July 14, 2006 #2, 630 Editor-Barry Block, DPM, JD

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TX Podiatrist Advises on Avoiding Pump Bump

Pump bump is a bony growth on the back of her foot where her high heels rub. Marybeth Crane, D.P.M. says, “Think of it as a reactive force that your body tries to fix the rubbing of the shoe by making extra tissue.” The condition can be extremely painful and the sooner it’s treated, the better. Crane says, “With anti-inflammatories like Ibuprofen or Naprosyn over the counter, icing, a little bit of local physical therapy and some padding of the area.”

Dr. Mary Beth Crane

To prevent "pump bump", avoid heels with a stiff back. Crane says, “This right here is a pump bump in the making. It’s very rigid here; you can see the edge is very rigid. There’s no padding whatsoever here.” She says, “And then because this shoe is so rigid, you have to work very hard to go forward, leather soles, so you tend to twist when you walk and unfortunately, a lot higher heel than most of us should be wearing.”

Crane adds, “If you have to wear high heels wear something like this. It’s got a nice, clunky heel, rubber soles in the areas that matter, nice and soft in the back. It’s got a little bit of padding so that you won’t get that pump bump from this shoe.” They're not the sexiest shoes, but they could be the first step to a lot less pain.

Source: News Channel 7, Spartanburg WSPA (SC) [7/11/06]

IL Podiatrist Charged With Sexual Assault of Patient During Examination

A Chicago podiatrist appeared in court Tuesday on charges he sexually assaulted a 75-year-old woman he was treating for a foot ailment. Anthony Myles Overton Jr., 61, of Olympia Fields, was ordered held on $250,000 bond.

The patient went to Overton's podiatrist office on June 6, 2006 because she had pain her right foot, according to court records. The doctor’s assistant took the woman to a room, gave her a gown and told her to disrobe and put the gown on, the record states, and the victim complied. Overton then came into the room, had the woman sit on the examining table, opened her robe and allegedly fondled her breasts, according to court records. He then allegedly penetrated her vagina with his finger, and used that same finger to penetrate her rectum.

The podiatrist then left the room, and the assistant took the victim to a different room for an x-ray, the record states. Overton then walked in and handed the victim a prescription for a vaginal yeast infection, court records show.

Overton received his license to practice in Illinois in 1979 and has never been disciplined, said a spokeswoman for the Department of Financial and Professional Regulation. Overton's lawyer, Jeffrey Burt, said his client has served on staff at various South Side hospitals. He added that the woman had consented to treatment. "I understand there was consent given," Burt said. "We feel that this is an injustice, he has no business being locked up. He is not a criminal."

Source: Chicago Sun Times, Chicago Tribune [7/12/06]

Senate Leaders Urged to Increase Physician Payments

Sens. Jon Kyl (R-AZ) and Debbie Stabenow (D-MI) in a letter to Senate Majority Leader Bill Frist (R-TN) and Senate Minority Leader Harry Reid (D-NV.) said the Senate should increase Medicare physician reimbursements before it adjourns in October, CQ HealthBeat reports. According to Kyl and Stabenow, physician reimbursements will be cut by 5% as of Jan. 1, 2007, unless Congress
intervenes.

The senators cited a 2006 American Medical Association survey that found that if reimbursements are cut in 2007, 45% of physicians would cut the number of new Medicare beneficiaries they treat, and 43% would lower the number of new Tricare beneficiaries they see. Tricare bases its physician reimbursements on Medicare rates. "At a minimum, we must provide physicians with a positive Medicare payment update for 2007," Kyl and Stabenow said

Source: CQ HealthBeat via American Health Line

ATTENTION ALL RESIDENTS, RESIDENCY DIRECTORS AND NEW PRACTITIONERS

Finally! A meeting to address the core needs of residents: practice management. A comprehensive one-day meeting specifically for residents and new practitioners sponsored by The American Academy of Podiatric Practice Management is being held at the Pittsburgh Airport Marriott on Saturday, August 26th. All issues will be covered by podiatric experts, such as securing a top rate associateship, partnership, options for practice, and financial matters relating to debt management or financial future. Registration is at an unbelievable rate of only $49 for AAPPM resident members and $69 for non-AAPPM residents. AAPPM would also like to extend a huge thank you to PM News for their assistance with this program and in general for support in providing practice management to younger practitioners. Visit www.aappm.org to register for this meeting online and download a complete meeting brochure. Any questions call 978-646-9091 or e-mail office@aappm.org.

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

RE: Research Observation (Bruce Leibowitz, DPM)
From: Elliot Udell, DPM

This coming August at the APMA national convention, the American Society of Podiatric Medicine, the oldest APMA affiliate will be hosting a workshop on doing medical research. Our goal is to enable every podiatrist to not only engage in needed research but to publish his or work. After the workshop we will offer participants the opportunity to work on specific projects which will be supervised by the directors of the program. It is possible that some of these projects will take place in the Baltimore, Washington area.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Orthoses Research Study (Craig Payne)
From: Multiple Respondents

I have read with some interest the ongoing vitriol surrounding Landorf, Keenan, and Herbert's manuscript in the Archives of Internal Medicine. The beauty of projects of this ilk is that they often have the effect of bucking the system and challenging preconceived notions. I suspect that strong feelings elicited on both sides of this discussion means that this project was successful.

I would urge clinicians to use this opportunity to take a few minutes and actually read the work. I think those that haven't had the privilege of participating in these sorts of projects will derive some degree of appreciation for the difficulty and care in their design. No project is perfect-- not even close. However, the only way to really know this is to read the methods-- not just the sound bites.

I would hope that this project and others spurs clinician-scientists with an interest in this cozy corner of medicine to further refine and modify the question asked by these three investigators. Only then will we continue to move toward the truth (hopefully without heel pain).

David Armstrong, DPM, PhD, Chair of Research and Assistant Dean, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science armstrong@usa.net

I am not a research methodologist, so some of my concerns may be slightly off topic regarding this study. As for being participant blinded- I am not sure. Patients talk. Most of my patients seem to already know what a real custom-made orthoses is. I see no graphs or charts indicating the sex of the patients, average daily on their feet time, shoe types, activity levels or length of time the plantar fasciitis has been present, not to mention the BMI or even the weight of the patient’s in the study. I see no place in the article showing where the patients were informed to perform stretching exercises and then followed up to see how many actually complied, and further, I see no place the patient’s were warned not to take any over-the-counter medications such as an NSAID’s, etc. .

These are all critical faults of this study and indeed, if this were a study on some new medication, I highly doubt that any journal would have published it. This is just another indication of how little thought is given to the feet and treatment of them in otherwise respected journals.

As always: Where is the valid podiatric research? This study quoted is – in my opinion- nothing more than well-stated anecdotal stories, as we ourselves are wont to quote- when they are in our favor.

David E. Gurvis, DPM, Avon, IN, deg1@comcast.net

Whether or not a study is well randomized or controlled does not make a conclusion valid if the methods and materials are flawed. I am most confused by the notion that orthoses alone might be considered a cure for this acute injury. Plantar fasciitis in an over-use injury. I always explain to my patients that we must take steps to heal the acute injury. And we must also take steps to solve the problem that caused the injury. I believe it is reasonable to say that orthotics are more useful as a long-term correction so that the patient does not suffer recurrent plantar fasciitis or other, more serious manifestations of end-stage pronation like TP dysfunction. I do not understand the confusion about this distinction. Physicians and surgeons seem to understand that braces and other orthoses, along with other medical treatments, are valuable even if they do not cure acute injuries. Why in the world would we think that a foot orthosis would mend tears in fascia or soothe an entraped calcaneal nerve?

If I beat my head against a wall, I will likely get a headache. The headache will likely be relieved by morphine. But If I simply stop banging my head against the wall, it will still throb. Am I to conclude that the cessation of banging my head on the wall has no contribution to my headache care plan? Is morphine (while I continue to bang my head) the only valid cure for this headache?

No publication is above questioning I suggest that we all make a point to read this article. Whether we accept the article's conclusions or disagree with them, I believe that we have professional and intellectual duty to respect each other's ideas.
Richard Gosnay, DPM, Danbury, CT, beautifulbaldhead@hotmail.com

RE: Off-Loading Healed 5th MPJ Ulcerations (Itamar Rosenbaum, C.Ped.)
From: Howard Dananberg, DPM, Simon Young, DPM

When serious plantar lesions exist, there may be numerous biomechanical reasons as to why these have occurred. This is when in-shoe pressure testing becomes a valuable tool in patient assessment. The area of high pressure can be determined, and subsequent treatment methods assessed objectively as to which truly off loads the site, vs. which are ineffective. F-scan's thin, flexible sensors are ideal for this type of testing, and take the guess work out of the treatment process.

I am a consultant to Tekscan, the makers of F-scan.

Howard Dananberg, DPM, Bedford, NH, HowieDBPG@aol.com

Mr. Rosenbaum suggests a rocker sole, a spring steel toe bar, a high-top shoe and an internal metatarsal bar to prevent fifth metatarsal head ulcer recurrence. Although this solution will prevent ulcer recurrence, so would complete bed rest. How productive and active will this patient be for the rest of his life once restricted to this type of footgear?" What kind of life will this person have with a chronic foot ulcer? I hope etiologies such as diabetes, PVD, peripheral neuropathy, biomechanics, and digital and metatarsal deformities are assessed.

Maybe surgical intervention might be the appropriate choice in addition to more normal and appropriate fitting footgear. In my experience I have had wonderful success utilizing rocker-bottom sole shoe modifications. These shoes are widely available and are generally more stylish than their predecessors. Even shoes in a Versace boutique are showing evidence of rocker-sole modifications. To blanketly dismiss Mr. Rosenbaum's recommendation based on footgear appearance is not a prudent path to take. Although I don't agree with all of his recommendations, he is offering a solution to a problem.

Simon Young DPM, Director Podiatric Medical Education. Cabrini Medical Center,
New York, NY, simonyoung@juno.com

RE: Senator Clinton to Introduce Legislation to Create 'Privacy Czar'
From: David Secord, DPM

I guess it shouldn't surprise me that Hilary has decided that yet another layer of bureaucracy is needed in our lives, and done for no other reason than to make it appear as though she is 'doing something' and to take the spotlight off her campaign promise to create a few hundred thousand new jobs for New York state, when, during her watch, the state lost about 100,000 jobs instead. There is not a single provision of the 'Act' which isn't already protected by some other law and it is a thinly veiled attempted to hamstring the Bush administration's efforts to fight terrorism and look as though it is protecting the little guy. Such political posturing and grandstanding is not uncommon from this individual (and I’m frankly surprised that Kennedy, Kerry, Biden, Hyde and Pelosi didn’t get their names on it somehow) but surely, there must be better things for our people in Washington to do than vote down this sort of time-wasting anti-American neo-socialist junk?

David Secord, DPM, Corpus Christi, TX, ledocdave@aol.com

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

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

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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

HOUSE CALL PRACTICE OPPORTUNITY- CHICAGO / NORTHWEST INDIANA

Chicago-Home Physicians specializes in house calls to the elderly homebound. Full and part-time positions available in Chicago/Northwest IN. Competitive Compensation, including malpractice. Contact Scott Schneider. Phone-773-292-4800. Fax-773-486-3548. E-mail sschneider@homephysicians.com www.homephysicians.com

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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