The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

May 24, 2007 #2,944 Editor-Barry Block, DPM, JD

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There are Better Open-Toe Options to Flip-Flops: AL Podiatrist

If flip-flops are your shoes of choice for the summer, you may want to consider other open-toe options. Montgomery, AL podiatrist Mark S. Veres said there are a number of reasons to fling the flip-flops. "No. 1, it increases the likelihood of trauma to the feet -- stubbing toes and ripping off toenails, for example," Veres said. "There is also no support for the foot. That can cause plantar fasciitis and foot trauma."

Dr. Mark S. Veres

Plantar fasciitis is heel pain caused by inflammation of the plantar fascia, which is the tissue along the bottom of the foot that connects the heel bone to the toes. Any sandal will leave feet vulnerable to injuries such as stubbed toes, but even Veres admits to wearing sandals occasionally. He said the important factor is arch support, which will decrease the chance of foot fatigue.

Source: Teri Greene, Montgomery Advertiser [5/22/07]

Aung Named to AAPPM Board of Trustees

Dr. Barbara Aung has been named to the board of the American Academy of Podiatric Practice Management (AAPPM). Aung is a nationally known author and speaker on podiatric practice management.

Dr. Barbara Aung

She has practiced in Tucson, AZ since 1991 and is on staff at Carondelet Health Network. She is a certified wound specialist and co-director of the St. Joseph Hospital Wound Center.

Source: Tucson Citizen [5/22/07]

Congress to Debate Several IT Health Bills

Look for a flurry of new health IT bills in Congress in the coming weeks and months. At a Capitol Hill news conference last Wednesday marking Health IT Week, advocates pointed to several bills, according to Government Health IT. One, to be re-introduced by Sens. Debbie Stabenow (D-MI) and Olympia Snowe (R-ME), calls for tax incentives, subsidies to certain doctors and clinics serving low-income patients, and Medicare payment changes to favor users of clinical IT systems.

Another, sponsored by Sen. Sam Brownback (R-KS) and Rep. Dennis Moore (D-KS), would call for the creation of nonprofit health records trusts that would maintain banks of the electronic records, the publication reports.

Source: Today in E-Health Business [5/22/07]

Query: Cold Laser Therapy for Morton’s Neuroma

I have a patient who was recently diagnosed with Morton’s neuroma in the 2nd & 3rd interspaces(confirmed by ultrasonography). The patient opted to try a cortisone injection as a starting point for her condition. The one treatment rendered was ineffective. The patient discussed the problem with her chiropractor who advised her to do 'cold' laser therapy, and gave her the impression that this is a much better way to treat her condition. Feedback or comments on this modality would be appreciated.

James M. Petko, DPM, Falls Church, VA

RE: Louis “Pete” Morris, DPM

I was deeply saddened to learn of the loss of Pete. I was fortunate enough to have been a student at CCPM during the time Pete was a student. We became friends and once he started his practice in Pacifica, CA, we kept in touch. Pete would call and invite me to have lunch with him. Pete would call and ask if I could see a patient for him because of his schedule. Pete would call and ask me to come to his office to assist him with a surgical case. Pete would come by my office just to say "hello." Dr. Morris was one of the most gentle and kindest individuals I have ever met. He was a great podiatrist and I extend my deepest condolences to his family. There was only one "Pete Morris." He not only cared deeply for his family, but for his patients and fellow podiatrists. Pete was a complete and genuine human being with a mannerism that was strictly Pete's.

Russell O. Lewis, DPM, Warsaw, VA

RE: Digital Camera For Office
From: Mutiple Respondents

I have just purchased a Canon Power Shot SD800 IS Digital Elph. It is by far the best camera I have owned to date. It falls into the ultra compact category. It has great macro, is easy to use and transfer images. It has a large viewing screen as well as a view finder, 7.1 megapixels, long- lasting lithium battery, bright flash, and auto lens cover. Believe it or not, Walmart currently has a 1 GB card for it for $15. I can't imagine anyone being disappointed with this camera.

Jon Purdy, DPM, New Iberia, LA, podiatrist@mindspring.com

I have been using a Pentax Optio S4i for several yrs. It has macro capabilities, is the size of a cigarette pack and is easy to download either directly from the camera or by removing the card and inserting
the card directly in your computer’s card reader slot. I carry it in a small baggie in my pocket ALL of the time.

Art Hatfield, DPM, AFOOTJOB@juno.com

Our office recently purchased Kodak EasyShare C533-5.0 mega pixel digital camera. It comes with its own software; however I use Picasa software to manage patient pictures. We have found that we do not need a higher pixel and if an 8x10 print is needed, they print out very clearly. Picasa can be set up to erase the memory stick after pictures have downloaded so the camera gets back to the nurses very quickly. Pictures are usually downloaded, edited and printed in a matter of minutes.

Marcia Holmes, southernohiofootandankle@yahoo.com

RE: Tibialis Anterior Tendon Tear (David O'Brian, DPM)
From: Multiple Respondents

Dr. O’Brian has a patient that he tried conservative treatment with casting but the MRI shows a longitudinal tear and has clinical pain to correspond. I would fix the tear and rehab this patient so he can resume his sport activity.

Larry Kosova, DPM, Westmont, IL, lkosova@yahoo.com

It seems that the cavus foot type has contributed to your patient's ant. tibial tear. He probably has a rigidly plantar-flexed first metatarsal with dorsal prominence at the base of the first metatarsal-cuneiform joint. This may have irritated the anterior tibial tendon predisposing to rupture. If cast immobilization for 6 weeks has failed to rendered him asymptomatic, then I would recommend exploratory surgery which may include removal of any bony prominence and primary repair of the longitudinal tear. Lately, I have been using the Topaz radiofrequency lesioning technique to augment my repairs. Lastly, check to see that he doesn't have an extreme varus deformity of the heel. If so, consider performing a Dwyer calcaneal osteotomy along with your other repair.

Richard T. Braver, Englewood, NJ, DrRun@aol.com

I have had a number of athletic patients with similar presentations though the onset was gradual and insidious and not acute as in Dr. O'Brian's case. In 3 cases, evident on plain x-rays, was a prominent medial eminence of the cuneiform immediately adjacent to the course of the tibialis tendon. One of the cases did exhibit increased signal on MRI though there was no longitudinal tear. In these 3 cases, surgery was performed to remove the eminence (the bone was “saucerized” to prevent recurrence) and in the one case the tendon was also tenotomized and debrided (adjacent to the prominent eminence) where mild degenerative changes were evident on inspection. The surgery in these 3 cases was curative- I speculate that the medial cuneiform eminence was the problem resulting in a tethering of the tendon with subsequent tendinopathy.

In your case, I would assure what you see on MRI corresponds exactly to where the patient is experiencing symptoms. Many times the MRI reveals signal changes in tendon that appear to be tears but end up being false positive findings. If you feel indeed this is a tendinopathy with a longitudinal tear and conservative treatment has failed and no medial eminence is identified, I would recommend treating the longitudinal tear surgically (as one would address a longitudinal tear of the peroneals) with inspection, debridement of degenerated tendon and either excision of the split portion of the tendon or repairing it. I would still thoroughly check the adjacent osseous structures to assure no constriction or impingement.

Re: conservative treatment, I would thoroughly look at this patient biomechanically both statically and dynamically and address any potential predisposing factors. I would try a course of heavy load eccentric strengthening exercises as well if tolerated. Results using this treatment strategy have been excellent with tendons that have symptomatic tendinosis without a tear. When a symptomatic longitudinal tear is present, surgery is required to address the problem in my experience.

Rich Bouche’, DPM, Seattle, WA, spmrtb@earthlink.net

RE: Numbness in Athletic Diabetic Patient (Michael Zapf, DPM)
From: Ray McClanahan, DPM, BS Ed

Editor’s note: This note can be read at: http://www.podiatrym.com/letters2.cfm?id=14165&start=1 This topic is now closed.

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

ASSOCIATE POSITION - PHOENIX ARIZONA

Seeking preferably an experienced podiatrist versed in all aspects of podiatry with current AZ License. Practice is well established over 25 years, successful and large volume in the Phoenix metro area. Position available immediately. Email CV and inquiries to : pprac4sl@cox.net

ASSOCIATE POSITION – CALIFORNIA

Permanent associate position for very busy Southern California, two office practice. We offer a competitive salary, bonus plan, and fully paid benefits. Good surgical training is a must, and experience is a plus. Please fax CV to (909) 796-3707, or call (909) 227-5393.

ASSOCIATE WANTED - IMMEDIATE OPENING- NEW YORK

Hudson Valley (NY) for multi-location well rounded podiatric practice including high volume orthotics and reconstructive surgery. Looking for well trained (PSR- 24/36), personable, energetic practitioner to expand practice. Outstanding opportunity to work into partnership. Competitive starting salary, bonus incentives, benefits, and pension. Please submit: CV, letter of intent and references to: footassociate@yahoo.com

ASSOCIATE WANTED – PHILADEPHIA AREA

Opportunity in a high volume office-based practice in suburban Philadelphia.full-time office, close proximity to hospitals for surgery, consults and in-house care. Candidate must be well-trained in all facets of podiatry.PSR24/36 board certified/eligible required. Email CV and contact info to:mrgpod@hotmail.com or fax CV to 610-688-5175.

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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

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

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

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