The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

May 24, 2013 #4,778 Publisher-Barry Block, DPM, JD

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MI Podiatrist Discusses Barefoot Dangers

The boots are off and plans for the beach are in order! However, shoeless lounging and beach walking does come with potential trouble for barefoot individuals. 

Dr. Jody Sengstock

“Often individuals don’t take time to protect themselves from non-visible dangers to bare feet,”  said Dr. Jodie Sengstock, Immediate Past President of the Michigan Podiatric Medical Association. “Pool areas and public showers are home to infections such as planter warts and athlete’s foot, while the sun’s powerful rays can cause painful sun burns.”

Source: Chris Morrisroe, Farmington Patch [5/22/13

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

Wedges and Platforms Still Not Safe: IL Podiatrist

High heels have been fashionable for—what?—centuries; the stiletto debuted back in the 1950s. Today, spike heels are more popular than ever. Experts warn about less-stable models sold at chain stores for those of us who can't swing the designer version. Podiatrists have been watching this trend with some alarm. "The higher you go, the more changes in your gait pattern and the more stress on your feet, knees, and back," says Marlene Reid, DPM, of the Family Podiatry Center in Naperville, IL. "Potential problems are going to be greater." In fact, she prefers that patients wear shoes with heels under 2.5 inches.

Dr. Marlene Reid

Don't kid yourself that wedges or platforms are a safer bet, Dr. Reid says. They may place your foot at a less-severe angle, but your staccato walk is still putting an unnatural burden of weight on the small, delicate bones of the feet and toes. Her advice: If you must wear towering heels, give your feet a rest and go low the next day.

Source:  Laura Beil, Health.com (ABC News) [5/22/13]

Walk Your Way Up to Marathon Running

The weather is warm and the race is on to get in shape for the season of charity runs and marathons. But if you haven't been training on a regular basis, you've got to walk before you can run, say the experts. "The attrition rate is fantastic because people go out too fast and get injured. Once people get injured, they drop out," says Stephen Weinberg, DPM at Evanston Northwestern Healthcare, Evanston, IL. In fact, you should be running at least two years before you tackle a marathon (26.2 miles), says Dr. Weinberg, who is a marathon runner and has served as medical director for the Chicago Marathon.

Dr. Stephen Weinberg

Concentrate on walking first. Wear the basic running shoes you'd use in a gym. Dr. Weinberg's advice is to take a brisk 15- to 20-minute walk on a regular basis. "From an injury prevention standpoint, you have to start loading your muscular-skeletal system. You want to build up gradually for stress," he says. Once you're comfortable, add jogging to the routine, taking a mile in 10 to 15 minutes. "Take the talk test. Start jogging. If you're breathing so heavily you can't carry on a conversation you're running too fast," says Dr. Weinberg.

Source: Bev Bennett, New York Daily News [5/22/13]

Bahamas Podiatrist Discusses The Effects of Smoking on Feet

Smoking cigarettes has long been known to have detrimental health effects on the body, contributing to problems such as heart disease and cancer. Smoking can also have many lesser known but just as deadly health effects on the feet. "The feet are the farthest part of the body from the heart, and the blood flow to them can be severely decreased by smoking, causing many effects on the skin and bones," says podiatrist Dr. Monique Mitchell.

Dr. Monique Mitchell

"If you are a smoker, you are encouraged to stop smoking, especially if you are planning to undergo foot and ankle surgery. It is worth it to stop smoking to ensure healing and good functioning of your feet," says Mitchell.

Source: The Nassau Guardian [5/21/13]

Over Half of Docs Have Received EHR Incentive Payments

Key federal programs to boost electronic health-record system use passed a milestone last month as more than half of physicians and other “eligible professionals” have received incentive payments for attesting to the adoption of a certified EHR system.

As of April, 191,305 physicians and EPs have received EHR incentive payments from Medicare, while 88,903 have received payments from Medicaid and 11,117 from Medicare Advantage under programs created by the American Recovery and Reinvestment Act of 2009.

Source: Joseph Conn, Modern Healthcare [5/22/13]

Query: Local Anesthesia for Patient with G6PD Deficiency

I would like to get advice on the choice of local anesthesia for a patient who has a G6PD deficiency and requires a nail avulsion.  
 
Svetlana Malinsky, DPM, College Park, MD

RE: Non-Union of the Hallux IPJ
From: Aidan Nguyen, DPM
 
Cases like this exemplify the overuse of surgical innovation while neglecting basics of fusion principles, i.e. thorough joint curettage and dynamic compression. I wouldn’t revise an asymptomatic (non-painful) nonunion, especially at the toe level, although your concern of cortical fracture is valid.

Regarding your surgical query, I would remove the implant, re-prep the fusion site, and use either a 3.5 cortical or 4.0 cannulated screw, compressing the joint from the toe distally. Using a bone graft to maintain length post-revision is worth considering, although it would complicate the compression screw placement process.

Aidan Nguyen, DPM, Yuba City, CA, nguyena2@sutterhealth.org

RE: Fluoroquinolone Toxicity
From: Robert Kornfeld, DPM

I am presently treating both my 8th and 9th patients who are suffering with fluoroquinolone toxicity. Not just in the form of Achilles tendon rupture, but more a systemic toxicity syndrome with resultant severe peripheral neuropathy, pedal tendinitis, CNS, and digestive complications. Working with these patients has led me to the understanding that there are many patients out there with single nucleotide polymorphisms (SNPs). These patients may have a long history of medical problems, many relating to adrenal dysfunction.

The SNPs make them susceptible to methylation disorders, inability to metabolize sulfur-containing foods and medicines, inability to convert ammonia to urea, and many others. These are the high-risk patients who are sitting ducks for this horrible and life-altering toxicity syndrome. Many have died from the effects of these complications. There is a growing (and somewhat large) population of these patients due to the high number of fluoroquinolone prescriptions being written.

I think at this time it is imperative to write for this class of drugs only when a C&S confirms its efficacy and only when it is critical to prescribe such a potent antibiotic. The age of personalized medicine mandates a deeper understanding of our patients' unique physiology. I have been ordering genetic tests and have been both enlightened and amazed at the number of patients with homozygous mutations that explain much of their recurrent or recalcitrant pathology. Please give serious thought to this post. Writing for fluoroquinolones in a cavalier way will surely lead to more medical disasters.

Robert Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com

RE: Staff Makes it Difficult to Get Appointments
From: Michael Robinson, DPM, MPH, JD, Elliot Udell, DPM

It is very easy; your staff doesn't care about your policies or practice needs.  It is time to replace them and get staff who listen and do what you want. This advice is short, not sweet, but it is what you need to do.

Michael Robinson, DPM, MPH, JD, Brookline, MA, drmrob@aol.com

The scenario that you describe makes my "blood boil" because many times I have referred patients and close relatives to specialists for urgent medical care and some front office person answering the phone refused to give the person a timely appointment. I still remember referring a patient to a hematologist for an urgent visit and the patient was told that the earliest appointment was in three months. I met this doctor a few days later in my local hospital and he lamented that his office was very slow and he can't figure out why.
 
The bottom line is that it does not take staff too long to realize that they have a vested interest in keeping a practice slow. It's less work for them. They will have fewer patients to contend with, less paperwork, and they will take home the same pay check irrespective of whether the office is busy or slow. The only way to address the issue long-term is to either monitor every call or offer them some kind of financial incentive that makes it worth their while to book patients.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Diabetic Shoe/Inserts (DME) Wholesale Suppliers (Isa Schwarzberg, DPM)
From: Robert M. Gaynor DPM, CPed

Dia-Foot is a podiatry-owned, full-service diabetic shoe company. Dia-Foot features high quality footwear from New Balance, Aravon, Dunham, Rockport, Hush Puppies, Pure Stride and Orthofeet. Dia-Foot manufactures pre-fab diabetic inserts (A5512), custom diabetic inserts (A5513) and custom orthotics (L3020). In addition Dia-Foot manufactures the Pure Stride line of pre-fab orthotics, comfort insoles, diabetic socks and diabetic shoes. Dia-Foot carries the Ossur line of soft goods and features custom AFOs from Pine Tree Orthopedics.
 
Dia-Foot offers their customers all the proper Medicare documentation needed to pass a Medicare pre-audit. In addition Dia-Foot will assist in helping your practice get the needed documentation from the patient's PCP so your patient can receive their diabetic shoes. We invoice once a month.
 
Robert M. Gaynor DPM, CPed, President and CEO Dia-Foot, NAILCUTTER@aol.com

RE: We Walk in a Tripod Fashion: CA Podiatrist (Neil H Hecht, DPM)
From: Robert D. Phillips, DPM

These snippets from these two doctors shows the importance of knowing the historical literature. Where did the rule of 12s come from that Dr. Hecht speaks about? It comes from Russell L. Jones, “The Human Foot, an experimental study of its mechanics, and the role of its muscles and ligaments in the support of the arch.” Am J. Anat 68: 1-39 (1941)

I hope that Dr. Sung realizes that the first metatarsal importance is the outgrowth of the multitude of articles written by Dr. Dudley Morton in the 1920s and 1930s. The tripod concept is also further expanded in the article by...

Editor's note: Dr Phillips' extended-length letter can be read here.

ASSOCIATE WANTED - CENTRAL/SHORE AREA - TOMS RIVER, NJ

FT/PT Looking for a HIGHLY motivated, organized, ethical associate. EMR/digital 20/20 x-ray/NCV/vascular testing all on premises. Trauma, DM, wound care & large routine & children mix. Must have NJ license. Should be Board Qualified/Certified Potential for future BUY-IN Send CV to toesec@aol.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

 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 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 - 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

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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