The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

May 26, 2007 #2,946 Editor-Barry Block, DPM, JD

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Summer Means Increase in Warm Weather Foot Injuries: CO Podiatrist

Dr. John McGarry, a Denver podiatrist, says warm weather means dangers are afoot.

Dr. John McGarry

"Usually three things happen. You start to get more active, which can predispose you to overuse kind of injuries," says McGarry, past president of the American Board of Podiatric Surgery. "The footgear changes and tends not to have as good support; you wear more sandals and flip-flops that can cause straining and problems with the feet. And we see a lot more foreign-body injuries - people step on stuff in the summertime."

Source: Lisa Ryckman, Rocky Mountain News [5/24/07]

When it Comes to Preventing Amputation in Diabetics, SITE, Not SIZE, Matters

Researchers at Scholl College’s Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University of Medicine and Science, Leiden University in the Netherlands , and Texas A&M University have presented important new information that could help physicians and their patients predict dangerous recurrent wounds that precede amputations in persons with diabetes. The study, conducted over a several-year period, identified two simple items that helped predict recurrence.

Dr. David Armstrong

“The study was surprising and promising in that, out of a whole lot of data, some simple truths emerged,” noted David G. Armstrong, DPM, PhD, Professor of Surgery at Scholl College and a principal investigator on the study. “The location of the ulcer (under the big toe) and the presence of poor blood flow were the key factors that dramatically increased the risk for recurrent wounds in these patients, thereby increasing their risk for gangrene and amputation. These findings could go a long way to help us predict and prevent the unnecessarily high rate of complications in persons with diabetes, worldwide.”

The findings are published ahead of print in the May 17th online edition of the journal Diabetes Care.

Pre-emptive Surgery in Diabetics Can Prevent Amputations: Frykberg

Diabetics who often face the risk of losing their limbs could prevent it by opting for a minor surgery for correction of foot deformities, according to leading podiatric surgeon, Dr. Robert Frykberg. "Damages to nerves and blood vessels of the legs are the main causes for amputation in diabetics", he said.

Dr. Robert Frykberg

"Neuropathy (nerve damage) is a more common cause of foot problems. This causes loss of sensation and disturbs the normal architecture and shape of the foot, hence exposing areas of the foot to high pressure during walking, thus causing ulcers which could lead to amputation", Frykberg said.

"Since these patients lose sensation in the foot, they often continued walking, leading to worsening of the damaged foot. This leads to limbs getting slightly deformed adding to the pressure on the foot, leading to ulcers. But the surgery can help correct the deformity and subsequently the chances of developing an ulcer", Frykberg said.

Source: The Hindu [5/24/07]

Query: Post Arthroscope Abscess

I have a very interesting case of a recurrent, now copious, extra-capsular abscess deep to an ankle arthroscope portal site. The aspirate was sterile for the first two I&D's, and was negative on a Gram stain. I’m awaiting cultures for fungal, e.g., w/ PAS staining, AFB (w/ staining), aerobic & anaerobic & Wright's stain.

Yesterday, I obtained 6 cc.'s of a shimmering heterogeneous olive-lime green, milky, aviscous (non-gelatinous), cloudy, minimally serous mixed-type, pseudo-encapsulated, non-odorous aspirate over the muscle belly of EDB. No micro-organisms were seen on the Gram stain. Does anyone have any thoughts?

Will Godfrey, DPM, Fort Polk, LA

Query: Posterior Heel Spur Coding

I performed a posterior calcaneal spur resection where the Achilles tendon was partially detached, and reattached using an anchor. Can the code, CPT 27650 (repair, primary, open or percutaneous, ruptured Achilles tendon) be billed in addition to the bone resection?

Charles Perry, DPM , Cambridge, OH

Response: The primary surgery was the removal of posterior calcaneal spur which can be billed using CPT 28120 (partial excision, calcaneus) or CPT 28118 (ostectomy, calcaneus). The partial freeing of the Achilles tendon to expose the posterior calcaneal spur would not be separately billed.

Howard Zlotoff, DPM, Camp Hill, PA

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RE: Orders for Nursing Homes (Tony Poggio, DPM)
From: Robert A. Iannacone, DPM, Gary Bjarnason, DPM

Is it possible to get a clarification of Dr. Poggio's response to Dr. Smith's question? From Dr. Poggio's response, it seems to read that he is saying that a standing order is not acceptable, but that a written order by the PCP for routine care is acceptable within one admission without having it written every time the podiatrist is to visit the patient for routine care. It is this kind of confusion in regard to Medicare's coverage of nursing home patients that led me to resign from any nursing home facilities which I was once providing care.

I believe that the local carrier in Florida, Blue Cross Blue Shield of Florida, requires an order for the podiatric consult and the reason why each time a patient is seen by the podiatrist for routine foot care. I have not cared for nursing home patients for about three years now, so if I am wrong, please correct me.

Before seeing patients in a nursing home, make sure you know not only what the Medicare guidelines are nationally, but you local carrier's interpretation of that policy as well.

Robert A. Iannacone, DPM, Port St. Lucie, FL, Recsculler@aol.com

I believe that each Medicare carrier may interpret this differently. In NC, I must get a new order every time I see the patient for routine footcare. If I am following them for something, such as an ulcer, the order is good until that diagnosis has resolved. My advice is to contact your local carrier and ask them directly.

Gary Bjarnason, DPM, Roanoke Rapids, NC, pedalpod@charter.net

ASSOCIATE PODIATRIC SURGEON – TEXAS

We are looking for an exceptionally trained podiatric surgeon to work in the Houston, Texas area. Candidates seeking this opportunity need to be dynamic, people friendly, and have current licensure in Texas . Future licensure in Arizona will be required. Exceptional opportunity, with attractive benefits, and excellent starting salary. The successful candidate will find a rare opportunity to integrate into a specialized lower extremity practice with emphasis on peripheral nerve surgery, endoscopic and arthroscopic surgery, and other special surgery of the foot and ankle. Please submit a cover letter with current curriculum vitae via email to: Slb99@pdq.net Stephen L. Barrett, D.P.M., MBA

ASSOCIATE POSITION – SOUTHERN KENTUCKY

Southern Kentucky's largest and most respected foot and ankle group is looking for an associate to start in July 07. An amazing opportunity to grow with an established four provider practice on beautiful Lake Cumberland, Kentucky. Very competitive salary/bonus with a buy in opportunity will be offered. Established satellite offices will make for immediate patient base ready to be nourished and grown by a friendly, well-trained associate. Excellent benefit package. Lexington, KK is 1.5 hours North while Nashville, Tennessee is 2.5 hours South. Please fax CV to 606-679-4626.

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

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

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 – MISSOURI

One of our longterm associates needs to relocate due to family reasons. Step immediately into full schedule. Partnership available after 2 years and board certification. Missouridpm@yahoo.com

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.

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

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) 796-3709, 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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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.

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