The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

May 06, 2009 #3,538 Publisher-Barry Block, DPM, JD

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OH Podiatrist to Run as Republican Candidate for Cincinnati Mayor

Announcing his candidacy  for Cincinnati mayor, podiatrist Brad Wenstrup says he's against one thing Mayor Mark Mallory is very passionate about - bringing streetcars to the city. "I worry about a streetcar named debt," he said at his press conference, held at Findlay Market in Over-the-Rhine.

Dr. Brad Wenstrup

The 50-year-old, flanked by his family and other Republican politicians, emphasized his previous service - to his patients, as a volunteer for several charities and as an Army soldier in Iraq. He said he knows he's not the typical politician, referring to his lack of prior elected office, but said he would bring real-life experience to the job.  No politician should run unopposed - "unless, of course, it's me in four years," he said, laughing.

Wenstrup lives in Columbia Tusculum and practices podiatry at Wellington Orthopaedic and Sports Medicine, Anderson Township.  He was on active duty in Iraq for 14 months in 2005 and 2006, serving with the 344th Combat Support Hospital as chief of surgery at the prison hospital at Abu Ghraib.

Source: Jane Prendergast, Cincinnati Enquirer [5/4/09]

IPMA President Discusses How to Choose a Podiatrist

Although a family practitioner may be a reasonable choice to treat some common foot conditions, your primary care doctor may refer you to a podiatrist, says Paul F. Brezinski, DPM, a Chicago-area podiatrist and president of the Illinois Podiatric Medical Association. "I would say that if you're having a specific foot problem, your best bet is to go see a podiatric physician."

Dr. Paul F. Brezinski

Because several serious conditions such as diabetes and peripheral arterial disease can show up first in your feet, a podiatrist who spots a more widespread disease may recommend that you see an internist or other doctor to treat this underlying problem, Dr. Brezinski says.

It's a good idea to seek out a podiatrist affiliated with the APMA, Brezinski suggests, since this large organization maintains standards of practice and supports continuing education for its members. In addition, look for a podiatrist with the same qualities that you'd seek in a general physician. "You want to have somebody who will answer questions, treat you with courtesy, and take time to explain and educate you about the problem you're having," Brezinski says.

Source: Eric Metcalf, MPH, Everyday Health [5/4/09]

CFPM Supports  Michener Institute Diploma Change to Include Podiatric Medicine 

The Canadian Federation of Podiatric Medicine says the name change of the diploma at the Michener Institute to include podiatric medicine is an important step in the evolution of the profession of chiropody and podiatry in Canada. The Michener Institute of Applied Health Science changed the name of the chiropody diploma to include a reference to podiatric medicine. Graduates, upon completion of Michener's Chiropody program, will now be granted  a "Graduate Advanced Diploma in Podiatric Medicine (D.Pod.M.)"

This decision was made after significant consultation with faculty, students, alumni and professional associations and received final approval by the Board of Governors on January 20, 2009. It was agreed that this new designation better reflects the current scope of practice and curriculum. This re-designation will take effect for the 2009 graduating class.

Stephen Hartman

"Over the past 25 years, the profession of chiropody and podiatry has advanced, one small step at a time to what it is today," says Stephen Hartman, CEO of the Canadian Federation of Podiatric Medicine. "The name change is a significant milestone in the profession."

Australian Podiatrist Wins Young Achiever Award

Country Health has featured strongly in this year’s SA Health Allied and Scientific Health Excellence Awards. “These awards are an excellent opportunity for us to recognize the work that these health professionals perform and they also present us with an opportunity to celebrate the pivotal role that they play,” said Health Minister John Hill. Winner of the Young Achiever award was Port Pirie Regional Health Service podiatrist Noami Zakarias.

Noami Zakarias

Ms. Zakarias took the Port Pirie position three-and-a-half years ago coming from a twelve-month position in Port Augusta after receiving her Bachelor of Podiatry at Uni SA. She is acting allied health team leader with the Port Pirie Community Health Service and is the chairperson of the Country Allied Health Advisory Group for podiatry.

Included in her nomination was the Operation Happy Feet project which was jointly run with the Port Pirie Regional Council. This project focused on improvement in work-boot safety of their workers. The prize for winning the Young Achiever Award was a certificate and $1,000 to go towards training and development.

Source: The Recorder [4/30/09]

Query: Venous Stasis Hyperpigmentation

I was wondering if anyone can share any pearls with regard to venous stasis hyperpigmentation. What products have been successful decreasing the discoloration associated with the hemosiderin deposition/discoloration?
 
Jeffrey Kass, DPM, Forest Hills, NY

Query: Discharging a Patient For Non-Payment

If you have a patient who has gone to collections for bad debt, do you routinely discharge the patient? If you have a patient who owes you money, can you say to them, "Mr. Jones, you will have to pay your balance before the doctor can see you?"Or do you not say anything about the balance because it is considered creditor harassment? Is there anything in writing with respect to reasons to block future appointments?

Maggi S. Smith, DPM, Toledo, OH

Editor's comment: PM News does not provide legal advice. In general, you can discharge  patients for non-payment as long as you are not treating them for acute conditions. If a patient is, for example, in the post-op period, you could be accused of abandonment if you did not provide him or her with adequate time to secure another doctor.

Discharging a patient should be done through  a letter sent via US Mail, Certified, Return Receipt Requested. Your language should be professional, as there is no need to inflame the situation.

Query: Ostectomy 5th Digit Coding

What would the code be for: "...incision was carried down to the extensor tendon, exposing the exostosis at the level of the proximal interphalangeal joint 5th digit?

Would it be CPT 28124 (partial excision [craterization, saucerization, sequestrectomy, or diaphysectomy] bone [e.g., osteomyelitis or bossing]; phalanx of toe) or CPT 28160 (hemiphalangectomy or interphalangeal joint excision, toe, proximal end of phalanx, each)? What is the difference? The diagnosis is hammertoe.

Sue Graff, CPC, Munster, IN

Response: You are correct that both of these codes sound very similiar, and have been used interchangeably, but one, CPT 28124, involves a portion of bone as opposed to more "involved" hemiphalangectomy or IP joint removal (CPT 28160).

I would suggest the use of CPT 28124.

Tony Poggio, DPM, Alameda, CA

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RE: Hammertoe Surgery (Neil B. Levin, DPM)
From: Jeremy Mason, DPM, Nat Chotechuang, DPM

I have been using the standard elliptical incision with my hammertoe surgeries, however, I have been using a running subcuticular closure with 4-0 Monocryl and Steri-strips which will typically leave a better cosmetic result. I have also been using the Smart Toe implants which seem to cut down on digital rotation and post-operative swelling which will facilitate healing. In limited cases, when there is no transverse plane deformity at the MTPJ, I will use a transverse elliptical incision over the PIPJ.

Jeremy Mason, DPM, Tulsa, OK, cowboyfootdoc@yahoo.com

I have done hammertoe repair via medial and lateral (i.e., intertriginous) incisions when there was a desire to avoid a dorsal scar.  I refer Dr. Levin to this 2006 article .
 

Nat Chotechuang, DPM, Bend, OR, natchot@hotmail.com

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

The dorsum of the foot is a poor choice for IV infiltration due to its high preponderance for developing phlebitis. As a resident, many moons ago, we had rare occasion to start IV's in the foot when left with no alternative. Incidences of phlebitis were dramatic compared with traditional IV sites.
 
I would place the patient on warm compresses and NSAIDs and monitor them. I believe that will clear it up.
 
Brian Kashan, DPM, Baltimore, MD, drbkas@worldnet.att.net

More than likely, he has symptoms of a contusion, possible neuritis. I would rule out causalgia/RSD. I check for chemical, thermal, and mechanical allodynia, comparing to contra-lateral foot.  If there are no signs of RSD, ice and oral NSAID's, off-load as needed. If there are signs of RSD, then contrast heat/ice as tolerated, weight-bearing as tolerated, anterior tibial nerve blocks, Elavil/Neurontin (or Lyrica), and consider referring to pain management.

Allen Sater, DPM, Jupiter, FL, Bunionpain@aol.com

I would recommend evaluating the patient for compression injury or possibly even for severance of one of the superficial nerves which could lead to a stump neuroma-type pain. Perform a V block proximal to the nerve branch and see if it takes the pain away. Another suggestion is possibly evaluate for RSD if the pain is "out of proportion.”

Nicole Hancock, DPM, Denton, TX, nhancock@completefootandanklecare.com
 

EQUIPMENT FOR SALE - ESWT

High Energy Shockwave Device (NEW);FDA approved as Class 1, payable by Medicare for treatment of Plantar Fasciitis (28890); Payable to surgery centers for Achilles tendinosis; 2 units available; Under $30,000. CONTACT: weil4feet@aol.com

PODIATRISTS NEEDED – DALLAS/ FT WORTH – TEXAS AREA

Texas 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

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