The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

May 21, 2007 #2,941 Editor-Barry Block, DPM, JD

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MI Podiatrist Discusses Causes and Treatment For Fungal Infections

Contrary to popular belief, sportsmen are not the only people prone to developing athlete's foot, one of the most common and treatable fungal infections of the feet. All people, regardless of age or profession, are susceptible to it, according to Dr. James Simonds, a specialist in podiatric medicine. Some people, however, are more vulnerable than others. "Basically, if your feet are in conditions that make it ripe for the fungi to grow, you're at risk of an infection, like if you work in wet environments or wear thick work boots, which may cause the feet to perspire and remain moist for long periods of time," said Simonds, who manages Simonds Foot & Ankle Clinic, in Portage, MI.

The types of treatments for athlete's foot often depend on the size of the area of infection, Simonds said. For smaller areas between toes -- a common place for infection -- topical antifungal medications, which are either prescribed or can be purchased off the shelf, are suitable. "There are several oral medications as well, which I tend to use when there are larger areas of infection, like over both feet," Simonds said. "It's tedious to have to put creams and powders all over your feet each day for up to a month."

The most common preventive measures that Simonds suggests are to keep the feet clean and dry, and dust them with medicated powder. "You want to get powders which have some sort of antifungal action, because the regular powders can only absorb moisture," he said. "The intention here is to impede the growth of the fungi." He added that alternating footwear, especially socks that have been washed and dried thoroughly, is essential, too.

Source: Santosh Rao, Kalamazoo Gazette [5/16/07]

Fingerhut to Deliver Commencement Speech and Receive Honorary Degree at OCPM

Chancellor Eric D. Fingerhut of Shaker Heights, OH will be the Commencement Speaker at the Ohio College of Podiatric Medicine (OCPM) Commencement Ceremony scheduled for May 25, 2007 at the Allen Theatre in downtown Cleveland. The former Congressman was appointed the seventh Chancellor of the Ohio Board of Regents back in March of 2007 and has been working in close collaboration with Governor Strickland and his Cabinet.

Eric D. Fingerhut

“The Ohio College of Podiatric Medicine is extremely proud to have Chancellor Fingerhut as our 2007 Commencement Speaker,” said OCPM President Thomas V. Melillo, DPM. “The 2007 senior class will be the last graduating class who attended OCPM at our school building in University Circle. As we prepare to start our future with the move to our new campus facility in Independence, OH this summer, it gives us great pride that Chancellor Fingerhut will be the person who helps close our historic chapter and begin a new era for OCPM”.

Chancellor Fingerhut will also be awarded the OCPM honorary degree of “Doctor of Humane Letters”. Current OCPM Board of Trustee, fellow alumnus, and former NFL referee Edward J. (Bud) Fiffick will also be awarded the honorary degree of “Doctor of Humane Letters” as part of the Commencement Ceremony.

Medical Associations Want Payment Formula Nixed

Medical organizations are recommending that Congress repeal Medicare’s sustainable growth rate, or SGR, formula and replace it with a system that reflects increases in physicians’ practice costs. In a proposal shared with lawmakers Thursday, the American Medical Association and 86 other medical organizations, including the American Podiatric Medical Association recommended that Congress enact legislation that would repeal the SGR and ensure that physicians are reimbursed like other providers, such as hospitals and nursing homes, whose formulas are based on practice costs.

If immediate repeal isn’t possible, Congress should establish a transition period to eliminate the formula and ensure positive updates to physicians until the repeal takes effect, the groups urged. The SGR ties annual expenditure targets to the economy and has called for negative payment updates over the past several years. Physicians in 2008 face a 10% payment cut under the current SGR formula.

In other recommendations, the AMA said that the Physician Quality Reporting Initiative, a program that sets up a financial incentive for physicians to participate in a voluntary quality reporting program, be re-examined before being expanded into future years. Other groups urging change included the American College of Physicians, the American Academy of Family Physicians and the American College of Radiology.

Source: Jennifer Lubell, Modern Healthcare [5/18/07]

Query: Recurrent Lesions on Patient With SLE

I have a 45 y.o female with history of systemic lupus erythematosus (SLE) who had multiple verruca carcinoma lesions on the plantar aspect of her foot. Besides wide excision of these lesions, can anyone who has other experience with this condition, provide suggestions for me on what else I can do intra-op or immediate post-op to minimize recurrent of these lesions? She has had excision of these lesions in the past by different surgeons, multiple times.

Thi Pham, DPM, Winnsboro, TX

Query: Numbness Athlete with Diabetes

I have a well-controlled diabetic patient of 35 years of age who develops numbness of both feet at the 15-20 mile mark of a bike run. Does anyone have any ideas about a mechanism and how one proves it one way or another? Is it neurogenic claudication, lower extremity edema, or something else?

Michael Zapf, DPM, Agoura Hills, CA

RE: Free Diabetic Shoes
From: Robert Schwartz, C.Ped

Ad For Free Shoes from Mesa, AZ Tribune (Submitted by Robert Schwartz, C.Ped.

RE: Therapeutic Shoe Fraud (Timothy Sorenson, DPM)
From: Multiple Respondents

Over the past six months, WPTV news in West Palm Beach has been running stories on Durable Medical Equipment companies that allegedly are involved in committing DMERC fraud in the Fort Lauderdale-Vero Beach corridor. It has been from wound care supplies to therapeutic shoes to home equipment supplies. Once you obtain that patient's EOB, you COULD conceivably contact WPTV and see if that is one of the companies that they have investigated. Again, I would check with a healthcare attorney or your state society before embarking on that course of action.

Eric J. Lullove, DPM, Boca Raton, FL, ericsops@yahoo.com

This was rampant in central Illinois 2004-2006. There is a company called Medsource that comes out of Arkansas and visits chain hotels and advertises in the local newspapers that they are providing free diabetic shoes, blood testers, and diabetic socks. Of course, everyone comes out to get their free stuff. The people getting shoes are not examined and give the vendor their MD/DO info and off they go. They send their shoes to them in the mail and only call them to see if they got their shoes.

I called the vendor and they said that they were doing nothing illegal and were following the supplier standards. I called my Illinois CAC rep and sent letter the medical director of Region B DMAC and they never responded. I called the Dept of Integrity at WPS Medicare Part B in Chicago and they said the people who received shoes needed to call to file a complaint. This is why there is a change in Medicare DMAC

Joseph Borreggine, DPM, Charleston, IL, footfixr@consolidated.net

About 4 years ago, I found out about an individual in the area doing the same sort of thing: dispensing shoes and over-the-counter innersoles to whomever he could get to bite on the deal. This individual had no training or certification, the shoes he dispensed often caused wounds instead of helping prevent them and the innersoles were basically a Spenco product. The billing to Medicare for these items was for accommodative shoes and custom innersoles and paid accordingly. Although my contact at the Texas Department of Health wanted this guy so badly he could taste it, I was only able to convince 1 patient out of the 13 affected to release their charting to the TDH. I assume they were afraid they would be convicted along with the perpetrator or something.

The individual involved in all this got off of the charges by convincing the orthopaedic surgeon he worked for to countersign all of the billings to make it look as though the surgeon approved. To the best of my knowledge, this guy is still in the area and still working with his wife to rip off Medicare. I don’t know what else I can do about it and have gotten hints of several other people in my area doing the same thing.

David Secord, DPM, Corpus Christi, TX, David5603@pol.net

RE: Poor Outcomes (Sheldon Marne, DPM)
From: Allen Jacobs, DPM

Everyone has patients with less than optimal results following non surgical or surgical therapy. I should say, everyone who actually treats large numbers of patients with real pathology.The late Dr. James Ganley used to speak of "limited results", IMPROVING the ability of the patient to stand or walk without pain, but not promising a "normal foot" or implying post treatment results which are not likely to be realistic. Dr. Ganley used to say "fix that which is deformed."

When a patient has true pathology and pain/disability, they are appreciative of improvement in their post treatment state, even when subtotal resolution of symptoms is achieved. Conversely, a patient that has been hustled into therapy with minimal symptoms or disability is frequency not happy at less than optimal resolution of symptoms or even worsening problems. In hindsight, some of these patients' know that they have been had.

If you place patient welfare and need FIRST, and your own financial needs and ego second, you will generally be okay. As Dr. Ganley used to question; "if a patient is at 90%, what are the chances that you surgery will make them 100%, vs. the chances of knocking the patient down to less than 90%? I suspect most PM readers know the answer; even Dr. Marne.

Allen Jacobs, DPM, St. Louis, MO, allenthepod@sbcglobal.net

Editor’s note: This topic is now closed.

EQUIPMENT FOR SALE – SURGICAL SYSTEM / TOURNIQUET SYSTEM

1) Osada Pedo-30w-electric surgical system with drill handpiece and oscillating saw handpiece. Includes several blades, and sterilizable handpiece rests (2) $2100 plus shipping (9 lbs,6.6 ozs). 2) DELFI Medical P.T.S. tourniquet system. Does not include tourniquet $1500, plus shipping (4 lbs,4 ozs). Both in excellent condition. TEMDPM@CS.com or 814-237-3338.

FOR SALE - EQUIPMENT

Boyd chairs, mini x-ray floor unit, Konica developer, ultrasound,Ellman surgitron, Imex 9000, Ille whirlpool, viewboxes, SmartDop, topical oxygen units, office furniture, etc. cast saw, lakeside carts, parafin wax bath, hand instruments. Contact jhallux@yahoo.com or fax (703) 264-7745 for full list.

PRACTICE FOR SALE WASHINGTON, DC

Hospital based 25 y/o practice, Billing 400k/yr/gross 285+. Four tx rooms fully equipped. X-ray, US, THBO, vascular testing. Loyal patient base, Wound care, diabetes, all aspects of surgery. Hospital priviledges. Seller very motivated to move fast. Relocating - $125k (OBO). Contact jhallux@yahoo.com or fax: (703)264-7745.

PRACTICE FOR SALE : LA JOLLA CA (SAN DIEGO) Price reduced!

$287K '06. No HMOs, bone surgery, or insurance panels, so opportunity abounds! Affluent community. General practice, biomechanics, DME. Possible finance Serious/principals only. Cell:858-405-4780, 10-8 PDT. No Sunday calls, please. $129K Selling due to age, health problems. www.SDFootDoctor.com DrRDWorley@yahoo.com

ASSOCIATE POSITION - EASTERN NORTH CAROLINA

Multi-physician Podiatric practice looking for PSR-24/36 trained Podiatrist to join our progressive, diverse practice. High surgical volume with teaching opportunities. Competitive compensation package with definitive plan leading to partnership. Must have North Carolina license. Position available late 2007. E-mail CV and/or letter of interest to ncdpmsearch@earthlink.net

ASSOCIATE POSITION - SUBURBAN PHILADELPHIA

Associate leading quickly to Ownership Wonderful opportunity to join Kaiser trained podiatrist in a well established, ethical, full scope podiatric practice. Competitive compensation Most be BE/BC Send CV and references to: reversoman@aol.com

ASSOCIATE POSITION- KNOXVILLE, TN

PT/FT, multiple positions to fill, surgically and non-surgically trained, immediate and in near future. State-of-the-art facilities with in office surgical suites as well as full privileges at all area hospitals. Area nationally ranked as fifth best place to live and work. davidphawk@adelphia.net

ASSOCIATE WANTED – NYC

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Associate wanted for practice with offices in Queens and Manhattan. Applicant should be 2-3 year trained, ABPS certified/ eligible. All aspects of Podiatry from necessary routine care to reconstructive rearfoot surgery. Growth potential, partnership potential, benefits available, access to managed care contracts. Send CV to METROFOOTAPPS@aol.com
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PRACTICE FOR SALE – OHIO – SOUTHEASTERN

Reputable, thriving, well-rounded practice available with EMR. Grossing over $320K over the last 3 years. Priced to sell. Owner relocating. Email inquiries and CV to podsx@yahoo.com

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EQUIPMENT FOR SALE: CRYOPROBE SYSTEM

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A cryoprobe system (less than one year old and rarely used) from CryoTech is available for only $12,000. This lists for $14,900. The CryoPac system comes complete with two fully sterilizable probes. This system has been used less than 15 times and can be used to treat plantar fasciitis, neuromas, and other foot pathology. E-mail serious inquires to: drsammendicino@gtef.org

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ASSOCIATE POSITION – SAN DIEGO COUNTY

Immediate opening for qualified forefoot surgeon for well-established practice in San Diego County. Opportunity to buy in as well. foothold@msn.com

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City. Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

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