July 11, 2006 #2,627 Editor-Barry Block, DPM, JD

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TN Podiatrist (Correctly) Mum on Paris Hilton’s Feet

Heiress/Internet icon Paris Hilton was spotted just days ago at a Hendersonville podiatrist, one Dr. H.H. Nuss (pronounced "Noose"), who apparently is a foot doctor to the stars.

Paris Hilton

Dr. Nuss pointed to the privacy act and politely declined to confirm or deny Paris was a patient. In fact, he wouldn't say anything about Paris, her feet or even her little doggie, Tinkerbell — or Tinkerbell's paws. All he did say: "I treat a lot of celebrities, a lot of athletes, and a lot of people from L.A. come out to have (sic) a lot of foot surgery."

Source: The Tennessean [7/9/06]

Study Claims Orthoses Provide Only Small, Short-Term Benefits for Plantar Fasciitis

Foot orthoses -- whether customized or pre-fabricated -- provide only small, short-term improvements in function and pain for patients with heel spurs, also known as plantar fasciitis, according to findings published in the Archives of Internal Medicine.

"Plantar fasciitis is one of the most common foot complaints," Dr. Karl B. Landorf, of La Trobe University, Victoria, Australia, and colleagues write. "It is often treated with foot orthoses; however, studies of the effects of orthoses are generally of poor quality, and to our knowledge, no trials have investigated long-term effectiveness."

The researchers therefore examined the short- and long-term effectiveness of foot orthoses in the treatment of plantar fasciitis in 135 patients. The subjects were randomly assigned to receive a sham - a soft, thin piece of foam that looked like an orthosis; a pre-fabricated orthosis (firm foam); or a customized orthosis (semi-rigid plastic). None of the patients was told which type they were given. The researchers measured the patients' level of heel pain and function after 3 and 12 months.

Patients in the pre-fabricated and customized orthoses groups had improvements in pain and function after 3 months of treatment, but only the effect on function was statistically significant.
http://news.yahoo.com/s/nm/20060708/hl_nm/orthoses_dc_1

Source: Reuters [7/7/06]

SOUTHWEST FOOT & ANKLE CONFERENCE

September 15-17, 2005, Westin Park Central Hotel, Dallas, Texas. Mark calendars now - PICA Risk Management course, FAIV workshop series, Coding Track , Assistants Tracks , Terrific Vendor Hall with giveaways. http:// www.txpma.org or 1-800-TEX-FOOT

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For a list of all meetings go to: www.podiatrym.com/meetings.pdf

Alleged Surgical Technique (Rhode Island)

Alleged Injury: Improper surgical technique that resulted in a follow-up Hallux varus surgery of the foot. Plaintiff alleged additional lost wages and diminution in earning capacity. She sought $ 13,199 in medicals, $ 33,740 in past lost wages and $105,629 in future diminution of earning capacity.

Facts: Podiatric malpractice was claimed by a 49 year old nurse who argued that her need for follow-up surgery was caused by her podiatrist's improper surgical technique. Defendant denied violating the standard of care. The jury returned a defense verdict after deliberating 3 hours.

Plaintiff Mildred Shelton suffered from several foot problems for which she sought treat-ment from defendant podiatrist. Plaintiff had a bunion on the big toe of her right foot, turning toes on her left foot, and hammer toes on both feet. In March 1999, defendant performed surgical corrections on the hammer toes of both feet. He treated plaintiff until June 1999, when she sought treatment from another podiatrist. A follow-up surgery was performed in January 2000 for Hallux varus, or an overcorrection of the hammertoes.

Plaintiff alleged defendant overcorrected the hammertoe condition of her left foot and caused her to develop hallux varus. She claimed defendant should have corrected all the toes of that foot during the surgery so additional surgery would not be necessary. Plaintiff argued that defendant failed to inform her that Hallux varus was a possibility and, therefore, she had not given informed consent for the surgery. Plaintiff, a nurse, claimed she was unable to return to work in the same ca-pacity or at the same level of income due to the Hallux varus condition.

Defendant contended hallux varus was a known complication of the surgery, he informed plaintiff of that possibility, and she signed the informed consent document acknowledging the possibility. Defendant asserted that he recommended correcting all of plaintiff's toes in one surgery, but she declined. He argued that, following the surgery, plaintiff's other toes looked worse because of the sig-nificant correction of the hammertoe.

Plaintiff's Expert: Jeffrey L. Adler, D.P.M. - New York, NY

Defendant's Expert: Martin M. Pressman, D.P.M. - New Haven, CT

Source: The Massachusetts, Connecticut, Rhode Island Verdict Reporter Vol. 17, No. 5

RE: Off-Loading Healed 5th MPJ Ulcerations (Thomasin Hammer, DPM)
From: Eric Fuller, DPM, Dennis Shavelson, DPM

There are two types of feet that typically get high loads laterally. The first is a not fully compensated varus foot. That is there is not enough STJ range of motion to fully load the medial side of the foot. To off-load this a forefoot varus wedge should be used under your custom molded device that could have a "hole" under the met head. The other kind of foot that can have high lateral load is a foot that supinated very easily (has a laterally deviated STJ axis). To tell the difference between these feet use the Coleman block test of putting a block (book) under the lateral forefoot and observing if there is eversion range of motion available. Alternatively you could have the patient stand and ask them to evert their foot. The foot that supinates really easy will have eversion range of motion available and the partially compensated varus foot will not have range of motion available. If there is a lot of eversion of the forefoot available in stance, you could add a forefoot valgus wedge under your device with a "hole" under the ulcer site.

Eric Fuller, DPM, Berkeley CA, efuller395@intergate.com

There are two ways to approach your scenario: accommodation or correction. Using neoteric biomechanical thought, your patient probably has a rigid rearfoot type and either a flexible or flat forefoot type. This causes weight to be compensated to the fifth metatarsal as the medial column unloads during forefoot function.

In addition, I would predict that the ulcer exists on the patient’s shorter side. Using Root-based biomechanical thought to fabricate a foot orthotic dedicated to reducing plantar pressures in gait does not offer the benefit of custom orthotics as your patient performs 90% of his weight-bearing tasks. A foot orthotic that custom balances both the rearfoot and the forefoot to the three body planes, balances each rearfoot to forefoot, balances each medial
column to the lateral and balances one foot to the other would not only protect your patients 5th met from overuse and pressure, but would upgrade his quality of life and performance all day long.

I would take a plaster cast (functional foot type 3 or 4 cast-corrected), prescribe foot type specific rearfoot and forefoot modifications and posts, and add a lift to the short-sided heel. The devices would sport forgiving, semi-rigid thermoplastic shells with a protective multi-density top cover. I would add an ulcer specific balance, PRN. I would dispense, break-in, and troubleshoot the devices while monitoring the patient’s status. I would alert the patient’s medical consultants about my biomechanical plan for the patient, as well as the prognosis for permanently keeping the ulcer from recurring.

I would charge the patient $700 for the "Mercedes Care" that I was offering and then I would ask the orthopedic, pedorthic, physical therapy, chiropractic, internet orthotic dispensing community and sadly, most DPM's who are dispensing "Chevy Care" to compete with me in the marketplace at any price.

Dennis Shavelson, DPM, Medical Director, The FootHelpers Lab
drsha@footworldusa.com

EQUIPMENT FOR SALE - ESWT - BEST OFFER CONSIDERED NOW!!!!

If you are using or thinking of using ESWT, I have a new machine that has only been used twice. There is no Orbasone in the country priced like this one. Will provide training and installation. Take a look at http://www.orbasone.com Call 1-856-229-2939.

ASSOCIATE POSITION – TEXAS

Full time associate position for a PSR-24 podiatrist to join established dynamic medical and surgical practice in Central Texas. Looking for a personable, motivated, ethical, hardworking individual to join our board certified group. Please send resumes or CV to centexfootdoc1@aol.com

EQUIPMENT FOR SALE – SONOCUR ESWT

I have a Siemens Sonocur shockwave FDA-approved machine for sale $70,000. Call 416-545-1166 or email: dracula65@hotmail.com

ASSOCIATE POSITION- LAUREL, MARYLAND (SUBURBS WASHINGTON DC)

Great opportunity for a hard working, ethical podiatrist to join a vibrant, successful podiatric medical and surgical practice. ASC on-site . Practice has dedicated, supportive staff with marketing knowledge. Board eligible/certified referred. Surgical residency. Competitive salary with bonus. Fax CV to 240 465 0332

PRACTICE FOR SALE--BUFFALO, NY

Part time practice with full time possibilities. Mix of conservative, biomechanics and diabetic foot care. Good surgical potential. Gross 180K. Willing to stay through transition. Call 716-836-8123.

HOUSE CALL PRACTICE FOR SALE – SOUTHERN CALIFORNIA

House Call practice for sale which includes approx. 400 patients and continued referrals. erfect for solo practitioner. Extremely easy and profitable practice to run. Yearly gross of over $200K. Current DPM is retiring. Financials will also be provided. Please contact
ccipinc@ccipinc.net

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

ASSOCIATE POSITION- NEW ENGLAND

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

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