The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

April 24, 2010 #3,840 Publisher-Barry Block, DPM, JD

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Parsley Named as New Dean At Scholl

Dr. William M. Scholl College of Podiatric Medicine has announced that Dr. Nancy Parsley will assume the position of Dean of Scholl College as of July 1, 2010. Dr. Parsley has served as Associate Dean of Academic Affairs and Assistant Professor of Surgery at Scholl College since July of 2007.  During her tenure as Associate Dean, she has promoted teamwork  among the departments in all aspects of academic and clinical functions.  

Dr. Nancy Parsley

Air Force Podiatrist Works in Remote Expanses of Alaska

Remote Point Hope is a very northern, very western village sitting on a stretch of Alaska land that juts into the Arctic Ocean. Medical services are provided by the Air Force Reserve Command's 477th Fighter Group at Elmendorf Air Force Base. They supervise and organize the personnel flying into the operation's hub in Kotzebue, and then out to one of the 11 villages the operation serve. Lt. Cmdr. Stratis Lagoutaris, a podiatrist from Jacksonville, FL was stationed in Kotzebue for the operation, the farthest away from home he's ever been.

Dr. Stratis Lagoutaris

"Podiatry support is one of those areas where it's certainly underserved in this population," he said. He treated diabetes, ulcerations, and arthritis during his visit. He said that certain ethnic groups are prone to certain diseases, and the Native American population is prone to diabetes. But he said the population in Kotzebue was well-educated about the effects of diabetes, and he saw fewer problems there than he did in his practice in Florida.
 
Source: Nina Peacock, Alaska Star [4/21/10]

DPM, DO Appointed as Acting President of WV Osteopathic College

At the Saturday, April 10 meeting of the West Virginia School of Osteopathic Medicine Board of Governors, the Board thanked Dr. Richard Rafes for his 15 months of service as President. The Board appointed Dr. Michael Adelman, Vice President for Academic Affairs and Dean, as Acting President, effective immediately. He also serves as Vice President for Academic Affairs and Dean. Prior to his appointment in August 2002 at WVSOM, he was the Associate Dean for Academic Affairs of Ohio University College of Osteopathic Medicine. 

Dr. Michael Adelman

Dr. Adelman is the current Chair of the American Association of Colleges of Osteopathic Medicine Board of Deans. Dr. Adelman has served as both Chair and Co-Chair for AACOM’s Annual National Educational Meetings. He is a member of the American Osteopathic Association Council on Post-doctoral Training; plus many other national, state, and local boards.

Dr. Adelman received his degree from the Pennsylvania College of Podiatric Medicine. Following a residency in podiatric surgery, Dr. Adelman went back for his degree in osteopathic medicine from the Des Moines College of Osteopathic Medicine and Surgery where he graduated with honors in Family Medicine, followed by a residency in proctology.

Query: Safely Removing Scalpel Blades

I have removed probably a few hundred thousand scalpel blades over many years without a problem. However, I have met some residents who told me that during their three years of residency, they never used a scalpel that was not a pre-packaged scalpel with blade attached. They were also not comfortable with removing the blade with their fingers. 

I would appreciate people’s thoughts on how they handle this in their office. I find that using a hemostat is difficult. Is there a device designed for this?

Kenneth Meisler, DPM, NY, NY

Query: Imaging for Needle Placement

I would like to hear from others regarding when it really is medically necessary to use fluoroscopy for injection guidance (and billing for the same).

I have reviewed many claims with the request for reimbursement of fluoroscopic guided injections into metatarsal-phalangeal joints and midtarsal joints. I, personally, do not feel justified in charging for or using imaging guidance for needle placement into any foot joint (with maybe the possible exception of the subtalar joint).

I would love to hear how others feel about this practice and the necessity for the imaging when injecting a readily accessible joint of the foot or ankle (one that previously never needed imaging to inject).

Barry A. Wertheimer, DPM, Torrance, CA

Response: I agree with Dr. Wertheimer. Podiatrists are trained - without imaging - to administer injections to the readily accessible foot joints, tendons, superficial cysts, plantar fascia...achieving very good results. I do not remember any studies which show a significant improvement in outcomes with needle guidance whether for a specific injection to a joint (e.g., ankle, tarsal, metatarsal-phalangeal) or structure (within a tendon sheath or infiltrative to the area of the plantar fascia).

Most foot joints are easily located and accessible. Personally, I can think of only a couple of specific injections where I would use imaging. The first is performing arthrograms. In those cases, you absolutely want to make sure that you are in the joint before injecting the dye; otherwise, you jeopardize getting a good image. The second is when aspirating a deep fluid filled mass in the posterior aspect of the ankle.

Tony Poggio, DPM, Alameda, CA

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RE: Hallux Hammertoe/Varus in an 8 Y/O (Mark Aldrich, DPM)
From: Lowell Scott Weil, Sr., DPM, Gino Scartozzi, DPM

Although I am quite comfortable performing standard hallux valgus surgery (Scarf bunionectomy) in an 8 year old, this is a case that I would opine waiting for skeletal maturity prior to operative intervention.The deformity is significant in several respects:

1. The first metatarsal is +longer than the lesser metatarsals, creating a deforming force of compression, as well as lever arm that can increase angular deformity.
2. The lesser metatarsals do not have a normal step-ladder parabola with 2-3-4 being almost equal in length and forming a square foot.(sometimes this foot type functions well but not always).
3. The great toe is +++long and for that reason, the distal phalangeal joint has abducted and flexed probably due to trying to get the foot into a shoe.

I believe that the chief objective here is to maintain a good range of motion at the MTP joint for the future. At skeletal maturity, various osteotomies can be performed to cosmetically correct the deformity and maintain ROM at the 1st MTP, but by operating now, there is a significant chance that a revision will be necessary in the future, leading to a greater chance of joint stiffness.

I cringe when I hear the comment, "let's watch it" and I answer that by saying, "if you watch it, you will watch it get worse!", but in this case, it is necessary to see what the mature foot will look like in order to perform a single-stage procedure which would be in the best interest of this patient.

Lowell Scott Weil, Sr., DPM, Des Plaines, IL, weil4feet@aol.com

This is an unusual case that Dr. Aldrich presents. Lateral view radiographs would be helpful to assess the sagittal plane components to the deformity development (i.e., extensor tendon contracture about the first ray). I would approach this surgical intervention with attention to...

Editor’s Note: Dr. Scartozzi’s extended-length letter can be read here.

RE: Neuroma Injections (Geoffrey Bricker, DPM, Kenneth Meisler, DPM)
From:  Multiple Respondents

Barry Block DPM., JD. must again be applauded for bringing us this great forum. I find it of great interest to have one topic with so many different points of view. The current discussion is whether or not one needs to perform an ultrasound guided injection for neuromas and whether or not the outcome is different.

I found Dr. Meisler's posting interesting in the fact he gives the injections through the interspace - something I hadn't thought about. No matter the direction one gives it though, a neuroma is a neuroma. I have not read anything telling me a neuroma occurs in different locations. They are still found in the same spot that they were when I graduated from school namely, between the met heads under the transverse metatarsal ligament (I understand a neuroma can be found anywhere there is nerve tissue, but the ones we are injecting 95% of the time are of the interdigital variety). That being the case, I am going to have to agree with Dr. Bricker, if you can't find the neuroma, there is something wrong. I seriously have to wonder if the radiologists who are performing ultrasound-guided neuroma injections, were being paid at the same rate as regular injection and not as an ultrasound-guided injection. You would see them advertising all over the place as has been written here.
 
Jeffrey Kass, DPM Forest Hills, NY, Jeffckass@aol.com

It is interesting that TUSPM teaches ultrasound. I wonder if they teach the use of sclerosing injections, which are very cost-effective and, in my experience, eliminate the need for surgery in 90% of cases without ultrasound.

Geoffrey Bricker, DPM, geoffreybricker1@msn.com

I do think I will take Dr. Bricker's suggestion to choose another profession regarding my use of diagnostic ultrasound in the diagnosis of plantar fasciosis. Please note I put fasciosis, not fasciitis. While I understand...

Editor's note: Dr. Bregman's Extended-length letter can be read here.

RE:  Scope of Practice   (Barry Block, DPM, JD)
From: Ira M. Baum, DPM

Overcoming inertia is the key to survival. Overcoming inertia took chiropody to podiatry. It is now time to move podiatry to the next level.The educational requirements, skills, and experience of today's podiatrists clearly define our profession as mainstream allopathic and osteopathic physicians. Participation in complex foot and ankle reconstruction, limb salvage, and foot and ankle trauma all demonstrate a profession that has evolved into the fabric of the healthcare system that is clearly integrated and interdependent. However, archaic forces, i.e., the insurance industry, and at times, federal and state governments, as well as local hospital politics, continue to brow-beat podiatry.

I understand the desire to continue to fight for equity with all physicians who provide care to the foot and ankle, as well as parity in reimbursement for our services, but there do not appear to be practical forces that will effectively bring equity and parity about. It's not to say we can't use the political and legal system as an avenue to reach these objectives, but I'm not sure the cost is within the grasp of such a small profession as ours. For those and other reasons, if podiatry and its members want equity and parity, the only practical method may be (and in my opinion, should be), integration of the podiatric schools into medical schools and graduate our students with either MD or DO degrees. Then the archaic forces will have no whipping boys to use as cheap labor or denigrate our value in the healthcare system.
 
Ira M. Baum, DPM, Miami, FL, ibaumdpm@bellsouth.net

RE: Podiatrists and Humanitarian Causes (Hal Ornstein, DPM)
From: Frank J Lattarulo, DPM

I would like to thank Dr. Ornstein, a respected leader in our profession, for recognizing these efforts. While none of us do this for personal recognition, only personal satisfaction, it is nice to see what he wrote. My recent trip to Haiti will certainly be something I will never forget, and hopefully my children learned that at some point in our lives, we must take action to try to make a difference.

Frank J Lattarulo, DPM, NY, NY, doclatt@aol.com
 

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

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