The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

May 15, 2013 #4,770 Publisher-Barry Block, DPM, JD

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DC Podiatrist Discusses What to Wear (or Not Wear) on Your Lunchtime Stroll

You forgot your athletic shoes at home, but you head out for your lunchtime walk anyway in a pair of 3-inchers. If your "walk" is a short stroll as you browse the shops, you're probably okay. But if you're planning a 20-block hike, you could be in trouble. "The sole of a high-heeled shoe is not constructed correctly for long-distance walking, and the higher the heel, the worse it will be," warns Stephen M. Pribut, DPM, past president of the American Academy of Podiatric Sports Medicine (AAPSM).

Dr. Stephen Pribut

Summer sandals and mules can be even more detrimental. "When your shoe's heel isn't closed in, the heel of your foot separates from the sole of the shoe as you walk, putting a lot more stress on your forefoot," explains Pribut. The worst-case scenarios: a sprained ankle or stress fracture—either of which could really curtail your lunchtime forays. Look for a shoe that bends where the toes bend, not in the middle, advises Pribut: "A flexion point that's in the middle of the shoe will put stress on that part of the foot and cause abnormal motion."

Source: Lorie A. Parch, Prevention, [May 2013]

PM News has begun a new weekly feature called Quick Poll. Each week, we will post a new poll based on some of the controversial issues discussed in our Comments/Responses section.

Quick Poll
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TX Podiatrist is President of Faculty Senate at UT Southwestern Medical Center

For years, the Faculty Senate has worked quietly behind the scenes of UT Southwestern Medical Center, playing an important role in many of the issues that directly affect the faculty. The Faculty Senate is led by its President, Dr. George Liu, podiatrist and Assistant Professor of Orthopaedic Surgery.

Dr. George Liu (right) talks with Dr. Gerald Casenave.

Dr. Liu, President of the 34-­member organization that represents 2,631 faculty members, wants to see the Senate become more visible. "Much of the important groundwork has been paved by past presidents and senators to keep the Senate visible and active at the Medical School,” Dr. Liu said. Dr. Liu notes that one of his goals as President is to represent the faculty interests at UT Southwestern.

Source: Jan Jarvis, Center Times [May 2013]

MD Podiatrist Conducts Extensive Research on History of Jews in County

Congregation B’nai Abraham was founded more than a century ago, and over the years since there has been a rich history of Jewish life in Washington County that has been marked by Jews winning political freedom, the congregation moving through a reform movement and memories of a tight-knit group.

Dr. Jerry Falke, a longtime member of Congregation B’nai Abraham and retired Hagerstown podiatrist who has conducted extensive research on the congregation, completed a 17-page history of the congregation that notes that the first resident of the county — Levi  Cohen — was Jewish.

Source: Dave McMillion, Herald-Mail [5/12/13]

English Podiatrist Practicing in AU Receives Suspended Sentence

South Launceston's Terence Williams, 40, received a suspended jail sentence for the 2011 aggravated sexual assault of a 30-year-old woman. While treating her for a sore foot, Williams removed the victim's underpants and inserted his ungloved finger or fingers into her bottom. During his trial last month, Williams said he was checking to see if her spine was out of alignment. A Launceston jury found him guilty in less than two hours. A decision to deport the English podiatrist would be up to the federal government.

Source: Patrick Billings, The Examiner [5/13/13]

Docs Press AMA to 'Educate' Feds on EHR Use

The New Jersey delegation to the American Medical Association's House of Delegates meeting next month wants the AMA to “educate” the CMS that the appropriate use of templates and cutting and pasting within an electronic health-record system is not tantamount to fraud. The request comes in the form of a resolution proposed for the annual meeting of delegates set for June 15-19 in Chicago.

It was issued in response to a controversy that arose late last year when HHS Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder jointly warned providers about rising levels of evaluation and management codes, suggesting EHRs might be used to fraudulently code patient encounters. The New Jersey resolution said “federal enforcement authorities appear to have a presumption that any increased medical costs are the result of fraud and not the result of better documentation of clinical services provided.”

Source: Joseph Conn, Modern Physician [5/13/13]

Query: Painful Bunion in a 12 Year Old

A 12 year-old female presented (with her mother) complaining of aching in the left great toe joint. She's already reached menarche.  She has noticed this bunion for several years and wears arch supports. She is only moderately pronated in gait and has no ligamentous laxity. There is no significant narrowing of the first MPJ joint space. The foot is moderately pronated in stance. On the lateral view, there is no anterior break of the cyma line.

AP and Axial Views of Hallux Valgus in 12 Year-Old

On the lateral view, the first metatarsal is not elevated as compared to the second metatarsal. On the AP view, the first intermetatarsal angle measures 14°, the HAV angle measures 20°. PASA is not increased and DASA is also not increased. First metatarsal protrusion is +3 mm.; metatarsus adductus angle is 25°. I know there are different ways to measure the metatarsus adductus angle, but no matter how you choose to do it, it is high. This along with her young age certainly would affect the selection of a surgical procedure. There are several ways to address this and I am interested in what my colleagues suggest.

Query: Coding Gouty Tophi Removal

How would you code removal of gouty tophi? This would included intra- and extra-capsular removal of a substantial amount of tophi from the 1st metatarsal-phalangeal joint. I estimate that I removed a golf ball amount of material. The approach was similar to a distal bunionectomy procedure.

Peter Miller, DPM, Middlebury, VT

Response: I recommend billing CPT 28090 - excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (e.g., cyst or ganglion); foot.

Howard Zlotoff, DPM, Camp Hill, PA 

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RE: Overlapping 2nd Digit Status Post Bunionectomy (Ed Cohen, DPM)
From: Don Peacock, DPM

I think Dr. Cohen is right on target with treating patients and not the x-ray. As Dr. Cohen has stated, we certainly need to try to achieve results based on the patient’s expectations and their ability to heal following our surgical interventions. Dr. Kittay is correct that the post-op x-ray I posted is slightly supinated. This x-ray was in the early post-operative period, and the patient may have been slightly guarding her foot while the x-ray was taken. These pre- and post-op photos and x-rays should be more in line with a rectus view. 

Pre- and Post-op X-Rays and photos

I appreciate everyone’s comments, including constructive criticism. I do not believe that minimally invasive surgery is better than traditional surgery. My feeling is that these two disciplines should  have more of a symbiotic relationship than an adversarial one. I believe that incorporating minimally invasive surgery in my practice has been beneficial for both myself and for my patients. I don’t believe these two disciplines should compete in a Darwin natural selection battle. I think these two disciplines can co-exist and thrive in harmony.

Don Peacock, DPM, Whiteville, NC, peacockdpm@gmail.com

RE: Dragon Problem (Craig Breslauer, DPM)
From: Brian Homer, DPM

I started using DNS Medical v.4 in 1999. Over the years, I have encountered countless issues with each subsequent version as DNS is a very unstable program. I am currently using v.11 and, believe me, it is far from flawless.

My saving grace has been a gentleman by the name of Lunis Ornicutt who owns and operates knowbrainer.com, which is a voice recognition software company. You can speak to Lunis directly and aside from his wealth of knowledge, you can also post your questions/issues on his website where several willing members are more than willing to help resolve your issues...AT NO CHARGE! I have no affiliation with knowbrainer.

Brian Homer, DPM, Clawson, MI, drbhomer@gmail.com

RE: Dr. Lidtke's Remarks (Flex OA Shoe) (Mr. Jeffrey Root)
From: Roy Lidtke, DPM

I would like to thank Jeff Root for his contribution and comments.  As Jeff knows, I am a big fan of his father, and agree that most of Dr. Root's work remains true today. Addressing the comments of both Mr. Root and Dr. Steinberg - The theoretical mechanism of action for the Flex OA shoe is to allow motion (probably pronation for most people) or more specifically to alter any shoe component that could produce an external moment into the lower extremity. There is no internal orthosis in the shoe.

During the larger extended study, there were two adverse events reported for the research (There were no serious adverse events).  Both were related to plantar fasciitis. The subjects were able to remain in the study with the use of a foam uniform density 3/4 length over-the-counter insert.

I want to stress again that each clinician must decide if their patient needs stability or mobility. As Dr. Root explains, both are needed at various times in the gait cycle.

Roy Lidtke, DPM, Chicago, IL, Roy.Lidtke@dmu.edu

PRACTICE FOR SALE - CALIFORNIA

Unique opportunity to purchase a very busy 50 year old practice in Coronado Ca. Large and stable patient and referral base with consistent new patient growth. Low overhead. Priced to sell. Great staff. Hospital privileges available. Willing to stay on for transition. Inquiries please email foothold@msn.com

ASSOCIATE POSITION - BRONX, NEW YORK

Excellent opportunity for a podiatrist with at least a 12 month residency and a license to practice in NYS. The office is located in Throgs Neck, Bronx and has been in the neighborhood for more than 30 years. This practice is diversified in all phases of podiatric care and offers a great chance, for the right candidate, to improve professional growth and financial security. Please send CV and list of references to: toejam.rs@gmail.com.

INDEPENDENT CONTRACTOR POSITION-LAS VEGAS, NV

Looking for personable, professional and motivated podiatrist for busy house call practice. Must have NV podiatry license & malpractice insurance. Pay is 45% of collections. Send CV to stuartfeldmandpm@yahoo.com

ASSOCIATE POSITION - VIRGINIA

Well-established practice in Arlington Virginia looking for first year associate DPM perhaps leading to purchase of office. Office is one block from metro and has onsite private parking for patients. Present owner is retiring but will aid with smooth transition. This practice has been in the same location for the 40 years and has an excellent referral base. Must be licensed to practice in the state of Virginia. Please contact drmichaelfine@aol.com. Cell Phone 703-582-5999.

PODIATRISTS NEEDED - LOS ANGELES, CA
 
Home Foot Care, Inc. Is looking for motivated podiatrists to provide quality mobile care to our home-bound patients. Flexible schedule, independence, great compensation. If interested, please email resume to homefootcare@hotmail.com

ASSOCIATE POSITION - NEW JERSEY

Looking for full time/part time associate in busy 3 office practice.  Offices are located in Union, Hudson, and Bergen counties. Competitive salary with benefits. Excellent growth opportunity. Please send C.V. to njpodiatry33@gmail.com

ASSOCIATE POSITION - WASHINGTON, DC/ MD SUBURBS

Prominent, established two office practice seeking well rounded, personable, ethical individual with sharp medical and surgical skills. Must be 24/36 month trained, ABPS qualified or certified. Partnership opportunity with ownership potential. Competitive salary with benefits package. Please send CV to ponyrunner66@gmail.com

ASSOCIATE POSITION - MARYLAND, DC, PA

A podiatrist is needed for the Baltimore, Washington, Pennsylvania area. Partner for the corporation. Surgery center, emergency room call and a hospital location. All areas of podiatry. Established practice. Salary and commission. Fax resume 410-857-4227 or email at butler@qis.net

ASSOCIATE POSITION – MISSOURI

Podiatric medical group seeks PSR24-36 individual who is interested in working with former residency director who can enhance your already strong training. Full scope practice with the cases to fast track to board certification. Four hospital affiliations, certified surgical suite in office, ultrasound, EHR Certified Stage 2. We are located close to St. Louis for day use. Exceptional school system in a low crime, low cost of living area. E-mail resume to: drfootski@hotmail.com

ASSOCIATE POSITION - MASSACHUSSETS

Located near Boston. Busy multi-office podiatry practice looking to expand. Need extremely energetic dedicated individual. Must be PSR 12-24 trained, EMR, laser, vascular testing the works. Must have sense of humor. MA License, NH License A+! Surgery, sports medicine, pediatrics, shoe store. Please send resumes to resumesent11@comcast.net.

ASSOCIATE POSITION - HAMPTON ROADS VIRGINIA

Needs to be highly motivated, INDEPENDENT and surgically-trained to join a successful 40+ year practice surrounded with water sports, beaches and hiking. PSR24/36; well versed in forefoot and rearfoot surgery, diabetic wound care, sports medicine and diagnostic ultrasound. Please email CV & cover letter to fixafoot@cox.net

TWO FOR TEXAS

Desiring to grow our group of successful medical and surgical professionals. We are seeking an exceptional Podiatric Physician and Surgeon with great interest and talent to serve as 1) Our Diabetic Foot Care Team Leader or 2)Our Sports Medicine Team Leader. Send CV and letter of interest to: greatdoctors1@gmail.com

ASSOCIATE POSITION - LAS VEGAS, NV

Need a Nevada licensed podiatrist to cover IN OFFICE for month of June 2013. Starting Date June 1, surgical experience not a requirement. Salary is negotiable. doctor@viawest.net

ASSOCIATE POSITION - NEW YORK

Large established podiatry practice 30+ years in New York Hudson Valley/Capital District area seeking associate/partner to eventually take over practice. Also would entertain reasonable offer to purchase one of the two offices. Serious Inquiries may contact: Podiatrygroupny@gmail.com

PODIATRIST WANTED - PENNSYLVANIA

Multi-specialty physician group seeking part-time or full-time to join our Johnstown, PA facility offering on-site x-ray, vascular ultrasound and other services. Patient base already established. Experienced or recent graduates considered.  Applicants send resume to cfleegle@atlanticbbn.net or call 814-288-1418 ext. 7.

ASSOCIATE POSITION - UPSTATE NY

Busy multi-specialty practice of PCPs, general surgeons, OB-GYN, podiatric surgeons looking for a full-time podiatric associate in  Upstate NY, Binghamton, Finger Lake Region. Great Benefits, opportunity for partnership. Must be highly motivated, personable and be Board qualified/eligible. Our podiatrists have over 100 years combined experience. Please send CV to associateinfoot@yahoo.com or fax 607-723-1567.

ASSOCIATE POSITION - CALIFORNIA

Established foot and ankle specialty group looking for an experienced podiatrist. This position entails making rounds at local hospitals, skilled nursing facilities and having scheduled office appointments. Must be comfortable with all aspects of podiatric care and will be doing no less than the hiring partners. Full-time position with a competitive salary.  Looking for someone with a great bedside manner, energetic and will to go the extra mile to make a positive difference. Send CV to administrator@footnankledoc.com

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. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed PODO2345@AOL.COM 516-476-1815.

EQUIPMENT FOR SALE - BIOMEDIX PADNET SYSTEM
 
PADnet is clinically valuable, provides fair financial return with medically appropriate testing and seamlessly integrates with the complete suite of BioMedix® products and services. One year old. In Excellent condition. Buyer pays for shipping. Please contact Rhonda Daggs at info@footanklecenters.com

EQUIPMENT FOR SALE - NEW AEROLASE YAG LASER

Brand new Aerolase Yag Laser Bought Feb 2013- Never Used Paid $35,000. Will sell for $25,000. Contact Kathy (352) 867-1155 or Michael after 7pm (352) 816-1155.

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