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May 07, 2008 #3,239 Editor-Barry Block, DPM, JD

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AZ Podiatrist Provides Advice on Summer Footwear

Those pretty summer sandals won't look so saucy on callused, swollen feet. "A lot of summer shoes are very flimsy, so if you have any predisposing things occurring in the foot, sandals can exacerbate those problems or bring on new ones," says podiatrist John Tassone of Glendale, AZ. "The main problem is lack of adequate arch support."

Dr. John Tassone

Common problems include claw-like hammertoes, the thickened heel tissue of plantar fasciitis, stress fractures and pain in your feet, legs and back. But you don't have to forswear summery shoes entirely. Tassone recommends sandals such as Birkenstocks with built-in arch support and stable soles that help prevent injury.

However, lightweight sandals probably won't hurt women with healthy, injury-free feet if they are worn infrequently, he says. "If you want to go out for dinner, you can probably go for an hour or two in fancy sandals. But if you're going to the mall, you should be in a good supportive shoe."

Source: Connie Midey, The Arizona Republic, [5/5/08]

Dr. Larry Block donates $50,000 to OCPM’s Stepping Towards the Future Campaign

Larry Block, DPM, OCPM class of 1965, generously pledged $50,000 to officially name the "Dr. Lawrence Block and Family Fitness Center" for the Stepping Towards the Future Campaign. In his own words, Dr. Block states, "As a podiatric student at OCPM and later as a resident in Philadelphia, I was shown many courtesies by my teachers and mentors. Basically their message to me was, 'Pay it forward.'

Dr. Lawrence Block

My family and I have been blessed with my successful career and we can think of no finer way of continuing to give back to the profession than to make this commitment. As certified personal trainers and past owners of a gym, my wife Irene and I know the importance of training the body, as well as the mind. We are hopeful that this facility will provide the Doctors of Podiatric Medicine of the future the basis for their own physical health so that they may serve as examples for their patients, families and friends."

Dr. James Mahoney Receives APMSA’s Kenison Award

The American Podiatric Medical Students’ Association recently selected James M. Mahoney, DPM, Assistant Dean of Academic Affairs and Associate Professor at Des Moines University’s College of Podiatric Medicine and Surgery, as the recipient of the 2008 Kenison Award. Dr. Mahoney was selected by the APMSA’s leadership from all podiatric medical schools to receive the association’s highest honor in recognition of his outstanding contribution to the progress of the podiatric medical profession.

APMSA CPMS Delegation Award Dr. Mahoney the APMSAs 2008 Kenison Award: Left to Right: Chess Chukwurah, Valerie Tallerico, James Mahoney, DPM, Kimberlee Hobizal, Eric Powell and Brian Ellis

Kimberlee Hobizal, APMSA Delegate (2010) and APMA PAC Liaison emphasizes, “Dr. Mahoney is not only an associate professor, faculty advisor, and superb doctor, but considered a mentor, and most importantly, an understanding and compassionate friend to all the students.” Many students voiced their appreciation for Dr. Mahoney’s leadership in the classroom, the clinic, and on a personal level.

“The future of our profession is brighter than it has ever been, and that is due to the type of people we teach and the superior education they are now receiving. It will be the current generation of three-year residency trained podiatric physicians that will remove any remaining barriers to our full acceptance by mainstream medicine, “said Dr. Mahoney.

Query: Employee Timekeeping

I have 2 full-time employees. I have had them write in their in/out times on time cards for years. I have one assistant that has been padding her times; 5 minutes here and there, which adds up. I have been noting actual in and out times for both employees; and the other lady does not pad time. I put in one clock that is to be used for all in/out times, hoping that would take care of variability of different clocks, but no change. The “padder” is a good worker and she feels she should be paid more (her wage is good for our rural area and at national average), but I think a raise would not help; it hasn’t in the past. I am hard-pressed to buy a time clock to punch time, with only 2 staff. Any suggestions on how to deal with this?

Mark A. Aldrich, DPM, Antigo, WI

Query: Metatarsal Resection with Toe Amputation

I would appreciate advice as to the proper code to bill a partial metatarsal resection (to midshaft) with digital amputation for treatment of osteomyelitis. Would CPT 28810 (amputation, metatarsal, with toe, single) be correct, or does CPT 28810 involve the amputation of the complete metatarsal?

I considered CPT 28122 (partial excision [craterization, saucerization, sequestrectomy, or diaphysectomy] bone [e.g., osteomyelitis or bossing]; metatarsal bone), but that doesn't address the digital amputation...and the digital amputation code, CPT 28820, doesn't address the metatarsal (even though CPT 28122 is bundled into CPT 28820 in CCI edits). I am assuming that a modifier "-59" would not be appropriate because the procedures are not unrelated.

Lynne Njirich, Billing Office of Steve C. Jensen, DPM, Sonora, CA

Response: When I amputate a toe with part or all of a metatarsal, I always code CPT 28810 (amputation of toe with metatarsal).

Walter Pedowitz, MD, Linden, NJ

Codingline subscription information can be found by clicking here:

RE: Synvisc (Ivar Roth, DPM)
From: Elliot Udell, DPM

The obvious question that many of us might be pondering is the legality of injecting Synvisc, Supartz, or a similar medication which is really indicated by the FDA for OA of the knee. If the person has a bad reaction are we liable? As many of you know, I am a staunch advocate of the proper use of off-label meds, however I tend to ask questions when it is a surgical treatment and injecting into an ankle would qualify as a surgical treatment albeit a minor one. What would make both myself and others like me feel more comfortable is if some literature was cited where it has been used successfully in the ankle. Posting on PM News is also good. Peer-reviewed medical journal are an even better source. The more doctors who post, the better we can prove (in the event of litigation) that many of our colleagues are using this treatment, even though its usage is off-label.

Elliot Udell, DPM, HIcksville, NY, Elliotu@aol.com

RE: Z-Coil Shoes (Michael Lawrence, DPM)
From: John Mishasek, CPed

Our pedorthic facility started selling Z-CoiL footwear over five year ago. Some individuals with chronic pain conditions (herniated disc, RA, fused ankle, etc.) have became long-term Z-CoiL users. Z-CoiL’s significant shock-absorbing capability is useful to reduce ground impact forces immediately and significantly. The aggressive front rocker sole design can help reduce ground impact forces to the forefoot as well as to the rearfoot in ankle fusion patients.

Individuals with unstable gait or balance problems may not do as well in Z-CoiL shoes due to the 1/2”-3/4” of compression of the coil at heel strike. However, a range of coil firmnesses can be installed in lieu of the factory coil to provide the appropriate shock absorption and heel strike stability for heavier or lighter weight individuals.

Z-CoiL shoes are not throw-away shoes as the coil/heel pad system is replaceable. This feature helps offset the initial cost that runs between $190-$260 per pair at our store. Some of our customers have used their initial pair for 3-4 years and have had to replace only the coils once or twice during this period. An enclosed coil option is available for those customers where there is a concern about catching hoses or tubing in the open coil design or for cosmetic reasons . The open coils are typically priced at $40-$50 per pair and the enclosed at $70-80 per pair. The rocker sole rarely wears out. With better brands of athletic shoes now running $95-135 and are useful for 600-900 miles, Z-Coil can be very cost competitive over a 3+ year period.

The manufacturer asks that stores offer a 14-30 day unconditional guarantee that covers a significant portion of the cost of the shoes if the individual is not satisfied with their outcomes. Z-CoiL technology has become a valuable tool that we recommend in certain situations.

John Mishasek, CPed, Colorado Springs, CO, jmishasek@earthlink.net

RE: ACFAS Members Vote to Reject APMA Membership Requirement
From: John M. Giurini, DPM, Beth Jarrett, DPM

As podiatric physicians and surgeons at ACFAS, we all share the same goals and objectives: To help our members provide the best possible care to your patients and navigate the many issues affecting your daily practice. We also recognize that collaboration with similar professional organizations is important to the strength of our profession.

A recent all-member vote on ACFAS membership requirements confirms what our members have been saying for several years – members want choice of professional memberships. While ACFAS has responded to our members’ concerns, we also encourage them to voluntarily maintain their membership with both organizations. And we look forward to working in harmony with APMA for the advancement of our profession.

Several questions and/or misconceptions on the vote endure. We urge interested ACFAS members to visit our website for final background information on this subject:

John M. Giurini, DPM, ACFAS President

The board of the American College of Foot and Ankle Orthopedics and Medicine (ACFAOM), currently APMA’s only affiliated specialty organization, anticipates working closely with APMA and its other affiliated and related organizations to resolve this situation in the best interest of the profession as a whole. This will include investigating the possibility of expanding ACFAOM's mission to include surgery if it is the desire of APMA and the profession as a whole to move toward a single, unified College to better represent podiatry.

Beth Jarrett, DPM, President, American College of Foot and Ankle Orthopedics and Medicine

Editor’s note: APMA has informed us that it has not yet created a plan or process to consider a new surgical affiliated organization. The APMA Board is scheduled to begin its discussions on this matter during its May retreat.

SOUTH CENTRAL PENNSYLVANIA-PM&S 36 ASSOCIATE WANTED

Large, busy podiatry group looking for associate interested in future partnership. Practice facilities and technologies include: Surgical Center, Physical Therapy Department, 6 appointment locations, EMR, MRI, Clinical Trials and Digital X-ray. Full compensation and benefit package offered. Mail CV to Martin Foot and Ankle, 1203 S. Queen St. York, PA 17403 or email johnreitzelmfa@aol.com

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