June 14, 2006 #2,505 Editor-Barry Block, DPM, JD

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Salon Pedicures Often Cause Foot Problems: CA DPM

Tim Dutra, a San Leandro podiatrist, says it's fairly common for him to see patients who have had a pedicure go awry. The most common problem is plantar warts, which you probably recognize by their common name: warts. They are characterized as a thickening of the skin on the bottom of the feet that's painful to squeeze and which may have black pinpoints — really blood vessels.

Bacterial infections — often caused by over-zealous clipping or cuticle nipping — cause redness, heat, sensitivity and pus. Such infections may need to be treated with antibiotics.

Finally, there's fungus, which can be the trickiest of all to deal with. Dutra says many women who love nail polish may not even notice that they have a thickened, white and chalky nail — signs of a fungus infection — until it's been there for some time. "It's a very stubborn disease to treat," Dutra says. "It's probably one of the most stubborn. Unlike a bacterial infection you don't just take a pill to get rid of it. The effectiveness is not 100 percent." There is a pill treatment, but it interferes with a host of other medications, particularly those processed in the liver.

Dutra, the president-elect of the American Academy of Podiatric Sports Medicine, says it's important to not be too aggressive nipping cuticles and borders of the nails. "I see a lot of ingrown nails because of aggressive nail boarding," he says. Dutra's recommendation is that prevention is the safest bet. "Bring in your own instruments and clean them yourself," he says.

Source: Elizabeth Jardina, Oakland Tribune, [6/12/06]

CMS Speeds up NCD Process

CMS is accelerating the time it takes to issue national coverage determinations (NCDs) for Medicare, the agency said in its annual report to Congress. That report follows on the heels of two recent CMS final guidance documents that aim to demystify the process behind such coverage determinations.

Deadlines imposed by the 2003 Medicare reform law, as well as internal improvements, "have significantly reduced the time to compete an NCD," CMS said in a May 11 report to Congress on fiscal year (FY) 2004 coverage determinations. Once changes in the Medicare law were implemented, CMS reduced the time to complete NCDs to 273 days from the 370 days it took in FY 2004 prior to the law's implementation, the report said. By contrast, in FY 2003 the average time to complete an NCD was 460 days, it adds.

While NCDs are made by CMS, LCDs (referred to as local medical review policies or LMRPs up until December 2005) are developed by contractors and apply only in a single contractor's jurisdiction.

Therefore, there is more variation on the LCD level compared with NCDs, which apply nationally and do not vary.Excluding policies reconsidered multiple times, CMS has made about 300 NCDs in 30 years, with roughly 9,000 locally made determinations in 13 years, according to Louis Jacques, M.D., director of the division of items and devices in CMS's Office of Clinical Standards and Quality.

Source: Report on Medicare Compliance [6/12/06]

SOUTHWEST FOOT & ANKLE CONFERENCE

September 15-17, 2005, Westin Park Central Hotel, Dallas, Texas. Mark calendars now - PICA Risk Management course, FAIV workshop series, Coding Track , Assistants Tracks , Terrific Vendor Hall with giveaways. http:// www.txpma.org or 1-800-TEX-FOOT

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For a list of all meetings go to: www.podiatrym.com/meetings.pdf

A 4 year old female presented with a growth on her right heel, first noted in "early childhood" (see photo). Exam revealed a well-circumscribed 3X5 mm. white keratotic papule with interruption of skin lines. Lesion was examined and assumed to be a wart. It was treated with salicylic acid with complete resolution and subsequent recurrence within 1 month. A shave biopsy was performed which showed subepidermal calcification consistent with calcinosis. What is your diagnosis?

What's Your Diagnosis?

See Answer After Classified Ads.

Charles Morelli, DPM, Mamaroneck, NY, charles@themorellifamily.net

RE: APMSA Silent Auction

The American Podiatric Medical Students' Association (APMSA) seeks prize donations to benefit the APMSA Scholarship Endowment Fund within the APMA Educational Foundation. The 14th Annual APMSA Silent Auction will be held August 7-9 in Las Vegas in conjunction with the APMA Annual Scientific Meeting.

The APMSA Silent Auction features items such as office equipment, podiatric medical supplies, vacation trips and homes, educational materials, sports and entertainment tickets or memorabilia, professional services, gift certificates, seminar registrations, and many other items and services.

Auction donations made prior to June 23 will be publicized in APMA News and the Silent Auction program so that donors receive maximum recognition and bidders have ample opportunity to review prizes.

Donations are tax-deductible to the extent permitted by law. Proceeds will provide scholarships for podiatric medical students. For more information or to donate a prize, please contact APMSA Executive Director Dorothy Cahill McDonald at apmsadcm@apma.org or (301) 581-9263.

RE: Inexpensive Nail Nippers (Barry Finkelstein, DPM)
From: Elliot Udell, DPM

Thank you Dr. Finkelstein for letting us know about a product that is far less than the medical suppliers are charging for a similar product. This is the tip of an iceberg. The entire healthcare system is in severe economic trouble and people point fingers at doctors to explain why healthcare costs continue to spin out of control. What they are overlooking is what Dr. Finkelstein inadvertently discovered. There is tremendous price gouging on the part of medical suppliers.

Recently, someone noted that they can buy an ultrasonic instrument cleaner made for jewelry at half the price of a similar unit marketed to doctors. I saw some probes and curettes for sale at a hardware store for under a dollar a piece and identical items are on sale in medical catalogs for twenty times as much. We can go on and on with more and more examples. We are small potatoes. Multiply what we buy by many thousands and we can get an idea of what hospitals and clinics overpay for instruments and supplies. Unless the government gets wise to this and investigates it, there will be no way that the healthcare system as we know can be sustained.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: CPR/Cardiac Arrest

The key for "life support" in our offices/clinics should be CPR with an "AED" (Automatic external defibrillator.),as well as obtaining your ACLS training.

About ten percent of victims will respond to CPR alone in a cardiac arrest. Having "electric" available is the key for patient's best chance for survival!

Joe Agostinelli, DPM, Ft Walton Beach , FL, jmpa21@cox.net

PRACTICE FOR SALE - COLUMBUS, OHIO AREA

Fully furnished practice, open ONLY 14 hours a week with an average yearly gross of 235K. 75% primary care, 20% surgical, 5% Nails. Plenty of opportunity for growth and surgery. Changing locations. Financials available upon request. Kyle_DPM@Yahoo.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.

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)

WEEKLY SPECIAL - One week of ads (6x) for only $75

PM Classified Ads Reach over 8,000 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most- effective way of reaching over 8,000 DPM's. Write bblock@podiatrym.com for details. Note: For commercial or display ads contact David Kagan at (800) 284-5451 dekagan@aol.com

Calcified Nodule Secondary to Heel Sticks

This lesion is associated with heel sticks used to draw blood in the neonatal period. Most have been described with high risk neonates receiving multiple heel sticks in the nursery. More recently, cases have been noted following a single heel stick in healthy neonates.

Spontaneous resolution may occur within 18 to 30 months yet recurrence following curettage has been reported. Plain films will reveal opacity in the soft tissue. Pathogenesis involves calcification following local tissue injury with deposition of insoluble calcium salts. These have been reported following burns, trauma and surgery. For recurrence, surgical excision may be warranted

Source: Archives of Pediatric Adolescent Medicine / Vol 160 - June 2006

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