The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

May 23, 2013 #4,777 Publisher-Barry Block, DPM, JD

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OH Podiatrist Provides Tips for Preventing and Treating Bromhidrosis

Your feet have been hiding out all winter, staying warm and snug inside layers of socks and boots. But with spring here and temperatures rising, it's just about time to slip on some sandals. Here are some tips from Dr. Lisa Roth, a podiatrist at MetroHealth Medical Center, to get your feet ready for the big reveal.

Dr. Lisa Roth

Foot odor is inevitable -- especially in warm months -- but some people have it worse than others. Use an antiperspirant made specifically for feet that can be found online or in the same section of the store as the underarm sprays and roll-ons. If you can't find a product for feet, underarm antiperspirants will do the job. "Just make sure you use a separate container for your feet and underarms," Roth advised. Use daily or according to package directions. After applying, let your feet dry thoroughly before putting on socks, shoes, or sandals.

Source: Ellen Jan Kleinerman, The Cleveland Plain Dealer [5/14/13]

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 recommend barefoot running?
Click HERE for Results

IPMSA Makes Donation to Scholl College

On May 8, a special luncheon was held to thank the Illinois Podiatric Medical Student Association (IPMSA) for its generous $30,000 donation to the Department of Podiatric Surgery and Applied Biomechanics at the Dr. William M. Scholl College of Podiatric Medicine.

(L-R) Maliha Tahniyath, Laura Lasecki, Kelli Iceman, Ali Malik, Department Chair Dr. Neil Horsley, David Schweibish, Laura Reitz, Allison Damon, and Farheen Wahid.

The funds will be used to purchase power console equipment and specialized instrumentation for student use in the surgery dissection lab.

New Study Confirms Hereditary Link for Bunions

Got bunions? You can thank your grandparents or parents for those, according to a new study. The research, published in the journal Arthritis Care & Research, shows that many common foot disorders, including hammertoe, claw toe, and bunions seem to be inherited, particularly among white men and women of European descent.

In the new study, researchers looked at foot bunions, lesser toe deformities, and plantar soft tissue atrophy among 1,370 study participants with an average age of 66 who were part of the Framingham Foot Study. Researchers found that 31 percent of the participants had bunions, 30 percent had lesser toe deformities and 28 percent had plantar soft tissue atrophy. They found bunions and lesser toe deformities seemed to be particularly heritable, though the plantar soft tissue atrophy didn't seem to be heritable.

Source: Huffington Post [5/20/13]

Lawmakers' Bills Keep Spotlight on ICD-10 Debate

Sen. Tom Coburn (R-OK) has introduced a Senate version of the Cutting Costly Codes Act of 2013, a bill aimed at blocking HHS from implementing the ICD-10 diagnostic and procedural codes, which it is scheduled to do on Oct. 1, 2014. Given the Obama administration's support for ICD-10, the chances that the bill will kill implementation efforts once and for all appear unlikely. But what it will most certainly do is keep alive the healthcare industry's debate on ICD-10 implementation.

Coburn, a physician, has lined up three co-sponsors in the Senate including optometrist John Boozman (R-AR) and two of his fellow doctors: John Barrasso (R-Wyo.) and Rand Paul (R-KY). The same bill was introduced in the House of Representatives last month by Rep. Ted Poe (R-TX).

Source: Andis Robeznieks, Modern Healthcare [5/20/13]

Query: Non-Union of the Hallux IPJ

A 75 year old active male presented to the office 5 months post IPJ fusion right hallux. He stated that recently he has noticed his toe "going over some" and is concerned about it getting worse. He denies pain but doesn't like the way his foot looks. Clinically, his neurovascular status is unchanged. Lateral deviation of the hallux at the IPJ is noted.

Non-Union of the Hallux IPJ

Radiographically (comparing 12/13/12 to 5/20/13), the IPJ non-union is apparent with medial deviation of the distal aspect of the implant. Radiolucency is noted around the distal aspect of the implant as well. I'm concerned about the distal implant disrupting the medial cortex of the distal phalanx. The patient is concerned about it as well and would like to get it revised. Surgical options would be appreciated.

Query:  Staff Makes it Difficult to Get Appointments

I suspect that my receptionist and office manager, who work side-by-side in the front office, are not giving timely appointments to new patients. A few patients have told me that they had to wait 2 to 4 weeks to get a new appointment, and I know that my schedule is not full on a daily basis. I’ve approached the staff regarding this topic and the typical response is that the patient was offered a more timely appointment but it did not suit the patient’s schedule, so the patient was given a later appointment.

Today, I had a friend “ghost call” for an appointment for a diabetic with an ingrown toenail. Today’s schedule was very light yet the ghost caller was told that the earliest available appointment would be tomorrow. The ghost caller even mentioned that if she could not get the appointment for today, she would have to call another doctor to be seen today. My receptionist still told her that she could not get in today. Last week, I told the staff that any diabetic patient should be put in the same day even if it means double-booking. I told them that if the patient is not given an appointment in a timely manner, the patient will go somewhere else for care. My office manual does not specifically address this problem. Does anyone have any suggestions on how to handle this problem, short of firing the receptionist, the office manager, or both? Is there any way to monitor or record the phone calls for “quality control” purposes?

Name Withheld

RE: Documenting Radiological Findings (Name Withheld)
From: David Secord, DPM

About 10 years ago, I was first informed that this needed to be done as a separate note from the E/M note. Although it is a pain to do all this documentation, it did come in handy when an insurance company wanted a Roentgenographic report on a patient before approving an MRI or computed tomography (or a surgical procedure).

David Secord, DPM, Corpus Christi, TX, ledocdave@hotmail.com

RE: Diabetic Shoe/Inserts (DME) Wholesale Suppliers (Isa Schwarzberg, DPM)
From: Josh White, DPM, CPed

SafeStep features shoes from Apex, Orthofeet, New Balance, Brooks, Hush Puppies, SureFit, OrthaHeel, and Darco at manufacturer direct prices. SafeStep is the exclusive podiatric distributor of Arizona AFO and features the Moore Balance Brace.

We have very competitively priced private label ready-made inserts, walkers, night splints, ankle gauntlets, canes, crutches and walkers. SafeStep also features Ossur, Aircast, Swede-O, EuroInternational, Darco Donjoy, PowerStep, Bledsoe, and others.

Most significantly, SafeStep guarantees Medicare shoe compliance when using our exclusive "WorryFree DME" documentation service. It creates all 6 required documents and even obtains signed and dated forms from the certifying MD, REGARDLESS OF WHETHER SHOES ARE ORDERED FROM SAFESTEP OR NOT. Customers are invoiced twice per month.

Josh White, DPM, CPed, President, Founder, SafeStep, joshwhite@safestep.net

RE: Biomechanics of Barefoot Running
From: Jefferson J. Mennuti, DPM

So, it seems we need to tally the pros and cons of minimalist vs. conventional shoes.

Pros of minimalist shoes: zero drop shoe, which allows for a midfoot/forefoot gait. Better protection from surface debris than barefoot running.

Cons of minimalist shoes: no support. You are forced to run with a mid/fore foot gait, therefore it's not good for slow paced running, or walking.

Pros of conventional running shoes: cushioning, and support. Allows for runners to run longer before fatigue.

Cons of conventional running shoes: elevated heel. Contraction of the Achilles. Basically forces heel strike running.

I think if people want to run the way they want to run, we should be flexible enough to recommend the appropriate measures.  

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

RE: How to Decline a Raise Request (Jon Purdy, DPM)
From: Bob Hatcher, DPM

I'd be interested on where Dr. Purdy (and others over the years) get their information that it costs $10,000 to hire a new employee "over 3 months."

I have heard this, or even higher figures, for many years but have NEVER seen anything other than anecdotal reports on this cost. If we live and die by EBM for the treatment segment of our practices, shouldn't we demand the same quality of information for the management piece as well? Thanks in advance for enlightening me.

Bob Hatcher, DPM, Raleigh, NC, bob@blhatcher.com

RE: We Walk in a Tripod Fashion: CA Podiatrist
From: Neil H Hecht, DPM

Many years ago, a weight-bearing concept was presented that I use to explain foot function and pathology to nurses in training: “The Rule of 12’s.”  The idea was that our body weight was distributed evenly when standing still between the forefoot and rearfoot, i.e., a value of “6” on the heel and “6” on the forefoot. The forefoot weight was distributed among the 5 metatarsals with met head 1 bearing a value of “2”, with the lesser met heads “1” each, thereby equaling “6”. (met head 1 larger than others, therefore greater weight-bearing “value”.)
 
This concept makes it easy for me to explain what happens to the body weight distribution after metatarsal head resection(s) with increasing weight values to the remaining met heads. This is especially pertinent for the neuropathic patient. (Removal of the first met head increases the weight-bearing value to each remaining lesser met head to 1.5, a theoretical increase of 50%, thereby increasing the likelihood of further ulceration, etc.)
 
Whether the “Rule of 12’s” is true or not, I don’t believe in a pedal “tripod” concept. This would negate the value of met heads 2-4. Further, that concept would make it unlikely that someone could balance after a 5th met head resection, a condition we know is not true. I am curious where Dr. Sung learned of this particular “tripod” concept.
 
Neil H Hecht, DPM, Tarzana, CA, drhecht@drneilhecht.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.

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

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

ASSOCIATE POSITION - NAPLES, FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Candidate should have the skills and desire to perform rearfoot/ankle surgery. Florida has a great scope of practice law and we rotate for ER call. Candidate needs to be ethical and motivated. Established practitioner or new practitioner. In a cover letter tell me why you should be selected for the team. Email cover letter and CV with subject line "I am your new team member." to: Drgordon@gulfcoastfootcare.com

ASSOCIATE POSITION- DAYTON, OHIO

Join an established group practice in Dayton, Ohio excellent reputation, large referral base. Base Salary$120,000, benefits and bonus structure. EMR; diagnostic ultrasound; Padnet; CO2 and Cutera Laser for nails, all aspects of DME. We need well trained personable PSR24/36 surgeon. Future Buy-in available. Please send CV to Ohiomedical@aol.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 - BEVERLY HILLS 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
 

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

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

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 - 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 - 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

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

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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