The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

April 26, 2007 #2,921 Editor-Barry Block, DPM, JD

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NJ Podiatrist Provides Spring Walking Advice

Dr. Peter Wishnie, owner of Family Foot and Ankle Specialists with offices in Piscataway and Hillsborough, NJ has lots of good advice, including "spring training," or preparing adequately for movement. Wishnie, who is affiliated with St. Peter's University Hospital and Somerset Medical Center, said those who have been sedentary for a while should ease into action. And one way to prevent foot pain is to wear the right shoes.

Dr. Peter Wishnie

"Shoes are extremely important. Most people don't wear the proper size shoe. They wear an 8 because they used to wear a size 8. But feet change," he said. Even orthotics, or inserts, won't help if the shoe doesn't fit property. Wishnie likes to recommend good walking shoes made by New Balance, Nike, Asics or Brooks. And he recommends starting slowly and working up to more strenuous exercise. "The key thing is you need to stretch," he said.

But before stretching, walkers should walk at a leisurely pace for about 10 minutes to warm up their muscles, either on a treadmill or outdoors, then stretch, then walk at a normal gait. For those just starting to become active after a long winter indoors, Wishnie recommends a 20-minute walk at a normal gait every other day. Walkers should maintain a natural stride and should not take longer steps, which can hurt their back and calf muscles. The doctor said a bead of sweat on the forehead is normal during an average walk. One should not be uncomfortable during a moderate walk, or they are doing something wrong or have a problem. Walkers may add five to 10 minutes a week to their walk while maintaining a comfortable gait.

Source: Donna Kenyon, Home News Tribune [04/24/07]

NC Podiatrist Helps Launch Shoe Drive to Aid Homeless

In honor of Foot Health Awareness Month, Cooperative Christian Ministry of Greater Hickory and Carolina Foot & Ankle Associates launched a shoe collection drive on Monday.

Dr. Todd Williams

Todd Williams, a podiatrist with Carolina Foot sees homeless patients suffering from foot ailments. “Many of these folks come in with heel and arch pain,” Williams said. “Many have pinched nerves in their feet. Children come in with shoes that don’t fit.”

Shoes are donated to CCM’s thrift store year-round. The problem is matching up the shoes with the wearer. “We try to find diabetic shoes for some of our clients who need them, or shoes with good support, through the thrift store,” Smith said. “But we need large sizes. Many clients need shoes as big as size 15.”

Source: Kim Gilliland, Hickory Daily Record [4/24/07]

VA Podiatrist Inducted into George Mason Soccer Hall of Fame

Dr. Richard "Doc" Resnick was inducted into George Mason's Men's Soccer Hall of Fame this past weekend as announced by head coach Greg Andrulis. He was honored, along with award winners from the 2006 squad, at the annual soccer banquet on April 21 on the campus of George Mason.

Dr. Richard Resnick

Dr. Resnick has been team doctor at Mason since 1979. Dr. Resnick began to increase his involvement with the soccer program under Richard Broad. When Gordon Bradley started coaching at Mason, Dr. Resnick's duties increased, including traveling with the team. He was also traveling with the men's basketball team, but by 1984 his travel was limited to men's soccer. He also spent time in the training room seeing all of the student athletes.

Dr. Resnick received his bachelor's degree from the City College of New York, his post graduate degree at the New York Medical School of Podiatric Medicine and then did his residency in sports medicine at Vassar Hospital in Poughkeepsie, N.Y. Dr. Resnick is originally from Brooklyn, NY, but now resides in Clifton, VA with his wife, Alice.

Source: George Mason University

Premium Costs vs. Reimbursement Reductions

Beneficiaries’ monthly Medicare premiums for routine doctor visits and outpatient services would increase around 4% to 5% if Congress again halts the physician reimbursement reductions required by law or instead uses a pay formula based on the Medicare Economic Index, or MEI, according to data in the Medicare trustee’s report. Under the MEI, physicians would see about a 2% increase each year.

Next year, for instance, Medicare beneficiaries would have to shoulder a hike in premium payments of a little more than $4, to $100.50 from $96.40, if Congress stops the expected 10% reimbursement reduction. Annual deductibles would also increase, according to the Medicare trustees report.

Congress has acted to override the scheduled cuts in five of the past six years, and the scheduled 10% reduction for 2008 is double the size of any of the previously overridden ones.

Source: Matthew DoBias, Modern Healthcare [4/24/07]

Query: Lesion of Heel S/P Needle Sticks

Does anyone have experience treating IPK's/Scars on kids' heels as a result of multiple heel sticks from a premature birth? Can the lesions be excised like a wart or is wide excision necessary? The patient is 2 years old with painful ambulation secondary to the lesions.

Lesion of Heel S/P Needle Sticks

Bryan C. Satterwhite DPM, Southport, NC

RE: Recommendations for the Strongest Marketing Tools ( Chad Schwarz)
From: Bob Levoy

Promotional giveaways such as refrigerator magnets, key rings, coffee mugs, pens and "foot-shaped" promotional items -- emblazoned with the name of the practice - - -are viewed by many of today's better educated, more discerning, Internet savvy patients as tacky and unprofessional... I'm still looking for the first patient who ever chose a healthcare provider, let alone a surgeon, by way of a refrigerator magnet.

What our market research shows is far more effective in terms of building awareness in both the medical and surrounding communities (as you asked about) is seeing a podiatrist in print as an author or quoted source, attending a talk given by an podiatrist, or seeing him or her interviewed on TV.

Bob Levoy, Great Neck, NY, b.levoy@att.net

RE: Serum Homocysteine Levels (Gary Adsit, DPM)
From: Multiple Respondents

Homocysteine, the cysteine homologue, is a non-essential amino acid. There is no level of homocysteine which is "normal." Generally, the contribution of homocysteine to impaired wound healing, neuropathy, cardiovascular/PAD, increased fracture risk, and impaired cognition begins at levels greater than 10 micrograms.

Allen Jacobs, DPM, St. Louis, MO, allenthepod@sbcglobal.net

You will likely see a variety of ranges. Homocysteine research is still in its infancy but appears to be important. I typically like to see values below 11. I would consider 12 elevated and 15 hyper-elevated. In my experience, treatment begins at a value of 12. I use these values during treatment for chronic wounds.

I'm sure values will change over time just like cholesterol and blood pressure. As soon as a major drug company makes a new medication for homocysteine, the high value will drop to 8!!!

Marc Katz, DPM, Tampa, FL,dr_mkatz@yahoo.com

Dr. Adsit's citing of differences in opinion with regard to normal and abnormal serum homocysteine levels are a tip of an iceberg. There have been many papers published over the years and lectures given at medical conferences that say that elevated homocysteine levels are cause for alarm. On the other hand, there are some recently published papers in respected journals that question how significant elevated homocysteine levels are with regard to cardiovascular pathology. Even more controversial is whether lowering these levels with vitamin B- folate combinations lowers cardiac mortality and morbidity rates.

I ran into this controversy head on, when I recommended that a patient of mine consult his cardiologist about taking a folate-vit B combination after I discovered that she has elevated homocysteine levels. The cardiologist called me and apprised me that most recent medical literature is very equivocal over whether there is any significant benefit over lowering the levels of serum homocysteine. I checked the recent literature and found the academically minded heart specialist to be correct.

The center of the controversy is this: Yes, there appears to be elevated homocysteine levels after certain cardiovascular incidents. The question is whether the elevated levels are indeed the cause of the CV pathology, a result of the pathology or present as a result of some other metabolic cause. Many but not all of the papers I read on this topic end by saying there is no clear cut cause and effect between lowering of homocysteine levels with folate - vit B Combinations and cardiovascular pathology but larger populations should be studied for long periods of time.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: CME Challenges (Lloyd Smith, DPM)
From: Multiple Respondents

Is requiring attendees to sign in at CME lectures really reminiscent of Orwell’s 1984? The CME system is certainly not perfect, but I understand the need for the organizers to have some form of monitoring. Frankly, if we have to be monitored, I would rather sign a sheet than get bar-scanned or worse, be denied a certificate because I missed a lecture. Let’s face it, we all pay large sums of money for seminars. Monitoring whether someone signs in or not for the lecture session is irrelevant.

More importantly, does podiatry, as whole, really suffer if some people don’t sit for that one hour lecture or miss an entire afternoon of lectures to go play golf, for instance? I don’t think so. We can all support the lecturers, who put a great deal of time and effort in their presentations, for the sake of CME. I am happy to hear or read the latest podiatry information and trends through this process supplemented by journal articles and the like. How would you improve this system? Being concerned about who is signing-in and who is not is unproductive and a waste of energy.

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

One of the things that is assumed when you take the Hippocratic oath is that you are ethical in all phases of your life: private and profession included. Aristotle once mused that you can’t be ‘partially virtuous’; you are either a virtuous man or not. As such, you either figure out that the CME conference you’re attending is a site for possibly learning something—even if it is just ONE thing you didn’t know or hadn’t considered before—or you think it is a joke and an egregious infraction upon your valuable time/wallet and as long as you’re required to be there, you’re going to get in some golf.

There are a fair number of people I see at the CME meetings I go to who are never in the lecture hall, yet claim the CME credit. Although I can understand Dr. Smith’s point, he offers no alternative to the sign-in system. In the end analysis, if your signature is your bond, then in the same manner, a signature on the CME credit blank without attendance states volumes about the signatories bond and virtue (or lack of same). Until the lecture hall is as full as the box of CME claim papers, the situation will be more Orwellian and not less.

David Secord, DPM, Corpus Christi, TX, David5603@pol.net

We have been using an "honor system" for CME's for a very long time. I have been attending seminars for the past 25 years. During that time, I have gone to numerous lectures and "skipped" numerous lectures as well. These are my personal observations:

1- My attendance is usually the result of the quality of the speaker/program presented. When it is a topic of interest, presented by someone with experience in that topic, I usually attend and am anxious to learn what is being offered. When it is a lecture on some far out, obscure procedure, only performed for a few weeks before it was presented, and then given by a resident with limited experience, I tend to not attend.
2- It is not uncommon to see some of those in attendance sleeping.
3- I have learned a significant amount from my "old classmates", whom I speak and network with instead of attending every lecture.
4- I have learned a great deal while questioning exhibitors about their equipment or technology.
5- It is the overall experience of the seminar, taking into account the material presented, the people lecturing, the exhibitors and products exhibited, as well as those colleagues attending the seminar that make it worthwhile.
6- I have found that listserves such as PM News have taught me, and continue to teach me on a daily basis. Yet I receive no CME for reading it.

So, what is CME and the credit system and what do they represent? It is basically a method of getting people into educational places in the hope that they will increase their knowledge. If someone does not want to do this, implementing rules will not change them. They will sleep, do crossword puzzles, and play video games on their cell phones. If they want to learn, they don't need the rigorous rules of surveillance and body tracking in order to do so. They will find a way, whether CME is required or not, to make themselves a better doctor.

Brian Kashan, DPM, Baltimore, MD, drbkas@worldnet.att.net

RE: Cosmetic Foot Surgery (Ivar E. Roth, DPM, MPH)
From: Alan Kalker, DPM

With all due respect, I think Dr. Roth’s suggestion misses the point. My impression of the cosmetic surgery debate is that it has nothing to do with the skills of its practitioners and everything to do with their ethics.

Alan Kalker, DPM, Middleton, WIm ajkalker@facstaff.wisc.edu

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WELL ESTABLISHED PODIATRY PRACTICE IN MT. AIRY, NC

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