The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

May 05, 2009 #3, 537 Publisher-Barry Block, DPM, JD

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Psychological Component to Foot Problems: NY Podiatrist

No one's suggesting it's a substitute for consulting your doctor. But the National Institutes of Health does report a somewhat uncanny ability of feet to flag what could be early signs of illness. Toe stiffness, for example, could indicate arthritis, numbness could signal diabetes, and swollen feet could be a warning of kidney disease, heart disease or high blood pressure.

Dr. Marc A. Brenner

What's more, now that open-toed shoe season is upon us, merely having feet that look less than healthy could exact a mental toll. "There's a psychological component to foot problems," says Dr. Marc A. Brenner, a noted author, lecturer and past president of the American Society of Podiatric Dermatology, who's aware of instances of embarrassed patients taking the extreme step of hiding their unattractive feet from loved ones.

Dr. Brenner says if you feel like something's wrong, see a podiatrist. "Foot pain isn't normal and you should not ignore it," he says.

Source: NASPI [4/29/09]
 

Dockery Receives WSPMA Lifetime Achievement Award

Dr. G. Dock Dockery, Seattle, Washington, was presented with a "Lifetime Achievment Award", from the Washington State Podiatric Medical Association, at the Annual State Meeting in Grand Mound, WA. Dr. Nick Tanner, outgoing WSPMA President, presented the award during the evening banquet.

Dr. Nick Tanner presents Lifetime Achievment Award to Dr. G. Dock Dockery

Dr. Dockery has been a member of WSPMA and APMA since 1977 and during that time has continuously contributed to the improvement of podiatric medicine and education by teaching, training residents, publishing scientific articles and authoring four textbooks on a variety of topics from forefoot surgery, dermatology to plastic reconstructive surgery of the foot and ankle. He is an accomplished speaker at medical meetings and lectures nationally and internationally from 20 to 30 times each year.

Additionally, Dr. Dockery founded and has chaired the Northwest Podiatric Foundation for Education & Research, USA, since 1979. This organization is responsible for providing 8 to 10 medical education programs yearly in an effort to fund continuing research and education.  As a mentor to countless students, residents and practitioners, Dr. Dockery, continues to share his time and teachings with all who seek it.

Polish Your Telephone Skills

Chances are, you use it every day. The telephone on your desk or in your pocket just might be the most important communication device at your disposal. Are you sure that you are making the best use of it? Think of a phone call as a more personal way to communicate than an e-mail message, yet not as interactive as a face-to-face meeting. Follow these guidelines:

• Always answer your phone as if your most important patient is calling. While it is okay to be informal, you should always remain professional. When you call others, prepare to treat them professionally and with respect.
• Think of each call as a meeting. In other words, you need an agenda— however informal—so you know exactly why you are calling and what you hope to gain. As in a meeting, start with a brief warm-up. Exchange the same kinds of pleasantries as you would exchange in an in-person meeting. Then turn to business.
•  Follow basic rules of good communication. Do not multitask while you are on the phone; that means no checking e-mail or conducting sign language conversations with patients or staff. Do speak slowly and clearly, and take notes so you remember important points.

Source:  Adapted from “Top Team Communication Tips” via Communication Briefings
 

Query: Hammertoe Surgery

What are my colleagues doing for surgical treatment of hammertoes particularly in young, black females to minimize scarring? I have a 22 year old attractive woman with elongated toes and PIPJ lesions, 2-5. The toes are somewhat rigidly contracted, but length is the major issue. I can ellipse the dorsal lesions, but I don't want the resultant scar to be more of a cosmetic problem than the original lesions!
 
Neil B. Levin, DPM, Sycamore, IL
 

RE: Pain in Dorsal Foot After IV insertion (Steven Lemberger, DPM)
From: Multiple Respondents

Differential diagnosis: Intermediate or medial dorsal cutaneous nerve injury or even deep peroneal injury, CRPS/RSD. Order EMG although nerves are too small. Start weeekly regional block (ankle/deep Peroneal/Superficial peroneal nerve), physical therapy without immobilization (if you suspect RSD/CRPS). Unfortunately, a Marcaine pump which we use on some of our patients post-operatively may cause more trauma. Bone scan may show early RSD.

Ido Friedman, DPM, Savannah, GA, habibi@pol.net

They may have nerve injury -- consider a superficial dorsal block.

Roody Samimi, DPM, San Diego, CA, roody.samimi@gmail.com

It sounds like your patient may have an iatrogenic A-V malformation.  Those can be extremely painful. I would suggest a collaboration with your vascular colleague for a study and/or intervention. Also, consider nerve injury in your differential.  
 
Svetlana Malinsky, DPM, College Park, MD,  drmalinsky@yahoo.com

I would want to rule out neurolgic injury, including but not limited to a CRPS1/RSD. 

Angelo J. Bigelli, DPM, North Providence, RI toedocri@aol.com
 

RE: Nocturnal Leg Cramps (Richard Mann, DPM)
From: Multiple Respondents

In my experience, half of these cases turn out to be a compression syndrome of either the tibial nerve in the soleal sling or the common peroneal nerve. They are easily checked by palpating the area or deep percussing. Usually, they are quite sore or tender. If it is the CPN, then you can try a local injection adjacent to the nerve and see if it helps. Use long-acting Marcaine and warn the patient about a potential temporary foot drop. Have someone drive the patient to the appointment.
 
Peter Bregman, DPM, Tewksbury MA, footguru@comcast.net

In forty nine years of active practice, I very frequently encountered patients complaining of “Nocturnal Leg Cramps.” I cannot recall even one patient who did not respond very well to Benadryl tablets.  Rx: 50 mg, tab i, h.s. I have also prescribed the quinine tabs, but the patient result was inferior to the Benadryl. Usually a week of the medication was adequate for complete remission. Many patients needed only 2-3 days of treatment. Calf muscle passive stretching also was prescribed when a limitation of ankle dorsi-flexion existed.

J. David Skliar, DPM (retired), Spring Hill, Fl.  dskliar305@bellsouth.net

Tonic water with quinine, which also comes in the diet version for patients with diabetes, works fairly well for patients with leg cramps. It is inexpensive, readily available, palatable and patients tolerate it well.

Kathy Satterfield, DPM, Boerne, TX, vksatterfielddpm@aol.com

I have found that 25-50 mg of Benadryl PO HS worked well in many cases. It is available OTC in 25 mg dosage. The only side-effect is drowsiness, which at bedtime is not a bad thing.
 
Joel Lang, DPM (retired), Cheverly, MD, langfinancial@verizon.net
 

RE: Ingrown Nails in 3 Month Old
From: Multiple Respondents

Infants do not have a memory for pain. You can remove the offending nail border in a few seconds and get just as much crying as you would from injecting the local anesthetic.  Moments later, after given a bottle or pacifier, the crying immediately stops the child now will laugh and smile as if nothing has happened. The trauma is greater for the doctor than the child, so if it will ease your conscience, you can apply or administer anything you want so long as it doesn't hurt the child. This has worked for the past 32 years for me and 30 years prior to that for the doctor who trained me.

Jan David Tepper, DPM, Upland, CA, jdtdpm@aol.com
 

RE: Break Self-Destructive E-Mail Habits
From: Al Musella, DPM

I have 3 more email mistakes to add to your list:
 
1. Always use a subject that relates to the message. It is more likely to be opened, and when you or the recipient is ever looking for it months later, it will be easier to find.
 
2. If you cc multiple people who don't know each other, consider if you want to give other people's private email addresses to others.  Sometimes it is okay, but you need to think about it. If you want to hide them, just use BCC  (blind cc) instead of cc, and the recipients won't see each other's email addresses.
 
3. Be careful about sending emails when you are angry.  Emails are forever. Once you send it, there is no taking it back and it can be used against you. If you are tempted to reply to an irritating email, print out your response before sending it, and let someone read it first, or save it as a draft and re-read it the next day before sending it.  
 
Al Musella, DPM, Hewlett, NY, Musella@aol.com

RE: APMA Code of Ethics (Richard Boone, JD)
From: Michael M. Rosenblatt, DPM

Richard W. Boone, JD provided a recent quote from the APMA "Code of Ethics." Recently, in my communications on-line, I read that financial certifying boards have been struggling with developing a code of ethics and trying to figure out how to enforce them. Some CFA respondents have actually spoken against that! 
 
A code of ethics for financial advisers is excruciatingly important. It is a wonder to me that they have not already gone through this effort. How else are we ordinary mortals supposed to know, identify and trust our own financial adviser?
 
I am proud that APMA has had a code of ethics for many years, and to my knowledge, it is taken very seriously by both APMA and its members. We often criticize ourselves. In fact, podiatrists are highly self-critical. Sometimes, we do something right. In this age of financial meltdown and horrible financial abuse by so-called financial advisers, we podiatrists have something to be proud about. 
 
Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

RE: Gifts to Patients for Patient Referrals (Brian Homer, DPM)
From: Michael A. Janning, DPM

When I was still in practice, my habit was to send a thank-you note, personally signed by me, for the referral of Mr. or Mrs. So-and-So. If the referring patient had referred more than one new patient, I would also send a single carnation or rose as a thank you. I do not know how there could be any objection to this practice.

Michael A. Janning, DPM (Ret.), South Euclid, OH, drmikej1008@sbcglobal.net

PODIATRISTS NEEDED – DALLAS/ FT WORTH – TEXAS AREA

exas Home Footcare Associates, a podiatry exclusive company specializing in house calls and visits to facilities for the elderly, is looking to hire podiatrists. We are located in the Dallas area. Full and part-time positions are available. Immediate Openings Available. Must have a Current Texas license. Competitive Compensation Package. If interested fax curriculum vitae to 972 931-4819 or e-mail gjmdpm@tx.rr.com. For further information, call 972-380-8028.

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

EQUIPMENT FOR SALE- ALLPRO IMAGING 2010 XRAY DEVELOPERThis processor is only two years old. It is in good working order and has always been regularly maintained. We are in the process of changing to digital films. Will sell for $1300. New Hampshire e-mail wcgcoach@aol.com

ASSOCIATE POSITION – ILLINOIS 
 
Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings available. If interested, fax curriculum vitae to 312 225-9366 or e-mail feetwork@aol.com

ASSOCIATE WANTED - FLORIDA

Associate needed for a dynamic multi-doctor practice in the Tampa Bay area. Partnership opportunity for the right candidate. Preference given to a PSR 24+ resident completing their education this spring/summer, and must have a Florida license. Well-established practice, high tech with EMR and digital x-rays, with specialties in sports medicine, surgery and wound care. No nursing homes or HMO's. Excellent hospital privileges available. Choose an area of practice concentration that you are passionate about and enjoy a lifestyle for yourself and your family that is second to none. E-mail: kimvelez@tampabay.rr.com

ASSOCIATE POSITION - CONNECTICUT

Nice community outside of New Haven. Well-established, busy practice seeking part-time or full-time associate. Excellent opportunity for a highly motivated and ethical professional. Must have good patient skills. PSR-12 or higher with excellent skills required. Send resume and cover letter to fax # 203-439-7916.

OFFICE SPACE/ MRI RENTAL – NYC, LI   
 
Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, and Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

ASSOCIATE POSITION AVAILABLE-MIDTOWN MANHATTAN

Looking for Full-time associate to work in well established practices in midtown Manhattan and Forest Hills. Immediate opening for PSR 24-36 surgically trained Podiatrist. Great opportunity with competitive salary along with malpractice benefits. Please send CV to slurie@papapc.net

ASSOCIATE POSITION - CENTRAL VIRGINIA

Join a solo surgeon in a two office private practice, modern facilities with EMR and digital x-ray, reconstructive and trauma surgery.  Excellent starting salary and benefits. Position leads to partnership. Submit letter of introduction and CV to jdisabato@vfasa.com

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