The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

April 27, 2007 #2,922 Editor-Barry Block, DPM, JD

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MD Podiatrist Offers Summer Footwear Advice

Flip-flop season is around the corner, and with it comes blisters and fungus. “People come in with stubbed toes and sores, and can pick up foreign bodies,” said Dr. William Hahn, podiatrist at Good Samaritan Hospital in Baltimore. “We often see serious problems with thong sandals.”

Dr. William Hahn

Hahn suggests keeping blisters clean and covered and avoiding popping them. If your feet swell or turn red, and foot pain persists for more than a few weeks, you should see your doctor, Hahn said. “Just by looking at a shoe, a trained eye will know immediately what’s wrong [with your foot],” he said.

Hahn recommended wearing shoes that lace up, especially when walking long distances or on hard surfaces. When the heels or soles of a shoe are worn, bending easily, it’s time to replace your shoes, Hahn said. Summertime footwear doesn’t typically support the arch in the foot, causing inflammation in the soles, Hahn said. “Flip-flops can even cause sprains when people fall off of them,” he said.

Source: Jessica Novak, The Examiner [4/17/07]

Study Links Fungal Nail Infections to Diabetic Foot Amputations

Unsightly toenails may be more than a reason not to wear sandals. Now, doctors say acting quickly to eradicate fungal nail infections may save diabetic patients from amputation. Researchers from Rosalind Franklin University in North Chicago report about 75 percent of people with diabetes who are at high risk for amputation will also have diseased toenails. Spotting fungal nail infections and starting treatment quickly may help a diabetes patient avoid a more severe infection, which could force doctors to amputate a toe, a foot, or even a leg.

Dr. David Armstrong

"If someone shows up with an ugly toenail, then that, by extension, seems to be a harbinger for a toenail infection, which is also a harbinger for complications in high risk people with diabetes," Rosalind Franklin podiatrist David Armstrong, D.P.M, M.Sc., Ph.D., told Ivanhoe. "Often the fungal toenail can also lead to athlete's foot, and athlete's foot can lead to cracks in the skin, which can lead to other types of bacterial infections."

Source: KGBT-TV CBS 4 Harlingen (TX) [4/24/07]

Son of CO Podiatrist Becomes Media Darling After Football Accident

Caden Thomas was just your average 4-year-old playing catch on the sidelines at Colorado State University's spring football game. Ram football player George Hill was just a receiver making a nice touchdown catch at Hughes Stadium. On Wednesday, both are in the national spotlight as part of the media blitz brought on by images of Hill making the diving touchdown catch and then crashing into Caden.

Dr. Mike Thomas with son Caden (Photo courtesy of Today Show)

Videos of the event - showing Hill and the boy slamming together into a wall, then Hill rolling over and handing the crying, bloodied child to an on-field official - have swept across the Internet and television stations around the world in recent days. The collision opened a cut on the young boy that required 30 stitches to close, but tests showed no skull fracture or other trauma.

Caden and his parents, Mike and Holly Thomas, joined Hill Wednesday morning on NBC's "The Today Show,' CBS's "The Early Show" and the syndicated "Inside Edition' to talk about the catch that has grabbed the nation. "He's going to be wearing a lot of CSU paraphernalia ... to show his support for CSU," his father, a Fort Collins podiatrist, told the Rocky Mountain News on Tuesday.

Source: Miles Blumhard, and Tony Phifer, Fort Collins Coloradoan [4/25/07]

Query: 15 yo Girl With Posterior Tibial Tendinitis

For the past three months, I have been treating a 15 y/o girl with posterior tibial tendon pain of three years duration following a volleyball injury. Another doctor treated her with a CAM walker and physical therapy. She has had only 10% improvement. An MRI done in Feb 07 shows inflammation of the PT tendon. I had her non-weight-bearing for eight weeks, and now she is in orthotics. Her pain still persists from the navicular tuberosity and passes inferior to the med malleolus on palpation. X-rays are normal. She is 6'2" and 245 lbs, with a cavus foot. Any advice on other treatment options, both conservative and surgical would be appreciated.

Marc Goldberg, DPM, Olney, MD

RE: Lesion of Heel S/P Needle Sticks (Bryan C. Satterwhite, DPM)
From: G Dock Dockery, DPM

This is most likely a calcified nodule and will need to excised for the best result. Curettement has the potential for being too shallow and the subcutaneous calcified portion of the lesion may remain. This lesion will probably not resolve itself and should be treated. A couple of resent articles may add more to understanding these relatively common lesions.

Lemont H, Brady J: Infant Heel Nodules: Calcification of Epidermal Cysts. J Am Podiatr Med Assoc.2002; 92: 112-113 N.-K. Rho, S.-J. Youn, H.-S. Park, W.-S. Kim, E.-S. Lee: Calcified nodule on the heel of a child following a single heel stick in the neonatal period, Clinical and Experimental Dermatology 28(5):502–503, 2003.

G Dock Dockery, DPM, Seattle, WA, gdockdockery@aol.com

RE: Recommendations for the Strongest Marketing Tools ( Chad Schwarz)
From: David Secord, DPM

We attempt to market ourselves in a few different ways, which seem to be very effective, including making sure that within 24 hours of being seen, a letter of findings and treatment plan is sent to the primary care physician (whether that individual referred the patient or not) sent on letterhead with a professionally-designed logo.

We also send out a newsletter to about 100 primary care doctors in the area every other month, which puts us in front of these doctors on a routine basis. I also do several lectures a month for different organizations and to the residents at a hospital, and have a full-color tri-fold brochure left and distributed that outlines what I do and my qualifications.

We don’t do a large, splashy Yellow Pages ad, as the percentage of patients looking in the Yellow Pages for a doctor—as opposed to going word of mouth—is low. When we see new patients, they receive a premium (their choice of a pocket knife or Waterman-type pen) with our logo and phone number on it, and have found that something really nice is retained by the patient and not seen as ‘cheesy.’ They carry this with them and have our number to give to others who need our type of services.

I’ve also tried very hard to make my office the most beautiful in town, and my staff and myself try and make the patient feel welcomed. I do a lot of education of the patient in the office. All these things in concert has been very effective at drawing new patients, retaining those we get, and are not as expensive as you might think.

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

RE: Serum Homocysteine Levels (Gary Adsit, DPM),
From: William Barry Turner, DPM

I have been treating a dialysis patient whose skin would not adhere to her leg. I was the 4th wound care physician she had seen. We did a homocystine level on her, it was 46. She was placed on Mentax and we saw dramatic results in about a week. I notified her nephrologist and her cardiologist, niether was impressed or offered to help me get this number down. She is currently taking 3 Mentax tid and we have seen a dramatic improvement, but alas she is still around 26. I believe that much more attention needs to be spent on homocystine levels.

William Barry Turner, DPM, claret32853@hotmail.com

RE: CME Challenges (Lloyd Smith, DPM)
From: Joel Gluck, DPM, Howard L. Lazar, DPM

“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.”

Wow, this is an interesting comment. Of course podiatry will suffer as a whole. Organizers of CME events/seminars have to give you credit for attending. In turn, your state organization or hospital is renewing your license or privileges based on the assumption you are bettering yourself and learning something. in turn, your patients will suffer if you are playing golf and miss something relevant to their care. Being a professional means that you have ethical obligation. You want to play golf, be my guest, but don't ask for educational credit for doing so.

Joel Gluck, DPM, Warwick, RI, JGluc1@aol.com

Many podiatrists seize opportunities to learn new techniques, learn about new products, engage in networking, and pick up practice tips at CME seminars. Others attend CME seminars only because they must be able to prove such attendance as a condition for license renewal. Some members of this latter group view seminars as ‘credit only’ social events from which they choose to learn little.

The Michigan Board of Podiatric Medicine and Surgery (Board) is far less interested in whether one actually participates in educational programs than it is in helping to generate income for the Michigan Podiatric Medical Association (MPMA). The American Association of Podiatric Physicians and Surgeons (AAPPS) has been hosting 40-hour CME programs annually in Michigan for over 30 years. For most of that time, the APMA-populated Board has assiduously discouraged attendance by Michigan licensees. It has done this by withholding AAPPS program approval until after the MPMA has completed its program, by withholding the necessary Category I credits and, last year, by spreading the word that AAPPS’ program would not be approved, even before the AAPPS’ program had been submitted for the Board’s review. Obviously, program quality is not an issue.

Organizational identity is the deciding factor. APMA-hosted programs are granted Category I CME credits without regard for program content. They frequently include billing/coding and other practice management material. While these topics are of interest, they are not medical topics, and they neither contribute to "medical education", nor comply with the state requirements. AAPPS programs are 100% science, yet are routinely denied Category I credit by the Board simply because they are not APMA programs. The Michigan Board of Podiatric Medicine and Surgery does not really care whether a licensee learns anything, but does care about which organization gets the CME seminar fees.

Howard L. Lazar, DPM, Bloomfield Hills, MI, howardlazar@comcast.net

RE: Cosmetic Foot Surgery (From: Alan Kalker, DPM)
From: Jodi Schoenhaus, DPM

Making someone walk with comfort and look great doing it is not an ethical issue. Most podiatrists practice some form of cosmetic services whether they use the word cosmesis or not. For example, most people with brachymetatarsalgia or syndactyly do not have pain, they dislike the appearance of their foot. This type of correction, although not classified as cosmetic, is aesthetic. Furthermore, if a patient has terrible bunions and would like correction because they are uncomfortable with the appearance does not make correction unethical. Is a plastic surgeon unethical for performing their services if they make a person feel better about themselves?

In a warm climate where people's legs and feet are exposed just as often as their face, it is understandable that someone may be embarrassed to be barefoot on the beach with an unsightly skin growth, just as someone with a big nose may want correction. As long as correct biomechanical and surgical principles are employed, there is no problem with the correction. Cosmetic foot services also extend beyond surgery. For example, I had a patient who had reconstructive rearfoot surgery and was dissatisfied with the scar. We performed post op scar reduction and she was thrilled. Now, if a patient presents stating that they want to fix their feet to wear smaller shoes I would hesitate to perform the surgery. The goals and expectations of every patient must be evaluated.

From a business standpoint, cosmetic foot care is also a form of marketing. I'm sure that most podiatrists are providing a lot of the same services as the cosmetic specialists i.e. toe shortening versus hammertoe arthroplasty- same procedure, they just aren't branding it as cosmetic just as a lot of us perform the same services as a sports medicine podiatrist, we just don't necessarily call it sports medicine.

Jodi Schoenhaus, DPM, Boca Raton FL, jschoenhaus@hotmail.com

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Harvard Podiatric Reconstruction and Research Fellowship Available July 1, 2007

Beth Israel Deaconess Medical Center is accepting applications for a 2-year fellowship, focusing on reconstruction of complex deformities, and an associated substantial research project. Requirements: 3+ years CPME-approved surgical residency, research interests, recommendation from residency director, CV, letter of intent, MA License. pbasile@bidmc.harvard.edu by 5/15/07.

PRACTICE FOR SALE – OHIO – SOUTHEASTERN

Reputable, thriving, well-rounded practice available with EMR. Grossing over $320K over the last 3 years. Priced to sell. Owner relocating. Email inquiries and CV to podsx@yahoo.com

ASSOCIATE WANTED – BRONX, NEW YORK

Seeking an ethical and personable Board Certified/Eligible residency trained individual (PM&S 24/36). Position available June 1, 2007 to become part of this prestigious and established NYC podiatric practice operating for 25+ years. All aspects of podiatry - Excellent opportunity leading to partnership with unlimited income potential and more. Fax CV to (718) 931-9324. WWW.BRONXFOOTCARE.COM

ASSOCIATE WANTED - BOCA RATON-DELRAY BEACH AREA

Full time for growing practice-surgical training a plus-hard working a real plus-opportunity of a lifetime-partnership after 1 yr. Need Florida license. Fax resume to 561-865-2225

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City. Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

WELL ESTABLISHED PODIATRY PRACTICE IN MT. AIRY, NC

Dr. John H. Hodges had a well established practice in Mt. Airy, NC that is either for sale or in need of an associate/partner to take over patient care. Dr. Hodges unexpectedly passed away, leaving approximately 3,500 patients. This is a unique opportunity to be able to begin work in a busy podiatric practice. If interested, contact Carolyn McMackin at (336)577-2886 or cmcmackin@triad.rr.com

PRACTICE FOR SALE - DETROIT MICHIGAN

General practice for sale. This well established muiltple location practice is grossing over $1M. Potential, potential, potential! Professional sports, acedemia, dining, and entertainment galore. Nice mix of commercial insurance, cash, Medicare. Staff willing to stay making this a true "TURN-KEY" opportunity. Contact AMERICAN DOCTOR SALES at 614-918-3000 or email sell_my_practice@yahoo.com www.americandoctorsales.com

ASSOCIATE POSITION - EASTERN NORTH CAROLINA

Multi-physician Podiatric practice looking for PSR-24/36 trained Podiatrist to join our progressive, diverse practice. High surgical volume with teaching opportunities. Competitive compensation package with definitive plan leading to partnership. Must have North Carolina license. Position available late 2007. E-mail CV and/or letter of interest to ncdpmsearch@earthlink.net

PRACTICE FOR SALE- FLORIDA

A 13 y.o. well established podiatry practice in Tavares, FL ( Lake County ) the 23rd fastest growing county in the nation. This is an opportunity not to be missed. All aspects of podiatry with hospital privileges available. PRICED TO SELL! If interested, contact Susan at (352) 406-2513 or at acrysue@gmail.com

PRACTICE FOR SALE: LA JOLLA CA (SAN DIEGO) Price reduced!

$287K '06. No HMOs, bone surgery, or insurance panels, so opportunity abounds! Affluent community. General practice, biomechanics, DME. Possible finance Serious/principals only. Cell:858-405-4780, 10-8 PDT. No Sunday calls, please. $129K Selling due to age, health problems. www.SDFootDoctor.com DrRDWorley@yahoo.com

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

ARIZONA- OFFICE SPACE TO SHARE- TUCSON, AZ

Office was previously occupied by a podiatrist for ten years. Shared space in a modern, well designed, chiropractic and podiatry office. X-ray and processor provided. High growth area in Northwest Tucson. Potential patients walking in asking when a podiatrist will open for business. Respond: parksovc@aol.com, 520-544-2445.

ASSOCIATE POSITION - SANTA FE, NM

Established, 30 year practice with multiple office locations looking for a PSR 24/36 trained, hardworking, personable, ethical, highly motivated individual for associate position with immediate partnership available. E-mail CV and reference letters to sfpodiatry@aol.com

ASSOCIATE POSITION – SOUTHERN KENTUCKY

Southern Kentucky's largest and most respected foot and ankle group is looking for an associate to start in July 07. An amazing opportunity to grow with an established four provider practice on beautiful Lake Cumberland, Kentucky. Very competitive salary/bonus with a buy in opportunity will be offered. Established satellite offices will make for immediate patient base ready to be nourished and grown by a friendly, well-trained associate. Excellent benefit package. Lexington, KK is 1.5 hours North while Nashville, Tennessee is 2.5 hours South. Please fax CV to 606-679-4626.

Seeking Resident who wishes additional training: Baltimore, MD Mercy Medical Center

Resident position CPME accredited either 12 or 24 month commitment for a highly motivated individual 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 2007. Includes competitive salary/benefits. Send inquiries to rsher18@yahoo.com

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