The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

April 29, 2010 #3,844 Publisher-Barry Block, DPM, JD

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Daily Feet Inspection is the Key to Wound Prevention: NJ Podiatrist 

Approximately five million Americans suffer with chronic wounds on their feet and lower legs that don’t respond to standard medical treatment. But, the best wound treatment is preventing wounds in the first place. “When the actual wound is there, half the battle has been lost,” says Michael Sears, DPM, podiatrist and director of Raritan Bay Medical Center’s (RBMC) Central Jersey Wound Care Center. “Preventive care can be as simple as checking your feet every day for red marks, cuts or bruises.” 

Dr. Michael Sears

Source: NJ Today [4/26/10]

AAPPM’s Historic Practice Management Course Completes First Year at OCPM

The first year of the first-ever student podiatric practice management course came to a rousing conclusion at the Ohio College of Podiatric Medicine (OCPM) on Friday, April 23, with a student standing ovation for the faculty from the American Academy of Podiatric Practice Management (AAPPM). This historic practice management course was created through a joint effort involving the AAPPM and the OCPM and funded by a grant from Powerstep Orthotics and Dr. Les Appel. The unique, first year curriculum, delivered by faculty from the AAPPM, consisted of monthly two hour lectures designed to introduce the students to the critical elements of self, patient, and practice management.

Drs. Jeff Frederick and Jonathan Moore of AAPPM present Dr. Thomas Melillo (center) with a plaque symbolizing the induction of the “AAPPM Dr. Harvey Lederman Leadership Scholarship Award” which will be given to a deserving OCPM student each year.

"As the students from the 2013 class progress through the years, they will be challenged with more complex practice management topics that are relevant to their stage of education," explained Dr. Hal Ornstein, chairman of the AAPPM. "In the years to come, the students will learn skills to enhance patient communication and compliance, conflict resolution , stress management, and the business administration skills needed for success in private practice," added Dr. Jeffrey Frederick, president of the AAPPM.

“Practice management courses will be a major educational advantage for our students as they go through their residency training and become practicing podiatric physicians and surgeons,” said Dr. Thomas V. Melillo, president of the OCPM.

Murano Re-Appointed to MA Podiatry Board

Dr. Raymond S. Murano, chief of Podiatric Surgery for Hallmark Healthcare was recently re-appointed to the commonwealth of Massachusetts Board of Registration for Podiatry by Gov. Deval Patrick. Murano has been in practice for 26 years in Medford. He has been on the Podiatry Board since 1999. For the past four years, Murano has served as the board’s secretary. He has also served as chairman of the board for the past several years.

Dr. Raymond S. Murano

Murano is on the medical staffs at the Lawrence Memorial Hospital, Melrose Wakefield Hospital, and the Winchester Hospital. He is board certified in podiatric medicine, podiatric surgery, and is a certified wound care specialist. In addition, he is secretary/treasurer for the Ohio College of Podiatric Medicine’s Board of Alumni Trustees.

Source: Medford Transcript [4/26/10]

APMA Podiatrists Respond to Rising Need for Podiatric Care in Haiti

More than three months after the January 12 earthquake in Haiti, the injuries many sustained in the event are still changing and claiming lives. With the initial earthquake leaving between 4,000-6,000 amputees to combat infection, podiatrists have continued to visit the battered area to help treat amputees and stave off future limb loss. In these types of disaster situations, a podiatrist’s role is considered vital to keeping victims alive.

Dr. Patrick DeHeer applies a Ponseti clubfoot cast in Port-Au-Prince, Haiti.

As the number of worldwide amputees continues to rise as a result of natural disasters and complications of epidemics such as diabetes, the foot and ankle care that podiatrists provide is going global more than ever before. Many American podiatrists are traveling to provide aid, and have worked alongside other medical providers in makeshift trauma centers during catastrophes such as the Haiti earthquake.

Others, like APMA member Patrick DeHeer, DPM, of Carmel, IN, have long worked to provide wound care overseas in impoverished areas of Honduras, Iraq, Trinidad and Haiti—volunteering for mission trips to areas where equipment and medical supplies are limited, but medical care is still urgently needed.

Phrase Your Praise to Boost Morale

Workplace enthusiasm will soar if you craft compliments around phrases like these:

•  “What I most admire about you is …”
•  “You made my day when you …”
•  “I am so impressed by …”
•  “You should feel very proud of …”
•  “You are doing great work on …”
•  “You really made a difference when you …”

Source: Adapted from Retain or Retrain, Ed Rose, et al., DC Press via Communication Briefings

RE: Toenail Pain from Nail Polish (Bill Weis, DPM)
From: Paul Busman DPM,RN, Robert S. Schwartz, C. Ped

As a long shot diagnostic test, ask your friend to polish only part of that nail. For a couple of days, try polishing only the proximal 1/2. For the next couple of days, only polish on the distal 1/2. Then, prehaps, a longitudinal strip of polish, leaving the medial and lateral nail margins clear. If there's any difference in the pain pattern, this might help narrow the problem down.

Paul Busman DPM,RN, Clifton Park, NY, brewerpaul@aol.com

Check her shoes and measure her feet. You will probably discover the painful toe is on her longer foot and is pressing on the toe box of the shoe. A longer shoe size should resolve the problem.

Robert S. Schwartz, C. Ped., New York, NY rss@eneslow.com

RE: Diagnostic Studies For Mechanically-Induced Plantar Heel Pain
From: Michael Turlik, DPM
 
The value of a diagnostic test is dependent upon the accuracy of the test (likelihood ratio) and the pretest probability of the disease (prevalence) in the population of interest. Pre-test probability X likelihood ratio of test = post-test probability^.1 If the initial visit of a middle-age patient presents with non-traumatic plantar heel pain characterized by first step morning pain without inflammatory signs, the most likely diagnosis is mechanically-induced heel pain (plantar fasciitis / fasciosis). The pre-test probability of PF in this clinical scenario is very high >90% in my patient population (general suburban practice), and is consistent with most of the literature that I have reviewed on the subject. ^2,3 Since PF is a common, benign, self-limited disease, further diagnostic studies in this patient population are usually not necessary in establishing a diagnosis; a clinical exam should be sufficient.

For patients who fail a course of conservative care, a diagnostic study(s) may be useful, however, I am not sure which studies have the best test parameters (likelihood ratio, predictive value, sensitivity /specificity). I have not been able to find anything written on the subject. What are the likelihood ratios for pedal radiograph, sonogram, MRI, or scintigraphy in the evaluation of PF for this population? What is the prevalence of PF in the population of conservative non-responders?

1. Richardson S. and Wilson M. The Process of Diagnosis.  In: Guyatt G, Drummond R, Meade MO (eds). Users’ Guides to the Medical Literature. New York: McGraw-Hill, 399-406, 2008.
2. Buchbinder, R.  Plantar Fasciitis. NEJM 350:2159-66, 2004.
3. Clinical Practice Guideline Heel Pain Panel. The Diagnosis and Treatment of Heel Pain. JFAS 40:329, 2001.

Michael Turlik, DPM, Cleveland, OH, mmturlik@aol.com

RE: Ultrasound-Guided Injections
From: Art Hatfield, DPM, Geoffrey Bricker, DPM

Am I missing something? Since 1973, I have given blind neuroma injections with a mixture of lidocaine and a steroid. I assume if the interspace gets anesthetized, the steroid got to the neuroma. Or is there some proof they become separated and only the lidocaine gets to the nerve? 

Art Hatfield, DPM, Long Beach/Huntington Beach, CA, Afootjob@Juno.com

My thanks to the many respondents in regard to ultrasound. I am converted, and will endeavor to use it. Thanks to Dr. Block for this forum, as I have learned many things which I use in my practice daily and was not taught in school or during my residency.

Geoffrey Bricker, DPM, Springfield, MO, geoffreybricker1@msn.com

RE: Treatment Room Flooring (Jill Scheur, DPM)
From: Lloyd Nesbitt, DPM

LSI International has a nice selection of vinyl tiles, some of which have a 3-D appearance, but are flat. They also apply some sort of special finish that has kept its shine without the need for waxing. We've had a lot of compliments on our treatment room floors. It’s easy to clean vs. other tiles that may have raised portions that can trap debris. 

Lloyd Nesbitt, DPM, Toronto, Canada, lloydn@rogers.com

RE: Safely Removing Scalpel Blades
From: Multiple Respondents

Please do not mistake my flippancy regarding the safe removal of blades from scalpel handles for either carelessness or ignorance of the possibility of real and serious infection. My point was simply that removal of blades from scalpel handles is hardly a topic requiring endless debate and discussion. Blade removal is a task quickly learned by any DPM and taught to his/her assistant and is easily and safely accomplished, with or without instrumentation.  As correctly noted by the editor, OSHA regs are requirements for employees, not employers, and are irrelevant to the current issue. 
 
Jeff Kittay, DPM, Boston, MA, twindragons2@verizon.net   

While OSHA rules apply only to employees, if the the office is a PC, technically, the doctor is also considered an employee and will fall under all OSHA guidelines.
 
Avi Kornbluth, Stone Podiatry / HIS, getavi@aol.com

I, too, remove scalpel blades with my fingers. After 27 years, I still have all ten digits intact. Interestingly, the only times I have cut myself on sharps is when attempting to remove them using a hemostat or one of those supposed 'safety' gadgets. 
 
Jeanne Arnold, DPM, Coeur d'Alene, ID, jarnolddpm1@verizon.net

RE: Scope of Practice (Russell F. Trahan, DPM)
From: Multiple Respondents

Earlier this month, APMA launched the Today’s Podiatrist campaign, based on research and created with the individual podiatrist in mind. It was designed to educate the public about the scope of care that today’s podiatrist provides based on his or her education, training, and experience. Today’s Podiatrist will benefit every DPM by elevating the perception of podiatric medicine and surgery, creating and solidifying relationships in the medical community, furthering APMA’s Vision 2015 objectives, and unifying the podiatric medical profession. APMA members can find more information about how they can use the campaign materials by going to apma.org/todayspodiatrist.

Glenn Gastwirth, DPM, Bethesda, MD, GBGastwirth@apma.org

Dr. Trahan's answer is a great summary of the thinking that has failed podiatry over and over for the last 30 years. Reread it and think about how everything he advocates has been tried and has failed. Let's stop trying to make a "silk purse out of a sow's ear," and just go out and buy some silk!

Robert Bijak, DPM, Clarence Center, NY, rbijak@aol.com
 
Although I see the positives of gaining educational parity, testing, and acquiring an MD/DO degree (like our maxillofacial colleagues), I recently had an experience which was interesting. Over the years, we have had various foreign orthopedic and trauma MDs come and visit our residency training program. In exchange, we have sent residents and fellows to their hospitals abroad. The experience has benefited both sides.
 
Recently, we had a Mexican MD who is completing a residency in podiatry in Mexico spend a month with us. Apparently, there is a DPM who moved to Mexico 20 years ago and graduated from a Mexican medical school. He stayed there and practices as an MD podiatrist. He started a residency program and trains 10-12 residents in a 2-year residency. Here is the interesting part: Although he is a licensed MD and a surgical residency-trained DPM, he and his residents cannot perform surgery or admit patients to the hospital. He has a surgical suite in a clinic he owns and practices like many DPMs did here in the '70s and '80s. Guess who is blocking him and the residents use of the hospital system?  Yes, the orthopedists have opposed this surgically-trained DPM/MD, stating that only orthopedic-trained MDs should perform foot and ankle surgery. So, for scope of practice, it appears that the MD degree does not really change the argument.
 
I do believe that it does change public perception and legislation/insurance issues pertaining to the term physician. As long as we compete with another group for surgical patients, the MD/DO degree may not stop the battles over credentialing and scope. The focus may then shift to post-graduate training, and we may experience some of the issues non-surgeon MDs have faced when they turn invasive. This does not mean we shouldn't move on, but I just thought it was a good story to share.

Samuel S. Mendicino, DPM, Houston, TX, DrSMendo@aol.com

RE: Parsley Named Dean At Scholl
From: Kathleen Neuhoff, DPM

Congratulations to Dr. Parsley. Dr. Parsley and I graduated from Scholl the same year, and it has been wonderful to watch her steady and well-deserved rise in our profession. Nancy has always been outstanding because of her passion for podiatry and her integrity. Her communication skills and professionalism will be an asset for Scholl, and she will certainly represent our school and our profession very well. Persons such as Nancy are the best reason that podiatry continues to move towards parity in the medical field. 
 
Thank you for all you do for us!
 
Kathleen Neuhoff, DPM, South Bend, IN, vetpod@aol.com

ASSOCIATE POSITION – GREATER MILWAUKEE, WI

Great opportunity: our busy multi-physician, podiatric group practice, with multiple locations, strong hospital based affiliations and clinical appointments, with teaching faculty positions at PM&S-36 residency programs, is seeking a full-time RRA BQ/BC, PM&S-36 surgically trained doctor. Position will be available for July/August, 2010. Applicant should be well trained in all aspects of conservative care and surgical forefoot, rearfoot, reconstructive surgery, trauma, wound care and limb salvage. Candidate should be ethical, hard working, outgoing and a self-starter. Commensurate pay, income guarantee, with incentives and full benefit package. Definitive plans will be discussed leading to partnership tract. Contact: Daniel Hellman, M.D. @ 414.831.0512 or by e.mail @ hellmandr@gmail.com

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.

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 – LONG ISLAND 
 
Busy Bellmore, NY office. Motivated, board certified, hard-working, experienced in all phases of podiatry. F/T, P/T hours available. excellent salary, call 516 242-7540 or Fax Resume 516 826-9036 or email jobke@aol.com

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

ASSOCIATE POSITION - LAS VEGAS, DALLAS, HOUSTON, AND SAN ANTONIO AREAS

Seeking well trained ABPS board rearfoot/ankle certified/qualified foot surgeons for surgical practice with national foot/hand/orthopedic surgery group. Excellent salary/benefits. Email CV and cover letter to: slb99@pdq.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

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