The Voice of Podiatrists

Serving Over 10,900 Podiatrists Daily

June 20, 2008 #3,277 Editor-Barry Block, DPM, JD

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Only Surgery Can Cure Bunions: NY Podiatrist

It is sandal season and as feet are exposed, the problem that has been lurking under shoes all along becomes noticeable. Bunions are painful bony protrusions that affect an estimated 5.2 million people. Everything from slings to pads have been said to fix or in some cases shrink bunions, but Manhattan podiatrist Dr. Jacqueline Sutera says that's not the case. "Nothing will cure or remove bunions other than surgery," said Dr. Sutera.

Dr. Jacqueline Sutera

Bunions are hereditary, but there are other contributing factors, including the shoes you wear. Dr. Sutera believes that high-heeled shoes are a big part of the problem. Regardless of the type of shoe you wear, it is important to make sure it fits well to prevent bunions and other foot problems.

See video by clicking here

Source: Dr. Lisa Thebner, WNBC/NBC News Channel [6/17/08]

Armstrong and Boulton Release Comprehensive Diabetic Foot Guidelines at ADA Meeting

Professor David G. Armstrong of the Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Professor Andrew J.M. Boulton of Science and University of Manchester have announced the official release of the Comprehensive Diabetic Foot Examination Guidelines of the American Diabetes Association (ADA) at the ADA's 68th Annual Scientific Sessions in San Francisco last week.

Professors AJM Boulton and David G. Armstrong

"This work was several years in the making", noted Armstrong, the current chairperson of the ADA's Foot Care Interest Group. "To work with such a world-class interdisciplinary task force to see it through was an honor and a privilege." This task force consisted of experts from the fields of podiatric medicine

Senators Fight Competitive-Bidding Program

Senate leaders joined their House counterparts in an effort to delay a controversial Medicare program that would move the agency away from paying flat fees for wheelchairs, home oxygen, diabetic-testing equipment and other types of medical hardware and move toward competitively bid dollar amounts.

Senate Finance Committee Chairman Max Baucus (D-MT) and ranking member Sen. Chuck Grassley (R-Iowa) introduced legislation that would effectively scrap the first round of bidding and freeze the program for up to two years while concerns over quality and fairness are examined. Under current law, the first round of bidding begins July 1. At that time, the CMS will pay contracted suppliers a certain dollar amount for various durable medical equipment, prosthetics, orthotics and supplies—commonly referred to as DMEPOS. A second round of bidding, set to begin next year, would also be delayed.

“The competitive bidding program for (DME) should stay on hold until it’s certain that seniors will get the products they need in a way that works for them,” Baucus said in a written statement.

Source: Matthew DoBias, Modern Healthcare [6/18/08]

A 4-step Approach to Improve Creativity

The next time you have a project to complete, try this method:

1. Investigate your needs
2. Create ideas to solve your problem
3. Evaluate your proposed solutions
4. Activate a plan and put it into effect

Source: Gerard Haman, Thinkulator (Chicago, IL)

Query: Lack of ROM, Post-First MPJ Arthrodesis

I recently treated a healthy 48 yr old male who had both of his great metatarsal proximal phalanges fused five years ago. His right foot has good alignment in the sagittal plane at the fused location, but there still is a medial "bump" present. The left foot (at the level of the proximal interphalangeal joint) has a component of unusual dorsi-flexion (12 degrees) during weight-bearing and off-weight bearing. He gets a painful spin callus during toe-off on the medial aspect of both first proximal phalanges due to the fusion and increased peak pressure plantarly at toe-off. He wants the range of motion back in his great toes. He has no transfer lesions sub 2-5 metatarsals. Does anyone have any recommendations or suggestions to aid his condition?

Steven S. Melek DPM, Charleston, WV

Query: Multi-Function Digital Scanner

Any suggestions for a scanner that is cheap and easy to use in order to eliminate the paper-producing, expensive ink-consuming copying machine. Is there such a device that has multiple capabilities: e.g. fax, copier, scanner, etc?

John Moglia, DPM, Berkeley Hts. NJ

RE: Hallux Extensus (Larry Dorman, DPM)
From: Allen Sater, DPM, Susan L. Boren

Do the x-rays reveal a 1st metatarsal that was plantar-flexed too much or did the osteotomy rotate plantarly? If it is plantar-flexed too much, then go to the apex of the deformity and elevate the bone with a new osteotomy. If the capital fragment rotated plantarly due to non-compliance or poor fixation, then a Waterman-Green osteotomy will rotate it back into position if the original osteotomy was done at the distal aspect of the metatarsal. Also consider EHL lengthening/adhesiotomy and concomitant Weil osteotomies with either procedure.

Allen Sater, DPM, Jupiter, FL, Bunionpain@aol.com

Dr. Dorman may want to consider orthotic therapy prior to performing an additional surgical procedure. In a effort to get the patient to purchase, a functional orthotic may resolve his problem. Two issues need to be addressed individually in an effort to get the desired result:

1. The patient's plantar-flexion at the 1st MPJ is most likely caused by a compensated gait due to excessive pronation. Aggressive support along the medial longitudinal arch can redistribute his surface geometry, increasing his range of motion at that joint.
2. Because the plantar flexion is a byproduct of his limited range of motion, the 1st MPJ should be off-loaded with a teardrop shaped cut-out from the medial, distal corner of the orthotic, and a dancer's pad added. The hallux will need to be supported with a customized pad designed to fill the empty space between the plantar surface of the hallux and the corresponding dorsal surface of the orthotic. The patient will no longer have to bring his foot to the floor, as this will bring the floor to his foot.

Medial arch support, combined with accommodations designed to release excessive pressure off the joint, should allow sufficient propulsion off the hallux, releasing pressure on the 2nd and 3rd met heads.

Susan L. Boren, President, Earthwalk Orthotics, Inc., eworthotics@neo.rr.com

RE: Charging for Prescription Renewals (Dean Clement, DPM)
From: Multiple Respondents

Would a physician's refusal to refill a prescription based on a patient's refusal to pay for the refill be considered an abandonment (and, hence, malpractice) if the patient is subsequently harmed due to the lack of the prescribed medication?

I don't know the answer to that question. I hope I never find out.

Richard W. Boone, Sr., Health Care Attorney, Fairfax, VA, RWBoone@aol.com

Dr. Clement makes an excellent medical and practice management point regarding his office policy for prescription refilling. If the medical rationale is shared with a patient why their re-evaluation is necessary prior to precription writing, most rational patients will appreciate this because you are demonstrating what is in for them, namely your assurance that the proper medication is being prescribed for the appropriate problem. There is only so much information a physician can garner from a telephone call. Without visualizing the patient, what they now may be suffering from might not be the same issue the original prescription was written for. As such, the medication being sought might not be appropriate, and in some rare cases, possibly even contraindicated. With potential medico-legal issues with prescription medication refills by phone w/out evaluating the patient in existence, in general, it is wise to re-evaluate the patient prior to prescription filling.

Depending upon the perceived medical circumstance and type of medication requested, on occasion, I may opt to prescribe a 1 or 2 day dose to allow the patient enough time schedule an appointment for re-evaluation. Because of my approach, similar to Dr. Clement's, this doesn't happen often, so I haven't found it necessary to charge a fee.

Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

Times have changed; therapy has improved, but the patients have not changed. You have agonized over the idea of charging for prescription renewals, and, I say that it is a negative return practice. You will lose patients and your reputation will suffer. Not renewing prescriptions for patients who have not been seen in greater than six months without a reevaluation is a good and ethical as well as defensive practice. Stand your ground with this practice and you will gain the respect of your patient population who will spread the word in a positive fashion..

Jay W. Slepner, DPM, Margate City, NJ, jaymarcia@comcast.net

ASSOCIATE POSITION - WEST CENTRAL MINNESOTA

Associateship possibly leading to equity ownership. Compensation package of $100,000. Option for partnership or purchase as soon as associate feels ready. 260 402-7490.

IMMEDIATE OPENING – CHATTANOOGA, TN

Excellent opportunity for a young well-trained personable podiatrist to join a rapidly growing practice. $100,000 salary. PSR-36 minimum required. Live, work and play in a beautiful area with many recreational opportunities including rock climbing, hang-gliding, whitewater paddling, fishing, boating, etc. Option for partnership/ownership track. No nursing homes. No weekends. E-mail cover letter and CV to drsegler@anklecenter.com

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

ASSOCIATE POSITION - SAN ANTONIO, TEXAS

Seeking three-year trained resident for associateship, hopefully leading to partnership. Competent in all phases of podiatry particularly reconstructive rearfoot surgery. Outstanding opportunity for the right individual. Reply to Richard Pollak at 210-692-0279, or fax resume to 210-692-0028 or e-mail drpllk@hotmail.com

ASSOCIATE POSITION WITH OPPORTUNITY FOR PARTNERSHIP NY/PA

Group practice located on NY-PA border with excellent growth in the area’s industrial, retail, and college campuses. Surgical privileges in medical centers in NY and PA. This position will involve rotating through multiple office locations, and wound care centers. Local insurance reimbursement involves mostly private pay PPO models. We are looking for an ABPS Board Qualified podiatrist to join our team. Candidates would need to obtain licenses in NY and PA, and become ABPS certified to maintain hospital privileges. Base salary starting at 85,000.00 with bonus plan incentive, vacation, and health/mp insurances. Forward CV to prefprovider@hotmail.com

ASSOCIATE POSITION – CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for full-time podiatrist in a multi practice location in the Chicago land and Northwest Indiana area. Must have two years of surgical residency. Please e-mail resume to d-kitchens@footexperts.com

IMMEDIATE OPENING - MINNEAPOLIS, MN

Associate leading to partner in well-established practice. Seeking personable, skillful, and attentive podiatrist. No nursing homes, evenings or weekends. Competitive compensation package including health insurance, malpractice, short term disability, 401(k), generous vacation, paid holidays, and excellent salary plus bonus! E-mail cover letter and CV to jbremer@associatedpodiatrists.com or fax to (612) 866-5875 attn: Jennifer Bremer

ASSOCIATE POSITIONS – CALIFORNIA

Coast to Coast Mobile Podiatry Group, California's premier provider of mobile on-site health-care services is seeking hardworking, caring Associates to provide excellent health-care to the greater Los Angeles areas, Organge County, San Bernadino County, Riverside, San Diego, and Santa Barbara. Salary and benefits available. Please email you CV and salary request to coasttocoastpodiatry@yahoo.com

BIOMECHANICS FELLOWSHIP – NEW YORK

Neoteric Biomechanics (patent pending) Nine-Month Fellowship: At The Foot Typing Center® in New York City. Practice, Research, Publish and Credentialize Yourself In This New Paradigm. $36,000 Stipend. New York License Required.Fax Interest to: 212 288 3034 or apply to Dr. Shavelson @ drsha@lifestylepodiatry.com.

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