The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

April 22, 2009 #3,526 Publisher-Barry Block, DPM, JD

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Exercises Can Improve Dancer’s Technique and Protect From Injuries: IL Podiatrist

Although dance training on its own strengthens the body, it doesn't necessarily target every muscle needed to maintain ideal placement and minimize the risk of injury. Follow Dr. Lisa Schoene's simple but comprehensive exercise routine to improve your technique and protect you from bunion development and other injuries.

Dr. Lisa Schoene

Each exercise consists of two stages: concentric and ecentric. The concentric stage is the part we consider the main movement: the "up" of a grand battement, the sitting up part of a sit-up, etc. The ecentric stage is the return to the starting position, such as the return to fifth position after a grand battement. The targeted muscles remain contracted in both stages, shortening in the concentric stage and lengthening in the ecentric stage. According to Dr. Schoene, the ecentric phase is most important for building strength and control. "Dancers tend to be stronger than most other athletes in the ecentric stage," she says. "Your silent landing from a jump is a good example of controlled ecentric movement."
 
Source: Russian Pointe Newsletter [April 2009] 

Stressed Americans Postpone Healthcare

Twenty percent of Americans say they have delayed or postponed medical care, mostly doctor visits, and many said cost was the main reason, according to a survey released on Monday. The Thomson Reuters survey found 21 percent of U.S. adults expected to have difficulty paying for health insurance or healthcare services in the next three months.

"The results of this survey have serious implications for public health officials, hospital administrators, and healthcare consumers," Gary Pickens of the Healthcare division of Thomson Reuters, who led the study, said in a statement. "We are seeing a positive correlation between Americans losing their access to employer-sponsored health insurance and deferral of healthcare."

Pickens and colleagues surveyed 12,000 Americans in February and March and said their findings were representative of the United States in general. They found that 24 percent of people who canceled or postponed care said cost was the primary reason. In 2006, the last time the question was asked on the survey, 15.9 percent of people said they had postponed or canceled medical care in the past year.

Source: Maggie Fox, Reuters [4/20/09]

Heard Any Good Excuses Lately?

When some people hear “It’s time to change,” their first response is not action but excuses. They may tell you:

• “We tried that once and it didn’t work.”
• “Someone else tried it and it didn’t work.”
• “It’s never been done that way.”
• “We have always done it this way.”
• “If it’s not broken, we are not going to fix it.”
• “We don’t want to rock the boat.”
• “We can’t afford to risk it.”

Don’t fall for it. Instead of accepting excuses, counter them. Offer these responses:

• “What should we do differently this time to make sure it does work?”
• “Breaking new ground can be intimidating, but I think we are up to the challenge. Don’t you?”
• “If we do not make this change, there are the consequences we will face …”

Source: Adapted from “What Is Your Reason for Refusing to Make a Change?” Bob Kelly, The KellyGram via Communication Briefings

Query: PICA Demutualization Checks to Associates

I am curious as to how group practices are handling the PICA demutualization checks to their associates who have policies paid for by the practice.  A prior employer of mine, group practice, is claiming the rights to a percentage of my PICA check since they paid the premium during my employment with them.  Is this the proper/legal standard for this situation?

Steven Frank, DPM, St. Louis, MO

Editor’s comment: PM News does not provide legal advice. The answer to this question may vary from state to state based on contract law. The starting point is to look at the terms of the employee contract.

In general, if the malpractice premium was paid as part of compensation, it is likely that the rebate benefit  should go to the employee. This is especially true since the employee will have to pay the income tax on the insurance check proceeds. One should always check with an attorney in your state to ascertain if your state law would result in a different outcome.

Query: Toe Strapping With Fracture

If I am buddy-splinting a toe fracture, can I bill CPT 29550 (strapping, toe) with an E/M service code?

Robert Lee, DPM, Los Angeles, CA

Response: In my opinion, you can bill strapping with an E/M service code, but not along with a fracture code.

Walter Pedowitz, MD, Linden, NJ

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RE: Chronic Achilles Tendinitis (Alan Mauser, DPM)
From: Multiple Respondents

It sounds like the patient has failed conservative treatment for hypertrophic tendonsis but you must also rule out other etiologies, such as tendonous xanthomas or other pathologies. Get an MRI. If this proves to be primary hypertrophic tendonosis with failed conservative treatment; the patient will likely need tendon debridement and repair with or without augmentation, depending on degree of tissue necessary to be debrided of scarred tendon. The greatest concern with athletes or patients with extreme activity levels is discussion of pathology and realistic expectations with or without surgical intervention.

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

High-power extracorporeal shockwave therapy is safe, non-invasive, and effective in the treatment of chronic Achilles tendinopathy. (Fridman R, Cain JD, Weil L Jr, Weil L Sr. Extracorporeal shockwave therapy for the treatment of Achilles tendinopathies: a prospective study. J Am Podiatr Med Assoc 98(6): 466–468, 2008).

In a prospective study, 23 feet were treated with extracorporeal shockwave therapy for Achilles tendinosis, insertional tendonitis, or both. Ninety-one percent were satisfied or very satisfied with treatment. Four months after extracorporeal shockwave therapy, the mean visual analog score for morning pain decreased from 7.0 to 2.3, and activity pain decreased from 8.1 to 3.1.

Robert Fridman, DPM, New York, NY, rf2256@columbia.edu

I have found myself and other podiatrists/orthopedic doctors using shockwave therapy to have very effective results for both insertional and non-insertional AT.
 
Here is an article that is very interesting and I hope is helpful. (ajs.sagepub.com/content/early/2007/01/23/0363546506295940.abstract)

David Zuckerman, DPM, Woodbury, NJ, footcare@comcast.net

RE: Recalcitrant Metatarsal Tyloma (Elliot Udell, DPM)
From: Kenneth Meisler, DPM, Michael M. Rosenblatt, DPM

I agree with Dr. Udell that marking the cast helps place the accommodation which can reduce and in some cases eliminate tyloma.  However, I disagree that only one lab does this well. I have used many labs over the years and all of them can do similar accommodations, especially if you tell them what you want. You can also do this on many different types of devices. There is also no need for a "special" marker. A Sharpee works very well.

If you outline the lesion on the patient’s foot, the marking will transfer well to the cast.  You can then darken it if necessary after you remove the cast. One thing I have learned is that even if the accommodation appears to line up perfectly with the lesion when placing the device against the foot, it is frequently in the wrong position when the patient uses the orthotics in shoes or sneakers. I find this happens no matter how you cast the patient.

I check all accommodations as soon as the device is dispensed.  I color the skin over the lesion with lipstick, this works the best in my experience. The patient then puts the device into the shoe and wears the shoe and orthotic without socks and walks around on it. I think you will be surprised to find that frequently the foot slides laterally on the orthotic and the accommodation is slightly too medial and has to be moved.  You end up having to send back a lot of orthotics for adjustment, but when accommodating for one specific lesion, it is important to make sure it is in the right position. 

Kenneth Meisler, DPM, New York, NY, kenmeisler@aol.com

Dr. Udell reports that hand-made orthotics (made by Bergmann Labs)  that take the pressure off of tylomas under metatarsal heads can help improve or get rid of them.
 
In some cases, there are bursal sacs that develop just under the dermis in these lesions. Many clinicians have used dilute absolute alcohol injections to treat them, along with appropriate supportive and accommodative orthotics.
 
In my practice years, I would occasionally recommend metatarsal osteotomies for this painful condition. However, as alcohol injections got more common and into the standard of care, I feel that conservative injection treatment is a much better choice, and should be utilized along with supportive therapy. 
 
Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

RE: Diabetic Socks (Cheryl Martinetti, PMAC)
From: Blake Zobell, DPM, Rob Zellmer

Take a look at Dr. Comfort’s new diabetic sock. They’ve created a full line that includes four styles and multiple colors, and the quality and comfort is better than any other sock on the market.  This is a great sock for anyone and the perfect sock for a diabetic.  Physicians at the Midwest Podiatry Conference loved the socks earlier this month, and you’ll be able to retail them for $9.95 (ankle, extra roomy & Merry Jane styles) and $11.95 (crew style). These are great socks. 

Blake Zobell, DPM, Richfield, UT, blake.zobell@ihc.com

Disclaimer: I am a representative of Dr. Comfort and had a hand in the thorough testing of the new diabetic socks.

Doctor Specified has a line of diabetic and medical grade socks which carry the APMA Seal of Acceptance. All six styles are non-compression socks featuring hand-linked seamless toe, Med Dry™ moisture managing synthetic yarns, and extra deep heel pocket for proper fit.  One style incorporates a mohair yarn blend in the foot which is extremely effective protection from sheer friction blisters.

Rob Zellmer, General Manager - Doctor Specified, rob@doctorspecified.com
 

RE: 6.8% Drop In Physician Income If NPH Instituted
From: Michael M. Rosenblatt, DPM

The Lewin Group, analysts for healthcare financial issues reported (PM News 4/20/09 and AMNEWS 4/13/09) a likely drop in physician income if National Public Health Care is instituted. Podiatrists should view this with alarm. It is vitally important for you to write to all of your Federal Congressional legislators and the White House to fight this. Later is too late. They do this to us because we allow them to.
 
Suggestions: Government should:
1. Pay a 6.8% allocation toward your professional liability insurance.
2. Cancel 6.8% of your student loans.
3. Require that liability insurers NOT raise their fees due to Government allocation.
4. Cover 6.8% of adverse rulings or settlements.
 
It is possible that the negative effects on physician income can be lessened depending on the extent of inclusion. (Illegal aliens, welfare recipients, etc.) We have seen a tide in corporate welfare that is unprecedented in U.S. history. Congress will continue to ride healthcare providers like horses if we let them. Your silence is our peril. 
 
Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net
 

EQUIPMENT FOR SALE

Battery operated K wire driver, Stryker oscillating surgical saw and osteotome (drill) complete set. Ille Extremity whirlpool, Osada drill set, power base (30w), 3 hand pieces, Reece Osteotomy guide, Orthoposer and axial x-ray devices. Send email  raybrown@bellsouth.net for pictures, price, or call 704-892-7301

ASSOCIATE POSITIONS – MARYLAND

Are you motivated, personable and enjoy working with the elderly? We are offering full or part-time positions in Maryland. Our group, Podiatry Management Services, provides care to the elderly in Nursing Homes, Assisted Living, Senior Homes, Adult Daycare and other similar facilities. Please call Dr. Herbert Rosen at 410-580-0255 or e-mail your c.v. to drhprosen@comcast.net or fax to 410-486-2049.

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

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

NEED EXTRA INCOME? IMMEDIATE OPENING FOR A PER-DIEM DPM

Our practice continues to grow and we’re in need of a well-trained DPM who is great with patients. Our multi-office practice is located in the scenic Hudson Valley region of upstate NY. This is a great opportunity to grow with our practice and provides unlimited income potential. Reply to: Hudson Valley Foot Associates, PO Box 3300, Kingston, NY 12402-3300; or email CV and cover letter to: jobs@hvfa.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

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

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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