July 15, 2006 #2,631 Editor-Barry Block, DPM, JD

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FL Podiatrist Provides Advice on Preventing Summer Foot Problems

Cracked heels, fungal infections and smelly soles are anything but sexy. Sandal season is here, but people with fissure-prone skin should opt for closed-toe, closed-heel shoes instead, said Dr. Mark Lambert, a Pensacola podiatrist. One reason is sandals do not support the skin of the heel, causing it to deform and crack.

Also, exposed skin on the feet tends to dry out because of the elements, and germs can penetrate cracked skin and cause infections. "I've had to do surgery on some nasty heels because fissures have become infected," he said. His recommendation: Prevent fissures in the first place. "Moisturize with a good, high-quality, non-cosmetic-type product that you can get over the counter, like Nivea, Lubriderm or Curel, or use a prescription lotion such as Amlactin, Cerovel or Vanamide," he said.

Rotating your shoes also helps stave off bacteria and fungus. "Never wear the same shoes every day," he said. Another suggestion: Spray your shoes with Lysol or Clorox spray, lay them sideways and put in front of the vent of the refrigerator overnight to dry, he said. "Putting them in the dryer tends to wear them out," he said. "Setting them in the sun is the best of all worlds, but the refrigerator vent is good because it provides a constant flow of warm air."

Source: Sloane Stephens Cox, Pensacola News Journal [7/13/06]

CA State Podiatrists To Get 10% Top Pay In 2007

Negotiators for the Schwarzenegger Administration have reached tentative agreement on a new 2-year contract with the union representing State physicians, psychiatrists, podiatrists, and dentists.

The Union of American Physicians and Dentists represents 1,600 doctors employed at prisons and youth correctional facilities, mental health hospitals, developmental centers, veterans homes, and the departments of social services and health services.

Under this agreement, State doctors will receive a 3.5 percent cost-of-living increase effective July 1, 2006, plus a second COLA next July of 2 to 4 percent, depending on the consumer price index. In addition, beginning Jan. 1, 2007, the top of their pay range will increase by 7.5 percent (10 percent for podiatrists).

Source: Department of Personnel Administration (CA Govt)

CLEAR and VA Collaborate to Develop Nationwide Amputation Risk Prevention Profile

The North Chicago Veterans Affairs Medical Center and researchers at Rosalind Franklin University of Medicine and Science are collaborating on a novel high-tech method to prevent amputations in high-risk patients. The profile, which is being tested in a local pilot study, takes a widely utilized risk scoring system developed in part by Rosalind Frankin University Clinician-Researcher David G. Armstrong, DPM, PhD, and adopted by the International Diabetes Federation, and incorporates itinto the treatment plan of every person with diabetes being cared for in the system.

“It is our goal that a system like this can facilitate a logical treatment process, and even better prevention schemes,” noted James S. Wrobel, DPM, MS, Director of Outcomes Research at Rosalind Franklin University’s Scholl Center for Lower Extremity Ambulatory Research (CLEAR), and this study’s Co-Principal Investigator.

“The VA has always been at the forefront in diabetes care and amputation prevention,” said Dr. Armstrong, CLEAR’s Director and study Principal Investigator. “What this project enables us to do is to further push the envelope to improve care for all veterans and, ultimately, for everyone with diabetes at risk for amputation.”

Query: NPI Clarification

I was on the NPI (National Provider Identifier) website (http://www.cms.hhs.gov/apps/npi/01_overview.asp) to see how much trouble the application process is. The main source of confusion for me is whether I am Type 1, Type 2, or both. Type 1 is an individual - which I assume I qualify for. Type 2 is an organization - I am a corporation (solo). I assume I am to get an individual NPI (Type 1), but I want to make sure. Any clarification would be appreciated.

Joe Borden, DPM, Reseda, CA

Response: To be safe, and since we do not know the exact details of your entity, I would suggest calling the phone number on the main NPI (National Provider Identifier) page (below), and give them the details and obtain direction from them. Groups get Type 1 for each individual, and Type 2 for the group.

Telephone: 1-800-465-3203 (NPI Toll-Free). 1-800-692-2326 (NPI TTY) Email: customerservice@npienumerator.com

You will certainly need a Type 1 number, and can get that now. They have been a bit slow lately due to volume, but our last number came in about a week.

Richard Papperman, MBA, CHBME, Cape May Court House, NJ

Codingline subscription information can be found at http://www.codingline.com/subscribe.htm

Podiatrist Charged With Sexual Assault
From: Richard W. Boone, Sr

As an attorney with entirely too much experience defending physicians of all specialties against allegations of sexual improprieties involving patients I was not surprised to read of the charges against this Illinois podiatrist. Frankly, what has surprised me over the years is that there aren't more of these allegations against podiatric physicians.

Most other medical specialties routinely and invariably require the presence of an "assistant" in the room at all times when a patient of the opposite sex is undergoing any examination or treatment. I know of no podiatrist who does so. Indeed, when I have raised this issue with my podiatric friends, most seem astonished that I would even suggest the necessity of such a chaperone.

I personally believe this practice is something which podiatry ought to adopt. I can tell you from experience that most cases of alleged sexual impropriety with patients ultimately involve a credibility contest to determine who is telling the truth. A witness who can corroborate the physician's version of events is, quite literally, worth her weight in gold.

As for the actual facts of this unfortunate Illinois case, there's a lot more going on here than the fragmentary news report reveals. I hope the physician involved has exceptionally competent legal counsel because, based on my own experiences on behalf of my former clients, I know that he is really going to need it, whether the accusations of the patient prove to be true or not.

Richard W. Boone, Sr., Health Care Attorney, Fairfax, VA, rwboone@aol.com

RE: Orthoses Research Study (Craig Payne)
From: Jeff Root

I have not had an opportunity to read the study by Dr. Karl Landorf, but I would agree with his statement that “studies of the effects of orthoses are generally of poor quality.” Before becoming too alarmed about conclusions of this study, it would be important to look into the study’s protocol.

The article describing this study states “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).” It is important to note the use of the term “customized orthosis” as opposed to the term “custom-made orthosis.” A customized orthosis is a prefabricated orthosis that has been modified in some way. The term customized orthosis must be differentiated from a true “custom made orthosis,” in order to avoid confusion concerning the nature this study.

If this study used customized orthoses and not custom-made orthoses, it would be totally inappropriate to draw any conclusions whatsoever about the efficacy of custom-made, functional foot orthoses in the treatment of plantar fasciitis.

It is always difficult to study the effects of custom-made, functional foot orthoses because of their custom nature. One could attempt to compare the effects of custom made, functional foot orthoses to prefabricated foot orthoses in the treatment of plantar fasciitis. However, even a study of this nature would be limited because one can’t possibly compare every type of pre-fabricated orthoses (i.e., material and orthotic design option) to the all the various prescription permutations and sources for custom made foot orthoses.

On the other hand, an outcome study comparing the efficacy of the average custom foot orthosis to the average prefabricated foot orthosis in the treatment of plantar fasciitis would be interesting. As always, Root Laboratory would be more than willing to contribute the custom orthoses to any such well-designed study.

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

RE: Off-Loading Healed 5th MPJ Ulcerations (Thomasin Hammer, DPM)
From: Itamar Rosenbaum, C.Ped

While I discussed the types of modifications to the shoes, there was no discussion of the following;

1. What type of shoe this patient wears.
2. What style of shoe this patient wears.
3. What durometer of soling material will be used to create this rocker.
4. What type of soling material will be used.
5. What type of Steel Sole Bar will be used. (Carbon Graphite or Spring Steel)
6. How big of a Rocker Sole will be placed on the shoe. (Is usually determined by checking the shoes’ current heel height and creating a balance between the height of the rocker, the height of the heel and the amount of toe spring needed.
7. Will the steel sole bar be embedded in the current sole of the shoe which is done by opening a window in the sole and placing the bar between the current insole and outsole, or will it be placed on top of the current sole and sealed in by the soling material of the rocker sole.
8. What size Met Bar will be used and what angle will it have to its distal end.
9. How much does this patient weigh?
10. How tall is he?
11. Are there any other medical conditions present?
12. Are there any bone spurs in the area that might be causing this re-ulceration?
13. Does the patient wear his shoes only when he comes to the doctor or does he wear them at home and elsewhere as well?

There is a long list of things that we take into consideration when we have a patient like this come into our facility before we do any kind of modification to anything. In short, there are many acceptable, presentable and patient compliant ways to create these types of shoe modifications.

As the Gait Analysis Tech. at The New York College of Podiatric Medicine, under the guidance of Dr. Justin Wernick and Dr. Russell Volpe, I have been utilizing the F-Scan system along with a video software called Dartfish which is used worldwide for video analysis of gait and motion, to quantify the effects of different types of rocker soles, with and without internal shoe modifications. In the majority of cases, a rocker sole was very beneficial in offloading forefoot pressures among other things.

Itamar Rosenbaum, C.Ped., New York Pedorthic Associates, nycped@verizon.net

MEDICAL EQUIPMENT FOR SALE- PENNSYLVANIA

4 Micromac 300 "Podo spray" Nail Buzzers-- ($1500- retail) $100 each. 1 X-ray processor- Good condition- $500 each. 3 X-ray View boxes-Fair condition- $50 each. As Is. Shipping will be added. Questions or Interest, Email: barb@martinfootandankle.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

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

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

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.

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