The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

May 05, 2012 #4,454 Publisher-Barry Block, DPM, JD

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Proper Footwear Prevents Many Injuries: FL Podiatrist

When Teree Harrison decided to start actively walking last year, she was focused on her waistline, not her footwear. "I never used to think about it. If I found a pair of shoes that fit, I bought them. Usually they were men's shoes because my feet are big, so I had to go into the men's sizes, and then they were too wide, so my foot would move around a lot in them," Harrison said. As a result, she suffered a stress fracture.

Dr. Elizabeth Scheiber

"This is not unusual. I see a lot of this kind of injury from wearing the wrong shoes," said Cleveland Clinic podiatrist Dr. Elizabeth Scheiber. Scheiber also sees patients with black and blue toenails from wearing shoes that are too big or too small. She said getting the proper fit means being measured every time you shop for shoes. "What you should do is go into a reputable sneaker store initially so they can watch your gait, how you're walking up and down, and they have to notice how long your foot is down on the ground," she said.

Source: Kathleen Corso, Local 10 News [5/1/12]

APMA Honors Rosalind Franklin University President

Dr. K. Michael Welch, president of Rosalind Franklin University of Medicine and Science, received the Meritorious Service Award from the American Podiatric Medical Association at the 29th Annual Dr. William M. Scholl College of Podiatric Medicine Scholarship Benefit. Scholl College, celebrating its centennial anniversary this year, is one of five colleges or schools at Rosalind Franklin. 

APMA president Dr. Joe Caporusso; Rosalind Franklin University president Dr. K. Michael Welch; APMA president-elect Dr. Matt Garoufalis; and Scholl College dean Dr. Nancy L. Parsley (seen in background).

Dr. Welch is a neurologist and world-renowned researcher whose career has focused on the study of brain function in cerebrovascular disease, stroke, and migraine. He earned his medical degree at the University of Bristol School of Medicine, United Kingdom, and came to the United States in the early 1970s. He held several positions at Baylor College of Medicine (Houston, Texas), including Chief of Neurology at the Ben Taub Hospital.

Education the Key to Treating Diabetics: Canadian Podiatrist

In a new survey of Canadians living with type 1 and type 2 diabetes conducted by Léger Marketing, sponsored by Eli Lilly Canada and being released in collaboration with the Canadian Diabetes Association, results indicate that while 9 in 10 Canadians with diabetes are aware they are at an increased risk of serious foot injuries, 4 in 10 admit to having their feet examined by a doctor less than once a year, only when something is wrong, and for some, never. Of equal concern is that 7 in 10 do not examine their feet for blisters, cuts, temperature differences, or other injuries on a daily basis, and less than 1 in 10 admit to never following a daily nail or foot care regimen.

Dr. Axel Rohrmann

"Having the right information can enable people with diabetes to take action. When they know the right questions to ask their healthcare professional, they develop a better understanding of how to properly care for their feet as risks can be identified and precautions advised," says Dr. Axel Rohrmann, podiatrist and co-chair of the Canadian Diabetes Association's Clinical Practice Guidelines Foot Care Tool Kit.

Source: Pharmalive.Com [5/3/12]

TX Podiatrist Discusses Summer Risks to Feet

In summer, your feet may be exposed to risks that don't occur in winter, such as cuts and abrasions from walking barefoot on the beach where broken shells or sharp debris may lurk, burns from hot sand or too much sun, and pain or blisters caused by ill-fitting flip-flops or sandals that lack support. 

Dr. Joseph M. Caporusso

"Knowing how to prevent and treat summer-specific foot problems can help ensure your summer fun stays on track this year," says Joseph Caporusso, DPM, president of the American Podiatric Medical Association (APMA)." Always seek medical attention for significant injury, burns, or if you experience persistent foot pain. Foot pain is not normal, and a podiatrist can help diagnose and treat foot injuries.

Query: Podiatry Chair Repair
 
Can anyone recommend how to find a person who repairs podiatry chairs at a reasonable cost?
 
Elliot Udell, DPM, HIcksville, NY

Query: Hallux Varus Repair Coding

Please advise correct coding for the following:

1) Extensor hallucis brevis tenodesis/transfer [extensor hallucis brevis tendon cut at musculotendinous junction, rerouted beneath the deep transverse metatarsal ligament, and sutured to the proximal-lateral 1st metatarsal]; 2) Abductor hallucis tenotomy; and 3) Reverse distal chevron osteotomy procedure.

I assume the abductor tenotomy and distal chevron are per the book, but I'm not sure what is the best option for the extensor hallucis brevis tendon tenodesis.

Donald Brann, DPM, Orland Park, IL

Response: I recommend these codes:

CPT 28306 - ostectomy first metatarsal, angular correction
CPT 28313 - reconstruction, angular deformity of toe, soft tissue procedures only

Howard Zlotoff, DPM, Camp Hill, PA

Codingline subscription information can be found here
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RE: Nerve Compression vs. Fictitious Injury (Jeffrey Smith, DPM)
From: Joseph Menn, DPM

If you would like to rule out various nerve or soft tissue injuries to the patient, I suggest a series of simple anesthetic blocks of various structures to see if there is improvement. If a "buggy" rolled over my foot, I would expect a crush injury to the deep peroneal nerve. If it struck the side of the ankle, the tarsal tunnel might be injured. I find it difficult to imagine how both could be damaged given the type of injury described.

If the DPN was crushed, it would explain the dorsi-flexory guarding you have described as the extensors would contract over and irritate the DPN. Additionally, any severe crush bad enough to cause CPRS would likely radiate pain up to the source of the DPN to the CPN at the fibular head, possibly also causing radiating pain through the dorsal cutaneous branches of the SPN. I would first block the DPN with Marcaine. If drastically improved, you have found the source of the pain.  If not too much improvement, then begin combining this block with others sequentially. 

The DPN is a fairly easy nerve to decompress, but it should definitely be done by someone trained in these techniques. That said, the same block technique can be used for other soft tissue structures as well (i.e., TA tendon sheath). Don't underestimate the power of serial diagnostic anesthetic blocks.

Joseph Menn, DPM, Myrtle Beach, SC, jmenn@coastalpodiatry.com

RE: Home Infusion, Medicare Patients, and Compounding for the Podiatry Practice
From: Stephen Kominsky, DPM

Recently, I came upon a company that specializes in providing infusion and compounding  services exclusively  for podiatry patients. They provide intravenous antibiotics, nutrition, and pain management services for the out-patient setting. Their management team is quite knowledgeable regarding insurance reimbursement (they have contracts with all of the major payers nationally), including Medicare. They taught me that I didn't have to deny the service to my Medicare patients in need as I had been told by so many other companies. Apparently, in most regions across the country, the infusion can be done, and covered by Medicare when it is done in the office setting (you can bill for that), or in a surgery center. So, not only did I learn from them that my Medicare patients may still receive the antibiotics, but I can bill for certain CPT codes associated with the service. 

In addition to the infusion services, they also specialize in compounding both by prescription and for OTC dispensing for in-office dispensing practices. This has been another source of revenue generated for our practice, while providing convenience to the patient. The name of the company is Guardian Podiatric; the contact person whom I have been dealing with is Joe Gulla at joegguardianpod@aol.com  He has become a great resource for me regarding these issues.

Stephen Kominsky, DPM, Washington, DC, sjkom120@aol.com

RE: It's Time for Podiatry to "Occupy" Healthcare (Peter Wiggins, DPM)
From: Robert Kornfeld, DPM

While I think Dr. Wiggins makes a good point regarding podiatry being excluded from Title XIX (it cannot be acceptable for any medical/surgical specialty to be singled out and excluded from any healthcare programs), it is going to take a whole lot more than Title XIX inclusion to improve healthcare in this country. No doubt we prevent amputations and heal wounds, but the financial crunch on doctors and hospitals is only going to get worse and healthcare delivery is going to become more crippled than it is now.
 
Robert Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com

RE: Recent Research Confirms Therapeutic Effect of Foot Orthoses for Anterior Knee Pain (Robert Bijak, DPM)
From: David E. Gurvis, DPM

As Dr. Bijak states, we should never accept a poorly designed study as fact; however, Dr. Bijak fails to see any difference between a poorly designed study and one with either preliminary results, or results limited by the study design itself. There is a difference. But since, as he has stated numerous times in PM News, he hates orthotics, and as a matter-of-fact refers to them disparagingly as arch supports, I dare say there is not study sufficiently appropriate to his criteria that we would believe unless it proved orthotics did no good at all. Any study at all showing this result would please him and be accepted.
 
David E. Gurvis, DPM, Avon IN, deg1@comcast.net

RE: Recent Research Confirms Therapeutic Effect of Foot Orthoses for Anterior Knee Pain (Jeffrey Root)
From: Dennis Shavelson, DPM

Mr. Root: The fact that “Kevin Kirby is one of the most knowledgeable people in the world when it comes to research related to foot orthotic therapy” makes his evidentiary suggestions powerful here on PM News. I was not questioning "the methodology of the study” as you suggest; rather I was questioning Dr. Kirby’s exaggerations when calling it “recent and significant.” As one who follows the biomechanical literature and Dr. Kirby’s suggestions closely, I cannot count on one hand recent additions to the biomechanical literature that have direct clinical EBM application or that prove or disprove any current theory of biomechanics, thereby making them significant.
 
To that end, Kevin, can you name and list 4-5 recent, significant high-level articles that either have clinical validity or applicability as per “The Levels of EBM”, or ones that prove or disprove any of the modern theories of biomechanics?

Dennis Shavelson, DPM, NY, NY, drsha@foothelpers.com

RE: Sterilizing Bits Between Debridements (Lancing Malusky, DPM)
From: Bryan C. Markinson, DPM

Some of the opinions fly in the face of standards developed long ago. The latest post by ABPS-certified Dr. Malusky is why I feel this way. He states that a podiatrist should not be made to feel "retro" for drilling nails. He supports this by indicating that "we spin the bit in the cold sterile solution, instantly removing remnant debris," a method not up to snuff by any standard of cleanliness, let alone sterility.

He probably would even say that he would not hesitate to use the bit on himself or a family member, as he is "lung disease free." Aerosolization of nail dust and drill bit sterility are two completely different issues.

He has an installed central vacuum which has been shown to...

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

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ASSOCIATE POSITION - CALIFORNIA

Office and hospital-based podiatry group in Bakersfield, CA seeks highly-trained surgical associate to join us. Prefer surgeon with trauma and Charcot reconstructive experience. Staff privileges with 5 local hospitals. Offering health insurance, CME allowance and competitive salary. Must be PSR 24/36 trained, ethical and thoughtful when treating patients. Please forward CV to aghams2@aol.com

ASSOCIATE POSITION - ST. LOUIS

Multi-location group practice seeks motivated DPM with initiative and leadership skills to contribute to our growing group practice. Foot Healers Podiatry Group enjoys a strong reputation within St. Louis and looking for the right individual to complement our team. Must have the confidence to lead you own clinic and the willingness to draw on the expertise that exists within our group. Starting salary ($100k), plus incentive comp plan, malpractice coverage, health insurance, 401k, group bonus/profit sharing. Please send CV to jmurray@foothealers.com and visit our website www.foothealers.com

ASSOCIATE POSITIONS - MULTIPLE STATES

Podiatrist Needed in Arkansas, Kansas, Missouri, Nebraska, Iowa, Minnesota, North Dakota, South Dakota, Texas, Colorado, Wisconsin, and Oklahoma. Expanding multi-state medical practice seeking podiatrists to service long-term care community residing in nursing homes and assisted living facilities. We offer an established patient base, scheduling, equipment allowance and cover travel expenses. Provide generous compensation, bonus opportunities, disability, health insurance benefits, malpractice coverage and flexible scheduling. Looking for a Podiatrist with excellent skills, able to provide expert and compassionate care to patients. Email CV to: careers@aggeus.org or call 773-770-0140 x300/x305. www.aggeus.org

ASSOCIATE POSITION - FINGERLAKES REGION, NY

Podiatry Group looking for a dynamic and motivated associate to join our medical and surgical practice. Track to partnership. Competitive salary, incentives, health insurance, malpractice insurance, educational expenses, and professional dues included. Familiarity with the region encouraged. Candidate should be ABPS qualified or certified. Close to Pennsylvania if expanded scope of practice desired. Send CV to nypodiatrygroup@gmail.com

ASSOCIATE POSITION – ANCHORAGE, ALASKA

Associate wanted for hospital-based podiatry group practice. Full scope of practice. PSR24+. Outstanding opportunity, work environment, and recreational pursuits. Fax CV to 907-562-5195, please call 907-562-4958.

ASSOCIATE POSITION - KANSAS CITY, MISSOURI

Kansas City may be the perfect move for you and your family. I am looking for an entrepreneurial minded associate who wants to grow and then own part of an already successful practice. If you are the right candidate for this associate position, you will enjoy a competitive compensation package and you will be working with a doctor who is as committed to your success as he is to his own. Go to: www.YourFutureInPodiatry.com for full details.

ASSOCIATE POSITION - NEW YORK

Full-time position available immediately in Capital District multiple doctor practice. Good salary with percentage. All phases of podiatry. NYS license required. Email resume to Lchittenden68@gmail.com or call Lori at 518-577-6171

ASSOCIATE POSITION - MANHATTAN

Podiatrist needed for busy state-of-the-art offices in Manhattan. Offices are located near Penn and Grand Central Station. 10+ years experience only and an out-of-network doctor for most insurances. Please forward your information and CV to: roni@myfcny.com

ASSOCIATE POSITION - TENNESSEE/NORTH GEORGIA

Multi-physician, Multi-office practice looking for motivated new associate leading to partnership. We are a busy practice with state of the art technology: EHR, Digital X-ray, Diagnostic Ultrasound, PADnet, EPAT machine. Applicant should be PMS 36/Board Qualified/Certified. Applicant should be ethical, personable, hard working and interested in providing all aspects of podiatric care to our patients. Competitive Salary and benefits. All interested candidates please send a CV with two letters of reference to: mybestnewjob@gmail.com

ASSOCIATE POSITIONS – MARYLAND

Are you motivated, personable and enjoy working with the elderly? We are offering part-time positions in Maryland. Our group, Podiatry Management Services, provides care in Nursing Homes, Assisted Living, Senior Homes, Adult Daycare and other similar facilities. Please e-mail your c.v. todrhprosen@verizon.net or fax to 410-486-2049 or call Dr. Herbert Rosen at 410-580-0255.

PRACTICE WANTED - FINGERLAKES REGION, NY

Looking to purchase a podiatry practice in the Finger Lakes Region of NY. Serious inquiries should be sent to: aspenpodiatry@gmail.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 516 476-1815 PODO2345@AOL.COM

F/T CERTIFIED MEDICAL ASSISTANT - NEW YORK

**Must have NYS certification for podiatric x-rays. Primary responsibility is to provide full clinical support to the podiatrist. THIS INCLUDES THE FOLLOWING: Maintenance logs, inventory, preparing patients for visits, x-rays, assisting with patient registration, appointment scheduling, calling in prescriptions to pharmacies, chart retrieval, providing lab result with charts to physicians, etc. Salary commensurate with experience; benefits/ after probationary period. Fax resume to 212-713-1631 or e-mail to  ttolliver@wpmg.org

PRACTICE FOR SALE — BROOKLYN, NY

This practice has been in the same location for 31 years, seeing 80-100 pts/week, working 4.5 days/week. Grossing $350K and netting close to 70%. All surgery referred out. Low rent, option to buy the building in future. Asking $225K, doctor willing to finance. Call 800-983-4194, or email  contactus@podiatrypracticeconsultants.com

PRACTICE FOR SALE - HOUSTON, TEXAS

30 year old busy, progressive practice for sale with an excellent reputation and well established, diverse referral base. Well trained, dedicated, supportive staff. Excellent cash flow ($400K net income after overhead). EMR, digital x-ray, diagnostic ultrasound. Free standing building also available with large outdoor sign. Owner retiring and willing to stay part time during transition. Contact: mcrosby@picagroup.com or call (888) 776 2430.

PRACTICE FOR SALE - BROOKLYN, NY

A large, busy practice is for sale in Brooklyn, NY. This practice has been in the same location for over 50 years. Average 150 pts/week, average gross 730K, most surgery is referred out. Financing available. Call 800-983-4194, or email contactus@podiatrypracticeconsultants.com

PRACTICE FOR SALE - AUSTIN TEXAS

Great opportunity for new practitioner or an additional office. 18 year practice with large patient base. Current physician transitioning to part time then retiring to pursue another business opportunity. Start turn-key without need for a bank loan. Great area to live and work. Susieintx@aol.com (512) 565-6634

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