The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

April 23, 2009 #3,527 Publisher-Barry Block, DPM, JD

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Barefoot Runners are More Efficient: MO Podiatrist

“There have been studies with runners that have shown that, biomechanically, you actually run more efficiently without shoes than with running shoes,” said Scott Foster, a podiatrist with Columbia Podiatry, affiliated with Boone Hospital Center.

Dr. R. Scott Foster

Being barefoot, meanwhile, “is much more natural for your feet. It allows for better use of all the muscles that make your feet and legs more efficient. What shoes do is make you less efficient. They can change the alignment and maybe the way the muscles work. That can sometimes cause problems,” Foster said.

Source: Caroline Dohack, Columbia Daily Tribune [4/19/09]
 

TUSPM's Gait Study Center Helps Solve Medical Mysteries

At Temple’s Gait Study Center, researchers are using patients’ gaits to solve their medical mysteries. In this high-tech laboratory, located at the School of Podiatric Medicine, doctors are studying the way their patients stand and walk in order to identify the underlying causes of pain not only in the feet and ankles, but also in the hips, back or neck.

Dr. Howard Palamarchuk

“If something’s not right with the way you’re walking, it sets off what we call a kinetic chain,” said Howard Palamarchuk, DPM, associate professor of medicine and orthopedics and director of sports medicine at the School of Podiatric Medicine. “When our feet or ankles are bothering us, it sets off a chain reaction that can shoot all the way up the spine and cause problems elsewhere. If a patient comes in with back pain, we’ll look at the way they’re standing or walking to see if there’s a problem there.”

“For example, a patient who comes in with a bunion or a plantar wart will modify the way they’re walking — by putting pressure on the outside of the foot, or the heel — to avoid that pain,” said Palamarchuk. “This causes balance issues and can lead to pain elsewhere in the body.”

 People Who Can Help You Succeed

See immediate improvements in your work performance when you commit to this effort over the next 30 days: Spend time listening to what the following people have to say. Included below are questions you can use to prompt conversations that will reveal your pathway to success.

1. Your friends. Ask: “What do you see me doing that is not serving me well?” “If you could have me change one thing in my life, what would it be?” “How can I be a better friend to you?”

2. Your employees. Ask: “What frustrations are you facing right now?” “What are some challenges you are experiencing?” “What do you really like about your work?” “What is one thing I can do to help you be more effective?”

3. Your patients. Ask: “What is one thing we can do to improve your dealings with us?” “What do you need that no one is providing?” “What will it take to keep you as a patient for life?”

4. Your suppliers. Ask: “What can you do for us that you are not doing now?” “How can we make it easier for you to serve us more fully?”

5. Your mentor. Ask: “Am I doing anything to shoot myself in the foot?” “What am I doing that you think is highly effective?” “What personal development goals should I set for myself?” “How can you help me meet those goals?”

Source: Adapted from Smart Moves for People in Charge, Sam Deep and Lyle Sussman, Addison-Wesley via Communication Briefings

Query: Positional Hallux Limitus
From: Dale M. Smith DPM
 
Within the last couple of weeks, I've had four 17 to 30-year-old females present with a rectus hallux, no signs of the abductus, complaining of pain of the dorsum medial aspect of the first metatarsel head and exhibiting anywhere from minimal to moderate limitation of motion.

Positional Hallux Limitus

In all four cases, lateral weight-bearing, angle and base of gait, x-rays show a significant metatarsus primus elevatus. Some show spurring of the metatarsel head. Maybe I'm reviewing the wrong literature, but I am not finding a plethora of articles suggesting the panacea of procedures for this condition. Any thoughts on the best procedure for a positional hallux limitus.   
 
Dale M. Smith, DPM, Chicago IL

Query: Blood Work-up Protocol?

If a doctor refers a patient to you, and part of your work-up is to have knowledge of bloodwork results, is there a protocol where the patient should go for the bloodwork? Is it politically incorrect to send the patient to a lab versus back to the doctor? I thought that a patient referred to me had gout. I asked the patient to get a CBC with diff, ESR, uric acid blood level, and 24-hr urine. The internist called me and was upset that I sent his patient for blood work. Did I commit a faux pas? 
 
Jeffrey Kass, DPM, Forest Hills, NY
 

RE: Chronic Achilles Tendinitis (Alan Mauser, DPM)
From: Geoffrey Bricker, DPM, Jan David Tepper, DPM

I have been using prolotherapy for tendinosis for over 2 years now with a greater than 90% success rate, even in cases where surgery was contemplated. Inject 1-2 cc each of 50% dextrose, Sarapin, and 0.5% Marcaine along the tendon every 1-2 weeks for up to 7 injections. Sarapin is optional. The effects seem to be cumulative so you can space out as desired. There may be some injection soreness for 2-3 days after the injection. Use adjunctive therapy as indicated. It is cheap and easy with few compliance issues. I First heard about this on PM News, researched it and perfected it. It should definitely be taught in the schools. If there are questions contact me by e-mail or phone (I'm still old school).

Geoffrey Bricker, DPM, Springfield, MO, geoffreybricker1@msn.com

When all else fails for chronic Achilles tendonitis (the fusiform swelling is classic for greater injury), I cast for 6 to 12 weeks, or as long as they are responding to therapy, and treat this as a partial tear. Once no longer symptomatic, I consider bracing (orthotics, AFO ) to whatever extent is necessary to remove the deforming forces.  If the condition is resistant to this form of care or if it fails this form of care, I use further diagnostic testing such as MRI to determine the extent of the injury and treat appropriately. 

Jan David Tepper, DPM, Upland, CA, jdtdpm@aol.com

Editor's note: This topic is now closed.

RE: Scanners for Orthotic Fabrication (Larry Huppin, DPM)
From: Robert Zeien

Editor's note: This extended-length note can be read at: http://www.podiatrym.com/letters2.cfm?id=25921&start=1

Editor's note: This topic is now closed.

RE: Diabetic Socks (Cheryl Martinetti, PMAC)
From: Paul Kesselman, DPM

Knit Rite is a leading manufacturer of socks specifically engineered for diabetics and others with venous compromise. Their socks are competitvely priced (~$14 per pair) and meet the most advanced textile industry standards for diabetic and compression hosiery. The standard requirements to look for in highly advanced hosiery have been recently been reviewed in several Podiatry Managment articles.

Knit Rite Stockings contains a patented Corespun Technology. This avoids internal seams in the design of their hosiery and eliminates bunching. This significantly reduces the risk of ulceration while still allowing for appropriate support, shock dispersion and compression. Knit Rite socks are solely represented to podiatrists by Med Reps USA.

Disclaimer: I am a consultant to Med Reps USA

Paul Kesselman, DPM, Woodside, NY pkesselman@pol.net
 

RE: 6.8% Drop In Physician Income If NPH Instituted
From: Philip McKinney, DPM

Speak with any politician and they will tell you this is how they view the idea of financing healthcare. This is NOT about decreasing the cost of the actual healthcare - that project is too difficult for the small political mind. Ask the politician, that if there needs to be a decrease in physician reimbursement by 6.8% to help finance healthcare, then by that reasoning, should we not decrease teacher pay by 6.8% to finance schools, police and fire by 6.8% to finance community protection, politicians by 6.8% to finance government? Do we ever hear these proposals?
 
Philip McKinney, DPM, Eugene, OR, opodiatry@oregonpodiatry.net
 

ASSOCIATE POSITION - MIAMI-DADE FLORIDA
 
Partnership w buy out opportunity for the right candidate. Well-established modern practice. EMR, digital x-rays, gait scan, etc. Excellent hospital privilages. SALARY...two options. $40,000 starting, 40% of everything you generate over $120,000. Want a fixed salary instead? $75,000 a year I feed you patients and provide an excellent well-trained staff. Contact doctorinhialeah@aol.com

ASSOCIATE POSITION AVAILABLE GREATER HOUSTON

Looking for full-time associate to work in well established practice with 3 offices in the Houston area. Practice focused on sports medicine, surgery with EMR, Digital X-ray, Musculoskeletal Ultrasound and new office built in 2007. Great opportunity in one of the fastest growing areas in the country that has been least impacted by economic woes. No nursing homes, routine care. Available to start in July/August for PSR 24-36 surgically trained podiatrist, Spanish speaking a plus. Great opportunity with competitive salary along with malpractice benefits. Please send CV and letter of interest to officemanager23@gmail.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 - 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

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

 
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