The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

May 01, 2007 #2,925 Editor-Barry Block, DPM, JD

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Women Should Choose Function Over Fashion: GA Podiatrist

Perry Julien, a podiatrist who specializes in sports-related injuries, says foot pain can sometimes even warn us of a more major problem. For instance, prolonged toe pain can indicate a circulation problem, and significant ankle swelling can signal congestive heart problems, he said.

Dr. Perry Julien

The best way to prevent foot problems is to wear proper-fitting shoes made with rubber soles and with good arch support that provides plenty of room for the toes, Julien said. But that's not an easy task for most women. "When you look at the shape of the foot and the shape of most shoes, it's not a match," he said, adding that high heels tighten calves, push feet forward, cramp toes and lead to arch and Achilles tendon pain.

"Everyday shoes are designed for fashion and not function. I'd rather compromise looks for function."

Source: Vikkie Conwell,Cox News Service, [4/29/07]

Barry University Graduates 39

Thirty-nine students received the Doctor of Podiatric Medicine degree (DPM) from the Barry University School of Podiatric Medicine. The commencement ceremony at the Broad Center on the Miami Shores campus was the 19th graduation of the School of Podiatric Medicine which now has more than 900 graduates.

The class of 2007 represents a diverse group of healthcare professionals from around the world, including four international students who received medical degrees in their home countries before enrolling in the School of Podiatric Medicine – students like Alix Charles. Charles, who received his MD from the State University of Haiti, had spent three years completing an orthopedic residency in Germany before making the decision to move his family to the United States and enroll in BU’s School of Podiatric Medicine.

A tough decision, but one that Charles felt he had to make to protect his family. “It wasn’t safe,” said the father of four. “You had the feeling that at any time something may happen. When you listened to the radio in the car you would hear that there had been an incident someplace you just left 10 minutes ago.” Studying for his doctorate of podiatric medicine while working full time and raising a family wasn’t easy, but Charles, who plans to open an office in Miami’s Little Haiti after he completes his podiatric residency, said it was well worth it, especially when he sees the relief on the faces of his Haitian patients.

Denial-Management Systems Can Bring Cleaner Claims

"Denial management" is the catch-all phrase for any process that practices hope can lead to cleaner claims and fewer denials from insurers. Experts say denial management can be part of an entire electronic medical record/billing system, or it can be a "bolt-on" to an existing system. It can be a Web-based system that reviews claims. It can also be a manual, retroactive review of denied claims. It can be paid for through the up-front purchase of software, or by giving a claims-review service a percentage of collections.

Given that most surveys find physicians undercode to ensure claims get through, denial management also offers the promise of greater collection from insurers. Experts say every practice should have some sort of system in place to review and challenge health plan denial of claims. But what system you need depends on what infrastructure you have in place and what you can afford up front.

Billing companies offer help to paper-based practices as well as to electronic practices without a denial-management system. The companies can take the piles of unpaid claims, use "rule engines" specific to each payer to determine the errors and collect retroactive payments on their clients' behalf.

Experts say it's better to code correctly and risk a backlash than to undercode in hopes insurers leave you alone

Source: Pamela Lewis Dolan, AMNews [4/30/07]

Query: Chronic Weakness and Atrophy, Right Lower Leg

I have an 44 yo male patient with a history of chronic weakness and calf atrophy of his right leg. It began in his 20s and has been progressing. He denies any trauma to the area. He has no pain and is able to walk/exercise without issue. He was seen recently by a neurologist and had EMG and nerve conduction studies performed. The NC studies showed absent action potential of the superficial peroneal nerve and posterior tibial nerve. Pelvic and lumbar spine MRIs were all negative. The neurologist had no answers as to the cause. I was wondering if anyone has had a case similar to this and if the etiology was determined, as well as treatment.

Jennifer Sartori, DPM, Portsmouth, NH

RE: Pruritis in Well-Controlled Diabetic (John Spina, DPM)
From: Multiple Respondents

It doesn't matter how well-controlled her diabetes is now, but what has been her control in the past ? Years ago there was a saying in the ADA, "what is happening to your body today depends on how you took care of it 10 years ago. .How long has she had diabetes? Type 1 or Type 2? Hgb A1C? I've personally experienced a similar condition, and have come to the conclusion that it is a type of neuropathy. Nothing helps, except scratching the area, but after 38 years of type 1 diabetes, who knows?

Neil A Burrell, DPM, Beaumont, TX, nburrell@gt.rr.com

Consider a peripheral neuropathy, such as DM or spinal, tarsal tunnel. Maybe consider EMG/NCV, Lyrica, Capsaicin. Not all that itches is necessarily due to a dermatitis.

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

There is a good chance her pain can be originating from her lower back. A lumbar radiculopathy from a herniated disc can cause similar symptoms. See if she has a history of lower back pain or Sciatica.

Craig Herman, DPM, Bronx, NY, foothealer@aol.com

Without a obvious skin cause, I would check for possible neuropathic cause. I have seen early cases of DPN and tarsal tunnel syndrome where the only symptom was itching.

Greg Mowen, DPM, Margate City, FL, gregmowen@comcast.net

RE: Jack Valenti (Stephen Doms, DPM)
From: Multiple Respondents

I worked for Charlie Turchin, DPM, in 1970, the year he was President of the APMA. He was the podiatrist for many well-known political figures in the nation's capital, including President Lyndon B. Johnson and his family. I had met Charlie in 1963. I visited him many times during the years leading up to my employment as his associate. When President Johnson needed care, he would send a car for Charlie.

The story goes that one day, President Johnson summoned Charlie to drop everything and come to the White House. He sent a secret service detail to pick Charlie up.
Charlie was concerned when he walked into the Oval Office because Johnson had his three chief physicians waiting there. The president was very free with his language in berating his band of physicians. You see, a new drug called Griseofulvin has just come on the market. President Johnson had a fungal nail challenge and Charlie gave him a prescription for it.

Unbeknownst to Charlie at that time, the president had suffered (for years) with jock itch that his physicians were unable to clear up. Charlie cleared it up as a side-effect of the nail treatment. "I have the top doctors in the world taking care of me, but my podiatrist cleared up my worst problem", said the president.

I wasn't aware of what Jack Valenti did for us in those days and perhaps it was as noted, but I do know that podiatry got into Medicare because a case of resistant "jock itch" was cleared up by one of our best and brightest, Charles R. Turchin, DPM. And now you know the rest of the story!

Mark D. Sussman, DPM, Annapolis, MD sussmanwellness@comcast.net.

Dr. Charles Turchin was Lyndon Johnson's personal podiatrist. As such, he often made house calls to the White House during the Johnson administration. Charlie was a remarkable fellow; Intelligent, gregarious, charming, and charismatic. Charlie treated not
only LBJ, but Lady Bird as well.

I had the pleasure of meeting Charlie in 1979 (he passed away over 25 years ago). I still treat his brother. Charlie once told me the story of the inclusion of our profession in the Medicare program. Charlie was working on Johnson's feet while Johnson was discussing the Medicare bill with his aides. Johnson looked at Charlie, thought for a moment and then turned to his aides and asked if podiatry was included in the program. The aides responded that they did not know. Johnson then turned toward his feet and asked Charlie what he thought. Charlie told Johnson that he felt podiatry should definitely be included in the program. Johnson made it so. As a profession, we all owe an enormous debt to the great Dr. Charles Turchin.

Richard Mann, DPM, Delray Beach, FL, rhm123@gmail.com

One of the major reasons that podiatrists were covered under Medicare was because of efforts of my late friend, Charles Turchin, D.P.M.. He was not only the president's podiatrist, but Johnson’s daughter worked for Charlie at one time.

Earl L. Cherniak, DPM, Editor, The Hospital Podiatric Physician,
Los Angeles, CA, Drearlcherniak@aol.com

RE: Severe Pain After Sclerosing Alcohol Injection (Robert Lagman, DPM)
From: Steven H. Goldstein, DPM, Simon Young, DPM

This can be a fairly common reaction after alcohol injection as I have personally experienced this situation. For some patients the alcohol can become quite irritating. I was unable to bear any weight on the ball of the foot for the first 24 hours and resorted to percocet for the pain. I can tell you that what has worked for me was to re-inject the area with some marcaine and fast acting steroid such as dexamethasone phosphate 4mg. 1/2ml. plus place the patient on a 4mg. Medrol dose pack in combination with the injection.

Steven H. Goldstein, DPM, Livingston, NJ, Stevefootdr1@cs.com

The initial injection is extremely painful since you are chemically destroying the nerve and it's reacting. Ideally, with sclerosing you want to be as close to the nerve as possible.
To cause less local tissue damage and be more precise, consider ultrasound guided injection.

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

Editor's Note: This topic is now closed

MICHIGAN- DETROIT NORTHWEST SUBURBS

Associate/Partner wanted for busy group practice. Opportunity for exceptional pay and benefits for hard working, well-trained person of integrity. Enjoy full scope of practice while working with progressive and team oriented colleagues. Historically patient flow has allowed for obtaining enough cases for boards in less than 2 years. PSR-24/36 or practice experience needed. Please e-mail resume to nmoz@aol.com

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

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 MOINES, 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 - MICHIGAN-DETROIT AREA

Great opportunity-must be hard-working, reliable, responsible and good with patients & staff-surgical training a plus-partnership after 1 yr. Michigan license required fax resume to 248-478-1370

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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