The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

July 05, 2010 #3,901 Publisher-Barry Block, DPM, JD

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OH Podiatrist Opposed to Flip-Flops in a High School Setting

Dr. Robert Atwell, a local podiatrist, is not a personal fan of flip-flops. “It’s one thing for high school kids to wear them around the pool or something like that,” he said, “but I’m not a big fan of flip-flops in a school setting. I think it is appropriate to ban them, as well as open-toed shoes. Besides the potential for injury, and certainly for adults, flip-flops provide no support, and I think support is important."

Dr. Robert Atwell

"With young people, their feet are going to be a little more forgiving, but when you think about wearing flip flops, the toes are going to curl a little bit to keep the flip-flop on the foot. And that will affect the gait. When you don’t have support around the heel counter, like the back of a shoe, it would tend to allow the foot to pronate more.” Atwell said he also thinks it is very practical to prohibit shoes with heels over 3 inches high.

Source: Pamela Schehl, Mt. Vernon News [7/1/10]

Scholl Researchers Publish Paper on DPN and Postural Control

Scholl’s researchers, for the first time, demonstrated a potential deficit in postural compensatory strategy in diabetic patients suffering from peripheral neuropathy. In a recent study published in the Journal of Diabetes Science and Technology entitled ‘Assessing Postural Control and Postural Control Strategy in Diabetic Patients Using Innovative and Wearable Technology’, Scholl’s CLEAR researchers explored postural control and postural compensatory strategy (PCS) in 17 patients with diabetic peripheral neuropathy (DPN) and 21 healthy subjects.

(L-R) Deena Horn (Scholl '12) and Dr. Bijan Najafi

This study suggests a novel index that allows quantifying PCS performance (i.e., anticipatory strategy to compensate movement of the proximal segment by movement of the distal segment). Clinical results of this investigation suggest that alteration in somatosensory/proprioception feedback due to DPN will significantly impact postural reciprocal coordination between ankle and hip joints movements. This important study is a fruit of a student summer research study led by Bijan Najafi, PhD (lead author) and Deena Horn, a Scholl student.

NY Podiatrist Returns to His Foot Constituency 

In the months since losing last year’s primary to Jumaane Williams, Kendall Stewart has had time to put his feet up—or, at least, others’ feet. “That was one stage of my life,” said the former Council member and podiatrist, discussing his time in politics via phone from his East Flatbush office. “Now I’m moving on to do other things and serve the people in another way.”

Dr. Kendall Stewart

Today, Stewart reflects openly about the vote to extend term limits which ultimately proved a liability in his district, saying he only voted for the extension because he wanted to work a few more years to qualify for a full city pension. Now out of politics, Stewart says he is putting more time into his podiatry practice on Church Avenue in Brooklyn, working two days a week at a nursing home and also still devoting at least one day a week to community affairs. The people, who had been coming for the past eight years, still look to him for help.

Source: Katie Honan, City Hall [7/1/10]

WA Podiatrist Accused of Medicare and Medicaid Fraud

A Yakima podiatrist is accused of falsely billing the federal government for more than $700,000 worth of Medicare and Medicaid payments. Federal prosecutors in Spokane filed a civil lawsuit Wednesday against Curtis Holden, the owner of Yakima-based Advanced Podiatry Specialists.

The lawsuits allege that the Medicare program overpaid Advanced Podiatry at least $701,000 between 2004 and 2007. The bills included surgery, office visits, and medical equipment. The complaint alleges that Holden, as the authorized biller for the practice, submitted invoices for himself and two other podiatrists, even though those services were never performed.

Source: Yakima Herald-Republic [7/2/10]

RE: Undiagnosed Nail Disorder (Kevin Lam, DPM)
From: Bryan C. Markinson, DPM, Michael Koch, MD

Dr. Lam presents a case of nail pitting and thinning in an 8 year old girl. He states that a nail biopsy was signed out as onychauxis. Onychauxis means "thick nail."  Yet clinically, he characterizes the nails as "thin." This leads to question what constituted his nail biopsy. Was a piece of nail fixed in formalin? Did he send clippings for fungus culture and KOH? I would like to know this information.

Nail pits, if no external cause exists, must be derived from a situation in the nail matrix, meaning the pathology would lie in the area represented by the visible lunula and proximal maitrix under the nail fold. If the pits are visible on the dorsal nail, then the pathology is more proximal in the matrix. Therefore, a better diagnostic "biopsy" would be a sample of the proximal matrix after nail avulsion. Due to the lack of serious problems associated with this clinical picture, it may be a bit much for an 8 year old. There should be a search for an atopic history as well, not only in the patient but in any first degree relative with asthma, hayfever, or eczema.

A trial matrix injection of a steroid using a very fine gauge needle, 26 or 30 may be used empirically to rule out an inflammatory cause, but also may be a bit much for an 8 year old.

Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org

The likely diagnosis is a nail dystrophy, specifically 20 nail dystrophy or “trachyonychia,” which most commonly occurs in childhood and is characterized by longitudinal ridging, pitting, loss of luster, and roughening of the nail plate surface. The disorder typically affects all twenty nail plates of the hands and feet. Slight nail abnormalities may be present at birth, with the condition slowly progressing over the years to cause changes in texture of the nail. 

The cause of this disorder is unknown, but can be associated with other skin disorders such as lichen planus, eczema, psoriasis, and alopecia areata. Males are more likely affected than females, and cases are typically self-limiting, and spontaneously resolve slowly with age. Treatment, which typically is ineffective, can include griseofulvin, or oral antifungal agents, systemic or topical corticosteroids, or PUVA. 

Michael Koch, MD, Director, Pathology Lab of Georgia, LLC

RE: Physician Status in Title XIX
From: John Chisholm DPM
 
I have just returned from the 2010 California Podiatric Medical Association House of Delegates meeting, where Kathleen Stone, Michael King, and Glenn Gastwirth spoke at length about the Title XIX legislation. I'm mad. I'm mad at APMA for painting an unrealistically rosy picture of our chances of getting our bill passed, especially at PPAC donation time, and then watching it go down in flames, year after year. I'm mad at APMA rank and file members who refuse to make a small contribution to PPAC, or take 3 minutes to send out an e-advocacy e-mail, or do any grassroots lobbying for our bill.
 
But I'm especially mad at the non-APMA members who keep their dues money in their bank accounts and who, when our bill DOES eventually become law, as I know it will someday, will reap all the benefits of Title  XIX inclusion while riding on the backs of dues-paying APMA members.  There should be no free ride. If you belong to APMA, get to work. If you don't, join today.
 
John Chisholm, DPM, San Diego, CA, dr_triguy@yahoo.com

RE: Discharging a Neo-Nazi (Name Withheld)
From: Multiple Respondents

It is a sad reality that this is still an issue. The reality is, and in the spirit in which you provide care, can you be comfortable in continuing your treatment with this patient? I think the answer is clearly no. That being said, (unfortunately), you have to get the patient through her post-operative course. After that...go through the appropriate discharge/referral process. In the final analysis, you'll probably sleep better. It is your office and I have to respectfully disagree with the editor's opinion. This goes beyond politics...as history clearly states.
 
Suffice it to say, there is no shortage of stupid out there. Unfortunately "stupid people" are, too often, not educated as to the consequences of their actions. The rights and freedoms that are a bedrock foundation of this country cannot and should not be undermined by groups or individuals whose belief system would subvert and destroy those very freedoms we cherish. The best result is that your patient would learn the error of her ways and "lose the tattoos" and more importantly, learn why support of "Nazism" to any degree is morally reprehensible to all clear-thinking individuals.
 
As this is being written just prior to Independence Day, I hope all of us will take pause to enjoy the freedom we have and fight to preserve it...regardless of race, creed, or color.
 
Arnold B. Wolf, DPM, Sterling Heights, MI, omnifootcare@prodigy.net

Discharging a patient must be well thought out and executed within legal parameters. Discharging a patient during the course of acute treatment can be very problematic and must be a last resort. 
After the acute treatment is over, discontinuation of your services is less problematic. You certainly have a breach of the doctor/patient relationship. This is clearly a radical mindset, and I’m not sure that letting the patient know you are Jewish would not spur on some radical reactions should any problems arise in the course of treatment.

This particular case is absolutely amazing. If I put myself in your shoes, I would have to say it would be very difficult for me to compassionately treat that patient. As much as we are committed to being impartial, we are also humans. When we have choice and know this patient will be well served in other hands that, in my opinion, IS doing the humanitarian thing.  It may help to keep in mind that during war, we treat the enemy.

Jon Purdy, DPM, New Iberia, LA, podiatrist@mindspring.com

I will be happy to assume the care of Name Withheld’s  patient in my clinic here in Israel. 

We will know how to discharge her.

Richard Jaffe DPM, Jerusalem, Israel, footsurg@netvision.net.il

RE: Elastic Shoe Laces (Chuck Ross, DPM)
From: Jay D. Helman, DPM

Frankford Leather in PA sells elastic laces. The only thing you have to watch with them is that, if they don't have your complete order and they split the order due to back order, they charge you each time they ship. 

Jay D. Helman, DPM, Pearl River, NY, footdr80@hotmail.com

RE: TENS (Olga Luepschen, DPM)
From: Cynthia Rouse

In regard to the TENS units, I don't know about other states, but some of the Alabama Blue Cross/Blue Schield's have stopped paying for the units and all the supplies that go with them, so you might want to check into the insurance aspect of them before using them.

Cynthia Rouse, Athens, AL, cindyrouse123@yahoo.com

RE: Arrested Podiatrists (Bob Kornfeld, DPM, Meyer Arbit, DPM)
From: Elliot Udell, DPM

Drs. Kornfeld, Arbit, and all of us, rightfully should be upset when we hear about a colleague being punished for violating the law. Let's not, however, fall into the trap of feeling that we have more bad apples in our profession than in any other field of medicine. As a licensed practitioner in California, I've received  bulletins from the state which lists all of the medical professionals who were recently indicted for crimes ranging from fraud, selling illegal drugs, to sexually molesting patients. Podiatrists are at the lowest end of the totem pole when it comes to these high-end crimes committed by other medical professionals. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

ASSOCIATE POSITION - SOUTHEAST GEORGIA

Beautiful weather year round & near the Coast. Opportunity for Early Buy-in. Seeking associate or new residency graduate to join practice. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facilities. E-mail cover letter & CV to melissafoot@pol.net

PRACTICE FOR SALE - MINNESOTA

Practice Grossing over $500K yearly. Good mix of surgery, orthotics, DME, diabetic care, general podiatry. Commute < 5 miles to work. Friendly Midwest lakes area with arts, good schools, affordable living, restaurants, shopping. Option to purchase building. Will consider associate to buy-in/ buy-out. Midwestpractice@gmail.com

CANADIAN PODIATRISTS COME BACK HOME!

An Edmonton, Alberta group of DPM’s requires an additional Podiatrist. Interest in biomechanics essential. Given Canadian visa restrictions, this position is open only to Canadian Citizens or permanent residents. Very attractive compensation package. Fax C.V. or letter of interest to: (780) 483-5796.

ASSOCIATE POSITION - FREDERICK, MARYLAND

Fredericks premier group practice is located only 45 minutes from both DC and Baltimore. Immediate opening for a minimum PSR 36 Podiatrist for full time position. We have it all: EMR, digital x-ray, ultrasound, ASC, etc. Excellent salary with bonus structure and benefits. Please email resume to docsbnb@aol.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Full-time 3-DPM group in South Bay of LA County. Minutes from best living in LA County. Practice is an excellent mix of surgery, general podiatry, diabetic care, and DME. Beautiful office with EMR, Digital X-ray and Orthoses, etc. Please e-mail cover letter, and resume to footcareone@verizon.net

PRACTICE FOR SALE – MAINE

25 year full scope in medical building, podiatrist friendly hospitals, appreciative and cooperative patients, excellent expansion potential, physician referrals. Wonderful place to raise a family. Retiring seller will stay for transition. mainefootdoc@yahoo.com

TN PRACTICE FOR SALE (SOUTH OF NASHVILLE)

Active, established practice with new equipment (digital x-ray, ultrasound, computer network, etc.). Great referral network with an excellent scope of practice. Turn-key operation with seamless transition. Grossed over $350K last year. Call 931-446-5724 or e-mail mchad500@gmail.com

1-YEAR PODIATRIC SPORTS MEDICINE FELLOWSHIP - MONROVIA, CALIFORNIA

Applicants must have completed a podiatric residency program and must have or be eligible for a California license. Annual stipend: $48,000 and $60,000. If interested, please e-mail your resume with cover letter to the Program's management company at victoriamanagers@gmail.com

MANHATTAN MEDICAL SPACE AVAILABLE

Multispecialty Medical Building with 24/7 doorman. Prime Luxury Building and Location, Gramercy, Stuyvesant, Peter Cooper Area. 305 Second Avenue (17th-18th). Prior tenants past 23 years; podiatrist, dentist (plumbing/electric intact), internist. Ideal for podiatry, co-share with dentist, MD, etc. (flexible lease terms). E-Mail; jbdrun@aol.com Phone; 480-951-2480.

ASSOCIATE POSITION – COLORADO

Excellent opportunity to grow and expand a practice in the northern front range, Great compensation package with buy in potential. Desire individuals with motivation to succeed and grow professionally, Please fax CV and letter of interest to; 970-351-0940.

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