The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

July 08, 2010 #3,904 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2010- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Toning Shoes Can Benefit Some: NY Podiatrist

Cary M. Golub, DPM, a podiatrist in Long Beach, NY, says toning or rocker-bottom shoes have a place in certain people's shoe collection. For starters, these shoes may help people with heel pain, he says. "They take the pressure off of the heel and give more support to the ankle," he says.

Dr. Cary Golub

"These shoes put the strain on your hamstrings and glutes; so, if you are not athletic or a seasoned walker, they may hurt the muscles that they are supposed to help," Golub says. "If you are not used to firing these muscles, the shoes may hurt." Golub's advice: "Break them in slowly for an hour or so. Don't start walking 2 or 3 miles in them."

Source: Denise Mann, Web MD

Early Treatment of Adult Flatfoot Can Prevent Future Problems: MO Podiatrist

Treatment and prevention of adult flatfoot can reduce the incidences of additional foot problems such as bunions, hammertoes, arthritis, and calluses, and improve a person’s overall health, according to research published in the July/August Journal of Foot & Ankle Surgery. “Flatfoot disorder may gradually worsen to the point that many of the tendons and ligaments in the foot and ankle are simply overworking, often to the point where they tear and/or rupture,” said Karl Collins, DPM, FACFAS, a St. Louis foot and ankle surgeon. “If this occurs, even simple walking and standing become increasingly painful, requiring much more energy.”

Dr. Karl Collins

In many cases, flatfoot can be treated with non-surgical approaches, including orthotic devices or bracing, immobilization, physical therapy, medication, and shoe modifications. “In some patients whose pain is not adequately relieved by conservative treatments, there are a variety of surgical techniques available to correct flatfoot and improve foot function,” Dr. Collins added.

Source: Health News Digest [7/7/10]

Runners Need To Take it Easy After Blisters: DC Podiatrist

Landing differently can mess up your body's natural shock absorption system, creating a domino effect of problems up your leg. That's why Stephen Pribut, a Washington podiatrist specializing in sports medicine, advises you to take it easy a day or two after a nasty blister. A short break is unlikely to destroy your training regimen, and you won't risk having to "cool it" for a much longer time.

Dr. Stephen Pribut

The worst-case scenario, of course, is that your blister gets infected and you don't do anything about it. "Then your foot could get gangrene and fall off," Pribut says. That fate is fairly unlikely, since you'd be in enough pain by then to visit a doctor and get a prescription for oral antibiotics.

Source: Vicky Hallett, Washington Post [7/8/10]

AZ Podiatrist Receives ADA Lifetime Achievement Award in Limb Salvage

Dr. David G. Armstrong, Professor of Surgery and Director of the Southern Arizona Limb Salvage Alliance (SALSA) at the University of Arizona, became the youngest ever recipient of the Roger Pecoraro Award and Lectureship at the 70th American Diabetes Association in Orlando. "Professor Armstrong has had a lifetime of work in a fraction of a lifetime", noted Dr. Lee Rogers, Director of the Amputation Prevention Center in Los Angeles and ADA Foot Care Council Chair. He has produced more than 300 manuscripts with 143 co-authors on six continents and mentored more than 40 physician and scientist leaders in the field. It is unprecedented.

(L-R) Drs. Lee Rogers and David Armstrong

Armstrong, in his formal remarks, was more circumspect, "This is such an honor, but we have so much work ahead of us.  Every 30 seconds someone loses a leg because of diabetes. These problems are preventable. These problems are worth a life's work."

TX Podiatrist Receives Appointments at University of Texas

Dr. Lawrence Lavery has assumed a position as a tenured professor at the University of Texas Southwestern Medical Center in Dallas, Texas. Dr. Lavery will have a joint appointment in the department of plastic surgery and the department of orthopaedic surgery.

Dr. Lawrence Lavery

Lavery will also act as the medical director of the comprehensive wound program at the University of Texas.

WI Podiatrist Suffers Injured Foot in 4th of July Celebration Mishap

Randy Kittleson, DPM, of Verona, Wisconsin, was injured by a pair of runaway carriage horses during a parade in Bellevue, Iowa, on Sunday, July 4th. The University of Wisconsin Health System podiatrist was viewing the 4th of July parade with his wife, Pam Kittleson (a University of Wisconsin pharmacy specialist), and his two young children when the two horses bolted through the small Iowa town.

Dr. Randy Kittleson

Randy Kittleson grabbed his children to snatch the youngsters out of harm’s way, as the horses raced through the 4th of July parade route. In the melee, one of the horses stomped on Randy Kittleson’s left foot, causing a podiatric fracture. The Kittlesons’ children suffered scrapes and bruises in the incident.

Source: Madison Equestrian Examiner [7/6/10]

HHS Sends Final Meaningful-Use Rules to OMB for Review

HHS has sent its final meaningful-use rules and certification criteria for electronic health-record system testing to the Office of Management and Budget—typically one of the last bureaucratic hurdles before rules are released. The criteria are called for under the EHR subsidy program established by the American Recovery and Reinvestment Act of 2009.

Under the Medicare provisions of the stimulus law, to receive an estimated $14 billion to $27 billion in federal subsidies for EHR purchases, hospitals and qualifying office-based physicians must use certified EHRs in a “meaningful manner.”

Source: Joseph Conn, Modern Healthcare [7/6/10]

Query: OPEIU and Podiatry

What exactly, has the OPEIU done for podiatry? Someone please enlighten me.

Steven D Epstein, DPM, Lebanon, PA

RE: 5th Metatarsal Fracture Complications (B. Zaccardelli, DPM)
From: Multiple Respondents

Are you sure it's a Jones fracture and not an accessory ossicle? Take a contralateral view.

Jennifer Ryder, DPM, Rapid City, SD, jenbenryder@yahoo.com

I would have tried a bone stimulator on the patient. Even though there were no clinical symptoms,  Jones fractures, in particular, are known for non healing.  Since, the radiographs are not available to us for review, I leave it to the discretion of the doctor to decide if this is a viable option.
 
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

Many musculoskeletally immature adolescents are frequently misdiagnosed with 5th metatarsal avulsion fractures that are easily confused with open apophyses. The failure of such an injury "to heal" may certainly raise suspicion. For clarification, the term "Jones fracture" is used to describe a 5th metatarsal fracture at the metataphyseal diaphyseal junction, not a basilar avulsion fracture. 
 
Prior to any surgical consideration, I would obtain a contralateral foot radiograph to evaluate the presence of a similar open apophysis, and a CT scan to further delineate the presence of actual fracture vs. open growth plate. Certainly, children can sustain Salter 1 type fractures of the open apophyses, and if this is the case, the injury is usually responsive to a course of protected immobilization.
 
Daniel J. Tucker, DPM, Orange, CA, reekat@aol.com

RE: Digital Scanners for Casting
From: Kenneth Meisler, DPM

I recently started using a digital scanner from Langer Laboratory instead of plaster casting to fabricate orthotics in my office.  I am extremely particular about casting in my office. I only use Gypsonna splints (Other splints do not capture the contour as well). I have found the scanner to capture the contour of the foot as well as a properly done plaster cast. I also tried a different scanner a few years ago and stopped using it because I found too many did not fit well. 
 
The scan/cast process is very quick. The transmission via computer of the image is almost instantaneous. Patients are very impressed with the technology. Orthotics are ready 2-3 days earlier because shipping is not necessary. My staff loves it because the set-up and clean-up are non-existent. I use the device to make 90% of my orthotics. If there is an orthotic that I use another lab for, I cast the patient. I think all practices, especially those that are busy, should consider switching to digital scanning. 
 
Kenneth Meisler, DPM, New York, NY, kenmeisler@aol.com

RE: Cross-over Toe Deformity
From: Geoffrey Bricker DPM

This may sound like overkill, but a lesser pan-metatarsal head resection would work well with no pins or osteotomies to worry about in an elderly patient. She would be back in oversized athletic shoes in 2-3 weeks, and dressier shoes in 6 months with less post-op pain than osteotomy procedures. I do resection almost always for lesser metatarsal pathology in patients over 50 with many fewer problems, and with excellent outcomes.

Unless they are rheumatoid, I don't take the entire head out, but round the stump and resect the plantar condyles.

Geoffrey Bricker, DPM, Springfield, MO, GeoffreyBricker1@msn.com

RE: Discharging a Neo-Nazi (Narmo L. Ortiz, Jr., DPM, Richard Jaffe, DPM)
From: Jeffrey Kass, DPM, Robert Bijak, DPM

I disagree with Dr. Ortiz regarding the relevance of discussing the Neo-Nazi patient on this forum. I don't believe this forum is restricted. What makes it special is that any topic is open for discussion. I, however, will agree with Dr. Ortiz that Dr. Jaffe's comment was out of line.  
 
Jeffrey Kass, DPM, Forest Hills, NY Jeffckass@aol.com

Dr. Jaffe's comment is clearly unprofessional, uncalled for, prejudicial and threatening to the patient who is expressing freedom of speech. As long as the patient takes no action, he/she has that freedom. Dr. Jaffe, living in Israel, has either forgotten or doesn't care about Independence Day.

Robert Bijak, DPM, Clarence Center, NY, rbijak@aol.com

RE: Physician Status in Title XIX (Randy Brower, DPM)
From: Jon Hultman, DPM, MBA

As the executive director of a state organization that has a hard-working and committed board of leaders who have been very effective in passing increased scope and other types of legislation that favorably impact practicing DPMs, I am curious to know how state leaders might be able to “standardize scope of practice in each state” (a goal I agree with) without also having a strong state organization?  Since Randy Brower advises us to drop out of APMA, this is, by definition, a recommendation to drop out-of-state organizations too.  

With no state organization, how would the leaders in Arizona ever gain the right to amputate, or have any influence on issues affecting their collective futures, for that matter? This would be the eventual outcome for all states should DPMs choose this path. While we all need to work harder to make our state organizations even more effective than they already are, it is difficult to envision a very bright future for practitioners if no organization existed to protect and advance the profession. 
 
Jon Hultman, DPM, MBA, Executive Director, California Podiatric Medical Association, jonhultman@gmail.com

RE: Arrested Podiatrists
From: Paul Kruper, DPM
 
While it is painful to read these stories about colleagues, the reasons are measureable. After years of school, residency and student loans, more loans to open a practice, marketing the practice, and doing everything imaginable to attract patients, it is still possible to have little or no profit. Unfortunately, there is no alternative for most pods because salaried positions are rare. This hopeless situation can drive a logical person to desperate decisions. The poor economy compounds the problem. Apparently, there are more lawyers being disbarred lately due to similar responses to desperate financial problems.

The absence of job alternatives for pods outside of private independent practice is related to  our limited license. Primary care providers have no shortage of salary job offers. This safety valve is not available to pods fed up with private practice. We will continue to read these sad stories until such time as podiatrists have the option of becoming primary care providers so that those in a no-profit private practice can switch to a salaried position and provide for their families. The 3-year podiatric residency should include courses and training to allow the graduate to qualify for a D.O., M.D., or at least a P.A. license upon completion. This would be more valuable than spending  months watching a general surgeon remove gall bladders.
 
Paul Kruper, DPM, Kingsburg, CA, prkruper@yahoo.com

PODIATRY ON CALL - MIAMI-DADE & BROWARD COUNTIES, FLORIDA 

Call us for vacations, "unexpected emergencies" and playing hooky. Part-time or Per Diem Basis! Extensive surgical and non-surgical training with Dr. Stanley R. Kalish in Atlanta, Georgia. On call everyday to meet your office needs! Contact: podiatryoncall@gmail.com or 305-342-9797

POSITION AVAILABLE - SOUTHERN CALIFORNIA 
 
Very well established, multiple location group practice has immediate opening for associate doctor. Attractive compensation and benefit package offered. E-mail resume to mrsmcmackin@aol.com

PODIATRISTS NEEDED NATIONWIDE

Seeking a part-time or full-time podiatrists to provide podiatry house call and diabetic shoe fitting services to patients nationwide. We are a podiatry management company and have contracts with clients that have 1,000’s of established patients and all we need are hard-working good doctors to service them. We offer an excellent compensation package with benefits and the opportunity to build a fairly large practice very quickly. coasttocoastpodiatry@yahoo.com

ASSOCIATE POSITION - VIRGINIA IS FOR LOVERS

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

PODIATRIST NEEDED - BROOKLYN, NY

Position available for 2-3 days busy office in large medical group. HIP credentialed. email resume to hallux62@aol.com

PART-TIME PODIATRIST NEEDED - LOS ANGELES, CALIFORNIA

Busy Podiatrist looking for assistance with patients located in facilities, home, office etc. Flexible hours, independence, and great compensation. If interested email CV to homefootcare@hotmail.com or call Terri at 323-353-8103.

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

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 - 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.

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.