The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

April 30, 2007 #2,924 Editor-Barry Block, DPM, JD

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TN Podiatrist’s Nail Salon Horror Story Cited in Canadian Press

Scarring, chemical burns, bacteria, viruses and fungi -- all complicated by the potential for transmission of bodily fluids. It's not a picture from some 19th century battlefield. It's the "wild west" of cosmetology.

In the U.S., politicians are calling for stepped-up enforcement after deaths in Texas and California that have been linked to unsanitary pedicure practices. The British Columbia. government announced a review of the industry a year ago but there has been no move to reintroduce regulations or standards to protect consumers.

Dr. Robert Spalding

In his book Death by Pedicure, U.S. podiatrist Dr. Robert Spalding recounts the story of Kimberly Jackson, the paraplegic mother of a 17-year-old boy and two 13-year-old boys who died from a staph infection after her foot was cut while she was getting a pedicure.

Source: Gillian Shaw, Vancouver Sun, [4/26/07]

Bakotic to Receive President’s Circle Award at Barry Graduation

Bradley Bakotic, DPM, DO, the medical director of the Institute for Podiatric Pathology, will be the featured speaker at this year’s Barry University School of Podiatric Medicine commencement ceremony.

Dr. Bradley Bakotic

Bakotic, who is an adjunct professor at Barry University and the 1992 class valedictorian, is one of the foremost authorities in podiatric pathology. He will also receive the President's Circle Award from BU President Sister Linda Bevilacqua, OP, PhD, for his accomplishments in podiatric medicine and his contributions as an alumni of Barry University.

Universal Coverage Legislation Unveiled

Lawmakers in the U.S. House and Senate this week introduced legislation that would extend Medicare to all Americans, from birth until the end of life. Sen. Edward Kennedy (D-MA), who is co-sponsoring the bill with Rep. John Dingell (D-MI), said the legislation would reduce costs and promote health information technology and preventive care.

“I believe this should be achieved by 2010” to provide universal care, Kennedy said at a news conference, although the bill would not eliminate the option of employer-based insurance. The plan would be financed by a combination of payroll taxes and general revenue. Businesses would have to pay 7% of payroll with workers contributing 1.7% of their pay, but the proposal would not add to current private spending, the sponsors said. By comparison, businesses providing coverage today spend an average of 13% of payroll to cover their workers, according to a statement on the bill.

Source: Jennifer Lubel, Modern Healthcare [4/25/07]

Query: Pruritis in Well-Controlled Diabetic

I have a patient who has had unilateral itchiness in her right foot for a few weeks. She has diabetes, but is well-controlled. She denies history of travel, food allergies, changes in shoes, socks or soaps .All bloods were normal. Objectively ,I saw no scaling, plaques, papules, cellulitis, etc. I saw a mild zone of erythema on her right hand. I started her on Elacon and told her to keep a journal re triggers, such as food allergies. Does anyone have any suggestions?

John Spina, DPM, Brooklyn, NY

RE: MD Podiatrist Offers Summer Footwear Advice
From: Barry Francis, Consultant Podiatric Surgeon

I was interested in the comments made by Dr. Hahn regarding flip-flops. I personally do not have a great deal of problems presented by patients wearing this kind of footwear, but that is possibly because these injuries are usually acute and in our health system go straight into the National Health Service (NHS). However, your readers might be interested to know that three years ago the NHS recorded 58,000 admissions to Accident and Emergency involving accidents and injuries to the foot in association with flip-flops. The debate regarding these shoes has continued and in the UK at least has now extended to ballet pumps. My own advice is to wear the right shoe for the job, and as long as there are women with feet, there will be those that prefer flip-flops and ballet pumps!

Barry Francis, Consultant Podiatric Surgeon, Enfield, UK

RE: Jack Valenti
From: Stephen Doms, DPM

Jack Valenti, who died on Thursday, was a personal advisor and Washington lobbyist for President Lyndon B. Johnson. (LBJ had a podiatrist who made White "House calls" to treat his corns and calluses). Mr. Valenti was instrumental in the inclusion of podiatrists within the definition of "physician" in the Medicare legislation. We were told in podiatry school that Jack was the best friend of podiatry in Washington. He became the president of the Motion Picture Academy of America.. Every time the Academy Awards were televised, I looked to Mr. Valenti as a champion for podiatry. He will be missed.

Stephen Doms, DPM, Hopkins, MN, sdoms@aol.com

RE: Severe Pain After Sclerosing Alcohol Injection (Robert Lagman, DPM)
From: Multiple Respondents

This has happened to me on several occasions. It is possible that you deposited some of the fluid on the way down towards the nerve or on the way out. I try to find the nerve based on the patient feeling neuroma symtoms and deposit most of the fluid there. What has worked for me is a Medrol dose pack and a Celestone/lido injection. It usually takes a few days to a week to resolve. We have also had more severe reactions with redness, intense pain and swelling. Surprisingly, those with the most intense reactions have had great result. I do use a short consent for this procedure.

Isidore Steiner DPM,JD,,MBA, Howell, MI, footlaw@hotmail.com

It is very common for the 1st sclerosing injection to cause increased pain. Patients should be warned about this expected result, as well as, the potential for CRPS-especially after prior surgical trauma. Prior to injecting after a failed release an ultrasound or MRI would've been prudent to perform prior to sclerosing. Most likely, the pain will wain and resolve. Unfortunately, multiple injections are needed and usually follow-up injections are less painful.

Simon Young, DPM, New York, NY, Simonyoung@juno.com

Over the years, I have had the rare but unfortunate opportunity to have had the experience of giving an injection for a neuroma and having the patient call me that he or she was in severe pain. Normally this goes away with the second injection. One theory given to me by one of my senior colleagues is that the first injection is like "whipping up a hornet's nest." The situation gets worse before it gets entirely better. Two other possibilities are that you might have actually hit the nerve with the needle and traumatized it. This should get better with the second and third injections.

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

RE: 15 yo Girl With Posterior Tibial Tendinitis (Marc Goldberg, DPM)
From: Barry Mullen, DPM

Based on the patient's past localized traumatic history of the PT tendon, the most likely diagnosis is post traumatic stenosing tenosynovitis of the PT tendon. I'm curious what the tendon sheath looks like on MR. If the MR is inconclusive, then a tenogram is ideal to confirm this diagnosis. Longitudinal tears may also be present, but are usually identifiable by coronal T1 MRI images. Double check those images to ensure the tendon is not partially torn. Also, double check the patient's existing bio-mechanical issues. Once the PT tendon has been traumatized, if the patient is an over pronator, then the combination of the prior tendon trauma, coupled with the persistent repetitive micro-trauma from high impact activity in a bio-mechanically weak foot would prevent the tendon from healing.

JRA and other inflammatory arthritic disorders can be considered, but usually present with bilateral symmetry and other associated constitutional symptoms. In JRA especially, these kids are generally pretty sick with history of fever, multiple arthralgias, iridocyclitis etc.)Plus, in this case, one simply cannot discount the prior trauma history. Based on a past history of failed physical therapy, the indicated treatment, if stenosing tenosynovitis is confirmed by tenography or further MR review, is tenolysis.

Barry Mullen, DPM, Hackettstown, NJ, YAZY630@aol.com

Editor’s note: This topic is now closed.

DETROIT MEDICAL CENTER RESIDENCY PGY1 AND PGY2 NEW POSITIONS

Detroit Medical Center PM&S-36 program is accepting applications for additional PGY1 and PGY2 slots. The DMC and Wayne State University Medical School sponsors 900+ residents. Highlighted rotations include: Orthopedic Trauma, Pediatric Orthopedics, and Plastic Surgery. With over 100 attendings, surgical volume is tremendous. Please call Beverly at 248.651.0162 if interested.

PODIATRIC SURGEON POSITION – DES MINES, IA

Full-time position available in busy county hospital-based foot and ankle group. Two year residency trained, BE/BQ, minimum. Private practice experience preferred. Competitive salary and benefit package. Inquiries to: Denise Mandi, DPM, Section Chief Broadlawns Medical Center, Des Moines, IA. dmandi@broadlawns.org

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

NORTHERN CALIFORNIA- PRACTICE FOR SALE

Great opportunity to own a well-established turn-key podiatry practice located in modern medical office building in East Bay; Electronic billing, good payor base, no HMO contracts; Biomechanics, general podiatry with great potential for surgery. Please send CV and letter of interest to: norcalpod@hotmail.com

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

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

EQUIPMENT FOR SALE + FREE JAPMA (1971-96)

1. Wall mount -Sanko x-ray, 55KVP, 7MA. $800 or best offer, 2. A/T 2000M Film Processor. $500 or best offer 3. Two gallon x-ray development dip tanks with hangers - best offer 4. One gallon xray development dip tanks with hangers - best offer 5. 30 years of JAPMA Free (You pay shipping). 704-892-7301 or 704-663-0094 raybrown@bellsouth.net

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

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.

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