The Voice of Podiatrists

Serving Over 10,900 Podiatrists Daily

May 09, 2008 #3,241 Editor-Barry Block, DPM, JD

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NY Podiatrist Recommends Comfort Over Fashion

Dr. Seema Ram-Charitar's pick for the summer's ideal comfort shoes is Birkenstock sandals. She knows they're not the most fashionable choice. She knows that the Prada-clad clientele who come to her New York podiatric practice haven't worn them since their college days. She knows that more than a few people even call them ugly. But the cork foot bed will conform to your foot over time for the perfect fit.

Dr. Seema Ram-Charitar

Short of that, Ram-Charitar recommends choosing shoes with a roomy toe box, shock-absorbent soles and a 1-inch heel. "If we want to stay active, preserve our joints, we have to preserve our feet - that's our mobility." She says that very few people start off with perfect feet, with the most common issues being either flat feet or high arches. So shoes have to compensate.

No matter the shape or style, though, the most important factor in choosing good-for-your-feet comfortable shoes is fit, "There really should be no such thing as breaking them in. A shoe shouldn't hurt from the start."

Source: Samantha Critchell, AP, [5/6/08]

Over 100 NYSPMA Podiatrists Lobby in State Capitol for Increased Scope of Practice

Over 100 New York State Podiatrists arrived in Albany on May 6th to let over 60 legislators know their views on scope of practice. They also took the opportunity to educate lawmakers about the role podiatrists play in diagnosing and treating diabetes, helping children with foot abnormalities and administering to the burgeoning aging population.

Dr. Robert Rampino

“We need to make every effort to keep our state capitol aware of the vast capabilities of our members as well as the challenges facing our profession,” remarked Dr. Robert Rampino, president of the New York State Podiatric Medical Association, the group that organized the event.

The present scope of practice legislation in the Empire State limits New York State podiatrists from practicing above the foot. “And those limitations are forcing the next generation to leave New York, where many are educated, to set up practice in states where they are not hobbled by scope restrictions and they can practice what they’ve learned,” Dr. Rampino says.

NYCPM Student Produces Fitness DVDs

Emily Splichal a graduating Senior at the New York College of Podiatric Medicine recently put together a series of fitness DVD's for women who wear stilettos. Her goal is to increase the awareness of the impact of stilettos on foot health and the body, and hopefully prevent injury through her fitness DVDs.

Student Dr. Emily Splichal

The aim of the first DVD is to increase ankle stability and balance, therefore preventing ankle injuries when wearing stilettos. The second DVD focuses more on maintaining adequate ankle joint ROM through stretching and yoga, and releasing the plantar fascia and preventing fasciitis.

Query: Selling Athletic Shoes
From: Chris Milkie, DPM

I often recommend New Balance and Brooks to many of my patients. Does anyone know of a program (other than the diabetic shoe program) that offers these shoes for sale as a "profit center" in the office?

Chris Milkie, DPM Wauwatosa, WI

RE: Z-Coil Shoes (Michael Lawrence, DPM)
From: Kevin A. Kirby, DPM

I have had some clinical experience with Z-coil shoes that I thought might be of help for my colleagues who have not yet suggested these unique shoes for their patients. Z-coil shoes have a rather large spring which connects to the heel portion of the sole of the shoe which provides unusually good shock attenuation characteristics to the shoe.

The shoe may be modified with springs that have different stiffnesses which may be used to adjust to the patient's body weight, to increase or decrease the height of the heel of the shoe and/or to increase or decrease the frontal plane rearfoot stability of the shoe. Z-coil also sells a cover that effectively hides the rearfoot spring so that the shoe appears to more traditional in construction. The shoes come both in a slip-on and lace-up styles. I have not had any patients that have had instability problems, trips or falls that can be attributed to the shoes.

I have found some success with Z-coil shoes in my patients with plantar heel pain (i.e., plantar fasciitis). However, the best indication for Z-coil shoes, in my experience, are for those patients that suffer from chronic retrocalcaneal bursitis and/or retrocalcaneal spurs. In these patients, I recommend the slip-on Z-coil design without a posterior heel counter to avoid chronic compression and/or shearing forces from the posterior heel counter on the posterior calcaneus. In addition, the higher heel-height differential of the Z-coil shoe, along with the shock attenuation characteristics of the rearfoot spring likely also decrease the tensile force from the Achilles tendon on the posterior calcaneus.

The Z-coil shoe, in combination with a well-designed foot orthosis, often renders even the most recalcitrant cases of chronic retrocalcaneal bursitis asymptomatic. I find them to be a very useful tool in the treatment of these patients. I do not have any financial interest in Z-coil shoes.

Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net

RE: Employee Timekeeping (Mark A. Aldrich, DPM)
From: Multiple Respondents

The issue of whether or not to employ a time clock has been debated over the 38 years I have been a DPM. There is no right or wrong answer to this question because there are clearly good arguments on both sides. Additionally, some tools just work better in some doctors’ hands than they do in others. When I was an unskilled, hourly worker, in a machine shop, a time clock made perfect sense. My value was based solely on the number of hours that I put in. The most productive employees were “rewarded” with overtime.

A time clock emphasizes hours put in rather than attributes such as productivity, attitude, and accomplishments achieved, and it measures “stars” and “slackers” in the exact same way. Being “on time” is but one criteria with which to measure an employee. In my opinion, if an employee is part time, or paid hourly, a time clock is probably an ideal way to assure that these employees are paid fairly. If an employee is salaried, however, I feel that using a time clock has a downside, especially in important areas such as attitude, productivity, and amount of effort given during the busiest hours of the day.

Jon Hultman, DPM, MBA, Los Angeles, CA, jhultmaned@podiatrists.org

I have found the best way to deal with it was to simply manage the problem. Sit down with the employee and discuss a specific example of the problem for example “last Tuesday you wrote a finish time of 4.00pm but you actually left at 3.55pm” Explain that its not acceptable and ask her to stop it straight away. Then set a review time of say 2 weeks when you will meet again to review the problem and make sure it’s fixed. This lets her know you are serious about it. If she leads into discussion about her wage explain to her that you can sit down and discuss that at another time as today we are talking about your time sheet problems and we will address other problems separately.

Stuart Blyth, Practice Manager, Holloway Podiatry, hollowaypodiatry@ozemail.com.au

We have an honor system of writing down the work hours instead of using a time clock. When I noticed someone padding the timecard, I would just tell them that they are to start work at a certain time and end at a certain time. Working in a medical office should be no different than a work schedule anywhere else. The exception would be on a day-by-day basis with authorization to stay late to finish a task. Most workplaces that have several employees have to post schedules. If someone was clocking in early or out late, the manager would have something to say about it. It is just a little harder sometimes for a doctor to set those boundaries, but I have found setting the boundaries is the only way to stop employees from taking advantage of me. If they try to stretch the set boundaries, I don't need them in my office.

Ellen Gebhart, DPM, Springdale, AR, MuelPh@aol.com

RE: Invest in Podiatry’s Future
From: William L. Reider, DPM

Editor’s Note: This extended-length letter can be read at:
http://www.podiatrym.com/letters2.cfm?id=19387&start=1

RE: New Medicare Criteria for Payment of I&D
From: Carl Solomon, DPM

Editor’s Note: This extended-length letter can be read at:
http://www.podiatrym.com/letters2.cfm?id=19386&start=1

RE: ACFAS Members Vote to Reject APMA Membership Requirement
From: Lawrence Kobak, DPM, J.D

Years back, the ACFAS (at the time, ACFS) actively prevented the American Academy of Ambulatory Foot Surgery (AAFAS) (at the time, AAFS) from joining the APMA. One of the reasons ACFAS gave was that the AAFS members were not required to become APMA members! The rest of the story was that the AAFS changed its bylaws to conform with the APMA requirements, and thanks to the ACFAS, lost its APMA affiliation by a handful of votes. Now, the same organization subverts its own argument and "votes" to violate the APMA requirement of membership. Does one detect a bit of cynicism in this action?

Lawrence Kobak, DPM, J.D, NY, NY, lkobak@optonline.net

PRACTICE FOR SALE - FLORIDA

Well-known practice in Coral Gables,FL for over 20 years. Excellent location on Coral Way with heavy traffic, great visibility and plenty of parking. Busy, fully equipped, full-time office with established patients. Grossing over 300K with tremendous growth potential. Office is currently open and ready to take over immediately. For additional information contact QVAN@aol.com or 305-975-5516.

Beautiful location in the heart of Miracle Mile. Excellent opportunity for a starting practitioner. Most insurances accepted. Good mixture of surgical and general podiatry. Fully equipped with low overhead. Located in a professional building, with referrals from other doctors in the same building. Contact zoesar@aol.com or call 786-877-5149.

LOCUM TENUM COVERAGE - CENTRAL FLORIDA

The Orlando Foot & Ankle Clinic (OFAC) is seeking locum tenum coverage.
OFAC has offices in Orange, Osceola, Seminole, Lake and Brevard
counties. A covering doctor is needed whenever one of the 13 OFAC doctors is on vacation or attending an educational seminar. If interested, please contact Greg Renton, CEO at 407-423-1234.

ASSOCIATE POSITION - TEXAS

Check out San Antonio, Wonderful place to live. Full or part-time podiatrist with current Texas license. Better pay. Unique mobile podiatry practice and mobile wound care clinics, in addition to office locations. Check out our website Fine working conditions with excellent support staff. E-mail Response to footcenter1@sbcglobal.net or fax to 210-495-6484.

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. 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

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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