The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

May 02, 2011 #4,149 Publisher-Barry Block, DPM, JD

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Foot Problems are Often Signs of Other Conditions: MD Podiatrist

“People tend to ignore their feet as they age,” says Neil Scheffler, DPM, a podiatrist at Sinai Hospital in Baltimore, MD, and author of the book 101 Foot Care Tips for People with Diabetes. “Some are so accustomed to having their feet hurt that they think it’s normal. But the longer you ignore a problem, the worse it might become.” Being vigilant about foot care can keep you comfortable and active for years to come. 

Dr. Neil Scheffler

Foot problems are sometimes the first sign of a more serious medical condition. Joint stiffness could indicate arthritis, for instance. Tingling or numbness could be a sign of diabetes. Swelling might indicate kidney disease, heart disease, or high blood pressure. And poor foot function can exacerbate existing problems like arthritis or lead to balance problems. “There are so many things that affect the feet as we get older. Everyone should have an individualized treatment plan based on their needs and the presence of other conditions or medications,” Scheffler says.

Source: Lisa M. Davila, Erikson Living Tribune [April 2011]

NY Podiatrist Recommends Yoga to Take Care of Feet

Dr. Robert Kornfeld, a holistic podiatrist in New York City, says he has seen it all: people hobbling in with knobby, inflamed bunions and hammertoes, the dull throb of tendinitis, the achy soles of plantar fasciitis. Those aren't just minor ailments; some foot problems can alter the foot's structure and trigger pain elsewhere in the body. "I sing that song to my patients," Kornfeld says: "The foot bone's connected to the leg bone..." In fact, experts say, one of the most important reasons to treat foot problems early is to prevent them from throwing the knees, hips, back, and shoulders out of whack. 

Dr. Robert Kornfeld

And one of the best ways to take care of your feet is with yoga. "I recommend that all my patients start yoga immediately," Kornfeld says. "When you treat foot problems with yoga, you end up treating back pain, hip pain, all kinds of structural problems. Not only does it stretch out the muscles and lead to a greater range of motion, but it helps heal the root issue of inflammation as well."

Source: Melanie Haiken, Yoga Journal, [4/27/2011]

AAPPM Holds First Super Users Meeting

The American Academy of Podiatric Practice Management (AAPPM), in conjunction with BioMedix™, successfully held the first TRAKnet™ PM – DPM Edition Super Users Meeting this week in Pittsburgh, PA. Approximately 40 podiatrists, including 19 new AAPPM members, were in attendance for this in-depth training session.

Drs. John Guiliana and Hal Ornstein at AAPPM Super Users Meeting

Dr. John Guiliana was the featured speaker and trainer during the meeting. AAPPM chairman Dr. Hal Ornstein said, "The AAPPM is proud to partner with BioMedix™ in these initiatives and looks forward to continuing the educational meeting series before all upcoming AAPPM events."

OH Podiatrist and Wife Receive 2 Week Sentences for Animal Cruelty

Heidi and Steven Friedman, a podiatrist, were both convicted April 6 of three counts of cruelty to animals. Both were sentenced to 14 days in jail with permission to leave for work. They were also sentenced to three years of probation, ordered to get psychological evaluations and allow random home inspections, and barred from having children and animals in their home.

The city took 25 dogs, eight cats, three birds, a rabbit and two guinea pigs from their house Aug. 13, when a neighbor complained that the family had gone on vacation Aug. 2 and left the animals locked in the house without air conditioning or open windows.

Source: Donna J. Miller, Cleveland Plain Dealer [4/29/11]

Query: Biomedix EMR

I was wondering what people's experience has been with Biomedix EMR. I am about to take the plunge, and my main concern is to decrease the amount of time it takes me to chart, bill, send referral letters, etc. 
 
Laura R Lefkowitz, DPM, Beverly Hills, CA

RE: Neuroma Injection Complication (Ron Werter DPM)
From: Rich Hofacker, DPM, Barry Mullen, DPM

I have had the same result with a couple of my patients. I believe it is an allergic reaction to the injection. I have used a Medrol Dose Pak to resolve the problem each time, and I do not re-inject after the symptoms subside.

Rich Hofacker, DPM, Akron, OH, cavsdoc26@att.net

Rule out a DVT via STAT venous duplex scan for possible iatrogenic, intravascular administration of your prolotherapeutic agent (alcohol) into the inter-metatarsal vein. In addition, immediately contact your patient to educate him of this possibility to: a)ensure he currently has no shortness of breath, and b) have him closely monitor this symptom until he gets the scan done; should it develop, inform him to immediately check himself into an ER. STOP his activity level immediately. In addition, review his medical history to see if he has any concomitant DVT risk factors (DM, obesity, smoker, blood dyscrasias i.e., polycythemia, past personal or immediate family history of DVT, etc).

ANY injury/insult to ANY venous vascular wall could trigger a DVT at a remote site. I've seen several undiagnosed DVT cases from relatively trivial forefoot injuries, though I must admit these are more common, though not restricted to, young women on BCP's. Clinically, ANY young female on BCP's who presents with vague calf pain is a DVT until proven otherwise. Often, patients do not recall trivial trauma, yet when thoroughly questioned, after the fact, will recall one.

In this case, the absence of an elevated white count w/no antibiotic response, the physical signs and symptoms (erythema, leg swelling, heat and dull calf pain) and their described locale signify, at minimum, a superficial phlebitis of the greater saphenous vein. Short-term, follow typical superficial phlebitis protocol (leg elevation, mild compression, moist heat, oral NSAIDs provided that there is no concomitant contra-indication, and rest).

Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

RE: Distal Hallux Nail Growing Into Distal Nail Edge (David Kahan, DPM)
From: Jon Purdy, DPM, Kevin L. Sneider, DPM

This is the exact reason why I hesitate to remove total nails. I probably only take off four a year. I would show them how to loosen the leading edge of the nail from the nail bed. It may be necessary for them to place a little wisp of cotton under the edge periodically. Urea cream or a similar keratolytic is good for the moisture part of things.

Jon Purdy, DPM, New Iberia, LA, podiatrist@mindspring.com

I have seen a few of these after oral anti-fungal treatment and a couple of times after nail loss secondary to trauma. Typically, these will resolve once the entire nail plate has grown out distally. Trim the leading edge of the nail to alleviate symptoms in the meantime. This will likely require use of a local anesthetic.

Kevin L. Sneider, DPM, Port Clinton, OH, ksneider@cros.net

RE: Duty to See Patients in Isolation (J M Cortez, DPM)
From: Jeffrey Kass, DPM, Paul Busman, DPM,RN

I do not understand the posting by Dr. Cortez.. If universal precautions are utilized, and the necessary precautions  are taken with patients in isolation, whether it be gowns, masks, gloves, respirator, I am not sure there is any more degree of cross-contamination than seeing two patients who are not in isolation.

Jeffrey Kass, DPM, Forest Hills, NY jeffckass@aol.com

Didn't we go into podiatry to treat all patients, not just the healthy ones? Otherwise, why go into any healthcare profession? Please don't cherrypick your patients-- treat all that need it. Follow the institution's isolation precautions, follow universal precautions, and you won't have a problem.

I wonder how many of us would come out positive for an MRSA nasal swab...that would require that we be put in contact precautions in the hospital where I work. Does that mean you wouldn't cut my toenails if they needed it or treat my heel ulcer?

Paul Busman, DPM,RN, Clifton Park, NY, paul@busmanwhistles.com

RE: Keryflex Toenail Restoration (Susan Papp-Mlodzienski, DPM)
From: Cindy Pezza, PMAC

We currently use Keryflex in our office and have for over a year. It definitely goes in cycles according to seasons. Begin introducing the product right away as you will want to start the patients on Formula 3 before treatment. That is how we do it. After the patient has used it for a few weeks twice daily, we perform the procedure. The doctor debrides the nail down until there is 20 percent left, and then I come in and build the new nail.

Introduce this as not only a cosmetic fix for the problem nail, but when you remove the keratin after two months or so, the nail underneath appears healthier as it has been protected, and the patient will continue to treat it with Formula 3. We also suggest using Dr.s' Remedy nail polish after the procedure, as it will not harm the new nail with chemicals. Please feel free to contact me with any further questions.

Cindy Pezza, PMAC, Stoughton, MA, cpezzapmac@yahoo.com

RE: Liquid Nitrogen for Warts (John Moglia, DPM)
From: James Ricketti, DPM

I cannot believe people are still dipping into a bottle of phenol these days. Complications can arise from foreign bodies introduced into the phenol. Also, the phenol denatures over time. A product such as Pedinol Phenol EZ Swabs would prevent all of the above problems. Also, one application per border for 60 seconds prevents excessive drainage.

Disclaimer: I am the inventor of the Phenol EZ Swabs

James Ricketti, DPM, Hamilton Sq., NJ, drj4foot2002@netscape.net

RE: Sometimes Size Really Matters (Doug Milch, DPM)

Dr. Milch's story reminded me of one I had. A patient who happened to be a veterinarian came in to see me for heel pain. When I put the lateral x-rays up on the light box, he commented that at first glance, it looked like I was showing him a dog's skull. I told him it brings new meaning to the saying "my dogs are barking." We both had a good laugh.

Jeanne M. Arnold, DPM, Coeur d'Alene, ID

PRACTICE FOR SALE - NORTHWEST SUBURBS, CHICAGO, IL

Great Opportunity! Present owner to stay on for transition. Average 20% growth over 3 years while open only 4 half days a week. Excellent growth potential with increased hours. Perfect for a new practitioner or a 2nd location. contact podiatrynwsuburbs@gmail.com for information.

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. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

ASSOCIATE NEEDED - MIAMI, FL

Full-time. Very Busy practice. Rearfoot/forefoot/wound care. Salary + % gross. Send CV to footdoctorinmiam@aol.com

PART-TIME PODIATRIST NEEDED - LOS ANGELES, CALIFORNIA

Busy podiatrist looking for assistance with treating home-bound patients. Flexible hours, independence, and great compensation. If interested, email CV to homefootcare@hotmail.com

ASSOCIATE POSITION - TEXAS

Need a good paying job in San Antonio or Austin? Just ask the other podiatrists working with us. Good hours and great support staff. Consider us first! Check out www.footmobile.com and reply to footcenter1@sbcglobal.net

ASSOCIATE POSITION AVAILABLE - THE BRONX

Excellent hospital based opportunity. Inpatient & Outpatient Care. Busy clinics. Large diabetic population. Practice all aspects of Podiatric Medicine & Surgery. Requires Surgical Skills. CV to nealblitz@yahoo.com

ASSOCIATE POSITION - SOUTH/CENTRAL PENNSYLVANIA

PSR-24/36 trained individual for busy practice in family-friendly college town. Seeking personable, ethical, motivated individual to join our well established practice providing all aspects of podiatric care. Competitive salary and benefits package. Reply with letter, CV and photo to Jagerone@aol.com.

ASSOCIATE POSITIONS - NW INDIANA, CHICAGO AREA

2 Full-Time positions open - One for Northwest Indiana and one for the Chicagoland area. Must have 2-year surgical residency. Must be motivated and a self-starter. State License required. If interested email: f-massuda@footexperts.com

ASSOCIATE POSITION – NEW JERSEY

Associate wanted full-time, for practice in East Orange NJ PSR 24-36 trained. Must be motivated to grow practice, especially build wound care and surgical services. Buy-in possible after the 1st year. send CV to Drfoot44@gmail.com

ASSOCIATE POSITION - CT - (FAIRFIELD AND NORTH HAVEN)

Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices, including EMR, digital x-ray, vascular and NCV studies, Pinpointe and CO2 lasers, diagnostic ultrasound and electrical stimulation therapy. You can expect a full schedule of patients the day you start, and a very competitive salary. For more info www.greatfootcare.com. Send resume to Dr.Kassaris@yahoo.com

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