The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

April 16, 2010 #3,833 Publisher-Barry Block, DPM, JD

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VA Podiatrist Discusses Children’s Shoe Fitting

Have you checked out your kids’ feet lately? Really? Sure, you might have taken a peek to make sure they had shoes on before heading out the door, but do those shoes fit properly? Does your child have ingrown toenails, athlete’s foot, blisters or bunions? “Just look,” urges podiatrist Ron Raducanu, president of the American College of Foot & Ankle Pediatrics. “Most parents don’t.”

Dr. Ron Raducanu

“When you’re putting the socks on, squeeze the foot a little bit and see if the child reacts,” he adds. This is the best way to spot foot problems, because most kids – especially those under age 8 – won’t otherwise complain of foot pain. Check your child’s shoes regularly for good fit, and check more often if you notice that he’s going through a growth spurt. This could be as often as every couple of weeks if it seems that your child is “growing before your eyes,” says Raducanu. “You’ve got to be conscious about it.”

Source: Christina Elston, Parenthood.com

CSPM Student Wins APMWA Student Writing Competition

Daniel Jones, a second-year student at  College of Podiatric Medicine and Surgery has been named the winner of the 24th Annual American Podiatric Medical Writers Association Student Writing Competition. His paper was entitled, "Being Involved, a Guide for Professional Success.”

Daniel Jones

Holm will receive a one thousand dollar honorarium from a special endowment by Dr. and Mrs. Steven Berlin to the APMA Educational Foundation.

The award for Honorable Mention went to Benjamin Elgamil, a first-year podiatric student at Temple University School of Podiatric Medicine for his paper “A Renewed Perspective on what Podiatric Medicine Means."

Patti Labelle to Receive Honorary Temple Degree at 2010 Commencement

The legendary songstress, humanitarian, and entrepreneur Patti LaBelle, a Philadelphia native with a worldwide reputation, will receive an honorary doctor of humane letters degree from Temple University during its 123rd Commencement Ceremony on May 13 in the Liacouras Center.

Patti LaBelle

LaBelle’s work on cancer and diabetes is rooted in her own family history. Within a 10-year period, she lost her mother, three sisters and best friend to the diseases. In 1994, LaBelle herself was diagnosed with diabetes, and shortly thereafter became a spokesperson for the American Diabetes Association. Two years ago, LaBelle began to partner with Temple University’s School of Podiatric Medicine to raise awareness about diabetes, the critical need for diabetics to pay special attention to their feet, and to get regular screenings by their podiatric physicians.

Source: Eryn Jelesiewicz, Temple University News [4/12/10]

MI Podiatrist Receives Ruby Award for Humanitarian Efforts

Dr. Vicki Anton Athens, a podiatrist, was recognized recently by the Soroptimist International of Trenton Area club for her efforts and contributions to women and society. Athens was selected for the Ruby Award for organizing and leading doctors, nurses, and medical assistants on nine trips to Guatemala City to treat children with foot deformities and other ailments.

Dr. Vicki Anton Athens (3rd from right). Photo courtesy of Soroptimist International of Trenton Area)

A $500 donation will go to a charity of Athen’s choice. She selected an orphanage in Guatemala to receive the donation. The Ruby award is presented to someone who volunteers in a way that helps other people and makes a difference for women.

Source: Anne Sullivan, The News Herald {4/10/10]

Medicare Payment Audits Criticized in GAO report

As the Obama administration works to expand the scope of recovery audit contractors to seek out improper Medicare payments, a new government oversight report concludes that Medicare must do a better job of addressing the vulnerabilities that the RACs identify.

A March report from the Government Accountability Office said the Centers for Medicare & Medicaid Services did not establish an adequate process to address payment system problems uncovered by the contractors either during the three-year initial pilot program of the RACs or in planning for the rollout of a permanent, nationwide version of the program. The RACs comb through past Medicare claims from hospitals, physicians and others to identify instances in which the government paid too much or inappropriately approved claims.

Source: Chris Silva, AMNews [4/12/10]

Take the Lead in Reference Checks

Improve your hiring process by improving the way you check top candidates’ references. Use these suggestions:

• Check technical competence. Some candidates excel at specialized tasks but don’t shine at assignments that are more mundane. Can the person spell? Handle multiple phone lines? Keep a tidy workspace? Ask references an easy question or two to set the stage.
•  Ask about smarts. Make it easy for the references to respond, by asking them to rate candidates using a 10-point scale: “On a 1-10 scale, how would you rate the candidate’s intelligence?”
•  Inquire about soft skills. You need to know how well they will fit into your workplace, so ask about candidates’ people skills too. Do they work well with bosses, subordinates and peers? Listen for silences, gaps, and omissions in response to your queries in this area.

Note: Don’t end the call before you ask, “Is there anything that I haven’t asked about?” Listen carefully to the answer as well as the way the speaker says it.

Source: Adapted from Hiring Smart! How to Predict Winners & Losers in the Incredibly Expensive People-Reading Game, Pierre Mornell, Ten Speed Press via Communication Briefings

Query:  Axial View Foot Devices

Where does one purchase the plastic/acrylic position foot blocks to obtain a good sesamoidal axial view?
 
Jeffrey Kass DPM, Forest Hills, NY

RE: Capturing Neutral Impressions (Ray McClanahan, DPM)
From: Jeff Root

Ray McClanahan, DPM wrote: “So, does it really matter how you capture your neutral impression? No, it does not. Because your orthotics are rarely, if ever going to function from the flat surface you conceptualized when you took your casts. Most of the time your orthotics are going to function, up to 2 inches higher in the rear part of the device, than in the front part of the device. How is this taken into account in the casting process that you use in your offices? It is not taken into account. All current casting techniques assume that the heel and forefoot are going to function level, in the shoe that the orthotic is worn in. This rarely happens.”

I must respectfully disagree with Dr. McClanahan’s statement above which ...

Editor's note: Mr. Root's extended-length letter can be read here.

RE: Stiff Joint, Post-op Bunion Surgery (Mathew John,  DPM)
From: Stan Kalish, DPM

The A.O. principle is that "no osteotomy can withstand the unsupported forces of weight-bearing,” however, a correctly designed and executed osteotomy will do just fine with immediate weight-bearing. I have performed over 5,000 Kalish osteotomies, and have permitted weight-bearing in 90% of these patients. The key is "tight tight-loose-loose-tight tight.” This refers to cortical purchase followed by medullary contact, followed by opposite cortical contact. Cortical bone screws have perfect ability in their design to hold healthy bone in these osteotomies. With the plantarflexed design {axis guide}, they have a higher incidence of plantar flexion limitus.

Like Dr. John, I use Dyna-splints on a regular basis for this limitation of plantarflexion. Patients are in a surgical shoe for two weeks, followed by a normal conservative and comfortable regular shoe or sneaker. If you are in doubt over the osteotomy stability TT-LL-TT, of course go non-weight-bearing or casting or CAM walker. Elevatus is something we will see with plastic deformation in certain types of osteotomies more than in others, e.g., base wedge, Scarf. 

Stan Kalish, DPM, Jonesboro, GA, srkalish@bellsouth.net

RE: The Passing of Martin L. Mintzer, DPM
From: James H. Mintzer, DPM

I regret to announce the passing of my father, Martin (Marty) Mintzer, DPM. My father practiced in Maryland for almost 50 years.  He was a former president of the Maryland Podiatry Association, and was the inspiration for me to enter podiatry

My most cherished memory was the day he "hooded" me at my graduation in 1982.

James Mintzer, DPM, Washington, DC

RE: Tissue Glue for Fissures (Sam Rosen, DPM, NY)
From: Multiple Respondents

Dr. Paul Busman posted a comment regarding this very question . His suggestion of trying Gorilla glue was intriguing, so I tried it. It seems to work pretty well. I have used it 4-5 times with good results. Some fissures will recur due to the patient’s foot type and repetitive trauma, but for the acute painful condition (combined with debridement), it seemed to be an effective option.     
 
Charles Morelli, DPM, Mamaroneck, NY, podiodoc@gmail.com

Plain old super glue works extremely well. I have used it for years with no complications.
 
Brian Kiel, DPM, Memphis, TN, footdok4@gmail.com

I have used Crazy Glue or a generic version of that for numerous years and it works great. First debride the fissure, especially if there is hyperkeratotic tissue extending beyond the fissure. Make sure the area is clean and does not appear clinically infected. Deposit the glue into the fissure and squeeze the fissure together for ninety seconds, and the problem will usually be resolved for $2.00. You can always buy Dermabond, which is technically sterile Crazy Glue for approximately $300.00-$400.00 for a box of ten applicators. You do the math on this one!
 
Steven H. Goldstein, DPM, Royal Palm Beach, FL, stevefootdr1@yahoo.com

RE: Radiology Lab Performing Neuroma Injections (Elliot Udell, DPM)
From: Vince Marino, DPM

Unfortunately, we are all seeing this more and more given the decreasing reimbursements to physicians as a whole. Family practice docs injecting plantar fasciitis and doing nail avulsions despite a lack of training is becoming more common in our area in northern CA. Although they may “legally” be able to perform such procedures, the proverbial sh_t will hit the fan when a complication occurs and they are strung up in court. But until then, expect more of this to occur.

Vince Marino, DPM, San Francisco, CA, drmarino@marinofootandankle.com

RE: Consent For Office Procedures (Nicole Hancock, DPM)
From: Shari Lee, PMAC

In our office, we do have general consent for patients to sign every year and when they are new. However, we also have specialized consents for the doctor to review with the patient before any procedures are done in the office; both patient and doctor sign. The consent lists the type of procedure, risks and complications, along with the statement of post-operative instructions given, and that all documents have been reviewed. This may seem as overkill to some, but it is one of the best ways to limit your liability. The more specific the better.

Shari Lee, PMAC, CLR-P, Columbia, SC, midlandspodiatry@bellsouth.net

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

I think everyone agrees that there is a problem with paying for “expert opinions” and the quality of information that actually comes from them. Why not have “Independent Reviews” with a panel of a certain number of doctors of that discipline who review the case prior to it going to trial, and each gives an opinion on whether the case has merit?  If the case doesn’t have merit, then it gets dismissed. If the reviewers say the case has merit, it goes to trial with the “expert opinions” already on file. The panel can either be mandatory, such as jury duty for physicians, or it can be a group that is paid by both defense and plaintiffs.

I know that there are details that need to be worked out, and I’m sure it’s a very naïve idea, but it seems that the system now is completely broken. There shouldn’t always be a doc who agrees and a doc who disagrees for every case. The testimony seems like it would just offset, and I for one, wouldn’t listen to either since I know that they are being paid. I’m sure that this has been proposed in the past, and I’m sure there are some major flaws with it, but it seems like this is what I’d rather have if I ever had any legal action taken against me for malpractice.

Rob Lagman, DPM,  Mandeville, LA, rlagman@drlagman.com

SEEKING ASSOCIATE POSITION – WESTERN STATES

PSR-36 trained podiatrist seeking position in western states esp. CA, WA, or UT (Current licenses in these states). Finishing a sports medicine fellowship in July. Patient-oriented and ethical podiatrist. Ideal situation would be mutually beneficial relationship with a diverse practice. Please contact me at sportsmedpod@gmail.com

ASSOCIATE POSITION – GEORGIA

Immediate opening for a surgically-trained individual for associate position in northern suburb of Atlanta. Hospital privileges available. Position could lead to partnership or purchase of practice. Send resume and CV to pd751@hotmail.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.

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

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

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

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