The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

April 26, 2010 #3, 841 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2010- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

MA Podiatrist Provides Shoe Safety Tips for Seniors

Dr. Daniel Paknia, a podiatrist with Pioneer Podiatry, P.C. and DeCaro Footcare in South Deerfield, offers several shoe-safety tips to help seniors keep a firm footing:

Dr. Daniel Paknia

*Avoid shoes with heavy rubber lugs or ridges on the outer sole that can catch on carpets. Paknia says these are only recommended in cases of arthritis in the arch area. The rubber tips on the toes of running shoes can also cause a stumble on carpet.

* Shoes that tie are safer than shoes that just slip on, says Paknia. Laced shoes do not fall off the foot and can be adjusted to accommodate swelling and orthotic devices. If tying laces presents a problem, consider shoes with Velcro closures or elastic shoe laces that hold the shoe firmly on the foot, but stretch enough to allow shoes to be slipped on and off without tying and untying the laces.

Source: Patricia Levine, Amhearst Bulletin [4/23/10]

Volcano Won't Come Between SALSA and Vascular Symposium

The travel crisis borne by the eruption of the Eyjafjallajokull volcano in Iceland affected the travel plans for countless people, worldwide. That included those of Professor David G. Armstrong, of the University of Arizona's Southern Arizona Limb Salvage Alliance (SALSA), who was scheduled to address the EviVenice 2010 vascular symposium in Italy. Immediately after the last minute flight cancellation, Armstrong set up a laptop-to-laptop lecture to the hundreds of assembled physicians and surgeons gathered at the Palazzo del Casino in Venice. "This could never have happened even 5 years ago", noted Dr. Armstrong. "The ubiquity of webcams and high-speed connections has made the world a smaller place."

SALSA's Armstrong lectures via laptop to EviVenice Symposium after being marooned by volcano-related flight cancellations

Armstrong noted also that it was particularly apropos to limit travel on Earth Day. "It is always terrific when a podiatrist can have a positive aspect on a foot print-- whether it's a human one or a carbon one." Armstrong's lecture, on foot reconstruction, was chaired by Professors Alberto Piaggesi and Sjef van Bal, of Italy and the Netherlands, respectively.

Query: Treatment Room Flooring

I'm looking for the best ideas for treatment room flooring. I want something elegant and class A.

Jill Scheur, DPM, Deerfield Beach, FL

RE: Hallux Hammertoe/Varus in an 8 Y/O (Mark Aldrich, DPM)
From: Multiple Respondents

I think the hallux IPJ may be buckling secondary to the excessively long/large first metatarsal. Perhaps addressing the deformity at this level will reduce the contracture. If there is still quite a bit of deformity after decompression, perhaps a hallux IPJ arthroplasty or arthrodesis will be warranted. 

This patient has 1st metatarsal megalic deformity. The patient needs to have a shortening 1st metatarsal osteotomy along with 1st MTPJ joint contracture procedure. A second option would be an epiphysiodesis of the 1st metatarsal, and then upon natural epiphyseal closure, a shortening osteotomy can be utilized.  Shortening the metatarsal should relax the contracted FHL and EHL contractures and may just require peri-articular capsular releases.

Randall Brower, DPM, Roswell, NM, randoman33@yahoo.com

I think the hallux IPJ may be buckling secondary to the excessively long/large first metatarsal. Perhaps addressing the deformity at this level will reduce the contracture. If there is still quite a bit of deformity after decompression, perhaps a hallux IPJ arthroplasty or arthrodesis will be warranted. 

Kelley A. Gillroy, DPM, Glendale, AZ, kgillr@midwestern.edu

Editor’s note: Dr. Todd Lamster’s extended-length letter can be read here.

RE: Ultrasound-Guided Injections
From: Multiple Respondents

Sending patients for ultrasound diagnosis has dramatically changed the way I work-up neuromas and soft tissue masses. For those who believe their neuroma and fasciitis injection results are better with use of ultrasound guidance, allowing them to inject the "heart" of the inflammation, I have a question: After the procedure is performed, and the patient stands up, does the medication stay in the heart of the inflammation? Or does it diffuse around in all directions away from the injection site? And does the benefit result in cure or longer duration of relief between episodes? Has there been a study with a sham injection arm?

Lastly, in contrast to posts regarding the need for fewer injections, I am seeing patients who have had 4,6,, even 10 ultrasound-guided injections in a few months. One broke down with necrosis of subcutaneous tissue after the tenth injection, necessitating surgery. What possibly could be legitimate justification for that?

I think the idea of US guidance for needle or trocar biopsy of a mass is great. But I would like to be convinced that depositing some steroid in the heart of inflammation of plantar fasciitis or -osis, or close to it makes any difference when the patient stands up.

Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org

I resisted buying an ultrasound machine for many years because I thought it was being promoted and used as a way to make more money. I finally bought one and very gradually started using it. At this point, it has become a very important part of my practice. I never do an ultrasound on a patient who presents with a classic case of plantar fasciitis. I also rarely inject the patient the first visit.

I find that conservative therapy improves 75% of patients: stretching, ice, NSAIDs, heel cushions, night splint and PT. Those who have very little improvement after 3-4 weeks have an ultrasound, and frequently, we find a partial tear. In those cases, I wait another month before injecting with a steroid. Sometimes, I place the patient in a CAM walker. If there is not a tear, they are given an US-guided injection. You will find that the area with the most inflammation is frequently proximal to where you would have normally given the injection without US guidance. I have also found better results with the US-guided plantar fascia injections. Again, you don't have to "flood" the area.

Regarding neuromas, I almost never do an MRI for a neuroma. Ultrasound in the right hands is, in my opinion, as good as an MRI. This saves the insurance companies many thousands of dollars. Ultrasound is especially helpful in those patients where you are trying to differentiate between pre-dislocation syndrome and a second interspace neuroma. 

Finally, I feel much more comfortable injecting directly into the nerve, when injecting a neuroma. I worry much less about the steroid effect on the normal tissue. I have found both steroid and alcohol sclerosing injections of neuromas to be more effective under ultrasound guidance. Frequently, I am not paid for the ultrasound, but we do it anyway.

Kenneth Meisler, DPM, New York, NY, kenmeisler@aol.com

Editor's Note: Dr. Ed Davis' extended-length letter can be read here.

RE: Diagnostic Ultrasound  (Joel Morse, DPM)
From: Mark K. Johnson, DPM

Regarding the Esaote Mylab 5, I have been using that unit in the office for about 10 months after "upgrading" from an Aquila. The unit is truly useful with the high resolution probe 10-18 MHz. Also, the add-on modules for continuous and power Doppler work well. I've worked with the company rep Greg Ferri extensively in the past, and highly recommend the My Lab 5.

Mark K. Johnson, DPM, West Plains, MO, DDR004@centurytel.net

RE: Podiatry Ignored Again
From: Barry Drossner, DPM

This past Wednesday morning, the medical correspondent for the Good Morning America show, Dr. Nancy Snyderman answered questions about various foot problems such as bunions, plantar fasciitis, orthotics, and neuromas. What angered me was that the word "podiatry" was never mentioned by her. She did suggest, however, that if conservative treatment for neuromas did not help, the person should see an orthopedist specializing in feet!

There is still such bias against podiatry. I do not know how to correct this. Perhaps she did not want to offend her MD orthopedic friends. The omission of podiatry may have been more political than one of ignorance. Regardless of the cause, what if anything can be done to make the word podiatry a word that others in the medical profession can comfortably say without fearing negative feedback from their non-DPM colleagues?

Barry Drossner, DPM, Aventura, FL, bdroz50@aol.com

Editor’s comment: The APMA has responded by having its public relations department contact the producers of GMA. APMA has offered to provide media-trained podiatrists to inform Dr. Snyderman on the education, training, and scope of practice of podiatrists.

RE: Safely Removing Scalpel Blades (Kenneth Meisler, DPM)
From: Multiple Respondents

This device will facilitate safe removal of scalpel blades.

Scalpel Blade Remover

It is available at Havels.com

Connie Motichek, PMAC Covington LA fahc@bellsouth.net

As a precautionary measure, I do not allow anyone in the office to handle sharps but me. I use a standard suture needle holder to remove blades from the holder. The needle holder has wider jaws, and the blade slips right off and goes straight to the sharps container.
 
Pete Harvey, DPM, Wichita Falls TX,

Our office uses a product from Miltex called "Blade safe". You just slip in the blade, press down, and remove. Very simple and much safer!

Alan Schram, DPM, Allen Park, MI, aschram@ameritech.net

I use a pair of nail nippers to pull the blade off; it works every time.
 
Michael N. Fine, DPM, Kansas City, MO, Dr.Fine@finefootcarecenter.com

RE: Ryan Hess, DPM
From: Nicholas Post-Vasold, DPM

I have recently been made aware of a classmate of mine in podiatry school whose family needs help.  We graduated from SCPM in 2008.  Ryan Hess was completing his three year residency when in June of 2009, it was discovered he was diagnosed with hepatoslpenic T-cell lymphoma (HSTCL). After three rounds of chemo and a bone marrow transplant, he went into a brief remission. Unfortunately, the cancer is back again.

Ryan has been placed in hospice and given two weeks to live. Ryan is the main support system for his wife and two children. Any support through their website would greatly be appreciated. I thought this would be a good post for PM News since podiatry is family-oriented and we support each other. Please feel free to visit their blog and familiarize yourself with his story.
 
Nicholas Post-Vasold, DPM, Grand Blanc, MI, npost_vasold@hotmail.com

RE:  Scope of Practice (Barry Block, DPM, JD, Ira Baum, DPM)
From: Narmo L. Ortiz, Jr., DPM

While I could not agree more with Dr. Block and Dr. Baum about the MD and/or DO degree bringing parity to our profession, no one has taken into consideration what is to become of the generation of podiatrists who have graduated from 1990 to today, with quite a few years left to practice, and many of them with student loan debt? Are they to be the "lost generation" of your profession?

A true inclusion of our specialty into the allopathic and/or osteopathic fields would be to have them include podiatry as another specialty, like any other of their existing specialties; then have their graduates apply for available residency positions, like any other. This will mean either to eliminate the existing schools of podiatric medicine or have them convert and/or integrate into allopathic or osteopathic schools. Would this also be fair to those institutions and their graduates?

The mentality of "if you cannot beat them, then join them" (i.e., a degree change) is in contradiction to what our profession has accomplished and is still to accomplish. Are we all forgetting the ever-growing inclusion and contributions of our profession into academia, research, and multi-specialty groups with nationally and internationally recognized professionals in all specialties of medicine?

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com

Editor’s comments: There is an apt expression, “A rising tide lifts all boats.” The constant goal of podiatry, as proven by our history of advancement, is to strive towards true parity with other allopathic specialties. Those who now hold the DPM degree will also benefit when podiatrists graduate with MD or DO degrees. We must plant the seeds for future generations of podiatrists. We need to establish alternate pathways for DPMs to obtain MD or DO degrees.

If our predecessors would have been satisfied with the status quo, we would still hold the Pod.D or DSC degree, and there would no such thing as a podiatric surgical residency.  

RE: Parsley Named as New Dean At Scholl
From: Michael Tritto, DPM

Kudos to Nancy Parsley, DPM on becoming Dean of Scholl College! While on the  APMA Health Systems Committee, I had the great pleasure of working with Nancy while she was at the APMA. I can say without hesitation that she is one remarkable individual and one of the greatest assets to the profession that we have in our quest to continually improve. Her ability to facilitate communication and get things done is second to none! She will be a great leader for the Scholl College as well as our profession.
 
Congratulations Nancy!
 
Michael Tritto, DPM, Rockville, MD, mtdpm@verizon.net

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

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

PM News Classified Ads Reach over 12,000 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,000 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.