The Voice of Podiatrists

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July 14, 2012 #4,514 Publisher-Barry Block, DPM, JD

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Women Have Shorter Break-in Period Than Men for New Shoes: NY Podiatrist

For both men and women, the shopping challenge is to distinguish shoes that need breaking-in from those which will be uncomfortable in the long term. Most consumers still buy shoes in stores rather than online, according to a new report by market-research firm Mintel. About 13% of the more than 1,500 adults surveyed who bought footwear in the 12 months ended February 2012 had bought shoes at an online shoe retailer.

Dr. Andrew Shapiro

Women tend to have higher arches than men, so the shoe's upper can feel tight, says Dr. Andrew Shapiro, a podiatrist and a spokesman for the American Podiatric Medical Association. But because women have less muscle in their feet than men and less cartilage around the bones of their feet, they may not face as long a breaking-in period, he says.

Source: Ray A. Smith, Wall Street Journal [7/11/12]

NY Podiatrist Does Not Support Cosmetic Foot Surgery

Many podiatrists do not support the idea of cosmetic foot surgery. "I don't think it's ethical unless you're having pain," said Dr. Hillary Brenner, a podiatric surgeon in New York and a member of the American Podiatric Medical Association. "You're undergoing risks -- there's the risk of anesthesia, infection, deformity of the toe if the surgery is not done right, a risk of reoccurrence and the risk of surgery in general," Brenner said. "It's trauma to the foot."

Dr. Hillary Brenner

Brenner said a number of patients -- mostly women -- have come to her requesting cosmetic surgery. Several women hoped to have their pinky toes removed in order to fit into smaller shoes. She always turns them down, however. "Why fix something that's not broken?" she said.

Source: Kim Carolla, Good Morning America (ABC) [7/11/12]

Runners Should Follow a Training Program to Avoid Injury: MD Podiatrist

Running coaches and doctors say a little planning and proper training will help people run, rather than hobble, across the finish line. "It's the only sport where you have to plan months in advance what you eat, what you wear, when you're going to run," said Dr. John Senatore, a veteran marathoner and chief of podiatry at MedStar Union Memorial Hospital in Baltimore. "It takes a lot of thought and planning. The people who get hurt aren't usually the ones who follow a program. They are the ones who train haphazardly."

Dr. John Senatore (Photo Kim Hairston)

Coaches suggest following a training program that includes three to four short runs during the week and a long run on the weekend. The long runs will get those in training accustomed to being on their feet for hours at a time. Long runs during training should be at a slower pace than times on race day, Senatore said. He also suggests running the last long run three weeks before the race so muscles have time to recover.

Source: Andrea K. Walker, The Baltimore Sun [7/11/12]

CDC Warns About Reuse of Single-Dose Vials

The use of single-dose or single-use vials for more than one patient has been linked to outbreaks of invasive Staphylococcus aureus infections in 10 individuals being treated for pain at outpatient clinics in Arizona and Delaware earlier this year, according to a study in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

Three patients who suffered MRSA infections after receiving treatment at an Arizona pain-management clinic required hospitalizations that ranged from nine to 41 days. A fourth patient was found dead at home six days after receiving treatment. According to the CDC, a drug overdose was reported as the cause of death, but “invasive MRSA infection could not be ruled out.”

Source: Andis Robeznieks, Modern Physician [7/12/12]

Query: C0₂ Lasers for Onychomycosis

I ran across an advertisement by a local cosmetic facility (Mississippi Medical Aesthetics) operated by plastic surgeons. I quote, ”There are several lasers that have been FDA-approved for treating nail fungus. One of the lasers used for this condition is the CO₂ laser. This laser works by killing the fungus by direct heat. It also bores tiny holes in the nail plate that allow a drying of the nail bed and provides a much more favorable application route for topical anti-fungal agents to be applied.” 

I was unable to find “FDA approval" for this use, nor have I ever heard of using a CO₂ laser for this. Has anyone heard of this? 

Tip Sullivan, DPM, Jackson, MS

Query: Co-Payments for Global Follow-up Visits

Is it appropriate to collect co-pays for surgical follow-up visits during the global period?

Arden Smith, DPM, Great Neck, NY

Response: I believe you can only collect a co-pay when you perform a billable event such as the taking of an x-ray or application of a cast, etc..

If the visit only entails a post-operative follow-up visit, which you would not bill for because it falls within the global post-operative period, I do not believe you can collect a co-pay - no billable event was generated.

Vincent Marino, DPM, San Francisco, CA

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RE: Failed Phenol Procedures (Charles F. Ross, DPM)
From: Charles Morelli, DPM, Barry Mullen, DPM

The main thing that dilutes, neutralizes, and decreases the effect of phenol is blood. Use a tourniquet.  You'll get better results
 
Charles Morelli, DPM, Mamaroneck, NY, podiodoc@gmail.com

The most likely scenario is that you are under-phenolizing the nail matrix. Typically, my standard has been to utilize 3 or 4 30-second applications of phenol. This is usually performed within a bloodless field when appropriate. In your case, the combination of the presence of blood and utilizing one phenol stick is insufficient to destroy the nail matrix. In addition, phenol is lithotrophic, so ensure the sticks are stored in a dark environment. Lastly, air dilutes carbolic acid over time, so the advantage of the sticks is to ensure maximum 88% potency secure from the negative affects of repeated air exposure...that lends even more credence to under-application as the cause.
 
Barry Mullen, DPM, Hackettstown, NJ, Yazy630@aol.com

RE: Recovery Time for Bunionectomy for Karate Artist (Richard Jaffe, DPM)
From Stanley Beekman, DPM, Charles Morelli, DPM

This all depends on the kick that she uses. The most common kick for breaking boards is the side kick, which contacts with the calcaneus or the side of the foot. Either way, this will not matter. If she uses a round house kick or a front kick, she should contact with the metatarsal heads (however, in the round house kick, the instep is used occasionally, especially with higher kicks). In this case, I would use the same criteria as I would for runners, which is 3 months. You also would want her to work on returning the digital flexor strength to normal. Remember, it is the muscles that convert eccentric loading to concentric loading.

Stanley Beekman, DPM, Cleveland, OH, sbkmn1@gmail.com

It depends on the age, medical history, type of wood, bone stock, history of osteoporosis, the technique used when breaking the board (side kick, ball of foot, heel, roundhouse, back kick), type and severity of bunion procedure (Silver, head osteotomy, base osteotomy, midfoot fusion, Cotton, etc), and fixation (K-wire, screws, plates, implants, etc.), stability of Aiken if also performed, level of compliance, degree of immobilization that may require physical therapy for muscle re-education, and other things I am sure I am not mentioning. Combine clinical judgment, x-ray evaluation, CT scan, signed consent form, and gut instinct, and still wait 10-12 weeks.
 
Charles Morelli, DPM, Mamaroneck, NY, podiodoc@gmail.com

RE: PA Podiatrist Receives Dr. G. Dock Dockery Special Achievement Award
From: Kathy Satterfield, DPM

Very, very rarely do we encounter a podiatrist whose impact on this profession is truly immeasurable – someone whose hard work, in the trenches, moved podiatric medicine and surgery up the respect scale more than any other podiatrist I can think of. Guido LaPorta is the role model for that rarified category of DPMs.
 
Dr. LaPorta is a physician who gives without even a thought of what he will get back. Every young DPM, graduating from a residency program and walking into a hospital to do cases in the OR, probably doesn’t realize that people like him made that possible. Practitioners now just accept it as “the way it is” and don’t realize that a dear price was paid for that privilege.
 
When I think about what he has done for us and how far his actions and those of others have brought us, well, I simply don’t know how we can repay them but I do know that we should. Thank you, IFAF for doing that for Dr. LaPorta. Class move for a class act. 
 
Kathy Satterfield, DPM, Pomona, CA, vsatterfield@westernu.edu

Arkansas "Toe Suck Fairy" Jailed For One Year

An Arkansas man known as the "Toe Suck Fairy" for a series of assaults directed at women's feet over more than two decades was sentenced to one year in prison on Wednesday. A judge at Faulkner County District Court jailed Michael Wyatt, 51, after he broke the terms of a previous deferred sentence earlier this year for harassment charges in 2011, to which he pleaded no contest.

In the early 1990s, he pretended to be a podiatrist in order to fondle and suck a Conway, Arkansas, woman's toes at a clothing store. He was convicted in 1991 of making threats for telling a convenience store clerk that he wanted to cut off her feet and suck her toes while she bled to death. For that, he was sentenced to four years in state prison, but served just over a year.

Source: Suzi Parker, Townhall.com [7/11/12]

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