The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

April 24, 2009 #3,528 Publisher-Barry Block, DPM, JD

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Kids Feet Grow Faster Than Most People Think: CA Podiatrist

Buying shoes with "room to grow" is a common practice, but it could cost more in the long run. A new Swedish study of 250 children finds nearly 70-percent of kids were wearing shoes too small or too big. "It can lead to problems like: hammertoes, bunions, and fatigue in both legs," said podiatrist Dr. Claire Futenma.

Dr. Claire Futenma.

This could plague kids until adulthood. Dr. Futenma says kids feet grow faster than you might think.

* Under 16 months: Shoe size increases a full size every two months
* Up to 2 years: A half a size every 2 to 3 months
* Up to 3 years: A half size every 3 or 4 months
* From 3 to 5: A half size every four months

Source: Denise Dador, KABC-TV, Los Angeles, CA [4/20/09]
 

TX/AR Podiatrist Discusses Treatment of Black Nails and Blisters

Black nails occur from constant trauma or impact. Runner Robert Klein, a podiatric physician, says, "Impact can cause blood to collect under the nail. If it isn't aspirated, the extra blood and fluid can eventually separate the nail from its bed, causing the nail to fall off." It's important not to take the nail off yourself. Find a doctor or athletic trainer to help. This will prevent infection or further problems. Put a bandage around the toe to cushion the nail bed from trauma, too.

Dr. Robert Klein

Blisters occur when you don't wear the right socks. Poorly fitting shoes can also cause chafing. A small blister should be left alone, yet a large blister can be decompressed. Using a sterilized needle and opening the base of the blister is the best way to prevent further problems. Klein also suggests to "leave the skin over it - it works as a biological Band-Aid."

Source: Tori Tyler, The Orion [4/22/09]

Cherry Blossum Dermatology Meeting Another Success

The Cherry Blossom Seminar held this past weekend in Washington, DC was very sucessful. This annual event, sponsored by The American Society of Podiatric Dermatology was attended by over 100 podiatrists and was very well received.

(L-R) Patricia Schwartz, DPM, Harvey Lemont, DPM, Ivan Bristow, FCPod, Carmen Myrie-Williams, MD Bryan Markinson, DPM,  M. Joel Morse, DPM

Query: Employee Salaries

My full-time employees get several benefits- 4 day work week, sponsored savings plan, etc. We do not have a health plan because my employees can get a better deal through their spouses’ plan. They have not had a pay raise in 3 years. I am considering a cost of living raise (5.8%) plus some sort of an incentive bonus plan. Is it better to have a plan that is geared more toward the specific indicators of the employee's job, for example, base it on number of patients seen or other objective parameters, or is it better just to look at the bottom line and base bonuses on the net income of the practice?

Tip Sullivan, DPM, Jackson, MS
 

Query: Hallux Limitus (Dale M. Smith, DPM )
From: Multiple Responses
 
Have you tried any conservative treatment. I find that a functional orthotic with a first ray cut out may work quite well. It allows the first metatarsal to plantar-flex giving those with a functional hallux limitus improved range of motion and decreased discomfort with dorsi-flexion. Of course, if the problem is structural, this may cause more discomfort rather than relief so the patient has to be evaluated carefully. For functional hallux limitus, I always recommend this conservative treatment before surgery because I see too many patients post-op that complain of a limited range of motion secondary to the surgery.
 
Lisa LaRocca, DPM, Smithtown, NY,  lisadpm@aol.com

In cases of more severe metatarsus elevatus with functional hallux limitus recalictrant to orthotic control with a Morton's extension, I prefer rotational osteotomies for significant correction while maintaining length such as a Juvara C-1 or crescentric osteotomy. In lesser elevatus, I prefer a Modified Reverdin-Green-Watermann-type procedure where I can decompress the head without losing as much length as I see in modified Youngswick procedures, but that's just my preference and experiences.

Christopher Formanek, DPM, Baton Rouge, LA, DrChris@BRPodiatrist.com

Editor’s note: An extended-length note by Dr. Sullivan appears at: http://www.podiatrym.com/letters2.cfm?id=25938&start=1
 

RE: Blood Work-up Protocol? (Jeffrey Kass, DPM)
From: Paul Kesselman, DPM

I think this varies with the patients' insurance and the PCP. Many PCP’s are referring the patient’s foot care to you and some may want you to handle everything concerning the foot problem (including lab work). Other PCPs want feedback on every aspect of their patients' care, including performing the lab, choosing the anesthesiologist; ID/endocrinologist, and hospital for care, etc.

Many managed care carriers do not compensate any specialist for vein puncture and only compensate the PCP; others don’t pay the PCP either and require the PCP to refer the patient to a central drawing station. Even when a fee is paid, it is often such a paltry amount (~ $5.00), not making this aspect of patient care very profitable. This is especially true if this takes up a significant amount of the physician’s time.

My suggestion would be for you to develop a database for your practice which alerts your staff concerning which carriers allow a fee for vein puncture and which don’t. When you do not wish to provide this service (for logistics of financial reasons) ask your patient if their PCP draws blood or refers them out. If they refer them out DON’T refer the patient back to the PCP.

In the final analysis, calling PCPs and asking how they wish you to proceed can never hurt. This will also give you a chance to discuss the case with the PCP from the onset and thank him/her for the referral.

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

RE: Diabetic Socks (Cheryl Martinetti, PMAC)
From: Jason Gross, MHA
 
Over the years, we have carried a number of different diabetic socks but none have been as well received as those made by Dr. Comfort.  Not only are they constructed in a manner to benefit our diabetic patients, but, as has been pointed out earlier, they have many styles and colors which improves our patients' acceptance and compliance. From a business standpoint, the profit margins are comparable to just about any other brand we have carried as well. 

I have no financial ties to Dr. Comfort.  

Jason Gross, MHA, Practice Administrator, Foot and Ankle Center of the Carolinas, Forest City, NC, jgross@footandanklenc.com

EQUIPMENT FOR SALE

Used Acoustic Imaging Diagnostic Ultrasound. Comes with 10 MHZ linear probe. Printer included. Unit is a console on wheels and cannot be shipped, must be picked up. Price includes 3 hours of hands-on and didactic material on podiatric ultrasound. See website www.hurtheel.net for more details. Price: $4,750 Contact Information Henry Slomowitz  E-mail hslomowitz@gmail.com Phone 973-479-6305.

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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