The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

May 03, 2013 #4,759 Publisher-Barry Block, DPM, JD

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Healthy Feet Required to Meet Demands of Urban Walking: NY Podiatrist

The average American takes only 5,117 steps a day—that’s just shy of 1.5 miles. While New Yorkers’ walking habits are poorly studied, anyone who lives in the city knows the distance of their daily trek is well above the national average. Your feet have to last you a lifetime of travel,” said Dr. Paul Betschart, a podiatrist at Midtown Podiatry. “In New York, you have to walk or you go broke—you can’t take a cab everywhere.”

Dr. Paul Betschart

“The more steps you take, the more strains you put on your feet, and the more the little problems people have are going to be magnified,” Betschart said. A search on WebMD’s directory turns up 821 podiatrists in the five boroughs, a testament to that statement. “Quite often we have people who are overweight, they have foot problems, and can’t exercise,” Betschart said. “If we can get their foot pain under control, they can get their weight under control. If they get their weight under control, they get less foot pain, too.”

Source: Christine Lin, Epoch Times  [5/1/13]

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

CA Podiatrist Discusses Risk Factors for Achilles Tendon Rupture

The weekend warrior athlete is a term loosely used to describe adult males (aged between 30 to 55 typically) who engage in sporting activities for social or competitive reasons, but not as professionals. These males tend to be de-conditioned compared to professional athletes who routinely train and condition their bodies for physical sports. Although anyone can experience an Achilles tendon rupture, there are certain recognized risk factors that place people at increased risk for rupture, says CPMA spokesperson Wenjay Sung, DPM (Los Angeles, California), who has written and spoken nationally on the repair of ruptured Achilles tendon. These risk factors include:

Dr. Wenjay Sung

• Weakness of the calf muscle due to de-conditioning
• Over-extension or exertion of the tendon
• Specific antibiotic use (ex. Fluoroquinolones)
• Cortisone injection(s) around the Achilles tendon
• A previous history of Achilles tendonitis
• Previous Achilles rupture treated non-surgically

Source: Tutorial Finder [4/30/13]

MPMA Announces New Officers and Board Members

Enzo Leone, DPM, who practices in Pasadena, has been named president of the Maryland Podiatric Medical Association for 2013-2014.

Dr. Enzo Leone

The other officers are:
Vice president - Jordan Stewart, DPM
Treasurer - Benjamin Kleinman, DPM
Secretary - Justin Lewis, DPM
Immediate past president - Jerry Katz, DPM

Board members, elected to a five-year term, are: Ashleigh Korvis, DPM, Ross Cohen, DPM, Andy Liss, DPM, Brad Toll, DPM, and Jason Weber, DPM.

Source: Daily Record  [4/30/13]

TX Podiatrist Is Running for Victoria City Council Seat

Dr. Andrew Young is a candidate for Victoria City Council District 5. He is a licensed physician practicing in Victoria since 2001 and has been co-owner of Podiatry Associates of Victoria since 2004. He is an active supporter of numerous community groups and organizations as well as an avid sportsman and member of Trinity Episcopal Church.

Dr. Andrew Young

 "While some have pointed to my lack of political experience, I don't believe people here want or need more politicians. We need public servants who will listen, use common sense, and lead. My experience as both a physician and businessman make me uniquely qualified to do these things. In the course of running a busy podiatric practice, I make decisions with patients every day. I listen, analyze data, weigh risks versus benefits, and focus on improving a patient's quality of life while being mindful of their financial situation. I strive every day to do all this with the highest degree of honesty and integrity, and I will take these same traits to City Hall as a councilman," says Young.

Source: Victoria Advocate [5/1/13]

MA Podiatrist Presents Poster at Wound Healing Society’s Annual Meeting

Macrocure, a biotechnology company developing advanced cell therapy products, has announced that Dr. Latricia Allen, a physician in the group of Vickie R. Driver, DPM, will present a poster focusing on the positive results of a recent study conducted with the company’s flagship product, CureXcell®, at the Symposium on Advanced Wound Care - Wound Healing Society’s Annual Meeting, May 1-5 in Denver, Colorado.

Dr. Latricia Allen

The poster Dr. Allen will present is titled, “A prospective multi-center 24 week observational study evaluating wound healing outcomes in 131 patients in seven community wound care clinics in the largest HMO in Israel, treated with human activated leukocytes suspension, CureXcell." The poster summarizes the results of a phase-IV study in adult patients with chronic wounds (diabetic foot ulcers, pressure ulcers, venous ulcers, post-operative ulcers), resulting in approximately 70% of the wounds being closed within 24 weeks. The conclusion of the study was that CureXcell appears to be both safe and effective in healing chronic wounds.

Source: Biospace [4/29/13]

Query: Post-Keller Complication

The patient is a 54 year-old woman who wears orthotics. In 2011, she successfully underwent a Keller procedure (interpositional arthroplasty) for a moderate HAV with 1st MTP joint DJD. There is no pain or other problems in this area. What started as a mild contracture deformity of the 2nd toe has developed into a multi-planar deformity of the toe with pain and swelling at the 2nd MTP joint which has not responded well to treatment. Her best relief was through the use of a Medrol Dose Pack. Her arthritic profile was negative.

Post-Keller Complication

The Keller procedure likely increased pressure on the 2nd MTP joint with a subluxation/predislocation now evident. What is surprising is the rapidly advanced DJD with loss of joint space and bone cyst formation in the 2nd met head. I am concerned about the long-term integrity of the 2nd met head if I do not specifically address the bone cyst formation. I would prefer to leave her with an intact met head for weight-bearing, if possible. Suggestions?

Gregory Caringi, DPM, Lansdale, PA

Query: Does Rounding Cause Ingrown Toenails?

Can anyone show me any real evidence how rounding toenails cause them to become ingrown. I must personally be immune to this phenomenon as are thousands of patients I have treated over 20 years, who have had their nail grooves cleaned out and nails rounded. I read this being quoted all the time, but I can't find a single thing to prove that.

David E. Samuel, DPM, Springfield, PA

RE: Dorsiflexed Hallux (Kel Sherkin, DPM)
From: Monty Peerbhai, DPM, Don Peacock, DPM

Was the bone loss caused by OM? If so, a technitium and gallium combination may help to show if that process is still ongoing. If the dorsiflexion is caused by OA at the MTPJ, arthrodesis with iliac crest graft is recommended by Schur in a recent study, and by Myerson and Brodsky in older ones. Extensor tendon Z-plasty and the Keller may be options. RSD can also cause digital bone loss by the way.

Monty Peerbhai, DPM, Monticello, IN, mapmrt@gmail.com

This is another case where minimally invasive surgical procedures could be used with very little risk to the patient. In your lateral weight-bearing x-ray, there is obvious midfoot faulting and diminished first metatarsal declination angle. The etiology of his hallux extensus deformity is most likely due to gastrocnemius equinus attributing to hypermobility of the first ray and associated diminished ROM in the first MPJ. It is also likely that the FHL tendon insertion has been compromised from the osteomyelitis.

Address the gastrocnemius equinus deformity  by preforming an endoscopic gastric recession. This will improve the first metatarsal declination angle as well. Alleviating the gastrocnemius deformity will allow for a more functional pull of the peroneal longus tendon and aid the tendon in plantarflexing the first ray. It is likely that the extensus deformity is reducible and could be improved by percutaneously transecting of the EHL tendon. The EGR would also greatly reduce his forefoot pressure and should prevent the  ulceration from returning. 

The second and third toes which are deviated medially could be corrected via minimally invasive surgery using a modified Isham hammertoe correction. A lateral wedge osteotomy on the base of the proximal phalanx of the third and second toe would allow placement of these toes in a more normal anatomical position. You could perform all of these procedures minimally invasive. The procedures would be safe and would give the patient both improved cosmesis and greater biomechanical foot function.

Don Peacock, DPM, Whiteville, NC, peacockdpm@gmail.com

RE: Hired Gun Testimony of a Radiologist (Charles Lombardi, DPM)
From: Lawrence J. Kansky, DPM, JD

Dr. Glenn Schwartz did nothing wrong. He was not a hired gun because the transcript reveals that this was Dr. Schwartz's first court appearance, he was a subsequent treater, and he was paid a reasonable $4,000 for his time. Dr. Schwartz's testimony was consistent with his written report of 2006. He simply supplemented what he believed the "post-operative changes" were on the MRI. We all know that a nerve can be partially cut in the healing phase, or be damaged, mangled, or compressed while still being "intact".

A jury determines whether there is podiatric negligence, and not just a common unavoidable post-operative complication, based largely on the testimony from the podiatric expert(s) regarding causation and departure from the standard of care. Dr. Schwartz admitted multiple times that he did not know what surgical procedures were performed, so the jury only gleaned from him that the nerve at issue was not normal.

Calling Dr. Glenn Schwartz as a witness should have been somewhat anticipated by Dr. Lombardi's defense team because all potential witnesses, which usually includes all treating doctors, are listed with the court before trial. I thank Dr. Lombardi for sharing his upsetting and stressful experience with us, and congratulate him on his win.
 
Lawrence J. Kansky, DPM, JD, Wilkes-Barre, PA, Larry.Kansky@gmail.com

RE: Wireless Printers and HIPAA (Elliot Udell, DPM)
From: Raymond Posa, MBA
 
When I advise and/or consult with my HIPAA clients, I always advise against using wireless networking. While encryption protocols are much stronger than in the past, it is still a weak link in your network security. To turn on wireless network just to support a printer would be a totally unacceptable risk. There are so many business class printers that offer hardwire networking built in (i.e., HP 2000 series laser printers are an excellent choice for the office). Also, with wireless come other wireless issues like slower speed than hardwired (one tenth the speed of wired) and the nagging issues of dropped or weak signals to the printer. My advice is to stay wired, stay safe, and stay productive.
 
Raymond F. Posa, MBA – Farmingdale, NJ, rposa@themantagroup.com

RE: Patients' Requests for X-Rays (Michael Brody, DPM)
From: Charles Morelli DPM

Dr. Brody stated that emailing copies of x-rays is a potential HIPAA violation. Whenever I do this, and do it with some degree of regularity, the digital image that is sent to the patient (or to anyone for that matter) has no information or demographics printed on it. There is absolutely no way to identify who the x-ray would belong to. Does this qualify as a potential HIPAA violation?

Charles Morelli, DPM, Mamaroneck, NY, podiodoc@gmail.com

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

I had an X-Cel x-ray unit for over 10 years, and went to a digital x-ray system about 2 years ago. It was retrofitted to the X-Cel base and integrates into my EHR. The quality is very good and the support is excellent. In the long run, it will save you money over processing films. The company was FOZ Networks. Anytime I had a question or needed to know how to do something, I received an immediate response.
 
Harvey Danciger, DPM,  Palm Desert, CA, docofeet@hotmail.com

RE: Purchasing a Digital X-Ray System (Kenneth Meisler, DPM)
From: Larry Kosova, DPM

In 2007, I contacted Naomi, a manufacturer of digital imaging systems. I thought that their price was too high. After talking to them, they came out with a podiatry "lite" version. We don't need as powerful sensors to get a good foot and ankle image. I even used their software to lecture at the Midwest conference in Chicago.

Both Drs. Meisler and Brody make some good points, but not all of them were factual. For the most part, both CR and DR systems have the ability to produce excellent images for podiatry. Any x-ray machine can be...

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

RE: Laker Basketball Star's Injury May Have Been Preventable: TX Podiatrist
From: Doug Richie, DPM

As one of several colleagues who have been misquoted by the Wall Street Journal, I hope that this recent interview with Dr. Ed Davis represents poor journalism, rather than a true representation of what Dr. Davis actually stated. We are all aware that there is no evidence that a "tight Achilles" is more prone to rupture. To suggest that stretching, manual therapy, or "more advanced biomechanical intervention" would have prevented this high profile injury defies current scientific evidence. 

It is hard to imagine why any physician would want to second guess the world class sports medicine team who attend to the Los Angeles Lakers or any other NBA team. I can only wonder what MD sports medicine specialists are saying about this interview?
 
Doug Richie, DPM, Seal Beach, CA, DRichieJr@aol.com

ASSOCIATE POSITION - SOUTH EAST FLORIDA

Large established podiatry practice looking for a part-time associate. Experienced or recent graduates considered. Serious inquiries may contact us at podiatryg@yahoo.com

ASSOCIATE POSITION - WASHINGTON, DC/ MD SUBURBS

Prominent, established two office practice seeking well rounded, personable, ethical individual with sharp medical and surgical skills. Must be 24/36 month trained, ABPS qualified or certified. Partnership opportunity with ownership potential. Competitive salary with benefits package. Please send CV to ponyrunner66@gmail.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 - NORTHWEST CHICAGO SUBURBAN AREA
 
Medical-surgical podiatry practice seeking well-trained individual to work full-time with future partnership opportunity. PM&S-36 a minimum. Pleasant community 45 minutes outside Chicago. Send resume to feetdpm@yahoo.com

ASSOCIATE POSITION - WEST VIRGINIA 

Seeking podiatry associate in well-established, growing practice in small, friendly, safe city. New hospital built 2 years ago in nearby. large college is 35 minutes away. Immediate employment. Senior podiatrists is retiring. email resume to associatedpodiatrists@gmail.com or fax to (304) 623-2638. 

POSITIONS AVAILABLE -  PHILADELPHIA, PA AREA , & TEXAS

Looking for podiatrist to see patients in Nursing Home Facilities in Philadelphia, PA area  and Texas. AVAILABLE IMMEDIATELY.  Please contact me at doconcall@aol.com.

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.

TWO FOR TEXAS

Desiring to grow our group of successful medical and surgical professionals. We are seeking an exceptional Podiatric Physician and Surgeon with great interest and talent to serve as 1) Our Diabetic Foot Care Team Leader or 2)Our Sports Medicine Team Leader. Send CV and letter of interest to: greatdoctors1@gmail.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 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.

PRECEPTOR POSITIONS - PHILADELPHIA

(1) Preceptor Position available in Philadelphia and possibly (1) or (2) more in NY/NJ. Practice is diverse with a strong offering in podiatric rehabilitation, sports medicine and pain management. Two preceptors successfully completed this past year and gained tremendous hands-on experience. Please send resume to: ediamond7@comcast.net. To learn more:www.philadelphiapodiatrist.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.

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.

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.

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