The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

June 30, 2009 #3,584 Publisher-Barry Block, DPM, JD

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Bad Shoe Selection Can Cause Heel Pain: WA Podiatrist

"We see a lot of foot gear problems, especially with runners," notes Douglas Hale, DPM, a podiatrist in the Seattle area. "However, bad shoe selection also can cause heel pain in people who walk for exercise or who are on their feet a lot in their jobs. It should be stressed that price alone is not an indicator of quality in shoes."

Dr. Douglas Hale

He suggests three things people should look for in a shoe (whether they be walking or running):

*Hold the back of the shoe where your heel is located and try to squeeze the two sides together. If there is a sufficiently firm heel counter, you will not be able to collapse it.
*Take the toe of the shoe and bend it up toward the heel. The shoe should bend at the front, not in the middle. If it bends in the middle, the shoe is too flexible and will not provide enough support.
*Put one hand on the heel and the other on the toe. Twist the shoe like you are trying to wring out a towel. The less you can twist it, the more support there is for your foot.

Source: Kurt Ullman, Third Age

SC Football Player/ Honor Student Forgos Eligibility to Attend TUSPM

Aaron Haire is not worried about what the future holds because he knows what he holds for the future, beyond his bright smile and pleasant demeanor. Haire has been equipped with an outstanding acumen in both the athletic and academic fields, along with a penchant for civic service which is driven by a desire to make his community a better place.

Aaron Haire (right)

Haire is the 22-year-old son of Orangeburg City Councilman Bernard Haire and his wife, Vernell. He graduated May 24 from South Carolina State University, where he majored in professional biology and served as a star punter on the football team. The straight-A honor student practiced the ideals of integrity, humility and teamwork both on and off the field.

He organized the school's first charity road race in partnership with his fraternity, Alpha Phi Alpha Fraternity Inc., and has been a member of the Fellowship of Christian Athletes since his days as a student at Orangeburg-Wilkinson High School. He is also a member of S.C. State's Health Profession Society and the National Golden Key Honor Society. Haire has chosen to forgo his final year of eligibility with the Bulldogs to enroll in medical school in August at Temple University in August, where he will major in podiatric medicine.

Source: Dionne Gleaton, Times & Democrat [6/29/09]

Alleged Unnecessary Bunion Surgery Damaged Nerves (New York)

Facts: On Feb. 11, 2002, plaintiff Susette Ryniec-Schilia, 51, a chemist, presented to defendant podiatrist, complaining of worsening pain in her right foot. Ryniec-Schilia had had pain on and off for five years. Defendant ordered an X-ray, diagnosed hallux rigidis and mild hallux valgus, and advised her that the only definitive way to treat the condition was surgery.

On March 14, 2002, defendant performed a Waterman osteotomy with a chielectomy. Ryniec-Schilia's pain became severe three months later. Ryniec-Schilia sued defendant, alleging that he failed to treat her conservatively and that he negligently performed an unnecessary surgery. She said that he had not told her of any alternative to surgery. Ryniec-Schilia claimed that defendant should have treated her first with orthotics, a shoe change, physical therapy, steroid injections and pain medication. According to her later treating surgeon, Dr. Michael Parentis, defendant should have operated only if those measures did not provide relief and even then should have performed only a chielectomy, not an osteotomy.

Defendant argued that he had properly advised the plaintiff of her options and that the surgery he performed was not unnecessary. He denied departing from any standard of care. He said that she had told him that her pain had recently become constant, which the plaintiff disputed.

Result: Defense Verdict

Plaintiff’s expert witnesses : Joseph Carbone, DPM; Rochester, NY Michael Parentis, M.D.; Orthopedic Surgery; Buffalo, NY Romanth Waghmarae, M.D.; Pain Management; Buffalo, NY Ronald R. Reiber, Ph.D.; Economics; Buffalo, NY

Defendant’s expert witnesses: Charles Coyle, DPM; Rochester, NY Shari Withiam-Leich, M.D.; Neurology; Buffalo, NY Thomas Lombardo Jr., M.D.; Orthopedic Surgery; Buffalo, NY

Source: VerdictSearch New York Reporter Vol. 26, Issue 41

Query: Non-Painful Limb 1 Year Post-op

A 10 y/o F with painful pes planus and assoc forefoot deformity L>R, painful during activities, failed conservative treatment.  On 7/11/08, the following procedures were performed: arthrodesis talo/nav joint, advancement posterior tibial tendon with spring ligament (McGlamry’s technique), Austin bunionectomy, TAL. One year post-op, she reports no pain, she is able to play basketball with no foot pain or swelling. X-rays show a non-union of T/N, not painful and stable. Dorsiflexion is about +10 degrees on the surgery side  ankle joint and -15 on non-sx side. The continued complaint is that she still has a limp. Her muscle strength seems normal and basically symmetrical.

Her PMH is not contributory except that she was born with spondylolithesis and underwent a L4-5 fusion 12/20/06. Gait evaluation showed a limp with a very early heel-off on the non-surgical side. My first thought was over-lengthening of Achilles, but the exam shows only +10 on the surgery side vs. a marked equinus on the non-sx side.  Will a simple heel lift help? Has anyone seen this non-painful limp in a child 1 y post-op? Ideas and comments appreciated.
 
B.T. Sullivan, DPM, Jackson, MS

Query: Laser Repair

Does anyone know of someone who services a Directed Energy (Pfizer) Model 20C CO2 Laser?

Stefan Feldman, DPM, Westlake Village, CA

RE: Peeling on Heels (Patrick J. Nunan, DPM)
From: Steven H. Goldstein, DPM

Although there could be many causative factors, this may simply be an issue of excessive friction. I would still take a sample of the skin and send it out for a culture, but it this proves negative, I would try the following treatment plan. Have the patient try placing a Spenco innersole or something similar in the sneaker to reduce the amount of friction. You may also have her rub a moisturizer into her skin before putting on her socks. Thor-Lo or some other brand  of socks with padding may also help reduce shear forces.

Steven H. Goldstein, DPM, Royal Palm Beach, FL, stevefootdr1@yahoo.com
 

RE: Melanoma in Situ (Bret Ribotsky, DPM)
From: Paul Hilbert, DPM

Three years ago, an 81 y/o female presented to my office at the suggestion of her PCP's nurse practitioner to get her toenails cut. She said that the nurse practitioner had been treating an ulcer on her heel for the past 2 months. When I saw this:

Melanoma

I explained to her that my training extends beyond toenail cutting and I strongly believed that this lesion is not a "normal" looking ulcer. I got her consent to do a punch biopsy and marked it urgent. Two days later…

Paul Hilbert, DPM, Navarre, FL, coastalp@bellsouth.net

Editor's note: Dr. Hilbert's extended-length note can be read at: http://www.podiatrym.com/letters2.cfm?id=27125&start=1

RE: Answering Service (Anas Khoury, DPM)
From: Sam Bell, DPM

We use an answering service that has two levels. People calling get a message with our office hours and an option to stay on the line if they need to speak to someone. Most calls do not go on to a person, but if one is needed, they do a pretty good job of handling the call per our instructions. I have noticed that most insurances that we participate in frown on answering machines.  When we filled out the insurance application and got to the emergency coverage part, it said that "an answering machine with a message saying go to the emergency room" is not satisfactory.

Sam Bell, DPM, Schenectady, NY, dpmbell@aol.com

RE: DC Podiatrist Supports Public Healthcare Option
From: Paul Busman, DPM,RN

Kudos to my classmate and friend Steve Pribut for supporting a public healthcare option. Most docs I know, both in podiatry and other fields, view this as nothing short of raging communism, which is really a shame. It's scandalous that a country like the USA can't provide healthcare for all of its citizens. Sure, docs may make a bit less income, but didn't we all sign on to help all people. 

Paul Busman DPM,RN, Clifton Park, NY, brewerpaul@aol.com

ASSOCIATE POSITION AVAILABLE-MIDTOWN MANHATTAN 
 
Looking for Full-time associate to work in well established practices in midtown Manhattan and Forest Hills. Immediate opening for PSR 24-36 surgically trained Podiatrist. Great opportunity with competitive salary along with malpractice benefits. Position includes Saturday office hours. Please send CV to slurie@papapc.net

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS 

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

INTERESTED IN JOINING A DYNAMIC GROUP PRACTICE?

That treats all patients ethically? · That offers an academic environment with an exceptional residency program?· That will improve your clinical and surgical skills?· That offers a strong case load to get you Board Certified fast?· That provides a guarantee for growth and advancement? Does this sound unusual and refreshing? IT IS! Do NOT miss this incredible and exciting opportunity- apply now to: Hudson Valley Foot Associates, PO Box 3300, Kingston, NY 12402-3300; or email CV and cover letter to: jobs@hvfa.com

PRACTICE FOR SALE – NEW YORK CITY

NY Manhattan, prime location. Upper East Side, 23. Y.O. practice, high visibility-traffic area next to post office, street level, All phases of Podiatry, NO surgery, retiring due to disability. call 516-759-4062 or Paulfxfeet@aol.com

PRACTICE FOR SALE - FLORIDA

Who wants to continue making good money in a down economy, and who would like to live in Florida on the coast? I have been working for over 45 years and have had enough. My business grosses over $940,000 dollars a year and my net is over $250,000. I see approximately 40 patients a day in a coastal Florida town and am sitting on a little gem. Office is 2000 sq. ft. Hospital very close with surgical center. Large scope of practice in Florida. Contact me if you are ready to step up. $585,000 dollars. Contact me at: hagen5644@yahoo.com

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

PRACTICE FOR SALE - ALABAMA, GULF COAST

Established 26 year old practice. Owner desires to sell and relocate. Operated 25 hours per week. Mixture of surgery and general podiatry. MD referrals. Surgery center and hospitals in close proximity. Highly profitable. Priced to sell.  Will lease office to buyer. Call Mike Crosby at 888-776-2430 or email mcrosby@providerresources.com

ASSOCIATE POSITION – MARYLAND

Maryland Eastern Shore Practice has opening for associate with ownership interest. MCR approved ASC, EMR, Ultrasound, Flouro, with Hospital Privileges available. E-mail CV to: patimmons@comcast.net 

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