The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

July 09, 2010 #3,905 Publisher-Barry Block, DPM, JD

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1) Time is running out to purchase tickets to the PM Podiatry Hall of Fame Luncheon honoring Allen Jacobs, DPM and Lynn Homisak, PRT in Seattle on Friday, July 16. We strongly recommend that you buy your tickets now by calling APMA at (800) ASK-APMA or e-mailing sfarez@apma.org. Only a limited number of tickets will be available in Seattle. 

2) PM News will NOT be publishing from July 18-25th while we attend the sold out AAPPM/PM News Alaska Practice Management Cruise.

Dancers Must Recognize Warning Signs of Injury: NJ Podiatrist

According to a study published in the January 2010 issue of International Orthopaedics, 50 percent of all activity-related injuries are due to overuse, and the most common overuse issues are stress fractures and soft-tissue problems in the feet. For dancers, stress fractures often involve the shinbone or the ball of the foot—specifically the second or third metatarsal, which are among the five long foot bones located between the toes and ankle.

Dr. James Ludden

One of the biggest problems for dancers, however, is recognizing the warning signs before the injury escalates. “Dancers, like athletes, operate at higher pain thresholds and tend to wait longer than they should,” says podiatrist James Ludden. “They should be evaluated if they have a sudden onset of pain, or within a day or two if they complain of the symptoms. If you leave it unattended, you can get a through-and-through fracture.”

Source: Hannah Maria Hayes, Dance Teacher [7/1/10]

Markinson, Crawford Named to New Positions at NWPF 

At the recent 40th Annual Graduation of Podiatric Residents in Seattle, Dr. G Dock Dockery, Chairman of the Board and Director of Scientific Affairs, Northwest Podiatric Foundation for Education & Research, USA, announced that Dr. Bryan Markinson, Mount Sinai School of Medicine, NY, NY, was named to a two-year position on the Board of Medical Advisors.  At that same meeting, it was announced that Dr. Mary E. Crawford was named the Chair of the Board of Medical Advisors. 

Drs. Bryan Markinson and Mary Crawford

The NWPF is actively involved in providing educational opportunities for residents in the State of Washington as well as sponsoring research and multiple continuing medical educational scientific meetings at resort venues.

MI Podiatrist Receives "Brown Bomber" Honor

Dr. Stuart E. Kirschenbaum of Detroit, Michigan was the recipient of the Joe Louis Brown Bomber Jacket Award at a ceremony at the Charles H. Wright Museum of African American History, Detroit. In honor of the 72nd anniversary of Joe Louis knocking out Max Schmeling on June 22, 1938, the Brown Bomber Jacket is awarded to those individuals who honor the legacy of Joe Louis in making significant contributions to the community.

Dr. Stuart Kirschenbaum

Kirschenbaum served as Michigan Boxing Commissioner under three governors from 1981 through 1992, the second longest tenure in state history. He received the Sports Illustrated "Joe Louis Award" in 1993 and served as guardian for Martha Louis, Joe's widow for the last years of her life. "It is quite an honor to be among former recipients such as President Jimmy Carter, Congressman John Conyers, and Motown founder Berry Gordy, Jr.," Kirschenbaum said.

MI Podiatrist Competes in Morgan Show Horse Circuit

From time to time, it’s nice to get a glimpse into the lives of the doctors at the Community Health Center of Branch County (CHC). Dr. James McClain, podiatrist at CHC, enjoys showing horses. He currently has a total of six horses, including four Morgans and one Andalusia, which is a Spanish saddle horse. 

(Dr. James McClain with Morgan horse in Gold Cup)

Dr. McClain keeps busy showing horses on the Morgan Show Circuit at different events across the country. He recently competed in the Gold Cup in Springfield, Ohio, and won first place in two divisions, and second in another. Dr. McClain is planning on attending a show in Lexington, KY, and if everything goes well and the horses qualify, they will be headed to Oklahoma for nationals and the world finals.

Source: The Daily Reporter [7/7/20]

Query: Hypopigmentation Following Injection

I injected a woman of color with Kenalog 40 and diluted it 1:10 with lidocaine 2% to the first MPJ. Her pain resolved, but she developed a hypopigmented patch 5 months later.

Hypopigmentation Following Injection

How can I avoid this in the future, and will the skin go back to its original color?

Joan E Schiller, DPM, Euclid, OH

RE: 5th Metatarsal Fracture Complications  (B. Zaccardelli, DPM)
From: Robert Bijak, DPM, Jay D. Helman, DPM

You have a 14 year old who twice demonstrated abnormal healing of the bone, has siblings and relatives who also have had abnormal bone healing response to injury. The boy shows ligamentous laxity as pes planus, and you want to know what kind of arch support to make for him. I suggest a referral to a pediatric endocrinologist for evaluation, especially in light of an apparent abnormal osseous familial propensity.

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

When fractures in children cease to heal in a timely fashion, consider rickets. With parents constantly applying sunscreen to protect children from the sun, they also prevent the sun from allowing Vitamin D to form, therefore increasing the risk of rickets. The other thing to consider since his sibling also had fractures is child abuse.

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

RE: Digital Scanners for Orthotics (Kenneth Meisler, DPM)
From: Jeff Root

Dr. Meisler stated that he used an in-office foot scanner that was able to capture the contour of the foot as well a properly done plaster cast. I would be interested to know how Dr. Meisler was able to compare the contour of his plaster negative casts to the contour of the computer files that he generated using a digital foot scanner. As the owner of an orthotic laboratory that utilizes both manual fabrication and a computer-aided orthotic manufacturing system, I’m not opposed to cast scanners, but I do encourage practitioners to be cautious about their use and promotion.

The main issues that I have found with in-office foot scanners are: 1) image/scan quality, 2) ergonomics, 3) an inability to capture the posterior surface of the heel for cast orientation (heel bisection), and determination of forefoot to rearfoot relationship (deformity).  All three of these issues can contribute to variability in multiple scans of the same foot, let alone variability between a scan and a corresponding plaster cast of the same foot. There are advantages and disadvantages to in-office foot scanners. It may be fair to say that some scanners produce contours that are reasonably close to that of plaster, but it is a little misleading to say that there is no difference.

Larry Huppin, DPM, a medical consultant for ProLab Orthotics, has an excellent lecture on this subject. I encourage anyone considering the use of a scanner to attend Dr. Huppin’s next lecture, if possible.

Jeff Root, President, Root Laboratory, Inc., jroot@root-lab.com

RE: OPEIU and Podiatry (Steven D Epstein, DPM)
From: Gregory T. Amarantos, DPM, Michael Davis

OPEIU has enriched their pockets to the tune of at least $99 per year, per member for the past 10 years in Illinois alone. 700 members equals $693,000. In Illinois, we are MANDATED to belong to OPEIU.  Besides getting an audience with Senator Kennedy, they have done nothing but enrich their pockets. Get ready to hear all the fluffy, mushy mumbo-jumbo about how we get to meet with the union, and how much they respect us and want to help us. In Illinois, we were told that our scope of practice was expanded because of help from the union. Now we can do more amputations and removal of the talus. Not much bang for your buck, if you ask me. This will affect how many members doing this type of surgery? 

If you pay me $693,000, I will respect you all the way to the bank, laughing all the way. There has not been one patient who came through my doors because of the union. The same dollars could have been spent with the state PAC or APMAPAC with tangible results.  
 
Gregory T. Amarantos, DPM, Chicago, IL, amogreg@aol.com

In response to Dr. Epstein’s question, I am enclosing the report offered by Dr. John Mattiacci to the House of Delegates in California. This is a lengthy response to Steve’s short question, and only relates to the narrow topic of Title XIX, which is now threatening all states, including Pennsylvania. While reports such as this were made to the Guild states, this is the latest one with the most up-to-date Title XIX status.

In addition to the Title XIX issue that threatens the entire profession, the Guild has worked on numerous state issues with various individual state Associations over the years. The Pennsylvania AFL CIO, through the Guild, has worked with the PPMA on legislation relating to health insurance, hospital and ASF practice and professional liability.

Finally, the Guild offers a long list of member benefits as disparate as...

Editor’s note: Michael Davis’ extended-length letter can be read here.

RE: Arrested Podiatrists (Paul Kruper, DPM)
From: Kathleen Toepp Neuhoff, DPM, Simon Young, DPM

All of us are saddened by reports of misbehavior of our podiatric colleagues. However, attributing the blame for unethical/illegal behavior to our limited licenses seems inappropriate. A review of Medicare audits will show significant numbers of MD/DOs committing fraud in spite of their unlimited license. In my own community, several physicians have gone to jail for illegal claim filings, violation of the Stark laws, etc. No podiatrists have been jailed, although we have had equal opportunity to break the law.

Ethicists continually debate the ethics of performing a "wrong" act to prevent a worse evil (i.e., is it a worse crime to steal a loaf of bread or let your child starve?) However, I have seen no podiatrists facing starvation. Receiving an unlimited license will not remove character flaws.

Kathleen Toepp Neuhoff, DPM, South Bend, IN, vetpod@aol.com
 
It's sad to read Dr. Kruper's note, but unfortunately, he is correct. Every profession has its success stories and failures. I am sure many practitioners have had successful careers. Except for a few podiatrists who we continuously read about in PM News, a significant sector of our colleagues are not so fortunate. It was sad to read from Dr. Block's statistics that 43% of DPMs make less than $75,000. With expenses going up and reimbursements decreasing, I foresee this number increasing.

PAs , NPs, nurse anesthetists make more than that coming out of school. Their training is not as extensive as ours, yet they have the backing of the medical community. Their training is under the auspices of MD's/DO's. We need to stop being isolated and incorporate  our schools with medical practitioners, provided they want to participate in our training. We need to decrease the number of graduates and increase the quality of our training programs.

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

RE: Physician Status in Title XIX (Randy Brower, DPM)
From: Gregory B. Nellis DPM
 
The Title XIX discussion always seems to revolve around the number of legislators supporting it. I do understand that they pass the laws, but our President does have influence. Have we made any progress in getting our case to President Obama? He has spoken about the use of medical extenders like PAs, nurses, and nurse practitioners. It doesn't seem like he would have a bias for MD's over DPM's.

Efficiency in medical care and cost-savings would be meaningful to him. Discrimination is something he'd probably be sensitive to. I suspect that having the President advocate for us could make Title XIX physician status for podiatrists a reality.
 
Gregory B. Nellis, DPM, Gloversville, NY, gbndpm@yahoo.com

RE: Runners Need To Take it Easy After Blisters: DC Podiatrist
From: Howard J. Bonenberger, DPM

I just read Dr. Pribut's comment that, with an infected blister, "You could get gangrene and your foot could fall off." Now, if he was misquoted that is something that he needs to address with the reporter. However, in his opening comment, he also states that, "Landing differently can mess up your body's natural shock absorbing system..." Really doctor, it can be "messed up"?! 

This is the time of year when new doctors are vying for patients with radio, newspaper, and TV spots. Please, think before you do or say something that will reflect on you and the profession. The PCPs whom you are hoping to impress will write you off in a heartbeat. Avoid hyperbole and self-aggrandizement.  Remember the saying about getting one chance to make a first impression. Use that opportunity wisely.   
          
Howard J. Bonenberger, DPM, Nashua, NH, howardbon@aol.com

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

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

Podiatry referral company has thousands of diabetic patients nationwide in need of immediate service. We are looking for podiatry practices interested in joining our network to receive referrals. Email 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

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