The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

May 01, 2010 #3,846 Publisher-Barry Block, DPM, JD

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MBT Shoes Work Muscles, But Are Not For Everyone: FL Podiatrist

Tampa podiatrist Marc Katz bought a pair of MBTs two years ago after hearing his patients talk about them. "I wore them to take a brisk walk, and the next day I was sore from my butt down," Katz says of the first time he wore the $250 shoes. "I knew I had gotten a workout. And they did make me stand straighter." But the shoes aren't a magic bullet, he says. "The shoes will work some muscles and may give you a little toning. But it doesn't replace a general fitness program," Katz says. Katz says he found the shoes to be heavy, bulky and hard to tolerate for long periods. People with foot or back problems should check with a doctor before wearing fitness shoes; they change the way you walk, Katz says, which could create problems or aggravate an existing condition.

Dr. Marc Katz

Katz also advises patients with balance issues or weak ankles not to wear the shoes. "Since the goal is to make you unstable, if you have back or knee problems, you could throw your back (out) or hurt your knee." For patients who are able to tolerate the shoes, he advises wearing them for short amounts of time to work up endurance. And be aware of any joint pain developing that can be a sign of overuse.
 
Source: Cloe Cabrera, The Tampa Tribune [4/27/10]

Scholl College Sweeps 2010 ADA Research Awards 

Foot care research at Dr. Wm M Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science was given an unprecedented recognition by the American Diabetes Association (ADA) for its upcoming Scientific Sessions in Orlando, FL. Of the eight oral abstracts to be presented in the foot session, three abstracts were from the Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR) researchers. 

Laura Shin, BS (DPM/PhD student)

The top two awards, the prestigious Marvin E. Levin, MD, Travel Scholarship were given to Bijan Najafi, PhD for his work entitled, "Incorporating Standing Time into Physical Activity Assessment of Patients at Risk of Diabetic Foot Ulceration," and to Laura Shin, BS (DPM/PhD student), for her work entitled, "The Contribution of Bone Marrow-Derived Mesenchymal Stem Cells to Diabetic Wound Healing." 

The third abstract selected was from Stephanie Wu, DPM, for her work "Geographic Variation of the Biofilm using PCR."  This is the third year in a row for Dr. Wu's work to be selected for the prestigious oral abstract session. 

NY Father & Son Podiatrists to Compete in One Lap of America Car Race

Podiatrists Freddie and Eric Edelman are about to embark on a unique race called One Lap of America (onelapofamerica.com). It’s an 8-day event which begins on May 1, and covers 3,500 miles at 9 different race tracks.

(L-R) Drs. Eric and Freddie Edelman with their 2006 Dodge Ram SRT-10

The Edelmans will be racing in a 2006 Dodge Ram SRT-10. Races vary from traditional oval racing to drag racing.

First Prison Sentence for Record Snooping

A former UCLA Health System researcher was sentenced to four months in prison for illegally perusing the medical records of co-workers and celebrities. Huping Zhou will be the first person in the U.S. to go to prison for violating the medical privacy provision of the Health Insurance Portability and Accountability Act of 1996, according to the U.S. attorney's office in Los Angeles.

Zhou is licensed as a cardiothoracic surgeon in China and worked as a research assistant at one of UCLA's facilities, which is not named in court documents. In October 2003, Zhou was notified that he would be terminated. Over the next three weeks, he abused his access to the computer system to look up health information of patients, most of them celebrities and people Zhou worked with, he admitted in a plea agreement with prosecutors.

Source: Gregg Blesch, Modern Healthcare [4/28/10]

Query: Burning Pain During Active Plantarflexion

A 36 y/o healthy male presented with burning pain, present for one month, in his dorsal left foot. This pain is only present when the foot and toes actively plantarflex at the MTPJs. This is localized to the 3rd and 4th MTPJ. He first noticed pain while getting out of his car, and it is present when the left foot plantarflexes or stretches. The pain is relieved by dorsiflexing the foot and toes. After about 5 seconds, the pain goes away.

X-rays were negative, and I was unable to duplicate pain by passively plantar flexing the foot. There is mild point tenderness on dorsal 3rd and 4th MTPJ, but no edema. There are no signs of neuroma. There is no point tenderness on the EDL tendons, and no crepitus with tendon movement. There are no signs of nerve entrapment of the common peroneal, deep peroneal, superficial peroneal or dorsal cutaneous nerves. There is no history of low back disease or sciatica. Any ideas of what can be causing this?

Edward Orman, DPM, Perry Hall, MD

Query: Sending Blast E-Mails

During registration of my patients, I ask for the e-mail addresses. Most patients provide this. The intent is to be able to communicate with the patient, if necessary, on a one-on-one basis. I also want to blast e-mail information to all patients and keep their email addresses confidential. Can you give me information on how to do this task?
 
Ira M. Baum, DPM, Miami, FL

Editor’s comment: For smaller lists, generally of 100 e-mails or less, the blind carbon copy (BCC) feature should be used. For larger groups, there are a large number of companies, such as Constant Contact, that can inexpensively provide a professional-looking product.

Query: Excision of Accessory Ossicle Code

I am looking for a code for an excision of an accessory bone located just off of the fifth metatarsal base. Would it be the same CPT code used for an accessory navicular?

Melissa Kolanowski, CMM, Office of Scott Schulman, DPM, Indianapolis, IN

Response: I would not recommend using the code for navicular os tibiales excision. It would be more accurate, in my opinion, to use an ostectomy code for a metatarsal bone.

I would therefore recommend using CPT 28122 (partial excision [craterization, saucerization, sequestrectomy, or diaphysectomy] bone [e.g., osteomyelitis or bossing]; tarsal or metatarsal bone, except talus or calcaneus).

Howard Zlotoff, DPM, Camp Hill, PA

Codingline subscription information can be found at:
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RE: Burning Feet in Summer (Schelli McCabe, DPM)
From: Elliot Udell, DPM

This sounds like a rare condition called erythromelalgia. I have seen at best four cases in my entire career, and that is above the norm for most doctors in any field of medicine. One patient had it so badly that he used to drive his car with a bucket of ice next to him and stop on the side of the road to sooth his feet.

Systemic pathology should first be ruled out, especially malignancy or other rare peripheral neuropathies before initiating treatment.  Once these are ruled out, an approach which was developed by a group of doctors at Mt. Sinai Hospital in New York City, many years ago, is the use of SSI inhibitors. Their theory was that the cause of erythromelalgia is the same as what causes clinical depression in the brain, and hence medications that inhibit seratonin, would also work even though the problem presents in the foot. Cymbalta is a good first choice. There are similar medications that you can also try.

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

RE: More Bad News About Folic Acid, B6, and B12 Pills For Diabetics (Elliot Udell, DPM)
From: Larry Kollenberg, DPM, Pharm D, Marc Katz, DPM

This article is well done by the authors. There has been significant controversy associated in the medical literature about homocysteine levels and the use of vitamin food supplements of this magnitude of folic acid in combination, and the ill effects of nephropathy. This article reaches the same conclusions as reported in the past about nephropathy and the combination of vitamins.

The article does not compare L-methylfolate vs folic acid, nor does it compare the assorted dosages of L-methylfolate. It does bring this reader to a cautious approach, and thus I recommend that you consider this in your prescribing habits.

I work with a multitude of patients who fit both the MDRD and CG criteria on a daily basis for treating severe life-threatening infections from cellulitis, UTI's and sepsis. The devastating effects of nephropathy cannot be emphasized enough in antibiotic metabolism, not to mention daily medications such as gabapentin, lisinopril, etc.

There are numerous pharmaceutical products available with the combination studied and similar groupings like L-methylfolate. Perhaps, this readership will remember the recent CME article published in PM News, and be cautious.

Larry Kollenberg, DPM, Pharm D, Baltimore, MD, lkollenberg@hotmail.com

This is an interesting study. I was only able to read the summary and could not find the whole study. However, I would love to know the other 15-20 FDA approved drugs that these people were taking along with their vitamins. Did they smoke or drink alcohol? What was their diet like?  I'll bet they weren't eating well. Perhaps, their high fructose diet led to some renal issues. I think if we consider all of these factors and probably hundreds of others, these people likely had worsening disease from many other factors.

Personally, I feel  less concerned over vitamins but more concerned over drugs like statins that provide such low LDL levels that healing defenses are shot and there are increased risks for cancer. Unfortunately, we have little control over their primary medications. I find it alarming that my patients get sicker and sicker with each additional drug that gets added based on some of these studies.  We over-treat with drugs and under-treat with diet. That's my take on it.

Marc Katz, DPM, Tampa. FL, dr_mkatz@yahoo.com

RE: Toenail Pain from Nail Polish (Peter Smith, DPM)
From: Robert Schwartz, CPed

Although I have not seen this particular individual and can’t be sure it is the cause of the problem in this case, it is important to include the practice of evaluating shoe fit in establishing the etiology of the problem. The easiest way to do it is to inspect people’s feet with their shoes on. Simply palpate the key pressure areas of the foot while they are standing in their shoes. Then inspect the inside of the shoe for wear patterns. Most adults have mismated feet, and wear shoes that are too small. Each and every day we see clients who have this problem. It isn’t the nail polish that is causing the problem; it’s the pressure against the toe box of the shoe.  The nail polish is often the “smoke screen.” Let’s see what Dr. Bill Weis tells us about this case.

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

RE: Scope of Practice
From: Michael M. Rosenblatt, DPM

There have been many good suggestions on how to improve the scope of DPM licensure, from becoming an MD/DO to political pressure, public relations, and education, etc. But one avenue has been missed so far. Most scope of practice issues are decided on a state-to-state basis. We all have heard of the "possibility" of a general all-state license for healthcare professionals. This approach, while a possibility, remains unlikely because states are very reluctant to give up any more authority to our federal government.
 
A number of years ago, the chiropractic profession sued the AMA in open court because AMA attacked chiropractic as "non-scientific." The entire chiropractic profession got squarely behind their leaders, fighting every inch of the way. Eventually the MD's gave up, probably as much from legal expense as for any other reason.
 
A similar approach might be taken when MD's deny our licensure in the political market of ideas. It's hard to sue somebody for their comments, due to freedom of speech issues, but MD's have their own battles to fight that exist whether or not podiatry licensure is improved. By any measure of definition, medical doctors are sensitive to lawsuits in the extreme. Sometimes, it is necessary to fight fire with fire. 
 
Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

EQUIPMENT FOR SALE – PAD NET

5 month old PAD Net device for sale. Very lightly used with 7 months of the warranty left and an extra set of toe cuffs. Serious calls only. 928-774-4825

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. Grossed 350K last year, priced to sell with financing available 200k. Call 931-446-5724.

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 – 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 – 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

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