The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

June 20, 2007 #2,966 Editor-Barry Block, DPM, JD

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High Heels Won’t Cause Permanent Damage: MO Podiatrist

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Dr. John J. Holtzman, a podiatrist with Missouri Foot and Ankle in St. Louis, says high heels won't cause permanent damage.

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Dr. John J. Holtzman

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But "with that tight toe box, you'll cause inflammatory areas on the skin that can lead to pain," he says, or hammertoes, corns and bunions. Hard, flat shoes with no arch support can cause foot pain, too.

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Wear sandals and flats that have thick, spongy soles and arch supports. The danger from ankle breaks or other injuries if you fall off one of those high-high heels is real.

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Source; Harry Jackson Jr., St. Louis Post-Dispatch [6/18/07]

Armstrong Gives Keynote at University of Sao Paulo Medical School

David G. Armstrong, DPM, PhD, Professor of Surgery at Scholl’s Center for Lower Extremity Ambulatory Research (CLEAR), became the first podiatrist to keynote a symposium at the renowned University of Sao Paulo’s Institute for Orthopaedic Traumatology. The symposium, which focused on bone and joint infections, was chaired by Professor Arnaldo Zumiotti, Chief of the Institute, and Dr. Anna Lucia Lima. The wide range of lectures covered topics from infectious diseases to reconstructive surgery to public policy.

Professor David G. Armstrong, Dr. Anna Lucia Lima, and Prof. Arnaldo Zumiotti.

“No physician is an island,” noted Dr. Armstrong in his concluding remarks. “The only way to fight the onslaught of amputations is to team up. In that way, we can truly make a difference.”

Dr. Armstrong also showed intriguing data to suggest that very point. “The data discussed today show that individuals and individual teams can make a difference in prevention. I think this is splendid ammunition to take back to clinic on Monday.” Sao Paulo University is considered by many to be the most prestigious university in Latin America. The symposium was attended by physicians and surgeons from around the region.

First HIPAA Trial Results in 87 Month Jail Time & $5 Million in Restitution

Fernando Ferrer, who was convicted in February in the first HIPAA case to go to trial, was sentenced to 87 months in prison and three years of supervised release. The U.S. Attorney's Office for the Southern District of Florida alleged that Ferrer's cousin, Isis Machado, then an employee at the Cleveland Clinic, stole patients' personal information and gave it to Ferrer.

That information was used to submit fraudulent claims to Medicare. Machado pleaded guilty to the charges and testified at Ferrer's trial, and was sentenced to three years probation. Each was ordered to pay $2.5 million in restitution, which is the amount billed to Medicare.

Source: Report on Patient Privacy [June 2007]

Query: Distance Education in Podiatry

I am a general surgeon by training and practicing as a surgeon, providing wound care and diabetic foot care in the Philippines. I am looking for a distance education in podiatry that can make me eligible to take a certification exam or board exam for the degree of podiatry or consider me as a podiatrist. I am also interested to have a fellowship in diabetic foot. Are there any institutions that offer such program?

Luin Tongson, M.D., The Philippines

Query: Removal & Reapplication of External Fixator

One of our doctors removed an external fixator because it was too short, and needed to be replaced with a longer rail to get more distraction. This was done in the office with local anesthesia. The new fixator was put in place using the same incision holes as the old fixator. What would be the correct billing for this scenario?

Cory Ricket, Longwood, FL

Response: When asked to clarify whether the adjustment of an external fixator can be independently billed beyond the global allowance given for the original application, AMA's CPT Assistant (July 2000) noted (and I am paraphrasing): Bedside and/or office adjustments of an external fixation device would be expected in the treatment course use of an external fixator, and, as a consequence, would not be separate reimbursable. If, however, the patient is taken to the operating room, and general anesthesia is administered (I assume spinal anesthesia would also be acceptable) to allow for the adjustment or revision, then CPT 20693 can be billed.

If the adjustment/revision meets the code guidelines, you would append a "-58" modifier (staged procedure - if it was an expected "within the global" adjustment) or a "-78" modifier (return to the operating room - if this was not expected, but performed as a related additional procedure to the original procedure).

Harry Goldsmith, DPM, Cerritos,CA

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RE: Ankle Brace For Tennis Player With Ligament Laxity (Stephen Levin, DPM)
From: Multiple Respondents

Dr. Levin’s brevity makes it difficult to answer his question. Does the patient have generalized ligamentous laxity or is his laxity localized to the ankle area? If the patient is experiencing fatigue, then it may not be due to ligamentous laxity but rather to a cavus foot type, which is not uncommon amongst active tennis players. If the patient has a plantar-flexed 1st ray and a cavus foot type, then a custom foot orthosis which supports the forefoot valgus may eliminate the feeling of ankle fatigue or weakness.

At 15 years of age, his symptoms warrant a comprehensive biomechanical examination as his condition may be a precursor to inversion ankle sprains. In the absence of a history of ankle sprains, a custom foot orthosis should probably be used as an initial line of treatment. There are a number of anti-supination modifications that can be incorporated into his orthotic prescription. If an ankle brace such as a Richie Brace™ is needed, then an articulating brace would be indicated over a fixed hinge brace for purposes of an active tennis player, since a restricted hinge would be too limiting in the sagittal plane at the ankle.

Jeff Root, President, Root Laboratory, Inc., jroot@root-lab.com

Depending upon the severity of the ligamentous laxity, you may want to consider the Swede-O brace. They have lace-up and Velcro versions. Good for mild to moderate cases. Great for active patients.

Bruce Pinker, DPM, Pomona, NY and White Plains, NY, docpinker@yahoo.com

Our practice utilizes the DonJoy Velocity Ankle Brace for ligament, tendon, and structural issues around the ankle. The brace allows for full range of dorsi-flexion & plantar-flexion while limiting inversion & eversion.

Unlike other brace's on the market, patients find the Velocity brace comfortable, easy to apply, and it fits into gym shoes without difficulty. I have found great success using this brace to treat teenage athletes with ankle instability.

Howard A. Stone, DPM, Glenview, IL, justus313@comcast.net

I have used the ASO ankle stabilizer made by Med Spec for many years with great success. It comes in various sizes from pediatric to extra extra large.

Marc Klein, DPM, Boca Raton, FL, drklein@fdn.com

PRACTICE FOR SALE - CENTRAL FLORIDA

Practice, all phases, including wound care and hyperbaric, with excellent building and location in central Florida, in 21st fastest growing county in U.S. Outstanding place to live and work; low penetration by managed care. Excellent exposure, and parking at 2000 sq. ft building near hospital and on busy highway. Great price and opportunity to grow large practice. windnwave@earthlink.net

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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