June 10, 2006 #2,602 Editor-Barry Block, DPM, JD

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Summer Shoes With “APMA Seal of Acceptance” Better Than Flip-Flops

You know what the ol' adage says: "If the shoe fits, wear it." Some, though, say that's not entirely accurate, especially when it comes to summer shoes like flip-flops. "I'm a big 'no flip-flop' person," says podiatrist Florida Dr. Douglas H. Cohen. And the American Podiatric Medical Association said in a recent release that flip-flops lack arch support, shock absorption and foot protection. "Tendonitis, arch pain and sprained ankles are just some of the problems flip-flops can cause. They can also make existing problems worse," Dr. David Schofield, president of the APMA, said in the release.

Flip-flops offer no support for the foot's arch, Cohen says. Also, they can cause heel spurs, hammertoes, bunions and ganglionic cysts. But Birkenstocks, the ever-so-earthy slip-ons college students shuffle around in, are the best summer shoes, Cohen says. They have a cork insole that molds to their wearer's foot, providing support as the wearer walks. The doctor advises Birkenstock owners to break the shoes in for a couple of weeks before wearing them full-time: Wear them an hour a day for the first week, then up to four hours a day the second week, he says. Also, some of Birkenstock's shoes are made of rubber, which is ideal for those summer afternoon rain showers, Cohen says.

The APMA suggests summer shoes by Crocs, Chaco, Dansko, and Rockport, all of which bear the association's Seal of Acceptance.

Source: Tiffany St. Martin, Herald Today, [6/8/06]

Patient Alleged That Foot Condition Worsened After Surgery (FL)

Facts: On Oct. 18, 2000, plaintiff Mary Smith, 45, disabled from a back injury, went to defendant to discuss foot pain. Defendant recommended surgery, which included the removal of a bunion and the insertion of pins among other procedures. After the surgery Smith suffered from a number of problems,

Smith sued for medical malpractice. She claimed that the surgery was unnecessary and that she required two more surgeries to fix the damage the first one caused. Plaintiff counsel argued that defendant didn't complete the original examination and rushed Smith into unnecessary foot surgery; that it was poorly performed; that follow-up care was inadequate. Her attorney contended that her medical records were missing important items that a podiatrist should have noted. Smith also claimed that Defendant never discussed any alternative treatments or warned of any possible dangers of surgery.

The plaintiff's podiatry expert, Jack Gorman, testified that surgery wasn't appropriate and that there were more appropriate medical alternatives available. Defense counsel claimed that Defendant, like most physicians, didn't note every single rudimentary aspect of an exam because it would be a waste of time. Defendant claimed that in Smith's case, surgery was absolutely necessary. His podiatry expert, Michael Downey, testified that Smith had a number of foot problems and if they were treated without surgery, they would have just come back. According to defense counsel, even Gorman eventually testified that part of the surgery, the removal of a bunion, was necessary. Defense counsel contended that Smith had been warned of possible problems that might arise from surgery. Defense counsel claimed that Smith had signed a consent form, which stated she was told of possible alternative treatments and risks, after her initial visit, but that it had been lost.

Defense counsel brought into evidence a second consent form that Smith signed before the operation, also stating that she had been informed of alternatives and risks. According to defense counsel, Smith admitted to having a bad memory during cross-examination.

Injury: Smith claimed that following the surgery she had far worse foot problems than she had before. She claimed that afterwards, she suffered from delayed healing and needed more surgeries. A few months after the surgery a piece of bone in Smith's toe chipped off and one of the pins that was inserted, moved into a joint. Due to these problems, Smith claimed that she required two more surgeries, one to fix the bone chip and to remove the pins and another to repair the foot.

Defense counsel contended that the delayed healing was a normal risk. Both Gorman and Downey agreed that it was an inherent risk in any surgery. Defense counsel also contended that the bone chip and pin movement were largely Smith's fault. Downey testified that X-ray records showed that the bone chip happened suddenly and directly after Smith had stubbed her foot. Defense counsel also noted that in reports Smith admitted to exercising against doctor's orders. Downey testified that this exercise could have caused the delayed healing and other foot aggravations. Defense counsel contended that the surgery to remove the pins was one that Defendant planned to do himself and that the third surgery was unnecessary. Downey testified that by the time Smith had the third surgery, her foot was completely healed and the surgery was unnecessary.

Plaintiff’s Expert Witness: Jack Gorman, D.P.M.; Warminster, PA
Defendant’s Expert Witness: Michael Downey DPM, Moorestown, NJ

Result: The jury rendered a defense verdict.

Source: Verdict Search

Query: Going Bare

With the cost of malpractice soaring over the past few years, I wonder how many podiatrists have gone bare. I realize every state's statutes for this are different. Here in Florida, all you need to do is state that you will pay any judgment in a fair and reasonable timeframe within the guidelines of the Florida statutes. It is also necessary to post a sign in your waiting room notifying your patients you no longer carry malpractice insurance. In Florida, more and more podiatrists are going bare while also protecting their assets. I am seriously considering dropping coverage, but haven't had the courage to pull the trigger. I’d like to hear responses; for and against

Name Withheld

Editor’s comment: PM News does not provide legal advice. We believe that having malpractice insurance is vital on many levels.

1) Practice management: Would you have surgery by a doctor who isn’t insured? When you patients read that you don’t have insurance, they won’t want surgery either!

2) Ethically: What happens when you screw up? We all have. Who compensates the patient? Do you in good conscience tell the patient “Didn’t you read the sign in the waiting room?”

3) Peace-of-mind: We think it’s better to sleep at night, instead of tossing and turning.

Those who try to cut corners are generally the same people who “save” money by not joining APMA, not attending seminars, ordering up-to-date coding books, etc. These are all legitimate tax-deductible business expenses.

Over the past 25 years of analyzing podiatric practices, we have seen a clear pattern: those who spend the most to improve and protect their practices out earn the “savers” by a wide margin. We don’t believe that this is a mere coincidence.

RE: Barefoot is Dangerous - Pribut

With due respect to Dr. Pribut, I don't feel barefoot vs. shoes is an 'all or nothing' scenario. Whilst it is true we are slowly paving the planet, training barefoot in the right conditions, such as on the beach, on lush grass or on sandy dunes strengthens the feet and lower leg. The trick is to find the ever decreasing safe areas on which to train. Walking the vicinity with shoes first to make sure it is clear of potentially injurious or unpleasant matter will help lessen the risk and anxiety.

Training or walking barefoot on natural ground also introduces a little understood subject -- that of bioelectromagnetism. By naturally grounding the body electrically (through ESD) and inducing the earth's magnetic field into the body through the feet, we are both reducing our electrical potential to zero (which is optimal) and reinforcing the body's magnetism by contact with the Schumann resonance on the surface of the earth. This is a feature yet to be introduced into synthetic insulated footwear. The right shoe for the right purpose is absolutely the way to go, but let's not give up on nature entirely.

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

RE: Windswept Toe Deformity (Neil Levin, DPM)
From: Lowell Weil, Jr., DPM

Samuel Barouk, MD of Bordeaux, France has written extensively about correcting this type of deformity with the use of the Weil metatarsal osteotomy. His original book is a wealth of knowledge for these types of disorders and he has just published his second edition.

We have significant experience in successfully correcting the windswept deformity with this type of osteotomy.

Lowell Weil, Jr., DPM, Fellowship Director, Weil Foot & Ankle, Institute, WeilJr@aol.com

PM&S-36 POSITION – SAN ANTONIO, TEXAS

The University of Texas Health Science Center at San Antonio. Contact Program Director, Javier La Fontaine, DPM at (210) 567-5174 or e-mail casteele@uthscsa.edu

ASSOCIATE POSITION - PHILADELPHIA, PA

Full time associate to join large 6-doctor group. PSR-24 trained with excellent people skills. Competitive salary/benefits package. Fax CV and introduction (215) 742-3902.

RESIDENCY POSITION – NORTHERN VIRGINIA

One Year Foot and Ankle/Rearfoot Surgical Fellowship with excellent salary/benefits available July 1, 2006. If you are finishing a PSR24 and don't have a job yet, this is an excellent way to learn additional surgical and business skills. Please fax resume to 703-491-9994.

RESIDENCY POSITION - HOUSTON, TX

RPR, PSR-24, Houston Podiatric Foundation, Starting ASAP. Must have successfully completed PARTS 1 & 2 of National Boards. Contact: Dr. Randal M. Lepow, Director (281-348-3338) (713-725-8988)

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.

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

ASSOCIATE POSITION - PALM BEACH COUNTY, FLORIDA

Excellent for upcoming residency grad. Well rounded practice- 2 podiatrists. Fax resume: 561-637-9596.

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.

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