The Voice of Podiatrists

Serving Over 10,900 Podiatrists Daily

June 10, 2008 #3,268 Editor-Barry Block, DPM, JD

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Flip-Flops Cause More Problems Than Other Shoes: NY Podiatrist

"Flip-flops have singlehandedly caused more problems with people's feet in the last couple years than probably any other type of shoe," said Dr. Rock Positano, a podiatrist at New York's Hospital for Special Surgery. Women and others may be heading feet first into a world of short- and long-term foot problems. Positano sees about five to 10 flip-flop related injuries a week -- injuries he believes are a direct result of women wearing flip-flops in place of normal walking shoes.

Dr. Rock Positano

"The problem with this is absolutely no support & the foot is able to go in any direction it wants to go in, and it directly impairs the ability of the foot to function as a shock absorbing part of the body," Positano explained.

In addition to aggravating old problems, people with flat feet or high arches can also do long-term, serious damage by wearing flip-flops. "These foot types normally will predispose a person to developing problems with their tendons with joint stability," Positano said. "And long- term there is always the possibility of developing chronic tendinitis or overuse injuries not only in the ankle but also the knee, the hip and the back."

Source: KTRK-TV ABC 13 Houston (TX) [6/7/08]

MA Podiatrist and Wife to Receive Temple Award

Ruth and Richard Vallon have become the 10th recipients of the Eleanor Trebach Award. This award, created in loving memory of Eleanor Trebach, honors Temple members, who like Eleanor, have provided Beth El Temple Center community. During more than 40 years of Temple membership both Ruth and Richard have served this congregation in a variety of wonderful ways.

Dr. Richard Vallone

In the early years, Richard, who so many of the congregation cherish for his wonderful warmth, humor and dynamic personality, worked on stage and behind the scenes to produce memorable plays, musicals and dances at Temple. Over the succeeding years, Richard responded to any committee request for help, was an active member of Brotherhood, has served on the Board of Trustees and is currently the chairman of the Bethelders group and its program coordinator.

It is not surprising to learn that both Ruth and Richard have been caregivers in their professional lives. Richard has been a beloved podiatrist for many years and Ruth worked as a registered nurse.

Source: Belmont Citizen-Herald [5/30/08]

NYSPMA Holds 112th Annual House of Delegates

Nearly 100 podiatrists from all parts of the state gathered this weekend in Cooperstown, NY for the longest-running political podiatry meeting in America. Delegates heard many positive committee reports on topics such as scope of practice legislation, insurance reimbursement, membership recruitment, and public relations. Amid much optimism, plans were mapped out to meet the many challenges facing practitioners today. The following officers were elected:

Dr. Roy DeFrancis

President – Roy DeFrancis, DPM
President-Elect – Mark Schilansky, DPM
Vice President- Robin Ross, DPM
Treasurer- Vito Rizzo, DPM
Board of Trustees: Joseph Schiandra, DPM, William Pierce, DPM and Jeffrey Falcone, DPM

The following awards were presented:

Lifetime Achievement Award- Raymond Mollica, DPM
Excellence in Action – Michael Barkin, DPM, Bruce McLaughlin, DPM, and David Rosenweig, DPM
Special Achievement – Karen Santi

Keep Employees Informed

Put yourself in your staff’s shoes. What would you want to hear if you were in their place? Employees typically are eager to stay on top of the following information:

• How the practice is doing. Inform workers how the practice compares to other practices and alert them to changing industry trends.
• Any changes—large or small—in direction, strategy or priorities.
• How they are doing against goals and expectations.
• Individual contributions that have helped elevate the practice’s overall performance.
• What’s on your mind—and what’s on your plate.

Source: Adapted from The Career Troubleshooter by Sherrie Gong Taguchi

Query: Dry Socket

We have a healthy 38 year old active female who presents with pain in her right 1st metatarsal-phalangeal joint (MPJ). She reported pain as being present for the past year. The pain is reported as sharp and aggravated by prolonged standing, walking...especially going upstairs. Patient notices a popping sound and sensation on a regular basis. The pain is localized to the joint.

PE: Mild HAV right with excellent ROM 1st MPJ with no pain or crepitus. Patient denies any pain at the medial eminence. No pain upon palpation of the sesamoids. Significant popping or suction-type sensation noted when distracting the hallux distally off the 1st met. head. X-rays unremarkable with no degenerative changes or joint space narrowing and no exostosis. This seems to be a "dry socket" or dry joint. It was treated with an injection into the joint with .5 cc sterile saline and.5 cc. dex. phoshpate. Does anyone have any treatment recommendations?

Melinda Hefti, DPM, Concord, NC

Query: Synthes Electric Pen Drive System

I am interested to get opinions about the Synthes Electric Pen Drive System. My hospital is looking to buy a new power system to replace our antique Hall Micro 100 system. The new power system must meet the needs of orthopedists, oral surgeons, hand surgeons and podiatrists. I have only seen the product literature. The K-wire attachment looks very odd.

Greg Caringi, DPM, Lansdale, PA

RE: Chronic Pain Post Multiple Neuroma Surgery (Jorge Nasr, DPM)
From: Robert K Hall, DPM, Marc Katz, DPM

Many years ago, I performed a routine Morton's neuroma excision. Several weeks later, the pain continued, despite cortisone re-injections. An exploratory revealed a recurrent deep mass (amputation/stump neuroma?) which was excised & the dead space was again closed with Dexon. The pathology report revealed a "suture granuloma" (to the Dexon), necessitating a third procedure, this time with NO deep sutures, and was closed with skin staples. The third time was a charm. Always be honest with your patients and keep them informed as to exactly what is happening and they will rarely find fault, despite their frustration. This patient even referred her mother for surgery.

Robert K Hall, DPM, Ft. Lauderdale, FL robertkhalldpm@bellsouth.net

Hopefully Dr. Nasr did a C&S. If he didn't, I would try to obtain a deep tissue culture, not just pathology. I would get anaerobic, aerobic, acid fast and fungal cultures. I would avoid the quinolones. They are poor empiric choices for foot infections. Many Staph infections are resistant to Cipro and Levaquin and they can lead to MRSA infections with prolonged use. I would do a rheumatoid titer and ANA and consider referral to a rheumatologist. I would avoid any surgery until you have a diagnosis unless there is a deep abscess or osteo. I would avoid any further cortisone as you may already have sub metatarsal pain from fat pad atrophy. I would also consider a diagnosis of CRPS and refer to a pain management specialist, if necessary.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

RE: Surgical Excision of Lipomas (WJ Tronvig, DPM)
From: Bryan C. Markinson, DPM

Dr. Tronvig seems to be describing a normal anatomic structure known as the para-malleolar fat pad. Although some patients complain that they are large or "swollen," they are never painful in my experience. I would strongly discourage removing or attempting to de-bulk this structure, as scarring, nerve entrapment or frank nerve damage is usually present when these "cosmetic" procedures go bad.

Bryan C. Markinson, DPM, NY, NY, bryan.markinson@mountsinai.org

RE: Ethics
From: Arthur, Helfand, DPM

For those interested, Public Health and Podiatric Medicine - Principles and Practice - Second Edition contains an extensive chapter dealing with the Ethical Issues in Podiatric Public Health. The text was published by the American Public Health Association in 2006. The chapter (13) can be found on pages 177 - 198 with an extensive bibliography. The first edition, published in 1987 by Williams and Wilkins in 1957 also contained an ethical chapter. An ethical chapter was also included in the Clinics in Podiatric Medicine and Surgery, The Geriatric Patient and Considerations of Aging - Part I, January 1993, W. B. Saunders Company, pages 35 - 46.

In addition, during my tenure at Temple University, School of Podiatric Medicine (Pennsylvania College of Podiatric Medicine) and as Chair of the Department of Community Health, Aging, an Health Policy (1963-2002), ethics, law, and the concerns for reimbursement were always included in the curriculum, including discussions of fraud and abuse, presented by various special faculty in law, health education, public health, government, and representatives from major insurance carriers, including Medicare and Medicaid.

Arthur E. Helfand, DPM, Narberth, PA, Aehelfand@aol.com

SEEKING RESIDENT FOR PSR-24 POSITION: BALTIMORE, MD

Mercy Medical Center Position for a highly motivated individual who desires a surgical residency or an individual wishing additional surgical training in a 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

ASSOCIATE POSITION - WILMINGTON, DE

Busy 25-year old state-of-the-art Four-Dr. Practice, -Three offices/ Two Hospitals - PSR 24/36 preferred - Need energetic/motivated DPM proficient in EMR/Computers - Fax CV with cover letter to Brandywine Podiatry, Attn: Dr. Christopher Savage -Fax # 1-302-658-7646

X-RAY PROCESSOR FOR SALE

Konica qx-70 automatic processor in perfect working condition. Has been maintained professionally on a monthly basis. Office is going digital priced for quick sale. Must be picked up - Long Island, NY. Send inquires to soledr@aol.com

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

PART-TIME ASSOCIATE POSITION - INLAND EMPIRE, CA

Ethical hard working physician for long term care practice. Send CV with salary requirements to dtoedoc@earthlink.net

PRACTICE FOR SALE - VENTURA, CALIFORNIA

Selling satellite office, fully furnished and equipped. Existing patients and room for more growth. Inquire at tkhk@sbcglobal.net

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