The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

May 13, 2011 #4,159 Publisher-Barry Block, DPM, JD

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CA Podiatrist Discuesses Plantar Fasciitis 

As we step through spring and head into summer, many people might be dealing with excruciating heel pain. Podiatrists say it's the number-one foot complaint among their patients. One local doctor says most people can stop the pain without surgery. Dr. Franklin Kase, a foot specialist at Providence Saint Joseph Medical Center, says if people knew what causes heel pain, or plantar fasciitis, they would know how to alleviate and prevent it. 

Dr. Franklin Kase

"You get this inflammatory process developing right at the insertion of the plantar fascia to the bottom of the heel right here," said Kase. And that's where most people feel the excruciating pain. Kase advises patients to wear shoes with solid heel support that bend at the front. And you shouldn't be able to twist it much. "If you don't have that, what happens is you compensate by breaking down the midsection of your foot or you can develop pain in your knees as well," said Kase.

Source: Denise Dador, KABC-TV [5/10/11]

More Medical Licenses Taken Away, Fewer Disciplinary Actions in 2010, FSMB Finds

Although the number of medical licenses taken away in 2010 was up 4.5% over 2009, the total number of disciplinary actions taken by state medical boards fell 1.2%, according to the Federation of State Medical Board's (FSMB) annual summary of state board actions. According to the report, which compiles the disciplinary actions taken by 70 state medical and osteopathic boards, 1,815 physicians and other medical professionals had their licenses revoked, suspended, or mandatorily retired in 2010, compared with 1,736 in 2009.

State boards took 5,652 total disciplinary actions—including probations ordered, licenses modified, or penalties and reprimands issued—in 2010, compared with 5,721 in 2009, according to the Federation's summary.

Source: Andis Robeznieks, Modern Healthcare [5/11/11]

Query: Podiatrist's Responsibility When Taking Patients' Blood Pressures

What would happen if a non-primary care physician discovered that a patient's blood pressure was mildly "temporarily" elevated, and the patient went on to have a cardiovascular incident? Would that podiatrist be held liable for not intervening? 

Elliot Udell, DPM, Hicksville, NY

RE: Ultrasound-Guided Popliteal Infusion, Post-Bunion Surgery (Brian Kiel, DPM)
From: Charles Morelli, DPM

For complicated midfoot and rearfoot procedures where post-op anesthesia and pain management is a concern, we will ask the anesthesiologist to give this block. It is done easily in the OR, and I don't see any reason for needing to perform this under ultrasound guidance. But then again, there are quite a few practitioners who use this modality for giving plantar injections for heel pain as well as for other similar conditions. Why is ultrasound used? I think we all know the answer.

Charles Morelli, DPM, Mamaroneck, NY, podiodoc@gmail.com

RE: Dorsalis Pedis Artery Aneurysm (Cedric Cooper, DPM)
From: Bryan C. Markinson, DPM

Dr. Cooper reports a very interesting case of a dorsalis pedis artery aneurysm. In reading the post, I think I might have proceeded differently. In his exam, he reports that the lesion could be trans-illuminated and was also pulsatile. He then indicates that he did an excisional biopsy. I don't think that is what he did. The very next sentence reports that he aspirated serous fluid and blood from the lesion, diagnosed an aneurysm, and sent the patient to the vascular surgeon for successful excision of the lesion.

After determining that the lesion was fluid-filled AND PULSATILE, I would have gone right to imaging and NOT aspirated the lesion. There is a reasonable chance of hemorrhage (or clot formation which) due to the aspiration, depending on whether or not the lesion was venous or a very fragile thin-walled artery. A Doppler may have helped as venous lesions may not be (but could be) pulsatile, but characteristic sounds help differentiate an artery from a vein.

Another non-invasive clinical test looks for Branham's sign. If this lesion had been an arterio-venous fistula, compression of the dorsalis pedis artery proximal to it would induce a bradycardia. Additionally, I wonder if the patient was screened for aneurysms in the usual places?

Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org

RE: OIG to Hold Free Provider Compliance Training Webcast on May 18, 2011
From: Paul Kesselman, DPM

OIG will offer a free, live webcast of its HEAT Provider Compliance Training to be held at the Department of Health and Human Services on Wednesday, May 18, 2011 from 8:30am-1:00pm EST. For those unable to watch the live webcast, a video of the training will be available for online viewing on or before May 31, 2011. 

Hear from Inspector General Daniel Levinson and other government experts as they educate local healthcare providers and compliance officers about the realities of Medicare fraud and the importance of implementing an effective compliance program. For information regarding viewing the free webcast and to download program materials, click here.

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

RE: The Passing of Rob Roy McGregor, DPM
From: Lloyd Smith, DPM

Dr. McGregor, affectionately known as Rob Roy, was a pioneer in the world of podiatric sports medicine and diabetes. He was a past president of the Massachusetts Podiatric Medical Society. He was one of my early mentors as I explored the issues of sports injuries, running biomechanics, and how to understand, evaluate, and treat runners. He was a kind man dedicated to his family and his profession. He will be missed.

Lloyd S. Smith, DPM, Newton, MA

RE: Vibram Fivefingers Shoes (John Hart, DPM)
From: Brad Shollenberger, DPM

I recently treated a 30 year old  female runner who started running this past fall with Vibram FiveFingers. She reduced her initial miles as recommended, and within 2-3 weeks was experiencing significant dorsal midfoot pain. Her PCP ordered a bone scan before referring her to me. This showed uptake at the 4th tarso-metatarsal joints B/L. Follow-up x-rays in my office confirmed stress fractures with subsequent remodeling. Due to the B/L nature, I placed her in surgical shoes, with restricted activity, and she was able to return to light running (in conventional running shoes) in 10 weeks.

Personally, I think Vibram FiveFingers should be reserved for Halloween costumes.

Brad Shollenberger, DPM, Reading, PA, nohav@aol.com

RE: Adam Smith's "The Wealth of Nations" (David Helfman, DPM)
From: Dwight L. Bates, DPM

Recently, I borrowed The Wealth of Nations from the public library by mistake. It was the only book I had, so I read it. It is wonderful. Smith described exactly what is going on today. You can predict the future and position yourself accordingly if you read what Smith wrote.

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

RE: TrakNet EMR
From: Brooke Weaver

Like everyone else, we faced the EHR decision. It wasn’t the enticement of the money offered, but more the fear of the fee cut if we did not have appropriate software that made us commit to a new product. We had been a Medinotes/Lytec user since the beginning, and the thought of changing was a bit intimidating. We liked what we had and we knew the ins and outs of the program, so changing was not high on the list of things we really wanted to do.

After careful consideration, we did choose Traknet, and we have to say that we are very pleased we did. Having trainers available to us who came from a Medinotes/Lytec background helped tremendously, especially...

Editor's note: Ms. Weaver's extended-length letter can be read here.

RE: This Patient Was Really "Ticked" Off

Always check between the toes. I found this in the first web space on one of my diabetic patients; he didn't know it was there.

Interdigital Tick

It is a tick.
 
Calvin Britton, DPM, North Little Rock, AR

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. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

ASSOCIATE POSITION – IOWA CITY AREA

Modern practice seeking a well-trained (PSR 24/36) associate. Excellent opportunity for an energetic, hardworking individual with strong surgical and medical skills. Solid referral network and 13 years of growth. Come live in the Iowa City area and enjoy the quality of life and stability of a Big Ten University community. Competitive salary and benefit package available. If interested, fax CV to 319-354-1014 or e-mail to dave@341foot.com

POSITION AVAILABLE - LONG ISLAND PRACTICE (NASSAU COUNTY)
 
looking for part time associate for 8-12 hours/week with room to grow. Please email pittpod@gmail.com with interest (write 'position available' in subject line).

ASSOCIATE POSITION - SW FLORIDA

Huge opportunity. Are you an outstanding person? Would you like the freedom to utilize your talents to the max? Opportunity awaits right candidate. Excellent mix of office/surgery motivated/experienced staff. Full Time Associate PSR 12-36. Great Salary/Benefits, Bonus Package, Unlimited Potential, Buy-In Opportunity. Email resume to podiatry22@yahoo.com

ASSOCIATE POSITION - TAMPA BAY, FL

Associate with PSR 24+, needed for a dynamic practice. Well-established high-tech with specialties in sports medicine, surgery, and wound care. No nursing homes or HMOs. E-mail: flpodiatrist@tampabay.rr.com

ASSOCIATE POSITION – NEW YORK

Well-established, multi-doctor podiatry practice with offices in Putnam and Westchester counties. Compensation based on productivity. Excellent opportunity for recent residency graduate to build skills and learn practice management. Full-time preferred but right part-time candidate will be considered. Email cover letter and CV to:  Podiatry2011@gmail.com

ASSOCIATE POSITION - WA (KIRKLAND, SEATTLE, EVERETT, AND REDMOND)

Join one of the fastest growing podiatry practices in Washington state. Must be motivated to grow practice. Competitive salary and benefits. For more information go to seattlefootdoctor.com. Send resume to seattlefootdoctor@yahoo.com

ASSOCIATE - POSITION - SOUTHEAST GEORGIA & SOUTH CAROLINA

Seeking recent residency graduate to join practice. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facility. E-mail to melissafoot@pol.net

ASSOCIATE NEEDED - MIAMI, FL

Full-time. Very Busy practice. Rearfoot/forefoot/wound care. Salary + % gross. Send CV to footdoctorinmiam@aol.com

ASSOCIATE POSITION - NEW YORK CITY & QUEENS

One of the fastest growing podiatry practices in New York City and Queens seeks a podiatrist who participates with HealthFirst, Fidelis, and other Medicaid plans. Preferably a Spanish speaking podiatrist. Contact me at Podocare@aol.com

ASSOCIATE POSITIONS - NW INDIANA, CHICAGO AREA

2 Full-Time positions open - One for Northwest Indiana and one for the Chicagoland area. Must have 2-year surgical residency. Must be motivated and a self-starter. State License required. If interested email: f-massuda@footexperts.com

ASSOCIATE POSITION - CT - (FAIRFIELD AND NORTH HAVEN)

Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices, including EMR, digital x-ray, vascular and NCV studies, Pinpointe and CO2 lasers, diagnostic ultrasound and electrical stimulation therapy. You can expect a full schedule of patients the day you start, and a very competitive salary. For more info www.greatfootcare.com. Send resume to Dr.Kassaris@yahoo.com

PRACTICE FOR SALE - NORTHWEST SUBURBS, CHICAGO, IL

Great Opportunity! Present owner to stay on for transition. Average 20% growth over 3 years while open only 4 half days a week. Excellent growth potential with increased hours. Perfect for a new practitioner or a 2nd location. contact podiatrynwsuburbs@gmail.com for information.

PRACTICE FOR SALE - MISSION VIEJO, CA

Relocating to Tulsa. Great opportunity to buy my office. Located on Mission Regional Hospital Campus. Gross income 2010 was $340,000. Approximately 1300 sq ft with 3 treatment rooms, digital x-ray and fully computerized. Only 3 years old. Will consider all offers. 949-702-1052. David Stoller, DPM (Family Footcare) david@missionviejofootcare.com

PRACTICE FOR SALE - MARYLAND, DC SUBURBS

Great opportunity. Well established and equipped practice for sale. Office includes state licensed Ambulatory Surgical Center. Present owner is retiring but will stay on as needed for smooth transition. Average gross over past 3 years is $575 K. dpmpracticeforsale@yahoo.com

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