The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

May 18, 2013 #4,773 Publisher-Barry Block, DPM, JD

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We Walk in a Tripod Fashion: CA Podiatrist

We owe our balance to the 26 bones that make up the hindfoot, midfoot, and forefoot. The toes connect to the midfoot by five long bones called metatarsals, one for each toe. Though all the bones in the foot come together to form the structure of the foot, the main bones responsible for our balance are the metatarsals, explains Dr. Wenjay Sung, attending physician at White Memorial Medical Group.

Dr. Wenjay Sung

“We walk in a tripod fashion, where the big toe knuckle, the fifth toe knuckle and the heel have a tripod walking ability,” Sung says. “If you remove one part of that tripod, you lose balance.” So even though the pinky toe itself has no functional value, removing the metatarsal would make running, walking, and skipping nearly impossible.

Source: POPSCI [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. Today is the last day to vote.

Quick Poll
Do you charge a penalty fee for missed appointments?
Click HERE for Results

WesternU Graduates First Podiatry Class

Western University of Health Sciences celebrated another milestone Wednesday morning when 160 new healthcare professionals from the charter classes of the Colleges of Dental Medicine, Optometry, and Podiatric Medicine picked up their degrees during a ceremony at the Pasadena Civic Auditorium. Degrees were presented to 64 doctors of dental medicine, 73 doctors of optometry, and 23 doctors of podiatric medicine who are the first graduates of their respective programs.

(L-R) Deans Lawrence Harkless, Elizabeth Hoppe (Dentistry), Stephen Friedrichsen (Optometry) with Edward James Olmos

Actor and producer Edwards James Olmos delivered the keynote address. Olmos, who was presented with an honorary degree from the University, thanked everyone but especially the students and faculty present. Olmos is a supporter of non-profit organizations benefitting youth, the environment, and health including diabetic foot conferences. His interest in diabetes stems from a history of diabetes in his family. The work of Dr. Lawrence Harkless, dean of the College of Podiatric Medicine and others help diabetics avoid having limbs amputated from problems associated with their condition, Olmos said.

Source: Monica Rodriguez, Contra Costa Times [5/15/13]

AAWP Holds Scientific Conference

The 2013 AAWP Scientific Conference was recently held at the Biltmore Resort in Coral Cables, Florida led by AAWP Co-Vice President and Conference Chair Aparna Duggirala, DPM.  A diverse group of topics were presented from speakers across the country, and an exhibitor hall was filled with an assorted group of sponsors.

(L-R) AAWP Board: Drs. Alison Garten, Sheryl Strich,  Elizabeth Bass, Karen Langone, Aparna Duggirala, Erika Schwartz, and  Kathleen Satterfield.

During the course of the conference, the Past Presidents of the AAWP were honored during a luncheon. Attendees were able to obtain up to 15 CECH hours in a relaxed atmosphere, with time available in the schedule to enjoy the world renowned spa. Western University College of Podiatric Medicine sponsored the continuing education hours.

AOPA Files Suit Against HHS Over RACs and Physician Documentation Requirements

On May 13th, the American Orthotic & Prosthetic Association (AOPA) filed suit against HHS in the Federal District Court for the District of Columbia. The complaint seeks relief from the unfair and unauthorized actions of the Center for Medicare and Medicaid Services, primarily via actions of its RAC auditors and DME MACs relating to physician documentation requirements.

AOPA has stated emphatically that they will not stand by when government acts inappropriately to threaten either the quality of care we provide to patients or the economic viability of the small businesses and providers that comprise the orthotics and prosthetics profession.

Source: AOPA via Dr. Michael Robinson

Query: Pre-Op Office Visit Denial

We have an established patient who came to the office with a wound that has severe cellulitis and osteomyelitis. I billed an office visit with x-rays, and then referred him to be admitted to the hospital under the services of the hospitalist. I did not see the patient in the hospital the day of admission. I did come in prior to surgery (amputation of the digit) that we scheduled to perform the following day.

Medicare denied the office visit performed the day prior to surgery saying "pre-op care not included. Is there a way around this? This certainly was not a planned "pre-op visit." The patient came in with an urgent problem that required attention within 24 hours.

Steve Carter, DPM , Covington, GA

Response: The office visit the day before surgery or the day of surgery would be covered if, during this encounter, a decision was made to perform a major surgical procedure (90 follow-up days).

In this case, it appears that you evaluated the patient's severe cellulitis and osteomyelitis and made a decision to amputate the digit. You should bill the appropriate level for the established office visit and append a "57" modifier.

Robert Weatherford, Jacksonville, FL

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RE: Painful Bunion in a 12 Year Old
From: Sloan Gordon, DPM, Ed Cohen, DPM

First, I believe showing partial x-rays are not the way to go.  For example, I can't see the hindfoot:forefoot relationship, and the TN joint looks uncovered to me. So there may be more to correcting this bunion than just a forefoot procedure. The child may need an arthroresis procedure.
 
That said, I believe your options are an opening wedge of the first metatarsal vs. an epiphysioidesis. Are you sure the metatarsal protrusion is +, as it looks - to me.

Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net

Most painful bunions are aggravated by shoes. I find that it can be a big problem for young active people 12 years and older. I generally will not do bunion surgery on patients under 12, but I feel that these young patients over 12 do as well or better than the other age groups that have bunion surgery.

These painful bunions that appear on young people can get dramatically worse with time and can also cause significant...

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

RE: Painful Bunion in a 12 Year Old
From: Name Withheld

Thank you to those who gave me your input. I did not provide an extensive biomechanical exam with my first presentation. This patient has at least 10 degrees of ankle dorsiflexion with her knee extended or flexed. Her hamstrings are not tight. She has symmetrical hip motion, more with no internal position. There is no internal tibial torsion. She does not have ligamentous laxity. Her first ray is stable on exam. She is only moderately pronated in stance and gait. Her lateral x-ray does not have an anterior break in the cyma line. There is no Kirby's sign. There is no elevation of 1st ray (Seeberg's index).

She has noticed the bunions for several years, and has had moderate aching in the joint for...

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

RE: Hallux Varus (Kel Sherkin, DPM)
From: Charles Morelli DPM

One way to address and successfully correct a hallux varus, in addition to what others have already posted, is to simply do a tendon transfer of the EHL into the lateral base of the proximal phalanx.

Mobilize the tendon, drill a hole perpendicular to the long axis of the phalanx, and follow the same protocol for any tendon transfer. Insert the tendon from the lateral side of the phalanx and keep pulling until the hallux is in the desired position. Insert your choice of interference screw and close. No fusion, no osteotomy.

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

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

I appreciate Dr. Shavelson's response. I have gotten some rather unsavory personal emails from those that have either parted ways with or never met their acumen. One such individual wanted me to imagine running in a forefoot contact way and then imagine my Achilles as a bungee cord being rather slack than in a very strong moment of contraction. I think this is rather incorrect. I believe the posterior groups work in conjunction with the anterior groups, some in eccentric contraction, some in concentric contraction, depending on the moment.

I am interested in the concept of the PL taking less load with the forefoot contact (FFC) vs. heel contact (HC). In addition, since FFC requires a higher cadence, the number of contractions to the PL encounters would perhaps quadruple.

Reviewing the literature, the two articles confirmed that FFC runners have faster times, yet fatigue and revert to HC. The one article directly referred to was based on "recreational" runners. Hasagawa attempted the "elite." Moving forward, three EBM studies so far in the literature are begging further study.

Jefferson J. Mennuti, DPM, Orange City, FL, dr.mennuti@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

FT OR PT ASSOCIATE - SOUTH JERSEY

Great opportunity for FT or PT associate starting July 2013 in established practice in South Jersey. EMR, FDA-approved Lasers for fungus. Will work with Board Certified/Qualified podiatrist. Must have New Jersey License. Diverse practice in a nice area with a pleasant environment. e-mail CV at hhfootdoctor@gmail.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 - 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

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 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.

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 - 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

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 - 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 IN CENTRAL FLORIDA  

33 year old practice grossing $550k seeing an average of 40 patients per day.  Possible owner financing for both practice and large office building.  Five year average profit margin of 35%.  New Listing.  For more information call Chas Smith at 863-688-1725 or email Chas@cpalliance.com

PRACTICE FOR SALE - BROOKLYN, NY

28 year old practice in a desirable part of Brooklyn. EHR certified with stage 1 criteria successfully met. Practice has room to grow. Good mix of Medicare hazardous foot care; surgery and wounds. Low overhead. Priced to sell. Email Inquires to: brooklynpracticeforsale@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

PM News Classified Ads Reach over 14,000 DPMs and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 14,000 DPMs. Write to:bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $115 for a 50-word ad. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451. 

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