The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

May 15, 2009 #3,546 Publisher-Barry Block, DPM, JD

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Some Flip-Flops Can Provide Support: MD Podiatrist

Flip-Flops are ubiquitous. But some foot-health experts worry that our collective love of the open toe is ruining our feet. Last year at the annual meeting of the American College of Sports Medicine in Indianapolis, Justin Shroyer, a biomechanics doctoral student at Auburn University in Alabama, presented findings that show flip-flop sandals alter the way a person walks, changing the gait in ways that could lead to heel, sole and ankle problems.

Dr. James Christina

James R. Christina, a doctor of podiatric medicine and the director of scientific affairs for the American Podiatric Medical Association, wore these sandals following his running and elliptical training workouts. “There’s no medical reason to wear an après-sport sandal,” he noted, but if you want to wear something other than athletic shoes after exercise, “most of these were surprisingly supportive.”

Source: Dana Sullivan, New York Times [5/14/09]

NJ Podiatrist Re-Elected as Mayor of Passaic

City voters gave their support to the incumbent mayor Tuesday night over a veteran city employee. Mayor Alex Blanco won re-election, garnering 4,988 votes compared with 4,409 for challenger Vincent Capuana, according to unofficial results from the city clerk's office.

Dr. Alex Blanco

The win gives Blanco four years to fulfill his campaign promises of greater government transparency, helping small businesses, promoting redevelopment and providing more recreational opportunities for young people.

"I'm happy that the people elected me for the second time," Blanco said. "I started working in November to unite the city and I'm glad I have four years to move the city forward."

Source; James Yoo, NorthJersey.com [5/13/09]

Medicare Funds Expected to be Exhausted in 2017

Medicare’s trust fund is expected to be exhausted in 2017, two years earlier than previously estimated, according to the 2009 annual report released by the Medicare trustees. In 2008, total Medicare expenditures were $468 billion and are expected to increase in future years at a faster pace than either workers’ earnings or the economy overall, the report stated.

It’s clear that Medicare’s financial challenges “are larger and more imminent than those of Social Security,” Treasury Secretary Timothy Geithner said at a news conference. Medicare’s annual costs were 3.2% of the gross domestic product in 2008, or nearly three-quarters of Social Security’s, but are projected to surpass Social Security expenditures in 2028 and to reach 11.4% of GDP in 2083 compared with 5.9% for Social Security.

Source: Jennifer Lubel, Modern Healthcare [5/12/09]

Query: Osteotomy?

We have a female patient in her 40s with an IM angle 12-13 degrees (factoring in her metatarsus adductus). The met protrusion is zero, so the 1st and 2nd metatarsals are equal in length. There is also a 2nd digit symptomatic hammertoe deformity and there is sub-met 2 pain with callus formation.

Osteotomy?

When would one decide to do a 2nd metatarsal osteotomy? If so, which procedure specifically?
 
Margaret Portela, DPM, Union City, NJ
 

Query: New Patient Ethical Dilemma
 
A couple of days ago, my medical assistant scheduled a new patient visit on the telephone. Afterwards, my MA told me that during the conversation the patient asked, "What nationality is the doctor?" She answered, "German & Irish." The patient replied, "Oh good, as long as he's not Black or Hispanic"....I don't mean to come across sounding "better than thou", but although I am Caucasian, I was upset by this comment and do not wish to treat this patient....Do I have the right to call and cancel the appointment with this patient since I haven't seen or treated him yet?  What is my legal obligation here?
 
Chris Seuferling, DPM, Portland, OR

Editor’s note: PM News does not provide legal advice. Unless a patient belongs to a protected class (e.g., race, religion, disease, disability, etc) a provider has a right to refuse to treat a new patient if the doctor/patient relationship has not yet been established. Making an appointment does not establish a doctor/patient relationship. Since bigots are not a protected class, you are under no legal obligation to accept them as new patients.  
 

RE: Spider Bite Complications (Wm. Barry Turner, DPM)
From: Multiple Respondents

Any atypical ulcer presentation that keeps reoccurring should be biopsied.
 
Michael Krischer, DPM, Talihina, OK, MSKrischer@cnhsa.com

Your patient may be suffering from incompetent perforators in the Cocketts region of the lower leg as they join the greater saphenous vein.

I do endovascular ablation utilizing the VNUS RF device for the closure of incompetent perforators and also the greater saphenous vein. I also use a foamed endovascular sclerosing agent and have found that once these incompetent perforators are identified and closed, and the patient wears a appropriate 30 to 40 mm Hg. weight-compression hose following the procedure for four to six weeks, these types of skin lesions that you demonstrated in your picture will no longer occur. There has been a recent research article on the closure of gator ulcers in the lower extremity with the identification and closure of the incompetent perforator vessels, utilizing endovascular RF ablation.

Utilizing 8MHz duplex ultrasound scanner transducer, and having the patient in a standing position, augment the calf muscle while evaluating these perforators and you may find a severely incompetent perforator and/or reflux involving the greater saphenous vein in this area.

John Hahn, DPM, Portland, OR, jmhahn2@comcast.net

Editor’s note: An extended-length by Frank Lattarulo, DPM appears at: http://www.podiatrym.com/letters2.cfm?id=26310&start=1

RE: Diabetic Ulcer Sub-Met 3
From: Dennis Shavelson, DPM

This patient is insensate (LOPS) and possesses a flexible rearfoot, flexible forefoot functional foot type as viewed on your weight-bearing x-rays. The 3rd met stump and 4th ray are bearing excessive weight as the vault of the foot collapses and the forefoot off-weights the medial column.

I would consider casting the patient in a more vaulted position than weight-bearing, especially plantar-flexing the first metatarsal aggressively. I would consider prescribing a 0 degree rearfoot post with some amount of heel lift on the affected side after correcting for a possible short limb on the other side with lift, prn.
 
Post the forefoot with a 3-4 degrees, 2-5 varus forefoot post. Place it proximal to the third met stump with an aggressive 1st ray cutout. Cover the entire device with a Poron/memory foam laminated top cover with a possible 3-4 met balance for the ulcers on the affected side. Make sure the patient is shod at home. I bet he walks on stocking feet.

Dennis Shavelson, DPM,  New York, NY, drsha@foothelpers.com

RE: Coding a Brace Adjustment (Paul Kesselman, DPM)
From: Doug Richie, DPM

I disagree with my friend, Paul Kessleman, on this issue. Orthotists commonly refurbish ankle foot orthoses and are reimbursed by Medicare for these services. So should podiatric physicians. Replacement of screws and pins are not a common refurbishment service needed for ankle foot orthoses. Rather, the soft interface and Velcro straps will normally wear out within one year of daily use and will require repair or replacement.

A podiatric physician can easily replace the padding of the orthosis and change out the Velcro straps in the office setting, particularly when the AFO fabrication company supplies a refurbishment kit to the doctor. Yes, codes L4210 (parts cost) and L4205 (labor component) are appropriate for this service. While there is a separate HCPS code for the soft interface when a NEW AFO is dispensed (L2820), this is not appropriate to bill for a simple repair or refurbish. The Velcro straps are integral to the original design of the AFO and are not ever billed under a separate HCPS code. It is well-recognized that the padding and Velcro straps will wear out long before the useful purpose of the AFO has been achieved, and the providing physician is qualified and entitled to provide this repair to assure the ongoing medical benefits of the device to the patient.
 
Doug Richie, DPM, Seal Beach, CA, DRichieJr@aol.com

RE: HIPAA and ID Theft (Pete Harvey, DPM)
From: Glenn B. Gastwirth, DPM, Michael L. Brody, DPM

A reminder that APMA provides a free HIPAA Security Manual and HIPAA Privacy Manual on its "members only" website. These documents include the process that should be followed if there is a “security incident”.

Glenn B. Gastwirth, DPM, Executive Director and CEO, APMA, gbgastwirth@apma.org

The loss, theft, or misuse of patient information is a HIPAA violation. All data in your practice must be properly secured, both the data on your computers and your backup data. HIPAA has specific regulations that address how to prevent physical theft of equipment and virtual theft of data.

If there is a theft or loss of data, you are required to report that to the Department of Health and Human Services. There are also other requirements under HIPAA. HIPAA Violations can result in federal fines and civil suits from the patients who have had their information compromised, and unwanted publicity in the media.

Michael L. Brody, DPM, mbrody@tldsystems.com

Editor’s note: An article on this topic by Dr. Brody will appear in the June/July issue of Podiatry Management.

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

SEEKING PODIATRIST FOR SUNDAYS - HOWELL, NJ
 
Our practice of over 18 years is looking for a DPM to provide treatment on Sundays at our Howell office located approximately 1 mile from Lakewood , NJ. Speaking Hebrew preferred, but not required.  Please reply by emailing a CV and cover letter to: toetoe@optonline.net or by faxing to 1-888-645-0241.

BIOMECHANICS FELLOWSHIP – NEW YORK CITY

Neoteric Biomechanics 3-6 Month Fellowship: At The Foot Typing Center in New York City. Practice, Research, Publish and Credentialize Yourself In This New Paradigm. $1,000 a Week Stipend. New York License Required. Fax Interest to: 212 288 3034 or apply to Dr. Shavelson @ drsha@lifestylepodiatry.com.

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

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 – TUCSON, ARIZONA

Full-time position which involves all phases of podiatry. Compensation based on training and experience. Must have current Arizona podiatry license. Send Resume to Transcription697@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.

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                            

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