The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

May 22, 2012 #4,468 Publisher-Barry Block, DPM, JD

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Nail Polish Can Mask Nail Diseases: DC Podiatrist 

"People like to have pedicures done straight through the summer or even all year long, but the problem with that is nails don't get an opportunity to breathe," says Washington podiatrist Dr. Howard Osterman, who notes that chemicals in nail polish can eat away at the top layer of toenails, resulting in changes in color or texture that may or may not be a sign of a true medical issue. "Fungus grows in dark, moist environments, so anything that doesn't let air dry it out, such as nail polish, can allow fungus to fulminate underneath," he explains, noting that clear nail polish isn't any better than colored, since it's the enamel itself that's the problem.

Dr. Howard Osterman

Osterman points out that pretty hues can also mask infections, skin cancer, and other medical problems, and he suggests, at the very least, changing your polish frequently, so you can keep an eye on the state of your nails.

Source: Carolyn Butler, The Washington Post, [5/18/12]

Bunions are “Misunderstood and Underestimated.” - TN Podiatrist

According to Morristown podiatrist Dr. Sebastien Demoiny of HealthStar Orthopedics & Podiatry, bunions are “misunderstood and underestimated.” He discussed the causes and treatment for bunions during the recent A Meal & More luncheon series at Morristown-Hamblen Healthcare System.

Dr. Sebastien Demoiny

Demoiny said despite a number of myths about the cause, bunions are actually most commonly found in people with flat feet. Because of the biomechanical problems caused by flat feet, the big toe begins to move toward the smaller toes. Because shoes can rub the protruding bone, the skin on top can become inflamed and red. The fluid-filled sac in the joint can become inflamed, causing bursitis.

Source: Denise Williams, Citizen Tribune [5/19/12]

Despite Settlement, CT Podiatrist Says Skechers May Help Some With Foot Pain

Skechers USA, Inc. recently agreed to pay $40 million to settle charges that the company made unfounded claims about the weight-loss benefits of Shape-ups and other products. Dissatisfied Skechers customers may be eligible for a partial refund. The settlement is the result of an investigation that involved attorney generals from more than 40 states, including Connecticut and the District of Columbia.

Dr. Howard Harinstein

However, at least one professional said Shape-ups do have some health benefits, though those benefits have nothing to do with weight loss. Dr. Howard Harinstein, chief of podiatry at Bridgeport Hospital, said the rocking motion caused by walking in the shoes can actually help people with certain kinds of foot pain. "It does eliminate some of the discomfort," Harinstein said. "It's really not a bad shoe at all. It just can't live up to the claims it's making."

Source: Amanda Cuda, Connecticut Post [5/18/12]

AMA Renews Call for ICD-10 Delay Until 2015

The American Medical Association has renewed its call to hit the pause button on the national adoption of the ICD-10 diagnostic and procedural codes. In a letter to CMS acting Administrator Marilyn Tavenner, AMA Executive Vice President Dr. James Madara referenced a November 2011 House of Delegates policy vote in which that body called for a “repeal” of the move to ICD “so that physicians and other stakeholders could assess an appropriate alternative to such a costly, burdensome regulatory requirement. The AMA has since pressed the case for a second look at ICD-10 overall.

Physicians need the delay because they are “overwhelmed with the simultaneous implementation of multiple health IT programs,” Madara said. He asked for a two-year extension to Oct. 1, 2015, with the caveat that “if stakeholders cannot reach consensus on this matter during this two-year period, then the move to ICD-10 should be postponed indefinitely.”

Source: Joseph Conn, Modern Healthcare

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Robert Bijak: What are your thoughts about the evolution of biomechanics?

Dr. Stephen Smith

Stephen Smith: I'm so disappointed because we made such great progress through Merton Root, Sgarlato, and Weed in the middle of the ‘70s. I don’t see it going anywhere. It seems that most of the biomechanics is related to bone healing and screws and fixations, but not on the theory. I don’t see any advances whatsoever, and it’s a shame because there's lots to know and a lot we don’t know.

Dr. Ross Taubman and Robert Golstrucker

Meet the Masters is broadcast each Tuesday night at 9 PM (EST). This week's guests are malpractice experts Dr. Ross Taubman and attorney Robert Golstrucker. You can register for future events by clicking here

A Key Question to Retain Staff

Retain employees by asking this question: “If I were calling from another practice to recruit you, what could I offer to lure you away?” The answer will reveal what you must do to keep your employee.

Source: Adapted from “Stop Turnover With These 3 Questions,” Ashlie Turley, Refresh Leadership via Communication Briefings

Query: Konica SRX 101 X-Ray Processor

I am looking at a used Konica film processor for my office. The company that services our office is very reputable and the owner suggested a Konica SRX 101, stating reliability and fewer moving parts as the key points for this particular processor. Does anyone have any experience with this model? Any other suggestions on other processors would be appreciated.

Jack Ressler, DPM, Lauderhill/Delray Beach, FL

RE: Lamisil, Tamoxifen Drug-to-Drug Interaction (Craig Herman, DPM)
From: Elliot Udell, DPM, Howard R. Fox, DPM
 
Dr. Herman deserves to be acknowledged for making us aware of this. There is a great deal of literature identifying this problem. The problem is that oral Tebinifine can reduce the ability of Tamoxifen to stave off a recurrence of breast cancer. Since we rely upon drug-to-drug interaction programs to warn us when there are potential interactions, it would be wise to find out why the E-Clinical works program did not pick up on this. What is even more alarming is why the pharmacy where the prescription was filled did not flag this problem with their drug interaction programs.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

As a general rule, when there is any doubt, especially with patients taking multiple medications, prior to prescribing something new, I run a drug interaction check through Epocrates, which is free and can be installed as an app on smart phones as well as a web-based program:
epocrates.com

Epocrates also contains a pill identifier, dosage calculators, and several other nice features. Using the interaction checker with Lamisil and Tamoxifen, it readily alerted me to the potential interaction and explained why in one sentence.
 
Howard R. Fox, DPM, Staten Island, NY, Fox.howard@gmail.com

RE: Soft Tissue Mass (Bryan Markinson, DPM)
From: Anna Olvera, DPM, Jeffrey Manway, DPM

First, I would like to applaud Dr. Lagman for his question as I am sure MANY of us do not have ALL the answers, but it takes a good podiatrist to ask for help instead of not admitting that one requires assistance, and a botch job winds up being the end result. As my podiatric surgery professor told me a few years ago, there is no such thing as a dumb question when a patient's life is in question. That always stuck with me. I think it's important for ALL podiatrists to remember that, even the ones who consider themselves "seasoned", because no one has all the answers.

Second, Dr. Markinson's comment, "But I am positive that the patient could be in better hands" is inappropriate and unnecessary.  Belittlement has no place here. If you have something constructive to add to the subject, the responder should do so with a modicum of professionalism and sensitivity. We are all professionals and should conduct ourselves in that manner and not resort to this pettiness. Instead of chastising a fellow colleague for a perfectly legit question, we should throw our energies into uniting our profession which, quite frankly, has always been fractious, with this comment being a pertinent reminder of it.

Anna Olvera, DPM, TX, annathefootdoc@yahoo.com

Just to echo Dr. Markinson's thoughts, I believe if there is any doubt in treatment plan, diagnosis, or technique, suspected malignancies should be referred out. I believe the possible morbidity of performing a biopsy is significantly understated. We should not have the mentality of, "I'll biopsy it and if it's malignant, then I'll refer it out." As he states, these are not skin lesions and should not be treated as such. This is a well documented problem in the literature and biopsy is not without its risks. Poor technique and improper surgical planning can leave the patient with suboptimal results - including additional (and sometimes unnecessary) treatment, more aggressive amputation, increased risk for metatastasis, and possible increased risk of mortality. 

Further, when biopsies are performed in community facilities, they are generally reviewed by pathologists with lesser experience with rare oncologic issues (as any primary or secondary malignancy to the foot and ankle would be). This leaves the patient open to further harm as well. This is described in two landmark classic articles by Dr. Henry Mankin. They are both free articles at this point and I've listed the links below. I encourage everyone to read these. jbjs.org/article.aspx?volume=64&page=1121         jbjs.org/article.aspx?articleid=23264
 
Jeffrey Manway, DPM, Pittsburgh, PA ,jeffrey.manway@gmail.com

RE: Hyperpigmentation of African-American Women After Using Corn Remover Pads (Shelley Gath, DPM)
From: Janet McCormick, MS

Hyperpigmentation is not usually due to friction, but if it is, it is usually temporary. Long lasting hyperpig is usually caused by sun or chemical damage, such as by incorrect or overuse of salicylic acid. Any color skin will produce darker coloring (called age spots by lay persons, no matter their cause), with of course the Fitzpatrick 4-6 skin classifications producing the darkest (olive-coloring Caucasians, Latinos, African Americans, Asians).

This discoloration is almost never cured, especially in the Fitz 4-6, though it can be controlled to some degree with continual care. You might reconsider prescribing hydroquinone 4% or higher, however, for discoloration on the foot. In most other countries, hydroquinone is already illegal for OTC (under 4%) and highly discouraged for use at medical level (4%+) due to potential systemic problems. The FDA is actively moving towards that here, with investigation happening right now. If you do prescribe it at medical level, it is recommended that its use be restricted to 90 days and then to change to alternative lighteners, such as those with kojic acid and other good but non-toxic lightening ingredients. These can be used from the start to produce lightening. They take longer, but they are non-toxic. All require continual use to control hyperpigmentation.

Janet McCormick, MS, Signal Mountain, TN janet.mccormick.info@gmail.com

RE: Shredding Documents (Frank Lattarulo, DPM)
From: Michael Brody, DPM

I recommend using a shredding company that brings a shredding truck to your office. You watch them shred the documents and then receive a manifest. There are many companies that offer such services.

Michael Brody, DPM, Commack, NY, mbrody@tldsystems.com

RE: MOC in Podiatry (Elliott Hudson, DPM)
From: Kathy Satterfield, DPM

I am pleased to say that the American Board of Podiatric Orthopedics and Primary Podiatric Medicine (ABPOPPM), the board associated with ACFAOM (American College of Foot and Ankle Orthopedics and Medicine), received the go-ahead for the MOC for their members. This puts more money in their members' pockets each month.

We welcome those who will be able to qualify to become Diplomates of ABPOPPM and Fellows of ACFAOM!

Kathy Satterfield, DPM, President, ACFAOM, Pomona, CA, vksatterfielddpm@aol.com

PRACTICE FOR SALE — BROOKLYN, NY

This practice has been in the same location for 31 years, seeing 80-100 pts/week, working 4.5 days/week. Grossing $350K and netting close to 70%. All surgery referred out. Low rent, option to buy the building in future. Asking $225K, doctor willing to finance. Call 800-983-4194, or email: contactus@podiatrypracticeconsultants.com

PRACTICE FOR SALE - BALTIMORE, MARYLAND

Established 40+ year old well-rounded practice of both surgical and non-surgical care with special emphasis on sports medicine. Medicare and BS/private insurance base, no Medical assistance. Needs to transition to a confident well trained individual. Purchase can include building. Contact: podiatrypracticesale@gmail.com

ASSOCIATE POSITION - NEW JERSEY

Immediate opening for a full-time podiatrist in a rapidly expanding multi-office practice in central New Jersey. Well established referral base with full admitting hospital privileges. Availability to become part owner of a multi-room, multi-specialty ASC. Excellent opportunity for the right doctor with potential to achieve $200K in the first year. Wonderful working conditions. Applicant must have at least PSR-24 surgical training. Valid NJ license and Medicare number is required. Applicant should also be familiar and competent in biomechanics, trauma, ESWT, PRP, wound care, and ultrasound diagnostics. Participating insurance #'s a plus. Please fax resume to:(609) 259-6637.

ASSOCIATE POSITION - ILLINOIS

Full and Part-time opportunity to provide conservative, ethical podiatric care to residents in long-term care throughout Illinois . Full time position includes health, disability, 401, auto/travel expenses. Ideal Full-time candidate would be willing to travel 2-3 days per month, or be located in central or downstate IL. We have a 30 year history of providing exceptional care and service, with appropriate reimbursement. Please email queries or resumes to: gh@podiatryplus.net.

ASSOCIATE POSITION - CALIFORNIA

We are hiring podiatrists for part-time positions in California: San Francisco, San Diego, San Jose. Duties: Diagnosis and treatment of Onycomycosis using Pinpointe laser in our facilities (training at the clinic); flexible schedule. Qualifications: Valid DPM California license; active medical liability insurance. email CV to: ofer@lasernailtherapy.com

ASSOCIATE POSITION - WORCESTER MASSACHUSETTS

Podiatry practice in Worcester Massachusetts is looking for an associate podiatrist. Busy 2-person practice. High surgical numbers. No nursing homes. Call to hear free recorded message for more information. Call 641.715.3800 Access Code 32299 and message 4 to learn about the practice. Visit our website www.centralmasspodiatry.com

ASSOCIATE POSITION - KANSAS CITY, MISSOURI

Kansas City may be the perfect move for you and your family. I am looking for an entrepreneurial minded associate who wants to grow and then own part of an already successful practice. If you are the right candidate for this associate position, you will enjoy a competitive compensation package and you will be working with a doctor who is as committed to your success as he is to his own. Go to:www.YourFutureInPodiatry.com for full details.

ASSOCIATE POSITION - FLORIDA

Looking to hire an associate who is caring, friendly, and holds a patient in the highest regard. I am a single practitioner with a large podiatry practice in Tampa, FL. Will provide an outstanding salary with additional incentives, excellent healthcare benefits, retirement and cell phone. Please email resume toHeliodiety@aol.com or fax to 813-854-6105.

Very busy, two location group practice seeking a full-time, self motivated and hard working podiatry associate. Competitive salary and benefits are offered. Please email CV to: footcare4all@aol.com

ASSOCIATE POSITION - NORTHWEST IOWA

A well-established, midwest multi-physician practice with strong hospital affiliations seeking FT podiatrist. Applicant should be well trained surgical physician, completed a 24-36 month residency, & board eligible. Practice offers high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume: 712-258-9977

ASSOCIATE POSITION - MANHATTAN

Podiatrist needed for busy state-of-the-art offices in Manhattan. Offices are located near Penn and Grand Central Station. 10+ years experience only and an out-of-network doctor for most insurances. Please forward your information and CV to: roni@myfcny.com

ASSOCIATE POSITION - BEAUTIFUL LONG ISLAND

Business-oriented, mature Board eligible/certified podiatrist who is not just looking for a job, but a secure future. Buy-out of practice will be available. Practice does in excess of $500K. 2 hospitals available. No nursing homes, no Medicaid. Competitive package. Please fax CV to 631-581-0857.

ASSOCIATE POSITIONS - MULTIPLE STATES

Podiatrist Needed in Arkansas, Kansas, Missouri, Nebraska, Iowa, Minnesota, North Dakota, South Dakota, Texas, Colorado, Wisconsin, and Oklahoma. Expanding multi-state medical practice seeking podiatrists to service long-term care community residing in nursing homes and assisted living facilities. We offer an established patient base, scheduling, equipment allowance and cover travel expenses. Provide generous compensation, bonus opportunities, disability, health insurance benefits, malpractice coverage and flexible scheduling. Looking for a podiatrist with excellent skills, able to provide expert and compassionate care to patients. Email CV to: careers@aggeus.org or call 773-770-0140 x300/x305. www.aggeus.org

ASSOCIATE POSITION – ANCHORAGE, ALASKA

Associate wanted for hospital-based podiatry group practice. Full scope of practice. Surgical residency 24month+. Outstanding opportunity, work environment, and recreational pursuits. Fax CV to 907-562-5195, please call 907-562-4958, e-mail us at contactus@alaskapodiatry.com

ASSOCIATE POSITION - OH

Join a well-established modern practice in Dayton, Ohio. Excellent reputation and referral base. Base salary $120,000, benefits and bonus structure. EMR, diagnostic ultrasound, Padnet vascular studies, CO2 lasers, all aspects of DME. We seek a surgeon that is well-trained and personable to join our group of 4 podiatric surgeons. Would like to have this individual buy in to the practice eventually. Please send CV and to Ohiodoctors@aol.com

ASSOCIATE POSITION - CALIFORNIA

Office and hospital-based podiatry group in Bakersfield, CA seeks highly-trained surgical associate to join us. Prefer surgeon with trauma and Charcot reconstructive experience. Staff privileges with 5 local hospitals. Offering health insurance, CME allowance and competitive salary. Must be PSR 24/36 trained, ethical and thoughtful when treating patients. Please forward CV to: aghams2@aol.com

EQUIPMENT FOR SALE: EPAT 

(Extracorporeal Pulse Activation Treatment) for sale. D-Actor 200. This machine is still new. Purchased in late 2011.( new machines>30K). It is the conservative alternative to surgery. Treats Plantar Fasciitis, Heel spurs, Achilles Tendonitis, Joint pain. Great Buy. $19,995. Please call 713-541-3199 for more information. or email contactus@houstonfootankle.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 516 476-1815 PODO2345@AOL.COM

PM News Classified Ads Reach over 13,500 DPM's 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 13,500 DPM's. 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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