June 01, 2006 #2,595 Editor-Barry Block, DPM, JD

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Wedges Increase Chance of Ankle Sprains: PA DPM

Podiatrists warn that even seemingly harmless warm-weather shoes can have some consequences. Flip-flops have no support for the arch and very little structure," says Dr. William Lenz, a podiatrist at the Foot and Ankle Institute in Friendship. Besides being almost impossible to run in, flip-flops lack structure, which requires wearers to use their tendons and muscles to hold them on. This can cause some strained ligaments in the bottom of the foot, Lenz says. Flip-flops also leave the top of the foot vulnerable to sunburn, cuts or clumsy run-ins, he says.

This season's hottest sandal trend -- wedges -- pose unique dangers. "Ankle sprains can be caused by those," Lenz says. "We're not really seeing it quite yet, but we probably will." Although wedges have thicker heels, they still put all of the weight on the ball of the foot and provide no flexibility in the arch, which can cause lower back pain and instability, Lenz says.

In some cases, people have even broken bones by wearing the towering shoes. When people make sudden turns, the wedges don't always follow. "The sudden twisting motion can pull loose part of the bone at the (fifth) metatarsal," a bone that runs on the outside of the foot from mid-sole to the base of the small toe, Lenz says.

Source: Rochelle Hentges, Pittsburgh Tribune-Review [5/31/06]

Army DPM Meets NFL Stars

A group of NFL stars past and present visited Landstuhl Regional Medical Center on Sunday after attending the NFL Europe’s World Bowl XIV in Dusseldorf on Saturday. NFL Commissioner Paul Tagliabue, along with NY Giants Michael Strahan and Philadelphia Eagles safety Brian Dawkins.

The group visited patients in the intensive care unit and signed autographs for fans at the hospital’s dining facility. Lt. Col. Michael Neary, a podiatrist at the hospital, brought his family to see the players and wore an Eagles button-down shirt. He got the chance to talk to his favorite team’s free safety, Dawkins.

Source: Scott Schonauer, Stars and Stripes [5/29/06]

Health Information Technology Bill Moves Closer to Passage

Before adjourning for its Memorial Day recess, the House Ways and Means Health Subcommittee — by an 8-to-5 party-line vote — approved the Health Information Technology Promotion Act of 2006. H.R. 4157 was approved after subcommittee Democrats criticized many provisions.

These included the bill's creation of safe harbors under anti-kickback and physician self-referral laws to allow hospitals and other healthcare providers to help physicians adopt new technology by providing them the necessary equipment, and its lack of a deadline for the adoption of health IT. The bill now needs only the consent of the full Ways and Means Committee before a vote can take place in the House, where it is expected to pass. The Senate passed a similar bill in November

Source: Today in E-Health Business [5/30/06]

Query: MPJ Pain While Squatting

I have a patient in his 40's who works as a plumber and is constantly in a squatting position. He has a painful 1st MPJ, which is worse on dorsi-flexion of the digit. Radiographs reveal small osteophytic production to the head of the first met and base of the phalanx. There is hypermobility of the first ray as well Surgery is not currently an option.

I am unsure of whether to try a Morton’s extension versus first ray cut-out with forefoot posting. I am also unsure an orthotic device would help at all as the pain is not on ambulation, but more when he is in the squatting position. Any thoughts?

Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

RE: Familial Keratoderma (Al Musella, DPM)
From: Dennis Shavelson, DPM

As closed-chain specialists, podiatry can offer biomechanical compensation of these kinds of congenital callosities. Since they grow in areas of pressure and shear, the same way this patient should wear gloves to prevent callus on his hands when riding a bike, every DPM can fabricate weight-balancing orthotics to reduce the underlying pressure in specific areas from inciting callus growth.

In Dr. Musella's case, the callus pattern and look of the feet pictured suggest a functional foot type 3, rigid rearfoot, flexible forefoot and a semi-rigid foot orthotic, cast corrected and posted foot type specific would be the gold standard for biomechanical control of the foot type and reduction in callus formation.

Dennis Shavelson, DPM, medical director FootHelpers Lab,
drsha@footworldusa.com

RE: Competitive Acquisition Program for DME
From: Lloyd Smith, DPM

The issue with DME is not quality, but cost. As APMA recently summarized, Medicare is about to implement a competitive acquisition program of its own that might prevent most of us from dispensing DME in our offices (diabetic shoes excepted). The revised program proposals are being challenged by APMA, AMA and others but the mandate is there to change the program and something less costly is going to happen.

Healthcare as a business is being challenged daily with these issues. Economic credentialing is showing up daily. Medicare fees - no increases are likely for many years to come. Certification for MRIs are trying to reduce imaging costs. Drugs - pre-authorizations for virtually all non-generic drugs is close to a reality.

Our economy simply will not allow health care to be delivered without supervision and scrutiny. Get used to it - it is not about to go away.

Lloyd Smith, DPM, Newton Center, MA, lloydpod@yahoo.com

ASSOCIATE WANTED - NEW YORK

Associate Wanted - Rockland County, Rockland County. Associate with minimum 5 years experience, high volume established general practice. Reply with CV to nypodiatry111@aim.com

ASSOCIATE WANTED - MINNESOTA – MINNEAPOLIS SUBURB

Busy, well-established, full-scope podiatry practice, seeking highly motivated podiatrist for a full-time position with buy-in opportunity. Looking for PSR 24/36 trained individual, to help increase surgical volume. Excellent opportunity for long-term growth with unlimited income potential. E-mail CV to employment@associatedpodiatrists.com or fax to (612) 866-5875 Attn. Jennifer.

1st YEAR RESIDENT SLOT AVAILABLE - CALIFORNIA

Sherman Oaks Hospital, in Sherman Oaks CA, has a (PM&S-24 I 1st. year) program available, beginning 7/1/06. Our program offers the Residents a wide variety of cases from ankle fractures, subtalar joint, fusions, & tendon transfers as well as all other podiatric forefoot & rearfoot cases, with very impressive procedure activity numbers at a "C" level. The Residents meet & exceed the requirements for surgical case loads, usually by the first 6 months. Residents will also see an average of 250 to 300 wound patients per month.

The stipend for the 1st year Resident is Thirty Thousand dollars ($30,000) and 2nd year Resident; Thirty- Four Thousand dollars ($34,000). For more information please call Dr. Boghossian at (818) 905-2222 or e-mail him at gbogi@sbcglobal.net

PRACTICE FOR SALE – ARKANSAS

Thriving Ozark Mountains practice in prime retirement area seeks to sell on long term note. Two locations: Mountain Home and satellite office in Harrison, Arkansas, both with established patient base with full range of services and nursing homes available. Hospital privileges. Wonderful Staff. Fully equipped. Priced to sell. (870) 425-1466 orchristinag@centurytel.net

POSITION WANTED - NEW YORK

Non surgical podiatrist with 20 years experience is seeking practice opportunity 1-2 days/wk. ABPOPPM board certified, own malpractice insurance, many insurance plans. Please call (516) 557-6862 or e-mail Joelme@aol.com.

ASSOCIATE POSITION- NEW ENGLAND

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

EQUIPMENT FOR SALE - ESWT

If you are using or thinking of using ESWT, I have a new machine that has only been used twice. There is no Orbasone in the country priced like this one. Will provide training and installation. Take a look at http://www.orbasone.com Call 1-856-229-2939.

POSITON AVAILABLE - WASHINGTON, DC

The George Washington University Medical Faculty Associates, a large multi-specialty practice affiliated with a teaching hospital, is seeking a full-time podiatrist. The practice has a diverse population encompassing inpatient and outpatient surgery, as well as a thriving outpatient clinical practice. Must be board certified/board eligible and have experience in diabetic limb salvage. Send CV to cdugan@mfa.gwu.edu or fax to (202) 741-2241.

ASSOCIATE POSITION RICHMOND, VIRGINIA AREA

Partnership possible after two years. Two office practice. Palliation; biomechanics/orthotics; woundcare; office/hospital surgery. Must have Virginia license. Associate will do most of the practice’s surgery. PSR24/36/Board qualified/certified in surgery preferred. Available SAP. Send CV to: Dr. Marc Jay Pinsky; 9550 Midlothian Turnpike; Suite 104; Richmond, VA 23235; mjpinsky@juno.com.; FAX: 804-320-6627.

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