The Voice of Podiatrists

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June 21, 2007 #2,967 Editor-Barry Block, DPM, JD

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PA Podiatrist Uses Hyperbaric Oxygen Therapy to Heal Chronic Wounds

Although hyperbaric oxygen therapy was originally developed by the Navy during World War II to treat divers with decompression sickness, the technology has expanded to become a treatment for many other illnesses and medical conditions, including healing chronic wounds, said Dr. Gary Cortese, a podiatrist and one of the medical directors of the medical center's Wound Healing Center.

Dr. Gary Cortese

Oxygen, according to Cortese, is essential to proper healing of bodily tissues, skin, muscle and bones. In most cases, the act of breathing, combined with a healthy network of veins and arteries, provides enough oxygen for body tissues to heal. However, in certain circumstances, hyperbaric oxygen treatment can be used to substantially increase oxygen flow within tissues to improve healing.

Patients with diabetes often develop severe non-healing wounds, requiring surgical intervention. Diabetics with pressure ulcers, arterial ulcers and other types of wounds that fail to respond to conservative therapy may be ideal candidates for hyperbaric oxygen therapy, Cortese said. "Non-healing wounds on the feet and lower legs can lead to loss of function through amputation," he said. "By using proven wound care practices and advanced clinical approaches such as hyperbaric oxygen therapy, more patients' lives and limbs will be saved."

The therapy is painless and side-effects are usually minor. The patient lies comfortably in a cylindrical, clear chamber while the treatments are given. "Often, they'll fall asleep," Cortese said.

Source: Maria Herne, The Republican & Herald [6/15/07]

Barry University Opens New Foot and Ankle Institute

The Barry University School of Podiatric Medicine is pleased to announce the grand opening of the Barry University Foot and Ankle Institute at Bay Harbor Islands. “The new medical center will provide the same high quality podiatric health care services as our other three Foot and Ankles Institutes,” according to Dr. John Nelson, associate dean of clinics for Barry’s School of Podiatric Medicine. Moreover, the new center will offer in-office surgery which will save patients from the high costs of hospital deductibles for bunion and hammertoe corrective surgeries.

The Barry University Foot and Ankle Institute at Bay Harbor Islands

The Barry University Foot and Ankle Institutes, first established in 1986, are part of the clinical training component for podiatric medical students and residents of Barry University. The center will utilize the best possible and most innovative techniques for care and treatment of disorders of the foot and ankle. For example, laser treatment will be available for removal of cutaneous lesions such as warts and moles as well as spider veins. In addition to general podiatric care, other services will include, wound care, diabetic foot care, athletic injuries, and a diabetic shoe service which is available free to diabetic elders through Medicare.

The center, located in Bay Harbor Islands will open on July 9, 2007, and is open to Miami area residents from pediatrics to seniors. Each patient will be personally attended to by a board certified Barry University clinical faculty member, podiatric medical students and residents.

Physician Profiling Could Start in 2008

Until recently, the concept of Medicare gauging how efficiently physicians provide care under the program was largely theoretical. But the Government Accountability Office now thinks the Bush administration could make the leap from theory to practice as early as next year.

In a recent report and testimony to Congress, the GAO said Medicare resource use comparison, also known by the more ominous term "physician profiling," could be ready to go live by the middle of 2008. By combing through Medicare claims and compiling utilization statistics for individual physicians and groups, the Centers for Medicare & Medicaid Services could determine how doctors compare with each other when it comes to volume and intensity of services.

CMS then could send doctors and physician groups reports that give them a sense of how much care they provide for particular patient conditions in relation to their colleagues. For instance, a physician might realize that he or she bills far more complex office visits for diabetes patients than do other doctors in the area. This could spur the physician to shift treatment patterns to match his or her peers more closely.

Source: David Glendinning, AMNews 6/25/07]

Query: Forefoot Pain

I have a 40 male with forefoot pain, b/l in the area of the 3rd interspace. This was diagnosed in colleague in 1987 as neuromas, which were treated unsuccessfully w/ orthotics , injections, etc and subsequently resected in 1997-98. The pain was absent for 2.5-3 yrs, but has since recurred. I began treating as neuromas using sclerosing alcohol & homeopathic injections, plus a Sole Support orthotic, which has excellent arch contact for those cavus type foot structures. Nothing has helped. I sent him for an MRI which shows absolutely nothing-no bursitis, neuroma, soft tissue abnormalities other than some mild effusion in the 1st MPJ b/l. Now I am beginning to think it is just his cavus type foot. Any comments/suggestions?

Cynthia Ferrelli, DPM, Williamsville, NY

RE: Distance Education in Podiatry (Luin Tongson, MD)
From: David G. Armstrong, DPM, Alan Sherman, DPM

Dr. Tongson can check out our website at http://diabetic-foot.net/ for more info and to contact us.

David G. Armstrong, DPM, PhD, N. Chicago, IL, Armstrong@usa.net

Dr. Tongson’s training in lower extremity wound care and diabetic foot care will serve as a great start to a comprehensive course in podiatric medicine and surgery. There is some excellent online educational programming available to you now. PRESENT Courseware ( http://www.podiatry.com) has been providing distance education in podiatry since 2003. We provide the standard curriculum to podiatric residency programs here in the US, and have a complete online board review course as well. A list of our current lectures is available online at http://www.podiatricresidency.com/courseware_list.html PRESENT Board Review is featured at http://www.podiatriceducation.com/boards/

As a surgeon, Dr. Tongson knows that there is no substitute for hands on training in general surgery and podiatry is no different. I'd encourage him to seek a residency program in podiatric surgery, of which there are almost 300 in the US. The American Association of Colleges of Podiatric Medicine posts a comprehensive list of podiatric residency programs online at http://www.casprcrip.org/html/residencies/Wherepr.asp I admire his pursuit of advanced training.

Alan Sherman, DPM, CEO, PRESENT e-Learning Systems,
asherman@presentelearning.com

RE: Medicis (Omnicef and Loprox)
From: Sloan Gordon, DPM

I received a very caring letter from Jonah Shacknai (CEO of Medicis) that due to economic factors and generics of Omnicef and Loprox, they will no longer call on podiatrists, and instead focus on their line of anti-psoriatics and anti-acne medications on dermatologists.

In my opinion, this company has been very good to podiatry. I always had a rep and samples and always was treated equitably. I applaud Mr. Shacknai's letter and his "disappointment" at this news. I wish more companies were so honest and upfront.

Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net

RE Ankle Brace For Tennis Player With Ligament Laxity (Stephen Levin, DPM)
From: Barry A. Wertheimer, DPM, Paul Kesselman, DPM

There are dozens of well made, functional OTC and custom ankle braces. But.... any and all of what is available will have a limitation of inversion and eversion. After all, that is what we are attempting to limit to prevent ankle sprains. Any ankle assist will create limitations of the patient's ability to play the game of tennis because his/her ability for side to side motion will be somewhat limited by any and all ankle braces.

Barry A. Wertheimer, DPM, Torrance, CA, bwertheimer@cox.net

There are a myriad of braces, custom and pre-fabricated AFO's on the market which may be appropriate. The patient's biomechanical pathologies, weight, height, sports activities, and what the primary parameters are causing the patient's dysfunction all must be considered prior to determining exactly which device would be most appropriate. This is no simple decision and the number one principle to be adhered to is to prescribe the best possible brace for the patient's needs.

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

Editor’s Note: This topic is now closed.

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

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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