The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

July 09, 2011 #4,202 Publisher-Barry Block, DPM, JD

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Younger People Have Less Problems With Flip-Flops: NJ Podiatrist

Flip-flops, the traditional, inexpensive sandal of the summer: while they come in all different colors, shapes, and sizes, they do not come with enough arch support for hardworking feet. Dr. Michael Kowalski, a podiatrist based out of Chilton Memorial Hospital with an office in Wayne, calls them "lazy shoes" because they're so easy to slip on. And while teenagers seem to be the biggest section of the population that wear them, it's 35-year-old to 50-year-old women who have the most problems wearing them. 

Dr. Michael Kowalski

"Younger people tend to have fewer problems when they wear flip-flops, mostly because they can compensate for the lack of support easier," said Kowalski. When women get older, sometimes gaining unwanted weight, they cannot compensate so well for the lack of support. Their feet become tired, they develop heel pain, and the problems start to travel up their leg in the form of knee and hip pain, eventually becoming gnawing back pain.

Source: Rebecca Greene, northjersey.com [7/6/11]

OCPM Provides Foot Aid Station at 2011 Cleveland Marathon and Half Marathon

Kathy J. Siesel, DPM, Class of 1989 and interim chair in biomechanics, along with Abe Osbourne, DPM, Class of 1990 and member of the department of podiatric medicine provided faculty coverage at the recent 2011 Rite Aid Cleveland Marathon and Half Marathon. They were joined by students in the classes of 2012 and 2013. 

OCPM Volunteers at 2011 Cleveland Marathon

The OCPM booth was stationed in the Cleveland Browns Stadium in part of Brownstown, along with the massage therapists. The booth was relatively close to the finish line. Students treated a few blisters and saw many musculoskeletal complaints, including plantar fasciitis, Achilles tendinitis, and muscle strains this year.

Source: Footsteps (OCPM) [June, 2011]

Dietary Management With Mentax® Increases Nerve Fiber Density in DN Patients: Study 

The results of a study published in the second quarter 2011 issue of Review in Neurological Diseases showed increased nerve fiber density in diabetic neuropathy (DN) patients after dietary management with a medical food. At the end of 6-months of therapy, compared to baseline measurements, 8 of the 11 (73%), patients demonstrated an increase in ENFD. Mean ENFD of the 11 patients at end of treatment was 3.07/mm, as compared to a mean of 1.56/mm at baseline, representing an overall 97% increase in ENFD (p=0.004). Eighty-two percent of patients experienced both reduced frequency and intensity of numbness, tingling, and burning pain.

Dr. Allen M. Jacobs

Allen M. Jacobs, DPM, of St. Louis, Missouri, acted as lead study investigator. "Diabetes patients often have a disruption in the metabolic processes that regulate vascular and nerve repair. By providing nutritional management with Metanx® to correct this imbalance, patients in this trial experienced an increase in nerve fiber density which correlated with improvement in numbness, tingling, and burning pain."

AMA Advocates for Bill That Would Nix IPAB

The American Medical Association is lending its support to federal legislation that would repeal the controversial Independent Payment Advisory Board (IPAB) provision included in last year's healthcare reform law.

Currently, there are bills in both congressional chambers to repeal the IPAB, a panel of nonelected officials tasked with drafting Medicare-savings proposals to the president and Congress. Rep. Phil Roe (R-TN), a physician, introduced a bill in the House of Representatives this year that was referred to the House Energy and Commerce Health Subcommittee, which will examine the issue in a hearing July 13. Meanwhile, Sen. John Cornyn (R-TX) introduced legislation in the Senate that has been referred to the Senate Finance Committee.

Source: Jessica Zigmond, Modern Healthcare [7/7/11]

Query: Credit Card Processing for Physicians
 
I just received a call from "Retriever Medical and Dental" credit card processors. Beyond the usual sales pitch of saving me 10-30% on my fees, the salesperson said that a medical account is governed under different rules than a normal merchant account. He said special forms are given to the patient with a medical account. Is there actually a difference between accounts?
 
Ron Werter, DPM, NY, NY

Query: Repair of Spring Ligament 

My doctor performed a number of procedures at the same time, and the coding I am confused about concerns operative repair of the calcaneonavicular ("spring") ligament. To my review, there does not appear to be an applicable CPT code that reflects this procedure. He also performed a calcaneal osteotomy, posterior tibial tendon repair, flexor digitorum longus tendon transfer, and Achilles tendon lengthening.

I have been told that it is an 'unlisted' code, as well as that its performance is bundled into the other services provided. Does anyone have any other information I could share with my doctor?

Kelly Traver, Office of Steven Below, DPM, Peoria, IL

Response: I would share the same opinion of those who told you that repair of the spring ligament is a component of the other procedures your doctor has performed. I am focusing on the posterior tibial tendon repair in particular.

If this tendon repair was done at the same anatomic level as the spring ligament [as opposed to a higher ankle level repair], then I would be inclined to NOT bill for the spring ligament repair. You can always bill for the spring ligament repair as an unlisted code (CPT 28899) and ask for a review, but I would be very surprised if additional payment would be added. 

Howard Zlotoff, DPM, Camp Hill, PA

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RE: NaHCO3 with Local Anesthetic (Ivar Roth, DPM, MPH)
From: Philip E. Larkins, DPM

I am almost certain that if you change the pH of the lidocaine, it will not work, meaning not cross the myelin sheath barrier, and thus there will be no nerve block. That is why it is lidocaine HCL. 
 
Philip E. Larkins, DPM, Escondido, CA, larko33139@yahoo.com

RE: Austin Complication
From: Barry Mullen, DPM

Your colleagues need a lot more information regarding the history of the chief complaint in order to render intelligent, relevant opinions.

First, exactly what is the patient's current complaint? Is it pain along the medial side of the 1st metatarsal (presumably what she complained of six years ago pre-bunionectomy), persistent pain where the soft tissue mass was removed, or pain about the 1st MTP? What is the nature of the pain? What exacerbates it? What is the 1st MTP ROM? Is there crepitus? Is passive joint ROM painful, especially at end range of dorsiflexion?

Can you provide a lateral x-ray projection to determine if concomitant metatarsus primus elevatus exists? The mass that was...

Editor's note: Dr. Mullen's extended-length letter can be read here.

RE: DVT Prophylaxis Protocol (Lawrence Kollenberg, DPM, PharmD)
From: Elliot Udell, DPM
 
For those who are considering the use of heparin post-operatively to prevent DVT, consider the possibility of a rare side-effect called heparin-induced thrombocytopenia (HIT). In patients affected, the platelet counts drop and they can actually develop thromboses for which heparinization is supposed to prevent. This side-effect hits home because a close relative of mine recently developed HIT after being put on heparin for what was considered a routine operation. He suffered a massive stroke which left him with virtually no movement on his right side.
 
Speaking with the chief of anesthesiology of a major hospital about this, I was told that the complications associated with heparin are far from rare, and many people do suffer minor changes in mental status after being heparinized. Hence, if you do put a patient on this drug, do test the patient for drops in platelet count and monitor him/her for any signs of thrombosis. One good paper published on this topic is in the October 2008 issue of Blood and is titled: "Heparin-Induced  Thrombocytopenia: An Historical Perspective" by Kelton JG, Warkentin TE.  
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Chargeback for Credit Card (Barry Block, DPM, JD)
From: Keith Gurnick, DPM

I would like to slightly disagree with the response from our esteemed editor. Do not send the orthotic lab invoice to the credit card company as your cost for orthotics from the lab is not their business.

Usually, when there is a dispute over credit card charges, the credit card company will side with their customer, the cardholder, who is not your patient. If you have the following documentation on file, this is what I would send in:
 

1) Your information sheet signed by the patient that orthotics are custom-made, and there is no guarantees or refunds once they are made.
2) Signature on your form from the credit card holder authorizing the charges for your unhappy patient, and also the card holder's signature on form #1.

When the credit card company takes back the money from your account, you can go after your patient with the same documentation in small claims court, if you want to waste the time and effort to do so. I suggest that you learn from your mistake, forget it, and move on.
 
Keith Gurnick, DPM, Los Angeles, CA, keithgrnk@aol.com

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

Dr. Korbel, I believe you are giving too much credit to the letters behind the name and not to the individual who acquired the degree. The ability and desire to proceed on to acquiring your medical degree is probably why you have captured the respect of your allopathic colleagues. That is not to say that the same respect could not be possessed with only your DPM degree. I too share the same acknowledgement and that includes many foot and ankle trained orthopedists who have referred to me through the years as a podiatric physician and surgeon.

As I am now more involved in the training of our young residents, I stress the importance of being articulate, professional, and having the confidence of knowledge in our specialty. You do not need the MD degree to achieve parity among your peers. In fact, conversely, there are many who have achieved their MD degree and command little respect. It is ultimately the individual who defines his/her place in any environment.

Michael H Theodoulou, DPM, Cambridge, MA, mtheodoulou@challiance.org

RE: Runners Who Wear Minimalist Shoes Should Wear Orthotics: IL
From: Nat Chotechuang, DPM

Minimalist shoes such as the Vibram Five Fingers are both physically and philosophically incompatible with orthotics. They are about as polar opposites as one can get. David Jenkins, DPM and David Cauthon, RPh have written an extensive review of the literature regarding the barefoot/minimalist running trend in the May/June 2011 Journal of the American Podiatric Medical Association, and it would be a good place to start reading if you are unfamiliar with this exercise trend.

However, if you are dead set against having your patients using minimalist shoes, for whatever reason, then it would be preferable to simply come out and tell them that you don't want them to use those shoes. Telling your patients to use orthotics inside Vibram Five Fingers might be analogous to telling them to ride a bicycle for exercise but to make sure they get one with a motor so that they don't get tired.

Nat Chotechuang, DPM, Bend, OR,  natchot@hotmail.com

EQUIPMENT FOR SALE - CLASS FOUR LASER

I have a class four pain laser for sale. Used for plantar fasciitis, Achilles tendonitis, neuroma, arthritic conditions and even fungus toe nails This laser is portable, re-chargable and can be move from room to room or office to office. This isn't the cold laser that you see. It is a 10 watt laser. We have used this laser on NFL sports players. For those that understand a good laser. E-mail David Zuckerman, DPM for Details and pricing. footcare@comcast.net 

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 POSITION – NEW YORK
 
Busy, well-established for 35 years, multi-site practice in upstate New York looking for licensed podiatrist who is ready for a thriving practice. Must be highly motivated, personable and great with patients. Competitive salary and benefit package. Send CV or letter of interest to associateinfoot@yahoo.com

ASSOCIATE POSITION - TEXAS

San Antonio, Texas. Prefer an experienced practitioner in all phases of podiatry; will consider PSR36 trained resident, with good people skills. This opportunity will lead to full partnership for the right person. Good starting salary and benefits in modern office in Northeast Medical Center. Fax CV to 210-495-6484 or email footcenter1@sbcglobal.net

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

PM News Classified Ads Reach over 12,500 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $109 for a 50-word ad THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

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