The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

May 01, 2013 #4,757 Publisher-Barry Block, DPM, JD

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CA Podiatrist Discusses Foot Care Safety Tips When Beautifying Feet

You probably already know to cut your toenails straight, leaving just a sliver of white at the top. Rounding them like you would your fingernails leads to ingrown toenails, then pain, maybe pus. Once a week, remove any calluses or dry, dead skin with a pumice stone or foot file. It'll take a minute; two, tops. If you have diabetes, podiatrist Dr. Jeffrey DeSantis suggests leaving the exfoliation to your doctor, since poor circulation can dull sensation and prevent you from noticing when you've scraped too far.

Dr. Jeffrey DeSantis

If you want pretty feet, consider the professional pedicure: calluses scraped down, ingrown toenails removed, skin softened through various soaks and ointments. Plus, you get a foot rub. Just ask them not to buff your nails, which tends to look like you got a coat of clear polish. One warning: some salons don't properly disinfect between customers, which can lead to fungal infections. If you're particularly worried about this, DeSantis recommends investing in and bringing your own tools.

Source: Rodney Cutler, Esquire [4/29/13]

PM News has begun a new weekly feature called Quick Poll. Each week, we will post a new poll based on some of the controversial issues discussed in our Comments/Responses section. Straw polls are not scientific and do not represent standards of care.

Quick Poll
What would you recommend as a career for your child?
Click HERE for Results

PA Podiatrist Discusses Buying Athletic Shoes for Teens

Parents of active kids face a seemingly endless variety of athletic footwear with an equally endless price tag. “You don’t have to break the bank to get the best sneakers or shoes,” said Dr. Allan Grossman, podiatrist at Harrisburg Foot and Ankle Center. “People think the more money you spend, the better the shoe, cleat, or sneaker is and that’s definitely not true. A lot of time it’s the cosmetics you pay for.”

Dr. Allan Grossman

“You have kids playing at high intensity all year round now,” Grossman said, making it all the more important to find well-fitting shoes that distribute the force from the body’s weight. “It’s more of an education of what to look for.” Teens, though, often derail the best-laid plans, seeking the latest trend or a shoe that matches their uniform. “It looks cool, but functionally they don’t work at all,” Grossman said.

Source: Yvonne Feeley, Pennlive.com [4/29/13]

Unmatched Residents Number Drops to 96: AACPM

According to the statistics just released by the American Association of Colleges of Podiatric Medicine (AACPM), the number of unmatched residency applicants have dropped from 104 to 96.  Of the 96, 59 are from the Class of 2013 and 37 are from the Class of 2012 or earlier.

When taking the overall placement stats into consideration, 83% (524) of the 631 residency applicants have found residency positions thus far this year. With nearly 2% (11) of residency applicants not seeking or ineligible for placement, it leaves close to 15% (96) total applicants that have yet to find a residency position for the 2013-14 training year.

Query: Foreign Body Granuloma?

This new patient, an otherwise healthy 29 year old female, with a 4 month old "infection", failed  a course of Septra DS. A few weeks after pedicure, she noticed the nail as you see it. It is more annoying than painful. The granulomatous tissue is completely isolated from the nail and the nail is in perfect condition (no proximal lifting). 

Foreign Body Granuloma

The only affected area of the toe is the superior portion of the eponychium. C&S pending. I don't expect much from the culture. Do I perform a punch biopsy? Is it a foreign body granuloma? It seems simple, but looks funky.

David Kahan, DPM,  Sacramento, CA

Query: Extensor Tendinitis ICD-9 Code

What is the ICD-9 code for extensor tendinitis?

Scott Margolis, DPM, Houston, TX

Response: In ICD-9, you go to the Index first, and look up "tendinitis". Tendinitis exists, but not specifically extensor tendinitis. You have to look at the codes in the Tabular section.

Go to the Tabular section, to ICD-9 726.7 (enthesopathy ankle and tarsus). When I am there, I feel the condition you are looking for falls under the "Other" option which is ICD-9 726.79. The reason is that this is a specified diagnosis, not an unspecified diagnosis (the reason I do not recommend ICD-9 726.90).

David J. Freedman, DPM, CPC, Silver Spring, MD

Codingline subscription information can be found here

APMA Members: Click here for your free Codingline Silver subscription

RE: Chronic Onychomadesis (Joseph Reynolds, DPM)
From: Neil H Hecht, DPM

Distal disruption of nail plate to nail bed is termed onycholysis. I know of no acceptable surgical procedure to “tack down” this non-living protein (keratin) nail plate to a living nail bed. This doesn’t make any sense to me on a physiologic basis.
 
Proximal disruption of the nail plate to the nail bed is termed onychomadesis. In case any of the readers remember Dr. Philip Gardner (CCPM in the 1970s), the nail groove callus is termed onychophosis. I use onychauxis to describe a thickened (hypertrophic) nail and onychogryphyosis to describe a grossly distorted nail (“claw nail”). Both would be examples of onychodystrophy. 

Neil H Hecht, DPM, Tarzana, CA, drhecht@drneilhecht.com

RE: Non-Specific Bone Marrow Edema Syndrome?
From: Howard J. Bonenberger, DPM

It is difficult to tell from one MRI slice, but it looks like the subtalar joint line is angled relative to the tibia-talar joint line, and that there are signal and morphology changes at the sustentaculum tali. Has tarsal coalition been considered? Additional slices posted by the podiatrist could be helpful. Certainly, the compressive forces brought on by a coalition could lead to pain and marrow edema in the associated bones. Are there other physical findings such as peroneal spasm, limited ROM of the STJ? Is the halo sign seen on the lateral x-ray?

I had a similar case with a late-teen female athlete who had a fibrous, extra-articular coalition at the posterior-medial STJ. Her diagnosis took a very long time as her symptoms and the diagnostic studies were confusing to the multiple specialists who evaluated her.  Eventually, she underwent a STJ fusion and has done well.

Howard J. Bonenberger, DPM, Nashua, NH, howardbon@aol.com

RE: Post-Op Hallux Varus (Kel Sherkin, DPM)
From: Andrew I. Levy, DPM

I have read Dr. Sherkin's question and what I believe are all of the answers you have gotten so far. There are some things I agree with and something important I think that has been missed. First of all, I agree that no casting of stones is appropriate; this result could have come from a podiatric surgeon just as readily. At this time, the deformity may just be cosmetic. While none of us can accurately predict the future, I have a high suspicion of it being progressive over the years.

What is critical in planning a corrective procedure is the proximal retraction of the sesamoids. That would indicate the separation of the sesamoidal-phalangeal ligaments and would doom any of the suggested soft tissue procedures suggested to failure due to loss of the plantar stabilization of the base of the proximal phalanx. If and when the time comes for a definitive procedure, my vote would go to the 1st MPJ fusion

Andrew I. Levy, DPM, Jupiter, FL, rcpilot48@gmail.com

RE: Wireless Printers and HIPAA (Elliot Udell, DPM)
From: Michael L. Brody, DPM

As Barry Block indicated, most wireless printers have a 'wired' network option. The issue with HIPAA and wireless printers is the same for any and all wireless devices, and that is security. If you can avoid going wireless and use only a wired network, it has a higher degree of security. If you intend to utilize wireless networking in your practice, you want to ensure that you have the best possible security on that wireless network.

When using wireless communications, I recommend that you always utilize WPA-2 or better encryption, turn on MAC filtering, and monitor your wireless access points for attempted "break-ins" to your network. It is best to utilize the services of a network professional when deploying wireless networks. No matter if you have a wired, wireless, or a hybrid network (Part wired, part wireless), you want to have a good firewall and good security for your entire network to protect the network from attacks.

Michael L. Brody, DPM, Commack, NY, mbrody@tldsystems.com

RE: Wireless Printers and HIPAA (Elliot Udell, DPM)
From: Al Musella, DPM

Dr. Udell brings up an important point. There are free tools available that allow anyone to scan  your wireless network. If your wireless network doesn't have encryption, anyone can have all of your passwords and access to everything on your network within minutes.

To prevent that, you need to use encryption. The older style was called WEP. Older computers can only use this method - but it is an option on...

Editor's note: Dr. Musella's extended-length letter can be read here.

RE: Patients' Requests for X-Rays (Don Blum, DPM, JD)
From: Michael J. Hodos, DPM, Michael L. Brody, DPM

Prior to getting a digital x-ray system, I would do the same; take a digital photograph of the x-rays and send it to the patient.

Whenever I send sensitive information over the Internet, I always encrypt it. I typically send a PDF file that is encrypted with the patient's SSN. It is free, something that the patient knows, their PCP would know, etc., and allows for safe transmission. I do the same thing when I send information to my accountant, as he has my SSN already as well.

Michael J. Hodos, DPM, Wake Forest, NC, mike@mikehodos.

Dr. Blum indicates that he emails copies of x rays to patients. I strongly recommend against this practice as email is not secure and this is a potential HIPAA violation.

Michael L. Brody, DPM, Commack, NY, mbrody@tldsystems.com

RE: Success Tips From The Masters (John Mattiacci, DPM)
From: Leonard A. Levy, DPM, MPH

A DPM is a physician: A rose is a rose by any other name. In the April 30, 2013 Success Tips From The Masters, John Mattiacci, DPM, says that “parity is the wrong word” regarding DPMs and MDs. Furthermore, he indicates that Temple Medical School MCAT scores are 10 points higher than for podiatry students. MCAT scores are not relevant when talking about the issue of parity. Many U.S. students are Foreign Medical Graduates (FMGs) not accepted to a U.S. school. The vast majority become licensed to practice medicine as do students graduating from Temple.

Also, many FMGs had MCATs equivalent to (or less than) students applying to U.S. podiatric medical schools. The analogy of “printers vs. plumbers” is not appropriate. A better analogy is comparing  podiatric physicians to ophthalmologists, both of whom virtually have the same responsibilities in their specialty.
 
Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL, levyleon@nova.edu

RE: Purchasing a Digital X-Ray System (Laura R Lefkowitz, DPM)
From: Neil Levin, DPM

I recently purchased a Konica Sigma Pilot CR digital x-ray system. My X-Cell machine is 20 years old and did not have to be modified at all. The system is perfect for a solo practitioner office. It has all the bells, whistles, and tools you will need. The images are terrific. The support has been excellent, and if you don't want to buy computers/monitors for all your rooms, you can bring the image up on a laptop or I-pad and bring it room to room. (It is a little bit of a hassle if you are busy, but works well). The system is also more affordable than others I considered.
 
Neil Levin, DPM, Sycamore, IL, DRFEET1@aol.com

RE: Podiatry's Secret Problem (Victor S. Marks, DPM, MPH)
From: Richard M. Maleski, DPM

Is it mere coincidence, clever manipulation by the editor, or some Karmic influence that put the posts about podiatry's secret problem and 104 graduates not having residencies together in the latest PM News?

I read Dr. Marks' retort to Dr. Moskowitz's concern about billing for routine services, and agree with Dr. Marks, the aging of America with the resultant morbidities that age brings should be a major focus of...

Editor's note: Dr. Maleski's extended-length letter can be read here.

RE: Appreciative Jerry Seinfeld Donates to NYCPM (Richard Jaffe, DPM)
From: Joe DeTrano, CPC

I hope Dr. Jaffe was being sarcastic when he said Seinfeld defamed the podiatry profession when he said, "anyone can get into podiatry school." If you remember, the show also skewered dermatology. Again, like all things in the world of "Seinfeld," it was just a joke.

I know Seinfeld is very pro-podiatry. Before the show hit it big, he did a promotion with the APMA promoting podiatry and letting patients know how important a podiatrist visit is. A poster with him was in every podiatry office I visited in the early '90s. One doctor in NY still has it hanging in his waiting room today!

I think he was helped by a DPM and gave a donation to the doctor's school who helped him.

Joe DeTrano, CPC, Medical/Medical Data Resource Providers, joe@medical-billing.com

EQUIPMENT FOR SALE - CUTTING EDGE MPL  THERAPEUTIC "COOL" LASER

Purchased 04/2010 Purchase price $27,000 Asking $13,000 (Image 1, Image 2, Image 3). Our doctors just haven't been using it enough. email mrobsondpm@aol.com

EQUIPMENT FOR SALE - BIOMEDIX PADNET SYSTEM
 
PADnet is clinically valuable, provides fair financial return with medically appropriate testing and seamlessly integrates with the complete suite of BioMedix® products and services. One year old. In Excellent condition. Buyer pays for shipping. Please contact Rhonda Daggs at info@footanklecenters.com

EQUIPMENT FOR SALE - FOX YAG LASER

Mint condition, still under warranty. Unit is portable & includes all the accessories. $14,500.00. Call 727 586-3668 or 727-321-310.

PRACTICE FOR SALE - VIRGINIA

62 years consecutive private podiatry practice, excellent referral base, busy, modern equipment; X-Cel Xray machine, digital Tigerview scanner, Traknet EMR, and 3 new Midmark chairs for the doctor and patient. Virginia license is required. Please contact Dr. Fine at drmichaelfine@aol.comor 703-582-5999.

PRACTICE FOR SALE - BROOKLYN, NY

28 year old practice in a desirable part of Brooklyn. EHR certified with stage 1 criteria successfully met. Practice has room to grow. Good mix of Medicare hazardous foot care; surgery and wounds. Low overhead. Priced to sell. Email Inquires to brooklynpracticeforsale@gmail.com.

PODIATRIST SEEKING EMPLOYMENT - CHICAGOLAND AREA
 
Personable, well trained ABPS Board Certified podiatrist with 10 years experience seeking associate position or buy-in opportunity in the Chicagoland area. Please email inquires to ewcv5@hotmail.com.

ASSOCIATE POSITION - SUBURBAN WASHINGTON

Busy 4 office practice in suburban Washington, DC seeing highly motivated individual for full time associate position leading to partnership. Minimum PSR 24. Competitive salary and benefits.  Respond to mlmltm@aol.com

FT OR PT ASSOCIATE - SOUTH JERSEY

Great opportunity for FT or PT associate starting July 2013 in established practice in South Jersey. EMR, FDA-approved Lasers for fungus. Will work with Board Certified/Qualified podiatrist. Must have New Jersey License. Diverse practice in a nice area with a pleasant environment. e-mail CV at hhfootdoctor@gmail.com

ASSOCIATE POSITION - NEW JERSEY

Immediate opening for a full time podiatrist in a rapidly expanding multi-office practice in central New Jersey. Well established referral base with full admitting hospital privileges. Compensation is performance based with patients scheduled from day 1. Wonderful working conditions. Applicant must have at least PSR-24 surgical training. Valid NJ license and Medicare number is required. Applicant should also be familiar and competent in podiatric surgery, biomechanics, trauma, PRP, wound care, and ultrasound diagnostics. Participating insurance #'s a plus. Please fax resume to: (609) 259-6637.

ASSOCIATE POSITION - NORTH TEXAS

Associate position available. Located 50 miles from Dallas. All phases of podiatric care with no ER call. PSR 24 required. Hospital privileges & strong referral base. Practice has EMR, digital X-ray & on site vascular testing. Very competitive salary and benefits. Please send CV to Footdoc3143@gmail.com

ASSOCIATE POSITION - NEW YORK

Large established podiatry practice 30+ years in New York Hudson Valley/Capital District area seeking associate/partner to eventually take over practice. Also would entertain reasonable offer to purchase one of the two offices. Serious Inquiries may contact: Podiatrygroupny@gmail.com

PODIATRIST WANTED - PENNSYLVANIA

Multi-specialty physician group seeking part-time or full-time to join our Johnstown, PA facility offering on-site x-ray, vascular ultrasound and other services. Patient base already established. Experienced or recent graduates considered.  Applicants send resume to cfleegle@atlanticbbn.net or call 814-288-1418 ext. 7.

ASSOCIATE POSITION - UPSTATE NY

Busy multi-specialty practice of PCPs, general surgeons, OB-GYN, podiatric surgeons looking for a full-time podiatric associate in  Upstate NY, Binghamton, Finger Lake Region. Great Benefits, opportunity for partnership. Must be highly motivated, personable and be Board qualified/eligible. Our podiatrists have over 100 years combined experience. Please send CV to associateinfoot@yahoo.com or fax 607-723-1567.

ASSOCIATE POSITION - NORTH CENTRAL, NJ

Well established busy solo physician seeking a well trained podiatrist (PMS 36) to join our growing practice. Bilingual English Spanish a big +. Competitive salary/benefits package. Send CV to email: njpod2013-1@yahoo.com

ASSOCIATE POSITION DETROIT SUBURBS

Multi-location practice seeks individual with excellent surgical training.  Practice is well established for over 30 years.  EMR’s available, ultrasound, Doppler & circulation testing, digital x-ray.  Buy in opportunity as owner plans on retiring in 2016 or sooner.  Please send cover letter with CV to footlaw@hotmail.com

ASSOCIATE POSITION - NORTHWEST IOWA

A well-established, Midwest multi-physician practice with strong hospital affiliations seeking FT podiatrist. Applicant should be well trained surgical physician, completed a 12/24 month residency, & board eligible. Practice offers high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume: 712-258-9977.

POSITION AVAILABLE - CENTRAL FLORIDA

Two doctor practice looking for an associate to take retiring doctor's position with partnership opportunity for the right person.  Competitive salary, health insurance and incentives. Two offices serving a diverse number of routine, surgical and wound care patients. Two years surgical residency training and FL license required. If interested in this great opportunity please e-mail CV, surgical log and references to toesrus7@yahoo.com.

ASSOCIATE POSITION - MARYLAND, DC, PA

A podiatrist is needed for the Baltimore, Washington, Pennsylvania area. Partner for the corporation. Surgery center, emergency room call and a hospital location. All areas of podiatry. Established practice. Salary and commission. Fax resume 410-857-4227 or email at butler@qis.net

ASSOCIATE POSITION – MISSOURI

Podiatric medical group seeks PSR24-36 individual who is interested in working with former residency director who can enhance your already strong training. Full scope practice with the cases to fast track to board certification. Four hospital affiliations, certified surgical suite in office, ultrasound, EHR Certified Stage 2. We are located close to St. Louis for day use. Exceptional school system in a low crime, low cost of living area. E-mail resume to: drfootski@hotmail.com

PODIATRISTS NEEDED - LOS ANGELES, CA
 
Home Foot Care, Inc. Is looking for motivated podiatrists to provide quality mobile care to our home-bound patients. Flexible schedule, independence, great compensation. If interested, please email resume to homefootcare@hotmail.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Requiring full-time podiatrist (PSR-24 or greater) in established Practice situated in a foothill community of Southern California. There is an existing patient base and a strong support team. Compensation is performance based with practically an unlimited earning capability. A possible buy-in is negotiable. Send resume to office@uplandpodiatry.com, titled "podiatrist."

ASSOCIATE POSITION - MASSACHUSSETS

Located near Boston. Busy multi-office podiatry practice looking to expand. Need extremely energetic dedicated individual. Must be PSR 12-24 trained, EMR, laser, vascular testing the works. Must have sense of humor. MA License, NH License A+! Surgery, sports medicine, pediatrics, shoe store. Please send resumes to resumesent11@comcast.net.

ASSOCIATE POSITION - SOUTH CAROLINA

South Carolina's largest provider of foot care is a multi-doctor, multi-location practice currently seeking a highly skilled, personable, and hardworking physician to join our TEAM. South Carolina License is necessary. Above average salary and benefits. Please send Letter of Interest and CV to scdpmjobs@gmail.com.

PODIATRY PRACTICE LOCATION AVAILABLE - UPPER EAST SIDE NYC

Prime NYC Practice Location: 200 East 72nd Street. Street level with signage. My equipment or yours. Will stay on to introduce or leave.  E-mail Dr. Shavelson. drsha@lifestylepodiatry.com

SPACE AVAILABLE - NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview, Long Island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed PODO2345@AOL.COM 516-476-1815.

PM News Classified Ads Reach over 14,000 DPMs and Students

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