The Voice of Podiatrists

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July 04, 2008 #3,289 Editor-Barry Block, DPM, JD

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IN Podiatrist Warns on Long-Term Effects of Wearing Flip-Flops

The popularity of flip-flop sandals has some experts concerned about the long-term effects on your feet. These inexpensive shoes can have a costly effect if worn excessively over time, according to Muncie podiatrist Dr. Matthew Dewitt.

Dr. Matthew Dewitt

“I think over time we’re going to see more people coming in with bunions, hammertoes, flat foot and general arthritic problems just from basically going barefooted in flip-flops,” Dr. Dewitt said.

Dr. Dewitt recommends saving your flip-flops for the pool. He also recommends wearing tennis shoes with good arch supports when walking long distances.

Source: Tiffany Taylor, Newslink Indiana [7/2/08]

Summer Footwear is a Balance Between Fashion and Comfort: Canadian Podiatrist

Blisters are a common problem with summer footwear, but often go unnoticed until you've been on your feet for a while, says podiatrist Dr. Julie Enrico at the Associated Foot Clinic in Edmonton. "Protect the skin before they blister," she warns. "If you know that you have a tendency to get rubbing on the heel or straps you should get blister protection pads."

Dr. Julie Enrico

Enrico acknowledges that women do have to find a balance between looking feminine and feeling comfortable. Dressy sandals are better for your feet, she says, if they have a thicker, more flexible sole and a lower heel. But a lot of the time, "you have to find what looks good first and then kinda find what's comfortable."

The Naot sandals are not as bulky as Birkenstocks, and they're a little more feminine looking," says Enrico. "They're not as dressy but for everyday walking, (something) more casual, those are really good."

Source: Jennifer Fong, Canwest News Service [7/2/08]

Prime Healthcare Faces Lawsuit Over Balance Billing

California regulators are suing Prime Healthcare Services, a Southern California hospital chain, to stop it from seeking payment from HMO patients for unpaid medical services, a practice known as balance billing. The state Department of Managed Health Care (DMHC), which regulates HMOs in California, filed the lawsuit in Orange County Superior Court. The action seeks a court order prohibiting Prime Healthcare from engaging in alleged balance billing, and penalties of up to $2,500 per violation.

The state alleges that Prime Healthcare has billed thousands of emergency room patients for outstanding payments, using its own collection agency to seek reimbursement. About 6,000 Kaiser Permanente patients have received collection notices from Prime Healthcare, and in May, Kaiser won a temporary restraining order to halt the practice while its own case against Prime Healthcare moves forward.

Prime Healthcare said in a written statement that “this frivolous suit is not about the actions of one provider but the failure of the DMHC to do its job to regulate HMOs and provide assistance to providers who have the right to be reimbursed properly for emergency services rendered to HMO enrollees.” The DMHC has issued draft regulations that would ban balance billing for emergency services, but those rules are not yet final.

Source: Rebecca Vesely, Modern Healthcare [7/2/08]

Improve Staff Meetings

“What are the three most important things we need to cover in this session?" Limit the agenda to those items. Anything else, by definition, was not that important; so don’t waste the group’s time.

Source: Adapted from Conducting Effective Business Meetings by Doug Staneart

Query: Paronychia in a 6 Week Old Infant

I have a 6 week old infant with paronychias of both halluces. The mother states that the infant was born with this problem. The distal aspect of the toe has granulation tissue present preventing the nail plate from growing out. I started cortisporin otic solution and daily soaks. Short of performing surgery to remove/remodel the distal aspect of the toe, any pearls would be appreciated.

Stuart W. Honick, DPM, Hammonton, NJ

RE: Large Post-op Shoe (Jeffrey Kass, DPM)
From: Multiple Respondents

I have a patient who wears a size 17, and I was able to fit him into a Darco Body Armor Walker II. This was the only walking boot I could find that would fit him. Gill carries them in both a high and low model. It *might* fit a size 18, but definitely test fit it before dispensing. If that doesn't work, another option would be to put him in a short-leg walking cast, or perhaps a slipper cast.

Robert Wunderlich, DPM, San Antonio, TX, rwunder@gmail.com

Depending on the procedure, use the old time-honored “slipper cast” or simply a BK cast.

Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

Consider a posterior splint with fiberglass or fashion a foot cast.

Simon Young, DPM, NYC, NY, simonyoung@juno.com

RE: Protocol for NAOH (Marta Losa Iglesias)
From: Marc Katz, DPM, Name Withheld

Marta, I did reflect on your words and conclude the following. All patients are different and unique and all doctors are different and unique, that's a fact. We all commented on the same basic procedure and they all were very similar with minor modifications to accommodate the unique patient and the unique Dr. We are all doing the right thing. Or do you believe that the procedures explained by Rounding and Bloomfield are the only answer? I believe that matrixectomies are proven straightforward procedures that do not require any new extensive research.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

I applaud Ms. Inglesias' suggestion that our profession would benefit from investing in evidence-based medicine. I feel much more comfortable offering treatments based on solid research and hard science. Institutions like Scholl's CLEAR center are the future of our profession. Cochrane Data Base is an excellent suggestion for finding the most up-to-date information available on clinical questions. Registration is free. Thus, I recommend to other doctors considering a switch to a new method of treating ingrown nails the following:

Sodium Hydroxide Chemical Matricectomy for the Treatment of Ingrown Toenails: Comparison of Three Different Application Periods Viewed at: http://podiatrym.com/go.cfm?n=210

Frankly, I get a great deal of value out of hearing the experiences of my colleagues. Some opinions offered are based on many years of clinical experience. I feel the criticism offered was both harsh and unnecessary. Please continue to provide a forum for practitioners to seek advice and benefit from the experience of others.

Name Withheld

RE: Automatic Processor (Vincent L.Travisano, DPM)
From: Dan Klein, DPM

I have used the 2010 All Pro processor for over 10 years. It takes little maintenance and has been a workhorse for my office.

Dan Klein, DPM, Fort Smith, AR, toefixer@aol.com

PRACTICE FOR SALE WA STATE: BELLINGHAM - WITH ASC

Located by hospital and medical community. Owner will carry part of financing. Potential for increased revenue abounds. This is a value that should not to be overlooked. Bellingham is rated in national magazines as one of the most desirable places to live or retire. 386 597-5766.

ASSOCIATE POSITION - CALIFORNIA

Central Valley/Southern CA. Salary excellent with all paid benefits/incentives including malpractice/401k and profit sharing. Surgery Center and hospital based with no HMOs/no rest homes. Bilingual in English and Spanish. Offering a permanent position/partnership in a multi-million dollar hi-tech practice. E-mail CV to: Tonya@wetreatyourfeet.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 full-time podiatrist in a multi practice location
in the Chicago land and Northwest Indiana area. Must have two years of surgical residency. Please e-mail resume to d-kitchens@footexperts.com

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

IMMEDIATE OPENING - MINNEAPOLIS, MN

Associate leading to partner in well-established practice. Seeking personable, skillful, and attentive podiatrist. No nursing homes, evenings or weekends. Competitive compensation package including health insurance, malpractice, short term disability, 401(k), generous vacation, paid holidays, and excellent salary plus bonus! E-mail cover letter and CV to jbremer@associatedpodiatrists.com or fax to (612) 866-5875 attn: Jennifer Bremer

ASSOCIATE POSITION - BOSTON, MA

Associate wanted, Full-time or part-time, for busy long time, well established, and well rounded practice. Good mix of general podiatry and surgery. Office will generate approximately 100+ surgical cases per year. Must have surgical background for this practice, ABPS Qualified minimum needed to obtain hospital privileges. Associate position is open for partnership or purchase. Contact robert.nunberg@comcast.net

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. 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

ASSOCIATE WANTED IMMEDIATELY – NEW YORK

Part-time or Full-time for group practice Fast track to partnership. Located in Orange & Sullivan County, NY. Commute from adjoining counties to see how it fits. Monroe, NY office is only 1 hour from Manhattan. All phases of podiatric care. Call Dr Marc Hudes 845-807-8864. Check out our practice website

ASSOCIATE POSITION WITH OPPORTUNITY FOR PARTNERSHIP NY/PA

Group practice located on NY-PA border with excellent growth in the area’s industrial, retail, and college campuses. Surgical privileges in medical centers in NY and PA. This position will involve rotating through multiple office locations, and wound care centers. Local insurance reimbursement involves mostly private pay PPO models. We are looking for an ABPS Board Qualified podiatrist to join our team. Candidates would need to obtain licenses in NY and PA, and become ABPS certified to maintain hospital privileges. Base salary starting at 85,000.00 with bonus plan incentive, vacation, and health/mp insurances. Forward CV to prefprovider@hotmail.com

ASSOCIATE POSITIONS – CALIFORNIA

Coast to Coast Mobile Podiatry Group, California's premier provider of mobile on-site health-care services is seeking hardworking, caring Associates to provide excellent health-care to the greater Los Angeles areas, Organge County, San Bernadino County, Riverside, San Diego, and Santa Barbara. Salary and benefits available. Please email you CV and salary request to coasttocoastpodiatry@yahoo.com

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