The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

July 08, 2011 #4, 201 Publisher-Barry Block, DPM, JD

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Toning Shoes Not Recommended for Children: TX Podiatrist

Podiatrist Dr. Neil Strauss said Skechers certainly wasn't thinking about the support little feet need when kids are still growing. "They teach people to walk differently," Strauss said. "That is not necessarily a good thing when you're talking specifically about kids." He said shoes are supposed to be flat and stable with a little toe and heal lift.

Dr. Neil Strauss

Shape-ups have a rounded sole that creates a rocking motion. Strauss said the sole can cause all types of injuries. "A lot of injuries I am seeing with this shoe are ankle injuries, Achilles tendon injuries … there has also been known hip injuries from it and posture injuries," he said. "And with children, you want to teach good posture ... not bad posture."

Source: Amy Davis, Click2Houston.com [7/6/11]

OCPM Provides Foot Aid Station at Podiatry School Basketball Tournament

Kathy J. Siesel, DPM, Class of 1989 and interim chair in biomechanics, along with students currently enrolled at the Ohio College of Podiatric Medicine provided prevention/injury aid during the basketball tournament at the Independence High School Field House. Multiple games were played simultaneously on both days for the double elimination tournament. 

Dr. Kathy J. Siesel and OCPM Student Volunteers

Numerous players from multiple colleges of podiatric medicine sought their help. The students performed many ankle/foot tapings, provided several adhesive dressings, dispensed numerous ice bags, and performed one thumb taping. 

Source: FootSteps (OCPM) [June 2011]

ME Podiatrist Receives Patent for Osteotomy Guide

O'Brien Medical, LLC of Orono, Maine has announced the successful issuance of one of its pending medical device patents. The device is specially designed for the most common bunion procedure performed in the United States, the so-called chevron bunionectomy. The instrument simultaneously  facilitates more accurate bone cuts (osteotomies) during surgery while retracting a vital tendon out of harm's way. 

Dr. Todd O'Brien and Osteotomy Guide

The product has been marketed as the O'Brien Osteotomy Guide by Innomed, Inc of Savannah, GA since early 2010. Todd O'Brien, DPM, inventor of the instrument and owner of O'Brien Medical notes a circuitous path from idea to market for the product. "The fate of the instrument was in question at several points along the way," O'Brien said.  

MD Podiatrist Pleads Guilty to Fraudulently Billing Medicare Over $1.1 Million

Dr. Larry Bernhard, age 55, a podiatrist who operated his business from his home in Gambrills, Maryland, pleaded guilty to healthcare fraud and aggravated identity theft related to a scheme to fraudulently bill Medicare for more than $1.1 million.

Bernhard admits that from October 31, 2007 to July 20, 2010, he fraudulently billed Medicare Advantage plans and was paid at least $1.1 million from these plans. All of the fraudulent billing occurred while Bernhard was excluded from billing all federal healthcare programs, including Medicare Advantage plans. Of the $1.1 million received by Bernhard, at least $1 million was for services that were not rendered.

Source: U.S. Attorney's Office [7/6/11]

Query: NaHCO₃ with Local Anesthetic

I am interested in using sodium bicarbonate with local injections to decrease the burn from the injection. What percentage should be used (7.5% or 8.4%),  and what is the mixture percentage with the local anesthetic? Any other hints when using it or anything else that works would be appreciated.

Ivar E. Roth DPM,MPH, Newport Beach, CA

Query: Reconciling Daily Depositis with TrakNet

One fundamental function of any medical office is being able to reconcile at the end of the day. EMR and electronic fund transfers (EFTs) are becoming more common, if not required. We have been using TrakNetDPM from Biomedix for two years. While we like the program, there are some shortcomings, one of which is an inability to reconcile deposits at the end of the day.

I am curious as to how other TrakNetDPM users are reconciling the daily deposits.

Steven Block, DPM, Owensboro, KY

RE: Chargeback for Credit Card

I was notified by a credit card company today that my patient's friend used his credit card  to pay for my patient's prescription orthotics. He and his friend then told the credit card company that they wanted their money back because the orthotics were not successful. Before taking the impressions, the patient was told that functional biomechanical orthotics are not guaranteed. My patient/doctor relationship is with my patient. My HIPAA responsibilities are with my patient. I have no responsibilities to the patient's friend. I notified the credit card company of this today. Am I correct? Should I tell the credit card company anything else?

Tyler B. Brahm, DPM, Clearwater, FL

Editor's Response: PM News does not provide legal advice. The recommended course of action is to send the credit card company a copy of your policy on orthotics, preferably one signed by the patient. If you do not have such a form, it is recommended that you print one for all future orthotic dispensements. Also include the bill you received from the orthotics lab to show your out-of-pocket expenditures.

RE: Austin Complication
From: John Etcheverry, DPM, Jeffrey Kass, DPM

First, I recommend a plantar axial or sesamoid view to evaluate the fibular sesamoid. An MRI to evaluate for bony edema of the fibular sesamoid would be useful as well. I would be very aware that the tibial sesamoid is "peeking" as is; any removal of the fibular sesamoid could easily result in a hallux varus.

John Etcheverry, DPM, Bakersfield, CA, johnetch@att.net

Before any further surgery is contemplated, a clear well thought-out differential diagnosis should be made and then an appropriate treatment protocol. I am not sure I understand why you would want to remove the lateral sesamoid or part of it. My recommendation is, if you have not already done so, order an MRI. Maybe this would help shed light onto what exactly is the etiology of the condition.

Jeffrey Kass, DPM, Forest Hills NY, jeffckass@aol.com

RE:  DVT Prophylaxis Protocol Yelana Barsky, DPM
From: Larry Kollenberg, DPM, Pharm D

I have been asked about clarification from this readership regarding my comments on DVT prophylaxis. With any medication you prescribe, consider the renal function for dosing.

For office-based consideration of DVT prophylaxis, what is your patient's medical status? If indicated, then what treatment will your patient's insurance cover? Do you need to assist with prior authorization? Should you Rx just support stockings, or medications, or both? Will insurance pay for any LMWH? If not, then consider Heparin; it's cheap. According to the literature (NIH, orthopedic, etc.), there are different protocols and recommendations, depending on renal function and if treating a patient medically or orthopedically .

For example, if you have a diabetic who is supposed to be NWB due to ulcers cellulitis, etc., then consider following the protocols from medicine. Let's say you did a double osteotomy for a bunion with the patient being NWB for 10 days or 3 weeks. Then perhaps you should follow orthopedic protocols.

For prophylaxis of DVT, when medications are indicated and if your patient has a CrCl of < 30ml/min, the literature recommends either Enoxaparin 30 mg daily or Heparin 5000 units, two or three times daily. If you need full dosing for active DVT, then it is a different situation beyond the scope of these comments.

Larry Kollenberg, DPM, Pharm D, Baltimore MD, lkollenberg@hotmail.com

RE: Source for Dehydrated Alcohol (Olga Luespchen, DPM)
From: Brian Kiel, DPM

For general information, dehydrated alcohol, which has been difficult to get, is now being shipped once again by American Regent, but only in 5 ml vials. It seems that no podiatry supplier is carrying it yet, but we ordered it from McKesson through a local pharmacy. The McKesson order# is 2789154.

Brian Kiel, DPM, Memphis, TN, footdok4@gmail.com

RE: How Would Your Life be Different if You Had an MD Degree (Art Korbel, DPM, MD)
From: Marc Katz, DPM

Dr. Korbel makes some interesting statements. The main difference between myself and Dr. Korbel appears to be that he has the added MD after his name. I'm an equal with MDs and we talk as friends and about medicine. We even go out together and have similar non-medical interests. They even ask my medical opinion in some cases, and of course, they ask my opinion about treatments for foot and ankle.

I guess the big difference is that some orthopods who belong to the AOF&AS actually ask my opinion in cases because we share patients. So, I guess I'm better off with the DPM alone, and I'm really happy with my standing in the medical community!

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

RE: OCPM Students Have First-Ever Orthotics Rotation
From: Neil Scheffler, DPM

Interesting. I had assumed, obviously incorrectly, that students have always had hands-on orthotic experience. When did this stop? When I was in school (NYCPM, then named M.J.Lewi, class of 1971), we had lots of hands-on experience making all types of orthoses...from "rubber butter" to Rohadur.  Thanks to our instructors in biomechanics (Schuster, Langer, Wernick, Skliar, Tax), we had fundamental basics both in the classroom and in the orthotics lab. I'm glad to see that the pendulum is swinging back.

Neil Scheffler, DPM, Baltimore, MD, feetone@aol.com

ASSOCIATE POSITION - NEW YORK CITY & QUEENS

High Income Potential. One of the fastest growing podiatry practices in New York City and Queens seeks a hard-working podiatrist who participates with HealthFirst, Fidelis, Metroplus, and other Medicaid plans. Preferably a Spanish-speaking podiatrist. Contact me at Podocare@aol.com

ASSOCIATE POSITION - SAN DIEGO

Well-established practice is seeking an associate with the opportunity for a future partnership position. Great location and medical environment. Must have a California license and an interest in the full range of podiatric services. Please email resume and cover letter to ethuen@hotmail.com

ASSOCIATE POSITIONS - NW INDIANA & CHICAGO AREA

2 Full-Time positions open - One for Northwest Indiana and one for the Chicagoland area. Must have 2-year surgical residency. Must be motivated and a self-starter. State License required. If interested email: f-massuda@footexperts.com

ASSOCIATE POSITION/PART TIME - ORANGE COUNTY CALIFORNIA

Experienced podiatrist - 2-3 days/week, two office locations in beautiful south Orange County California. Exceptional opportunity for seasoned semi-retired practitioner. Fax or e-mail Resume and LOI to 949-488-0868/ Info@feetfixer.com.

ASSOCIATE POSITION – IOWA CITY AREA

Modern practice seeking a well-trained (PSR 24/36) associate. Excellent opportunity for an energetic, hardworking individual with strong surgical and medical skills. Solid referral network and 13 years of growth. Come live in the Iowa City area and enjoy the quality of life and stability of a Big Ten University community. Competitive salary and benefit package available. If interested, fax CV to 319-354-1014 or e-mail to dave@341foot.com

ASSOCIATE POSITION - CENTRAL NEW JERSEY

Seeking associate for busy, growing practice located in Toms River, Ocean County. Looking for PSR 24/36, board eligible doctor. Basic podiatry a must. Practice has a up-to-date EMR and practice management program. Digital x-rays, ultrasound, laser, vascular studies. Excellent opportunity for highly motivated and ethical DPM. Send CV to toesec@aol.com

ASSOCIATE POSITION - NORTHWEST FLORIDA BEACHES

Excellent opportunity for an energetic, compassionate, hardworking individual with superior surgical and medical proficiency. Recent graduate or experienced practitioner. Excellent salary, benefits and partner-buy in offered, full admit privileges and surgical scope. Fax CV to Ecpodiatry@aol.com

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 516 476-1815 PODO2345@AOL.COM

TURN-KEY PODIATRIC OFFICE - CALIFORNIA

Fully equipped modern suite with built-ins at Mission Regional Medical Center, Mission Viejo CA. Four treatment rooms, New Midmark chairs, x-ray/processor, phone system & much more. $45,000/assume lease. Call Jackie, 949-493-8020.

PRACTICE FOR SALE - NANAIMO, BRITISH COLUMBIA, CANADA

Have you ever dreamed of owning a practice where... you can see 0-50 patients daily .. .average 100 new patients monthly have zero accounts receivable ... gross $480 M per year .... live in a beautiful community with skiing, hiking, fishing and boating on your doorstep. This could be yours! If interested contact pistone@telus.net or 250-754-4192.

PRACTICE FOR SALE - MISSOURI

Well established, but still growing. Grossed over $300,000 last year. Located in a thriving medical community. Good payer mix. All aspects of podiatry needed in the area. Do not let this opportunity to own your own practice pass you by. Contact footdoc2002@yahoo.com for more information.

PRACTICE FOR SALE - MISSION VIEJO, CA

Relocating to Tulsa. Great opportunity. Located at Mission Regional Hospital. Sale price $205,000 including supplies. Gross income 2010 was $340,000. Gross income 2011 estimate $420,000. Approximately 1200 sq ft with 3 treatment rooms, digital x-ray and fully computerized. A/R available at 50% discount. 949-702-1052. David Stoller, DPM (Family Footcare)david@missionviejofootcare.com

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