The Voice of Podiatrists

Serving Over 10,900 Podiatrists Daily

May 26, 2008 #3,255 Editor-Barry Block, DPM, JD

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FL Podiatrist Injects Sculptra to Treat Heel Pain

Women who refuse to give up their favorite high-heeled shoes are turning to a Miami podiatrist for relief. Dr. Cynthia Marzouka-Lousito said some of the pain comes from the loss of fat in the ball of the foot. "What happens is when you lose the fat, you're walking on the bones. And imagine your whole body weight on your foot, along with gravity," said Marzouka-Lousito.

Dr. Cynthia Marzouka-Lousito

At Protech Sports Medicine in Miami, Marzouka-Lousito offers patients a potential solution by injecting a synthetic compound called Sculptra into the foot. "You recover immediately," said Marzouka-Lousito. "We inject you today, you walk out with a plump foot immediately."

Sculptra was approved by the Food and Drug Administration as a facial filler for patients with human immunodeficiency virus (HIV), but some doctors have used it off-label for other purposes. Marzouka-Lousito said a treatment typically lasts eight months to a year. The procedure costs about $1,000 per foot.

Source: Clickondetroit.com [5/22/08]

Foot Health Becoming More Important to the Public: UK Podiatrist

This month is World Foot Health Awareness Month, and South Tynesiders are being urged to take a fresh look at the state of their feet. Dean Glozier, podiatrist at the Westoe Practice, thinks that foot health is an issue which is becoming increasingly important to the public. He said: "During the past 10 years or so, more and more people have started considering the health of their feet.

Dean Glozier, UK podiatrist

"I think this is linked to a general improvement in the way people are looking after themselves and the fact that we are now willing to invest more time and money into our health."But despite this, few of us are aware that our feet can give vital clues to the state of our overall health, and that more serious problems can sometimes be avoided by taking preventative measures earlier on.

"I specialise in biomechanics, a process which looks at how foot alignment can affect the rest of the body," Mr Glozier adds. "It is often the case that people who are referred to us with neck and lower back pain have problems because of the way they are walking.

Source: Kim Carmichael, The Shields Gazette [5/22/08]

CMS Sticks to National Provider Identifier Deadline

The CMS is going forward with implementing a long-delayed federal requirement that electronic claims, including those of Medicare, be submitted using the National Provider Identifier, beginning today. The CMS is claiming both it and the nation are ready as it brushed aside recent requests by healthcare organizations to postpone by six more months the effective deadline for compliance, which was originally specified by the Health Insurance Portability and Accountability Act of 1996.

Regarding the transition to the NPI, Steve Speil, senior vice president of health finance and policy for the Federation of American Hospitals, declared its for-profit hospital members, “ready, willing and able” to comply. But George Arges, senior director of the health data-management group at the American Hospital Association, said, “A lot of institutional providers have done the work, but there is still a fairly high percentage, more than I would like to see, who aren’t ready,” Arges said.

Source: Joseph Conn, Modern Healthcare [5/23/08]

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RE: Injectible Silicon (Louis W. Nordeen, DPM)
From: Ira Meyers, DPM

Although I haven't tried it, GraftJacket is promoting its use for soft tissue augmentation. If you go to their website, you can get more info. This looks promising.

Ira Meyers, DPM, Huntingdon Valley, PA, idmrun@aol.com

RE: Chronic Ankle Sprain (David T. Taylor, DPM)
From: Jon Strong, DPM, E. Farr, DPM

It looks like the pain is due to heterotopic bone formation in the syndesmosis. If the CT scan shows no diastasis, consider stress x-ray. Pain will usually improve with resection of synostosis and interposition of fat and tight rope fixation
.
Jon Strong ,DPM, Jefferson City, MO, jwstrong2002@yahoo.com

It is hard to see from the reprint of the x-ray, but it appears that there is a break in the anterior portion of the plantar aspect of the calcaneus. Is it a fracture? I also note that the calcaneal angle of inclination is low. These factors may be placing stress on the ankle joint.

E. Farr, DPM, Gloversville, NY, ececropia@yahoo.com

RE: MD/DPM Debate Video
From: Leonard A. Levy, DPM, MPH, Amram Dahukey, DPM

This Sunday the first DPM to complete our accelerated American Osteopathic Association approved program will be graduating from NSU-COM. This DO degree program is designed for those DPMs who wish to obtain added value to their current podiatric medical practice rather than for those who intend to engage in another field not related to podiatric medicine.

Leonard A. Levy, DPM, MPH, Nova Southeastern University College of Osteopathic Medicine, Levyleon@nova.edu

I watched the debate on the webcast and was delighted to see that Dr. Block is in the forefront of change to MD degree. I believe that the reason we see no change is because if we do so, there may not be a need for APMA but for specialty organizations. There is always the claim that we are different and need to keep our identity. I do not agree with it, rather that we distinguish ourselves with our practice. Dr. Block mentioned parity over all areas of the world and I wholly agree. If I had an MD degree, I would have no problem with practicing or consulting in my hometown Jerusalem.

Amram Dahukey, DPM, Tucson, AZ, drd@premiersurgeons.com

Editor’s comment: Regardless of degree (and podiatry has had many) there will always be a need for APMA. It is likely that eventually APMA could become a component of AMA or AOA, much as other medical sub-specialty organizations have. To view the debate video click here.

RE: Conflicts of Interest
From: Multiple Respondents

It has always amazed me that medical professionals can go through their entire careers without ever receiving a minute's worth of formal instruction on ethics. Podiatry is by no means alone in this, of course. Ethical training for medical students is non-existent. It is my understanding that not one of the 432 graduating podiatry students this year will have received a single minute of instruction in ethics. I would imagine that the same is true for M.D.s and D.O.s

Residency training is no better. Although CPME 320 includes a "Professionalism Competency," I also understand that none of the residency programs accredited by the Council actually has any formal training on the subject in its curriculum. Nor is there any mechanism in the CPME documents for measuring that "Competency."

There is no ethics training requirement in continuing medical education. CPME 720, which governs accreditation for CME programs, similarly has no requirement for any ethics or professionalism content. So, why are you surprised that your colleagues have problems recognizing and dealing with conflicts of interest? A sense of ethics is not intuitive. It must be acquired through education and experience. Paid speakers at CME conferences is surely a problem. But it is just the tip of the iceberg. Medicine has not yet even begun to deal with the ethical problems inherent in the delivery of patient care for compensation.

Just by way of example, Is it ethical to refer a patient for surgery to a surgery center in which you have a financial interest? I can make a good argument that it isn't. Are non-compete agreements in associate physician contracts ethical? I can make a compelling argument that they are not. It may be time for medicine to start thinking seriously about the ethics of its profession.

Richard W. Boone, Sr, Health Care Attorney, Fairfax, VA, RWBoone@aol.com

Corporate donations have had an insidious and negative impact on all of medicine, not just podiatry. The idea that educational programs would cease to exist without corporate largess is patent nonsense. There are many studies showing the adverse effects on appropriate prescribing among doctors attending corporate sponsored lectures and accepting and using their free samples. Nofreelunch.org has documented the problems well. 95% of doctors claim they are not adversely affected by these pitches but studies routinely show that almost all of us are. I am not aware of studies showing the reverse which is why the companies are so eager to lavish us with gifts.

25 years ago conference lectures were less supported and talks were of much higher quality. If a product were discussed, it was reviewed by physicians who had tried all or most of the competitors' products and the talks functioned as a consumer reports discussion of sorts. Today, an advocate of one product will speak when much of the time they have hardly even used the competitor's product. They are paid to lavish praise. There is good reason why the media has heaped scorn on those accepting these gifts. That level of scrutiny will likely intensify.

The ethics are dubious at best. Why don't we stay ahead of the curve and do the right thing. Stop taking this tainted money. In a profession, where the average pay is in the low six figures, there are few who can't afford an extra $100 to attend educational conferences and buy their own lunches and dinners.

Alan Kalker, DPM, Middleton, WI, ajkalker@facstaff.wisc.edu

Editor’s Note: Dr. Kesselman’s extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=19768&start=1

EQUIPMENT FOR SALE

Relocating satellite office and selling redundant equipment, all less than 2 years old. Koven Smartdop45 - $2995 Scan X Digital X-ray - $17995.00 SIUI CTS 5500 Diagnostic Ultrasound and cart with printer - $4695 Chattanooga Therapeutic Ultrasound - $495. Please call Priscilla at 281.313.0090 if interested.

ASSOCIATE POSITION - PITTSBURGH, PA

Excellent opportunity to join busy and established practice for 27 years. Must be graduate of PSR 24+/36 Residency. Terms negotiable. 30-40 hours per week. $100,000+ guaranteed. Please fax resume to (412) 563-0740.

EQUIPMENT FOR SALE - POLAROID X-RAY FILM

Polaroid 803 x-ray film for x-rays - 41/2 boxes, 2 Cassette holders,
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PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

ASSOCIATE POSITION - SAN ANTONIO, TEXAS

Seeking three-year trained resident for associateship, hopefully leading to partnership. Competent in all phases of podiatry particularly reconstructive rearfoot surgery. Outstanding opportunity for the right individual. Reply to Richard Pollak at 210-692-0279, or fax resume to 210-692-0028 or e-mail drpllk@hotmail.com

SOUTH CENTRAL PENNSYLVANIA-PM&S 36 ASSOCIATE WANTED

Large, busy podiatry group looking for associate interested in future partnership. Practice facilities and technologies include: Surgical Center, Physical Therapy Department, 6 appointment locations, EMR, MRI, Clinical Trials and Digital X-ray. Full compensation and benefit package offered. Mail CV to Martin Foot and Ankle, 1203 S. Queen St. York, PA 17403 or email johnreitzelmfa@aol.com

ASSOCIATE POSITION: BALTIMORE, MARYLAND

Seeking motivated and outgoing individual for part-time position in very comfortable office with a great working atmosphere. Office is turn-key with ASC in a fantastic location. Must be ABPS eligible. competitive salary + incentive and part-time benefits are available. CV to 410-602-9781.

ASSOCIATE POSITION – LEHIGH VALLEY, PA

Large medical/surgical practice centered in Lehigh Valley, PA looking for exceptionally trained podiatrist. Excellent opportunity for income as well as potential partnership. E-mail resume to jkaufman@lvfoot.com

INTERNET FOOT THEMED CANDY BUSINESS FOR SALE

Well-known foot-themed chocolate and candy company with over 6,000 customers. Unique products with trademarked names for seasonal (Mistle Toes, Valentoes, etc.) as well as everyday (A Foot of Feet, Twinkle Toes, etc.). Excellent opportunity to generate income from home with an established business. Serious inquiries to Mwolpa@ToeFood.com

ASSOCIATE POSITION – NW INDIANA (1 HR FROM CHICAGO)

Great opportunity for financial and personal success. Start at $150K plus incentive compensation, good benefits, and ownership potential. Must be highly motivated, have a great bedside manner and excellent surgical skills (forefoot and rearfoot). E-mail resume to friendlyfootcare@comcast.net or fax resume to (219)662-7290. Learn about us here

ASSOCIATE POSITION - ILLINOIS

Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings available. If interested fax curriculum vitae to 312 225-9366 or e-mail feetwork@aol.com

PRACTICE FOR SALE - FLORIDA

Well-known practice in Coral Gables,FL for over 20 years. Excellent location on Coral Way with heavy traffic, great visibility and plenty of parking. Busy, fully equipped, full-time office with established patients. Grossing over 300K with tremendous growth potential. Office is currently open and ready to take over immediately. For additional information contact QVAN@aol.com or 305-975-5516.

SEEKING RESIDENT FOR PSR-24 - BALTIMORE, MD (MERCY MC)

Position for a highly motivated individual with completed non-surgical residency or one desiring additional surgical training in well-established Podiatric Residency Program. Busy metropolitan hospital with high surgical numbers and inpatient care. Resident is integral member of multidisciplinary team. Begins mid June 2008. Includes competitive salary/benefits. Send inquiries to rsher18@yahoo.com

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