospital was awarded the VA's Certificate for Excellence in Research at a ceremony held March 28 at the North Chicago VA Medical Center.

Dr. David G. Armstrong receives award from Dr. William Chagares, Chief of Podiatry at the North Chicago VA Medical Center

"Dr. Armstrong has epitomized excellence in clinical care and research at the VA," noted William Chagares, DPM, Chief of Podiatry at the North Chicago VA Medical Center. "In fact, the work that his team has done has, when combined with our aggressive efforts at clinical management, led to a major decrease in hospital admissions, wounds, infections and amputations. That is impressive success for our veterans."

Armstrong was appreciative of the honor. "I think that the goal of clinical and translational research is to impact the lives of our patients," said Dr. Armstrong. “At the North Chicago VA, my thanks goes to Drs. Chagares, Yong and definitely my colleagues Jim Wrobel, Ryan Crews, and Jill Nyland in making that difference every day for our nation's veterans. It is an honor to serve those who have served us."

Query: Limb-Length Discrepancy in Biker

My patient is a 30 y.o. female who loves to bike (sometimes runs), but has 1 and 1/2 cm. limb length discrepancy and also needs orthotics Biking and running cause low back pain on her short side. What can be done to the bike, shoe, or patient so she can bike long distances or race without experiencing low back pain?

Steve Wolfington, DPM, Sheboygan, WI

Query: Powerpoint Lecture

I am interested in a good Powerpoint general podiatry lecture suitable for presenting to internal medicine doctors. Where can I find such presentations?

Sandy Schustek, DPM, Charlottesville, VA

Conscious Sedation (David S. Wolf, DPM)
From: Carl Ganio, DPM

Contact your local dental school. I attended a 2-day course in conscious sedation at the University of Florida. It was a very comprehensive course. Others will comment on the practicality of using it in your practice. I practiced 9 years with it, and now 10 years without it. I found it very useful in some cases... however, it became a crutch (non-reimbursable) for other patients. I have not missed it.

Carl Ganio, DPM, Vero Beach, FL, drcarlganio@bellsouth.net

RE: Duty to Provide Interpreter Under ADA (Randy Bernstein, DPM)
From: Multiple Respondents

I also have had this unpleasant reality hit my practice. The $150 plus travel always seems to be less than the actual cost and the interpreter. The interpreter seems to add time taken from travel and include this in the time required. This is then compounded by the fact that my patient is a Medicaid patient which then costs me about $200 each time I see her.

The only advice I can give is to have the staff notify you when he/she arrives and do your best to get the patient in and out in the quickest possible time without affecting quality. Also the more that you can do in one visit the better off you will be financially, as the less money you will lose by seeing them.

Bob Sage, DPM, Beloit, WI, sagedoctorbob@hotmail.com

I have dealt with several deaf patients over the years, and phone calls are usually handled through the TDD service. An interpreter speaks with you and types the messages to the patient. In the office, they usually bring their own interpreter or family member to assist in signing. Otherwise, we communicate with pen and paper, or as in most cases, my patients are able to lip read, and we communicate just fine.

One "cute" story that I wished to share was as follows: I had to operate on one nice lady who did not lip read, but her daughter who was 12 at the time did sign for her. We made special arrangements for her daughter to be in the operating room while she was being put under and waking up. This young lady was very mature for her age, and stood in the corner of the room the entire time watching the procedure. She mentioned she might like to pursue podiatry as a profession when she finished college. This was indeed a very special young lady.

Ira Weiner, DPM, Las Vegas, NV, vegasfootdoc2005@yahoo.com

My experience with this issue is not only do you have to provide an interpreter for these people, it cannot be just anyone well versed in signing. They also have to be "certified" for medical interpretation which is what makes it so expensive. The one individual I dealt with was very astute regarding this law and knew her rights. Unfortunately, she was a Medicaid patient so essentially you pay for the opportunity to provide her care.

This would also hold true for anyone who cannot speak English. It is your responsibility to have someone there to interpret.

John Clarke, DPM, Fremont OH, jclarke2735@sbcglobal.net

Editor's Note: PM News does not provide legal advice. The requirement to supply a language interpreter is a state, not a federal requirement.

RE: AMA’s Scope of Practice Report (Allen Mark Jacobs, DPM)
From: Douglas Pacaccio, DPM

I can say that in the two years I have been in practice since residency I have seen, as we all have, my share of other people's patients. I can also say that I am never quick to judge the other surgeon during less than perfect outcomes. However, there are two patients that stick in my head to this day. One was a diabetic who I had to fuse his ankle because the day he sustained his unstable tri-malleolar fracture 11 months prior, he was fortunate enough to have a hip and spine surgeon taking call.

I am still fairly certain that he would not have had to sit in an ex-fix for 12 weeks had an early ORIF been done instead of placing him in a CAM walker and letting him walk on his neuropathic limb. Great call! Even better, was a patient who had a bunion done by a podiatrist that became a hallux varus. What did her foot and ankle fellowship-trained ortho doc do after scolding her for letting a DPM operate on her foot? He fused the IPJ of her hallux!

I have seen complications from my DPM colleagues as I have had them myself, but I had yet to see such egregious errors in surgical judgment come from other DPMs. After looking at the AMA document, I am left to wonder about how well some of the ortho guys are really trained to treat the subtle nuances of the foot and ankle. Was ortho doctor #1 too busy thinking about total joints to recognize an unstable ankle fracture? Was ortho doctor #2 asleep during biomechanics in fellowship? And lastly, is it really that clear that DPMs trained and comfortable treating trauma are more dangerous to the general public than the general orthopedist dabbling in foot trauma. I am sure I'm not alone in these experiences and perhaps we should start keeping score. I will submit my notes and cases that demonstrate not all MDs have inherently better surgical or clinical acumen. Obviously, some MDs are very, very good at foot surgery and to generalize would be stooping.

Douglas Pacaccio, DPM, Yorkville/Sycamore, IL, pacman25@hotmail.com

ASSOCIATE POSITION- LOS ANGELES AREA

Dynamic well established practice in brand new office building with surgery center, adjacent to hospital, seeks energetic rearfoot and ankle trained associate with partnership aspirations. E-mail CV to dr4feet@sbcglobal.net.

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

PRACTICE FOR SALE - BUFFALO'S KENSINGTON SECTION

Established satellite practice. In urban metropolitan area on a busy commercial street corner - commercial building with an attached retail store that allows easy advertising of the podiatric medical practice. Gross $170K+ at 2 ½ day per week. Great potential for growth. 260 402-7490

SEEKING RESIDENT FOR PSR-24 - BALTIMORE, MD (MERCY MC)

Position for a highly motivated individual with completed non-surgical residency or one desiring additional surgical training in well-established Podiatric Residency Program. Busy metropolitan hospital with high surgical numbers and inpatient care. Resident is integral member of multidisciplinary team. Begins mid June 2008. Includes competitive salary/benefits. Send inquiries to rsher18@yahoo.com

ASSOCIATE POSITION - NORTH CAROLINA

Beautiful area; Thriving economy. Seeking Nice, Well Trained Associate who can Work Independently (experience a plus). Unique "Associate Security" Clause so that you control your destiny. Send resume and cover letter to greatpodjob@yahoo.com

PRACTICE FOR SALE - EASTERN WASHINGTON

Established practice located in the fastest-growing city in the state of Washington. Enjoy the lifestyle available in the area. Practice is directly across the street from the hospital - surgery center located within the hospital, and podiatric surgical privileges are not restricted. Gross $200K+ at 4 days per week. Can easily grow. 260 402-7490

ASSOCIATE POSITION - MONTANA

Two Doctor group seeks individual with 3 years of surgical training. This well-quipped office deals with all types of reconstructive foot surgery. Diabetic foot fellowship desirable. Practice includes two physical therapists that work on-site. Rural setting with excellent outdoor activities. Competitive salary and benefit packages with opportunity for partnership. Respond to: jclough@sofast.net or Fax to: 406-761-7219

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City . Currently four (4)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

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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