The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

June 30, 2007 #2,975 Editor-Barry Block, DPM, JD

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Stuart A. Marcus, DPM, 70

Dr. Stuart A. Marcus

Marcus went on to become the longtime residency director at the Rockland Psychiatric Center in Orangeburg, NY. He was extremely active in the American College of Foot and Ankle Surgeons, and held many positions, including president. In 1984, Marcus edited the 2nd Edition of Complications in Foot Surgery (with Barry Block, DPM, JD, one of his former residents).

Although retired, Marcus remained academically active and was preparing to assume a faculty position at St. Petersburg College. Funeral arrangements are scheduled for Sunday July 1, 2007 at B'Nai Israel, 1625 S. Belcher Rd. Clearwater, FL at 10 AM.

PM News policy is to request that memorial donations be made to the APMA Education Foundation Student Scholarship Program, 9312 Old Georgetown Rd. Bethesda, MD 20814.

NV Podiatrist Discusses Common Foot Problems in the Aged

Dr. Jeffrey Bean, a Nevada podiatrist says that ingrown toenails are one of the most common ailments afflicting aged feet. Unfortunately, ingrown toenails can be a chronic condition, occurring over and over again. Symptoms may be an area on your toe that hurts when pressed and is red and warm to the touch. You may also feel the nail edge digging into the side of the affected toe. Ingrown toenails can be treated at home or during a pedicure, unless you're diabetic, have peripheral neuropathy or any other circulatory problem. See the doctor pronto!

Dr. Jeffrey Bean

The doctor described another aspect of aging: your oil glands slow down production, making the skin drier. That, combined with Nevada's very dry climate, causes extremely dry cracked skin, especially on the heels. He recommends a special medicated foot cream gently massaged into the heels and any other very dry spots on the foot and covered with a footlet or light sock at night.

Bean emphasized that many harmful foot conditions could be mostly prevented if men and women wore properly fitted shoes with some cushioning and padded socks. If women insist on wearing the last word in fancy shoes, he said they should be saved for special occasions.

Source: Jean Mitchell, The Dayton Courier, [6/27/07]

Waterproof Shoe and Socks Can Prevent Marathoners’ Blisters: TUSPM Podiatrist

Dr. Howard Palamarchuk, a Temple University podiatrist who frequently cares for runners' feet, treated participants after they completed April's Boston Marathon, during which a Nor'easter struck.

Dr. Howard Palamarchuk

While the pros only had to brave the 40-degree weather and wind gusts for two hours, everyone else slogged away for four to five hours. Some runners' feet were so wet, wrinkled and blistered that half of their soles were falling off, Palamarchuk says. Wearing waterproof shoes and socks and applying a layer of Vaseline to their feet might have prevented the problem.

Source: Allison Van Dusen, Forbes.com [6/27/07]

Query: Hallux Valgus-Hallux Rigidus Correction

A surgeon performs a dorsal cheilectomy and Moberg-Akin osteotomy to correct both hallux valgus and hallux rigidus.

In the procedure, the medial eminence is excised, as are the dorsal osteophytes and an osteophytic rim from the proximal phalanx. Dorsal closing wedge and medial closing wege osteotomy of the proximal phalanx follows and the osteotomy is fixed with a single screw. The surgeon would like to report codes, CPT 28289 (cheilectomy) and CPT 28310 (osteotomy, proximal hallux phalanx). Are these code selections appropriate?

Heidi Stout, CPC, CCS-P, New Brunswick, NJ

Response: I would code this procedure, which includes an phalanx osteotomy and a metatarsal head remodeling, as CPT 28298 which is bunionectomy correction by phalanx osteotomy.

The CPT description and associated diagram shows the osteotomy of the phalanx and the resection of the metatarsal medial prominance which would be the same amount of work as resecting a portion of the dorsal metatarsal head. Any resection of spurring at the base of the proximal phalanx would be inclusive of this procedure.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found at http://www.codingline.com/subscribe.htm

RE: Clear Cell Sarcoma (Al Kline, DPM)
From: Donald Jay Arenson, DPM

I have had experience treating one case of ‘Clear Cell Sarcoma’ (Enzinger’s Tumor). It was a sixteen year old female who was seen with a ‘pea sized’ mass at the medial aspect of her hallux, present for about one year. It was essentially asymptomatic. As in your case, this was presumed to be a benign cyst. It was excised completely and the biopsy report was a complete surprise.

She was immediately referred to an orthopedic oncologist. A hemi-pelvectomy was performed, however the patient still succumbed to pulmonary metastasis within two years of her diagnosis.

Lesson: All excised lesions must be biopsied irrespective of their being presumed benign.

Donald Jay Arenson, DPM, Elmhurst, IL, darenson@pol.net

RE: Restoring Aerosolization to Spray Bottles
From: R. D. Teitelbaum, DPM

The following is one of those "Heloise-type” remedies that I discovered one day. Have you ever had difficulty with a finger actuated spray bottle (that contains a non-aqueous fluid) whereby the aerosol pattern is completely lost and replaced by an annoying fine stream? I know I have and I have tried to reduce the size of the little hole in the spray head by various means without success. Here is the solution: Put a quarter inch of distilled water in the container. That's it. The water sinks to the bottom and gets drawn up in the draw tube in such a manner that the spray pattern is restored.

Yes, the first few sprays will seem lighter in density, but for the next hundred sprays there will be no noticeable difference. Eventually, the water level vanishes on the bottom and the process can be repeated.

R. D. Teitelbaum, DPM, Naples, FL, mfvandange@aol.com

RE: Alcohol Injections for Neuromas (Marc Katz, DPM)
From: Michael J. Schneider, DPM

I respectfully disagree with Dr. Katz and his global assessment of podiatrists and their propensity for greed. We use 6% alcohol in Marcaine in our practice to treat those patients who are not candidates for surgery for intractable neuroma pain and who have not experienced relief with other conventional treatment. We advise these patients that, in our experience, a percentage of patients will experience enough relief so that normal activity may be restored. We also advise our patients that many experience little or no relief. We will administer three to four injections 7-10 days apart.

If there is no relief then we advise the patient that the process is not a viable treatment. We administer multiple treatments as it is our understanding that sclerosing with alcohol is a process that works over time. We do not do this to "line our pockets" but to try to provide the most current and appropriate treatment. We all know that medicine is "not an exact science" but we must try all modalities and treatments if we are to provide the best for our patients.

Michael J. Schneider, DPM, Aspen-Vail-Frisco, CO, MJS10Vail@aol.com

PRACTICE FOR SALE - RIVERSIDE, CA

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Practice grossing over 250K/yr three days/wk. room to expand, large physician referral, good mix of sx., wound care, DME's, routine care. no rest homes. Medicare cert. surgery center on site. Will consider associate-to-purchase. may carry paper. Consider all offers. Office and sx. center also for sale. e-mail tentoes001@hotmail.com or call 951 7804782.

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ASSOCIATE POSITION FLORIDA - NORTHEAST REGION

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Busy, well established, full scope podiatry practice seeking highly motivated, hard-working, reliable, responsible and especially likeable to the average human, Associate. Surgical training a plus. Prefer PSR 24+. This is an Associate position with lots of potential. Team players only. Email CV to: healthparkmgr@bellsouth.net or fax CV to: 904-826-1586, Attn: Amy

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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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PRACTICE FOR SALE – OHIO – SOUTHEASTERN

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Reputable, thriving, well-rounded practice available with EMR. Grossing over $320K over the last 3 years. Priced to sell at 150K. Owner relocating. Email inquiries and CV to podsx@yahoo.com

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WANTED: BIOMECHANICS CONSULTANT

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West Houston Medical and Kingwood Medical Centers are seeking a biomechanics consultant to help develop competency based curriculum/assessment forms, provide workshops, and lecture to their residents. The individual must be Board Certified by the ABPOPPM, be a Fellow of the American College of Foot and Ankle Orthopedics and Medicine, and must be able to come for quarterly visits to Houston, Texas. Interested candidates should fax a C-V and consulting fees to Dr. Samuel Mendicino, Residency Director, West Houston and Kingwood Medical Centers. 281-589-1618.

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