June 27, 2006 #2,616 Editor-Barry Block, DPM, JD

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Flip-Flops a Full-time Flop: Podiatrists

Flip-flops. People are wearing them everywhere and virtually around the clock. But, podiatrists say wearing flip-flops all the time might not be such a good idea. You may find yourself with a dull ache in the arch or ball of your foot.

"Overwork the muscles in the sole of the foot and the top of the foot and that causes some overuse injures such as tendonitis and bursitis," says podiatrist Greg Cohen at Long Island College Hospital. Because flip-flops have spongy soles, your foot rolls around more when it hits the ground. "If you're walking total more than I would say, a half a mile, that's too much in a flip flop," Cohen says.

Flip-flops also contribute to more sprained ankles in the summertime. Harold Glickman, chief of podiatric surgery at Sibley Memorial Hospital, recommends using ice and an anti-inflammatory, such as Advil or Aleve, to treat a twisted ankle. But if your ankle's black and blue and still swelling after 24 hours, it's time to go to the doctor. Glickman says sandals made by Birkenstock, Teva, and Asics offer a little more support than the standard flip-flop.

Source: WTOP (Washington, DC) [6/23/06]

Dr. Edward R. Hommel, Madison WI

Dr. Edward R. Hommel

Before retirement my job was: Practiced podiatric medicine and surgery for 38 years. I also taught family practice residents for 25 years and was a member of the Air National Guard for 25 years.

What is the Benevolent Specialist Project/Free Clinic in Middleton? It's a multidisciplinary clinic staffed by retired and active Madison-area physicians. We see patients who have slipped through the cracks and are without insurance, or who cannot afford medical care through the normal channels.

Tell us about your medical missions to Jamaica: Our church in Florida has adopted a sister parish (St. Pius X) in the inner city of Kingston and sends a medical team to Kingston three to four times a year. I'm in the early stages of attempting to establish a program for diabetic foot care, which would provide these patients with protective footgear as well as regular treatment and diabetic education. These people are the poorest of the poor, often barefoot and without adequate food or shelter. Treating them is an honor and a privilege.

Source: Barry Adams, Wisconsin State Journal [6/25/06] Photo credit: AJ Maclean -- State Journal

Efficacy and Mechanism of Orthotic Devices to Unload Metatarsal Heads in People With Diabetes and a History of Plantar Ulcers

Michael J Mueller, Donovan J Lott, Mary K Hastings, Paul K Commean, Kirk E Smith, and Thomas K Pilgram

Background and Purpose. Total-contact inserts (TCIs) and metatarsal pads (MPs) frequently are prescribed to reduce excessive plantar stresses to help prevent skin breakdown in people with diabetes mellitus (DM) and peripheral neuropathy. The first purpose of this study was to determine the effect of a TCI and an MP on metatarsal head peak plantar pressures (PPP) and pressure-time integrals (PTI). The second purpose of this study was to determine a possible mechanism of pressure reduction by measuring contact area and loaded soft-tissue thickness (STT) under the metatarsal heads and second metatarsal shaft.

Conclusion. The total-contact inserts (TCIs) and metatarsal pads (MPs) used in this study had substantial and additive effects at reducing pressures under the metatarsal heads. The TCI reduces excessive pressures at the metatarsal heads by increasing the contact area of weight-bearing forces. Conversely, the MP acts by compressing the soft tissues proximal to the metatarsal heads and relieving compression at the metatarsal heads. These findings can aid in the design of effective orthotic devices to relieve excessive plantar stresses that may contribute to skin breakdown and subsequent amputation in people with DM and peripheral neuropathy.

Source: Journal of The Physical Therapy Association. Volume 86 • Number 6 • June 2006
http://www.ptjournal.org/PTJournal/Jun2006/v86n6p833.cfm

Friday July 14- Sunday July 16, 2006.

See The Samoset Resort Website http://www.samosetresort.com/ for beautiful photos of the golf course directly on the Atlantic Ocean. 18.5 CME hours pending with focus on Diabetic Foot Care and Surgery. Come join Dr. G. Jolly, Dr. P. Flanigan, Dr. D. Shavelson, Dr. L. Harkless and others. Contact Dr. John Perry at drperry@atlanticfootankle.com or call 207-773-5800 for more details.

For a list of all meetings go to: www.podiatrym.com/meetings.pdf

RE: MD/DO Degree for Podiatrists
From: Lowell Scott Weil, Sr, DPM

The comments regarding the necessity of the MD degree for podiatrists may have been the most profound statements that Dr. Block has made since the birth of PM News.

For 41 years I have seen podiatric medicine and surgery make great strides in developing guidelines for the care of the foot and providing ethical and up-to-date treatment of foot and ankle conditions. The great majority of research and development of mechanical, medical and surgical procedures to treat the foot have been originated by podiatric physicians. Yet, the DPM degree has been inadvertently (and perhaps "advertantly") left out of various legislation both at the federal level and state level.

Sixty years ago, an editorial in the AMA Journal, stated that "Chiropody was a useful, ancillary health profession, in providing for care of the foot" and "Osteopathy was a CULT and not recognized by medical professionals" (quotes may not be exact and cap emphasis added by me, but the statements, in general are accurate) Well, look at where osteopathy is now!!

Based on the battles of fighting for financial equality (equal pay for equal work) for four decades, it is obvious to me that the degree of DPM is a barrier to equal and fair opportunity and treatment in the financial world of healthcare. I would like to make it clear that I am not proposing extension of our current practice scope (mechanical, medical, and surgical treatment of the lower extremity, distal to the knee along with soft tissue structures governing the function of that part) unless the training, in general, parallels that of an orthopedic foot & ankle surgeon.

But, I do believe that the time has come to stand up for who we are and what we believe and be assertive in our desire to achieve the financial rights that every other American has been awarded, "Equal Pay for Equal Work." It is apparent that the only methodology left is to find a credible manner in awarding the MD degree to podiatric physicians. PODIATRY LEADERSHIP, YOUR MOVE !! Dr. Block, thank you for the "kickstart!”

Lowell Scott Weil, Sr, DPM, Des Plaines, IL,

LSWSR@aol.com

I cannot tell you how critical it is for us (DPM) to forego these letters for a MD/DO. I had to quit podiatry as a profession due to health and medical reasons. Trying to find a job in other areas of medicine, besides private practice was a demoralizing eye-opener. Physician assistants, nurses (RN) and nurse practitioners have greater opportunities then a DPM in career opportunities. Even though our training and education greatly exceeds theirs, we are perceived as not being qualified to hold any type of a medical field position. I was informed I would have to go back to school and receive a different type of a degree if I expected to get a position in the medical arena.

As DPMs we area already classified and considered second-class citizens. We can only move upward from here. I am proud of being a podiatrist and knowing that our training of the foot and ankle is second to none. But why limit ourselves by holding on to these three letters, DPM. We all know how politics within the medical profession controls the future as the medical shrinks. Let us face reality that as a DPM, we are greatly outnumbered and sure to be squeezed into oblivion if the MDs have their way. So, I implore our leadership to understand and look forward into a future where we do not have to constantly substantial our importance and thus our existence.

Florida Podiatrist

RE: CMS vs DPM’s
From: G. Stephen Gill, DPM, MHS, MBA

Get clear on the CMS agenda: reduce, restrict and ultimately – eliminate podiatric medicine from government programs. The legislators propose – the regulators define - and podiatric medicine is not considered a critical service. CMS, and others, view our services as over utilized, over priced and optional! Others can – and do, provide our services for less with no documented difference in morbidity. The reality, DPM exclusion from the MD/DO provider panel of any government program – is the pathway to rapid elimination. Can APMA – the profession, avert yet another crisis? …this may be a defining moment for the profession!

G. Stephen Gill, DPM, MHS, MBA, Denver, CO,

g_gill@comcast.net

RE: Lawsuit From Residency (New Practitioner)
From: NJ Podiatrist

I would like to offer the resident the same advice that was given to me when I was in a similar situation. I was told that any doctor who has his or her name on a hospital chart, or is remembered by the patient, is named in these types of suits. Usually this is a fishing expedition in which the deposition is utilized to see if the resident will "bad mouth" or damage the case of the surgeon. You should be truthful and unemotional or, at the very least, follow advice of counsel and insist on a pre-deposition conference. Hopefully, your attorney was helpful in filling out any pre-deposition questionnaires.

I was eventually dropped from the case "with prejudice" but it took several years (6). I wish I was more forceful in demanding that motions were made to drop me from the case, as I suffered increased malpractice costs during all those years and had to subsequently name this incident on many application and reappointment attestations.

NJ Podiatrist

RE: New York Times Article
From: Dennis Shavelson, DPM, David M. Davidson, DPM,

A recent New York Times article entitled "Do You Really Need an $800 Custom Insole?" was biased towards the belief that podiatric orthotics are overpriced, over-prescribed, and often unnecessary. A podiatrist is quoted stating that he handles most patient complaints without custom orthotics and another states that orthotics are over-prescribed. Today I received an e-mail suggesting that I write my congressman in order to preserve podiatry's ability to dispense DMERC items under Medicare.

Before I send off my letters as requested, I felt that I had to take the time to ask of my colleagues, "If you don't support me, why should I support you?

I realize that there are many DPM's who have not updated biomechanics in decades and do not know what PFOLA is, and who press feet into foam, and Rx "post to cast," and that they and their families suffer from the very foot and postural problems that orthotics would de-compensate, but I cannot understand why they would take the time out of their busy lives to try to reduce the value of how I have decided to practice podiatry.

I could say that DPM's are charging $300 for shoes that cost $11 to produce in China and that I have treated my diabetic population, with rare exception, with OTC shoes that they pay for themselves because that would be true, but that would degrade a portion of my profession and therefore my profession itself. I simply say that if you want DMERC shoes there are other DPM's who have focused on this aspect of podiatry and that I am not the right DPM for you.

As Medicare and Multiplan reduce our ability to provide care and earn a living by dividing us and conquering, I wonder why any of my colleagues would want to fuel the fire?

Dennis Shavelson, DPM, New York City, NY,
drsha@lifestylepodiatry.com

Interesting about the New York Times article. I was, in fact, misquoted. Sadly the "99%" should have been "the majority of my patients with plantar fasciitis..."

David M. Davidson, DPM, Buffalo, NY, ddavidson@adelphia.net

HOUSE CALL PRACTICE FOR SALE – SOUTHERN CALIFORNIA

House Call practice for sale which includes approx. 400 patients and continued referrals. Perfect for solo practitioner. Extremely easy and profitable practice to run. Yearly gross of over $200K. Current DPM is retiring. Financials will also be provided. Please contact ccipinc@ccipinc.net

PRACTICE FOR SALE - CENTRAL FLORIDA

Well established surgical podiatry practice for sale. Located in a state-of-the art out patient surgical center.Grossed $1,038,000 in 2005. Low down payment. Price negotiable. Contact Camille Todd/Transworld 321 217-3625 or camille@tworld.com

ASSOCIATE POSITION- NEW ENGLAND

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

EQUIPMENT FOR SALE - ESWT

If you are using or thinking of using ESWT, I have a new machine that has only been used twice. There is no Orbasone in the country priced like this one. Will provide training and installation. Take a look at http://www.orbasone.com Call 1-856-229-2939.

ASSOCIATE POSITION--NEW YORK CITY

Excellent opportunity for a hard working, surgically trained podiatrist to join a well-established, high volume, multi/location practice in Manhattan and Queens. Must be willing to perform all aspects of podiatry. Must presently have New York license. Position available immediately for the right candidate looking for a future partnership opportunity. Fax resume to 212-753-3521 scottlurie@eastsidepodiatric.com

PSR-24 RESIDENCY POSITION - SOUTHEASTERN MICHIGAN

The P0H Medical Center (POH), Pontiac, MI has an opening in its Podiatric Medicine Residency Program. POH is a major teaching affiliate of Michigan State University College of Osteopathic Medicine. This is an excellent opportunity for a highly focused individual, who just graduated or has already completed a PPMR/RPR and or a PSR-12 program. POH offers an excellent learning environment with three high volume surgical venues and two busy foot/ankle clinics, including a limb salvage and wound clinic; as well as a competitive salary and benefit package. For further information, please contact S.J. Goldstein, DPM, POH Medical Center (248) 338-5392 FAX – (248) 338-5567

ASSOCIATE POSITION - NAPLES- FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills. Hospital privileges available at 548 bed hospital system and multiple surgical centers. Candidate should want to perform rearfoot surgery including Charcot reconstruction. Candidate needs to be ethical and motivated and have a current Florida license. Established practitioner or new practitioner OK. Base, percentage, benefits including insurance and 401K. Fax CV to (239) 566-8778.

RESIDENCY POSITION – VIRGINIA

One Year Foot and Ankle/Rearfoot Surgical Fellowship with excellent salary/benefits available July 1, 2006. If you are finishing a PSR-24 and don't have a job yet, this is an excellent way to learn additional surgical and business skills. Please fax resume to 703-
491-9994.

ASSOCIATE POSITION - PITTSBURGH, PA AREA

Excellent opportunity for a hard working, surgically trained podiatrist to join a well-established, high volume, multi/location practice in the suburbs of Pittsburgh. Must be willing to perform all aspects of podiatry. Incentive-based salary, compensation package, with potential for partnership. Must presently have Pennsylvania license. Would like to fill position asap. Fax resume to 412-831-2115.

ASSOCIATE POSITION - MINNESOTA – MINNEAPOLIS SUBURB

Busy, well-established, full-scope podiatry practice, seeking highly motivated podiatrist for a full-time position with buy-in opportunity. Looking for PSR 24/36 trained individual, to help increase surgical volume. Excellent opportunity for long-term growth with unlimited income potential. E-mail CV to employment@associatedpodiatrists.com or fax to (612) 866-5875 Attn. Jennifer.

EQUIPMENT FOR SALE-X-RAY DEVELOPER

Near-new podiatry/medical x-ray developer for sale. All-Pro Model 2010. Excellent condition. $2500. Call (216) 261-7662 or email: fergusondpm@aol.com

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