The Voice of Podiatrists

Serving Over 10,900 Podiatrists Daily

June 25, 2008 #3,281 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2008- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Cushioning in Running Shoes Not Always Better: MN Podiatrist

In the past few years, spurred by a 2001 research article titled "Barefoot Running" in SportScience, a peer-reviewed journal, the running world has seen a small revolution. Companies have started selling shoes that give control back to the foot. Nike's Free line, for example, tries to mimic the manner of a bare sole striking earth, eliminating arch support and reducing heel padding to provide a pliable sole that lets the foot flex. On the extreme end, Vibram released its FiveFingers "foot glove" in 2006 with articulated toes and a thin sole.

Dr. Paul Langer

"The phenomenon of cushioning in running shoes is a recent invention," said Dr. Paul Langer, a podiatrist and marathon runner in Minneapolis. "We're now seeing that all the innovations pushed for years by Nike, Adidas, et al., may not be better than a naturally functioning foot." Langer, who works at Minnesota Orthopaedic Specialists and is a clinical faculty member at the University of Minnesota Medical School, said misinformation in the 1980s started the myth that cushioning in shoes is always better. "It became more about marketing and less about biomechanics," he said.

The result was shoes with gel pockets, air pumps, exaggerated arch support and even computer chips. But the innovation backfired with many runners, Langer said, adding weight to the foot and promoting an unnatural gait where the heel -- not the forefoot -- was made to absorb most of the impact. Langer saw injuries ranging from shin splints to tweaked knees, often originating at least partly from bad form and pavement pounding in shoes that disabled the natural flex of the foot. With or without shoes, landing on your forefoot instead of your heels is better on the body, experts say. "About 80 percent of runners land on their heels while wearing shoes," Langer said. "But almost 100 percent of runners will land on their forefoot when going barefoot."

Source: Stephen Regenold, Star Tribune [6/23/08]

Armstrong to Develop World-Class Limb Salvage Team at Univ of Arizona

In a major initiative, David G. Armstrong, DPM, PhD, Professor and Director of Scholl's Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University in collaboration with Joseph L. Mills, MD, Professor and Chief of Vascular Surgery at the University of Arizona have entered into an agreement to develop a Limb Salvage Unit for the Southwestern United States. "This is a major step for Podiatric Medicine and for Amputation Prevention", noted Armstrong. The program will begin 1 August, 2008.

Dr. David G. Armstrong

As part of this initiative, Armstrong will become Professor of Surgery at the University of Arizona. He will serve as Founder and Director, with Mills as co-Director, of the University of Arizona's Southern Arizona Limb Salvage Alliance or SALSA.

James Wrobel, renowned podiatric clinician and epidemiologist, will direct Scholl's CLEAR operations under the aegis of Dean Terence Albright. "I think the central person to acknowledge here is Dr. Albright", noted Armstrong. "He and (Rosalind Franklin University President) Dr. Michael Welch had a vision of creating a fully-integrated podiatric medical clinical and research unit. That is now a reality.

NC Podiatrist Receives Highest Civilian Award

APMA Life Member Robert Sprinkle, Jr., DPM, has been awarded the Order of the Long Leaf Pine by the state of North Carolina. This is the highest civilian award presented by the state’s governor and honors individuals who have a proven record of extraordinary service to the state.

Dr. Robert Sprinkle, Jr., Receives Order of the Long Leaf Pine

Past recipients include Michael Jordan, Charles Kuralt, Maya Angelou, and the Rev. Billy Graham. Sprinkle is the first podiatrist to be awarded the Order of the Long Leaf Pine.

Source: APMA News [June 2008]

Scholl College Surpasses National Academic Performance

The Dr. William M. Scholl College of Podiatric Medicine in this past academic year surpassed the nation in its academic performance. Scholl College students earned an 89 % National Podiatric Medical Boards Part I passing rate compared to an 81 percent. Scholl College students earned a 97% National Podiatric Medical Boards Part II passing rate in 2008 as compared to the national average was of 83.5 %.

Most impressively, Scholl College students who took the part three licensure exam earned a 100 percent passing rate. “The student’s outstanding performance over the past year is a testament to the commitment by the students, faculty and administration for excellence in education,” said Dr. Terence B. Albright, DPM, the Dean of Scholl College.

Of those who desired to be placed into residency and entered into the residency placement system (CASPR), Scholl College placed 100 % of its graduation class into multiple-year residencies with over 80 % placing into three-year programs. Currently, the Scholl College Class of 2011 retention rate is 94%. On June 6, 74 students graduated from the Dr. William M. Scholl College of Podiatric Medicine.

House To Vote on Modified Senate MD Pay Fix Bill

The House on Tuesday is scheduled to vote on a modified version of Senate Finance Committee Chair Max Baucus' (D-MT) legislation (S 3101) that would eliminate a 10.6% reduction to Medicare physician fees scheduled for July 1, CQ Today reports. According to CQ Today, "If the House moves a bill, it will put pressure on Senate Democrats and Republicans to reach an accord." The House measure is similar to Baucus' bill, delaying the fee reduction for 18 months and increasing payments by 1.1% in 2009, but it will be introduced as a new piece of legislation because Baucus' bill failed to pass in the Senate. The measure would "rework several elements of the Baucus bill to cut down on the overall cost," according to CQ Today.

It would remove a $1.1 billion "Medicare Improvement Fund." It also would eliminate several provisions that would create bonus payments for physicians and other Medicare programs. The bill also includes provisions that would delay for one year a Medicare competitive bidding program for durable medical equipment.

The bill also would impose levies on Medicare providers who are late in paying their taxes (CongressDaily, 6/20). The House vote could be called off if the "Senate appears ready to move quickly and send over a compromise bill," according to CQ Today.

Source: CQ Today, Congress Daily via American Health Line [6/23/08]

Query: Flector Patch

Does anyone have experience with the Flector patch? Does it work? Do patients like it?

Doug Dickson, DPM, Syracuse, NY

Query: Qualifying Diabetic Shoes & Inserts

If a patient (Medicare) qualifies for diabetic shoes through "deformity," but has no history of ulcer or neuropathy, do they also qualify for the inserts (custom-molded or heat- molded)? In other words, can a patient qualify for shoes, but not inserts?

R. Alex Dellinger, DPM, Little Rock, AR

Response: In order to qualify under the Medicare diabetic therapeutic shoe benefit, it only requires that the certifying physician stipulates

1) The presence of one or more local foot pathologies; and

2) The MD/DO has the patient under a comprehensive plan
of care for diabetes mellitus.

You qualify both the shoes and the inserts. You do not qualify the shoes alone.

Medicare has no specific policy outlining which type of shoe and/or inserts are reimbursable under specific clinical conditions. The therapeutic shoe (custom-molded and insert [custom-molded vs. heat-molded pre-fabricated]) must, of course, meet the demands of the patient. Which type of shoe and insert you choose to dispense should be based on medical necessity, and nothing more. Your patient's medical record should memorialize your rationale for any given shoe and/or insert you choose to dispense.

Paul Kesselman, DPM, Woodside, NY

Codingline subscription information can be found by clicking here

RE: In-office Venipuncture and Lamisil (Lawann Scott, DPM)
From: John Clarke, DPM, Mark H. Sugar, DPM

When I first started practice I did blood draws regularly for pre-op office surgery, uric acid, sed rates, WBC's. I then did them for Lamisil therapy. Then insurances allowed only a small fee for drawing the blood and not for the testing that I sent out. Even though we did it for less than the local hospital, the insurance companies refused to pay anything beyond the drawing fee. Therefore, I send them to the hospital.

John Clarke, DPM, Fremont OH, jclarke2735@sbcglobal.net

We have been performing venipuncture for hepatic panel studies for treatment with oral Lamisil for years. We use both drug screen and onychomycosis for diagnoses. We don't charge much and get paid even less, but at least it gets done and the patient is compliant right on the spot to initiate treatment.

Mark H. Sugar, DPM, Potomac, MD, MSugar8364@aol.com

RE: Removing a Stayfuse Device (John L Etcheverry, DPM)
From: Robert M. Przynosch, DPM

These can be very difficult. I have had to cut a dorsal window in the phalanx to remove the "female" component.

Robert M. Przynosch, DPM, Asheville, NC, rprzynosch@hotmail.com

RE: Helping Flood Victims (Bob Warkala, DPM)

We would also like to know how we can help the podiatrists affected by the flooding in the Midwest. Let us know...we can all send a box of gloves, a sleeve of gauze, extra instruments, etc. Please let us know.

Pam Hoffman, DPM, Katonah, NY, katonahpodiatry@yahoo.com

RE: Non-Diabetic Orthopedic Shoes (Joan E. Schiller, DPM)
From: Mitchell A. Barber, DPM, John Mishasek, C Ped

Why don’t you just sell the line you currently use? Think about it...they are basically extra-depth shoes which would also be good for hammertoes, bunions and hard to fit patients. I use Orthofeet and Dr. Comfort and if the patient is interested in shoes but is NOT covered under the diabetic shoe coverage, you can sell the shoes as an off-the-shelf fitted shoe. It is my understanding that if the patient has Medicare and you are PAR with Medicare and dispensed shoes, you are required to charge NO less than the Medicare reimbursement.

I also sell the insoles (either gel variety or Plastizote) a-la-carte since the shoes are reimbursed separately. I think this is fair and patients usually understand that they are getting a good quality shoe and proper fitting. Don't undervalue the service you provide when fitting shoes to a non-diabetic. Many patients are in the wrong size, width or style for their foot.

Mitchell A. Barber, DPM, Laurel, MD, mitchbkid@hotmail.com

Editor’s Note: John Mishasek’s extended-length letter can be read at: http://www.podiatrym.com/letters2.cfm?id=20363&start=1

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.