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Serving Over 11,000 Podiatrists Daily

April 16, 2009 #3,521 Publisher-Barry Block, DPM, JD

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FL Podiatrist Discusses Effects of Different  Arch Types

Whether you’re hitting the road, track or trail, prevent foot pain by lacing up a well-fitting pair of kicks. For advice on determining your arch type and tips for selecting your next pair of shoes, we turned to Dr. Cary Zinkin, spokesperson for the American Podiatric Medical Association. “Your weight is supported in different places on your foot throughout the whole walking or running cycle, which is called the gait cycle,” Zinkin says. “If you wear a shoe that doesn’t have enough arch support, then [your weight won’t properly transfer] during the gait cycle.” Meaning, if your foot’s not properly supported, it can result in inefficient form, which can lead to injuries such as plantar fasciitis, shin splints and knee pain.  One step toward alleviating the amount of stress placed upon certain areas of the foot is to wear a shoe that supports your arch. Below is a breakdown of different arch types.

Dr. Cary Zinkin

High arch: The heel and midfoot bear the brunt of pressure on your foot as you run. You may under-pronate, meaning your foot rolls outward when it strikes the ground. “People with a high arch often have very tight Achilles tendons,” Zinkin says. “Therefore, more weight is targeted in the heel and on the metatarsal heads, which may cause heel pain, arch pain and metatarsal injury."

Neutral arch: You run even keel from toe to heel. Pressure is equally distributed across your midfoot, outer arch and heel.

Low arch: Your foot rolls inward, meaning you over-pronate, so more pressure is placed on your arch. “If you pronate too much,” Zinkin says, “pressure is put on some of the soft tissues in a way that’s not anatomically correct, thereby causing injuries.”

Source: Sarah Gearhart, Stack [3/29/09]
 

TUSPM Offers One-Stop Health Shop

“In terms of patient care, collaboration is imperative for successful treatment,” said Kathya Zinszer, DPM, newly appointed chair of podiatric medicine and orthopedics. “When we as medical caretakers work together, it benefits everyone. It’s much easier to keep those lines of communication open between doctors when they’re under the same roof.”

Dr. Kathya Zinszer

To that end, the podiatry school has developed a one-stop health shop of sorts, offering triage, surgery and most recently, Temple Total Therapy. This brand-new physical therapy clinic, complete with cutting edge rehabilitative equipment, is conveniently located within the Foot & Ankle Institute at 8th and Race Streets.

In addition, the school still houses the renowned Leonard Abrams Center for Advanced Wound Healing, which provides a myriad of treatment options for diabetics; the Gait Study Center, which monitors balance, foot pressure and strides to help diagnose more difficult cases; and the accredited Ambulatory Surgical Center, which allows podiatric surgeons to perform certain procedures on an outpatient basis.
 

Student Defers Podiatry School to Help Hondurans

Allison Ippel was a member of the St. Teresa High School 2004 girls Class A state champion basketball team. She was a member, too, of the Wheaton College Division III national champion women's soccer team in 2006 and 2007. "Even more memorable and challenging were the experiences and relationships I encountered through involvement with the Honduras Project," she said. The project is a student-led initiative that involves raising support for materials and travel expenses while working with a Honduran engineer and his wife to install a gravity-fed water system in a rural Honduran village.

Allison Ippel with Honduran Patient

Ippel said she has a desire to learn from a Honduran perspective. Although she was accepted in podiatry school, she deferred for one year in order to work in a rural hospital in Honduras, assisting with minor surgical procedures, and filling and explaining prescriptions, among other tasks. "I will return in May to begin preparing for studies at Scholl College of Podiatric Medicine in North Chicago in the fall," she said.

Source: Bob Fallstrom, Herald & Review [4/14/09]

NC Podiatrist Receives Fine, Probation for Drug Charge

A Grifton, NC podiatrist has received probation and a fine for a drug charge. Last week, Dr. Paul Joseph Civatte, 52, was handed a sentence of 12 months of supervised probation and a $1,000 fine for a reduced charge of possession of drug paraphernalia. The case dated back to Civatte's May 2007 arrest for possession of cocaine and maintaining a vehicle for the use of controlled substances.

At that time, Civatte - a doctor at the Greenville Foot and Ankle Center - was arrested for allegedly possessing two grams of cocaine while attempting to purchase the drug from undercover officers in the Kinston K-Mart parking lot. Last week in Lenoir County Superior Court, the possession of cocaine charge was reduced to possession of drug paraphernalia. The maintaining a vehicle charge was dismissed. Civatte was sentenced to supervised probation and fined $1,000. He was also ordered to pay court costs totaling $541.50.

Source: ENC Today, Jon Dawson, [4/13/09]

Low Risk of Thromboembolism Found in Podiatric Surgery

Venous thromboembolism presents a low risk in podiatric surgery, but practitioners should consider prophylactic treatment if the patient has at least two risk factors, according to a study reported in the April issue of the journal Chest. Andrew H. Felcher, M.D., of Northwest Permanente Medical Group in Portland, Ore., and colleagues collected electronic medical records for a 485,000-plus-member HMO in the Pacific Northwest and conducted an analysis of 7,264 patients who had 16,804 podiatric surgeries between 1999 and 2004.

The researchers identified 22 instances of post-operative venous thromboembolism for an incidence rate of 0.30 percent. In the podiatric setting, the three leading risk factors associated with venous thromboembolism were: previous venous thromboembolism (4.6 percent incidence), hormone replacement therapy or oral contraceptive use (0.55 percent incidence) and obesity (0.48 percent incidence).

"We identified a low overall risk of venous thromboembolism in podiatric surgery, suggesting that routine prophylaxis is not warranted. However, for patients with a history of venous thromboembolism, periprocedure prophylaxis is suggested based on the level of risk. For podiatry surgery patients with two or more risk factors for venous thromboembolism, periprocedure prophylaxis should be considered," the authors write.

Source: Modern Medicine [4/13/09]

Query: Bone Tumor Diagnosis

My patient is an age 38 male with a prior football spike injury to the left hallux in 1981 with changes noted on x-ray a few years later.
 

Bone Tumor, Hallux

A tumor was excised a few years later, and after 20 yrs has recurred as appears in x-ray as a large solid mass (3 cm. x 3 cm. x 4 cm. deep) dorsal to the hallux (lateral view) with no pain clinically. Any ideas on what type of tumor this might be?

Steven Melek, DPM, Charleston, WV

RE: Recalcitrant Shear Tyloma (Pat Evoy, DPM)
From: Multiple Respondents

Is there an undiagnosed forefoot valgus deformity not being adequately addressed by the custom orthotics? Several months ago, I treated a young man with a similar "pinch-type" callus. Initial custom orthotics with an accommodative cutout failed to resolve the problem. On re-evaluation, I noted a forefoot valgus deformity. I then added 1/8" layer of EVA (35 durometer) under the top cover of the orthotic to fill in this forefoot valgus void. The EVA began at about mid 4th and 5th metatarsal region and extended distally to sulcus level while avoiding the area of the tyloma itself. I tapered the EVA on all sides in order to avoid any sharp or uncomfortable edges. He noted relief within the first week following this adjustment, and the lesion is gradually resolving.
 
Be sure to rule out any bony abnormalities or spurring with appropriate radiographs (including axial views).
 
Chris Seuferling, DPM, Portland, OR, cseuferling@comcast.net

Be sure to assess gastrosoleal tightness, as ankle equinus can significantly increase forefoot forces. Also, hamstring tightness has been shown to do the same. A rocker-bottom shoe, or one with an external metatarsal roller bar, may be helpful.

Nicholas Taweel, DPM, PT, Philadelphia, PA, dpmpt@hotmail.com

In the latest edition of JAPMA (Volume 99, Number 2), there is an interesting article titled "Plantar Epidermoid Inclusion Cyst as a Possible Cause of Intractable Plantar Keratosis Lesions." Perhaps this type of tylomas may have the same causative factor as an IPK.

Bottom line,  if off-loading and conservative superficial debridement has not worked, consider a deep excision of the lesion with biopsy.
 
Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com

RE: Aldara and EMB (Michael Turlik, DPM)
From: Allen Mark Jacobs, DPM, David Gurvis, DPM

At the recently concluded meeting of the American Professional Wound Care Association, a European vascular surgeon was critiqued for "lack of evidence-based medical proof" that osteomyelitis could be managed by antibiotics alone. The speaker opined that "we need to end this obsession with EBM. He noted that 95% of what we do in medicine is not supported by EBM. He did not suggest any lack of value to EBM, but rather that our clinical experience, clinical sense, and clinical judgment ought not be devalued. He called for an end to "EBM terrorism." This was met with applause from the audience.
 
The recent commentary regarding Aldara is such an example. Many of us have had successful outcomes with Aldara for the treatment of verruca. Every day, we provide successful services in our offices without an RCT supporting the therapy provided.
 
I appreciate the commentary by such accomplished academics as Dr's Udell, Turlik, and others. However, let's get real about the science and ART of medicine. The lack of an RCT does not and should not trump the utilization of diagnostic or therapeutic modalities which the practitioner knows through experience or believes by judgment would be helpful to a patient. If we limit our services to only EBM/RCT established therapies, we would have little to offer our patients from day-to-day. Experience, judgment, opinions, are also a form of EBM. Let us not forget the ART of medicine.
 
Allen Mark Jacobs, DPM, Dt. Louis, MO, allenthepod@sbcglobal.net

I have read, and wanted to share the following. The question was, what do you do when faced with a problem for which there is no evidence-based solution:

The entire letter can be read at: http://podiatrym.com/go.cfm?n=343

David Gurvis, DPM, Avon, IN, deg1@comcast.net

RE: Unruly Children (Anas Khoury, DPM)
From: Multiple Respondents

I see a fair amount of children in my office as patients and tag-alongs with parents and grandparents. I keep children's books in the waiting room as well as one self-contained toy. I have had times where kids have been unruly. I personally went into the waiting room and verbally disciplined kids along the lines that I will not accept this behavior in my waiting room and if you can't control yourself you will be asked to leave. I'm not particularly worried about losing the adult patient because if the adult tolerates that behavior, you'll probably be happy to see them leave along with the kids.

David T. Taylor, DPM, Flint, MI, dttaylor_19@yahoo.com

Unruly children are usually the parent's fault for lack of discipline and respect. In my office, the parent is politely asked to control their child's behavior in consideration of the other patients. If they fail to respond or develop a cavalier attitude, they are asked to leave the office and/or reschedule their appointment, depending on the circumstances.

Unfortunately, we live in a day and age that discipline and respect for our elders and superiors is not a priority anymore. So, set your own rules. After all, it is your practice.
 
Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com

When the occasion of unruly or undisciplined children arise in my office I will inform  patients that they need to make arrangements for their children before returning to this office. This office is not equipped with day care for their children and if the parent cannot control their children they are asked to be seen at a later date without the children. 
 
Dan Klein, DPM, Fort Smith, AR, toefixer@aol.com

RE: Vascular Testing Systems (Richard Silverstein, DPM)
From: Frank Lattarulo, DPM

I currently have the BioMedix system in my office and couldn't be happier. The machine has worked flawlessly, (sometimes digital toe pressures can be challenging) but overall I am completely satisfied with the machine, the sales team and the tech support. They delivered, set up, trained, and have given wonderful support.

I recently passed my first full year with the machine and it is paying for itself by far. It provides beautiful color printouts with ABI's and waveforms. They will also put you in contact with a vascular surgeon who will get your report via a secure Internet connection, interpret the report, and get it back to you via the same connection. I highly (and have many times) recommend it.

Frank Lattarulo, DPM, New York, NY, doclatt@aol.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

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

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 

ASSOCIATE POSITION AVAILABLE-MIDTOWN MANHATTAN

Looking for Full-time associate to work in well established practices in midtown Manhattan and Forest Hills. Immediate opening for PSR 24-36 surgically trained Podiatrist. Great opportunity with competitive salary along with malpractice benefits. Please send CV to slurie@papapc.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 

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

SEEKING ASSOCIATE POSITION - NEW JERSEY

I am a 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

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