The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

June 02, 2007 #2,951 Editor-Barry Block, DPM, JD

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Patients With Diabetes Need Special Care and Daily Inspection: NY Podiatrist

People with diabetes also should inspect their feet daily and take steps to avoid foot dryness and cracking, swelling, burns (sunburns or campfire/radiator burns), blisters and puncture wounds, says Dr. Mark Durkin, podiatrist at Finger Lakes Podiatry in Lakeville, Livingston County.

Dr. Mark Durkin

He recommends washing feet daily with a mild soap, patting them dry gently but thoroughly (including between the toes) with a towel. Use a general moisturizing cream such as Eucerin or Vaseline Intensive Care lotion twice a day, he adds. For serious cracking, which can let bacteria enter, Bag Balm can help. If you don't see improvement, see a physician for a prescription urea-based cream, Durkin advises.

Durkin says people with diabetes who want a pedicure should ask questions about the training of the provider and be sure the equipment is sterilized. He and other podiatrists prefer that people with diabetes see specialists for toenail cutting or to address foot problems such as an ingrown toenail or athlete's foot. Otherwise, those initially small problems can get out of control.

Source: Chris Swingle , Rochester Democrat and Chronicle [5/30/07]

CA Podiatrist Ordered to Stand Trial for Child Molestation

A retired Nicasio podiatrist told investigators that he inappropriately touched a young boy and wanted to be caught, a sheriff's detective testified Wednesday. Alan Lawrence Ager, 59, was ordered to stand trial on three sexual molestation counts after a preliminary hearing in Marin Superior Court.

Dr. Alan Lawrence Ager

According to testimony from sheriff's detective Lisa Chapman, Ager inappropriately touched a boy on at least 30 occasions between October 2005 and December 2006. The boy was five when the molestations began, Chapman said. Ager, who owns a prominent hillside home overlooking the San Geronimo Golf Course, has six prior convictions, five for cultivating marijuana.

In court Wednesday, Chapman said the sheriff's office was notified by the mother of a 7-year-old boy of a molestation in a home on Ager's property on Christmas Day 2006. The mother of the boy said she walked into the child's bedroom and saw him with his pants down and Ager beside him. Chapman said Ager appeared startled and nervous and the boy jumped up and ran into the bathroom. The woman said Ager admitted to her that he touched her son and apologized, Chapman said, adding that he urged her not to file a police report.

Source: Nancy Isles Nation, Marin Independent [5/31/07]

Senior Medicare Patrols Report Modest Success in Fraud Recoupment

Senior Medicare Patrol Projects — now in their 10th year of operation — reported more than $110,000 in recoupments to Medicare and almost $590,000 in savings to beneficiaries in 2006, a May 3 HHS Office of Inspector General (OIG) report says. The projects "recruit retired professionals to serve as educators and resources in assisting beneficiaries to detect and report fraud, waste and abuse" in Medicare, OIG explains. In 2006, the projects educated more than 400,000 beneficiaries. The projects received 11,830 complaints as a result of the training, and 4,123 of those complaints were referred to contractors for follow-up.

The patrol projects started in 1997 and have resulted in more than $4.2 million in savings to Medicare, according to OIG. They have educated about 2.9 million beneficiaries, resulting in more than 86,000 complaints. Action was taken in 14,600 of those cases, OIG says.

Since 2001, CMS has had a tracking system for complaints initiated by the patrol projects. Contractors are required to submit semiannual reports to the project director in their state. According to OIG, "in 2006, 17 of the 65 projects submitted a total of 36 forms of documentation. Sixteen of the 17 projects submitted at least one tracking system report. Fifteen of the tracking reports documented actual savings to the Medicare program."

Source: Report on Medicare Compliance [5/28/07]

Query: Titles After Author’s Name in a Research Paper

I recently received my copy of "The Foot" which is a British-based journal. I noticed that when they list the authors of any paper, they do not have the author's degrees listed after his or her name. This practice is common in European journals. One of the advantages of the European approach is that it prevents a reader from being biased against the point of view or even facts presented in a paper because of potential prejudices that the reader might harbor toward certain degrees.

I get tremendous pleasure when I see an article on the lower extremity written by a fellow DPM rather than an MD. This is especially true if the paper is in a non-podiatric journal. By not seeing any credentials, I would be protected from my own bias. Should we push for the eliminations of titles in American professional journals?

Elliot Udell, DPM, Hicksville, NY

Query: Serial Performance of Flexor Release

The doctor performed a flexor release on the 5th digit left foot, and decided 5 days later to perform another flexor release 5th digit right foot. What would be the correct codes and modifier to use?

Lisa Maynard, New York, NY

Response: Two possible choices for coding the procedure would be CPT 28010, if the tenotomy is done percutaneously, or CPT 28230, if an open tenotomy is performed, You will need to add a "-79" modifier when performing the second surgery.

I would clearly document why the procedures were performed five day apart. If this is a common pattern, it could trigger an audit. Typically, these minor procedures are performed on the same day, one surgical session...so there will only be one facility/tray fee, and the second procedure is reduced.

Tony Poggio, DPM , Alameda, CA

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RE: Women's 12 ½ Narrow Shoes (Bonnie Tatar, DPM)
From: Itamar Rosenbaum, C.Ped, Mel Cheskin MBS.,C.Ped

There are a few companies who make such shoes. Aetrex makes the Essence Line which comes in Narrow. SAS as well as New Balance make narrows. You can reach Aetrex at 800-526-2739, SAS at 877-782-7463 and New Balance at 800-253-7463. Custom shoes are also an option.

Itamar Rosenbaum, C.Ped., NY, NY, nycped@verizon.net

Otabo www.otabo.com in Florida (954) 971-9900 are now making custom fitting dress shoes for women. They can custom make any size in an elegant dress shoe.

I'd try a men's 11 or 10.5 AA New Balance for the athletic. 12.5 Women's is a difficult size to find - especially in narrow. Most athletic brands will only make up to a 12 in women's. If your patient is a Quadruple narrow, custom made is probably the best choice. Eneslow in NY City can custom make athletic as well as dress shoes.

Mel Cheskin MBS.,C.Ped, Boca Raton, FL, Melcheskin@aol.com

RE: No Evidence of Flip-Flop Danger (Joel Lang, DPM)
From: Barry Mullen, DPM

I appreciate Dr. Lang's flip flop/plantar fasciitis comments with specific respect for his desire to avoid healthcare professionals harboring assumptions without evidence-based medical findings (validated through the medical literature) to support those claims. While plantar fasciitis does, in fact, occur from a multitude of etiologies, bio-mechanical issues represent the most widely accepted theory in podiatric medicine; the one, I believe, responsible for the majority of cases...at least in my 25 years of anecdotal experience. This anecdotal experience seems to be supported by the evidence-based teachings of Dr.'s Root and Weed as well as other notable and respected podiatric bio-mechanical "experts" who have commented on this topic.

That said, without having statistics to bear the burden of proof, I'm confident in assuring Dr. Lang, and my colleagues, that unequivocally, the largest percentage of new patient visits our practice sees suffering with acute plantar fasciitis, as well as the largest percentage of acute plantar fasciitis exacerbations in patients with a known previous history, occurs towards the latter part of the summer. Is it pure coincidence that this time frame also coincides with the largest percentage of prolonged flip flop and sandal wear? Is it mere coincidence that a vast majority of mechanically induced plantar fasciitis sufferers often spend large amounts of time walking barefooted, especially in their home environment? Is it also pure coincidence that mechanically induced plantar fasciitis sufferers who return to good supportive foot wear, and in some cases functional foot orthotics, experience symptom resolution, to the tune of approximately 90%?

Lastly, I don't feel our profession is demeaned in any way when we recommend certain types of foot wear that we think will benefit our patients; the corollary is also true in that certain shoes may be responsible for the formation of certain pedal symptoms. That (shoe advice), in part, is one of the services good podiatric clinicians should offer to their patients.

Barry Mullen, DPM, Hackettstown, NJ, YAZY630@aol.com

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