The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

April 20, 2011 #4,139 Publisher-Barry Block, DPM, JD

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IL Podiatrist Uses Laser Therapy for Chronic Heel Pain

Heel pain is one of the most common conditions people seek relief from when visiting a podiatric specialist. In fact, three out of four adults will experience some level of heel pain over the course of their life, estimates Howard Stone, DPM, a NorthShore University HealthSystem (NorthShore)-affiliated, board certified podiatric surgeon. Recently, Dr. Stone and his colleagues have begun using a relatively new and exceedingly successful laser therapy to treat heel pain, which has virtually eliminated the need for surgery among his patients. “Surgery is always the last resort for patients struggling with heel pain,” says Dr. Stone.

Dr. Howard Stone Using Laser

The Class IV laser can penetrate deep into the soft tissues, and is a completely non-invasive and painless procedure to jumpstart the body’s own healing response, explains Dr. Stone. The mechanism by which the laser works draws water, oxygen, nutrients, and new blood flow to the affected area to begin the natural repair process of the damaged tissue. The vast majority of plantar fasciitis patients find total relief in an average of six to eight laser therapy treatments, according to Dr. Stone. The treatments last approximately four and a half to five minutes and are generally given twice a week, he adds.

Source: Susan J. White, Chicago Tribune [4/15/11]

FL Podiatrist Cautions Against Barefoot and Minimalist Running Shoes

Do you dare to go bare -- barefoot, that is? Or will you go halfway with a minimalist shoe? This year's hot shoe industry trends include those two less-is-more philosophies, according to podiatrist Matt Werd, DPM, FACSM in a presentation to the American College of Sports Medicine's 15th-annual Health & Fitness Summit & Exposition.

Dr. Matt Werd

The question is -- will these trends be of any benefit to fitness walkers and fitness runners? As a podiatrist, Dr. Werd cautions about going shoeless or wearing shoes that don't give support and motion control for those who need it. "Research has not yet proven which type of footwear or running gait is best at preventing injuries, so I discourage a rapid transition to minimalist footwear," Werd says.

Source: Wendy Bumgardner, About.com [4/18/11]

Retired CT Podiatrist Still Going Strong at Age 90

During Dr. Charles Forster's 90 years, he has been a podiatrist, Equity actor, and airman. In the 1960s and '70s, all three interests shared the stage of his life. During those days, Forster would finish up his Meriden podiatry practice, fly himself from Meriden-Markham Airport to perform in a show, then fly back home and repeat the routine the following day. Of his ability to carry a tune, "I don't sing well, I sing loud," said Forster, who also performed stand-up comedy. 

Dr. Charles Forster

Forster grew up in Brooklyn and earned his pre-medical degree from Brooklyn College. During the war, Forster served in the Army Air Corps, for a year and a half flying supplies to China in the Burma and India theater of operations. He was awarded the Soldier's Medal, for valor. After the war, he graduated from the New York College of Podiatric Medicine, before setting up his practice in Meriden in 1948. In September, he and his wife, Hannah, will celebrate their 70th anniversary.

Source: Matt Andrew, MyrecordJournal.com

HHS Unveils a New Public-Private National Initiative

HHS has unveiled a new public-private national initiative, stemming from the health reform law, called the Partnership for Patients: Better Care, Lower Costs. The aim is to bring together hospitals, physicians, nurses, employers, insurers and other stakeholders to make hospital care safer and less costly, federal officials said.

HHS Sec. Kathleen Sebelius said the $1 billion initiative’s ultimate goal is to eliminate medical errors, but its initial goals are twofold: by the end of 2013, to decrease preventable hospital-acquired conditions by 40% and to cut unnecessary hospital readmissions by 20%, both as compared with 2010 rates. Achieving these goals could save up to $10 billion for Medicare, and as much as $35 billion throughout the U.S. healthcare system, during the next three years, according to federal officials. Numerous trade groups, including America’s Health Insurance Plans and the American Medical Association, voiced support for the new initiative.

Source: AIS's Health Reform Week, [4/18/11]

Query: Post-op Nail Complication

I have a patient who is three months post-NaOH matixectomy who still has not healed. There is no pain or cellulitis; the site looks like a normal post-op nail. Cultures were done originally and grew out Staph epi/sensitive only to Zyvox or Vanco and Pseudomonus of which I treated her with Cipro/Zyvox for two weeks. MRI was negative for osteo and biopsy of the nail bed was negative for pathology. This week, I told her to use Betadine ointment daily and gave her an Rx for Diflucan for one week to cover any fungal causes. The patient is healthy, non-diabetic, with excellent pulses. Any suggestions for causes and future treatment options.

Brent Rubin, DPM, Bradenton, FL

Query: Cryoprobe

I am considering switching from Histofreezer to Cryoprobe, which uses liquid N₂O, for treatment of warts. The salesman touts eradication in an average of two treatments. It is also much colder than Histofreezer at –127F. I would like to know what my colleagues’ experiences have been with this treatment. Is it worth the investment (approx 2k plus, for the device)?

Mark Aldrich, DPM, Antigo, WI

Query: Excision of Tophi from Wound

What code would one use to bill for the debridement/removal of tophi from a gouty nodule in an open chronic wound (that is excreting tophi) of the lateral heel? The patient has gout with joints in upper and lower extremities affected. He is not a good candidate for more extensive surgery.

Syed Ghani, DPM, Sterling Hts, MI

Response: You should use CPT 11042 - debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less.

Mark Schilansky, DPM, Catskill, NY

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RE: Exogen Bone Healing System (Tip Sullivan, DPM)
From: Narmo L. Ortiz, Jr., DPM

With all due respect to Dr. Sullivan, with the way health insurance is reimbursing for procedures, let alone for a bone healing stimulator without a pathological fracture and/or more than nine months of a confirmed non-union, why would you want to further burden the system and your patient's pockets? A properly made and fixated osteotomy should heal in due time without the addition of a bone stimulator. In addition, distal metatarsal osteotomies can be weight-bearing immediately post-op, while proximal ones can heal well with two weeks non-weight-bearing, followed by four to six weeks in a CAM walker boot.

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

The Smith-Nephew Exogen bone system has an FDA indication for "fresh" fractures. In my experience, patients have quicker osseous healing times and also have quicker pain relief of the soft tissues while using it. I believe that Smith-Nephew is currently seeking indications for tendonopathies and other soft tissue afflictions. Despite its approved indication for fresh fractures, getting a health plan to pay for its use on a fracture that is not a delayed/non-union (fracture of greater than 3 month duration) is another issue that is often fruitless.

Russell F. Trahan, DPM, NY, NY, dr.trahan@att.ne

RE: Uric Acid Crystals, Post-op
From: Paul T Slowik, DPM

I have dealt with uric acid ulcers twice before. They are impossible to distinguish from osteo-based ulcers on any test or scan; neg cultures are a good sign. My approach was instilling a small amount, 1/10th cc. of Decadron, around the periphery of the ulcer. These patients were both  poorly controlled diabetics on dialysis, and the nephrologist had tried a plethora of meds. It took two or three injections spread over a couple of months. The injections hurt like the devil, so I recommend a digital block beforehand.

Paul T Slowik, DPM, Oceanside, CA, foothold@msn.com

RE: Routinely Taking Patients' Blood Pressures in a Podiatric Setting (John Scheland, DPM)
From: Elliot Udell, DPM

Dr. John Scheland makes a good point that we all need to be taking vitals. He did, however, open the door to a greater conversation that our entire profession needs to have. What should a podiatric physical examination consist of? Each one of us seems to be absolutely certain as to exactly what a podiatric physical examination should consist of, but if we read the responses, we can see that each one of us differs on exactly what tests should be done. Dr. Scheland takes blood pressures. So do I. He also indicated a need to evaluate temperatures, and opened the possibility up for monitoring blood glucose on diabetic patients.

Other respected colleagues advocate the need to do routine Doppler studies with plethysmography, sophisticated gait studies, etc. At podiatric seminars, I am often astounded at what individuals participating in the discussion part of my lectures will say they do routinely for patients.

No one is wrong. Patients can benefit from each and every test. Our profession needs, however, to come up with a standard of care with regard to this, because at some point in time, insurance carriers will define what consists of a complete podiatric exam, and even worse, each one of us could be challenged in court by a colleague who swears that the components of his or her unique podiatric physical examination is the only correct one.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: More Malapropisms

I have a burning desire in my toes.
The Dr. plucked out the cells so the nail won`t grow back.
I had electrons put in my feet to test the circulation.
My feet hurt when I eat candy.
A protizone injection. (NASA engineer)
I had a traveler’s wart.
Fuckus toenail (fungus toenail)!

Jim Steinberg DPM, Tampa, FL

PRACTICE FOR SALE - HOUSTON, TEXAS

28 year old busy, progressive practice for sale with an excellent reputation and well established referral base. Well-trained, dedicated, supportive staff. Excellent cash flow $475K income after overhead. EMR, digital x-ray, diagnostic ultrasound. Free standing building also available with large outdoor sign. Also available are two transferable surgical center partnerships(with distributions). Owner retiring and willing to stay part time during transition. Cover letter/CV to softechpodiatrist@gmail.com

 PRACTICE FOR SALE - MARYLAND, DC SUBURBS

Great opportunity. Well established and equipped practice for sale. Office includes state licensed Ambulatory Surgical Center. Present owner is retiring but will stay on as needed for smooth transition. Average gross over past 3 years is $575 K. dpmpracticeforsale@yahoo.com

SPACE AVAILABLE- NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview long island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

ASSOCIATE POSITION - NEW YORK CITY & QUEENS

One of the fastest growing podiatry practices in New York City and Queens seeks a podiatrist who participates with HealthFirst, Fidelis, and other Medicaid plans. Preferably a Spanish speaking podiatrist. Contact me at Podocare@aol.com

PODIATRIST NEEDED - NY/QUEENS/LI

Must be min. PSR-3 with excellent training. Experienced in billing, selling non-covered services, products, Patient medical and surgical exp. with good rapport/comm. skills necessary. Unique position working in offices, clinics, hospital with orthopedist, podiatrist, P. therapists. P/T, F/T available. Growth, income potential and partnership opportunity excellent. A chance to use all your skills; foot, ankle and more. Please respond with cover letter and CV to hansfeet@aol.com

ASSOCIATE POSITION - SOUTH CAROLINA

Upstate, two-office practice seeking PSR-24/36 trained associate. Full-time position with partnership opportunity. Must be ethical, highly-motivated with strong surgical and medical skills. Please send CV to palpodiatry@att.net

PART TIME PODIATRIST NEEDED- LOS ANGELES, CALIFORNIA

Busy podiatrist looking for assistance with treating home-bound patients. Flexible hours, independence, and great compensation. If interested, email CV to homefootcare@hotmail.com

ASSOCIATE POSITION – NEW JERSEY

Associate wanted full-time, for practice in East Orange NJ PSR 24-36 trained. Must be motivated to grow practice, especially build wound care and surgical services. Buy-in possible after the 1st year. send CV to Drfoot44@gmail.com

ASSOCIATE POSITION - NORTH CAROLINA

Cornerstone Health Care, one of the largest physician owned and managed multispecialty groups in the Southeast, seeks podiatric physician for office located in the Piedmont Triad of North Carolina. The physician must be licensed in NC, have three years of training, and board qualification in forefoot and rearfoot surgery. Cornerstone has over 290 providers in 75 locations. Physicians benefit from centralized billing, purchasing, and human resources, while maintaining autonomy over office practices. A state-of-the-art EMR system provides instant access to all Cornerstone patient records. Send CV to page.redpath@cornerstonehealthcare.com.

ASSOCIATE POSITIONS - NW INDIANA, CHICAGO AREA

2 Full-Time positions open - One for Northwest Indiana and one for the Chicagoland area. Must have 2-year surgical residency. Must be motivated and a self-starter. State License required. If interested email: f-massuda@footexperts.com

EQUIPMENT FOR SALE - COOL TOUCH LASER

Cool Breeze Cool Touch CT3 plus laser used for ugly, unsightly, toe nail infections. Less than six months old. Great price won't last long. Considering a laser? We also have the Q- Clear Q- switch laser too. This laser is perfect for you. Also a used Lumix 2 laser, best price today. Dr. Zuckerman is in the Fort Lauderdale area and will demo these lasers on your patients. E-mail footcare@comcast.net

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