The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

May 16, 2013 #4,771 Publisher-Barry Block, DPM, JD

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Avoid Slipping Off Still-Tied Running Shoes - TX Podiatrist

You try to do all the right things to get the most out of your running—abide by your training plan, ice your sore spots, skip the drive-through. But even if you think you have a perfect record, there are some simple mistakes you could be making that can sabotage your best efforts. Here's how to side-step them to stay on the right track. For example,  slipping off still-tied running shoes.

Dr. Jeffrey Ross

Do it day after day, week after week, month after month, and all that ankle twisting can damage ankle ligaments and tendons and set you up for injury, says Jeffrey A. Ross, DPM, MD, podiatrist and associate clinical professor at Baylor College of Medicine. Here's Dr. Ross' fix -Untie your shoes already! Or switch to toggle or stretch laces, which allow for easy on, easy off.

Source: Deb Dellapena, Runner's World [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
Do you charge a penalty fee for missed appointments?
Click HERE for Results

AZ Podiatrist Contributes to Wounds International Best Practices Guidelines

Wounds International has launched new best practice guidelines on wound management for diabetic foot ulcers (DFUs) at the annual European Wound Management Association meeting in Copenhagen 15-17 May. This important document offers specialists and non-specialists everywhere a practical, relevant clinical guide to appropriate decision-making and effective wound healing in people presenting with a DFU.

Dr. David Armstrong

The scope of the many local and international guidelines on managing DFUs is limited by the lack of high-quality research. This document aims to go further than existing guidance by drawing from the wide-ranging experience of an extensive international panel of expert practitioners including Dr. David Armstrong, Professor of Surgery and Director, Southern Arizona Limb Salvage Alliance (SALSA), University of Arizona College of Medicine.

It's Time 'to Break Cycle' on SGR: Baucus

Senate Finance Committee Chairman Max Baucus opened the panel's first hearing in six years on Medicare physician pay with assertive rhetoric about scrapping the hated sustainable growth-rate formula this year. “In 2010 alone, we passed six short-term fixes,” Baucus (D-MT) said. “It is time to break this cycle.” He did not, however, say when a bill might be introduced.

Baucus said Tuesday that he is encouraged by the willingness of physicians groups to put forward ideas for alternative payment systems. He also said he is looking for “short-term, ready-to-go solutions” that would allow Congress to replace the SGR this year and lay the groundwork for a transition from the fee-for-service payment approach to a value-based model.

Source: Rich Daly and Jonathan Block, Modern Physician [5/14/13]

RE: Difficult Post-Trauma Case

Six weeks ago, my patient’s right foot sustained a triangular-shaped blunt trauma to the dorsum centered about the midshaft of the second met shaft. A matching triangular, mildly ecchymotic, area of swelling appeared soon after the trauma and remains; this triangular area and the immediate surround is hypalgesic. Initial x-rays were negative for fracture.

The triangular area of swelling continues to be as painful as the initial injury; this pain is mitigated by use of Xanax and Lidoderm patches that reduce the pain sufficiently to allow the patient to sleep. I did not prescribe opiates for fear that...

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

Query: Termination of Services

My service was just terminated from my local convalescent hospital after a patient was billed for their deductible. I was honest with them and told them I cannot write it off, because the patient is not indigent. They gave no reason for the termination in a certified letter. I wonder what are my options?

Joseph Cortez, DPM, Simi Valley, CA

Editor's comment: PM News does not provide legal advice. Medicare law requires you to bill patients for co-pays and deductibles. We suggest that you contact a healthcare attorney to assist in an appeal. The hospital's right to terminate you and the process of appeal should be clearly delineated in the hospital bylaws and/or any contract you entered into with the hospital. 

RE: Painful Bunion in a 12 Year Old
From: Elliot Udell, DPM
 
Over 35 years ago, a close relative of mine, who was roughly the same age as the patient described, presented with painful bunions. At that time, we were lucky to have Dr. Tom Sgarlato in the New York area. He evaluated the patient and found that the cause of her early bunion deformities was internal femoral rotation which led to abnormal pronatory forces and ultimately to bunion deformities.

She has been managed with orthotics and, to this date, her bunions have not gotten worse. Since that time, I have observed many similar cases of young teens presenting with bunion deformities and they have almost always had internal femoral rotation as the underlying pathology.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Painful Bunion in a 12 Year Old
From: Gary W Docks, DPM

The metatarsus adductus and positive metatarsal protrusion factor highly when considering the bunion correction. One thing you did not mention is whether she had a significant equinus, which definitely is causal when you're looking at a juvenile bunion deformity. That being said, you must also be aggressive in choosing your procedure versus being conservative, which likely will result in a recurrence. Remember, the met adductus deformity will increase the IM angle. I therefore recommend the following procedures:

1. Endoscopic gastroc recession  2. Scarf or Austin Bunionectomy with screw fixation. There are still remnants of the growth plate at the base of the lst metatarsal. You could perform a Juvara, but you would have to be careful to avoid the growth plate. Remember to be aggressive and reduce the IM angle or 10 years from now, you'll be looking at a re-do.

Gary W Docks, DPM, Beverly Hills, MI, gwdocks@aol.com

RE: Biomechanics of Barefoot Running (Jefferson J. Mennuti, DPM)
From: Dennis Shavelson, DPM

This issue boils down to rearfoot contact gait, running, and biomechanics vs. midstance and forefoot contact. There are moments when one of these forms of function may be more optimal than another. There are moments when we are standing still washing dishes or waiting on line when neither are optimal. One question raised here is that when choosing sides: Which is better - to have peroneus longus be a stronger pronator of the RF (HC) or a stronger pronator of the FF (FFC)? I side with the latter, regardless of gait.

Since most of our high-level research, gait analysis, computer gait analysis, and the orthotics developed are based on HC gait, what would finding out that midstance contact or forefoot contact gait was better or healthier even some of the time than HC do to our evidence-based medicine? Podiatry is confronted with patients having problems in stance, moving side-to-side, going backwards, contacting the ground in forward gait differently, lifting, spinning and gyrating, in addition to problems arising from heel contacting or running.

We need devices, shoes, and a plan of individual patient care that address one's overall biomechanics along with EBM establishing their value. Devices, shoes, and a plan of care for going heel-toe from point A to point B alone often won’t satisfy the biomechanical requirements at hand. We need both acumen and our biomechanical scope to grow instead of the only option to be either or.

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

RE: Dragon Problem (Craig Breslauer, DPM)
From: Rob Eells, DPM

While we are on the subject of Dragon, I want to ask all of my colleagues to perform a simple experiment: take out your iPhone, open up a memo app, tap the mic icon, and dictate a detailed podiatric medical progress note. My iPhone, right out of the box, is FAR superior to Dragon as a voice recognition tool. I think we've been had.

Rob Eells, DPM, Des Moines, IA, rgeells@gmail.com

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.

PURCHASE NOW OR LATER IN DALLAS, TX  

Turnkey in Dallas’ beautiful and prestigious Uptown neighborhood:   modern, fully furnished office in 24/7 security high rise and large patient base. There is tremendous growth potential in this affluent and diverse area. Perfect for new practitioner, to share, or second office.  afc1dfw@gmail.com

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

PODIATRIST FOR NURSING HOME CARE - MASSACHUSETTS

Excellent Opportunity. Seeking independent physician for growing nursing home podiatry care Work independently, make your own hours. Must do own billing. YOU KEEP 100% OF PROFITS. Must be personable and have good patient skills. Acquisition fee based position. Please e-mail CV and short bio to: americanmobile@verizon.net

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 - 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

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.

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