The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

June 22, 2013 #4,803 Publisher-Barry Block, DPM, JD

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Medical Grade Glue Can be Used for Wound Healing

Medical-grade adhesives, mainly a compound called cyanoacrylate, have been in used by doctors for more than 50 years. “It's almost like Super Glue," said Dr. Brandon Hawkins, a podiatrist from Bakersfield, CA and a board member of the American Association of Wound Care.

Dr. Brandon Hawkins

“It's the same material, only they have some substrates in the glue so it doesn't burn as much as Super Glue does. Your body bioabsorbs it over a two-week period," Hawkins said.

Source: Markian Hawryluk, The Bend Bulletin [6/20/13]

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90% of Women Wearing Heels Report Foot Pain Within an Hour: Aussie Podiatrist

"Almost 90 per cent of women indicate that they're getting pain within an hour of wearing high heels," says Rob Mair of the Australian Podiatry Association. Corns, calluses, and ingrown nails, the most common conditions treated by Australian podiatrists last year, are just the pointy end of this stiletto-shaped problem.

Podiatrist Rob Mair

"We're seeing atrophy in the fat pad on the ball of the foot, and nerve damage," says Mair, who sees around 6,000 patients a year. He says a 20-centimeter heel is the highest he has seen. And although the line of the leg may look longer and sexier in a stiletto, they cause the back to arch and the chest to jut forward, affecting posture and leading to lower back pain. "They've been around for a long, long time and fashion will win, but high heels do impact multiple levels of structures in the body," Mair says. "There's a correlation between back pain, neck pain, and knee pain."

Source: Sarah Berry, The Canberra Times [6/20/13]

NY Podiatrist Appointed to Monroe Community Hospital Board

The Monroe County Legislature unanimously confirmed Legislator Dr. Joe Carbone’s appointment to the Monroe Community Hospital Board. The MCH Board works to advance the core mission of Monroe Community Hospital, which is to ensure the care, safety, and general well-being of the over 550 residents it serves. “I am honored to have received this opportunity to serve on the Monroe Community Hospital Board,” said Legislator Joe Carbone. 

Dr. Joseph Carbone

“I look forward to serving the residents of Monroe Community Hospital and people of Monroe County.” Legislator Carbone is a Doctor of Podiatric Medicine at Rochester Foot Care Associates, LLP. He also serves on the Board of Directors for Golisano Children’s Hospital at Strong, as well as the Italian Heritage Foundation.

NY Podiatrist Awarded Italian-American Man of the Year

Dr. Rob Conenello

On June 14, 2014, AAPSM President Rob Conenello, DPM was awarded 2013 Rockland County Italian-American Man of the Year. This award is presented to an Italian-American individual who best exemplifies achievement in his profession and service to his community.

AZ Podiatrist Keynotes Council on Aging, Discusses Human-Gadget Co-Evolution

Dr. David G. Armstrong, Professor of Surgery and Director of the University of Arizona's Southern Arizona Limb Salvage Alliance gave a wide-ranging keynote lecture addressing philosophy, technology, and the current merger of consumer electronics with healthcare this past week to the Pima Council on Aging.

Dr. David Armstrong

The lecture, which follows a series of talks given by Armstrong and his colleagues Bijan Najafi and Joseph Mills, coincides with clinical and translational research being done in their clinics, labs, and other units, worldwide.

Create a Sense of Urgency

When you can’t afford to miss an opportunity or need to avoid a big mistake, create a sense of urgency to prompt your employees and coworkers to act now. Follow these tips:

Explain why the time to act is now. Every decision can’t be urgent or else none will seem so. However, when time is of the essence, offer reasons why. Perhaps you have an opportunity today that you won’t have in a couple of weeks, or you have to act immediately to avoid a costly problem.

Share the benefits of acting now. What will the practice—and its employees—receive as a result of moving forward with a plan? You have to spell out what’s in it for your team if you expect people to jump on board and execute a plan quickly.

Describe what’s at stake if you don’t act now. Telling people how they will be worse off is often more powerful than telling them how their lives will improve. Don’t exaggerate or be overdramatic, but honestly point out what the practice—and they—could lose if they fail to act.

Source: Adapted from “Three Ways to Create a Sense of Urgency When You Communicate via Communication Briefings [June 2013]

Query: Heel Lesion in a 19 Month Old

A 19 month old female presents with a lesion on her heel. The onset was 10 months ago. There has been no increase in size. The lesion is non-painful to the touch. There is no history of trauma.

Heel Lesion in a 19 Month Old

The lesion was incised, but there was no sign of infection or a foreign body, or sign of verruca tissue. Comments welcomed.

Query: Opting Out of Medicare

I am considering opting out of Medicare. Any comments on this would be appreciated. Does opting out of Part B also include DME/the diabetic shoe program?
 
John Swangim, DPM, LaPorte IN

Query: In-Office Nerve Diagnostic Testing

I have been approached by a reputable company to perform in-office nerve diagnostic testing. Their claim is that their unit does autonomic nerve testing (CPT 95923 - testing of autonomic nervous system function; sudomotor, including one or more of the following: quantitative sudomotor axon reflex testing (QSART), silastic sweat imprint, thermoregulatory sweat test, and changes in sympathetic skin potential) and is applicable for a podiatrist to utilize.

My understanding is that tests like this should not be used for screening purposes. Is this a test, while, in fact, it might do what CPT 95923 outlines? Is this test in the scope of practice for a podiatric physician?

Howard Dinowitz, DPM, Brooklyn, NY

Response: Many payers have policies regarding autonomic testing and billing requirements. Many do not pay for it. Most require a formal nerve conduction study with EMG in order to be paid.

Check with your biggest payers including Medicare to see what their polices are for this unit and the need for testing (especially by a podiatrist). Often these units only tell you what you already know and the information will not necessarily alter your treatment plan, especially if you are not going to specifically be treating the underlying pathology, but, instead, the topical local issues.

Tony Poggio, DPM, Alameda, CA

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RE: Tibial Torsion and Femoral Anteversion
From: Russell G. Volpe, DPM

First, I would beg to differ that serial casting and night splints are “no longer considered acceptable.” I routinely use serial casting for a variety of congenital deformities in the pre-walking child. As for night splints, there are a number of splints (Dobb’s brace, Tibial Torsion Transformer, Wheaton Brace) that I employ in the infant and young toddler to help increase the bimalleolar or metatarsus adductus angles in moderate to severe cases, particularly those with “symptoms” associated with tripping and falling.
 
As for functional change, there is some objective evidence that gait plates improve the angle of gait based on a small cohort study by Anthony Redmond that reported a 6 degree average improvement in angle of gait with the use of a gait plate orthosis. So, this is a good option after a heel-toe gait is established at around age 2 1/2, provided there is some available external hip rotation, and that it is worn in a shoe with adequate flexibility for a light-weight child across the break in the shoe (at the ball). Also, be sure your lab makes the gait plate of adequate length. It will fail to exert the desired effect if it ends proximal to the lateral MPJs.
 
In more severe, or recalcitrant cases pelvic bands and other similar elastic band therapies can help to increase the external position of the leg in gait.
 
Russell G. Volpe, DPM, NY, NY, RVolpe@nycpm.edu

RE: Tibial Torsion and Femoral Anteversion
From: Edmond F. Mertzenich, DPM, MBA
 
In my experience, many children are still learning to walk at age two. When they get distracted, they will often trip and fall. However, one must keep in mind other issues which can cause these problems; for example, neuromuscular disease, eg. CP. Assuming no major problems are found, frequently I can only tell parents that the patient will usually grow out the problem and offer to see the patient periodically to make sure the patient is progressing positively. Most children will develop normally by age 5, however, it can take up to age 8 to get a complete resolution. If there is a serious problem, appropriate treatment per protocol is needed.
 
Edmond F. Mertzenich, DPM, MBA, Roscoe, IL, doctoreddpm@frontier.com

RE: EHR Hi Tech Audit (Daniel D. Michaels, DPM)
From: Ken Schenley
 
The Medicare stimulus is not for everyone, and neither is Certified EHR. We have always expected that by attesting to Meaningful Use, and requesting a large “stimulus” from CMS, the floodgates would open on serious Medicare audits. We at Quick Notes have felt from the very beginning that it simply may not be worth it for podiatrists to pay a fortune for Certified EHR, spend valuable time trying to meet Meaningful Use (compared to helping/treating your patients)… and then dealing with audits! More important may be the simple approach to improving and protecting your office with great patient care, complaint documentation, and appropriate billing.
 
Disclosure: I am executive Vice President for Quick Notes EMR. 

Ken Schenley, ken@qnotes.com

RE: Unmatched Residency Placements Currently Stand at 92
From: Michael Cherella, DPM

No wonder we can't find residencies for all graduates. We can't even have one surgical society. We have ASPS and ACFAS. Bickering about who is at fault is a long-standing podiatric tradition.

Michael Cherella, DPM, Philadelphia, PA, melrosepodiatry@aol.com

RE: Outrageous Socks of the Day

X-ray Socks?

Submitted by Dr. Keith Gurnick

PRACTICE FOR SALE - SOUTHWEST FL

Multilocation multidoctor practice in beautiful Southwest Florida . Practice has grossed over seven figures consistently and currently shows 10-15% growth in revenues with increase in new patients and patient visits. EHR is already implemented with meaningful use criteria met. Practice has been professionally evaluated by Provider Resources. Only serious inquiries to this email address. This is a great practice in Paradise and a good opportunity for the right doctor or doctors. Email to: practiceforsaleswfla@gmail.com

PRACTICE FOR SALE - CHICAGO

Three-office practice; newly furnished; all offices are within 20-30 min of driving; great for one Dr. coverage; well-rounded surgical/diabetic/sport medicine practice; grossing up to $500K/year; can be purchased with real estate or separately. only serious inquiry to dpms2@hotmail.com

PRACTICE FOR SALE - MISSION VIEJO, CA

Relocating to Tulsa. Great opportunity to buy my office. Located at Mission Hospital. Gross income 2012 was $548,000. Approximately 1300 sq ft with 3 treatment rooms, digital x-ray and fully computerized. Will consider all offers. Call David at 949-702-1052 or david@missionviejofootcare.com

EQUIPMENT FOR SALE - DIOWAVE 15 WATT, PORTABLE 980 LASER
 
This is a used multiple function laser, plantar fasciitis, Achilles tendonitis, joint pain. nerve pain, post surgical, warts, toenail  problems, two-year plus warranty, MSRP: $25,000. E mail Dr. Zuckerman at footcare@comcast.net. for questions and pricing.

ASSOCIATE POSITION – VIRGINIA

Well established practice in Arlington Virginia looking for first year associate DPM perhaps leading to purchase of office . Office is one block from metro and has onsite private parking for patients. Present owner is retiring but will aid with smooth transition. This practice has been in the same location for 4o years with an excellent referral base.  Must be licensed to practice in Virginia. Full time requirement to start by 7-19-13 Contact drmichaelfine@aol.com. 703-582-5999.

ASSOCIATE POSITION - BEAUTIFUL VICTORIA, BRITISH COLUMBIA CANADA

On the ocean, fast growing area, Associate for multi-office full scope practice Will be at the Seattle Conference June 27-29th. Reply to dr.cole@shaw.ca

ASSOCIATE POSITION - SOUTH CAROLINA

South Carolina's largest provider of foot care is a multi-doctor, multi-location practice currently seeking a highly skilled, personable, and hardworking physician to join our TEAM. South Carolina License is necessary. Above average salary and benefits. Please send Letter of Interest and CV to scdpmjobs@gmail.com.

POSITION AVAILABLE - CENTRAL FLORIDA

Two doctor practice looking for an associate to take retiring doctor's position with partnership opportunity for the right person. Competitive salary, health insurance and incentives. Two offices serving a diverse number of routine, surgical and wound care patients. Two years surgical residency training and FL license required. If interested in this great opportunity please e-mail CV, surgical log and references to toesrus7@yahoo.com.

ASSOCIATE POSITION - CENTRAL FLORIDA

Associate wanted for well-established practice in central Florida. Experienced support staff, malpractice coverage and health insurance provided. Excellent opportunity for a promising future, this position will provide for the possibility of partnership in the future. To apply please go to www.yourcareerinpodiatry.com

ASSOCIATE POSITION - TEXAS

Dynamic, busy practice in Dallas/Fort Worth area, seeking surgically trained, Board Certified/Board Qualified Podiatrist, PSR-36 preferred. Excellent salary and benefits compensation package, for the right candidate, who is motivated to work hard. Contact/Send resume to: jmh6122@yahoo.com

ASSOCIATE POSITION – NORTHERN CALIFORNIA

Busy, established practice in Redding California seeking surgically trained podiatrist for associate position leading into a partnership. All phases of podiatry, PSR-36 preferred. Two office locations, hospital and surgical center privileges. Please forward cover letter and CV to tjsong01@hotmail.com.

PODIATRIST NEEDED: NYC/QUEENS IMMEDIATE OPENING!

P/T Leading to full-time and partnership. PSR-36+ Min. Three office locations; NYC, ASTORIA & SUNNYSIDE QUEENS. All phases of podiatry; including Med., Forefoot, Rearfoot & Ankle SURGERY. Modern offices with all the Hi-Tech. equipment available. Candidate MUST have the skills & knowledge expected, ambitious, hard-working, ethical, detail-oriented and organized. A vibrant patient and staff-friendly personality a MUST! Good base salary, malpractice and % bonus incentive. You should easily surpass your bonus %. Reply with cover letter and C.V. to hansfeet@aol.com.

PODIATRIST WANTED – NORTHERN AND SOUTHERN CALIFORNIA
 
Podiatrist for SNF practice throughout California. Northern California need currently concentrated in the Bakersfield area but can be expanded. Other opportunities in Los Angeles and Orange Counties. Practice is professionally managed. Send CV with interest to: ZbubblesZ@aol.com

ASSOCIATE POSITION WITH OWNERSHIP OPPORTUNITY- WISCONSIN

Immediate need for talented surgeon with professional, caring and compassionate bedside manner to effectively treat, manage, and expand a booming patient population in multi-location practice with self sustained surgery center (with opportunity for investment and ownership). Practice located within driving distance to Chicago. Please send CV and letter giving insight into your personal treatment style including immediate and future goals to: associatematch@yahoo.com.

ASSOCIATE WANTED - MANHATTAN AND NORTHERN NJ

For group practice. Excellent opportunity to be the first podiatrist to join our team! PT/full-time negotiable. Convenient on-site surgical center. Current licensure in NJ and/or NY required. Call Gina 212-223-0716 or email CV to gina@premiersurgicalpavilion.com

ASSOCIATE POSITION - PENNSYLVANIA

Associate Wanted for busy, multifaceted podiatry practice in Chester and Delaware counties, Pennsylvania. Seeking PSR-24/36 trained podiatrist for full/part time associate position. Two offices and hospital privileges. Send CV and letter to 123bunion@gmail.com.

ASSOCIATE POSITION - BAKERSFIELD, CA

Office and hospital-based podiatry group seeking a highly trained surgical associate to compliment our 3-doctor group. Minimum PSR-36 trained with rear-foot reconstructive experience required. Must have CA license and x-ray and fluoroscopy license. Previous practice experience is preferred. Competitive salary and benefits package. Please forward cover letter and CV to modpm@aol.com

ASSOCIATE POSITION - SOUTHERN NEW JERSEY

Excellent opportunity for a full time podiatrist to join busy group practice! Surgery, wound care, sports medicine. Affiliated with residency program. Personable and great communication skills a must! Competitive salary, bonus, benefits package. Send CV to footdoc22@gmail.com

ASSOCIATE POSITION - KENTUCKY

Immediate opening in beautiful Southern Kentucky with 8-provider group with excellent reputation, full-time physical therapy, MRI, CPED/CO on staff along with a full schedule awaiting.  Wonderful place to raise a family, excellent schools and phenomenal quality and cost of living. Excellent compensation package, full benefits, and buy-in opportunity after 2 years. Email a letter of interest and CV: jonkim12000@yahoo.com

ASSOCIATE POSITION IN CHICAGO

Full- or part-time to do house calls; make your own schedule; logistical support provided. Contact dpms2@hotmail.com

ASSOCIATE POSITION - YORK, PA

Busy multi office practice looking for highly motivated PSR 24/36 podiatrist. This well established 39 yo 2- physician practice has excellent rapport with physician community. Intent is an associate leading to partnership after the first year. Competitive salary &benefits. Email CV to Footdocpa@aol.com

SPACE AVAILABLE - NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview, Long Island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed PODO2345@AOL.COM 516-476-1815.

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