The Voice of Podiatrists

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June 19, 2007 #2,965 Editor-Barry Block, DPM, JD

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NC Podiatrist Uses Topaz for Tendon Conditions

Dr. Andrew Milner, partner in Carolina Foot & Ankle Specialists is using new technology to treat tendon ailments. He specializes in foot and ankle surgery and sports medicine. The new technology, which is called Topaz, treats tendon problems without major surgery. In a 20-minute procedure, the doctor places the patient under mild sedation and makes a one-inch incision over the damaged tendon, at which time the tendon is treated with Topaz. Topaz delivers a controlled amount of radiofrequency energy that stimulates a healing response in the tissue.

Dr. Andrew Milner

The technology has been used to treat jumper’s knee, tendonitis and heel pain. Dr. Milner received his medical degree from the Temple University School of Podiatric Medicine in 1987. He received his undergraduate degree from Allegheny College in 1982.

Source: The Herald (NC) [6/10/07]

Temple Podiatrist Offers Advice on Sneakers for Teens

According to John Walter, DPM, a podiatrist at Temple University School of Podiatric Medicine, because children's feet continue to grow and develop into the teen years, good, supportive shoes are critical for foot health.

Dr. John Walter

"A lot of the sneakers out now are really quite good as long as they fit well," Walter said. "For support and to keep dirt and foreign objects from entering the shoe, children's sneakers and shoes should always be tied. This will also help prevent kids from coming out of their shoes and spraining an ankle."

Podiatrists can identify such problems and design custom orthotics, or shoe inserts. Other remedies include braces, casts and special shoes. "Often, the painful knee and hip problems we see in adults have developed over several decades of poor foot and postural mechanics that were never addressed earlier with the proper shoes or orthotics," said Walter.

Source: Hospital Law Week [6/17/07]

State Medical Liability Insurance Requirements Vary

Some states mandate that doctors have minimum levels of medical liability insurance or other forms of coverage to practice in the state or to qualify for tort reform protections. Below is a snapshot of some state requirements.

Require medical liability insurance or other forms of coverage to practice in the state: Colorado, Connecticut, Florida, Kansas, Massachusetts, New Jersey, Pennsylvania, Wisconsin

Require medical liability insurance or other forms of coverage to qualify for tort reform protections: Indiana, Louisiana, Nebraska, New Mexico, Wyoming

Require medical liability insurance to have hospital privileges: Missouri

Source: American Medical Association

Query: Ankle Brace For Tennis Player With Ligament Laxity

I have a 15yo very active male tennis player who has lateral ligament laxity of both ankles. He does not have a history of ankle sprains, but relates his ankles give out. What is the best ankle brace, hinged or fixed that will stabilize and allow motion for a tennis player?

Stephen Levin, DPM – Tampa, FL

RE: EMR/ Tablet PC (Michael Munson, DPM)
From: Multiple Respondents

I have been using the Toshiba Satellite tablet PC for the last 18 months for my EMR program. It works well but is large with a 15" screen. I find the tablet is not as convenient as I had first hoped. For the most part I find it easier to use the external mouse than the Pen with the tablet. It is faster when entering information that needs to be added in addition to what is contained in the EMR program. All in all the positive is it is easier to move room to room or location to location.

Mark Isenberg, DPM, Oldsmar, FL, msidpm@mindspring.com

I have used a Toshiba Tablet PC with much success. What I would suggest is to have your IT remove all unnecessary programs so that it loads/runs quickly. Make sure that no extraneous programs are added. One concern can be signing the document on the tablet. If you are using a program like Microsoft Word and use the electronic pen to sign the document, please use the safeguards of document protection to make sure that your signature cannot be copied and used on other documents. When you use the electronic pen it simply creates a jpeg image on top of the document. You can either protect the original or (as I do) once finished the document is converted it to a .pdf document that cannot be altered. Converting to. pdf (or. tif) is preferred because it now becomes a static document. These documents are copied to an SD Card which can be used to transfer them to the mainframe. Personally, I have no use for the wireless capability of the tablet and have it disabled.

Richard A. Simmons, DPM, Viera, FL, RASDPM32822@aol.com

We use the IBM Lenovo. I like to have the tablet in the room with me on my lap. It feels stable and is relatively light to carry around. The screen is big enough to not be an issue. The handwriting recognition on the Windows XP Pro platform is not great so I use an after-market software called Ritepen (http://www.evernote.com/en/products/ritepen/) which helps but is still not great. It is much slower and less accurate for me than voice recognition and it does not learn. But my handwriting is awful so that is likely a big part of the problem. I understand it is better on Windows Vista. The vast majority of my notes are entered via template. Almost all of the rest is with voice recognition so the handwriting issue should not be blown out of proportion.

Patients are impressed with the technology. I can pull up letters, handouts and my lecture photo slides and diagrams to explain problems. No more impossible to understand drawings on the paper under the patients’ feet. The downside of using a computer in the room is that you can also find yourself staring at the screen and not looking at the
patient if you don't make a conscious effort to do so. Patients find that annoying. It is not fun to talk to someone who is not looking at you.

Two of our doctors find the tablet inconvenient to use in the treatment room and go back to their office to enter their notes on their computer there. They keep their tablets in the treatment room so they can look things up (reports, previous notes etc.) but for them, buying a regular desktop or laptop would have been much cheaper and they would have had a larger screen. So find out what your users want before spending the money.

Alan Kalker, DPM, Middleton, WI, ajkalker@facstaff.wisc.edu

RE: MBT Shoes (Mel Cheskin, C. Ped)
From: Robert Scott Steinberg, DPM

I have not purchased the shoe, but, I have had patients who presented with multiple problems after wearing MTB shoes. In a nutshell, their observed gait was "wild," and just as weird as the gait of girls in stacked flip-flops. I wrote these patients letters saying that the shoes not only did not improve their foot function, nor their complaints, but instead made them worse. I felt that the MTB caused additional biomechanically-induced painful problems that went away after they stopped wearing the MTB and replacing them with a stability/motion control walking shoe from one of the major athletic shoe companies. Further, when biomechanically indicated, custom functional corrective orthotics corrected their initial complaints. Mel, as you can see, "It" can hurt.

Robert Scott Steinberg, DPM, Schaumburg, IL, doc@footsportsdoc.com

Editor's note: This topic is now closed

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POSITION AVAILABLE- MIDTOWN MANHATTAN, NY

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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

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