The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

April 23, 2010 #3,839 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2010- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Early Treatment of Heel Pain Means Faster Healing: CA Podiatrist

Over the course of a lifetime, the heels of our feet endure a lot of abuse. "Every time a person's heel makes contact, it sustains pressure equivalent to about 65,000 pounds per square inch - or the weight of two and a half elephants," says Fremont podiatrist, Warren M. Johnson, DPM, who is on the medical staff at Washington Hospital. "Heel problems are among the most common conditions podiatrists treat and seem to be on the rise."

Dr. Warren M. Johnson

"Often, if you treat heel pain early, you can minimize its debilitating effects," advises Dr. Johnson. "By the time someone with heel pain comes to see me, they have usually had the problem for three to six months. At that point, it may take a longer course of treatment-perhaps four to six months-before the condition is resolved. Stimulating the body to heal after a lengthy injury takes much more time." By doing the right things and diverting the pain early, people can avoid a long period of inactivity, Dr. Johnson explains.

Source: Tri-City Voice [4/20/10]

TN Podiatrist Publishes Homeless Survival Book

Dr. Robert Spalding has recently published a new book, How To Live Homeless in Style, subtitled 50 Ways to Survive with Plastic Bottles in These Economic Times.

Toronto Podiatrist Obsessed with Celebrity Shoe Collection

For Toronto podiatrist Hartley Miltchin, collecting shoes seemed apropos. It began in the 1990s with a pair of Air Jordans worn by Michael Jordan during the 1995-1996 Chicago Bulls season. Now Miltchin owns roughly $3 million in famous footwear. For years after buying them in a charity auction, Miltchin kept the shoes out in the open, where he could admire the shiny patent leather, the slightly-worn red-and-white soles, and the basketball star’s scribbled autograph.

Dr. Hartley Miltchin owns roughly $3 million in worn celebrity footwear, including Shaq's massive Reeboks, and Marilyn Monroe's pumps (Photo Tony Bock)

“I just let the shoes sit on my credenza,” Miltchin says. “I didn’t think much of it. And then at some point in time a few years later, I decided that perhaps I would try and get some other sports figures’ shoes.” He did. Then, “it became an obsession.” Miltchin expanded his collection criteria to include shoes of small screen divas, pop stars, musicians, actors and celebrities of all kinds.

Source: Nicole Baute, The Star [4/21/10]

Create a Positive Mindset

Create a positive mindset—and set yourself up for a more productive day—by focusing your thoughts before you start work. Identify the following:

•  The best thing that could happen today.
•  The worst thing that could happen today.
•  The one thing you can do to make sure that the best thing does happen.
•  The one thing you should do to make sure that the worst thing does not happen.

Source: Adapted from Bits & Pieces via Communication Briefings

Query: Hallux Hammertoe/Varus in an 8 Y/O

My patient is a little girl who has had this bilateral hallux deformity since birth. No treatment was ever given. The toes are reportedly “bending more” and the child has had pain for the past two years, with worse pain over the past year. The toes hurt with activity. The patient was full term, with uncomplicated, normal delivery. She has 5th fingers that curve toward the 4th fingers; and a maternal aunt has this as well. Her father had congenital rotational problems with both legs, necessitating leg osteotomies. No family history of this hallux deformity is related.

Hallux Hammertoe/Varus in an 8 Y/O

This girl has normal muscle mass and tone. She keeps up with peers at play. This is the first pediatric hallux malleus I have encountered. The hallux varus is significant and needs to be addressed as well. I would like opinions regarding what procedures my colleagues have used or would recommend. Is it best to address the hammering and varus together or at separate settings?

Mark Aldrich, DPM, Antigo, WI

Query: Diagnostic Ultrasound

Does anyone have any experience with either the Mindray M5 or the Biosound MyLab 5 devices? These are upgrades from the entry-level ultrasounds.
 
Joel Morse, DPM, Washington, DC

RE: Podiatrists and Humanitarian Causes
From: Hal Ornstein, DPM

With joy and pride, I often read in PM News about our colleagues who do mission work in countries near and far. God Bless them!  This requires much personal and professional sacrifice, and by all means, a dedication to humanity. The sunshine they shed is wonderful, and may we never take for granted all we have in our country. It’s all about people, and with all the crazy technology these days, unfortunately the human touch has taken a back seat.

I thank all those who represent our profession globally and recognize their sacrifices.

Hal Ornstein, DPM, Howell, NJ, toetoe@optonline.net

RE: H&P Referral Requirement (Glenn McClendon , DPM)
From: Multiple Respondents

Hospitals are free to make their own rules and regulations, and some will require that you send patients to an MD and others will require that you send them to the hospital where an allied professional such as a nurse practitioner or PA will do the work-up. It's their call.
 
There is, however, another point that you raise with regard to nurse practitioners and even PA's doing complete physical exams. As an allergy sufferer, I frequently have to be seen by staff at the treatment centers I go to. In most cases, I am examined by a PA or nurse practitioner since the doctors may be too busy. In some cases, those allied professionals do great work and give me a thorough exam and are on target as to what is causing my symptoms and how to address them. In other cases, I had a distinct feeling that the examiner was "not ready for prime time," and I had to wait for the doctor to examine me or make another appointment. So, if I were doing a surgical case on a patient who had pre-existing medical problems and I knew an allied professional at a hospital was going to clear my patient for surgery, I would probably insist that the patient see his own MD in addition to having the mandatory work-up at the hospital. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

This is something we have always had to live with here in our community of two hospitals. It is seemingly a growing trend for hospitals to shift liability away from themselves and onto the physician. 

Interestingly, they have started requiring our signature stating a patient can resume medications at home which have been prescribed by their various other physicians. I brought the point up to the CEO’s stating that I was unwilling to sign onto that form; primarily because I have no idea if those medications and dosages are accurate, nor do I know what those medications do. I now meet them half way by signing my name and writing the statement, “Resume your home medications as they have been prescribed by your doctors.”

As far as the H&P, they do not want their hospitalists nor their employed anesthesiologists incurring liability above and beyond what they already do. Both types of physicians seem to like this policy as well. I don’t have much of a problem with it. It is an additional safety measure, and the patients all seem to understand that it is a “requirement” of the hospital. Besides, it does provide an additional contact between myself and the area doctors. It gives me the opportunity to get my name across their desk as well as provide them a chance to see the type of surgeries we perform.

Jon Purdy, DPM, New Iberia, LA, podiatrist@mindspring.com

I believe it to be very important for you not to let this issue pass without going through the appropriate channels at your hospital. Even if you do not prevail, the process will point to "weakness" in their defense which you may likely overcome in the near future. To do nothing could be a grave mistake for the future. As I am sure you know, the Joint Commission and CMS have ruled...

Editor's Note: Dr. James DiResta's extended-length letter can be read here.

RE: Scope of Practice and Licensure (Barry Block, DPM,JD)
From: Robert Bijak, DPM

Dr. Block has written quite succinctly what I've been trying to say for the past year. His paragraph should be made into a plaque and placed in all podiatry schools. It should be near your checkbook when dues are asked (required, when it comes to boards!) of you. You students, whose future is implicit in Dr. Block's suggestion, make this your number one issue. We have evolved in training so that we need not be autonomous any longer.  We can move from the "foot of the bus." 

With some of the offshore medical schools looking at podiatry favorably, I foresee more DPM's getting the MD degree, leaving those with the DPM impotent, as "The Boards" did for those who refused to evolve. I have long advocated at least one DPM school convert to a medical school taking mostly DPM's. I believe the school would be swamped. College leaders, you've been put on notice. 

Robert Bijak, DPM, Clarence Center, NY, rbijak@aol.com

RE: Radiology Lab Performing Neuroma Injections (Alan Kalker, DPM)
From: Geoffrey Bricker, DPM, Kenneth Meisler, DPM

I have been doing "blind" neuroma injections for over 28 years with good results in respect to pain relief and obviation of need for surgery. This is just an expensive gimmick which unnecessarily adds to healthcare costs. In an era of evidence-based medicine and need for cost-containment, there needs to be good reason to use an expensive modality. This also applies to the ludicrous practice of using ultrasound to "diagnose" plantar fasciitis. If it cannot be done with history, physical, and an x-ray, except in very rare cases, one should seek another profession.

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

I have been performing ultrasound-guided neuroma injections in my office for more than two years. I follow the guidelines of the Hospital for Special Surgery, and I have attached a link explaining how it is performed and what their results were.
 
After 25+ years of "blind" neuroma injections, I give all of my neuroma injections under US guidance. I have found I am getting better results. We inject from between the toes directly into the neuroma. It is surprisingly less painful than from the dorsum. I do not block the area with lidocaine as they suggest, just use ethyl chloride. I follow their guidelines and use 3/8cc Kenalog (40mg per cc) and 3/8cc Marcaine. You can use less volume because you don't have to "flood" the area to get the neuroma. I haven't had anyone yet who said their neuroma became worse after an injection, however, I am sure it has to happen. 
 
The only problem I have found is that the Kenalog 40 sometimes does not flow easily through a 25 guage needle and sometimes I have to remove the needle, loosen the "clogging", and re-inject.
 
Finally, it requires someone who is very good at doing ultrasounds to perform the ultrasound as another doctor does the injection. It might be possible for one person to do both but it would be very difficult. There is a learning curve to giving the injection and making sure it goes directly into the neuroma. Marty Wendelken, DPM, ultrasound instructor at PCPM, and I have been teaching other physicians this technique in my office. Here is the link: ncbi.nlm.nih.gov/pmc/articles/PMC2504098/
 
Kenneth Meisler, DPM, New York, NY, kenmeisler@aol.com

RE: Reporting Diabetic Shoe/Insert Fraud
From: Paul Kesselman, DPM

The announcement of a pre-payment review of selected therapeutic shoe claims by DME MAC B should help to reduce this type of fraud. Among those items, the DME MAC B will be requiring prior to approving payment include:

1) Documentation of diabetes mellitus and secondary foot findings in the supervising physicians’ chart prior to... 
 
Editor's Note: Dr. Kesselman's extended-length note can be read here.

ASSOCIATE POSITION  - THE BRONX, NEW YORK

Growing Hospital-based practice in the Bronx. Part-time and full-time positions available. Compensation based on training and level of experience. If interested email: nblitz@bronxleb.org

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 – 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 FOR SALE - MAINE

20+ year full scope turn-key practice in the same medical building, podiatrist-friendly hospitals nearby, appreciative and cooperative patients, excellent expansion potential. Retiring seller will stay for transition. mainefootdoc@yahoo.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

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

ASSOCIATE POSITION - TUCSON ARIZONA 
 
Full-time position which involves all phases of podiatry.  Compensation based on training and experience. Must have current Arizona podiatry license. Send Resume to Transcription697@aol.com

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

PM News Classified Ads Reach over 12,000 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,000 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.