The Voice of Podiatrists

Serving Over 10,800 Podiatrists Daily

April 25, 2008 #3,229 Editor-Barry Block, DPM, JD

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IPMA Teams Up With New Balance Chicago to Fight Obesity

Podiatric physicians from the Illinois Podiatric Medical Association and New Balance Chicago stores are teaming up to encourage Illinois citizens to engage in a walking fitness program this Spring as part of a statewide campaign “Keep Illinois Walking” to fight obesity.

Dr. Theodore (Ted) Polizos

Illinois podiatrists and the Chicago-area athletic shoe company are backing up their campaign with free pedometers to any Illinois resident who visits a participating podiatrist. “Podiatrists, like all health care professionals, see obesity as a significant public health problem,” said IPMA president Theodore Polizos, DPM, Arlington Heights, IL. “And, we’re doing our part this spring to encourage people to engage in low-impact, calorie burning exercise to stay fit.”

Polizos and fellow podiatrists encourage a regular walking program but before engaging in a regular fitness program, proper preparation, warming up and stretching are recommended. The American Podiatric Medical Association offers walking tips for those interested in beginning a walking regimen.

Disciplinary Action Dropped 6% from 2006 to 2007

Disciplinary action by state medical boards against physicians decreased by 6% nationwide from 2006 to 2007, marking the third consecutive year the number has declined, according to a report by Public Citizen, the Los Angles Times reports. Since 2004, considering the increasing number of licensed physicians, the rate has fallen 22%, according to the report. The group ranks states by calculating the number of disciplinary actions over the number of physicians who are licensed in the state.

Alaska was the highest in discipline with 8.33 actions per 1,000 physicians, and South Carolina was lowest with 1.18 actions per 1,000 doctors (Miami Herald, 4/23). Other high-ranking states were Kentucky, Ohio, Arizona and Nebraska; other low-ranking states were South Dakota, Wisconsin, Mississippi and Minnesota. Sidney Wolfe, author of the report, said that more funding and staffing, as well as better investigations and leadership at medical boards, are necessary to discipline physicians appropriately.

Source: Los Angeles Times, Miami Herald, via American Health Line [4/23/08]

Query: Standard of Care - MRSA

If I take a culture of an ulcer or open wound (not red, not swollen, slight drainage) which grows out MRSA, is it obligatory to treat with an oral or IV antibiotic due to the organism found? Might a topical be sufficient?

Jeffrey Kass, DPM, Forest Hills, NY

Query: Disability Agreement Between Solo Practices

I and a number of other local solo practitioners would like to form an informal or formal arrangement between ourselves to cover each other in case of long term disability. We are proposing daily coverage for a period of no longer than 4-6 months with each doctor covering one day in the office of the disabled doctor. Does anyone have some thoughts on this? What are the possible ramifications with Medicare, etc.?

Pete Smith, DPM, Lancaster, PA

Editor’s comment: PM News does not provide legal advice. The idea of a coverage agreement is an excellent one. Statistics show that one in four podiatrists will be disabled for some period of time during their professional careers. Disability insurance is a must but it won’t cover the loss in value that a practice will suffer during closure.

A locum tenens arrangement will work well for short periods of time (Less than 60 days) but a healthcare attorney should be consulted to formalize a comprehensive agreement to protect all parties.

RE: Painful 2nd Digit (Rick Burnell, DPM)
From: Multiple Respondents

Have you considered or treated her for herpes simplex? I've seen it several times in my practice and treated it successfully with a topical anti-viral medication.

Carla Porter, DPM, Poughkeepsie, NY, buddha17@aol.com

I have had a number of older patients with other dermatoses in that area due to simply friction: hyperextension of the DIPJ while weight-bearing and causing friction in that area. Since all of the tests have been done, and I assume negative for any useful results, then perhaps the etiology is not a dermatitis or infective process and rather a traumatic one. Try a simple removable crest prop on that toe. Either a piece of dental roll in Tubegauz affixed on top of the toe with tape or another method using the dental roll within Elasticon tape cut to fit over the toe (personally, I think the first method would be more comfortable for a child with such sensitive skin).

Larry Sturm, DPM, Hallandale, FL, LSturm@bellsouth.net

Please make certain you rule out factitial causes. No one wants to believe that, least not a parent, but it happens.

Dress the toe so the patient cannot reach it. Make the dressing in such a fashion that the patient’s ability to duplicate it is not possible. If it recurs on a weekly schedule, for example, keep it dressed for 2 weeks. If the lesion only recurs when it is not covered, i.e., open for the patient to “play” with, you have your answer.

I have seen this happen in otherwise “normal” patients, both children and adults. It isn’t common, but neither is it rare. It is a true illness, and needs to be ruled out as just one possibility.

Click here to see an example of the types and extent of various factitial dermatitis, also occasionally called dermatitis artefacta.

David E. Gurvis, DPM, Avon, IN, deg1@comcast.net

RE: Custom-Made Dance Shoes (Martin Hersh, DPM)
From: Itamar Rosenbaum, C.Ped

Rosenbaum's Foot Health & Comfort Center makes bespoke and custom made
shoes incorporating all orthopedic accommodations directly into the
footwear. They can be reached at 718-236-7700 or at info@rosenbaumsny.com

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

RE: Computerized Radiography vs. Digital Radiography (Larry Kosova, DPM)
From: Bob Salzman

I appreciate the digital overview provided by Dr. Kosova and the references to our company 20/20 Imaging, but it is important that I set the record straight on some of his comments pertaining to our company. 20/20 Imaging did not “buy out” RF System Labs who manufactures the Naomi DR sensor. We did in fact make several trips to Japan, evaluated their product, and the result was a modified sensor built to our specifications that we market, sell and install as the 20/20 P-DR “direct radiography” system. The Naomi product is still available but not to podiatrists as they granted 20/20 Imaging exclusivity to sell our P-DR sensor to this market space. Secondly, we developed our own acquisition and viewing software to interface with our sensor versus any type of “redo” to the Naomi software. We continually invest in our technology to achieve both image quality and total system efficiency.

20/20 Imaging (formerly Reina Imaging) continues to provide the podiatric community “choice” when evaluating digital technology and the opportunity to “choose” a system that is configured to the physicians’ specific needs. We have been dedicated to providing turnkey systems to podiatrists for six years and remain the only company offering both DR and CR technology with on-line demos to compare image appearance. I encourage every doctor to do their homework when evaluating these technologies prior to making the capital investment as there is no “one size fits all” system, but creative financing has made it easier to afford a digital conversion and not sacrifice quality for price. As Dr. Kosova correctly points out, make sure the system includes training, can be expanded, and offers support options after warranty. When evaluating a company, get references that can comment on the support program as well as product reliability.

Bob Salzman, President, 20/20 Imaging, LLC, bob.salzman@2020imaging.net

RE: Sol Balkin, DPM
From: Multiple Respondnents

I was deeply saddened to hear of the passing of Dr. Balkin this week. He was without doubt a master clinician and leader of his profession. Similarly, he was a devoted husband to his delightful wife, Jannelle and their wonderful family. Sol was one of the rare breed of people that held true to a vision amidst significant obstacles. While he didn't live long enough to see all of his dreams realized, I feel very strongly that the people he touched along the way will take his work beyond what he even imagined. I guess the best legacy for a person is not how many papers are written, procedures done or symposia given, but rather how one touches and impacts the people around them. In that way and in every other way, his life was a rich one and podiatry specifically and medicine in general is the better for it.

David Armstrong, DPM, North Chicago, IL

Our profession has lost a true scholar and gentleman with the passing of Sol Balkin. I met Sol early in my career, 25 years ago when he lectured and presented his impressive prospective study on silicone injections for relief of pressure induced pathologies of the foot. I referred many patients to Sol for treatment and inclusion into his studies and all of them were highly impressed with his professional and caring approach. More important, most patients received significant improvement of symptoms for conditions for which there no other viable treatment options. When the FDA banned silicone implantation in humans, Sol continued to follow his patients and carefully documented the positive and negative outcomes. He had the unique opportunity to study the lymph nodes of patients who had given permission to have an autopsy performed post mortem. I remember his passion in a conversation several years ago about the fact that his treatments had shown no negative effects despite this rigorous scrutiny. Sol will forever serve as a role model to all physicians and researchers who are committed to improving treatments while adhering to a strict code of ethics and accountability.

Doug Richie, DPM, Seal Beach, CA

It was with great sadness that I read your obituary of Sol Balkin. I first met him in 1980 and brought back to the UK the use of silicone injections which he pioneered. He was a most generous man, giving his time and hospitality to me and my wife. He battled all his career to further the acceptance of his techniques and to promote the values of podiatric care and his profession.

He will be sorely missed. My condolences to all who knew him.

Ralph Graham, Past Chairman UK Society of Podiatrists, Essex, UK

I have very fond memories of Dr. Balkin and his lovely wife. He really helped a patient of mine live her life with RA and a very painful recurring foot ulcer, pain free for the rest of her life. It is a funny story, but it almost got me fired from the HMO I worked for. The administrators approved the silicone treatment. Then the Foot and Ankle Orthopods heard about it and got majorly upset that our HMO approved it. Since it was already approved, I was the last person who was ever allowed to have my patient see him with our HMO paying for it. Once I got it approved I found out that my patient had no transportation to make the trip from Colton to Glendale CA. I was working full time and had just had a baby. So Dr. Balkin was kind enough to open his office especially for us every Satuday so I could bring my patient in on my day off, with my baby daughter in tow. It was just a delightful trip for my elderly patient seeing Dr. and Mrs. Balkin, especially with a cute baby in the mix!

Diane D. Barry Branks, DPM, Baldwin Park, CA

PRACTICE FOR IMMEDIATE SALE- MT. VERNON, NY

Great opportunity Centrally Located on Busy Street corner in Fleetwood, Mt. Vernon. 15 year old practice... 2 days a week... May easily be expanded Low overhead ... Computerized billing. Fully equipped 2 treatment rooms Grossing $80,000 Call 914-572-3624

SEEKING RESIDENT FOR PSR-24 - BALTIMORE, MD (MERCY MC)

Position for a highly motivated individual with completed non-surgical residency or one desiring 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 2008. Includes competitive salary/benefits. Send inquiries to rsher18@yahoo.com

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City . Currently four (4)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. 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 -- www.homephysicians.com

Baltimore County, Maryland Practice seeking motivated and very personable individual with 2 years min. surgical training. Busy practice in great area with hospital grade ASC. Please fax your CV and contact information to: Dr. Maurice W. Aiken 410-602-9781.

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