The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

July 02, 2012 #4,503 Publisher-Barry Block, DPM, JD

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NY Podiatrist Discusses the Dangers of Flip-Flops

Flip-flops are all the rage on the Fourth of July, but by Labor Day, podiatrists' waiting rooms are often full of hobbling examples of the dangers of wearing flip-flops as a primary form of footwear. “They are fine for the pool deck or a casual barbecue,” suggests podiatrist Dr. Marc Ginsburg of Capital Region Foot Care in Albany. “But they are really not good for prolonged walking or any situation where you are going to be standing on your feet for long periods of time.”

Dr. Marc Ginsburg

The most troublesome problems associated with flip-flops are attributed to the way they can undermine healthy foot biomechanics, says Ginsburg. “The reactive forces of your foot hitting the ground are so much more dramatic when your foot is in a shoe that is flimsy and thin.”

Source: Beth Cooney, Albany Times Union [6/29/12]

MD Podiatrist and Vascular Surgeon Now a Doubles Team Again

When Dr. Tom Reifsnyder and Dr. Alex Kor combine to save someone’s foot at Johns Hopkins Bayview Medical Center, perhaps they have the same feeling of accomplishment they did when the Terre Haute North boys tennis team had a successful match nearly 36 years ago. Although their paths diverged, In 2003, Kor became one of the podiatrists at Kaiser Permanente, a clinic in Washington, D.C. “I lost track of [Reifsnyder] for several years. One day, I decided to Google him, and I discovered that he was working at Johns Hopkins Bayview,” Kor recalled. “I sent him an email and we re-connected.”  

(L-R) Drs. Dr. Tom Reifsnyder and Alex Kor

“He called me one day at work [last fall] and asked if we might be looking for a podiatrist,” Reifsnyder said. “I literally walked down the hall and ran into a supervisor, who was indeed looking for one.” By March 1, the two were in the same hospital. Kor, who has a particular interest (no surprise) in tennis injuries and other athlete-related foot problems — and who writes a column on injuries and their prevention in a tennis journal — is an accomplished surgeon. A No. 1 doubles team, if you will.

Source: Andy Amey, The Tribune-Star [7/1/12]

MPMA Provides Pedicure Safety Advice

As the warmer weather finally arrives, sandals and flip-flops are making their way out of the closet and slipped on underneath beautifully manicured feet. The pedicure season has begun! Unfortunately, not all pedicure facilities offer clean and proper foot care, and infections and other foot ailments may arise. The Michigan Podiatric Medical Association (MPMA) wants to make sure you keep the following advice in mind as you select where you may go for a pedicure: 

Make sure that the instruments used are clean and sterilized. Ask technicians which cleaning procedure they use, as well as the frequency of cleaning. Soaking in alcohol is NOT an approved sterilization method. Sterilization – rather than disinfecting – is the best method. This can be done by using a cleaning agent such as hospital bactericide, fungicide or viricide. Instruments can be sterilized in an autoclave or ultrasonic machine. If you are diabetic, pedicures are not advised. Visit your podiatrist before receiving a pedicure to identify any potential risks.

Source: WXYZ [6/30/12]

Podiatry's Most Challenging Procedure to Code

Many ASC coders will tell you that they find podiatry surgery to be one of the most challenging specialties to code. One podiatry procedure in particular — Haglund's deformity resection — is definitely a challenge to code. When auditing ASC podiatry cases, Lolita Jones, PHIA, CCS usually finds that the Haglund's deformity resection has been miscoded, and during coding training sessions with ASC coders, she finds that many are unclear about the clinical aspects of both the deformity and the surgical procedure. In the May 2011, CPT Assistant newsletter, the American Medical Association provided the following coding guidelines: Haglund's deformity and retrocalcaneal bursa removal with osteotome is coded as CPT 28118 Ostectomy, calcaneus; if additional work other than for exposure is also performed on the Achilles tendon, such as debridement of necrotic tissue, then also assign code CPT 28200: repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon.

If there is a spur on the bottom of the foot and a plantar fascial release is also performed, assign code CPT 28119 (with or without CPT 28118): Use CPT 28119: ostectomy, calcaneus; for spur, with or without plantar fascial release.

Source: Lolita Jones, Outpatient Surgery [June 2012]

Medicare Pay Woes are Medical Practices' Top Challenge: Survey

The sustainable growth-rate formula calls for slashing physician Medicare payments by more than 30% on Jan. 1, 2013. Uncertainty over whether that cut will take effect is the No. 1 concern of medical practice managers, according to the MGMA-ACMPE's fifth annual survey on the challenges of running a group practice. The MGMA-ACMPE, formerly the Medical Group Management Association, invited its members via e-mail to participate in an online survey ranking 54 daily challenges on a five-point scale. The 1,252 respondents identified "managing finances with the uncertainty of Medicare reimbursement rates" as their most intense daily professional challenge.

Other top five challenges for medical practice managers included preparing for payment models that "place a greater share of financial risk on the practice," preparing for the transition to the ICD-10 diagnostic and procedural codes, rising expenses, and participating in the federal incentive program for the meaningful use of electronic health-record systems.

Source: Andis Robezieks, Modern Healthcare [6/26/12]

Query: Congenital Adducto-Varus 4th Toe

I have a healthy 5 year old patient who has a congenital adducto-varus 4th toe on her right foot. PMH: unremarkable, x-rays show normal met parabola, growth plates, and visible bones appear WNL. It appears to be strictly a problem with the flexor tendon. The deformity seems to involve the PIPJ. I had the parents try taping the toe over the last year without improvement. It is easily reducible and I think a tenotomy would help correct the problem. My question is where would you perform the tenotomy, the DIPJ or the PIPJ?

Mark Ray, DPM, Latrobe, PA

RE: Severe Metatarsalgia (Judd Davis, DPM)
From: Todd Lamster, DPM, Dennis Shavelson, DPM

I would treat this like a rheumatoid foot, and perform the procedure that Dr. Davis  suggested, with the addition of "cleaning up" the stumps on 3 and 4. Perform a lesser metatarsal head resection with 1st MTPJ fusion.

Todd Lamster, DPM, Phoenix, AZ, tlamster@gmail.com

I believe a third surgery should be contemplated but put on the shelf until conservative, interventional care is exhausted. A Hoffman-Clayton’s comes to mind in light of the osteopenia and the iatrogenic parabola that this patient has been gifted with by her surgeons.
 
The easiest, quickest fix would be rocker bottom shoes. They obviate the internal forefoot rockers of the foot in lieu of the external rocker of the footgear: Shavelson, D, Rocker Bottom Shoes: A Position Paper, Present Podiatry Biomechanics, eZines, 12/30/2010.
 
Simultaneously use foot centering pads, foot type-specific, along with muscle engine compensatory threshold training as a test drive to see if a program of internal biomechanical care can be of benefit. Augment this with physical therapy and injection therapy to control the patient’s symptoms while increasing her quality of life. A consultation with a biomechanically-passionate podiatrist may be in order if this posting seems too challenging or time-consuming.
 
Dennis Shavelson, DPM, NY, NY, drsha@lifestylepodiatry.com

RE: Implant Exchange (Alan Spector, DPM)
From: Steve Goldman, DPM, MBA

The HemiCap will pretty much pop out. The stem of that implant has a corkscrew pattern and will unscrew easily. I suggest looking at the Primus implant (tornierdx.com/futura/primus.php). I've been using it with some degree of success from both a cosmetic and patient relief perspective.

Steve Goldman, DPM, MBA, NY, NY, stevegoldman@att.net

RE: Unrestricted Medical Licences (Leonard A. Levy, DPM, MPH)
From: Elliot Udell, DPM

Dr. Levy is correct when he says that even though anyone with an MD or DO degree could theoretically do brain surgery the day after getting a medical license, no one would dare do a complex procedure without years of training and certification in that procedure. The practice of medicine, in terms of what we demand as adequate training of medical practitioners, has come a long way. There is, however, an elephant in the room that society is ignoring and needs to be addressed before too many people are injured.

PAs and nurse practitioners with very limited training can virtually do any and every medical and surgical procedure under the licence of the doctors they work for. Although this lacks medical ethics, it makes good business sense for some busy physicians to...

Editor's note: Dr. Udell's extended-length letter can be read here.

RE: CA Podiatrist Comments on Supreme Court Decision on Affordable Care Act 
From: Robert Scott Steinberg, DPM

What  candidate Rogers did not say is that of the two choices for president, only President Obama will go after the health insurance companies and rein in even more of their abuses, including discriminatory premium pricing.

Robert Scott Steinberg, DPM, Schaumburg, IL, Doc@FootSportsDoc.com

RE: NY Assembly Passes Expansion of Scope of Practice Law (Fred J. DeLucia, DPM)
From: Vito J. Rizzo, DPM

I read and much appreciated Dr. DeLucia's post in PM News. As someone who has been deeply involved in this effort, I can confirm that everyone toiled selflessly with the single purpose to improve the climate for podiatry in New York. The effort took years to get us to this victory, and it took countless hours of dedicated volunteerism on the part of many of our members. Many more did absolutely nothing to help. The benefits of this Bill will be appreciated by all of us in one form or another. Let the detractors become quiet now, for it is time for our profession to pull together, think of the future, and finish the job without in-fighting and spreading of misinformation.

Vito J. Rizzo, DPM, Bayshore, NY, vjrizzo@optonline.net

Retiring from practice. Equipment For sale. Mini x-ray. One year old Ultrasound with MS arterial/venous X-ray plates. Great condition Ritter chairs. Drills, surgical tools. So much. Just ask, I probably have it: Footcare@comcast.net

WANTED TO PURCHASE- PINPOINTE LASER

Seeking to purchase Pinpointe used laser. Willing to pay top dollar. Please contact us at:sbalandrano@zapnails.com or (1) 713-541-3764. Product Information: Product: PinPointe (Patholase) Company: Cynosure / PinPointe Type: Nd:YAG Options: Podiatry/Toenail

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 516 476-1815PODO2345@AOL.COM

PRACTICE FOR SALE – KANSA  SOUTHWEST

For sale multi-location practice in beautiful Southwest Kansas. Practice has 10-15% growth in revenues with increase in new patients and patient visits. EHR is already implemented with meaningful use criteria met. Recently added new office space with digital x-ray. Only surgical podiatrist in 2 of 3 locations. Practice has been professionally evaluated by Provider Resources. Only serious inquiries to this email address. This is a great practice, a great location and opportunity for the right doctor. mcrosby@picagroup.com

PRACTICE FOR SALE - BALTIMORE, MARYLAND

Established 40+ year old well-rounded practice of both surgical and non-surgical care with special emphasis on sports medicine. Medicare and BS/private insurance base, no Medical assistance. Needs to transition to a confident well trained individual. Purchase can include building. Contact: podiatrypracticesale@gmail.com

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