The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

May 12, 2010 #3,855 Publisher-Barry Block, DPM, JD

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IL Podiatrist Uses Cartilage Replacement For Arthritic Joints

Arthritis in the big-toe joint may not sound like much to fret about. But it can be so painful, people with this condition can barely walk, let alone play golf, says Dr. Kimberly Eickmeier, a podiatrist at Christie Clinic. "It keeps you sedentary," she adds.

Dr. Kimberly Eickmeier

Eickmeier has long seen potential relief for arthritic big-toe joints and ankles in a procedure called cartilage replacement surgery that has been available in Europe for the past decade and was approved for use in the U.S. just two years ago. It involves replacing worn, damaged hyaline cartilage (which serves as a cushion and shock absorber in the joint) with new cartilage from juvenile donors.

Eickmeier, who has used this procedure on two patients with painful big-toe joints, says she goes in and cleans up the cartilage, smooths it out and glues in the new cartilage. "It's like what you were born with," she says. Patients can be back to work in two weeks if they have a sedentary job and can resume their normal activities in a month, she said.

Source: Debra Pressey, The News Gazette [5/10/10}

GA Podiatrist Educates Nurses on Diabetic Foot Health

Village Podiatry Centers’ Dr. Allen Raphael, a board-certified foot surgeon, recently led a medical education luncheon for workers’ compensation nurses. The seminar provided continuing education credit for more than 25 registered nurses and certified case managers. Dr. Raphael, who provides podiatric medical care at Village Podiatry’s Smyrna location, educated audience members on diabetic peripheral neuropathy, or nerve damage. Peripheral neuropathy occurs in the extremities, such as feet, hands, legs, or arms, with feet being the most common site.

Dr. Allen Raphael

“Those who suffer from diabetic peripheral neuropathy are more prone to injuries, both on and off the job, largely in part to symptoms such as numbness, fragile skin, and unsteady gait,” said Dr. Raphael. “The lack of sensation increases one’s likelihood to fall or sustain an undetected injury, while fragile skin can impede proper wound healing, leading to infection.”

AZ Podiatrist Opens New Equipment Repair Business

Dr. Michael Schubyn, who founded IMS Medical Equipment, was contacted by fellow podiatrists to see if IMS Medical would repair the equipment in their offices. Schubyn listened and acted. In December, 2009 he opened Doc's Medical Equipment Repair Shop in Scottsdale, AZ. Doc's Medical Equipment Repair Shop repairs and refurbishes autoclaves, cast saws, podiatry x-ray units, and whirlpools.

Dr. Michael Schubyn

Doc's Medical Equipment Repair Shop also re-upholsters podiatry and exam chair cushions. Doctors who practice outside of Arizona ship their equipment and cushions to the repair facility where the items are repaired or refurbished, and then shipped back to the doctor. Doc's Medical Equipment Repair also has an annual maintenance program for autoclaves. Autoclaves are thoroughly tested, cleaned, a PM kit is installed, and any necessary repairs are made. This annual maintenance program extends the life of sterilizer units, and increases their efficiency.

Source: Footsteps (OCPM [[March/April 2010}

Query: Bead vs. Autoclave Sterilization (Robert Spalding, DPM)

Dr. Spalding says that we should "adopt autoclave sterilization procedures for all routine foot care nationally." I have been using glass bead sterilizers for my hand instruments (between patient visits), for a few years now. Is there any data as to their effectiveness when compared to autoclave sterilization, and if there is, what is the minimum time period that an instrument needs to be immersed in the unit before it is deemed "sterile"?
 
Charles Morelli, DPM, Mamaroneck, NY

Query: Double Calcaneal Osteotomy Coding

How do you bill for an Evans calcaneal osteotomy performed with a medial calcaneal displacement osteotomy? Do you bill CPT 28300 (osteotomy; calcaneus [e.g., Dwyer or Chambers type procedure], with or without internal fixation) for both procedures? If so, would they need a modifier for the 2 different and separate procedures?

Ronica Holcombe, DPM, Irving, TX

Response: This is a common double osteotomy that I perform. I have no problem being reimbursed. Two separate incisions must be used.

CPT 28300 x2 is the correct code with the second procedure code appended with a "-59" modifier. Of course, expect the second code to be reduced by 50%.

Walter Pedowitz, MD, Linden, NJ

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RE: Post-Traumatic Pain in the Interspaces (Gregory Teles, DPM)
From: Multiple Respondents

Remember the dorsal cutaneous nerves reside in "No man's land" which means no man should operate there. Consider topical Prudoxin for what sounds like nerve contusion.       

Dwight L. Bates, DPM, Dallas, TX, dlbates04@yahoo.com

Think CRPS. Refer to pain management/physiatry and have them follow that treatment protocol

Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

I think it obvious that this is a nerve injury. The question is which ones? I would refer this patient to a peripheral nerve specialist in your area. However, if you want to try to treat this yourself, you need to start systematic diagnostic blocks with lidocaine, working your way from distal to proximal. Do not do more than one nerve at a time, as this can be confusing and you won't be able to isolate the problem. I would consider using desipramine 100-150mgs/day for pain relief, along with a topical compound of PLO gel in a mix with lidocaine, ketoprofen and Elavil, or gabapentin. Most of the time though, these cases need a neurectomy of the superficial peroneal nerve with replant and a deep peroneal nerve neurectomy, especially after this long time after injury. 

Peter Bregman, DPM, Tewksbury, MA, footguru@comcast.net

The brief description from Dr. Teles sounds like a post-traumatic neuropraxia. Pressure or injury to the soft tissues associated with injury may cause denervation and paralysis of the muscles supplied by that nerve. A severe consequence is loss of intrinsic muscle function with subsequent deformity. A literature review shows...

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

RE: Nurses to Take USMLE Exam in 2012
From: Stephen Doms, DPM

I was at an osteopathic medical conference this past weekend. At the meeting, it was mentioned that nurses in the Doctor of Nursing Practice programs will take the USMLE exam in 2012. The DNP will apparently be the only degree offered from 2012 and beyond for nurse practitioners.

If nurses can convince the NBME (National Board of Medical Examiners) to offer them this examination similar to that offered to MD and DO graduates, why can't our podiatric leaders approach the NBME for the test? I think it would benefit our profession to show competence in such an exam in furthering our advancement toward a degree change.
 
Stephen Doms, DPM, Hopkins, MN, sdoms@aol.com

RE: A2D2 DR Digital X-Ray unit  (Mario Dickens, DPM)
From: Brad Katzman, DPM

Digital x-ray works great. I have both the A2D2 x-ray and Traknet EHR and PadNet system. We are pleased with all three products, but have not yet integrated them into the electronic health record system. They tell us the PadNet is not yet ready for synchronization.

Brad Katzman, DPM, Ontario, CA, bkatzman2@earthlink.net

RE: The Media Impression of Podiatry (Doug Richie, Jr., DPM)
From: Multiple Respondents

Lowell Weil correctly identified the fact that the APMA projects our entire profession as being the “foot saver” in most of their PR info. The APMA could better serve our profession by promoting "foot and ankle physicians and surgeons" in conjunction with the name podiatry. The name "foot and ankle" “clearly” identifies what we do in podiatry and does not require an ongoing education campaign regarding the word “podiatry”. The name change to the North Carolina Foot and Ankle Society has clearly identified our profession in North Carolina. There is no mistake as to who we are or what we do.

James Mothershed, DPM, Winston-Salem, NC, jmothershed@triad.rr.com

Dr. Weil was right. The APMA MUST change the image of podiatry because podiatrists are still talking about pedicures, flip-flops, the dangers of socks, high heels, barefoot running, how to make the best arch support, and how to set up a cosmetic care room in your office. I could not be more embarrassed or ashamed of these practitioners. In my opinion, this should fall under unprofessional conduct. I wish we would eschew these articles and let them wither instead of resurrecting their purile ideation on those of us who wish to be doctors. Instead of talking about starting sulfone trials for a possible gram negative etiology for hyperkeratosis, we talk about #10 blades. Instead of ascertaining the etiology of a drop foot, we're bracing it, and talking about the plane of the deformity like a cobbler. Young students, start setting your future now, doctor or cobbler?

Robert Bijak, DPM, Clarence Center, NY, rbijak@aol.com

"We must realize that the media is mostly reader- or viewer-driven, not marketer–driven. We can send the media all the foot surgery stories we want, but in the end, they will run the danger of high heels or flip-flops stories every time." – Barry Block, DPM, JD

I must respectfully disagree with our esteemed editor. If you look at the first few...

Editor's note: Dr. Paul Bishop's Extended-length letter can be read here.

ASSOCIATE POSITION - PENNSYLVANIA

Western Philadelphia suburbs. 2-Office, Multi-Practitioner Practice ,has full-time position available. Must be ABPS Qualified or Certified. PSR-36 Preferred. Looking for hard-working, well-rounded, personable individual who is interested in all aspects of Podiatry including foot surgery and wound care. Please e-mail Resume to: pod1593@gmail.com

ASSOCIATE POSITION - TAMPA BAY, FL

Associate needed for a dynamic practice in the Tampa Bay area. Preference given to a PSR 24+ training and must have a Florida license. Well-established practice, high-tech with specialties in sports medicine, surgery and wound care. No nursing homes or HMOs. E-mail: drcosentino@tampabay.rr.com

ASSOCIATE POSITION - MARYLAND

IMMEDIATE Associate needed to join a multi-office podiatry practice in the Baltimore MD Region. Desired candidate should be surgically trained with Board Eligible/Certification. You must be hard-working, ethical, compassionate and confident in your abilities to deal with pathology, patients, staff and fellow physicians. Patient base is already established. Excellent income and growth potential for the right associate. Please forward a cover letter, resume, and surgical log (if a current resident) and availability to FootDocMaryland@Gmail.com

ASSOCIATE POSITION - PRINCETON, NJ

Looking for a full-time associate in a very high volume 2-office practice in the Princeton area in routine/sports/pediatric/surgical podiatric care. Excellent opportunity for a hard-working, ethical, individual with good personal and clinical skills. Candidate needs minimum PSR 24-36, board qualified/certified, and an active NJ state license. Send résumé’s – princetonpodiatry@yahoo.com

ASSOCIATE POSITION NORTH CAROLINA - ASHEVILLE/MOUNTAINS

Well established, multi-doctor, multi-office diverse practice has immediate need for associate doctor leading to partnership. Associate doctor will be very busy from day one. Attractive compensation and benefits. Buy-in potential after one year. Contact at smfc2@charterinternet.com or 828-734-1535

PRACTICE & BUILDING FOR SALE - MIDDLE TENNESSEE

Two locations each with 3 exam rooms, x-ray room, large waiting room, and ample parking. Excellent locations and growth potential. All equipment and furniture included. Website and marketing material included. Seller happy to assist with transition. Grossed 350K last year, priced to sell with financing available 200k. Call 931-446-5724.

SEEKING EMPLOYMENT - SOUTH FLORIDA

Board Certified Foot Surgeon. Had own practice in Texas for twenty years. E-mail:  ehe2852341@yahoo.com

ASSOCIATE POSITION - MINEOLA, NEW YORK 
 
Full-time or Part-time associate position with future partnership potential available with busy multi-office practices on Long Island. Must be proficient in all phases of podiatry with emphasis on surgery, biomechanics and RFC. Minimum standards include either a three-year PSR, or board qualified/certified status with ABPS. Existing hospital privileges with a NY-based facility helpful. Interested doctors are encouraged to e-mail their CV to mets724@gmail.com

ASSOCIATE POSITION - MARYLAND

Podiatrist needed for Maryland practice. Fax resume to 410-749-6807.

ASSOCIATE POSITION – GREATER MILWAUKEE, WI

Great opportunity: our busy multi-physician, podiatric group practice, with multiple locations, strong hospital based affiliations and clinical appointments, with teaching faculty positions at PM&S-36 residency programs, is seeking a full-time RRA BQ/BC, PM&S-36 surgically trained doctor. Position will be available for July/August, 2010. Applicant should be well trained in all aspects of conservative care and surgical forefoot, rearfoot, reconstructive surgery, trauma, wound care and limb salvage. Candidate should be ethical, hard working, outgoing and a self-starter. Commensurate pay, income guarantee, with incentives and full benefit package. Definitive plans will be discussed leading to partnership tract. Contact: Daniel Hellman, M.D. @ 414.831.0512 or by e.mail @ hellmandr@gmail.com

LOOKING TO PURCHASE PRACTICE IN FLORIDA

Experienced, surgically trained, very successful FL licensed podiatrist currently practicing out of state looking to purchase successful full time practice in Florida to relocate for family reasons. I have been in practice for over 10 years and am fluent in English/Spanish. Serious inquiries only. Please send email to faajobs@gmail.com.

ASSOCIATE POSITION -  NAPLES, FLORIDA  
Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office, multi-doctor practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. We rotate for ER call at all 4 hospitals. Candidate needs to be ethical and motivated. Established practitioner or new practitioner OK. Salary and percentage based on skills and experience, benefits including 401K. Current Florida license a plus. This a wonderful world class community. Fax CV to (239)566-8778 or Email CV to Drgordon@gulfcoastfootcare.com

CANADIAN PODIATRISTS COME BACK HOME!

An Edmonton, Alberta group of DPM’s requires an additional Podiatrist. Interest in biomechanics essential. Given Canadian visa restrictions, this position is open only to Canadian Citizens or permanent residents. Very attractive compensation package. Fax C.V. or letter of interest to: (780) 483-5796.

ASSOCIATE POSITION – NEW YORK 
 
Great Opportunity  NY podiatric practice – multiple locations – seeks well-trained, ethical DPM per diem and full-time positions available. Competitive salary. Send resume and CV to: info@advancedfootcare.org

ASSOCIATE POSITION - LAS VEGAS, DALLAS, HOUSTON, AND SAN ANTONIO AREAS

Seeking well trained ABPS board rearfoot/ankle certified/qualified foot surgeons for surgical practice with national foot/hand/orthopedic surgery group. Excellent salary/benefits. Email CV and cover letter to: slb99@pdq.net

TRAUMA FELLOWSHIP - FOOT & ANKLE

Broadlawns Medical Center in Des Moines, IA is currently accepting applications for its 12 month trauma surgery fellowship beginning August 1, 2010. Fellowship to include advanced techniques in all foot and ankle surgery with an emphasis on lower extremity trauma, reconstruction & total joint replacement. Residency training required. Competitive salary and benefits. Please submit a letter of interest, CV, and 3 letters of recommendation to: Ben Olsen, DPM, Director: Foot and Ankle Trauma Fellowship, Broadlawns Medical Center, 1801 Hickman Road Des Moines, IA 50314, 515-282-7927, bolsen@broadlawns.org

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