The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

May 04, 2013 #4,760 Publisher-Barry Block, DPM, JD

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CA Podiatrist Uses PRP to Treat Olympic Hopeful

Like Tiger Woods and Kobe Bryant, Olympic hopeful Norris Frederick turned to revolutionary Platelet-Rich Plasma (PRP) therapy to relieve pain. The athlete reported significant relief after receiving PRP injections by Dr. Bill J. Releford of Beverly Hills. Dr. Releford, a doctor of podiatric medicine, finds PRP therapy beneficial in his practice, using it to treat sports-related and orthopedic injuries, and many other conditions.

Dr. Bill J. Releford

Dr. Releford is the medical director and founder of The Releford Foot and Ankle Institute and Beverly Hills PRP. He describes how he used PRP injections to treat the American long jumper: “After suffering a knee injury, the patient was treated with a series of two injections of platelet-rich plasma over a four-week period. The most significant initial subjective findings showed reduced pain and moderate to significant increases in range of motion.” Frederick plans to continue his quest for gold at the 2016 Olympic Games in Rio de Janeiro, Brazil.

Source: Digital Journal [5/2/13]

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. LAST DAY TO VOTE!

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

Flip-Flops Not Appropriate for Everyday Wear: APMA President

“Flip-flops are hugely popular, but it’s important to remember they’re not appropriate for everyday wear or for all occasions,” says Dr. Matthew Garoufalis, a podiatrist and president of the American Podiatric Medical Association. “Every spring and summer, podiatric offices see an influx of patients with injuries and ailments directly related to wearing flip-flops at the wrong time or wearing the wrong flip-flops altogether.”

Dr. Matthew Garoufalis

The secret to safely enjoying flip-flops through summer is two-fold, Garoufalis says. First, find the right style, and second, know when to wear flip-flops and when to wear something else. Put away your flip-flops when the weather is bad. “This one may seem obvious,” Garoufalis says, “but some people continue to wear their flip-flops even when the temperature drops, rain falls, or snow is on the ground. Wearing flip-flops in bad weather puts you at risk of injury if your foot slips out of a wet shoe or even frostbite if temperatures fall too low.”

Source: Havasu News- Herald [5/2/13]

Treat Patients Like Family: NJ Podiatrist

"Treat people how you would treat a family member," is the philosophy of Dr. Dan Margolin's practice, NJ Foot and Ankle Center in Oradell. Margolin moved his office from Somerset to Oradell in 2000. He's board certified in American Podiatric Surgery and podiatric orthopedics and medicine, and has served as chairman of the Department of Podiatric Surgery at St. Peter's Hospital in New Brunswick for more than three years.

Dr. Dan Margolin (Photo: Aimee La Fountain)

Margolin also started Shoes for the Needy, a program that runs from September through March to collect new or slightly worn shoes. Margolin had the idea after he noticed various patients unable to wear new shoes due to foot pain. He offered to donate the shoes instead of people throwing them away. "We had hundreds of shoes show up," Margolin said. An average of about 10,000 pairs of shoes are collected a year. Children's shoes are the highest in demand.

Source: Aimee La Fountain, The Record (NJ) [5/2/13]

6th Annual Graham Implant Symposium Draws International Surgeons 

The Graham International Implant Institute’s (GIII) 6th Annual Symposium was held in New Orleans, LA, April 25 – April 27, 2013. In attendance were top orthopedic foot and ankle surgeons from China, Mexico, Puerto Rico, and South America, as well as podiatric foot and ankle surgeons from the United States, Dominican Republic, and Canada.

(L-R) Drs. Stephen Barrett, Michael E. Graham, Peter Bregman, and Jian Zhong Zhang (China).

The GIII symposium offered lectures on the latest technology and innovations in foot and ankle surgery as well as a practical hands-on cadaver course. Presenters from the Association of Extremity Nerve Surgeons (AENS) included Drs. Peter Bregman, Stephen Barrett, and Andrew Rader.  The Graham International Implant Institute is a global-reaching organization dedicated to research, training, certification, and support on implantology for foot physicians worldwide.

CA Podiatrist Accused of Groping Women During Foot Exams

A 32-year-old hairstylist tearfully described in court Tuesday how a Torrance podiatrist pulled down her pants and underwear and squeezed her exposed breasts during an exam to obtain shoe inserts to soothe her aching feet. The woman was among three alleged victims whose testimony during a preliminary hearing persuaded Superior Court Judge Hector Guzman to order Dr. Arnold Serkin to stand trial on four counts of sexual battery committed during the past 10 years. Besides that suit, Serkin's adopted daughter is suing him in Torrance court, alleging he molested her as a child. The Medical Board of California pulled Serkin's license to practice in December.

Source: Larry Altman, San Gabriel Valley Tribune [5/1/13]

Query: Chronic First MPJ Pain
 
A 66 year old active diabetic (well controlled) female presents with chronic 1st MTPJ pain left foot. The patient related that the pain has been present for years and seems to be getting worse. Physical examination reveals: Neurovascular status intact; bony dorsomedial prominence over 1st MTPJ left foot. The patient has about 50 degrees of dorsiflexion available with minimal crepitus noted.

Chronic First MPJ Pain

X-rays reveal bony medial prominence 1st MTPJ and decreased medial joint space 1st MTPJ with dorsal spurring seen on the lateral view. My first thought was to perform an Austin, but now I'm considering the Osteomed metatarsal resurfacing implant or the Arthrosurface. Surgical perspectives are welcomed.

Query: Source for X-Cell X-Ray Tube

Where does one obtain an X-Cell (MB700A1C) podiatry x-ray tube (SXR-15)? What is the approximate cost?

Bruce Krell, DPM, Chandler, AZ

Query: Joint Remodeling and Fusion

I have a patient who presented with severe 1st metatarsal-phalangeal joint degenerative arthritis with an abundance of hyperostosis to both the metatarsal and proximal phalanx. I took the patient to surgery when the joint - both metatarsal head and phalangeal base - was remodeled followed by an attempted permanent fusion via compression screw and then plate application.

CPT 28750 represents the fusion, but is there any allowance for the extra work regarding the extensive remodeling and the plate insertion?

Response: You coded the surgery correctly using CPT 28750 which is fusion of the first metatarsal phalangeal joint. There are no other codes that would be appropriate.

If you feel that significantly greater work was performed than was defined in CPT 28750, consider adding modifier "-22" to the procedure code. This indicates to the insurer that "services provided are greater than that usually required for the listed procedure." Be sure to add an operative report and request peer review.

Howard Zlotoff DPM, Camp Hill, PA

Codingline subscription information can be found here

APMA Members: Click here for your free Codingline Silver subscription

RE: Post-Keller Complication (Gregory Caringi, DPM)
From: Tip Sullivan, DPM

The first question should be why did she have the original first ray deformity? One reason that I often see is hallux limitus, which creates enough DJD to make the joint non-salvagable. A dorsiflexed first ray in hallux limitus can certainly result in 2nd met overload and plantar plate rupture/dislocation. I would not be overly concerned with the cyst, but would discuss it in depth with the patient.

Over the years, I have moved more toward first MTPJ fusion and away from Kellers, except in those older sedentary people. Arthrodesis changes weight-bearing functional dynamics, and if done correctly, can off-load the second Met. If you are going to surgically address this, I would consider a Weil osteotomy (2nd). While you are there, remove the cyst. Along with a plantar plate repair, check out the Scorpion by Arthrex. Make sure that the post-op orthoses accommodate by getting the first ray down.
 
Tip Sullivan, DPM, Jackson, MS, tsdefeet@MSfootcenter.net

RE: Post-Keller Complication (Gregory Caringi, DPM)
From: Don Peacock, DPM
 
Unfortunately, this case is a result of an inappropriate procedure performed on a 54 year-old patient. Keller procedures should be used with caution and have a significant history of complications. In Keller’s original paper, he discussed that he also performed an extensor hallucis longus lengthening. This is overlooked by some surgeons. Kellers are intended for use in the elderly.

Two of the most significant deformities resulting from Keller procedures are...

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

RE: Dorsiflexed Hallux (Kel Sherkin, DPM)
From: Randall Brower, DPM

This forefoot is offering the patient no biomechanical help. A transmetatarsal amputation gives the patient the quickest return to function. Sometimes, we get tunnel vision trying to save toes without looking at the big picture, what are these toes doing FOR the patient? Previous osteomyelitis should warrant a definitive procedure. TMA with TAL or EGR.

Randall Brower, DPM, Avondale, AZ, footdoctor33@yahoo.com

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

To address Dr. Morelli’s question regarding sending digital x-rays via unsecured email, the answer is "yes," it is a violation. There are 18 elements that constitute identifiable personal information. If any one of these is present and the email is unsecure, it is a violation. One of the elements is a person’s email address.
 
It may sound like a very technical issue, but the law is the law; at a thousand dollars a pop for a violation and opening the door for further scrutiny, just get a secure email service such as Zix mail (zixcorp.com).
 
Raymond F. Posa, MBA, Farmingdale, NJ, rposa@themantagroup.com

Regarding the post of using a secure email service such as Zix: The new HIPAA Omnibus Law which was published on January 26, became effective on March 26, and becomes mandatory on September 23 has some very strong language in it regarding sharing patient information (even encrypted patient information) with other entities such as Zix. You MUST HAVE a valid up-to-date Business Associate Agreement with service providers, such as Zix, that provide routing and storage of your e-PHI (Electronic Protected Health Information). Failure to have this document is a clear violation of the new HIPAA Omnibus Act.

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

RE: Purchasing a Digital X-Ray System (Michael Brody, DPM)
From: Raymond Posa, MBA

Regarding Dr. Brody’s post on digital x-ray systems CR vs. DR, there are some erroneous statements. First CR is not a “true” digital system. Think of CR as a copy machine; we all know as you copy originals, you lose quality. The CR system is more closely related to traditional film than it is to digital x-ray.

In a CR system, an x-ray sensitive plate is put inside a standard x-ray cassette and exposed just like a traditional piece of film would be. Then the cassette is...

Editor's note: Mr. Posa's extended-length letter can be read here.

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

I am disappointed to see Dr. Richie's response to the piece in the Wall Street Journal concerning Achilles tendon ruptures. First of all, the piece contains portions of a communication I had written, so it puzzles me why he felt the need to make the post, considering he is unaware of the context. It is part of a discussion about Achilles ruptures, their etiology and prevention. The mention of the Kobe Bryant injury is listed as an interrogative, not a statement.

Dr. Richie then goes on to state, "We are all aware that there is no evidence that a "tight Achilles" is more prone to rupture."  I guess if one does not accept basic tenets of podiatric biomechanics, then it is okay to make such a statement. Consider reading  the extensive article entitled "Acute and Chronic Achilles Tendon Ruptures in Athletes" by Jonathan Thompson, DPM and Bob Baravarian, DPM published in Clinics in Podiatric Medicine and Surgery, 28 (2011), pp. 117-135.

Parekh, et al. also reported a decline in power ratings for certain skill players, specifically running backs and receivers, in the three seasons prior to their acute Achilles tendon rupture. It is possible that this observation suggests the presence of a prodromal period of Achilles tendinosis. Prodromal symptoms are reported by 15% to 20% of patients with eventual ruptures and include sharp pain in the tendon with activity, as well as reduced ankle dorsiflexion

Ed Davis, DPM, San Antonio, TX, ed@sanantoniodoc.net

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 - CALIFORNIA

Established foot and ankle specialty group looking for an experienced podiatrist. This position entails making rounds at local hospitals, skilled nursing facilities and having scheduled office appointments. Must be comfortable with all aspects of podiatric care and will be doing no less than the hiring partners. Full-time position with a competitive salary.  Looking for someone with a great bedside manner, energetic and will to go the extra mile to make a positive difference. Send CV to administrator@footnankledoc.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.

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

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.

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