The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

April 24, 2007 #2,919 Editor-Barry Block, DPM, JD

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Cosmetic Foot Surgery:“If it’s Not Broken, Why Fix it?” IN Podiatrist

Women are seeking podiatrists to perform procedures from pinky tucks to straightening and shortening their toes, according to the Maryland-based American Podiatric Medical Association. The procedures are not only risky but can cost more than $20,000, doctors say. “I always tell people it’s not like a face-lift because you don’t walk on your face,” says Dr. Rock Poistano. “You walk on your feet. Is it worth taking even a small risk to possibly give up your ability to walk around comfortably?” Dr. Michael Worpell knows the answer: No.

Dr. Michael Worpell, Photo Samuel Hoffman/ Journal Gazette

Worpell operates the Fort Wayne Northeast Indiana Foot and Ankle Clinic . Although no one has asked him about the cosmetic procedure, Worpell, who has been a podiatrist for 20 years, knows what his answer will be. “Most cosmetic surgeries are just that, cosmetic. Feet are functional. Love handles are not,” says Worpell. “I have a lot of mixed emotions about it, but if it’s not broken, why fix it? Why go through the risk of surgery for a physical appearance?

“I understand if they had a toenail they wanted removed because they were suffering from pain, or it was a deformity. I understand removing that. But stilettos are not functional shoes. I tell people shoes have to match the activity. It’s more than wearing what looks good.” But Worpell’s experience has taught him that wearing ill-fitting shoes doesn’t automatically mean a person will end up with bad feet. “People incorrectly believe wearing bad shoes will cause a deformity. You may develop corns or ingrown toenails, but (ill-fitting) shoes that are not supportive cause the most problems because the foot isn’t getting the support that’s needed.”

Source: K.O. Jackson, The Journal Gazette [4/22/07]

PA Podiatrist Builds 6 Million Dollar Smart House

You know when you are in a Brad Bernstein house. Bernstein designs the unimaginable. For the last several years he has been working his magic for Stephen Monaco, a Havertown podiatrist who is building a $6 million ultramodern home on Creek Road in Birmingham for himself, his wife, Jean, his 21-year old son, Angelo, and 18-year old daughter, Ashley.

The view from the driveway of the home of Dr. Stephen Monaco. Photo by Kim Dietrich

The Monaco family lives in Thornbury, Delaware County now. ”This is a very, very intelligent house,“ Bernstein said, as he started a tour in the garage with parking for 10 cars. ”This is not your typical smart house.“ When the homeowner drives through the gates leading to the 22-acre property, the smart system opens his garage door, and the ”logic“ lights illuminate a path to Monaco‘s bedroom on the fourth level, Bernstein said. All controls in the house are integrated and monitored by computer.

While there is a stairway system to connect all four levels, more convenient is the commercial-grade four-stop elevator. Even the Monaco family dog enjoys that luxury. When Monaco purchased the property and hired Bernstein, he offered some rather interesting design concepts for his architect to tackle. Monaco, who travels frequently, said he ”loves“ the ambiance of a lobby in an upscale hotel and wanted that feeling in his new home. He wanted a house that projected warmth, a house with no angles.

Source: Gretchen Metz, Coatesville Daily Local News [4/22/07]

Feds Say Plans Can Soften Deadline For Doctors' Universal ID Numbers

The federal government has given the healthcare industry up to a year-long reprieve in adopting a new standard identification system for use on electronic claims. But that doesn't necessarily let doctors off the hook when it comes to obtaining and using the new ID numbers. Under a mandate from Congress, the Centers for Medicare & Medicaid Services established May 23 as the deadline for physicians and other medical professionals to apply for and start using a unique National Provider Identifier on all electronic claims. The 10-digit NPI, designed to replace all other identifiers, is required for anyone who files claims electronically with Medicare or any other payer. This applies even if the physician uses an outside firm that files electronically on his or her behalf.

CMS recently came to the conclusion that too few health plans, doctors and others would be ready to use the NPI in place of all existing IDs, known as "legacy" identifiers, by the May deadline. Small health plans already have until May 2008 to comply, but the agency decided that many other large payers and health professionals also would need more time to get up to speed. Numerous industry organizations, including the American Medical Association, lobbied the government to soften the deadline.

So for the 12 months after the May 23 deadline, CMS will allow payers to process claims using either NPIs or older ID numbers without penalty, as long as the insurers have adopted appropriate contingency plans for moving to an NPI-only system. Physicians who are not ready to use their new numbers on all claims would benefit from this contingency period only if the payers they deal with decide to take advantage of the extra time

Source: David Glendinning, AMNews, [ 4/23/07]

APWCA National Conference Sets Attendance Record

Over 600 podiatric and other allopathic physicians, nurses, and other healthcare practitioners from as far as India and Ghana gathered this weekend in Philadelphia to share a synergy of ideas at the 6th National Conference of the American Professional Wound Care Association (APWCA).

APWCA has grown dramatically in recent years and now boasts a membership of over 2,000 practitioners from every wound care-related discipline. The lecture hall was packed with world-class speakers such as Andrew Boulton, MD, David Allie, MD, Robert Frykberg, DPM, and Allen Jacobs, DPM .

Drs. Barry Block receives Recognition Award from APWCA Executive Director Dr. Steven Kravitz (L) and and APWCA President Dr. Robert Gunther

APWCA plans to hold next year’s meeting in Fort Worth, TX.

RE: CME Challenges
From: Lloyd Smith, DPM

As someone who has spent my entire career as a volunteer for many associations, and president of four, I have often questioned the mechanics of granting CMEs to conference attendees, seminar lecturers, committee volunteers, and organizational leaders. There certainly have been times where my volunteer efforts lessened my learning experiences at those meetings. I was often in organizational meetings when valuable lectures occurred. However, and I am totally adamant in this belief, my participation in those meetings enhanced my ability to be a competent podiatrist way beyond the one hour lecture I missed.

I look at our current “sign-in” systems as a weak, knee-jerk reaction to our legal system and the CME police. Who cares if you sign at 8AM, 1PM or 5PM? Did you actually attend those meetings or did you come back in time for the sign in? Did you learn anything? Did you become a better podiatrist that day? Did you really listen or were you talking to an old classmate? Were you out in the exhibit hall deciding about a new EMR system, orthotic scanner, or some other techno gizmo being sold?

No question – lectures and meetings are truly valuable in enhancing your knowledge. So are reading JAPMA, Podiatry Management, and the New England Journal of Medicine. Does anyone monitor those efforts? Do you get credits for that activity unless you take some CME test? I don’t know, but I do know that the latest flap on CME is reminiscent of Orwell’s 1984. Read that wonderful book if you want to get my perspective. Otherwise, signing in at a meeting is about as useful to your patients and your ability to be a competent podiatrist, as learning to use crayons when you were in Kindergarten.

Lloyd Smith, DPM, Newton, MA, lloydpod@yahoo.com

RE: Enchondroma on 11 Y/O (Michael Ryan, DPM)
From: Multiple Respondents

1. Use a bone graft and perform an arthrodesis to the middle phalanx
2. Use a spacer that will penetrate the middle phalanx for stability. I am thinking of the fixation and spacers that are normally used for post-type hammertoe surgeries.
3. Any other option would result in a floppy distal toe, which may be a problem in the years to come.

I can't help but consider the complicated nature of the procedure on this small (11 year-old's) toe and how cosmesis will be impossible to satisfy this parent, especially since loss of the toenail is a certainty. I would likely offer these options to the parent, recommend the terminal Symes procedure, and gladly refer them to a plastic surgeon if they want one of the other options. I also make it a rule that all children needing significant corrective surgeries (meaning other than nails and warts) always get referred for second opinions, if they have not had one yet.

Marc Greenberg, DPM, Dayton, OH, tripperdpm@yahoo.com

I have had a couple of cases of enchondromata involving an adult and one in a child of similar age. Treatment was successful without recurrence. Treatment consisted of cutting a rectangular piece of bone from the dorsal surfaces of the phalanges. The window of bone was then lifted off of the bone exposing the enchondromata. The enchondromata were then curetted out of interiors of the phalanges leaving the bones hollowed out. The hollowed out portions of the bones were then packed with bone chips from banked bone. The windows of bone previously cut out from the dorsal surfaces were then laid back into place and secured with a chromic gut suture that encircled the bone that was tied into place. Patients have done well without recurrence. This will preserve the bone and will not result in any deformity of the digit. Amputation is not necessary.

Mike Boxer, DPM, Woodmere, NY, mcbdpm@aol.com

Is it possible the recurrent enchondroma is not a subungual osteochondroma or Exostosis Cartilaginea of the distal phalanx? Osteochondromas are the most common benign bone tumor of the foot. I recently reported on a recurrent incidence of this bone tumor one year after excision and have successfully treated the recurrent lesion with bone graft material. You may want to read this article in the Podiatry Internet Journal Volume 2(2):4 in our February Issue. I have included the link:
http://podiatry.wordpress.com/2007/02/19/subungual-osteochondroma-or-exostosis-cartilaginea-of-the-hallux-a-case-report-of-recurrent-bone-tumor-one-year-after-removal/

Al Kline, DPM, Corpus Christi, TX, al@kline.net

RE: Videotaping Runners (James M. Petko, DPM)
From: Ray McClanahan, DPM

When I began treating runners early in my practice, I purchased an expensive treadmill, and an expensive camera system, and I began pouring over hours of tapes of the running gait of my patients. I was trying to find the cause of their running injury, assuming it to be some form of biomechanical dysfunction, or bodily asymmetry. I was looking for and measuring for the items I was taught. Especially over-pronation, early heel off, Q-angles, and so forth.

Then I read Dr. Howard Dananberg's Sagittal plane biomechanics series, and began looking at my runner's from the side profile, as well as from the front and rear. It was at this point that I stopped routinely video-taping my runners. I did so because I began to clearly see my runner's initial contact point on the ground was way out in front of their body, and on the posterolateral heel. As opposed to barefoot/lightly shod running styles, which are contacting under their body, and more on the forefoot. This is called the touch down angle for those who don't study gait.

I think we are not doing runners a service when we lead them to believe that the cause of their injury/pain is due to a gait fault or a problem within their biomechanics. I would recommend not focusing on how your runners are moving, but more on what they are moving in. Then on their training errors, such as increasing mileage and intensity too much. If those 2 factors have been adequately addressed and your runner is still hurting. I would THEN look at their biomechanics, and measure leg lengths, etc. This is what works in my practice, and I hope it may be helpful to some of you.

Ray McClanahan, DPM, BS Ed, Longview, WA footdr@nwfootankle.com

Editor’s note: The full text of this shortened letter appears at:
http://www.podiatrym.com/letters2.cfm?id=13769&start=1

Editor’s Note: This topic is now closed

RE: 6E Rubber-Soled Baseball Shoes, (Charles F. Ross, DPM)
From: Robert S. Schwartz, C. Ped.

Rubber-soled baseball cleats can be re-crafted to fit a 6E foot. Have the patient purchase a pair one size longer than he would normally wear. If you don't have a source near you to re-craft the shoes, Eneslow can do it for you. Take a weight bearing outline of both feet; Take circumference measurements of the heel to the instep, around the arch (waist measurement), and across the ball of the foot when standing. Mark the measurements on the footprint; send it along with the shoes. The price to the patient is $195 per pair.

Robert S. Schwartz, C. Ped., NY, NY, rss@eneslow.com

Editor’s Note: This topic is now closed.

RE: Psoriasiform Dermatitis? (Tip Sullivan, DPM)
From: Itamar Rosenbaum, C.Ped

This does not seem to be contact dermatitis related to footwear for several reasons. 1. The fact that it is unilateral. 2. Shoe related contact dermatitis is typically presented as a skin breakdown that looks like someone has scratched the area to the point of blood. 3. Shoe-related dermatitis is usually on both the dorsum and plantar aspects of the foot, although it does not have to be that way all the time.

Should the doctor want to rule out leather or glue-related contact dermatitis, it would be a good idea to send this patient for patch tests at a dermatological center such as NYU.

Itamar Rosenbaum, C.Ped., New York, NY, nycped@verizon.net

Editor’s Note: This topic is now closed

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

ARIZONA- OFFICE SPACE TO SHARE- TUCSON, AZ

Office was previously occupied by a podiatrist for ten years. Shared space in a modern, well designed, chiropractic and podiatry office. X-ray and processor provided. High growth area in Northwest Tucson. Potential patients walking in asking when a podiatrist will open for business. Respond: parksovc@aol.com, 520-544-2445.

ASSOCIATE POSITION - SANTA FE, NM

Established, 30 year practice with multiple office locations looking for a PSR 24/36 trained, hardworking, personable, ethical, highly motivated individual for associate position with immediate partnership available. E-mail CV and reference letters to sfpodiatry@aol.com

ASSOCIATE POSITION – SOUTHERN KENTUCKY

Southern Kentucky's largest and most respected foot and ankle group is looking for an associate to start in July 07. An amazing opportunity to grow with an established four provider practice on beautiful Lake Cumberland, Kentucky. Very competitive salary/bonus with a buy in opportunity will be offered. Established satellite offices will make for immediate patient base ready to be nourished and grown by a friendly, well-trained associate. Excellent benefit package. Lexington, KK is 1.5 hours North while Nashville, Tennessee is 2.5 hours South. Please fax CV to 606-679-4626.

Seeking Resident who wishes additional training: Baltimore, MD Mercy Medical Center

Resident position CPME accredited either 12 or 24 month commitment for a highly motivated individual additional surgical training in well-established Podiatric Residency Program. Busy metropolitan hospital with high surgical numbers and inpatient care. Resident is integral member of multidisciplinary team. Begins mid June 2007. Includes competitive salary/benefits. Send inquiries to rsher18@yahoo.com

PRACTICE FOR SALE - WASHINGTON, DC

Priced to sell, 100% financing available. Owner leaving area. Hospital based 27 yr old practice with large surgical and diabetic population. Four fully equipped rooms. x-ray, topical hyperbaic oxygen units. Hospital privileges - full scope. 600+ new/yr. Will lease to you until final sale. Contact Dr Benjamin at jhallux@yahoo.com or (202) 841-5545 (cell).

ASSOCIATE WANTED – BRONX, NEW YORK

Seeking an ethical and personable Board Certified/Eligible residency trained individual (PM&S 24/36). Position available June 1, 2007 to become part of this prestigious and established NYC podiatric practice operating for 25+ years. All aspects of podiatry - Excellent opportunity leading to partnership with unlimited income potential and more. Fax CV to (718) 931-9324. WWW.BRONXFOOTCARE.COM

ASSOCIATE WANTED - BOCA RATON-DELRAY BEACH AREA

Full time for growing practice-surgical training a plus-hard working a real plus-opportunity of a lifetime-partnership after 1 yr. Need Florida license. Fax resume to 561-865-2225

ASSOCIATE POSITION-YORK, PA

Excellent opportunity for PSR/24-/36 residency trained podiatrist to join 32 year established podiatric practice. Partnership opportunity. All aspects of podiatry, surgical, biomechanical and general podiatry. State of the art practice with up-to-date facility. Call and speak to Troy Wentling office manager or fax CV to 717-854-6519 or e-mail to beechtreepod@aol.com

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City. Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

ASSOCIATE POSITION - EASTERN NORTH CAROLINA

Multi-physician Podiatric practice looking for PSR-24/36 trained Podiatrist to join our progressive, diverse practice. High surgical volume with teaching opportunities. Competitive compensation package with definitive plan leading to partnership. Must have North Carolina license. Position available late 2007. E-mail CV and/or letter of interest to ncdpmsearch@earthlink.net

PRACTICE FOR SALE- FLORIDA

A 13 y.o. well established podiatry practice in Tavares, FL ( Lake County ) the 23rd fastest growing county in the nation. This is an opportunity not to be missed. All aspects of podiatry with hospital privileges available. PRICED TO SELL! If interested, contact Susan at (352) 406-2513 or at acrysue@gmail.com

PRACTICE FOR SALE: LA JOLLA CA (SAN DIEGO) Price reduced!

$287K '06. No HMOs, bone surgery, or insurance panels, so opportunity abounds! Affluent community. General practice, biomechanics, DME. Possible finance Serious/principals only. Cell:858-405-4780, 10-8 PDT. No Sunday calls, please. $129K Selling due to age, health problems. www.SDFootDoctor.com DrRDWorley@yahoo.com

ASSOCIATE POSITION - CENTRAL NEW JERSEY

Associate Wanted....For well established Central Jersey practice, diversified in all aspects of podiatric medicine and surgery. I am looking for a highly motivated, conscientious, individual with strong work ethics. My practice may offer great potential for the right person. Minimum PSR 24. Please reply to Jerseypod@gmail.com

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

PRACTICE FOR SALE – CENTRAL FLORIDA

Well established surgical podiatry practice in Central Florida . Gross 2006 $744,136. Very attractive lease in an outpatient surgery center. Very low down payment. Contact Camille Todd/ Transworld Business 321 217 3625

WELL ESTABLISHED PODIATRY PRACTICE IN MT. AIRY, NC

Dr. John H. Hodges had a well established practice in Mt. Airy, NC that is either for sale or in need of an associate/partner to take over patient care. Dr. Hodges unexpectedly passed away, leaving approximately 3,500 patients. This is a unique opportunity to be able to begin work in a busy podiatric practice. If interested, contact Carolyn McMackin at (336)577-2886 or cmcmackin@triad.rr.com

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