The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

June 18, 2007 #2,964 Editor-Barry Block, DPM, JD

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Sore Feet are Not Normal: WY Podiatrist

You don't have to live with foot pain. Studies show that 75 percent of Americans experience some degree of foot problems in their lives, and many never seek medical treatment because they mistakenly assume that having sore feet is normal. It isn't.

Dr. Michael P. Wilkinson

Foot ailments that may appear minor at first can lead to major problems if left untreated. "Any time you have an infection you should seek immediate help," said Dr. Michael P. Wilkinson, Doctor of Podiatric Medicine at the Family Foot Care Center in Casper.

For discomfort or mildly sore feet, try wearing better shoes that give you more support. If that doesn't help, see a podiatrist. For more serious pain, use the RICE method -- Rest, Ice, Compression and Elevation -- for two days. If your feet do not improve, see a podiatrist.

Source: The Casper Star Tribune, [6/12/07]

Dr. Nancy Parsley Joins Scholl College Administration

The Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University has announced that Nancy L. Parsley, DPM, will join its administration as Associate Dean, effective July 1, 2007. In this role, Dr. Parsley will be responsible, with Dr. Terence Albright, for the administrative management and academic affairs of the College.

Dr. Nancy L. Parsley

Dr. Parsley has been the Director of Health Policy and Practice at the American Podiatric Medical Association (APMA) since 2001, and has been instrumental in increasing Medicare reimbursement to podiatrists. She also launched the annual National Podiatric Carrier Advisory Committee and Private Insurance Advisory Committee Representatives Meeting. Prior to joining the APMA, Dr. Parsley was in private practice in Washington , DC , following her service as a Congressional Fellow to the Health Subcommittee of House Ways and Means.

“I am most pleased that Dr. Parsley has joined the Scholl College family,” said Terence B. Albright, DPM, Dean of Scholl College. “She brings a wealth of administrative experience; and she will serve as a role model to our students and assist the College’s efforts in patient care, recruitment and research.”

$ 1 Million Verdict In Suit Arising From Surgery To Treat Bunion And Related Problems (Texas)

Facts: Plaintiff, a 50-year-old, custodial worker was referred through another podiatrist to defendant, who examined her on February 5, 2002 in connection with Plaintiff's complaints of right foot pain, specifically a bunion and problems with her second toe. During that visit, Defendant diagnosed Plaintiff with a bunion deformity, flexible flatfoot, and second hammertoe. Based on this examination, Defendant scheduled Plaintiff for surgery, which took place on March 1, 2002. Defendant provided post-operative care to Plaintiff. Soon after the surgery, Plaintiff began experiencing complications which included pain, edema, paresthesias, delayed healing of the incisions, and infection.

In April 2002, Plaintiff was instructed that she would be allowed to walk on her foot with the aid of a special boot. This instruction was premature and ultimately resulted in broken screws that were used for fixation. Plaintiff returned to defendant who had discharged her a year earlier. Plaintiff's bunion deformity was never corrected after the surgery and her condition was made worse after Defendant's radical and unnecessary surgical procedures, plaintiff alleged.

Plaintiff alleged that Defendant breached the podiatric standard of care he owed to Plaintiff through his negligence in one or more of the following particulars (see full list at: http://www.podiatrym.com/letters2.cfm?id=14494&start=1

The Defense argued that plaintiff's injuries were from medical complications known to arise from the indicated foot surgery.

Injury: Plaintiff has a very severe non-functional right foot and an ongoing painful condition that continues to deteriorate. Both of the fixation screws are now broken and she is unable to perform any type of work requiring standing or walking due to the continued pain, paresthesias, and swelling of her right foot.

Result: $ 1,087,500 jury verdict. Pain and mental anguish sustained in the past $ 50,000. Physical pain and mental anguish that, in reasonable probability, she will sustain in the future $ 150,000. Medical care that in reasonable probability she will sustain in the future $ 750,000. Disfigurement $ 17,500. Physical impairment in the past $ 20,000. Physical impairment that in reasonable probability she will sustain in the future $ 100,000.

Plaintiff Expert Witness: Stephen L. Barrett, DPM, MBA,Associate Professor, Arizona Podiatric Medicine Program, Midwestern University College of Health Sciences , Glendale, AZ
Defendant Expert Witness: Sam Mendicino, DPM, Houston, TX

Source: Verdicts, Settlements & Tactics

Query: EMR/ Tablet PC

I serve on a committee that is instituting an EMR to our clinic. Our clinic is switching to an EMR on the financial side in one month. On the clinical side, we have decided to go with the "tablet" that goes room to room with the doctor. Has anyone used these tablets? Any cautionary tales or recommendations? We have looked at Toshiba, HP, and AGO. We are using EHS as our vendor. One of my concerns is whether the nurses should have the tablets as well to do the work-up/ updates in the room before the doctor goes in.

Michael Munson, DPM, Columbia, SC

RE: Gamma Graft (Tip Sullivan, DPM)
From: Marc Katz, DPM

I have been using GammaGraft for about 4-5years. It is a great product in certain cases. It is excellent for large leg wounds or large wounds that require coverage. This is also good for tendon coverage of the dorsal foot. In some cases I would use it temporarily for coverage but most often you can heal the wound completely. The key with the graft is not to treat it like a typical cadaver graft. After applying the graft, I typically use Steri-strips and a non-stick dressing.

The bed must be mostly vascular. I have the patient remove the dressing and leave the graft open to the air for about 2-3 hours. The graft will then adhere to the vascular bed and seal the wound. The graft will become dark and dry like a scab. The patient may shower but when drying should use no shear force. There is no dressing needed after this. The wound will heal underneath and slowly peel away. You should trim the dry edges. The graft may stay on for 1-2 weeks or up to 6 weeks.

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

RE: MBT Shoes (Charles Morelli, DPM)
From: Multiple Respondents

I fear Dr. Morelli is opening up a 'can of biomechanical worms' with his request for opinions on the function of and claims made by mBT shoes. Rather than getting embroiled in the complete subject (with subjective being the operative word,) may I suggest studying the three third party research papers listed on the mBT website www.swissmasaius.com conducted by Edinburgh Royal Infirmary, Sheffield Hallam Universtiy and University of Calgary.

Simplified, the mBT concept is a midfoot rocker with a soft heel wedge. Upon landing, the shoe forces the foot onto the mid and forepart of the sole; thus reducing loading pressure on the heel and transferring the body's center of gravity and weight forward. Depending on the patient's disorder, if the doctor feels the patient would benefit from this change in gait pattern, after reviewing the above studies - recommend it.

As for the shoes benefits and claims as an exercise modality, with the amount of obesity prevalent in today's society, as you say in New York - 'It might not help - but it wouldn't hurt.'

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

I too have been intrigued with the pseudo-science of the MBT shoes. So I purchased a pair. For the first two day I felt great (and taller). Then the problems started. My patella tendon became inflamed, then my neck at C5-6 started to hurt. I then got out my handy video camcorder and videoed myself walking in the MBT shoes, in sneakers with orthotics, and bare footed.

The results were interesting and beckon for a "real" research study. I was keeping my knee slightly bent for a greater amount of time at heel strike into mid stance with the MBT shoes on. I was slightly unstable at heel strike in the MBT's as I tended to load laterally and the increased compression of the heel caused a sagittal plan "rock", that I am sure would of hurt my hips if I kept wearing them..... In patients who do not have a propulsive gait, I am sure the results would be different. My opinion: let's all wait for some real research.

Bret M. Ribotsky, DPM, Boca Raton, FL, Ribotsky@doctorbret.com

I tried the MBT, and it felt interesting to walk around in. In the MBT, I feel like the foot is too far away from the ground, and doesn't actually mimic the Masai's gait. The Masai's tibia and fibula rock over a stable talus, that is supported by a bare foot, whose toes are spread, and whose heel is level with the toes.This is occurring when the foot is under their body.

The MBT is an overpriced, rocker soled shoe, which tapers at the metatarsophalangeal joints, as opposed to encouraging the toes to spread out as the natural Masai barefoot does. The heel is significantly elevated above the support surface, and there is approx. 25 degrees of toespring. This NEVER allows flexion to occur at the metatarsophalangeal joints, as would occur if the individual were actually walking across uneven ground barefoot, as the Masai do.

It sounds good, but it doesn't really mimic a barefoot gait. It is physiologically impossible to strengthen the intrinsic muscles of the foot, when they are stretched beyond their normal length to tension relationship, as is occurring from the toespring of the MBT.

It is possible for Americans to learn how to walk and run like the Masai, but not in the MBT for sure. The gait pattern of the MBT is faulty from the get go, due to the fact that the contact occurs out in front of the wearers body, increasing the touch down angle and the resultant slamming and deceleratory forces. Can a shoeimprove upon what nature gave us? It seems like the lack of shoe, and a greater adaptability to the ground surface is what makes the Masai worth mimicking.

Ray McClanahan, DPM, BS Ed, Longview, WA, footdr@nwfootankle.com

POSITION AVAILABLE- MIDTOWN MANHATTAN, NY

Immediate position for a part time leading to a full time associate. Long established practice with a mix of surgery, general podiatry and orthopedics as well a hospital affiliated nursing home. Office based OR suite with nitrous and power. Ground level Park ave. entrance with a total of four treatment rooms and a private office. Option to purchase in the next six months likely to become available. Candidate must have PSR/24 with some experience, Interested parties call (201)403-7685, E- Mail CV to ThakerMike@aol.com

ASSOCIATE POSITION SANTA FE, NEW MEXICO

We are looking for a highly trained, personable, ethical, and caring podiatrist, to work in a two doctor, three office practice, of thirty years. Send CV to sfpodiatry@ aol.com

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

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Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

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OFFICE TO SHARE AND RENT LONG ISLAND & MANHATTAN

3 treatment rooms, JACHO certified operating room, MRI extremity unit and x ray equipment on premises, turn-key operation -no investment- Space also available on East 22nd street to share Manhattan. Call 516- 4761815 or email podo2345@aol.com

ASSOCIATE PODIATRIC SURGEON – TEXAS

We are looking for an exceptionally trained podiatric surgeon to work in the Houston, Texas area. Candidates seeking this opportunity need to be dynamic, people friendly, and have current licensure in Texas . Future licensure in Arizona will be required. Exceptional opportunity, with attractive benefits, and excellent starting salary. The successful candidate will find a rare opportunity to integrate into a specialized lower extremity practice with emphasis on peripheral nerve surgery, endoscopic and arthroscopic surgery, and other special surgery of the foot and ankle. Please submit a cover letter with current curriculum vitae via email to: Slb99@pdq.net Stephen L. Barrett, D.P.M., MBA

ASSOCIATE POSITION - MIAMI BEACH, FL

Seeking well trained PMS 36 / PSR 24+ for Full-Time associate position. Leading to partnership for the person. practice is 50% hospital based. Must have strong Sx skills, including Limb Salvage & Trauma. Competitive Salary & benefits Package. Fax 305-652-6672 or Call 305-785-2559 Email: doctorsole@aol.com

ASSOCIATE POSITION – SOUTHEAST MICHIGAN

Very busy home care and office practice looking for associate/s for full time position. offering great benefit packages, very competitive salaries. excellent opportunity for right individual PM&S 24/36 preferred. partnership possibility significant for right person. please call 248-303-3736 or fax CV to (248)996-1023 poda1@aol.com

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