The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

May 23, 2011 #4,167 Publisher-Barry Block, DPM, JD

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Many Foot Injuries Result from Toning Shoes: PA Podiatrist

Dr. Eric Ricefield says he has had a number of toning shoe wearers complaining of injuries. "We've had quite a few ankle sprains," Dr. Ricefield said. He has also seen tendon and ligament strains, stress fractures, and nausea. 

Dr. Eric Ricefield

Dr. Ricefield says toning shoes change the way feet interact with the ground. "Some shoes rock from side to side, some shoes rock from front to back," Dr. Ricefield said. That instability is supposed to make muscles in the core, backside, and legs work harder. But the doctor says it can just make walking harder.

Source: Alicia Vitarelli, WPVI-TV (Philadelphia) [5/19/11]

A Pair of Shoes Can Change a Child's Life: IL Podiatrist

This past holiday season, Share Your Soles along with Advanced Foot & Ankle hosted the annual three-week long Holiday Shoe Drive. AFA was able to raise national awareness for the Holiday Shoe Drive. In addition, AFA collected hundreds of pairs of shoes through the shoe drive boxes throughout their Chicago and suburban locations; making this holiday giving season one of the most successful in Share Your Soles history. 

Dr. Dave Charnota

When you choose to make a difference in an innocent child’s life, you bring love, hope, and a sense of belonging. “It’s amazing what a pair of shoes can change in a child’s life,” commented Dr. Dave Charnota, an AFA Board member and podiatrist based in Lake Zurich, IL.

Source: Rebecca Berlin, Chicago Tribune [5/20/11]

NJ Lectures at Implant Symposium

Dr. Scott Fishman recently lectured to surgeons from across the United States at the fourth annual Graham International Implant Institute Symposium in Las Vegas, Nevada. The GIII Symposium promotes surgeon education and the role of extra-osseous talotarsal stabilization in the treatment of talotarsal dislocation syndrome, a common foot and ankle ailment that can cause many debilitating symptoms, such as heel pain, plantar fasciitis, and even knee, hip and back problems. 

Dr. Scott Fishman

Fishman presented the lecture "Meniscoid-Q Angle ebalancing" to inspire foot surgeons to think outside the box when it comes to diagnosing and treating TTDS and the many painful symptoms it can cause. Fishman is a master surgeon with the Graham International Implant Institute and is trained by GIII to perform the HyProCure® procedure, which corrects TTDS.

Source: The Daily Journal [5/20/11]

Query: Cracked arm of Smart Toe Implant

My patient is a 55 y/o female who had a Smart Toe arthrodesis of the 2nd toe. She was experiencing more than average surgical site pain, but the pain was still within normal limits. Her PIPJ was slightly more swollen than typical. Three-week post x-rays show a cracked arm of the Smart Toe implant within the proximal phalanx, with some mild to moderate opening of the osteotomy site, proving loosening of the hardware. 

Cracked Arm of Smart Toe Implant

Would you recommend immediately taking out the hardware and replacing it with new hardware like a K-wire, or would you focus on splinting the toe and hope that the fusion site solidifies around the implant?

Jay Hassenfratz, DPM, Buffalo, NY

RE: Idiosyncratic Reaction to a Foot Injection (Elliot Udell, DPM)
From: Multiple Respondents

This is not uncommon. I tell patients that the reaction is possible for a transient period (several hours the next day). This saves phone calls to explain the benign nature.

Michael DiGiacomo, DPM, Oakland, CA, mddpm2003@yahoo.com

It's called "steroid flush" and is a direct reaction to the steroid. I always warn patients it might happen, but it is inconsequential and will self- resolve in 24-48 hours. Now, I have a question. Where can you get dexamethasone? Our suppliers tell us it is no longer available.

Martin V. Sloan, DPM, Abilene, TX, doc@drmartinsloan.com

Perhaps it is a photosensitivity reaction. Was she outdoors even for a short time? (ehealthme.com/ds/dexamethasone/photosensitivity+reaction)

Al Musella, DPM, Hewlett, NY, musella@aol.com

RE: Unidentified Fixation (Richard Jaffe, DPM)
From: Joel Morse, DPM

We recently had a case where we had to remove a screw. I called the doctor who informed me that it was an Osteomed screw that he had placed in 15 years ago. I had the rep bring the screw set - and we have a Synthes set in the surgery center. After opening up the area, we discovered it was neither the Osteomed or the Synthese screw. So we used a dental burr to drill around the screw, and then used a Jacobs chuck to grab onto the outside of the screw. We tightened it down, and it worked like a charm.

Joel Morse, DPM, Wash, DC, Foxhallfoot@aol.com

RE: Cerner EMR in a Clinical Setting (Lea Elliott, DPM)
From: Gary S Smith, DPM

We have used Cerner's office software for many years, so we decided to go with Cerner's "powerchart". We have been using it for almost five months. The people who train you are all fresh out of school, and have some knowledge of Powerchart and absolutely none about Wisdom. The two softwares are not as compatible as they should be. For example, the doc can't see or click on a tab and find out what kind of insurance a patient has without searching through the admission scanned documents. Previously, our billing staff could just hit a "re-bill" tab for routine foot care patients seen bi-monthly.

In Cerner's Powerchart, the doc does ALL the billing, and there is no "Re-bill" tab. You have to manually enter in all the billing codes and modifiers each time. You can copy the previous note on these patients, and that does help to speed up the charting. The drop down menus for physical exam of the feet are a little lacking, and you'll have to type in on every patient. The treatment menus are very poor and typing will be required every time other than for nails. We were trained in January and did everything as we were supposed to. When it came time to attest, Cerner REFUSED to help us saying we were nowhere near ready. They sent out another trainer, and now we have to wait another three months to see if we get paid.

Gary S Smith, DPM, Bradford, PA, penndoc@verizon.net

RE: Vacuum System With an Umbrella Burr (Ivar E. Roth DPM, MPH)
From: Marc Garfield, DPM

Handler Vacuum with Flex hose should work with anything. It can be purchased from Henry Schein. It works great for cast cutting as well.

Marc Garfield, DPM, Williamsburg, VA, mgarfield1@cox.net

RE: To Be or Not to Be an MD/DO (Leonard A. Levy, DPM, MPH)
From: Paul Kruper, DPM

If I had to depend on income from ankle surgery, triples, flatfoot surgery, calcaneal fractures, and the like, I would have starved a long time ago. These procedures will never become a large part of my practice. A common complaint in podiatry circles is not enough patients or surgical cases. Solution: Upgrade to a plenary full scope DPM license. My practice would overflow, providing primary care to just diabetics, arthritics, and derm problems. Almost all podiatrists could provide primary care to these patients. It is time to expand the scope of the DPM license. The MD/DO is not necessary.

Paul Kruper, DPM, Kingsburg, CA, prkruper@yahoo.com

RE: Podiatrists' Responsibility When Taking Patients' Blood Pressures (Peter Harvey, DPM)
From: Brian Kashan, DPM

I just started going live on my EMR last week. I had never taken BP in my office previously. I would like to bring to everyone’s attention that one of the “meaningful use” criteria that will be used to reimburse us, our money (18k in year one and up to 44k), is the taking of vital signs. So, I would expect that many more of us will be taking BP’s in the near future! As far as my responsibility goes, a note telling patients to follow up with their physicians should suffice. In a hypertensive emergency, I feel comfortable referring them to an ER.

Brian Kashan, DPM, Baltimore, MD, drbkas@att.net

RE: Diabetic Shoe Refund Demand (Allan Hetelson, DPM)
From: Richard A. Simmons, DPM
 
The problem: dispensed shoes resulted in paying money back to Medicare. Another solution to this problem would be to know a patient's CMS status at the time of the visit, etc. My office subscribes to CheckMedicare.com. Before every visit, the patient's Medicare status is checked. If the patient is a resident of an SNF at the time of the visit, you can see that on the report. You can also see if the patient is part of an HMO, if the annual deductible has been met, along with a lot of other valuable information. It costs 25 cents for each check. Costly? Could be, but how many 25 cents would you have to spend to pay for what was lost in one pair of shoes?

The GA modifier may work for financially solvent patients, but if they are living on that pension, forget it. Also, I have seen the statement more than once from CMS: "As the provider you knew or should have known that this service was not reimbursible because..." Everytime I have sent a copy of the CMS report from CheckMedicare.com to my local carrier, they have backed down.

Disclosure: I have no financial interest in the company that provides CheckMedicare.com except that it has saved me hundreds, if not thousands, of dollars every year.
 
Richard A. Simmons, DPM  Rockledge, FL  RASDPM32955@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. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

PRACTICE FOR SALE - SOUTH CAROLINA

$800,000+ gross, single location practice needs well trained, energetic podiatrist. Confidential inquiries carpodpract@gmail.com

PRACTICE FOR SALE - HOUSTON, TEXAS

28 year old busy, progressive practice for sale with an excellent reputation and well established referral base. Well trained, dedicated, supportive staff. Excellent cash flow $475K income after overhead. EMR, digital x-ray, diagnostic ultrasound. Free standing building also available with large outdoor sign. Owner retiring and willing to stay part time during transition. softechpodiatrist@gmail.com

PRACTICE FOR SALE - MISSION VIEJO, CA

Relocating to Tulsa. Great opportunity to buy my office. Located on Mission Regional Hospital Campus. Gross income 2010 was $340,000. Approximately 1300 sq ft with 3 treatment rooms, digital x-ray and fully computerized. Only 3 years old. Will consider all offers. 949-702-1052. David Stoller, DPM (Family Footcare) david@missionviejofootcare.com

PRACTICE FOR SALE - MARYLAND, DC SUBURBS

Great opportunity. Well established and equipped practice for sale. Office includes state licensed Ambulatory Surgical Center. Present owner is retiring but will stay on as needed for smooth transition. Average gross over past 3 years is $575 K. dpmpracticeforsale@yahoo.com

ASSOCIATE POSITION – NEW YORK

Well-established, multi-doctor podiatry practice with offices in Putnam and Westchester counties. Compensation based on productivity. Excellent opportunity for recent residency graduate to build skills and learn practice management. Full-time preferred but right part-time candidate will be considered. Email cover letter and CV to: Podiatry2011@gmail.com

ASSOCIATE POSITIONS - TEXAS

Texas licensed podiatrists needed in San Antonio and Austin. Great paying positions for full or part-time. Well established, unique mobile podiatry practice servicing senior living facilities. Business office locations in both cities with excellent support staff for your assistance and scheduling. Check us out before looking elsewhere. Find us at www.footmobile.com Reply with cover letter and CV to doctor.cohen@yahoo.com with a cc: to lisa.schulze@yahoo.com or call us at 210-495-6477.

ASSOCIATE POSITION - MARYLAND

Looking For The Best. Busy practice. F/T associate possibly leading to partnership. Seeking sharp, honest and hard-working associate who is extremely personable. Board Certified or eligible. Exceptional surgical skills and training needed, but is just as important to diagnose accurately. Excellent salary and benefits. Email CV to Marylandfootcare@live.com

ASSOCIATE POSITION - SOUTHERN MI (NOT DETROIT AREA)

Leading to partnership for rapidly growing 3-physician group practice. Must be residency trained and willing to learn and follow our very successful business model. Salary plus incentive. If you're unhappy with where you're at now this may be the answer! If, interested send CV to: paulapmac@me.com

ASSOCIATE POSITION- NEVADA

Well established 22-year practice in Las Vegas/Henderson, Nevada seeking full-time associate. General podiatric care with moderate amount of surgery to be done in local hospital or surgery center. Competitive salary and benefits. Modern office in new area. Please respond by email to lvfootandankle@gmail.com

ASSOCIATE POSITIONS - NW INDIANA, CHICAGO AREA

2 Full-Time positions open - One for Northwest Indiana and one for the Chicagoland area. Must have 2-year surgical residency. Must be motivated and a self-starter. State License required. If interested email: f-massuda@footexperts.com

ASSOCIATE POSITION – NEW YORK

Great opportunity to share “state-of-the-art” offices and equipment in mid-town Manhattan and White Plains with Board Certified podiatrist. Out-of-network or participating providers welcome. Please call 212-704-4310 for additional information and fax your CV to 212-704-4311

ASSOCIATE POSITION – IOWA CITY AREA

Modern practice seeking a well-trained (PSR 24/36) associate. Excellent opportunity for an energetic, hardworking individual with strong surgical and medical skills. Solid referral network and 13 years of growth. Come live in the Iowa City area and enjoy the quality of life and stability of a Big Ten University community. Competitive salary and benefit package available. If interested, fax CV to 319-354-1014 or e-mail to dave@341foot.com

ASSOCIATE/OPPORTUNITY - PHOENIX (EAST VALLEY)

Established practice seeking motivated min. PSR24+ personable, ethical, motivated person to join state-of-the-art multi-office locations. Partnership/Ownership opportunity in practice, real estate, surgical center. Also interested in existing practitioner to merge or work part time. Contact AZPODAssociate@aol.com Must be pursuing or have AZ license.

ASSOCIATE POSITION - SW FLORIDA

Huge opportunity. Are you an outstanding person? Would you like the freedom to utilize your talents to the max? Opportunity awaits right candidate. Excellent mix of office/surgery motivated/experienced staff. Full Time Associate PSR 12-36. Great Salary/Benefits, Bonus Package, Unlimited Potential, Buy-In Opportunity. Email resume to podiatry22@yahoo.com

ASSOCIATE POSITION - TAMPA BAY, FL

Associate with PSR 24+, needed for a dynamic practice. Well-established high-tech with specialties in sports medicine, surgery, and wound care. No nursing homes or HMOs. E-mail: flpodiatrist@tampabay.rr.com

ASSOCIATE POSITION - WA (KIRKLAND, SEATTLE, EVERETT, AND REDMOND)

Join one of the fastest growing podiatry practices in Washington state. Must be motivated to grow practice. Competitive salary and benefits. For more information go to seattlefootdoctor.com. Send resume to seattlefootdoctor@yahoo.com

ASSOCIATE - POSITION - SOUTHEAST GEORGIA & SOUTH CAROLINA

Seeking recent residency graduate to join practice. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facility. E-mail to melissafoot@pol.net

ASSOCIATE POSITION - NEW YORK CITY & QUEENS

One of the fastest growing podiatry practices in New York City and Queens seeks a podiatrist who participates with HealthFirst, Fidelis, and other Medicaid plans. Preferably a Spanish speaking podiatrist. Contact me at Podocare@aol.com

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